Nurse Education in Practice 13 (2013) 239e243

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Nurse Education in Practice

journal homepage: www.elsevier.com/nepr

Review

Meaningful and engaging teaching techniques for student nurses:

A literature review
Kay Crookes a, *, Patrick A. Crookes b,1, Kenneth Walsh b, 2
a
School of Nursing Midwifery and Indigenous Health, Faculty of Health and Behavioural Sciences, University of Wollongong, Northfields Ave,
Wollongong, NSW 2522, Australia
b
Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, NSW 252, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Helping undergraduate nursing students to contextualise theory learnt in the classroom to their pro-
Accepted 15 April 2013 fessional practice can be challenging for nurse educators. This article provides a critical review of
contemporary literature that explores strategies and techniques that nurse educators within university
Keywords: settings have adopted to address this challenge. This review was conducted as part of a broader research
Meaning* project that involved interviewing nurse educators to explore how they attempt to make their teaching
Engag*
meaningful and engaging for student nurses. The data was analysed using thematic analysis and the
Teach*
intention is to share the wealth of ideas gleaned with other nurse educators, including in the form of an
Nurs*
Student
evidence-based inventory of teaching approaches found to be effective in enhancing the meaningfulness
and engagement of content to nursing learners.
Ó 2013 Elsevier Ltd. All rights reserved.

Introduction broader project attempting to access the store of knowledge and

For many nursing students coming into what they see as a very
practical discipline, the ability to be able to readily apply what they
are expected to learn, to what they see as practice (often based
upon a relative lack of experience of practice) is paramount. These
ideas are supported by Knowles (1984) who suggests that andra-
gogy “the art and science of helping adults learn” is distinct from
pedagogy, whilst acknowledging although the two terms do not
have to be dichotomous. Adult learners need to be able to see the
relevancy of content but also need to be engaged by a variety of
teaching techniques as do child learners.
Nurse educators share the view that undergraduate students are
often only really willing to engage with topics if they can see the
implications of and/or the application to their practice and this is
only achieved if nurse educators deliver content in a meaningful
and engaging way that links theory to practice.
This review is aimed at identifying what the literature says
about teaching undergraduate nursing students’ in ways that are
meaningful and/or engaging. It has been undertaken as part of a
* Corresponding author. Tel.: þ61 2 4221 3569; fax: þ61 2 4221 4718.
E-mail addresses: kay@uow.edu.au (K. Crookes), pcrookes@uow.edu.au
(P.A. Crookes), kwalsh@uow.edu.au (K. Walsh).
1
Patrick Crookes is visiting Professor at University of Huddersfield (UK) and
University of Stavanger (Norway). Tel.: þ61 2 4221 4208; fax: þ61 2 4221 4718.
2
Kenneth Walsh is visiting Professor at Canterbury Christ Church University, UK.
Tel.: þ61 2 4221 3472; fax: þ61 2 4221 4718.
expertise held by experienced nurse educators before they retire
and it is lost forever so that insights can be shared in an educational
format for less experienced nurse educators. In this project, nurse
educators were interviewed and then a thematic analysis was un-
dertaken, to explore ways they attempt to make their teaching as
meaningful and engaging for undergraduate nursing students as
possible. The aim over time is to create a repository of teaching
techniques that can be employed by nurse educators to engage
nursing students in meaningful ways.
Search strategy
The ERIC (educational content), PROQUEST (multidisciplinary
content) and CINAHL (Nursing/health content) databases were
interrogated using various combinations of the following search
terms e ‘meaning*, AND engag*, AND nurs*, student’. The initial
search yielded 1798 papers, this was limited to 205 by applying
review or scholarly articles only, published within the last ten years.
Further simple elimination took place based on skim reading the
abstracts and to see which were germane to the topic in hand. For
this reason several articles which focused on teaching post-
graduate students or clinically-based education were eliminated
as they were not about undergraduate nurse education per se. There
were many others in which the term ‘meaningful‘ or ‘engaging’
appeared in the abstract but not in ways relevant to the topic. This
process allowed the capture of research-based papers that were

1471-5953/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nepr.2013.04.008
240 K. Crookes et al. / Nurse Education in Practice 13 (2013) 239e243
grounded in contemporary practice. As a result, 55 articles were
finally selected for the literature review based on their being
scholarly articles, focused on nurse educators in tertiary settings.
