Document Type


Date of Degree

Spring 2010

Degree Name

PhD (Doctor of Philosophy)

Degree In

Educational Policy and Leadership Studies

First Advisor

Michael B. Paulsen

First Committee Member

Elizabeth A. Swanson

Second Committee Member

Timothy Ansley

Third Committee Member

Ernest T. Pascarella

Fourth Committee Member

David B. Bills


This study examined differences in the effects of three active-learning teaching strategies (case-based learning, simulation, and simulation with narrative pedagogy) on the outcomes of nursing student performance of intervention activities, performance retention of intervention activities, student satisfaction, self-confidence, and educational practice preferences. Engagement theory of student learning provided the overarching theoretical framework. An experimental posttest-only design incorporating two posttests (first performance and retention performance) was used with a sample of 74 nursing students at the University of Iowa College of Nursing. Students attended a cardiac lecture and completed a cardiac test prior to the teaching strategies. Students were randomly assigned and participated in one of the three active-learning teaching strategies and completed the Demographic Questionnaire, the Satisfaction and Self-Confidence in Learning Instrument, and the Educational Practices Questionnaire. Week 3 of the study, after the teaching strategies students participated in an individual performance demonstration in which they implemented nursing intervention activities in response to a cardiovascular scenario interacting with a high-fidelity mannequin. Week 8 of the study, another individual retention performance demonstration was completed by the students using a different case scenario. Both performance demonstrations were digitally recorded and scored using the Student Performance Demonstration Rubric.

Two-way mixed analysis of variance (ANOVA) revealed a significant main effect (within-subjects effect) of time, meaning that students in all three teaching strategy groups experienced improved performance of nursing interventions over time, from first performance to retention performance. No significant interaction effect (within-subjects) for time and teaching strategy groups were found. There was also no significant main effect (between-subjects effect) of teaching strategy groups (F 2, 71 = 2.33, p = .105). An exploratory one-way ANOVA on student's first performance rubric scores revealed results approaching significance for the three groups (F 2, 71 = 2.90, p = .06). The simulation with narrative pedagogy group had the highest first performance mean (72.74), followed by the case-based learning group mean (70.68), and finally the simulation group scored the lowest mean (66.16). One-way ANOVA revealed no significant differences across the groups for students' Satisfaction Total scores, Self-Confidence Total scores, and Presence and Importance of Educational Practices Total scores.


Active-learning, Engagement, High-fidelity simulation, Performance, Retention performance, Teaching strategies


2, ix, 198 pages


Includes bibliographical references (pages 191-198).


Copyright 2010 Anita Christine Nicholson