An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Journal Club Article: Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]


Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. The teaching strategies of nurse educators should be based on sound evidence or best practice.

“To teach these skills, knowledge, behaviors, and attitudes, nurse educators must utilize a variety of teaching strategies that actively engage their students (Billings & Halstead, 2012).

Students, who are increasingly skilled in technology, benefit from a diversity of teaching strategies based on their needs, including experiential and active learning (Samarakoon, Fernando, & Rodrigo, 2013).”

The principles of adult learning where the strategies encourage and allow ownership for one’s own learning.


Integrative literature review of sixteen studies.


Eight teaching strategies were identified:

  1. E-learning
  2. Concept mapping
  3. Internet-based learning (IBL)
  4. Web-based learning
  5. Gaming
  6. Problem-based learning (PBL)
  7. Case studies
  8. Evidence-based learning (EBL)

The following three strategies of concept mapping, IBL and EBL demonstrated the most increase in knowledge.

“Based on the findings from this review, the authors propose that multiple teaching strategies should be encouraged in a nursing curriculum to allow for the use of a set of strategies that are suitable for different learning styles and student needs.”

The authors recommend that nurse educators be trained to understand the different educational strategies and the benefits to learning that they offer to aid critical thinking, knowledge acquisition and decision making.


All teaching strategies enhanced the learning experience, but more research is needed. In summary a multi-modal approach to teaching and delivering content is required.

Keywords: Evidence-Based Teaching; integrative review; teaching; nurse educator.


Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Peyton’s 4 Step Approach for Skills Teaching

We have all either delivered or been on the end of a “see one, do one” or “do one, teach one” approach to learning, often delivered in simulation with the aim for skill development. But maybe we should add another two-steps into the approach and follow Peyton’s four-step method. To aid the processing of information (learning) and then apply this new knowledge in context (situational awareness) the four-stage technique can be utilised.

Peyton’s Four-Step Approach: 

1. “The teacher demonstrates the skill at his normal pace without any comments (Demonstration)

2. The teacher repeats the procedure, this time describing all necessary sub-steps (Deconstruction)

3. The student has to explain each sub-step while the teacher follows the student’s instructions (Comprehension)

4. The student performs the complete skill himself on his own (Performance)” (Nikendei et al, 2014).

There are clearly defined instructional steps to guide educator and student. Provides small group or a 1:1 teacher:student ratio for successful instructional training in skills learning sims.

Keywords: Simulation; skills labs; 4-step; experiential learning; technical skills.


Bullock, I., Davis, M., Lockey, A., & Mackway-Jones, K. (Eds.). (2015). Pocket Guide to Teaching for Clinical Instructors. John Wiley & Sons.

International Clinician Educators (ICE) Blog. (2017). Effective teaching of technical skills requires more than see one do one. KeyLime podcast No. 142. ICE blog.

Münster, T., Stosch, C., Hindrichs, N., Franklin, J., & Matthes, J. (2016). Peyton’s 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression–a pilot studyGMS journal for medical education33(4).

Nikendei, C., Huber, J., Stiepak, J., Huhn, D., Lauter, J., Herzog, W., … & Krautter, M. (2014). Modification of Peyton’s four-step approach for small group teaching–a descriptive study. BMC medical education14(1), 68.

Walker, M., & Peyton, J. W. R. (1998). Teaching in theatre. Teaching and learning in medical practice. Rickmansworth, UK: Manticore Europe Limited, 171-180.

Wang, T. S., Schwartz, J. L., Karimipour, D. J., Orringer, J. S., Hamilton, T., & Johnson, T. M. (2004). An Education Theory–Based Method to Teach a Procedural Skill. Archives of dermatology140(11), 1357-1361.