These articles were then grouped according to cognate content
which then formed the basis for the structure of the review under 7
teaching techniques that nurse educators employ in an attempt to
make their teaching as meaningful and/or engaging as possible for
undergraduate nursing students.
Current issues within nursing education
Nursing education is a constantly changing and multifaceted
field, characterised by a tension between theory and practice. As a
result, like all clinical and practice based disciplines, nursing edu-
cation is tasked with finding a balance between theoretical content
and practical use of that content. As such, nursing educators are
often pressed to contextualise, and make meaningful and engaging,
the theoretical material that they cover so that students are able to
explicitly map the connection between course content, and its
practical application, whilst this is desirable for students, it is not
always provided.
According to Shinnick et al. (2011) there is a significant gap
between “current nursing practice and the education for that
practice” (2011; p. 65) in that there is no explicit or institutionally
recognised structure or catalogue of information for the education
of student nurses in a way that makes course content contextually
meaningful and engaging either in Australia, or internationally.
What is clear from a study of the literature is that nursing students
crave knowledge that reflects “outcomes beyond the class”
(McCaffrey and Purnell, 2007; p. 75) and expect that the knowledge
is communicated in a way that makes the content memorable and
effective. In other words, students want the content of their degree
to mirror professional practice, and for it to be conveyed in a way
that makes it captivating, memorable and interesting enough for it
to be useful to them in a practical situation (Royse and Newton,
2007). It also became clear that nursing educators also perceive
the linking of content with practice in meaningful and engaging
ways as something important. However study of the literature in-
dicates that few nursing educators go into any detail about the
importance of sharing a suite of teaching techniques to engage
student nurses in meaningful education, with much of the litera-
ture simply being structured in and around the dissemination of
individual case studies rather than attempting to discuss this issue
or collate a catalogue of these techniques. Most would agree with
the statement that in nursing education “educators hope that the
knowledge and skills learned in the classroom and practiced in the
clinical setting, are transferred into the critical reasoning skills
required for direct clinical care of patients” (Becker et al., 2006; p.
103). Most would also agree that these kinds of teaching techniques
are important. It is perhaps pertinent to suggest the fact that there
is no existing collection (or push to create one) of meaningful and
engaging techniques could suggest that this kind of teaching
technique is perceived by nurse educators to be so inextricable
from nurse education, that it doesn’t need to be officially sanc-
tioned. The issue with this however, is that it promotes a lack of
intellectual-dissemination and sharing and discourages informed
teaching, in turn hindering teachers from providing the best edu-
cation they possibly can. According to the literature, using a
multifaceted/multi-method approach to teaching can enhance a
student’s retention of concepts and clinical knowledge (Wells et al.,
2002) thus bridging the gap between content and practice for
nursing students. However from a review of the literature there
seems to have been little or no attempt at categorising and
disseminating information on this kind of teaching for nursing
educators.
Growing interest in meaningful and engaging teaching
techniques
There has been a growing interest, in nursing education across
the globe, in relation to the study of new teaching techniques that
focus on linking theory with practice. This is supported by the
literature, with all of the 55 articles selected for this review, ranging
from different journals, institutions and countries, discussing in
some way the use or development of these kinds of teaching
techniques. Within the literature, evidence of institutional, national
and international studies into these forms of teaching techniques
have also been made evident, which reveals a growing institutional
interest in this issue, worldwide. However, as previously stated,
none of these articles attempt to generate a compendium of these
techniques, leaving a significant gap between the growing de-
mands of nurse educators and nursing students who need a more
explicit link between theory and practice. In short, academics
are talking about this issue, but not much is being done in the
way of practical application of these ‘meaningful and engaging’
techniques.
