Using Feedback from Nursing Students to Co-create Teaching and Improve the Learning Experience
Isaac Tuffour1*
1School of Nursing, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
*Correspondence to: Isaac Tuffour, PhD, Senior Lecturer, School of Nursing, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK; Email: i.tuffour@wlv.ac.uk
Abstract
Objective: To use feedback from students in mental health nursing as a step towards co-creating teaching and to improve learning experience.
Methods: During a teaching session, feedback was obtained from a group of 20 final year mental health nursing students. The data were analyzed using interpretive description methodology.
Results: The students were enthusiastic and eager to engage in the co-creation project. Students indicated co-creation strengthened their agency and learning experience.
Conclusion: The students’ feedback showed that in a collaborative and non-hierarchical classroom setting, self-confidence and learning experiences are improved. There is a need for nursing academics to change their mindsets and have the confidence in the classroom to bring about pedagogical innovations.
Keywords: co-creation, pedagogical innovation, student feedback, mental health nursing
1 INTRODUCTION
One of the most important current debates in higher education institutions (HEIs) is the co-creation of learning and teaching[1]. The literature has outlined many active examples of co-creation projects at HEI. For instance, Bovill et al.[2] list noteworthy and more active co-creation projects in which students have been tapped to play important collaborative roles as co-learners, co-teachers, co-inquirers, co-designers, and co-planners to improve their learning experiences. Poklop[3] notes that a range of co-creation projects are organized around a specific genre, such as creating brave spaces; belonging, trust and hope; risk; or issues stemming from a common curriculum. While co-creation can present challenges for students and academics alike[4] the reciprocity rooted in the concept can be an efficient way to boost the learning experiences of both students and academics[5]. Co-creation can therefore be identified as a social construction concept helping both academics and students to conceive innovative ways of teaching and learning[6]. Co-creation thus, involves academics who are willing to trust students with significant responsibility and insight into shared work, and students who are willing, often despite initial reluctance, to take on the roles they are given[3]. However, despite the allures of co-creation, a cursory glance at the literature reveals that it has received limited attention in the field of nursing education. Thus, the aim of this pedagogical project is to use feedback from mental health nursing students as a step toward co-creating teaching and to enhance learning experience of students.
The idea that collaboration in pedagogical interventions helps to explore and connect identities, share power and responsibility in the creation of culturally sustainable pedagogy has inspired this paper[5]. Cook-Sather[7] argues that bringing students’ identities and backgrounds to bear promotes inclusive classrooms, greater diversity, and makes faculty aware of pedagogical techniques that they already use but do not recognise as fostering inclusivity. These ideals of inclusivity and the integration of the unheard voices of students into teaching dialogues have also influenced this project. But it must be mentioned that classrooms are not places where students can find individual affirmation, because they must aspire to exist as part of a crowd[8].
1.1 Student Feedback
Student feedback is common and important practice for academics employed in HEIs. Studies indicate that student feedback provides an opportunity to assess if adequate and successful teaching and learning has taken place[9,10]. It has been argued that feedback from students could influence HEI teachers to adjust their classroom practices to students’ expectations[11]. This suggests that reciprocity is indeed the key outcome of feedback from students. In addition, Williams and Brennan[9] argue that student feedback plays a key role in maintaining and monitoring of quality and standards, assessing the effectiveness of course design and delivery, enabling dialogue with students, helping to identify good teaching practice, measuring student satisfaction, and contributing to staff development. Belch and Law[12] also claim that student feedback is routinely sought to inform the development of teaching and curriculum. Student feedback is thus characteristically an accountability and quality assurance framework. The most influential account of student feedback is to be found in the study of Birgbauer[13] who points out that incorporating the views of students in the development and teaching of courses can provide a valuable organizational and intellectual input and unique learning experience for students. This could undoubtedly, foster teacher-student relationship, warmth, and availability[14]. But despite the increased recognition that timely feedback from students can promote inclusivity[15], and increase collaboration with academic practitioners[1] there has been little consideration of how feedback from nursing students could be used to co-produce knowledge to enhance their learning experience.
1.2 Co-creation Conceptualized
Dewey[16] conducted preliminary work on co-creation in the educational context, suggesting that higher education students should be involved in pedagogical planning. While the idea of co-creation has acquired popularity in HEI in the UK, it is a recent phenomenon[2,17]. Co-creation has now become a viral subject and has been marketed as an alternative pedagogical innovation to improve teaching and student engagement[1]. According to Felten et al.[18], co-creation or partnerships in teaching and learning are focused on respect, mutuality, and collective responsibility between students and faculty. The authors argue that the strengths and qualities of co-creation or partnerships lie in the willingness to incorporate students’ perspectives into discussions in concrete ways that make teaching and learning possible.
