An Effective Teaching Method: Double Testing

An Effective Teaching Method: Double Testing

Current literature reminds us that active learning helps promote critical thinking and problem-solving abilities. Active learning requires that students be engaged through more than listening, reading, writing, and discussion. 

Research has significantly proven the opposition amid adult and child learning styles. Established on the research that adults do not learn in the same style as children, it is practical to accept that one cannot teach adults employing methods developed and planned to facilitate the learning experience of children. Malcolm Knowles, a pioneer in the field of adult learning, hypothesized some assumptions to assist teachers with teaching children and adults. These assumptions include:

The Need to Know. Adult learners need to know why they need to learn something before undertaking to learn it.

Learner Self-Concept. Adults need to be responsible for their own decisions and to be treated as capable of self-direction.

The Role of Learners’ Experience. Adult learners have a variety of life experiences that represent the richest resource for learning. These experiences are, however, imbued with bias and presupposition.

Readiness to Learn. Adults are ready to learn those things they need to know in order to cope effectively with life situations.

Orientation to Learning. Adults are motivated to learn to the extent that they perceive that it will help them perform tasks they confront in their life situations.

The reason most adults enter any learning experience is to create change. This could encompass a change in their skills, behavior, knowledge level, or even their attitudes about things. In a 2006 article published in the journal Urologic Nursing, Sally Russell suggested that, compared to school-age children, the major variances in adult learners are in the degree of enthusiasm, the extent of earlier experience, the level of engagement, and how the learning is applied. Double testing allows the adult student to be engaged in the learning process.

Students need support and validation from their peers. In any classroom, evaluation is necessary. In 2012, the National League for Nursing suggested in its fair testing guidelines that tests and other evaluative measures should be used “not only to evaluate students’ achievements, but, as importantly, to support student learning, improve teaching, and guide program improvements.” Double testing is one such teaching method in which evaluation, peer support, and validation can be instituted to support student learning.

Instructors who teach in higher education can no longer rely on lecturing as their main teaching method. In Teaching in Nursing: A Guide for Faculty, scholars Diane Billings and Judith Halstead emphasize that dependence on the use of the lecture is no longer an accepted teaching technique. Instead, faculty must integrate the use of technology so that students will be more actively involved and engaged in the learning process. Also, faculty must focus more on teaching in a learner-centered fashion, as opposed to the teacher-center approach.

Double testing has been proven to be an effective teaching method.  A 2013 study published in Nursing Education Perspectives found that learning, communication, and collaboration were prevalent themes in students’ perceptions and opinions of double testing. According to the researchers, the study found that “a majority of students preferred double testing and indicated that this testing method had more advantages than disadvantages.”

Throughout nursing programs, instructors are responsible for assessing students’ abilities and assuring they are competent to practice nursing. Since one of the nursing instructor’s goals is to prepare students to be safe and competent nurses, I believe that collaborative learning, such as double testing, is an excellent strategy to assist students in being able to successfully care for patients. I have used this teaching method for more than two years with senior two-year nursing students and have found that double testing promotes group interaction, interpersonal skills, and interdependence among the nursing students—qualities needed to work with members of any health care team.

In using the double-testing method, I have also found that students are more engaged and more cooperative; they also exhibit improved critical thinking skills. For example, when double-testing scores were compared over a six-month period, students’ overall grades increased from 69% to 82%. Indeed, a systematic review conducted by The Campbell Collaboration confirms that the benefits of collaborative testing “include—but are not limited to—better critical thinking skills, better collaboration and team work among peers, reduced test anxiety, and improved test taking performance.”

In a 2011 study published in Science, Deslauriers, Schelew, and Wieman  compared the amount of learning students experienced when taught—in three hours over one week—by traditional lecture and by using interactive activities based on research in cognitive psychology and physics education. The researchers found that students in the interactive class were more involved and absorbed more than twice the learning than their colleagues in the traditional class.

Twenty-first century students should be allowed some control over their learning. For many years, teacher-centered instruction has been dominant in higher education. In a traditional classroom, students become passive learners or just receivers of teachers’ information; whereas, with double testing, the students make the decision whether or not to participate. This way, students take charge of their own learning and are openly involved in the learning process.

