NR 621 Education Practicum Project Project

Name

Chamberlain University

NR-621: Nurse Educator Concluding Graduate Experience I

Prof. Name

Date

Disruptive Student Behaviors in Nursing Education

Disruptive student behaviors are actions that interfere with the teaching and learning process within a classroom. If not addressed, these behaviors can escalate and negatively impact both the educational environment and the quality of patient care in nursing education. Common types of disruptive behaviors include incivility, which involves aggressive or hostile interactions between students, threats of violence, and frequent unproductive arguments. Other behaviors include lateral or horizontal violence, bullying, and general disrespect towards peers and instructors. Regardless of the specific terminology used, these behaviors share two significant consequences: they undermine respectful relationships and degrade the quality of education and patient care.

Disruptive behaviors can cause psychological distress, including symptoms of anxiety, depression, and physical ailments among targeted individuals. Furthermore, incidents of classroom incivility such as tardiness, sleeping during class, excessive cell phone use, and general disrespect towards peers are increasingly common. Statistics indicate a growing number of students suffering from disruptive behavior disorders, particularly Attention Deficit Hyperactivity Disorder (ADHD). Recent studies show that approximately 40% of adolescents with ADHD exhibit behaviors that disrupt the classroom environment (Thompson et al., 2020). These disruptions often alter the classroom dynamics, shifting the focus from learning tasks to managing behavioral distractions. Consequently, both teachers and students experience distress, and the educational process is hindered.

NR 621 Education Practicum Project Project

Several factors contribute to disruptive behaviors in the classroom. Boredom is one of the most common causes. When students are not engaged or fail to see the relevance of the material being taught, they may act out. This may also occur when students feel they already know the material being covered. Another contributing factor is confusion, where students struggle to understand key concepts or explanations from instructors, often leading them to act disruptively in an attempt to cope with their confusion. In some cases, students may exhibit disruptive behaviors due to feelings of resentment, especially when they feel devalued by teachers or peers (Latif, Khan, & Khan, 2016).

Cognitive Rehearsal as an Intervention for Disruptive Behaviors

The PICOT question for this study is: “Should cognitive rehearsal intervention be considered for students exhibiting uncivil behaviors in nursing education, to improve their learning and help prevent failure?” Cognitive rehearsal has been proven to be an effective intervention in addressing incivility and workplace bullying, particularly within nursing education settings. This intervention involves three key steps: participating in didactic instruction, rehearsing specific phrases for managing uncivil encounters, and practicing these strategies in real-life situations. Given the prevalence of incivility in nursing education, it is crucial to implement interventions that help reduce negative behaviors among students.

Effective intervention strategies include proper acknowledgment of the disruptive behavior and the use of psychosocial approaches. Psychosocial interventions involve addressing an individual’s psychological development and their interaction with their social environment. These interventions may include structured counseling, motivational enhancement, case management, care coordination, psychotherapy, and relapse prevention. Another key strategy is the development of communication techniques based on classroom incivility surveys, which can provide feedback on the effectiveness of interventions and encourage open dialogue. In some cases, communication strategies may involve reporting uncivil acts to deans or instructors and fostering an environment of free expression.

NR 621 Education Practicum Project Project

Additionally, a zero-tolerance policy, when consistently applied, can help address and mitigate disruptive behaviors. Institutions should screen for signs of incivility and respond promptly and justly to any reports. This proactive approach helps ensure that students understand the consequences of their actions and the importance of maintaining a respectful classroom environment (Khasinah, 2017). Thus, this paper seeks to explore the issue of incivility in nursing education and propose effective strategies for managing disruptive behaviors.