Co-creation in education context, is defined as “a collaborative, reciprocal process through which all participants have the opportunity to contribute equally, although not necessarily in the same ways, to curricular or pedagogical conceptualization, decision-making, implementation, investigation, or analysis”[18]. This definition puts emphasis on closer relationship between students and the academic practitioners. Also, it[19] echoes description of teaching as a relational act that brings students and teachers together to form a transformative relationship. But Rudduck and Fielding[20] suggest that the popularity of co-creation could lead to surface reform, concentrating on how to go about it rather than a reflective analysis of why we really want to do it.
Various overlapping terminologies of co-production can be found in the education literature. These include: co-creating, coproducing, co-learning, co-designing, co-developing, co-researching and co-inquiring[4]. These terms have been developed by different authors from different disciplines, and they refer to the different but related phenomena[21]. Healey et al.[4] argue that they are modernization terminologies that highlight openness, collaboration, and sharing of responsibility.
2 MATERIALS AND METHODS
An interpretive description approach, a highly contextualized qualitative approach developed with nurse researchers in mind, has been used to address the study question[22,23]. Interpretive description assumes that nurse researchers are dissatisfied with description alone but are actively searching for definitions and explanations that are applicable to practice[23]. In addition, the idea that interpretive description is based on different theoretical bases from grounded theory, naturalistic inquiry, ethnography, and phenomenology[22,24] and its utilization of reflection and critical examination to understand the nuances of a phenomenon[23] was equally appealing. Since this project was a pedagogical innovation, ethical approval was waived by the host university. However, informed consent was sought from all students participating in the project.
2.1 Participants
Interpretative description is typically a small-scale inquiry that uses a small sample size to gain a deeper insight into a phenomenon and inform practice[23]. Thus, data were gathered from a cohort of 20 final year mental health nursing students in a large public university in London, United Kingdom during the second teaching session of the module. The rationale was to use the feedback from the students to adjust teaching style in subsequent sessions. Students were informed at the beginning of the module that feedback seeking their views about teaching and learning of the module would be elicited.
2.2 Data Collection
Thorne et al.[23] explain that interpretive descriptions use diverse data collection methods to gain meaningful and experiential account from the participants. To help accomplish the aims of this project, Poll Everywhere, an interactive audience participation (IAP) or online audience response system was used to collect data. Evidence suggests that technology can be used to support co-production projects[25]. Poll Everywhere is flexible to use as interactive questions can be created and chosen from diverse poll activities such as multiple choice, open response, live word clouds, clickable images, up-and down-voting for question and answers, and rank order[26]. Students were asked to bring their mobile phones, tablets, or laptops to class to be able to participate. On the data collection day, information was shown to the students on a large projector screen explaining why they are being asked to give their feedback. After this, open-ended questions, and more specific probe questions such as: In your opinion did the lecturer use a variety of teaching techniques to aid the learning process? In your opinion did the lecturer welcome your suggestions and criticisms? Please provide an overall impression of the teaching you have received, were shown in turn eliciting detailed responses from them. Since questions were facilitated and answered digitally, there were no verbal interactions between the students and the researcher. Thus, removing any pre-conceived ideas or personal biases from the data generated. Responses were automatically sent to Poll Everywhere database which was only accessible by the researcher using a password.
2.3 Reflexivity
Thorne et al.[23] suggest that interpretive descriptive is deeply a subjective method and thus requires practitioners to analyse carefully how their assumptions impact the research process. It is therefore necessary to focus on the preconceptions I have brought into this project. My desire to promote inclusiveness, empowerment, and cultivate an atmosphere in which students feel they have a voice in the classroom inspired the current project, but I realized on reflection that I was working to complicate the complexity of the structures of power between the teacher and the students in the classroom. But it was unequivocally made clear to all the students that participation in the pedagogical intervention was voluntary. I draw here on the suggestion of Felten et al.[18] that pressuring students to engage in co-creation can lead to alienation, so voluntary engagement is necessary. Also, while my goal was not to eradicate power dynamics in the classroom or tip the power scales in favour of the students, I was especially careful to break down the power hierarchies in the classroom[27]. From my perspective, the outcomes are dramatic and inspiring[28].
