Nursing education faced unprecedented challenges in 2020, with the COVID-19 pandemic causing the majority of classroom instruction to be moved to an online format. Much of the focus in higher education for prelicensure nursing has historically involved face-to-face training (Gharib et al., 2016), and for many students and faculty, the pandemic led to their first introduction to online education. The pandemic also brought with it the imperative to explore innovative pedagogies. This article discusses a quality improvement project conducted in a graduate-level nursing course before the pandemic began. It has implications for use as an effective strategy in a variety of areas of higher level education.

The findings of this project are timely as colleges across the country seek to bridge the gap between online education and traditional face-to-face courses. A study conducted in China, where COVID-19 was first identified, found that an intentional focus on the use of "voice" in teaching tools was particularly important when shifting to remote instruction and trying to maintain a sense of social presence. The use of voice was found to be less inhibited by technical challenges than visual elements with video feeds, for example, facial expressions and body language (Bao, 2020). Our project incorporated an audiovisual element with asynchronous online interactions and found similar degrees of satisfaction from students.

METHOD

This institutional review board-approved quality improvement research project was conducted in 2019 in a doctor of nursing practice (DNP) program to determine if, when given a choice, students would choose interaction formats that aligned with their self-perceived learning styles or time management/organization preferences. Participants included students who were enrolled in the BSN-DNP or post-master's DNP programs. A survey was administered at the beginning and end of the semester to gather student perceptions about their personal learning profiles, time management techniques, and leadership skills. Learning styles were ascertained utilizing a Qualtrics questionnaire adopted from QED Learner Sketch and NCLD Young Adult Screener. Of the 91 students enrolled in the course, 89 submitted the presurvey and 79 submitted the postsurvey.

The DNP course utilizes a hybrid model in which learners attend campus for one day during the semester. The remainder of the course is delivered online, and one of the online elements involves a series of four discussions facilitated using the Discussion Board feature of the Canvas Learning Management System. For this project, students were given a choice for the discussion board component. They were added to one of two groups based on their preference to engage conversations about the four prompts (a) in a traditional written format or (b) using a multimedia (video) format. Each group was given the same prompts. Guidelines for minimum lengths of audiovisual posts and text posts were developed based on a correlation of written word to speech at a slow rate of 100 words per minute (Speech-Words to Minutes, n.d.). Students in both groups were required to provide references in APA (American Psychological Association) format. Faculty feedback was provided to the students in their chosen format.

FINDINGS

Of the 91 students enrolled in the course, approximately one third chose to join the audiovisual discussion board format; the remaining two thirds chose to join the written format group. Learning profiles appeared to influence student choices, as those who chose the audiovisual discussion board were more likely to select, "I am good at expressing my ideas when talking to others" on the learning preferences inventory. Similarly, students who chose the written discussion format were more likely to select, "Taking notes during a presentation is easy for me."

Overall, student feedback from the audiovisual format was positive. One student commented, "The audio discussion board allowed my classmates and [me] to get to know one another and build peer relationships. The topics of discussion were intriguing and enjoyable to research." Another student emphasized: "It was nice to put a face and a voice with my peers. In addition, I believe I was able to convey my thoughts better through my own voice versus mere words on a page. Thank you for the opportunity to learn with this format." Students also shared feedback about how the video format challenged them. For example, one student commented, "I enjoyed participating in the audio/visual discussion boards because it took me out of my comfort zone and made me prepare the assignment differently." This feedback resonated especially with faculty teaching the course, who found it refreshing to "see" the students we typically do not meet until they are in the clinical (face-to-face) aspect of the curriculum. They also noticed that students seemed better able to convey enthusiasm for reading classic works (e.g., Henrietta Lacks) using the video format.

Even this relatively minor adjustment came with a learning curve for both students and faculty. Some students expressed the need to plan ahead to ensure they had sufficient time for recording in a quiet area as well as technical support. Students also voiced, "I enjoyed the variety of assignments in the class. I was tempted to try the AV discussion board format. I am very familiar with the written format. My decision-making to stay in the traditional model was influenced by comfort and my uncertainty about scheduling in the AV discussion board." As more classes and programs are offered online, not only will it be imperative to create engaging environments, but technical support must be easily accessible for students and faculty.

CONCLUSION

The use of choice in assignment formats enables students to tailor their method of expression to their personal learning profile and was used here to reduce barriers and maintain high expectations for all students. Student feedback indicated that audiovisual discussion boards may also provide an opportunity to increase learner connectedness and social presence in remote courses during this time of COVID-19. Stress is a common issue for many graduate students regardless of major, but practicing nurses who pursued additional education during the pandemic had the added stress of doing so while juggling extra work hours and workload, responsibilities that came with providing care, and home stressors (Maben & Bridges, 2020; Turale et al., 2020; Ye et al., 2020). Social isolation during the pandemic was a very real concern, and one method to increase interaction was through video conferencing. Video conferencing asynchronously alleviates the need to coordinate schedules but still enables an interpersonal feel to the interaction. Moving discussions to this format improves and increases the interactions of students.

Writing about experiences at a school of dentistry, Silva et al. (2020, p. 131) noted concerns resulting from the pandemic: "Facing social isolation never previously experienced by this generation, this sample are at a risk of reduced quality of life. Therefore, performing DE [dental education] activities through devices with teacher-student interaction is a key coping tool." This is true for the field of nursing as well, and increased opportunities for online interaction with our students in a safe environment are needed. COVID-19 quickly impacted the quantity of online course delivery across the United States, and faculty in all fields are exploring the use of instructional choices that align with student needs in ways that are parallel to this project. In addition, to ensure that our courses have strong content and are easy to navigate, faculty must look at courses from the lens of the student and utilize instructional techniques that foster meaningful and engaging interactions.

Sometimes, one minor course adjustment can help with that goal. Stewart et al. (2013, p. 301) summed it up well: "Changes in online education will continue to stimulate changes in the roles of traditional student affairs and student services professionals as they adapt and develop services to meet evolving needs in conjunction with instructors, course designers, and personnel at all levels of the institution." As we progress into the next chapters of COVID-19, we must share ideas with one another, iteratively and intentionally improve, and remain mindful about creating new avenues to improve the educational experience for our students and, most importantly, produce competent quality nurses in whatever field they are entering.

REFERENCES