Certainly at a committee and University level there is evidence
of interest in this field internationally, with some of the literature
discussing not only descriptions of individual method interventions
that nurse educators have employed in their classroom, but also
mentioning (though not nearly in enough depth), the projects of
national or international institutions. An example of this is pro-
vided by Shattell (2007) who states that the American society;
National League for Nursing (NLN) “has advocated a curriculum
revolution in nursing education to move away from the behav-
iourist content-focused undergraduate curriculum to one that is
participatory, active and experiential” (Shattell, 2007; p. 572) so as
to include new kinds of teaching techniques that focus more on the
practical contextualisation of theoretical content. Edwards et al.
(2008) also discuss several projects in this vein, which have been
funded by the Commonwealth Department of Health and Ageing in
Australia, they state that many of these projects have focused on the
development of non-traditional techniques, namely virtual
learning tools, in an attempt to bridge the gap between theoretical
learning and practical implementation of that learning with posi-
tive results. According to Graham and Richardson: “Bournemouth
University and other European and American partners have
developed and used with effect” (2008; p. 37) techniques which are
in the same vein as these, in particular in relation to the use of
‘games’. Rush et al. (2010), Wikstrom (2001), and Nagle et al. (2009)
all agree that these kinds of teaching methods are becoming more
widespread, stating that new forms of teaching have been “high on
the agenda of regulatory and other national nursing bodies”(Rush
et al., 2010; p. 468) around the globe, and that certain non-
traditional techniques which focus on practical contextualisation
of theoretical content have gained “wider acceptance in nursing
education in academic and clinical settings” (Nagle et al., 2009; p.
18). Thus, it is safe to say that the need for theoretical teaching
techniques that are more discernibly connected to practical appli-
cation is something that is on the agenda of institutions, world-
wide. This is in contrast to what has actually been done to date, in
that none of these projects have attempted to collate a series of
these types of techniques and strategies so as to inform nursing
education.
Teaching techniques
As part of a larger project to rectify the situation that a com-
pendium of ‘meaningful and engaging’ teaching techniques for
nurse educators has not yet been developed, a review of the liter-
ature was conducted to explore what techniques are currently
 K. Crookes et al. / Nurse Education in Practice 13 (2013) 239e243
utilised by nurse educators to deliver meaningful and engaging
education (as they see it) to undergraduate nursing students. This
will provide a sound basis for attempts at collating these types of
teaching techniques in the future.
Seven separate ‘meaningful and engaging’ teaching strategies/
techniques were revealed, all of which are linked by the universal
aim to create a more overt and measurable link between theory in
the classroom and application of theoretical knowledge in a prac-
tical setting, so that nursing students can explicitly recognise, and
so engage more meaningfully with nursing theory. These seven
techniques are: technology and online; simulation; gaming; art;
narratives; problem/context-based learning; and reflection. All of
these techniques are shown to have individual benefits, which if
employed properly, have the potential to promote engaging and
meaningful learning and teaching.
Technology and online teaching techniques
Ten articles were found that discuss the use of ‘technology and
online’ tools to incite student engagement (Tremel, 2004; Edwards
et al., 2008; Wells et al., 2002; Hoffman et al., 2011; Schmidt, 2009;
McConville and Lane, 2006; Cleveland, 2008; Clifton and Mann,
2011; Kluge and Glick, 2006; Simpson et al., 2008). All ten articles
suggest, implicitly or explicitly, the need for nurse educators to
cease relying wholly on traditional, passive methods of teaching
(Tremel, 2004; p. 63). The articles suggest that by implementing
techniques that involve technology and online forums, a more
defined link between theory and practice can be established,
resulting in better-equipped and better-informed nursing students.
The literature names two main benefits of technology and online
tools. The first benefit is that such techniques are said to improve
student interest and ability in the classroom, in that they have the
potential to increase student retention, motivation, and class par-
ticipation. [as well as aid in] learning and critical thinking.
instructional consistency; and enhanced clinical education” (Wells
et al., 2002; p. 92), which in turn inspires better and more informed
nursing practice (Tremel, 2004). The second benefit is the capacity
for technological and online teaching tools to inform and create
good nursing practice through explicitly linking theory with prac-
tice (Simpson et al., 2008; p. 637). According to Hoffman et al., the
use of technological tools and online techniques in the nursing
classroom has the potential to “foster experiential learning by
relating learning to real life problems” (2011; p. 587), in turn pro-
ducing “more interactive, assertive and self-reliant professionals”
(Tremel, 2004; p. 63). Thus, according to the literature, techno-
logical instruments and online tools are effective teaching mecha-
nisms that, if added to traditional methods of nurse education, have
the potential to foster better nursing practice.
