Using the send-a-problem activity for didactic learning in nursing education

What is didactic learning? 

Didactic learning in nursing programs occurs primarily in the classroom and/or online learning environment. In either environment, presence for both you and your students is needed for successful learning. Establishing social, cognitive, and teaching presence for online learning is particularly challenging, but is the best practice for creating a learning community. A learning community in either the classroom or online environment is most effective when a variety of activities and experiences are used to engage students and promote thinking or inquiry.   

Planning individual and group activities in a classroom setting is less difficult than planning peer interaction for online learning. Some online learners may not want to work with other learners in group activities. However, research shows that peer interaction is an effective online educational strategy that reduces the feeling of learner isolation and reinforces lifelong collegial learning. Therefore, be sure to plan activities that require peer interaction in any learning environment. “Send A Problem” is an effective activity to promote peer interaction while challenging learners to address complex questions.

What is a send-a-problem activity? 

“Send A Problem,” sometimes called “Pass a Problem,” is an educational activity or strategy that you can use in either a face-to-face or online learning environment to promote peer interaction. In this activity, students focus on a designated topic or concept in groups, develop their “problems,” and send their “problems” to another assigned group in the course. This activity nurtures collaborative problem-solving and related thinking skills. In pre-licensure nursing programs, this activity may focus on either specific course content or on synthesis of knowledge to help prepare for the NCLEX®. It may be designed as a group learning activity or as both an individual and group learning activity for classroom and online courses. Group size should range between two and four students. Send-A-Problem activities can also be used for formative assessment. 

What is best practice for setting up groups in an online environment? 

Setting up online learning groups is similar to setting up groups in a face-to-face campus classroom. Keep these considerations in mind when establishing online learner groups: 

• Don’t let students establish their own groups because they tend to select their friends more than peers who can work well together and make a good team. 

• Think about the ages, abilities, backgrounds, and experiences of your students. Based on this information and purpose of the learning activity, you may want to form groups with similar or different attributes. 

• Reflect on the student learning outcomes for the course and purpose of the learning activity to help determine the best make-up of each group. Keep the level of your students in the course in mind. 

• Ask each group to select a team name based on something they have in common. As an option, the group can adopt a sports team name.

How could I adjust this learning activity for students at different levels of the nursing program? 

The best way to answer this question is to present examples that students in different program levels might develop. Let’s say that you wanted to have student groups develop test items on nursing care of patients who experience fractures. Below are examples of NCLEX®-style test items that would be expected based on the level of students in pre-licensure nursing programs. 

RN Sophomore/Beginning Students and PN Level 1 Students (NOTE: Students may develop their own “problems” in groups OR you might provide similar “problems” at this level to ensure that students have the requisite knowledge of pathophysiology and basic care and comfort.) 

Q: The nurse is caring for a patient admitted with an open tibia/fibula (“tib-fib”) fracture. For what complication would the nurse monitor over the next several days? 

1. Constipation 

2. Acute pain 

3. Pressure injury 

4. Infection 

ANS: D 

The cognitive level of this question is Understanding/Comprehension, and would be appropriate for a beginning or first level nursing student (RN or PN) who is learning about basic care for patients who have fractures. To answer the question, students need to recall that open fractures penetrate the skin, which is the primary barrier to prevent infection. (NOTE: The NCLEX® uses the word “client” instead of “patient,” but for this activity, the students may use whichever term they prefer.) 

RN Junior/Intermediate Students and PN Level 1 and 2 Students

Q: The nurse is caring for a patient who has an external fixator to manage an open tibia/fibula (“tib-fib”) fracture. The nurse observes that the client’s affected leg and foot are swollen. What is the most appropriate nursing action based on this observation? 

1. Elevate the affected leg on 1-2 pillows. 

2. Report the edema to the primary health care provider. 

3. Administer the prescribed analgesic drug. 

4. Document the assessment finding and monitor. 

ANS: A 

The cognitive level of this question is Applying/Application, and would be appropriate for an intermediate RN student or second level PN student who is learning how to care for patients with common health problems that have predictable outcomes. To answer the question, students need to recall that patients who have this type of injury are expected to have edema, but the edema could cause impaired circulation, a complication of trauma or surgery. Therefore, the nurse would need to elevate the leg to help decrease the swelling. 

RN Senior/Advanced Students

Q: The nurse is caring for a patient who has an external fixator to manage an open tibia/fibula (“tib-fib”) fracture. The client reports increased pain since last night, and new-onset numbness and tingling in the affected foot. What would the nurse do first at this time? 

1. Administer the prescribed analgesic drug. 

2. Report the findings to the primary health care provider. 

3. Perform a complete neurovascular assessment. 

4. Document the findings in the electronic health record. 

ANS: C 

The cognitive level of this question is Analyzing/Analysis, and would be appropriate for a more advanced or senior level RN student who is learning how to care for patients with actual or potential complications that have unpredictable outcomes. To answer the question, students need to analyze the patient’s subjective data, interpret what the data mean, and determine which actions would be needed for the patient’s care. Additionally, this question asks which nursing action would be performed first.

Where could I read more about using send-a-problem learning activities? 

Here are a few resources that include discussions about this learning activity: 

• Barkley, E.F. & Major, C.H. (2020). Student engagement techniques: A handbook for college faculty. (2^nd Ed.). San Francisco, CA: Jossey Bass. 

• Boettcher, J.V. & Conrad, R-M. (2017). The online teaching survival guide: Simple and pedagogical tips. (2^nd Ed.). San Francisco, CA: Jossey Bass. 

• Herrman, J.W. (2016). Creative teaching strategies for the nurse educator. (2^nd Ed.).Philadelphia, PA: F.A. Davis.