Teaching Nursing Delegation: An On-Line Case Study

This study examined a delegation content focused multi-modal instructional design based on constructivism and andragogy. These new teaching strategies were offered in a professional concepts course offered online during the final semester before graduation of an Associates of Nursing program. This study found supporting evidence that this pedagogical framework is effective in delivering essential delegation concepts and skills in an online course as well as contributing to student self-efficacy related to delegation abilities. Preparation of safe graduate nurses and assisting in the transition to the professional nursing role is a central function of nursing education (Harmer, 2010). The professional nursing role as delegator can be problematic to learn and teach in the nursing education setting. As more unlicensed assistive personnel are utilized in the healthcare setting under the supervision of the professional nurse, it is imperative that graduate nurses understand their responsibilities and role in the delegation process (Powell, 2010). Unfortunately, students often feel unprepared to delegate upon graduation, either due to lack of self-confidence, lack of knowledge, or lack of understanding of how delegation can contribute to quality employee, patient, and organizational outcomes (Conger, 1999; Curtis & Nicholl, 2004; Masters, 2009; Quallich, 2005). This northwestern university had been offering a one-credit exclusively online professional concepts course, in which knowledge and skills related to delegation were a core course outcome. This online professional concepts course was offered in an associate degree of nursing program during the last semester before graduation. Although this course had been previously offered with examination of delegation being an integral course objective, informal student feedback in course evaluations indicated that they still were uncomfortable with delegating or did not clearly understand how delegation fit into their future nursing practice. The original instructional strategy utilized to teach delegation concepts was the purchase and use of an online delegation module developed by the National Council for the State Boards of Nursing (NCSBN). This module utilized a case study approach, in which a video representation of improper delegation on the part of the organization, nursing and unlicensed assistive personnel resulted in a sentinel event. In addition, there was a posttest reviewing the concepts examined at the end of the module. The student viewed the module at their convenience and then took the post-test at the end of the module and turned in their score to their assigned faculty. The NCSBN currently offers video clips and numerous suggestions for interactive activities related to delegation as part of their transition to practice communication and teamwork module available at https://www.ncsbn.org/1603.htm. Because of student feedback related to discomfort with delegation it was believed that use of the NCSBN module was not being optimally utilized to meet the multiple learning needs of these online students. Therefore, faculty examined a variety of instructional strategies that would meet differing learning styles, as well as being relatively easy to implement in the online learning format. The purpose of this pilot study was to ascertain if the use of a multimodal instructional strategy, including the NCSBN module, concept map development, and case study use with asynchronous online group discussion, successfully delivered foundational delegation concepts in the course. Additionally, students were asked to rate the instructional strategies offered, as to which technique best met their learning needs related to this fundamental nursing skill. Theoretical and Instructional Design Adult learning strategies and constructivist learning theory complement online instruction and the role of online faculty as facilitator of learning with adult learners (Magnussen, 2008). Adult learning theory is based upon the foundational belief that adults have prior experience and knowledge that contributes to the learning environment and that adults prefer problem-solving type learning activities. Constructivism not only supports the use of activities that This is an author-produced, peer-reviewed version of this article. The final, definitive version of this document can be found online at Teaching and Learning in Nursing, published by Elsevier. Copyright restrictions may apply. DOI: 10.1016/j.teln.2013.03.002.