2.4 Statistical Analysis
Interpretive description data analysis is an iterative process in which researchers use parallel and comparative methods to gain broad insight into the phenomenon under investigation[23,29]. As all the feedback from the students were digitally recorded, no transcription was needed. Instead, a digital report of the responses was created and retrieved from the Poll Everywhere database. The responses were read and re-read to gain insight into responses, as well as to notice emerging patterns and themes which were subsequently arranged in narratives (see below)[23].
3 RESULTS
3.1 Findings
The students’ use of hand-held digital devices to respond to questions resulted in short and direct answers. However, four key themes about their views of my teaching emerged from the data: organization of teaching, engagement with students, acknowledgement of students’ opinion, and overall assessment of teaching. In the following paragraphs, these are explicitly discussed in turn. For clarity, the students’ responses are verbatim and in italic.
3.2 Organization of Teaching
All the students used their responses to comment on my organizational skills as a teacher. A common thread highlighted throughout this theme is the student’s opinions about my organization and presentation of lessons using a variety of teaching techniques. For example, when prompted to comment whether the aims, objectives and learning outcomes were clearly stated by the lecturer at the beginning of the module, many students gave the following response: “Absolutely”. The students’ description of my organizational skills was conveyed in the context of accessible information on blackboard (virtual learning environment and learning management platform) and teaching sessions in the classroom: “Yes, through blackboard” and “through teaching sessions”.
In the responses, there is a suggestion that organizational techniques including advanced lesson planning and preparation, and the teacher’s pedagogical repertoire are important for positive student experience and learning.
This theme captures the perceptions of my interaction and teaching methods among the students. Many commented that they found the classroom discussion and group activities: “stimulating and thought-provoking”, “helpful” in “developing self-awareness”, “interactive” that “allowed self-examination and one to realise potential strengths and weaknesses”. In addition, for many of the students, group work in class seemed to provide a context for engagement: “Encouraged group participation to help understand the various viewpoints of others”, “students…interacting in small group activities to aid…learning”. He “not only answered questions but worked through them as a group to boost understanding”. He “fully encouraged the group to participate in an active manner and has fully supported us in doing so”. He “probed students to get them to explore on the topic under discussion”.
The responses of the students suggest that classroom conversation with students will produce simulative critical thinking, a detailed understanding of the main concepts of the subject under discussion, and a positive reciprocal relationship with students.
Many of the students reported that they found the attentive listening and inquiring probe helpful in their learning: “the lecturer listened, encouraged, and challenged our thinking processes”, “actively sought engagement and evidenced-based opinion”. These answers suggest that students appreciate the effort of teachers to consider the expertise and perspectives they bring to the discussions. It is also indicative of the excitement they showed during my inquiry probes that students are willing to engage in class once they realize that they make valuable contributions and teachers will benefit their individual strengths.
For some students, the use of humour in class encouraged active learning: “the entire module has remained interactive, and the course has been delivered in a professional but light-hearted way which has made it enjoyable to attend”. Such answers suggest that the use of humour not only promotes a healthy learning environment, but also encourages trusting relationship and participation in the classroom.
3.4 Acknowledgement of Students’ Opinion
This theme captures the students’ views on how their suggestions, criticisms, and questions were encouraged and answered during lectures. For example, the following statements were captured when prompted to comment whether they were encouraged to ask questions and their viewpoints: He “listens and allows student to express points and opinions”. He “Encouraged class discussion even with topics that were controversial as many students are very opinionated in the class”. He “actively sought feedback and questions…listened, acknowledged and advised where necessary”.
The students’ very frank comments suggest that establishing a learning atmosphere in which they are treated with respect and consideration in the sense of the sharing of important ideas is an effective way to ensure student participation in co-creating of teaching and learning. When asked to comment whether the lecturer accepted their suggestions and criticisms, many gave the following responses: “Problems and issues were discussed in detail with the group as they arose”. “Acting as a neutral party and allowed us to discuss / share different opinions”. “Acknowledging contributions and encouraging others to share differing views”. He “took on board individual viewpoints and criticisms in a positive and professional way”.
The frank feedback from the students shows that they appreciate collaboration with the teacher in the classroom and that their interactions were strengthened when they were able to express opinions freely. The students regarded the interactive learning environment as an opportunity to become self-directed, to take a stake in their learning environment's creation and development and to dismantle the proverbial boundary between the teacher and students.