Table: Disruptive Behaviors and Intervention Strategies

References

Khasinah, S. (2017). Managing disruptive behavior of students in language classroom. Englisia: Journal of Language, Education, and Humanities, 4(2), 79-89. Retrieved from http://103.107.187.25/index.php/englisia/article/view/1661

Latif, M., Khan, U. A., & Khan, A. N. (2016). Causes of students’ disruptive classroom behavior: A comparative study. Gomal University Journal of Research, 32(1), 44-52. Retrieved from http://www.gujr.com.pk/index.php/GUJR/article/view/139/49

NR 621 Education Practicum Project Project

Thompson, A. M., Stinson, A. E., Sinclair, J., Stormont, M., Prewitt, S., & Hammons, J. (2020). Changes in disruptive behavior mediated by social competency: Testing the STARS Theory of Change in a randomized sample of elementary students. Journal of the Society for Social Work and Research, 11(4), 591-614. Retrieved from https://www.journals.uchicago.edu/doi/full/10.1086/712494

NR 621 Learning Agreement

Name

Chamberlain University

NR-621: Nurse Educator Concluding Graduate Experience I

Prof. Name

Date

NR 621 Learning Agreement

Student Information

Student Name: Janice Chua
Student D# (ID): D88021513
Student Email: janice.chua@ucsf.edu
Student Phone: [Insert Phone Number]

Mentor Information

Mentor Name: Angel Barrios, DNP CNS RN-BC
Mentor Title: Assistant Clinical Professor, Master’s Entry Program in Nursing
Department: Physiological Nursing
University: University of California, San Francisco
Mentor Contact Information: angel.barrios@ucsf.edu | Cell: 650-922-8732

Introduction to the Learning Agreement

The NR 621 Learning Agreement is a formal document designed to guide students in their practicum experience. It outlines specific goals, plans, and self-evaluations related to course outcomes. The agreement must be reviewed weekly with a mentor to ensure continuous progress and necessary revisions. At the end of Week 6, students are required to evaluate their success in achieving their goals with their mentor’s signature.

The agreement consists of two primary sections:

1. Initial Learning Agreement (Week 1) – Worth 75 points
2. Updated Learning Agreement (Week 6) – Worth 50 points

Both sections require completion of specified goals, plans, and signatures before submission. Late submissions are subject to the Late Assignment Policy.

Due Dates:

• Initial Learning Agreement: Submitted by 11:59 pm MT Sunday of Week 1
• Updated Learning Agreement: Submitted by 11:59 pm MT Sunday of Week 6

Students are required to complete 72 hours of practicum experience in NR 621.

Learning Agreement Table (Week 1)

Updated Learning Agreement (Week 6)

NR 621 Learning Agreement

Final Signatures

Week 1
Submitted by: Janice Chua
Date: 7/11/2021

Accepted by: [Faculty Name]
Date: [Date]

Mentor Sign-off: Angel Barrios
Date: 7/11/2021

NR 621 Learning Agreement

Week 6
Submitted by: [Student Name]
Date: [Date]

Accepted by: [Faculty Name]
Date: [Date]

Mentor Sign-off: [Mentor Name]
Date: [Date]

NR 621 Intervention:Evaluation Plan

Name

Chamberlain University

NR-621: Nurse Educator Concluding Graduate Experience I

Prof. Name

Date

Introduction:

Incivility in nursing education has become a persistent challenge, with manifestations occurring in both academic and clinical settings. Various stakeholders, including clinical placement preceptors, academic staff, students, and patients, contribute to this issue, which has physical and psychological consequences for its victims. Moreover, incivility in nursing education can have direct implications for patient care, as it may lead to unsafe practices and cloud clinical judgment. Research on effective interventions to reduce incivility in nursing education is limited, but role-playing has emerged as a promising strategy. The goal of this project was to perform a mixed-methods literature evaluation to identify role-playing techniques that could address incivility among nursing students and explore the outcomes of such interventions.

