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Using innovative teaching strategies to improve outcomes in a pharmacology course.


It is often difficult to engage nursing students and keep their interest when teaching pharmacology. This article reports on an effective change from a lecture-only approach to teaching with the use of games and case studies in a baccalaureate nursing education program. Improvements have been noted in standardized test scores and student evaluations, and students are more engaged in the learning process. Learning has been shifted from the instructor, as in the traditional classroom, and is now student focused.

KEYWORDS Nursing Education--Pharmacology--Medication Administration--Games--Innovative Teaching Strategies


The study of pharmacology is vital to the provision of safe, quality nursing care in all settings. Errors in medication administration cost human lives, prolong hospital stays, and have serious financial implications for health care services (Adhikari, Tocher, Smith, Corcoran, & MacArthur, 2014). For these reasons, nursing students must grasp the information necessary for understanding medications and their impact on patients as well as principles germane to safe medication administration. Questions on pharmacological and parenteral therapies account for approximately 15 percent of the NCLEX-RN[R] licensure exam (National Council of State Boards of Nursing, 2013).

This article describes how faculty engaged students in the study of pharmacology through the use of various instructional strategies such as games, case studies, and humor. Data show that this approach has resulted in improved outcomes, including improved Health Education Systems Inc. (HESI) Evolve Pharmacology specialty exam scores and student evaluations (Evolve Elsevier, 2014).


For many years in our baccalaureate nursing program, pharmacology was integrated into the curriculum in clinical courses. However, students believed that concepts were not being adequately conveyed, and a separate nursing pharmacology course was implemented. For the first few years after implementation of the course, student evaluations were negative and performance on the HESI pharmacology specialty exams did not meet benchmark standards.

Faculty identified several factors contributing to these poor outcomes: a) students were disengaged in the learning process; b) for more than half of the students, typical classroom lectures did not incorporate individual learning styles; c) the amount of information given was overwhelming and difficult to retain; and d) students feared the consequences of not being successful on the pharmacology specialty exam, which was the final exam and accounted for 25 percent of the course grade. Students who did not meet the testing benchmark were required to take one hour of independent study the following semester.

A new two-credit-hour pharmacology course was then developed for the second semester of a five-semester program, following successful completion of a nursing pathophysiology course. The course had four primary objectives:

* Students will administer and document administration of medications to groups of patients in an actual patient care environment;

* Students will perform patient assessment and evaluation of a patient's response to pharmacological agents;

* Students will recognize nurse-sensitive quality and safety indicators in medication administration;

* Students will integrate current knowledge of pharmacological agents into patient education.

A master's-prepared faculty member new to academia was assigned to teach the pharmacology course after it had been offered for three years. This faculty member had an extensive clinical nursing background and a strong history of successful leading, mentoring, and teaching at the bedside and in staff education. She began the course with good intentions, using straight lecture from PowerPoint slides and notes that had been utilized by faculty who had taught the course previously.

Studies by the National Training Board show that students typically retain only 5 percent of information from lectures, but 75 percent to 90 percent when they participate in active learning or teaching others (Wirth & Perkins, 2008). Students in our pharmacology course found themselves overwhelmed by the number of slides to review and the amount of material delivered in the lectures. They often described pharmacology as "boring [with] too many drugs to remember," and their evaluations of the course and instructor were generally among the lowest in the school.

A different approach was needed. After reviewing the literature, examining feedback and outcomes, and discussions with more experienced faculty, it was apparent that lecturing as usual would no longer be satisfactory. It was time to change the course for the next semester.


According to Alpers, Brown, Jarrell, and Wotring (2007), "A new age of learners has dawned" (p. 144). The implication is that the learning styles of students must be incorporated into the course to address student needs. For this course, lecture presentations and PowerPoint slides were revised so that teaching is focused on systems of the human body and major drug classifications.

Among the activities implemented for the classroom is a simple card game created with the use of index cards. At first, the index cards were used as in the game Go Fish. The technique has evolved so that the instructor now uses a deck of cards and secures questions and answers to each card. If the student draws a question card from the deck, the student must seek out the classmate who has an answer card with the correct drug, with no assistance allowed from other students.

Positive feedback from students after playing this game has led to additional classroom games and activities and the use of humor in the classroom. For example, "Drugo" was created to be like the traditional Bingo game, with the names of drugs located on the Drugo cards. With Inspector Gadget, students are given a set of clues, which they must use to figure out the name of the correct medication.

Students work in groups for several of the games and activities. Group work reduces anxiety and promotes an atmosphere of collaboration and friendly competitiveness. Small prizes, items purchased by the faculty member from the local dollar store, may be given to the winners of the activity.


Billings and Halstead (2009) define games as "an interactive process that lends itself to the acquisition and appreciation of knowledge by reviewing and reinforcing information that has already been learned. Games not only teach but are also fun for the participants" (p. 243). The use of games as learning activities has been expanded in this nursing pharmacology course. Prior to exams, learning activities, such as games or case studies, are used to reinforce the information presented in reading assignments and lectures.