3.5 Overall Assessment of Teaching
Constructive feedback of the quality of my overall teaching was expressed as two ends of the same spectrum. At one end of the spectrum many gave satisfactory constructive feedback framed in the context of knowledge in subject, lecture delivery, and learning from peers: “Fully enjoyed this class. It was delivered well, and much was learnt from working with others and their viewpoints”. It is “obvious the lecturer has wide range of knowledge and experience”. “I enjoyed this class, ample opportunities to discuss and learn from others in their experiences”.
The above answers suggest that students trust teachers who have a deeper understanding of the topic and can show a wide range of practical and theoretical knowledge. In the sense of inadequate briefing on the requirements of the module assessment, few of the students framed their less satisfactory experiences at the other end of the spectrum: “More time should be given to understand the requirement of the assessment for the module”. The response suggests that timely briefing to help students understand assignment requirements is not only productive for them, but also powerful and beneficial for their learning experience. In addition, teachers should make it an essential aspect of learning to provide feedback to allow students to understand tasks.
Few students commented that they considered the overreliance on PowerPoint slides to deliver lectures distracting and alienating: “I would have preferred less reading from PowerPoint and free flowing teaching”. PowerPoint when effectively used can be an effective teaching aid, but the response presented here suggests that the students found it disengaging and hindered their learning experience.
4 DISCUSSION
The starting point for this pedagogical project was to use the input from students to co-create excellent learning experiences. In most of the feedback, it was evident that the learning experiences of the students were enriched in a collaborative and non-hierarchical classroom environment. This reflects the argument that the active involvement of students could lead to a transformative learning experience and cooperation in lesson planning and teaching[30,31].
Students’ eagerness to participate in this project shows that student feedback can enhance their learning experience and help unravel the prevailing power hierarchies between teachers and students in the classroom[27]. In addition, the results of this study indicate that the interactive learning environment has instilled a sense of trust in students so that they can openly express their views on their impressions of teaching quality, their learning experiences, and self-assessment. This reflects the evidence in the literature that indicates that student collaboration can strengthen their confidence and intellectual agency[2,30,32]. In addition, the students' timely feedback helped me gain perspective to analyse and focus on the consistency of my teaching. Palazzo et al.[33] found that timely student feedback gives practitioners the ability to focus on the timely mitigation of emerging problems and to handle student expectations in a constructive and inclusive learning climate. Moreover, the use of an IAP tool helped to collect the students’ timely feedback. This is consistent with results from many studies that have used technology to gather students’ timely feedback. For instance, Gause et al.[34] found that by utilising technology and electronic devices, timely feedback from nursing students could be facilitated. In addition, Hepplestone et al.[35] learned in a literature review that feedback mediated by technology can increase flexibility, efficiency, quality, and student experience. The writers, however, lament that technology is not commonly utilized to help and enhance student feedback. The present study helps to fill this void and encourage the regular use of digital technologies in HEIs to provide an efficient means of gathering timely feedback from nursing students.
Use of humour seemed to influence the students’ learning in terms of creating good climate in the classroom and inclusivity. Many studies state that boredom is the most challenging pedagogical barrier to teaching in the classroom, so humour, a fun environment in the classroom and constructive interactive communication can be used to encourage learning and learning outcomes[36,37]. In addition, Banas et al.[38] suggest that humour should be used in educational settings to foster inclusivity. However, because of its multidimensional, multifunctional, highly personal, subjective, and contextual nature, one must be mindful that using humour in the classroom can be complicated[36]. Therefore, Garner[39], Neff and Dewaele[40] caution the use of humour in the classroom sparingly, as inappropriate humour or ethnicity, sexuality, and politics related humour can lead to scorn and social isolation among some students.
There was a strong feeling from the comments that the teachers’ successful organizational skills were correlated with the students’ achievement of learning outcomes. This resonates with the statement by Boud and Molloy[41] that macro and micro planning and course execution can allow students understand and take responsibility for their own learning and build on their self-regulatory framework. Comments showed that the group activities were stimulating, fun and facilitated student professional competence. Xue[42] argues that group activities can stimulate the interest of students in learning, stimulate debate, refine comprehension, and improve innovative thinking and skills in communication. Studies also indicate that group activities can create meaningful interactions and lead to learning for students[43,44]. Group activities provide students with an important leverage to build the skills needed in the professional world[45].