Team Intelligence & Collective Intelligence

This Twitter post from @AVASociety provides a reminder of the importance of teamwork and team intelligence to learn, develop and work together to achieve your mission goals.  In higher education the historical methods of examination such as the exam or assignment have been set with a solo focus, not with a collaborative approach. Completing group assignments is not easy but the communication, delegation, reasoning, connecting, collaborating and problem solving are some additional skills, as well as learning of course. Instead of 1 persons resources, you have 4 peoples resources and ideas. The project is much more expansive and pushes the boundaries of the discussion and  evidence visited (as long as the group works together!).  This is all part of the Collective Intelligence aspect. This approach provides an education focus more along the lines of those desired work ready skills (#teamwork).

Keywords: Cognitive complexity; Team Intelligence; Teamwork; Collective Intelligence

Working in Unison: The System Works 

Matteo Vistocco


Bonabeau, E. (2009). Decisions 2.0: The power of collective intelligenceMIT Sloan management review50(2), 45.

Woolley, A. W., Chabris, C. F., Pentland, A., Hashmi, N., & Malone, T. W. (2010). Evidence for a collective intelligence factor in the performance of human groups. science330(6004), 686-688.

Authentic, Engaging & For The Learning

Authenticity is key, don’t worry too much on making everything beautiful and perfect is the message when creating online resources. Visualisation is important to grab attention, and imagery can portray powerful messages but follow the substance over style to start with. Authenticity can be seen in a range of ways from the delivery, to the content created with the target audience in mind for a personalised approach to education. Yes something more visual may be more eye-catching and engaging but we don’t all have the skills, resources or time to create such masterpieces (slide-ology). Just add this skill as part of your professional development or outsource it to an expert.

Focus on authenticity, engagement, participation, collaboration and learning new skills. Try to forget about worrying about the type of learning management system or password protection in the learning environment. Technology develops so fast that why not go with the free and open technology to prevent wastage of valuable money? It’s an expensive lesson when technology does not meet your training needs, becomes quickly outdated and requires specialist training for staff to understand and engage. Also if the resource was quick and cheap to make, your more likely to update and replace this resource than an expensively created one that you hang onto and over time becomes obsolete. In the real world, consider where you, your colleagues and students are communicating, it’s likely not in a learning management system. In everyday lives we use social media to network (socially and professionally), so why not engage and set some learning tasks in the online domain? Provide support to guide discussion around the topic and maintain confidentially (check your employer and national body social medial compliance rules if your the facilitator).

Learning Networks

Don’t forget using different media and resources can allow greater connection and engagement to a wider community of students, professionals and experts. Become a global citizen, who want’s to work in silo’s anyhow?


Dedicate some reading time from the resource section below, focusing on the potential benefits of how an open pedagogical approach can benefit learning for both student and educator. David Price (OBE) book on education OPEN: How we’ll work, live and learning the future is a fantastic look into the school, higher education and workplace of the future.

Inspiration: Take a look at this bio on Sir Tew from Wikipedia and using open access in education, “The end of throwaway assignments and the beginning of real-world impact for student editors”.

Skills Learnt

  • Digital literacy
  • Collaboration
  • Engagement
  • Creating
  • Authorship



#InternetAsThePlatform, #PersonalLearningNetwork, DigitalLiteracy, #FOANed, #FOAMed


DeRosa, R. (2016) My Open Textbook: Pedagogy and Practice. Actualham.

Blackall, L. (2016) No LMS- an argument for when your institution comes to reviewing their Learning Management System. Leigh Blackall Blogspot.

Price, D. (2013). OPEN: How we’ll work, live and learning the future. Crux Publishing Ltd. [sample here]

University of South Australia. (2013) Resourcing and Materials – Teaching and Learning Languages: A Guide.

Wikiversity (2015) Human Vision and Function.

Make it Visual with Slide-ology

Now I have always been a fan of using imagery to portray the message rather than cramming reams of words onto a PowerPoint slide. My approach to slide-ology (Nancy Duarte) is based on a little bit of education theory mixed with a dose of laziness as I am not the worlds greatest proof reader or checking for formatting issues (see any of my past assignments and feedback comments). One lesson I have learnt is to make sure you add plenty of notes with your slides in case one of your colleagues needs to step in last minute or you move job and you leave some quality resources for the next incumbent. Ones persons imagery and story is a total head scratcher for the next educator.