In “Helping Students Get to Where Ideas Can Find Them,” an article published in 2009 in The New Educator, Eleanor Duckworth asserts that teacher-centered learning actually hinders students’ learning. In contrast, double testing is a learner-centered teaching method, which focuses on how students learn instead of how teachers teach.

I believe that double testing is a worthy teaching method that instructors can use in the classroom to enhance student-student and student-teacher interactions. Most educators understand that learners have different preferences and styles of learning and believe that it is essential to use teaching methods and approaches that will satisfy the variety of learning styles in the learning event.

Annie M. Clavon, ARNP, PhD, MS, CCRC, is an associate nursing professor at Keiser University in Ft. Lauderdale, Florida.


Lessons for the Teacher

Lessons for the Teacher

My career in pre-licensure nursing education started in 1986. As a professor at Capital Community College in Hartford, Connecticut, I have taught and learned much in the last 20-plus years. I have had the privilege to teach students from the immediate Hartford and greater Hartford areas, Mexico, the Caribbean, and several countries in South America, Europe, Asia, and sub-Saharan Africa. During a recent data-gathering project as part of a teaching innovation, students at my college were asked to self-disclose on race/ethnicity, gender, and age. The Class of 2013 in nursing was 15% African American, 11.1% Hispanic, and 5.5% Asian. The students’ predominant (46%) age range was 25 to 34 years old, and 12.7% of the students were male. Reflections on this rich student sample resulted in my personal list of the following top 10 teaching lessons that I have learned.


1. Examine your words carefully, both verbally and in writing. 

I re-examine the words that I use in class or the college laboratory for double meanings. Common words such as “stoop” or “duck” are examples. If words can have more than one meaning, then I need to check in with the students to ensure that my message is clear. This is important when writing test questions. Some years ago, a student challenged the use of the words “granola bar.” This student was from Africa and did not know the type of food termed “granola.” My assumption was invalid, and now it is described as a cereal bar in a subsequent nutrition question.

2. Students may come from cultures where English is not their first language. 

Also, students’ pre-collegiate educational preparation may not have been in English. However, students still need literacy skills to meet current health care expectations. Written assignments can strengthen skills and identify the few students who might need assistance from the Academic Success Center related to literacy. Having students lead a post-conference is another educational technique that can strengthen verbal fluency. An excellent student from Columbia who had the ability to lead was reticent to contribute verbally. Exposing students to group speaking validates their knowledge and boosts confidence. During last year’s spring semester, I looked around the conference table as students from Columbia, Puerto Rico, Poland, and the United States supported and enriched the clinical experience for each other. Having students give verbal reports to other health care givers or give mock reports over the phone to each other helps boost their fluency and confidence.

3. Recognize the cultural background that each student brings with him or her. 

A student from Chile shared that when someone in her community was hospitalized the expectation was all family, friends, and neighbors would visit. It helped me to acknowledge and share that multiple visitors in a hospitalized patient’s room may be viewed as respect—not an assault on privacy or expediency.

A student from China offered up her cultural upbringing concerning the use of hot or cold foods related to a specific condition. There are two things that I have taken from this. Firstly, the reinforcement of alternative therapies such as heat and cold may be used before the prevalent dash to a pharmacological intervention. Secondly, it is an opportunity to encourage nursing students to assess the patient’s use of cultural therapies to ameliorate or cure a condition.

4. Appreciating the cultural background influences the teacher and student interaction. 

A student from the Philippines would not look me in the eye as I was giving her feedback on a nursing procedure on campus. What could be interpreted as lack of engagement and assertiveness was a demonstration of her respect for someone who was in an authority position. Her comments to me opened the door for more substantial communication and a discussion of communication expectations in her role in the US.

5. Because of the college’s diversity, a number of students are the first in their family to pursue a college education. 

Last year, a student from Vietnam shared that she was the only one in her group of friends who started the pre-requisite courses and who subsequently earned an Associate Degree in Nursing. As her advisor, I congratulated her on this significant accomplishment. I reviewed her resume at her request and went over sample questions for a hiring interview. This student’s paper was presented as an exemplar work in the nursing pharmacology course.

