For this study, baccalaureate nursing students completed arts-based assignments in two distinct courses. The assignments depicted their personal nursing metaparadigm and their definition of family. The aim of the study was to better understand student perceptions of an arts-based pedagogy (ABP) assignment and the impact of ABP on students' observational and communication skills. In addition, we sought to understand how ABP impacted critical thinking and future clinical practice.

BACKGROUND

Researchers have identified that new registered nurses are not adequately prepared for nursing practice and that innovative pedagogical approaches are needed to better support student learning and readiness for practice. ABP is a teaching methodology that is designed to address these concerns (Benner et al., 2010; Missen et al., 2016; National Council of State Boards of Nursing, 2019). During ABP, students engage in a creative process and integrate art with an academic subject, in this study, nursing.

ABP is grounded in the constructivist paradigm, which posits that knowledge is constructed through engagement with the world that facilitates dialogue and reflection (Rieger et al., 2016). Researchers have found that ABP can support learner engagement, transform learning, and foster empathy, developing new and innovative ways of thinking that increase self-awareness, emotional intelligence, and observational skills, all of which are critical aspects of nursing (Rieger et al., 2015, 2016).

METHOD

Upper-division students (n = 166) in a baccalaureate nursing program studying nursing theory and ways of knowing and care of families were asked to participate in a graded homework ABP assignment as part of their course assignments during the fall semester 2018. For nursing theory and ways of knowing, students created a mandala. They were asked to design their own interpretation of the nursing metaparadigm using a unique design, chosen symbols, and colors and to explain its relevance. The mandala provided a space for students to integrate their personal and professional values while reflecting on how they would operationalize theory and evidence to support their current and future nursing practice.

Students in the care of families course created a work of art that symbolized what family meant to them. During class, students engaged in a faculty-supported student-centered gallery walk, observing each work of art using the visual thinking strategies framework (Moorman & Hensel, 2016), a structured art viewing technique that combines the use of observation and critical thinking skills to enhance communication. After listening to classmates' interpretations, the creator of the work of art was asked to comment and offer a personal interpretation.

After the course assignments were completed, students were invited by email to complete six Qualtrics survey questions about their experience with ABP.

1. Were you aware of arts-based teaching-learning strategies before this class?

2. What did you think of creating a work of art (visual representation) for this class?

3. What impact did the arts-based assignments have on your observational skills?

4. What impact did the arts-based assignments have on your communication skills?

5. What impact, if any, did this arts-based assignment have on your future clinical practice?

6. Would you participate in a similar activity in the future?

Data were analyzed by the study team using descriptive and thematic analysis (Hsieh & Shannon, 2005). Institutional review board approval was obtained prior to data collection. Participation in the survey was voluntary and no incentives were provided.

RESULTS

Of the eligible 166 students, 89 students (53.6 percent) participated in the Qualtrics survey. Of the participating students, more than half (n = 51, 57 percent) were not aware of ABP before this project; the majority reported that they would participate in similar learning activities in the future (n = 80, 91.9 percent). Using thematic analysis, three key themes were identified from the students' qualitative responses. Students reported that ABP made them think more deeply about nursing concepts, helped them identify new ways to communicate, and will impact their future nursing practice.

In support of the first theme, students identified that ABP helped them think more deeply. This included an ability to notice slight differences among their colleagues' art, examine their critical assumptions, and have a better awareness of different viewpoints. For example, one student reported: "Looking deeper [I] noticed slight differences and changes in each [project] which made me realize we need to go into situations with an open mind. Not everyone has the same stance on something." Students also reported that ABP help them see connections between concepts, which included looking beyond the obvious and synthesizing important aspects of the concepts. Finally, using ABP supported their learning as reported by this student: "[ABP] was another means of learning the same material. If we can get the information in a multitude of ways it will stick better."

In the second theme, students reported that using ABP helped them identify new ways to communicate. This included communicating with patients and colleagues, as well as increasing their confidence generally about communication. For example, one student reported: "[ABP] broadened my ability to communicate my thoughts [and] allowed me to see others' perspectives regarding the material presented." Students wrote that ABP helped them communicate feelings and express themselves and gave them confidence to share and present their ideas.

In the third theme, students reported that ABP would have an impact on their future nursing practice by facilitating a holistic perspective of patient care and the larger health care system. For example, a student reported that ABP provided "better critical thinking and broadening of ideas to gain a better understanding of a more holistic [clinical] picture." Another wrote that "[ABP] allowed me to seek other, nontraditional/medical ways of engaging or utilizing clinical skills. Although this will not necessarily help me learn how to put an IV in a patient, it helped me to build on [my knowledge by] looking at a whole picture." Finally, a student wrote that this assignment helped in understanding "how everything in health care is connected to encourage a patient's well-being and safety. It demonstrates how we must all work together to achieve a goal successfully."

CONCLUSION

ABP provided students with the opportunity to discuss and explore their personal nursing metaparadigm or their definition of family using art. This methodology supported students to think more deeply and communicate in different ways, thus impacting their future nursing practice. This innovative teaching methodology helps nurse faculty support the development of students' critical thinking skills and enhance their communication skills to better prepare them for clinical practice, thereby improving client experiences and creating better health outcomes. More studies are needed to better understand innovative teaching methodologies that support thinking and readiness for nursing practice.

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