4.1 Implication for Practice
Findings from the current study show that there are lessons to be learned with respect to current and future academic nursing practice. The students’ excitement and enthusiasm for offering constructive and thought-provoking feedback on my teaching suggests that they were open to the concept of helping to co-produce an excellent learning environment. I have found that my teaching and my students’ learning have been improved through interaction and exchanging different points of view[46], and the co-creation that has taken place through this pedagogical project has strengthened collaboration, meaningful dialogue and the reciprocal teaching and learning process[47]. The insights gained from the present project require nursing educators to change their mindsets and have the courage to bring in pedagogical advances in the classroom. Moreover, this simple yet innovative project will make it possible for nursing academics to recognize that a co-creation project can be an adaptable pedagogical intervention to execute[1].
In addition, the relevant role IAP can play in gathering timely feedback from students is one of the issues arising from this study. It emerged that IAP could inject fun into learning, make the learning environment more stimulating, interesting, collaborative, interactive, imaginative, and scalable using IAP in teaching and co-production projects[48-50]. Therefore, it is important for nursing academics to examine ways in which technology can be integrated into their practice to improve collaboration and student experience. More significantly, the COVID-19 outbreak and the shift of teaching and learning to online platforms in the UK, Department for Education[51] has placed much emphasis on the use of technology-mediated teaching and learning[52]. While digital literacy, interactivity, and immediacy are favoured by the current student generation[53,54], practitioners should not ignore the accessibility and affordability constraints face by many students[52]. In addition, practitioners should recognise that IAP can be disruptive in the classroom, especially when using mobile devices, but the benefits of this digitally mediated pedagogy outweigh the challenges[48].
Although some research indicates that it can be difficult to incorporate co-creation, as collaborative work can be difficult in terms of resolving definitions, widening horizons, or sharing responsibility[19]. These difficulties are compounded by challenges such as resistance to change, heavy workloads, cynicism about co-production, and scepticism about students’ potential to make substantial contributions, all of which can impede co-creation ventures[6]. In addition, resistance may occur, especially in professional courses such as nursing, where students are expected to adhere to the code of professional standards. The issue is exacerbated by fee-paying nursing students who can behave as ‘consumers’ and can avoid tasks they consider to be above them[55]. However, Bovill et al.[6] point out that if co-creation projects are planned and made applicable to all stakeholders in a versatile and reflective way, these valid and critical challenges can be solved. In relation to the current project, its success can be attributed to its novelty, its manageable size and the careful steps taken towards its implementation within a single module and classroom rather than across the entire nursing department. It has been argued that small-scale projects are typically more successful when students and staff are new to co-creation[18,56].
Nursing academic practitioners should understand that negative input from students may cause bad feelings and unconscionable adjustments in the teaching style to satisfy students. Positive student input can also be related to better-quality teaching[11]. Practitioners should understand that the first stage of engaging and collaborating with students is to create feedback opportunities[57]. In relation to this project, the comments from the students revealed informative and thought-provoking questions regarding my teaching, which has helped to inform my practice. Cleary et al.[10] call on nurse educators to fully acknowledge the content of student feedback without being reactive and welcome such feedback as a win-win for students, teachers, and their respective institutions. Moreover, it is crucial for nursing academics to recognise that the benefits of co-creation far outweigh any associated risks[18,58]. Co-creation strengthens the autonomy and power relationships between students and academic staff[59]. It has informed my practice that educational institutions can be turned into more inclusive spaces for learning[7], and potentially enhance the quality of teaching and learning[60]. However, effective communication skills articulating the broader benefits and complexities of co-creation projects and institutional backing are all needed for such pedagogical innovation to succeed[17].
5 CONCLUSION
Healey et al.[1] argue that one of the most critical issues facing higher education in the 21st century is effective engagement of students and staff as partners in learning and teaching. The mental health nursing students’ enthusiasm to give insightful feedback about teaching in the classroom is a demonstration that engaging and empowering students as partners is a powerful idea that can transform nursing education[18]. More studies of this nature are therefore necessary to determine whether it would work in mainstream nursing education. The findings of this study are based on the responses of only 20 final year mental health nursing students. It therefore needs to be interpreted with caution. Arriving at an objective conclusion requires collection of data from a large group of nursing students. Co-production depends on both the teacher and the students’ collaboration. Therefore, further research involving teaching sessions with the active participation of the students in the design of teaching and learning in the sessions need to be considered.
Acknowledgements
Not applicable.
Conflicts of Interest
The author declared no conflict of interest.
Author Contribution
The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.
Abbreviation List
HEI, Higher education institution
IAP, Interactive audience participation
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