It is important, however, not to make this generalization. I taught a student from Albania whose parents were both educators. She was fluent in Albanian, French, and Italian prior to coming to this country. She worked in a bakery and lived above it until she mastered English. It was important to this student that I was aware of her personal history. She completed the Associate Degree, has since earned a Baccalaureate of Science in Nursing, and has been a homeowner for the last few years.

Another student from Bosnia privately shared her experiences during the war and the compelling reasons for her relocation to America. I often forget to acknowledge how nursing education is an important part in the process of achieving a student’s dream. I have learned to appreciate this important part in the student’s journey.

6.The student population that mirrors the cultural diversity in the community is an asset. 

The health care setting is enriched when there is less difference among the caregivers and the care recipients. The selection of clinical sites that reflect the diversity in the community is important. It reinforces the concepts of physical assessment findings consistent with ethnicity. It reinforces the embracing of humanity that will serve the students well in their careers. My clinical site at the Hospital of Central Connecticut at New Britain General Hospital has three predominant languages: English, Spanish, and Polish. Patient-teaching material is available in all three languages, and staff is often bilingual. Patient compliance with the treatment plan is promoted with these approaches. While the hospital subscribes to a telephone language line, the immediacy of material provides culturally competent care. The diversity at the clinical site provides a lived learning experience.

7. Increase the use of pictures and videos in your teaching to reflect the diversity in the community and the student population. 

My colleagues and I review textbooks and media that include cultural considerations. The nursing laboratory on campus has mannequins that represent virtual patients of diverse race/ethnicity and across the lifespan. Audio in any language can be uploaded to the human patient simulator to support cultural competency. Some cultural topics are anticipated, such as teaching about the cultural differences related to the epidemiology of tuberculosis. Other cultural topics are not as obvious, such as examining evidence-based literature to look for diversity in the study sample. For example, when I teach about nursing care of a person with a burn injury, I include pictures of burn survivors with lighter and darker complexions. In completing an online module on medication reconciliation, I was mindful to include pictures of persons from many ethnicities.

8. Students are taught to be lifelong learners. 

There is benefit in my position as a role model for students related to continuing education. I started as an AD graduate in the 1970s. Progressing from a BSN in the 1980s to a Master’s in the 1990s, I completed a Doctorate in Nursing Practice in 2013. I can empathize with students about the joys and challenges of working while continuing along the educational path. Since faculty members do not usually graduate with advanced degrees, students may benefit from hearing about our personal journey in the education process. However, I challenge students to shorten the timeline for meeting advanced educational goals. Providing dual enrollment in the AD and RN-to-BSN programs is one way to promote advanced education. A local university has invited students to sit in on Bachelor’s degree level classes. With support from my colleagues, I have learned to introduce advancing education early and often.

9. Faculty’s improvement in teaching results from formal education and outside experience. 

Formal education classes address strategies for teaching with diversity in learning styles, age, and culture. Education conferences or seminars are another mechanism for self-improvement. However, I have learned differently from travel experiences. On a nursing delegation to South Africa, I observed care at a rural HIV/AIDS clinic at Groote Schuur Hospital, which was the site of the first heart transplant, and visited a sangoma, the local healer. On a stay at a cattle station in the Australian outback, I learned about rural primary health care. On a trip to Costa Rica, I learned that some Americans receive care there for lower cost and comparable quality. Certification as a Reiki Master Teacher has provided me with another option to offer comfort to patients.

10. Appreciate the teaching and learning experience with a diverse student population.

I have taught students with a wide range of educational preparation. The spectrum has ranged from students with a GED in lieu of a high school diploma to a professor of economics who pursued nursing to give back to the Latino community. All nursing educators who teach a diverse student body deserve to be celebrated. Various and multiple teaching strategies are utilized by educators who teach students between the ages of 19 to over 50 years; students who balance the demands of school, work, and family; and students who bring different backgrounds to their nursing education. I admit to times of frustration, but the multiple teaching strategies can produce significant learning for students and teachers. This last lesson occurs over time after the other lessons have been internalized.

