Reflection is important for the development of critical thinking in undergraduate nursing students. Billings and Halstead (2012) state that reflection is in the high cognitive domain of learning activities. They further state that reflective practice allows nurses to understand the needs of patients and take action. Reflection allows students to integrate learning with their own personal context to develop knowledge at deeper levels.
In online classes, students integrate and reflect on course content in a variety of ways. However, undergraduate nursing students who attend courses through online, asynchronous programs often express difficulty in sharing themes, concepts, or ideas within courses and with their peers.
The use of word clouds, which provide a visual representation of written content, allows students to develop themes and concepts beyond traditional written discussion methods and introduces a creative, visual aspect into an online learning environment. The technology allows for the visual representation of themes that students can then utilize for a critical analysis. In a word cloud, the more frequently a word is used narratively, the larger and bolder the word appears in the subsequent cloud. Skiba (2013) stated that word clouds used within a course help build understanding and relate to the higher level concepts within Blooms Taxonomy, such as "interpreting, exemplifying, classifying, summarizing, inferring, comparing, (and) explaining" (p. 279).
The use of word clouds as a teaching method actively engages the viewer, as well as the creator. Word cloud activities offer active learning experiences for students. Brooks, Gilbuena, Krause, and Koretsky (2014) noted that active learning requires more than just engaging students in an activity. It should promote reflection to help students think critically about the content under study. Berson and Berson (2009) stated that, when using the visual aspect of word clouds, "students can expand their analytic capabilities and discover meaning by looking and thinking" (p. 126). DePaolo and Wilkinson (2014) noted that word clouds, as an active form of learning, are theoretically based in the learning modality of graphic organizers who "portray knowledge in a meaningful way, which helps bring clarity to ideas as connections are made" (p. 39).
COMMUNITY HEALTH ASSIGNMENT
RN to BSN students enrolled in an asynchronous, online community health course read chapters from their textbook regarding evidence-based practice (EBP) within community health settings. In the previous weekly assignment, students found research studies related to EBP in community health. Using these studies and the assigned textbook reading, students were instructed to create a synthesis of major themes and concepts related to EBP in community-based settings, using a word cloud or regular discussion.
Those students who chose the word cloud option were instructed to create a short caption (two to four sentences). Those who chose to create a traditional discussion were to write a statement (one to two paragraphs) with support from two sources for the topic. All students posted their responses to the discussion board by midweek. Students were then required to respond to the work of one of their peers by the end of the week to conclude the discussion. Nineteen of the enrolled 28 students (68 percent) opted to create a word cloud and word cloud caption for the assignment.
Students who chose the word cloud option viewed a short tutorial regarding use of the online application Tagxedo (http://www.tagxedo.com). Tagxedo allows the user to quickly enter a block of text into a box and, with the click of a few buttons, create a word cloud. The website has examples of word clouds from current news articles and famous speeches.
To begin the process, students developed a document of their thoughts and reflections about the reading assignment and research articles. They uploaded the document into the Tagxedo website to create the word cloud synthesis. The word clouds they developed captured the major themes of their reflection.
The most common themes developed in the students' word clouds were promotion, prevention, access, education, community, health care, and collaboration. The two student-created word clouds and captions that received the most peer responses can be viewed as supplemental digital material for this article (see Supplemental Digital Content 1, http://links.lww.com/NEP/A12). At the conclusion of the module, students completed a brief survey to analyze the learning and reflection developed during this discussion board assignment.
SURVEY QUESTIONS AND RESULTS
All students were invited to anonymously complete a short online survey using Survey Monkey. The questions asked a) if students felt the word cloud assignment allowed them to synthesize and reflect on the module's information, b) if reading and viewing their peer's word clouds/captions allowed them to reflect on their own learning and add to their knowledge base, and c) if they liked the ability to utilize an activity that incorporated a visual aspect. The final question asked if students felt the world cloud tutorial was easy to follow. Students responded using a 5-point Likert scale (ranging from strongly agree to strongly disagree). Expert nurse educators reviewed the questions and offered suggestions for improvement.
Twenty-two of the 28 students responded (80 percent), more than the 19 students who chose the word cloud option. The responses indicated overwhelming support for the use of word clouds as a discussion tool to develop reflection. All respondents strongly agreed that they liked the ability to create an assignment that required creativity and incorporated a visual aspect into learning. All strongly agreed that the use of word clouds allowed them to reflect on the major themes of EBP in community health. Sixteen students strongly agreed, and six agreed, that having the opportunity to read and respond to word cloud images and captions helped them reflect on their own learning.
The remaining question addressed the ease of the Tagxedo website to create a word cloud. Fourteen students strongly agreed, and seven students agreed that the tutorial was easy to follow and the word cloud was easy to make. This response prompted the instructor to develop a tutorial to demonstrate step by step, with audio commentary, how to create a word cloud.
The assignment had more peer responses than other assignments for the course, with students reading and replying to multiple word cloud and captions. The increased interaction appeared to show higher levels of interest from students and greater synthesis of the content for discussion as evidenced by student comments at the end of the online survey. Comments included the following: "I'm an artistic person and a visual learner, so I jump at any chance to let my creative side out" and "Doing this word cloud really strengthened my knowledge about evidence-based practice in community health settings, and being able to view my peers' word clouds allowed me to ponder other views that I may not have thought of myself."
WORD CLOUDS FOR REFLECTION
Results of the community health assignment support Hamm's (2011) assertion that use of word clouds as a pedagogical strategy "stimulates discussion that engages students in reflection, discussion, and content synthesis" (p. 156). Miley and Read (2011) noted that word clouds should be used cautiously, as they summarize word frequency and not necessarily relevance. Keeping this in mind, the use of the word cloud caption and peer responses helps address the relevance and importance of the themes developed in the clouds. Students were not merely listing words, but developing and reflecting on the themes and concepts of EBP in community health settings.
This assignment is one instance of exploring the use and outcome of word clouds as a stimulus for undergraduate RN to BSN students' reflection. It was found that students in an online, asynchronous program can successfully reflect on the major themes and concepts of EBP within community health settings through development of their word cloud and analysis of the work of their peers.
Students have different learning styles, and appealing to visual senses provides a superior learning opportunity for the visual learner (Hoffler, Prechtl, & Neredel, 2010). This assignment allowed students to build on course themes to construct deeper knowledge of community health concepts, integrating creativity and reflection into the online learning process. This reflective word cloud and captions assignment can easily be incorporated into other undergraduate nursing courses and address a wide variety of topics.
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