Simulation teaching techniques
Eleven articles were found which examine the use of ‘simulation’
as an effective tool for making theoretical nursing content mean-
ingful and contextually engaging for student nurses these were:
(Royse and Newton, 2007; Rush et al., 2010; Parker and Myrick,
2010; Cordeau, 2010; Shinnick et al., 2011; Norwood, 2008; Becker
et al., 2006; Nagle et al., 2009; Wilson et al., 2009; Larson-
Presswalla et al., 1995; Smith-Stoner, 2009). Simulation is much
venerated in the literature. It is described as an “experiential
learning tool” (Wilson et al., 2009; p. 2) that, according to Rush,
Acton et al. “has an important role to play in clinical learning” (Rush
et al., 2010; p. 477) in that it allows for theoretical content of a
subject to be practically applied, which in turn develops a distinct
link between theory and practice in nursing education allowing for
effective and engaged learning to occur. According to Rush et al.
241
(2010), the Canadian Association of Schools of Nursing (CASN)
“found that simulations might offer advantages over traditional
educational methods” such as learning on clinical placement (2010;
p. 469) in relation to the fact that simulation allows for the practice
and learning of formative skills in a controlled and unthreatening
environment. This allows for the acquisition of clinical skills, the
management of patient issues, and the practice of problem solving
and clinical-decision making in a safe environment, which arguably
allows for better retention of theoretical content (Becker et al., 2006;
Royse and Newton, 2007; Rush et al., 2010). Nagle et al., suggest a
number of benefits to simulation, stating that active participation
through the use of simulation in the classroom “fosters experiential
learning, problem solving, and immediate application of clinical
knowledge” (Nagle et al., 2009; p. 20), which is mirrored by Cordeau
(2010) who states that the use of simulation in nursing education
increases the transference of knowledge from clinical theory to
clinical practice by up to 95% in some studies (Feingold et al., 2004;
McCausland et al. 2004, cited in Cordeau, 2010; p. 14). According to
Knowles (1970) cited in Nagle et al. (2009), adults are more moti-
vated to learn if they are actively involved in the process of learning,
as it allows for them to relate the content to personal experience
more effectively and easily, and gives them an opportunity to work
out problems in an active and memorable way, allowing them to
apply what they have learnt more easily when faced with a practical
scenario. Knowles (1984) asserts that adults experiences should not
be ignored, indeed he emphasises the importance of using the
experience of adult learners as a rich resource for learning (Knowles,
1984; p. 11) Simulation obviously allows for this to happen in
planned ways in controlled environments.
Gaming techniques
Two articles were found that explored ‘gaming’ as an engaging
teaching strategy these were (Royse and Newton, 2007; Graham
and Richardson, 2008). Both Royse and Newton (2007) and
Graham and Richardson (2008) argue that the employment of
games in the classroom, which are by nature interactive and
competitive, has the ability to bridge the gap between theoretical
nursing, and nursing practice, thus making education more
meaningful for students. Royse and Newton (2007) argue that
because games are interactive; and have the potential to re-create
real-life situations and processes in a competitive, and so,
engaging, memorable and interesting manner; they have the ability
to strengthen learning outcomes and inform practical retention and
application of theoretical content. According to Royse and Newton:
“gaming can challenge students to tap into their cognitive reservoir
for knowledge about how they would handle various situations”
(2007; p. 264), and it is gaming’s capacity to encourage this in
students that, as Graham and Richardson argue, is such an effective
communicator and entrencher of nursing skills (2008).
