Although passive teaching strategies have been traditionally used in nursing education, Hudson (2014) notes that methods such as PowerPoint presentations and lectures tend to discourage collaboration in the classroom and may even act as barriers to student engagement. In contrast, active learning strategies, such as discovery learning through kinesthetic activities, support student engagement, which has shown to strengthen critical thinking and problem solving (Popkess & McDaniel, 2011). Nurse educators must demonstrate effective teaching skills, facilitate learning, and develop innovative teaching strategies that are inspirational and motivational to the learner (National League for Nursing, 2005).

BACKGROUND

Nursing students must understand and apply theory learned in the classroom to practice. Kolb's experiential learning theory and learning styles inventory (VARK) incorporate information processing or how students absorb and use new information to create knowledge through experience (Kolb, 1984). This experiential learning model is a four-stage circular process in which the learner undergoes active experimentation, concrete experience, reflective observation, and abstract conceptualization. The VARK inventory identifies learning style preference (Good, Ramos, & D'Amore, 2013). Based on how questions are answered, students are classified with a visual (V), aural (A), read-write (R), or kinesthetic (K) preference (Fleming & Mills, 1992).

Students with kinesthetic learning preferences represent a blend of these learning styles. Kinesthetic learners use perceptual modes (sight, touch, taste, smell, hearing) to connect to reality, through experience or simulation (Fleming & Mills, 1992). Increases in engagement and satisfaction have been reported with the use of kinesthetic learning, especially with more difficult concepts such as anatomy and physiology (Good et al., 2013; Wagner, 2014).

KINESTHETIC ACTIVITY

To increase student engagement and utilize a more learner-centered teaching approach, a kinesthetic teaching session was developed for students in a practical nursing program; 29 students nearing completion of the program participated in an activity designed to review complex anatomy and physiology prior to a standardized comprehensive exam. A tarp, 20 X 20 feet, served as the backdrop for the activity. Red and blue duct tape was used to make a visual depiction of the heart on the tarp; the red tape was used on the left side to denote the path of oxygenated blood, and blue tape was used on the right to denote the path of deoxygenated blood. White tape was placed at various structures for identification and labeling. Corresponding arrows denoting blood flow were included to guide students through the activity (see Supplemental Digital Content, available at http://links.lww.com/NEP/A193, for figure).

Basic Function

Following identification of basic heart anatomy, students were assigned to roles of right and left atria, right and left ventricle, valves, circulation, and lung. Two to three students were positioned around the atrium; three to four students were positioned around the ventricles; and one student, with a white balloon clipped to her shirt, was positioned outside the pulmonary artery signifying the lung. The remaining students were assigned to circulation.

Students assigned to the role of valve held card stock fashioned into leaflets that would open and close to simulate blood flow through the heart. To simulate heart function, students pushed hands forward for contraction and brought hands back to simulate diastole. Students playing the role of atria "contracted" by bringing their hands forward and then relaxed while the ventricles "contracted." Students assigned to roles of valves opened and closed correspondingly. Once students were able to visualize systole and diastole of the heart, cardiopulmonary function was discussed.

Circulation

Students in the role of circulation started on the right side of the heart a blue card signifying deoxygenation. They traveled through the right atrium, through the corresponding valve into the right ventricle, through the pulmonary artery, and then to the lung. As the student traveled to the lung, the blue card was exchanged for a red card by the student playing the role of lung to signify gas exchange and oxygenation. The circulatory student then entered the left pulmonary vein, traveled to the left atrium, through the corresponding valve to the left ventricle, and finally through the aorta to signify blood flow through the body.

Disorders of the heart including heart failure due to valvular dysfunction, hypertension, and myocardial infarction were simulated by circulation students "backing up" in the system. Each disorder was simulated and discussed for association and application purposes. Upon completion of the kinesthetic activity, basic care and management of clients with cardiovascular disorders were discussed. Concepts reinforced included oxygenation, perfusion, and changes in vital signs for the client experiencing problems with heart function. Core measures regarding congestive heart failure and myocardial infarction used in hospital settings were introduced. Client teaching regarding diet, exercise, and adherence to medication regimen were reinforced.

EVALUATION

Prior to the kinesthetic activity, students took an Assessment Technologies Institute, (ATI) customized cardiac exam to assess baseline knowledge of cardiovascular function. Following the activity, students took the same exam to assess changes in knowledge. The 10-question exam reflected questions regarding cardiac output and tissue perfusion paralleling content covered in the activity and drawn from an ATI test bank. ATI methods for test development are rooted in critical thinking theory and Bloom's taxonomy. In establishing construct validity, ATI uses American Psychological Association Delphi operational definitions for critical thinking (Facione, 1990) and uses the National Council Licensure Exam (NCLEX) test blueprints as a foundation for the exams (ATI, 2014). Content validity has been established by input from expert nurse educators and clinicians for entry-level nursing practice (ATI, 2014). Initial results from the pretest produced a group score of 66.7 percent. Following the activity, group scores were 78.5 percent, indicating that, overall, students had significant knowledge gains from the activity.

A self-evaluation tool was developed by the author to assess student satisfaction with the learning activity. The Likert-style survey had 10 questions asking students to rate the activity on 5-point scale; scores ranged from 1 (strongly dissatisfied) to 5 (strongly satisfied). Students scored the activity very high with an overall rating of 4.7.

Several students wrote comments that praised the activity for being "hands-on," indicating they "liked being able to visualize circulation and conduction." One student wrote: "Walking through the heart made it easier to understand how the heart works." Negative comments included: "I feel like the activity was a little crowded and it was hard to identify some of the areas of the heart." The fact that 29 students participated may have contributed to the student's experiencing a lack of space.

DISCUSSION

This kinesthetic activity was limited to 29 participants in one practical nursing program, therefore limiting its ability to be generalized to a larger population. Debriefing was limited due to lack of time and the inexperience of the educator. The evaluation tool developed by the educator lacked established reliability and validity. However, the activity does provide a starting point for further research. A mixed-method research design that provides both quantitative and qualitative data may provide greater depth of knowledge in demonstrating why kinesthetic learning experiences are successful. Using a control group would be beneficial for comparative purposes. Using valid and reliable evaluation tools as well as providing evidence-based debriefing would strengthen the proposed study.

The kinesthetic activity provided the educator with an opportunity to engage students and make learning more meaningful. The activity provided clarification of a complex system, the heart, stimulated thinking, and expanded discussions that fostered learning and critical thinking in a large group of students. It is crucial to connect what students learn in the classroom to practice in the clinical setting. Current trends in health care delivery require nursing programs to change how education is presented. Traditional teacher-centered nursing curricula must be transformed into flexible, evidence-based curricula using current technology and best pedagogical practice.

Although implementing curricula that reflects learner-centered teaching strategies can be challenging, nursing programs must design courses that reflect contemporary heath care delivery trends. Kinesthetic teaching strategies offer an exciting and satisfying learning experience that leaves the student with a vivid impression following the teaching session. The continuing development of learner-centered teaching environments will help bridge the gap between theory and practice, thus producing better learning outcomes and ultimately better patient care.

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