Nurse incivility is a critical issue within healthcare, as it has far-reaching effects on both the healthcare system and patient safety. Incivility can lead to intimidation, which may impair clinical judgment and jeopardize patient outcomes. In fact, studies indicate that incivility contributes to a significant number of fatalities, with an estimated 98,000 deaths annually in acute care settings. This issue not only impacts clinical practice but also affects nursing retention. High turnover rates due to incivility can be costly, with hospitals spending up to 125% of an individual nurse’s salary to replace each nurse who leaves due to these issues.

NR 621 Intervention:Evaluation Plan

Professional organizations, such as the Joint Commission and the American Nurses Association, advocate for zero-tolerance policies regarding disruptive behavior and emphasize the importance of addressing incivility to improve the healthcare environment. This project proposes the use of role-playing as a technique to engage nursing students in understanding the importance of civility in the healthcare setting and its potential impact on their future practice.

Role-playing as an educational strategy has been proven effective in various disciplines, including nursing, by promoting engagement and enhancing empathy. However, timing plays an important role in the effectiveness of role-playing interventions. For example, role-playing exercises should not be scheduled immediately before or after exams, as stress from the assessments can reduce the efficacy of the activity. In this project, careful consideration was given to the timing of the role-playing sessions to avoid conflicts with exams or other critical events. Through the strategic application of role-playing, nursing students are provided with opportunities to develop crucial communication skills and reflect on their roles as caregivers, which in turn fosters their sense of identity as nurses. The project further highlights the importance of integrating role-playing into nursing curricula to address incivility and promote professional development.

Project Goals and Stakeholders

The long-term goal of this proposal is to address and manage incivility within nursing education by implementing role-playing interventions. By using role-playing, educators can better equip students to respond to uncivil behavior when it occurs, while also enhancing their capacity to provide high-quality patient care. The successful integration of role-playing into nursing curricula will be evaluated through its impact on student learning outcomes, including NCLEX graduation rates, as well as faculty feedback on the intervention’s effectiveness in improving classroom dynamics.

The short-term goal is to assess the impact of role-playing on student performance, particularly mid-term exam results. The performance of students in exams before and after the introduction of role-playing techniques will be compared to determine whether the intervention leads to improved learning outcomes. Additionally, the role-playing technique will be evaluated in terms of its ability to enhance student engagement and reduce stress associated with clinical learning.

The project will involve collaboration with multiple stakeholders, including faculty members, administrators, and department chairs from five participating nursing schools. These institutions were selected through a competitive process, ensuring that they have the resources and commitment to implement role-playing effectively. The stakeholders are crucial in the development and evaluation of the intervention, as their support and involvement will influence the success of the project. Furthermore, the use of role-playing will be evaluated based on its alignment with the goals of critical pedagogy and emancipatory education, which emphasize active learning and the development of critical thinking skills in nursing students.

Project Implementation: Role-Playing in Nursing Education

To successfully integrate role-playing into nursing education, several factors must be considered, including faculty training, curriculum adjustments, and the development of appropriate scenarios. During the implementation phase, these factors will be carefully planned to ensure that role-playing activities are engaging and aligned with learning objectives. A variety of role-playing scenarios will be developed, including simulations of common healthcare interactions such as patient interviews, clinical assessments, and emergency care situations.

In one example of role-playing in mental health education, students were tasked with taking on the roles of both patients and healthcare providers during psychiatric interviews. The role-playing technique allowed students to explore the emotional challenges faced by both patients and clinicians, which led to increased empathy and improved communication skills. A study by Martin and Kahn (1995) found that such role-playing activities helped students understand patient behaviors and reactions more effectively. The students also reported that practicing these scenarios and receiving feedback on their performance helped build their confidence and reduce anxiety.

NR 621 Intervention:Evaluation Plan

In addition to mental health education, role-playing has been used to teach other essential clinical skills, such as conducting interviews and managing difficult patient interactions. For example, in a study focused on nursing students’ experiences with auditory hallucinations, students participated in a simulation where they donned headphones and experienced auditory hallucinations while completing various activities. After the simulation, students participated in a debriefing session where they reflected on their experiences and discussed how to improve communication with patients experiencing similar symptoms. The role-playing exercise increased students’ understanding of the challenges faced by individuals with mental health disorders and helped them develop greater empathy for patients.