Some of the resources being created in the #FOANed and #FOAMed communities are of such high quality, the imagery, podcasts and resources are very professional (see some examples below).

Below are some great resources to improve presentations from a visual aspect. Slide-ology skills await:


Do Marks Matter Anymore?

Now we can approach this one from a purely academic integrity approach and say yes, marks/grades matter and are vital for employment purposes. But I think its fair to say that as a postgraduate student balancing work, study and life, the picture is a little more complicated than academia portrays.  Motivation to learn, busy at work, busy in life, illness, children, pets, friends, family all show how complicated the balance of our lives really are. If we throw in additional study on top of normal nursing shifts, the art of maintaining a healthy work-life balance is key to success. Not everyone can afford to pay for studies and reduce work hours to allow greater focus on study, and so already an unintentional compromise has been made.  Planning ahead with timetabling and assignments is key, but you still have those pesky night shifts to recover from.

Yes, the marks matter

Adams, S. (2013) Do Employers Really Care About Your College Grades?

No, its a little more complex

SMH (2014) Do high distinctions matter? The Sydney Morning Herald.

Isn’t the purpose about the learning and development rather than a simplistic approach to hitting the aims of a marking rubric?


We all set ourselves targets and deep down hope to achieve those, but we must ensure we set realistic targets and if we don’t happen to achieve them, then use this as a learning experience and not beat ourselves up over a lower grade. I have seen massive growth in some students who really struggled to pass but toughed it out, often with adversity in their private lives. Yet these people I had so much respect and admiration for getting through to that graduation ceremony, does anyone care what the final mark was or is the learning agility, emotional intelligence traits, the resilience and ability to finish what they started part of important learning outcomes?

Keywords: learning agility; emotional intelligence; innovator; creator; learning.



Delirium in the ICU

What is Delirium?

  • “Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
  • The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
  • An additional disturbance in cognition (e.g.memory deficit, disorientation, language, visuospatial ability, or perception).
  • Are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.
  • There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies”  (DSM-5 American Psychiatric Association. 2013).

Delirium Diagnostic Tools

 Sedation and delirium in the intensive care unit by Reade & Finfer, 2014.

Standardised Approach 

The Australian Commission on Safety and Quality in Health Care (2016) Delirium Clinical Care Standard provides guidance across healthcare for consumers and professionals.

Delirium Factors

A few to consider, the full list of potentials from ICU is extensive:

  • Hyper and Hypo Delirium 
  • Sedation in ICU (SPICE study)
  • Pain
  • Sepsis
  • Anxiety
  • Environmental

Interventions That Are Not Medications.

  • Sleep (all those alarms and interruptions)
  • Day/night or light/dark cycles
  • Cognitive stimulation
  • Early mobilisation
  • Ensure sensory aids are utilised
  • Family
  • Get the hell out of ICU asap?

Post Intensive Care Syndrome

As ever early detection and intervention is essential for improving patient outcomes.


Australian Commission on Safety and Quality in Health Care. (2016) Delirium Clinical Care Standard. Sydney:

DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.

European Delirium Association. (2014). The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is saferBMC medicine12(1), 141.

Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The confusion assessment methoda new method for detection of deliriumAnnals of internal medicine113(12), 941-948.

Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unitNew England Journal of Medicine370(5), 444-454.

Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., … & Sedation Practice in Intensive Care Evaluation (SPICE) Study Investigators and the ANZICS Clinical Trials Group. (2012). Early intensive care sedation predicts long-term mortality in ventilated critically ill patientsAmerican journal of respiratory and critical care medicine186(8), 724-731.

Tullmann, D. F. (2001). Assessment of delirium: Another step forward. Critical care medicine29(7), 1481-1482.