These 10 items are not meant only as a summary of lessons learned but rather a vehicle to amplify the concepts and expand the list in the future. There are many opportunities for more lessons to be learned. Embracing new technologies such as virtual, online health settings is an area for growth. The use of creative assignments such as video production, Wiki sites, or social media are areas for further learning by educators. Systematic review of the curriculum for content, learning activities, and assessment methods will continue to ensure optimal outcomes are met for all students. As a teacher, I look forward to the new lessons I will learn from the students.

Leona Konieczny, DNP, MPH, RN-BC, is a professor at Capital Community College in Hartford, Connecticut.


Racial Disparities of Nursing Educators and Students

Racial Disparities of Nursing Educators and Students

Due to the shortage of nurses in the workforce, many nursing schools are making an effort to increase their enrollment of students. Although there is an effort to increase the enrollment of nursing students, there are still racial disparities within the nursing student population—and this disparity correlates to the racial disparity of nursing educators.1 Without a diverse population of nursing educators, minority students are often made to feel invalidated in various situations, particularly in relating to professors culturally and receiving appropriate advice on cultural and ethnic relations in the workforce. 

Ethnic Hands

According to the National League for Nursing’s Annual Survey of Schools of Nursing, only 12% of the nursing student population in a baccalaureate program in 2012 was African American. That number dwindles for other minority groups: 8% were Asian or Pacific Islander; 1% were American Indian or Alaskan Native; 6% were Hispanic; and 6% were “other.” When you compare that to the fact that only 12.6% of nursing educators are minorities and only 6.2% are male, then you realize there is a dire need for diversity within nursing school institutions to correlate with the student population.2

In addition to the academic stressors that all nursing students have to face, minority nursing students have other challenges. Those challenges include having limited access to moral and emotional support, inadequate academic advising, low professional socialization, and little to no mentoring. Due to these factors, minority students have to overcome additional barriers that may impede on their academic success. Minority students also often feel the encumbering emotions that are attributed to isolation and discrimination. Isolation is often felt by minorities in professional settings, and it is heightened in various professional schools.3 As a result of limited minority nursing peers and nursing educators, minority nursing students often feel as though they’re not supported. Veronica, an African American woman who recently matriculated from a nursing school in the southeastern part of the United States, noted experiencing the disheartening emotion of racism when she was told by a nursing school admission counselor, “They don’t want your kind.” Discrimination of a minority nursing student is often felt in the classroom as well as in the clinical setting. Minority students feel the burden of being discriminated against by patients who don’t wish to work with the student due to the color of the student’s skin. Additionally, too often minority students feel as though they’re going through a hazing process in school in order to be placed on the same level as their white peers.3 

Men continue to be highly underrepresented in the field of nursing, and their presence is even smaller in the classroom. Being a double minority comes with added hardships at times, and it may explain why many minority males do not choose to go into the field of nursing. 

Manuel Romo is a third-semester nursing student at Northern Arizona University’s Tucson campus. He is the president of the Student Nursing Association and one of the few Hispanic male students. When asked about his perception of his role as a double minority in the nursing program, he verbalized, “As I have seen, nursing is predominately white females, which in turn is probably a reason why there are mostly Anglo female instructors. I believe that more needs to be done to attract instructors from various diverse backgrounds in order to attract more minority groups to enter the nursing field.” 

The US Census Bureau predicts that minority ethnic groups will be the majority by the year 2043. With the change in our society will also come a change in the patient populations; they, too, will be predominately minority ethnic groups. The nursing profession will need to be able to be culturally sensitive and diverse in order to provide adequate clinical care. The fundamental change of the nursing profession starts at the level of the nursing students, and it’s imperative that nursing schools acknowledge this and begin to welcome an environment that represents diversity in its faculty. Currently, the National Sample Survey’s data notes that minority RNs are more likely than white RNs to obtain baccalaureate degrees and other terminal degrees in nursing.2 The reasoning for this isn’t fully understood beyond the recognition of knowing an advanced terminal degree brings about more career opportunities and the opportunity to have leadership and education roles—roles that seem to be absent in nursing institutions. 