Another important aspect of role-playing in nursing education is its ability to help students improve their clinical communication skills. In a study by King, Hill, and Gleason (2015), medical students participated in role-playing sessions that involved taking on the roles of both patients and healthcare professionals. The students reported that the sessions were beneficial for learning communication strategies and understanding the perspectives of both patients and providers. These findings suggest that role-playing not only enhances students’ clinical knowledge but also fosters the development of crucial interpersonal skills that are essential for effective patient care.

Conclusion: Evaluating the Impact of Role-Playing in Nursing Education

Role-playing interventions have shown significant promise in addressing incivility and improving communication skills among nursing students. By providing students with realistic scenarios in which they can practice and reflect on their actions, role-playing fosters empathy, self-awareness, and professional development. Furthermore, the use of role-playing in nursing education aligns with the principles of active learning and critical pedagogy, which emphasize the importance of student engagement and reflection in the learning process. The ongoing evaluation of role-playing interventions will help determine their effectiveness in reducing incivility, improving learning outcomes, and promoting a more supportive and respectful learning environment for nursing students.

NR 621 Intervention: Evaluation Plan

The intervention for this study used role-playing as a key educational method. The objectives of this intervention were varied, with three of the role-playing techniques focusing on role-playing as a teaching method, while the fourth aimed at exploring the students’ experiences with role-playing as a learning activity. Although the goals varied, the results were similar across the studies. Role-playing was found to improve students’ therapeutic knowledge, their attitudes, and their overall learning. Importantly, role-playing was identified as a tool that enhanced students’ capabilities as practitioners, helping them to develop critical skills necessary for their future roles in healthcare.

Quasi-Experiment

The quasi-experiment conducted sought to compare the effectiveness of lecture-based learning versus role-playing education on nursing students’ learning outcomes. The research aimed to explore the relationship between student characteristics and their scores on theoretical tests and role-playing checklists. At the start of the course, students were introduced to the benefits and relevance of role-playing in the educational process. The initial four lessons began with a lecture on key concepts, including the principles of patient training, instructor roles, and the various aspects of teaching and learning. During the second session, students were tasked with creating learning objectives in the cognitive, psychomotor, and affective domains for patient education.

The third session focused specifically on different teaching approaches, with an emphasis on role-playing. This workshop helped students understand the structure of role-playing and the creation of scenarios. During the fourth session, students were trained on evaluating patient teaching programs, followed by practical exercises where they applied the skills learned to real patients. In the final stages of the intervention, students performed role-play scenarios in front of their peers and instructors, with feedback provided to enhance the learning experience. The findings from this quasi-experiment suggested that the role-playing technique led to significantly higher scores compared to traditional lecture-based instruction, emphasizing its effectiveness in promoting student learning.

Project Evaluation

The evaluation of this project was conducted through a combination of faculty observations and student feedback. Faculty members, trained to assess the mentorship and teaching methods, used course evaluation forms to rate various aspects of the intervention. These included the effectiveness of online learning modules, the organization of role-playing activities, and the facilitation of student discussions. Additionally, students provided feedback via an end-of-course questionnaire, assessing whether their perceptions and learning experiences had changed as a result of the role-playing intervention. According to the student feedback, many reported an increased understanding of their own behaviors, particularly in terms of how they interacted with others in the learning environment.

NR 621 Intervention:Evaluation Plan

By reflecting on their actions, students were able to adjust and improve their behavior, enhancing the teacher-student relationship and fostering an environment of mutual respect and trust. Faculty members also reported that proper management of incivility in the classroom led to improved student engagement and participation, as students became more motivated to engage with the material and prepare for extracurricular activities. This was confirmed through interviews with both faculty and students, which highlighted the positive impact of the intervention on overall learning experiences and mentor-student relationships.