Art teaching techniques
Ten articles were found which examine the notion of ‘art’ as a
‘meaningful and engaging’ teaching strategy (Brand and McMurray,
2009; Wikstrom, 2003a; Jensen and Curtis, 2008; Casey, 2009;
McCaffrey and Purnell, 2007; Pardue, 2004; Wikstrom, 2001;
Wikstrom, 2003b; Epp, 2008; Pardue, 2005). Art was defined by
Jensen and Curtis as encompassing the fields of “[visual] arts, mu-
sic, literature and film” (Jensen and Curtis, 2008; p. 1) and it is
argued elsewhere in the literature that art can encourage students
to “incorporate aesthetic contemplation and inquiry into their
thinking about nursing practice”(Casey, 2009; p. 69). Thus art is
said to foster a more defined link between theory and practice,
through creating a learning environment that is less traditional and
242 K. Crookes et al. / Nurse Education in Practice 13 (2013) 239e243
passive and more interesting, expressive and active. Wikstrom
(2001) explicitly, and vehemently advocates the use of art in the
classroom, stating that it has the ability to make a “vital contribu-
tion to students’ knowledge about nursing care” (2001; p. 31),
adding that it has the potential to be used “in education as a
complement to standard textbooks” (2001; p. 31), which is a
sentiment that is echoed by all of the other nine articles that touch
on the use of art in the nursing student classroom. Each article
discusses the use of art in relation to the use of music, photographs,
visual art, craft and/or storytelling as teaching devices, providing
reports of projects and personal experience with the techniques
(Wikstrom, 2003a,b; Jensen and Curtis, 2008; Casey, 2009; Pardue,
2004) all provide quotes from student nurses about the effect that
the use of art in the classroom has had on their nursing capabilities,
skills and attitudes, which suggests that this kind of teaching
technique has obviously helped student nurses “link theory to the
reality of practice” (Brand and McMurray, 2009; p. 33) in ways
which are both unambiguous and practical, and seemingly valued
by students. According to Pardue (2004), the use of art can lead to
“an enhanced sense of patient empathy, heightened concern for
person-centred care, and a valuable opportunity for self-reflection”
(2004; p. 58) which suggest that the use of art is both meaningful
and engaging for nursing students in a way that stretches beyond
the classroom and into their practice as nurses.
Narrative teaching techniques
Ten articles were found that focused on the use of ‘narratives’ as
a strategy for engaging teaching (Balen et al., 2010; Schafer, 2002;
Ironside, 2006; Davidson, 2004; Lillyman et al., 2011; Ewig and
Hayden-Miles, 2011; Andrews et al., 2001; Christiansen, 2010;
Roberts, 2010; Shattell, 2007). The literature describes how the use
of narratives can facilitate students to link theory and practice,
through the exploration of testimonials, stories and conversations,
either written down for personal reflection, or shared openly in a
group setting by both students and educators. The use of narratives
in the classroom allows for nursing students to reflect upon the
theoretical content covered in class, and encourages the use of that
content in practical settings, which in turn encourages a greater
understanding and appreciation of the link between theory and
practice in nursing education (Schafer, 2002; p. 286). The pre-
dominant benefit of the use of narratives according to Schafer
(2002), Davidson (2004), Lillyman et al. (2011), Ewig and Hayden-
Miles (2011) and Roberts (2010), pertains to the fact that their
use fosters engagement beyond the classroom as it makes course
content more interesting and memorable. According to Davidson,
use of narratives in the classroom makes “the material become
more vivid, recallable and... [makes]the material seem more real-
istic” (2004; p. 187). Roberts asserts that when theoretical content
is steeped in reality, students are more likely to be interested, and
so more engaged with the material (2004). As a result, narratives
can serve as a “trigger for information recollection” (Davidson,
2004; p. 184). The literature suggests that making material more
memorable makes it is easier to recall in nursing practice.
Problem/context-based teaching techniques
Eight articles surfaced out of the literature search that focused on
the issue of problem/context based learning (Randle et al., 2004;
Ramjan, 2011; Darkwah et al., 2011; Barron et al., 2008; Magnussen
et al., 2000; Crawford, 2011; Yuan et al., 2007; Head and Bays, 2010).
