Engaging students can be a challenge for nurse educators, especially when teaching prelicensure students enrolled in large lecture-style courses. Active engagement allows students to learn best; engagement increases student motivation, academic performance, critical thinking, and practical competence.1,2 Although nursing students are challenged with a rigorous curriculum and academic progression standards, students report that they often do not feel engaged in student-centered or interactive learning.3 To facilitate an understanding of key concepts, nurse educators should work to actively engage nursing students in learning.

Engagement Strategies

There are many ways to engage nursing students in classes, whether face-to-face or online. Nurse educators can use higher level questions and case studies,4 gaming and crossword puzzles,5 Facebook groups and discussions,6 Twitter,7 or individual response clickers for NCLEX-style questions,8 among others. Many of the previously studied engagement techniques require the use of the latest technology beyond PowerPoint presentations.

Although technology use in nursing courses is expanding at a rapid rate,4 low-technology interventions can also help students achieve course outcomes. Some lower-technology student engagement methods include writing metaphors,9 forming a journal club,10 faculty skits,11 using scavenger hunts and kaleidoscopes,12 or simulating clinical research by conducting a class study on cookie preference.13

Concepts With Cookies

The purpose of this article is to describe an innovative, yet low-technology, approach to using edible curriculum aids to engage students in active learning during a lesson related to foundational pharmacological concepts. The specific concept taught through the use of food as a curriculum aid was drug half-life; however, critical thinking questions related to other pharmacological concepts and nursing actions were posed to students; for example, what are the rights of medication administration in order? How would the nurse evaluate a patient's pain? Why can't the patient have more medication before the ordered time? What nonpharmacological pain management interventions can the nurse offer? The objectives were for students to (1) define half-life in relation to pharmacology and (2) demonstrate understanding of the half-life concept (via use of a "medication" cookie).

Before a session related to the foundations of nursing pharmacology, students were assigned a reading from the course textbook about foundational pharmacological concepts. Chocolate chip, M&M, and peanut butter chip cookies were baked by the instructor and individually wrapped to maintain safety for those with food allergies. Once in class, each student selected a cookie. Students were provided with a patient scenario and provider order for the medication. The patient scenario described an older client admitted to a medical-surgical unit after a surgical procedure with a new concern of a headache requesting ibuprofen. The provider order stated the patient could receive 400 mg ibuprofen every 6 hours as needed for headache or pain. Students were instructed to use their selected cookie to represent a 400-mg dose of the medication and to demonstrate by eating the cookie how much active medication remained in the patient's body 2 and 4 hours after medication administration. Through discussion, other pharmacological and nursing practice concepts were reviewed, including the rights of medication administration, windows/grace periods for medication administration, drug metabolism, pain assessment strategies and challenges, approaches to seeking correction of provider orders, and nonpharmacological pain management interventions.

Lesson Evaluation and Modifications

Incorporating baked goods into the pharmacology curriculum served a purpose beyond being fun and tasty. Student engagement was increased by the use of food as a curriculum aid. Students not only viewed the lesson as a positive experience; all (n = 115) students correctly answered an examination question related to half-life.

In the future, the lesson will be modified to include more hands-on skills. A provider order, medication administration record, and nursing notes page for the hypothetical patient will be created and distributed to each student. Students will then be able to identify a purposefully placed medication order error, demonstrate correct documentation of the medication, and document a short SOAP (subjective, objective, assessment, plan) note for the patient related to the headache, medication administration, and nonpharmacological interventions used. A simulated "pill identifier" and drug guide page with safe dosing range based on patient weight will also be provided. The simulated pill identifier will display ibuprofen to look like a donut and an orange, not like a cookie provided to each student. This should facilitate thinking related to appropriate nursing actions when a medication's appearance is inconsistent with previous appearance or patient expectation, and a review of medication math to determine appropriate dosing based on patient weight.

Limitations

Limitations to implementing this lesson included the size of a class section, student dietary needs, and the faculty member's willingness to bake enough cookies for the entire group of students. For large class sections that would require more cookies than 1 faculty member could feasibly bake, packs of cookies could be purchased for lesson implementation. Considering food allergies and dietary restrictions among individuals, student conditions or preferences may limit participation in this activity. Before the lesson described, the faculty member asked students with allergies or dietary preferences to confidentially share restrictions. One student disclosed a peanut allergy but stated she was comfortable using a cookie prepared without nuts even if the faculty member's kitchen was not peanut-free. For class sections with multiple special diet needs (eg, severe allergies, gluten intolerance, diabetes), the teacher could ask all students to bring a food item to class, such as a cookie, muffin, bread, or other snack approximately hand-sized that could be reasonably split into a half and a quarter.

Summary

Engaged students are given a sense of connectedness, affiliation, and belonging while stimulating academic success and competency. Although innovation in the classroom is often related to the use of the latest technology, using edible curriculum aids is a low-technology way to simulate medication administration and engage students in a lesson. Students enjoy the experience and are able to master an understanding of key nursing concepts when nurse educators implement strategies for active classroom engagement.

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