Guidelines for Group Work in a Nursing Active Learning Classroom

This article is a collection of ideas and research for nurse educators related to structuring and organizing groups in a nursing flipped classroom.

Do you want to develop activities for a nursing flipped classroom? Group work will undoubtedly be a key component. When used under the guidance of a skilled instructor, it can create engagement, interaction, and learning in a way that no other activity can.  

That’s not to say it is without pitfalls. It can take a sour turn with poor planning and vague directions. These guidelines will help you optimize small group activities and keep students moving toward those learning targets.

Group Work in a Nursing Active Learning Classroom

Why is a flipped classroom important in nursing education?

Active learning, or flipped classroom, is a teaching model in which the focus shifts from the instructor to the student. Instead of a stand-and-deliver lecture-style classroom, this instructional methodology emphasizes critical thinking and practice. The goal is for students to develop a long-term, more profound understanding of the content.

The ideas I write about in this blog, called the Idea Bank, are all active learning techniques. I aim to make this learning style less intimidating and more accessible to all nursing educators. You do not need to completely overhaul your teaching style or content. You can just start with one activity at a time!

While various techniques are available to educators in an active learning classroom, group work is a cornerstone activity.

Educator Basics for Group Work

Preparation is key

Preparing for a group activity is essential. Group work is most effective when students have had long periods of individual, self-managed learning time, which correlates with the idea of an active learning classroom. Therefore, the first step is moving some lecture time out of class for independent review and utilizing small groups when everyone is together during class time.

Determining the size of the group

Decide on your group size based on the task they will complete. Pairs, according to seating, are helpful for occasional, short problem-solving activities. For example, a group of 3 is optimal for math or problem solving, while 4-5 is best for tasks with multiple answers, brainstorming, or problem-solving. Groups of up to 7 can function effectively.  

Long-term vs. short-term assignments

Long-term group assignments for major projects or ongoing tasks can help students refine collaborative skills. One study found that permanent groups produced better work and developed stronger interpersonal skills. In contrast, short-term assignments that change every few weeks allow students to get acquainted with more classmates.

Teacher-created vs. student-created groups

According to an informal Facebook poll, most educators create groups rather than allowing students to choose. Teacher-created group formation is supported by research. The educator can choose group members according to skill level, for example, in a clinical setting or randomly in a large theory class. When students formed their groups, they sorted primarily by demographic information and did not form diverse groups.  

Preparing students for group work in a nursing flipped classroom

Establish group rules or norms

Having group work guidelines for nursing students gives the educator the confidence that students are participating and interacting in a way that leads to meaningful learning.

  • Give the group a specific, structured task to complete. A written or visual product is excellent to show at the end.

  • Enforce time limits. Even for short tasks, set a timer for a few minutes. For longer activities, give a warning for 2-minutes remaining. Time limits help keep teams on task.

  • Assign individual roles. If nothing else, at least assign a leader. This person will speak and share the answers. I choose a leader randomly each week with a type of ice-breaker question - “Who has traveled the farthest?” or “Who has a birthday closest to January 1?” These types of questions help build camaraderie and students get to know a little about each other. Other roles could include note-taker, timekeeper, math whiz, or researcher.

  • Set some basic etiquette rules. Only one student is talking at a time. Bring the classroom to silence by raising a hand and asking them to stop talking and raise their hand when they see you do this.

Get involved in the group discussions

Be available for questions—no sitting up at the front podium sorting through email. Get in the trenches. Walk around and ask them to explain their thinking. Have the group leader practice what they will share with the larger group.  

I believe this is an essential step in creating a connection with your students. It moves the educator from an unapproachable podium speaker to a relatable human, there to help them learn and develop. It creates an environment where students are open with their questions and feel safe sharing their ideas.

Develop a routine that includes a beginning and conclusion

Routine is not boring! Routine lets our minds and bodies know what to expect. Routine can actually improve bandwidth for creative thinking because the basics are established in a well-worn routine.  

Start class with an informal activity. Wrap up by asking for progress reports or shareouts. Then, have students take a group exit ticket or complete a short quiz. This routine will ensure they have a genuine learning experience and can share what they learned.

Types of Group Work

Research supports that structured courses with collaborative learning (i.e., group work) have improved retention and persistence rates. There is a wide variety of ways that students can work in groups. It does not always have to be a “share with your neighbor” scenario. Here are a few examples.

Cooperative Learning

Cooperative learning is what you typically think of regarding group work: everyone on the team working on the same problem, completing the task together. It is a classic teamwork scenario where students must communicate effectively and use their “soft skills” to succeed. Some students may not come to your class with these skills and be uncomfortable with this type of learning. Another critical aspect is everyone has to agree. Throughout the problem-solving process, they will come to points where there may be disagreements. If the majority overrules, the whole group may go down the wrong path.

Collaborative Learning

This one takes the highest spot in Bloom’s taxonomy - create! Students create an actual product. It could be a patient teaching handout, a care plan poster, or a crowd-sourced study guide. But the idea is to move control of the activity from the instructor to the student groups.

Peer Teaching

In this type of group work, students become the teachers. I love using this type of activity. For example, in learning to interpret arterial blood gases, I have student groups learn different techniques through recorded lectures and online research. In class, we teach the other groups the process they have mastered. By teaching others, students can demonstrate that they understand the content. On the flip side, this is an activity that the instructor must monitor closely. You would not want one student teaching another student incorrect information or a wrong idea.

Drawbacks of Group Work

As with any teaching technique, there are disadvantages to group work. By being aware of the potential downside, you can be proactive in giving students the best group experience possible.

  • Inactivity by some members - there is a term for this: social loafing. It is the tendency for a student to exert less effort on a project when working with a group than if they worked independently. Some students will inevitably coast and allow others to carry the bulk of the group’s assigned task in a larger group.

    • Ways to combat social loafing: smaller group size and peer evaluations.

  • Even if everyone participates, there will inevitably be an uneven distribution of the work.  

  • Students can easily be distracted by social conversation.

  • Grading groups leads to unfair assessment for some.

  • Opportunity cost - lost time to direct instruction or other teaching methods.

Start building an active learning classroom by following these guidelines for group work activities

Group work can be a fantastic tool for educators in a nursing flipped classroom. Preparation, thoughtful setup and consistent structure can lead to engaged learners who demonstrate clinical judgment. An effective educator can use different forms of group work to add variety. Or modifications can be made depending on the type depending on the task. Group work can be engaging and build community. Following these group work guidelines for nursing students will ensure that you are successful as you move to a flipped classroom.


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