Change Model: Force Field Model and the Unfreezing-Change-Refreezing Model

The change model used in this intervention was based on Kurt Lewin’s three-step process, which includes unfreezing, movement, and refreezing. According to this model, individuals and groups must first “unfreeze” their existing behaviors and attitudes before moving to the next stage of change. Unfreezing involves identifying and addressing factors that resist change and fostering an openness to new ideas. In the context of this intervention, this meant moving away from traditional lecture-based learning and adopting role-playing as a more interactive and engaging method. The next stage, movement, involved the actual change in behaviors, attitudes, and practices. In this case, both educators and students had to shift their perspectives on teaching and learning, embracing role-playing as a powerful educational tool. Finally, refreezing refers to stabilizing the new behaviors and making them a permanent part of the learning environment. This final stage ensured that the role-playing method became a regular feature in the course, supported by both faculty and students. This approach to change, emphasizing the importance of addressing both driving and restraining forces, was crucial in ensuring the successful integration of role-playing as a pedagogical tool.

Self-Reflection

Reflection is a crucial component of both teaching and learning, particularly when addressing challenging behaviors such as incivility in the classroom. The experiences of both educators and students revealed that role-playing and reflective practices could be powerful tools in managing such behaviors. Educators were able to reflect on their teaching methods and past encounters with incivility to identify underlying causes and strategies for improvement. This reflection not only helped to enhance teaching practices but also boosted educators’ confidence in managing challenging classroom situations. For students, reflection on their own behavior, particularly when guided by instructors, allowed them to recognize and address disruptive actions. Through thoughtful consideration, many students were able to adjust their behavior, fostering a more productive and respectful learning environment.

Teaching-Learning Strategy

Several strategies emerged from this evaluation as being particularly effective in managing incivility and enhancing student engagement. These included the use of varied teaching methods to involve all students, particularly those who might be prone to incivility. The application of fair and transparent evaluation techniques helped students feel that their efforts were recognized and rewarded, contributing to a sense of equity in the classroom. Additionally, incorporating appropriate apprenticeship techniques that cater to different learning styles was found to be essential in managing challenging behaviors. By using engaging and motivating teaching strategies, educators could foster a more positive and respectful classroom environment, reducing instances of incivility and increasing overall student participation and satisfaction.

References

Burnes, B. (2020). The Origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32-59.

Deborah, O. K. (2018). Lewin’s Theory of Change: Applicability of its Principles in a Contemporary Organization. Journal of Strategic Management, 2(5), 1-12.

Mousavinasab, E., Kalhori, S. R. N., Sanaee, N. Z., Rakhshan, M., & Saeedi, M. G. (2020). Nursing process education: A review of methods and characteristics. Nurse Education in Practice, 102886.

Nes, A. A., Fossum, M., Steindal, S. A., Solberg, M. T., Strandell-Line, C., Zlamal, J., & Gjevjon, E. L. (2020). Research protocol: Technology-supported guidance to increase flexibility, quality, and efficiency in the clinical practicum of nursing education. International Journal of Educational Research, 103, 101628.

Radicchi, V. (2020). Technology and Nursing Education in Europe: A Literature Review.

NR 621 Intervention:Evaluation Plan

Williamson, K. M., & Muckle, J. (2018). Students’ perception of technology use in nursing education. CIN: Computers, Informatics, Nursing, 36(2), 70-76.

Martin, P., & Kahn, J. (1995). Medical students as role-playing patients. Acad Psychiatry, 19(2), 101–107. https://doi.org/10.1007/BF03341538

Rogers, C. (1994). Freedom to Learn. New York, NY: MacMillan College Inc.

King, J., Hill, K., & Gleason, A. (2015). All the world’s stage: Evaluating psychiatry role-play-based learning for medical students. Australasian Psychiatry, 23(1), 76–79.