Students come to class prepared for the activity. They are to review information that has already been covered as well as assigned readings of new information not yet presented by faculty. Students are not told what the activity will be, nor are they told what the reward will be for being prepared. The learning activities are designed to promote clinical reasoning and judgment, incorporate various learning styles, and provide a break from lecture. According to Bayer-Hummel (2010), "The use of gaming ensures that all students are winners because all have the opportunity for involvement and engagement in experiential learning. Gaming can also provide versatility throughout the class, promote attention, and provide a change of pace or variety to the teaching experience" (p. 13).

Humor is frequently used during class to keep students engaged. Research suggests that when instructors use humor in the classroom, students are more likely to attend class, pay attention, and have higher rates of learning (Baid & Lambert, 2010; Lei, Cohen, & Russler, 2010). Students view instructors who use humor as knowledgeable communicators who are easier to approach than other instructors. Humor is presented in moderation through stories and cartoons of patients and situations connected to disease management and medications.


Prior to the use of these innovative teaching strategies, up to 40 percent of the class achieved less than the benchmark score on the pharmacology specialty exam. Now, fewer than 3 percent fail to attain the required score, and the mean HESI exam score has increased from 856 to 1004. Scores on other tests have also improved. Previously, 10 percent of the class earned an overall course grade of A, with 67 percent of the class earning B's. Now, 47 percent of the class earn A's, and 52 percent earn B's.

Previously, average student evaluations were routinely below the school of nursing benchmark of 3.5 on a 5.0 scale; scores are now 4.5 or greater. Although an enormous amount of information is still presented to students, retention of information has greatly improved. Students are more engaged during classroom time, and their verbal and written feedback suggests that the information provided is better received and retained.


The use of games and case studies requires faculty to prepare for class differently. The outcome is that students learn to think critically and retention improves. These results are vital for practicing safe nursing care. Students indicate they feel more confident about administering medications and teaching the patient and the patient's family regarding the medication administration process.

As a result of the course, students believe they have a solid foundation for recognizing the importance of patient assessment before and after the administration of medications to evaluate for positive therapeutic outcomes. Students have become much more active in their learning as innovative teaching strategies are implemented. Importantly, "Active teaching strategies help students transfer knowledge from the classroom to the practice setting" (Croteau, Howe, Timmons, Nilson, & Parker, 2011, p. 338).

Valarie Thomas, MSN, RN, is assistant clinical professor, Auburn University School of Nursing, Auburn, Alabama. Jenny B. Schuessler, PhD, RN, is former associate dean, Auburn University School of Nursing. For more information, contact Ms. Thomas at

doi: 10.5480/14-1402


Adhikari, R., Tocher, J., Smith, P" Corcoran, J., & MacArthur, J. (2014). A multidisciplinary approach to medication safety and the implication for nursing education and practice. Nurse Education Today, 34(1), 185-190. doi:10. 1016/j.nedt.2013.10.008

Alpers, R. R., Brown, G., Jarrell, K" & Wotring, R. (2007). That's edu-tainment! Using games to engage, excite, and educate. Teaching and Learning in Nursing, 2, 144-145.

Baid, H., & Lambert, N. (2010). Enjoyable learning: The role of humour, games, and fun activities in nursing and midwifery education. Nurse Education Today, 30(6), 548-552. dol:10.1016/j.nedt.2009.11.007

Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St. Louis, MO: Elsevier Saunders.

Bayer-Hummel, T. (2010). The effects of jeopardy as a test preparation strategy for nursing students. Teaching and Learning in Nursing, 5, 12-15. doi:10. 1016/j.teln.2009.05.002

Croteau, S. D., Howe, L. A., Timmons, S. M., Nilson, L, & Parker, V. G. (2011). Evaluation of the effectiveness of "The Village": A pharmacology education teaching strategy. Nursing Education Perspectives, 32(5), 338-341. doi: 10.5480/1536-5026-32.5.338

Evolve Elsevier. (2014). Evolve for educators. Retrieved from http://www.evolve.

Lei, S. A., Cohen, J. L, & Russler, K. M. (2010). Humor on learning in the college classroom: Evaluating benefits and drawbacks from instructors' perspectives. Journal of Instructional Psychology, 37(4), 326-331.

National Council of State Boards of Nursing. (2013). NCLEX-RN[R] examination: Test plan for the National Council Licensure Examination for Registered Nurses. Retrieved from

Wirth, K. R., & Perkins, D. (2012). Learning to learn. Retrieved from
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Title Annotation:Innovation Center
Author:Thomas, Valarie; Schuessler, Jenny B.
Publication:Nursing Education Perspectives
Article Type:Report
Date:May 1, 2016
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