Using Social Annotation to Connect Reading With Clinical Judgment in Nursing

By Rachel Derr of Rutgers University

Description #

In this educational resource, a teaching and learning activity that uses social annotation to connect reading with clinical judgment in nursing is presented. Social annotation pedagogy is intentionally designed to link relevant information to theory, practice and life. In nursing, we need to teach our students how to think like a nurse; it is a different type of thinking and a new way of thought for many students. Thinking like a nurse takes practice, we need to train the brain to create new thought patterns. Social annotation can be used as a method to help students do this. Tanner’s Clinical Judgment Model (2006) helps students to develop nurse “think” and fits nicely with social annotation. This model explains how students should frame their thinking when approaching their readings and supports student interaction and engagement with the reading. In Tanner’s Clinical Judgment Model (2006), we look at Noticing, Interpreting, Responding and Reflecting, and that is exactly what students are doing when participating in social annotation. Social annotation exposes students to diverse perspectives and cultivates thought processes as they progress toward their goal of becoming a nurse.

Materials  #

• Reading material
• Digital social annotation tool (Hypothesis)
• Learning Management System (LMS)
• Prompt
• Rubric 

Instructions #

• Select reading material for the assignment. Some suggestions:
  • Discipline-specific evidence like Position Statements, Clinical Practice Guidelines, Research or Quality Improvement
  • Subjects that generate difficult dialogue
• Develop a prompt based on the reading
• Create a Hypothesis assignment in your LMS
  • Dividing the class into groups of 4-5 students works best
• Provide the Instructions and Rubric
• Determine the point value of the assignment

Clinical Judgment Social Annotation Instructions #

Noticing	Interpreting	Responding	Reflecting
Read the article. Consider the prompt and highlight what “speaks” to you.	Analyze what “speaks” to you. Why is it important? Does it connect to theory, practice or your life?	Annotate.Share your thoughts with others through mediums like text, images and video.	Engage in collaborative discussion with your classmates by responding to what “speaks” to them.

Rubric: Based on 10 Points #

Substantive	Grammar/Spelling	Participation
Substantive annotations add meaning to the conversation and include those that reflect on the reading or response, answer a question, pose a question, connect the reading or response to theory, practice, or life.  -1 point if the annotation is not substantive.	Annotations should not contain grammatical or spelling errors, although use of emojis, casual conversation or texting language to convey emotion is encouraged.  -1 point if the annotation contains substantive grammatical or spelling errors.	Annotation assignments should include at minimum 2 annotations and 1 response to a classmate.  + 1 point if the number of annotations/responses exceeds the minimum requirement. Discussion is encouraged!  -1 point if the number of annotations/responses does not meet the minimum requirement.

Student Learning Outcomes #

Student learning outcomes for the social annotation assignment are based on the American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (2021). Overall Student Learning Outcomes are for the social annotation activity, while the Reading Specific Student Learning Outcomes change depending on the selected reading.

Overall Student Learning Outcomes #

The student will:

1. Demonstrate clinical reasoning (AACN 1.3a)
2. Consider individual beliefs, values and personalized information in communications (AACN 2.2b)
3. Demonstrate emotional intelligence in communications (AACN 2.2f)
4. Use culturally and linguistically responsive communication strategies (AACN 3.2c)
5. Communicate the nurse’s roles and responsibilities clearly (AACN 6.1a)
6. Effectively use electronic communication tools (AACN 8.1c)
7. Demonstrate best practice use of social networking applications (AACN 8.1e)
8. Demonstrate ethical use of social networking applications (AACN 8.5b)
9. Apply principles of professional nursing ethics and human rights in patient care and professional situations (AACN 9.1a)
10. Reflect on one’s actions and their consequences (AACN 9.1b)
11. Communicate in a professional manner (AACN 9.2g)
12. Demonstrate adherence to a culture of civility (AACN 9.3f)
13. Describe nursing’s professional identity and contributions to the healthcare team (AACN 9.5a)
14. Demonstrate the core values of professional nursing identity (AACN 9.5b)
15. Demonstrate sensitivity to the values of others (AACN 9.5c)
16. Demonstrate emotional intelligence (AACN 9.5e)
17. Engage in guided and spontaneous reflection of one’s practice (AACN 10.2a)
18. Expand personal knowledge to inform clinical judgment (AACN 10.2d)

Reading Specific Student Learning Outcomes #

The student will:

1. Demonstrate the ability to conduct sensitive or difficult conversations (AACN 2.2d)
2. Articulate a need for change (AACN 3.5a)
3. Demonstrate an awareness of one’s biases and how they may affect mutual respect and communication with team members (AACN 6.4a)
4. Recognize the impact of health disparities and social determinants of health on care outcomes (AACN 7.2b)
5. Recognize internal and external system processes and structures that perpetuate racism and other forms of discrimination within health care (AACN 7.3d)
6. Demonstrate empathy to the individual’s life experience (AACN 9.2c)
7. Advocate for practices that advance diversity, equity and inclusion (AACN 9.2d)
8. Advocate for social justice and health equity, including addressing the health of vulnerable populations (AACN 9.3g)
9. Demonstrate respect for diverse individual differences and diverse communities and populations (AACN 9.6a)
10. Demonstrate awareness of personal and professional values and conscious and unconscious biases (AACN 9.6b)
11. Integrate core principles of social justice and human rights into practice (AACN 9.6c)
12. Participate in ongoing activities that embrace principles of diversity, equity, inclusion and anti-discrimination (AACN 10.2f)
13. Demonstrate self-awareness of one’s own implicit biases and their relationship to one’s culture and environment (AACN 10.3g)

Reading specific student learning outcomes based on the selected reading: Increasing Cultural Competence with LGBTQ Patients by Margolies and Brown (2019). 

Sample Assignment #

Reading: Increasing Cultural Competence with LGBTQ Patients by Margolies and Brown (2019)

Prompt: In this annotation, consider the LGBTQ population. Examine personal and professional biases and consider how health disparities and social determinants of health can impact outcomes of care. Reflect on the suggested strategies for health care professionals. Did you learn anything new? How will the information in the article affect your future nursing practice?

References #

Margolies, L. & Brown, C. (2019). Increasing cultural competence with LGBTQ patients. Nursing 2019, 49(6), 34-40. 

Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi-org.proxy.libraries.rutgers.edu/10.3928/01484834-20060601-04

American Association of Colleges of Nursing. (2021). The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

License #

Creative Commons Attribution 4.0 International license