NR 621 Literature Review

Name

Chamberlain University

NR-621: Nurse Educator Concluding Graduate Experience I

Prof. Name

Date

NR 621 Literature Review

Introduction to Role-Playing in Learning

Role-play activities provide an effective, engaging method for learning by involving participants in small groups that analyze tasks based on specific learning objectives. These objectives are determined both individually and collectively within the group. During role-play exercises, learners meet with a tutor to discuss various issues, supporting one another in connecting new knowledge with prior concepts. This process of collaboration encourages cognitive connections that lead to deeper understanding. In the context of problem-based learning (PBL), role-play activities promote teamwork as participants work together to solve given problems.

The emphasis in PBL, particularly in role-playing, is not necessarily on the correct answers but on developing problem-solving skills and fostering interpersonal relationships. According to Zhan (2012), the bonds formed during these exercises are just as valuable as the solutions students generate. The underlying theoretical foundation of PBL is constructivism, which emphasizes that new knowledge is built on a learner’s existing understanding. Through these activities, students not only learn from their own participation but also by observing others, allowing for a deeper engagement and understanding of various perspectives.

Key Themes in the Literature

The literature on role-playing in nursing education has been organized around several key themes, which include the development of problem-solving skills, the promotion of critical thinking and creativity, and the use of role-play as a simulation methodology.

Role-Playing to Improve Problem-Solving Skills and Patient Education

Clinical skills in nursing often fail to directly correlate with actual clinical situations, which presents a challenge in nursing education. Traditional teaching methods may not fully prepare students for the complexities of real-world scenarios. Role-playing, however, offers a solution by immersing students in simulated clinical environments where they can practice their responses to real-life challenges. This active participation helps students cope with real-world situations, boosting their clinical performance and confidence (Safoura et al., 2018). Role-play, as part of PBL, has been shown to enhance nursing students’ problem-solving abilities and improve patient education skills. Research by Safoura et al. (2018) demonstrates that using role-play in nursing education led to greater patient satisfaction and better learning outcomes. Moreover, Kirkpatrick’s evaluation model confirmed that role-playing significantly improved nursing students’ learning, which in turn resulted in better patient care outcomes.

Role-Playing to Promote Critical Thinking and Creativity

Critical thinking is essential for nursing practice, as it enables students to analyze complex concepts and make well-informed decisions. Role-play is an effective tool for enhancing critical thinking, as it requires students to actively engage with hypothetical clinical scenarios, interpret patient needs, and reflect on their actions. As noted by Couger (1995), critical thinking involves decision-making and problem-solving, which are integral to everyday life and nursing practice. Role-play exercises encourage students to think critically, not only by participating in the scenarios but also by observing and reflecting on the role-plays of others. This promotes the development of creative solutions to challenges and fosters deeper understanding of diverse viewpoints. DeYoung (2003) highlights that such activities require students to examine their assumptions, justify their decisions, and critically assess the implications of their actions. Role-playing, therefore, serves as a valuable tool for developing both critical thinking and creativity in nursing education.

Role-Playing as a Simulation Methodology

Role-playing serves as a valuable simulation methodology in a variety of educational contexts, including nursing and medical training. It allows students to practice real-world skills in a controlled, yet dynamic, environment. Studies by Nestel and Tierney (2007) describe various approaches to role-playing, including fully scripted, partially scripted, and unscripted formats, each designed to facilitate different learning outcomes. For example, medical students may engage in role-plays to develop patient-centered communication skills, with the opportunity to switch roles and gain insights into the perspectives of both healthcare providers and patients. This active engagement in role-playing exercises has been shown to improve clinical skills, particularly in areas such as physical examinations, diagnosis, and patient interaction (Yamauchi et al., 2021).