The methods for recruiting and retaining minority nurse educators aren’t a one-size-fits-all solution. Every school is different and unique in its own way, but the methods can’t wait too long. It’s about time that nursing institutions implement a reliable and realistic plan to promote diversity within their faculty and within their students. As nurses, we’re committed to being lifelong learners for the advancement of our patients and ourselves. Cultural competence is a key factor in relating to one another, and if it’s not cultivated in the classroom, then we as nurses are bound to face problems beyond. 

Eliss Cucchiara is a second degree nursing student at Northern Arizona University. She will obtain her bachelor’s of science degree in nursing in the fall of 2014.


1. National League for Nursing. 2010 NLN Nurse Educator Shortage Fact Sheet. February 2010.

2. American Association of Colleges of Nursing. Enhancing Diversity in the Workforce. Fact Sheet. Last updated April 17, 2013.

3. Loftin C, Newman SD, Dumas BP, Gilden G, Bond ML. Perceived Barriers to Success for Minority Nursing Students: An Integrative Review. ISRN Nurs. 2012;806543.

Issues to Consider for Older Nursing Students

Issues to Consider for Older Nursing Students

Are you a seasoned nurse interested in returning to school, but feeling unsure about your ability to handle the demands of work, life and studies?

Going to nursing school as an older student requires commitment and planning. If you’re on the fence, start with being honest about your feelings. Is your reluctance to earn a B.S.N. or master’s degree rooted in fear?

Dealing with long study hours and difficult courses as a middle-aged student juggling a hectic schedule can be scary. But consider this: as an experienced nurse you bring advantages to the classroom. Older students possess maturity and relevant life and work skills, which help you relate to the course material better.

Consider your learning style. Explore whether the best fit for you is to take classes online, enroll in a traditional bricks- and -mortar university or an accelerated BSN or master’s degree program.

Think about your career goals. Even if you have a well-established career, pursuing a degree can boost your confidence, change your outlook, provide job security and make you more marketable for other opportunities down the road. Advanced education can also improve your nursing skills. Research links better-educated nurses to better patient care.

Another major perk mature nursing students cite is the positive message earning a degree sends to their children.

Other critical factors that will play a role in your decision include family support, flexible job scheduling, finances and stress management.

As you weigh your options, make a list of the advantages and disadvantages of going back to school. Whatever your decide, learning is a lifelong process. And people are living and working longer than ever.

Five years from now, you will be five years older, that much is a given. But will you have that first, second or third degree you wanted, too? Only you can decide.






Role Model Creates Inspirational DVD for Nursing Students with Disabilities

Would you tell a bright, promising student that he or she just doesn’t have what it takes to be a nurse–before he/she has even been accepted into a nursing program? All too often, this kind of prejudice is exactly what students with disabilities encounter when they apply to nursing schools. Just ask Susan Fleming, MN, RN, a nurse who was born without a left hand. Fleming has been a nurse for more than 20 years and currently teaches nursing at Washington State University (WSU) in Spokane, yet she was once denied admission to a nursing program because the school automatically assumed—incorrectly—that she would not be able to perform certain essential nursing skills with only one hand.

To inspire students with disabilities to not give up on their dreams of becoming a nurse, and to promote disability awareness among nursing school admissions committees, faculty and nursing skills labs, Fleming has collaborated with Donna Maheady, EdD, ARNP, to develop a new DVD, “Nursing with the Hand You Are Given: A Message of Hope for Nursing Students with Disabilities.” Maheady is the author of the award-winning book Nursing Students with Disabilities: Change the Course and founder of, an online community for nurses and students with disabilities.

The DVD is presented through the eyes of a nursing student with a disability, who interviews Fleming about how she taught herself to perform a variety of nursing skills with one hand. Fleming takes the student into the nursing skills lab, where she demonstrates such skills as putting on sterile gloves, giving an injection, lifting a patient and applying a sterile dressing.

Produced with support from WSU Intercollegiate College of Nursing, the film is also designed for use by state departments of vocational rehabilitation and disability services staff at universities, colleges and technical schools to encourage students with disabilities to pursue nursing careers.

The “Nursing with the Hand You Are Given” DVD can be purchased for $45 plus tax and shipping. For more information, or to order, contact the WSU Intercollegiate College of Nursing Multimedia Library at (509) 324-7321 or [email protected].