There is currently major growth in interest in research related to
practice/context-based learning, that “offers the potential to bridge
the theory-practice gap in nurse education, through the recognition
and evaluation of practice-based problems” (Barron et al., 2008; p.
963) and which explicitly highlights the link between theory and
practice through the use of practical, situation-based scenarios to
frame theoretical content. Crawford argues that problem/context-
based learning allows for a more obvious “construction of mean-
ing, [in that] the problems mirror the real world” (Crawford, 2011; p.
124) which allows for a more explicit link to be drawn between
theory and practice. Ramjan (2011) and Barron et al. (2008) concur;
with Ramjan stating that the use of problem/context-based learning
“led to a deeper learning” (Ramjan 2011; p16) for students, which
allowed them to develop practical nursing skills more effectively
and efficiently. Randle et al. (2004), Darkwah et al. (2011), Yuan et al.
(2007), and Magnussen et al. (2000) agree, arguing that problem/
context-based learning equips nursing students with important
practical tools such as: skills in critiquing information; problem-
solving; communication and higher-level thinking; and clinical
skills; as well as self-directed learning; a greater sense of personal
responsibility and self-confidence, all of which allow for a smoother,
more enhanced transition into the work setting.
Reflection teaching techniques
Five articles were found that examined reflection these were
(Binding et al., 2010; Honey et al., 2006; Murphy, 2004; Scanlan,
2002; O’Connor and Hyde, 2005). According to this literature,
reflection is an effective tool for relating “the content being pre-
sented [in a subject], to [one’s] own practice or experiences”
(Scanlan, 2002; p. 140), in that by picking out certain points of
content being covered in a class and linking them explicitly to
practical experiences, students are able to explicitly map the
connection between theory and practice. A series of benefits were
highlighted by the literature about the use of simulation with
respect to reflective practice, with many of the articles on the
innate potential for reflection to function as a technique for linking
nursing theory with practice, which is an issue that is pivotal to
nursing education and indeed all clinically-related fields. The
article that explores this issue the most comprehensively is that by
Murphy (2004), which provides a list of benefits that the technique
of reflection may provide for nursing education. Murphy (2004)
emphasises the benefits of reflection, through written or verbal
articulation, in relation to its ability to reduce the repetition of
clinical errors in student nurses, the fact that it allows for self-
regulation, that it develops clinical reasoning skills, and that it
fosters life-long learning skills. Scanlan (2002) states that reflection
has the potential to formalise the connection between theory and
practice as it can “assist students to make connections between the
theory taught in the classroom, their experiences (both personal
and professional), and assumptions that they have held about the
topic under discussion” (Scanlan, 2002; p. 140). Thus, according to
the literature, the use of reflection as a ‘meaningful and engaging’
technique has the potential to create a more explicit and obvious
link between nursing theory and nursing practice.
Conclusion
One of the characteristics of adult education proposed by the
foundational author on andragogy (Knowles, 1984) is that adults are
relevancy orientated, this was corroborated from a review of the
literature as it became clear that nursing students need to be taught
in a way that emphasises the practical use of the information that
they glean in the classroom so that they can become more engaged
with the content. Much of the literature argues that for this to be
achieved new methods of teaching need to be developed, cat-
egorised and adopted. Much of the literature seems to agree with
the sentiment that nursing education needs to evolve by “moving
away from the traditional, passive lecture styles” (Tremel, 2004; p.
 K. Crookes et al. / Nurse Education in Practice 13 (2013) 239e243
63), towards incorporating techniques that make more explicit the
connection between nursing theory and nursing practice. It is as a
result of this, according to the literature, that student nurses will be
better prepared for their role and responsibilities in the health care
environment (Tremel, 2004; Balen et al., 2010; Shinnick et al., 2011).
Presumably it will do so by making their learning experiences more
meaningful and/or engaging and so more memorable and retain-
able. All of the literature that has been reviewed here seems to
suggest, explicitly or implicitly, that nursing education needs to
address the schism between theory and practice by creating a more
explicit link between course content and nursing practice and that a
compendium of techniques should be developed for better teaching
to occur for future nursing students. It is the intention of the authors
that this will happen into the future.
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