The Impact of Teachers on Incivility

Teachers play a significant role in managing classroom dynamics, including addressing disruptive behaviors. Research by Erturk (2015) and Latif et al. (2016) suggests that teachers’ actions, including the use of punitive measures, may inadvertently exacerbate disruptive behavior. Effective teaching strategies, including role-playing, can help mitigate these behaviors by fostering a positive, supportive learning environment where students feel more engaged and less inclined to act out. In contrast, harsh disciplinary approaches may create a negative atmosphere that reinforces incivility among students.

Peer Role-Playing in Simulation Education

Peer role-playing is an effective simulation technique that has been demonstrated to improve clinical competencies in various settings. Yamauchi et al. (2021) found that peer role-playing in musculoskeletal (MSK) physical examinations enhanced medical students’ proficiency in clinical reasoning and diagnosis. By engaging in low-fidelity simulations, students can practice essential clinical skills and improve their overall competency in patient care. This hands-on approach to learning provides students with the opportunity to develop practical skills in a realistic, yet controlled, environment.

Struggles Faced by Students with Disruptive Behaviors

Several studies have explored the challenges that disruptive behaviors pose to students’ learning experiences. Vizeshfar, Fatemeh, and Dehghanrad (2016) found that students who exhibited disruptive behavior often performed poorly in exams and were less engaged in classroom activities. Similarly, Kessels and Heyder (2020) noted that low-achieving students may find disruptive behavior helpful in avoiding class tasks. These findings underscore the importance of addressing incivility and implementing strategies, such as role-playing, to prevent disruptive behaviors and foster a more productive learning environment.

Connection to the PICOT Question

These themes align with the PICOT question, which asks: “Among nursing educators, is a role-playing intervention, compared to cognitive rehearsal intervention, a more effective strategy in the management of incivility as measured by a pre- and post-test of learner perceptions of a positive learning environment?” This question seeks to identify effective methods for preventing disruptive behaviors and promoting a positive learning atmosphere. Role-playing, with its emphasis on engagement, creativity, and problem-solving, offers a promising solution to managing incivility in educational settings.

References

Chan, Z. (2012). Role-playing in the problem-based learning class. Nurse Educ Pract, 12(1), 21-27. https://doi.org/10.1016/j.nepr.2011.04.008

Couger, J. D. (1995). The information systems curriculum: Teaching critical thinking and decision making. Journal of Information Technology Education, 6, 1-10. https://doi.org/10.1007/978-1-4471-2589-2_11

DeYoung, S. (2003). Critical thinking and decision making in nursing. Nurse Educator, 28(2), 69-74.

Erturk, E. (2015). Evaluation of role play as a teaching strategy in a systems analysis and design course. International Journal of Learning, 13, 150-159. https://www.researchgate.net/publication/284285165_Evaluation_of_Role_Play_as_a_Teaching_Strategy_in_a_Systems_Analysis_and_Design_Course

NR 621 Literature Review

Kirkpatrick, D. L. (1998). Evaluating training programs: The four levels. Berrett-Koehler Publishers.

Latif, D., et al. (2016). The influence of teacher behavior on student incivility in nursing education. Nurse Education Today, 40, 36-42. https://doi.org/10.1016/j.nedt.2016.02.020

Nestel, D., & Tierney, T. (2007). Role-play for medical students learning about communication: Guidelines for maximising benefits. BMC Med Educ, 7, 3. https://doi.org/10.1186/1472-6920-7-3

Safoura, D., Mansoureh, A., Elnaz, M., & Hamid, H. (2018). Effect of role-playing on learning outcome of nursing students based on the Kirkpatrick evaluation model. Journal of Education and Health Promotion, 10, 415-425. https://doi.org/10.4103/jehp.jehp_138_19

NR 621 Literature Review

Yamauchi, K., et al. (2021). Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations. BMC Med Educ, 21(1), 322. https://doi.org/10.1186/s12909-021-02742-4

Zhan, Y. (2012). Role-playing in problem-based learning. Nurse Educ Pract, 12(1), 21-27. https://doi.org/10.1016/j.nepr.2011.04.008