Teaching and Learning in Nursing (2013) 8, 8890

www.jtln.org

Employing thinkpairshare in associate degree

nursing curriculum
Debbie Fitzgerald PhD, RN, CNE
Joliet Junior College, Joliet, IL 604318938, USA
KEYWORDS:
ThinkPairShare;
Student engagement;
Associate degree nursing;
Assessment Technologies
Institute

Abstract
The purpose of this article is to describe the use of thinkpairshare during instructional delivery
with associate degree nursing students. thinkpairshare is a 3-step and tiered instructional process
that fosters individual, collaborative and, finally, full class input on questions posed by the educator.
An overview of the traditional Think-Pair-Share cooperative learning technique is presented.
Modifications employed for nursing students and student learning outcomes (as measured by the
Assessment Technology Institute end of course assessment) are reported. Implications for employing
thinkpairshare in associate degree nursing education are explored.
2013 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.

Nurse educators continue to seek instructional delivery

methods that offer alternatives to the traditional and static
lecturediscussion format. Transforming classrooms from
being focused on content coverage by the educator to
vehicles for students to seek and process information
promotes critical thinking skills (Stanley & Dougherty,
2010). It has been reported that undergraduate nursing
students perceive their coursework to be more rigorous, yet
less engagement opportunities were employed in nursing
classrooms as compared with their peers with non-nursing
majors (Popkess & McDaniel, 2011). Nursing students
assume passive learning roles when traditional content
coverage is delivered via lecture and discussion.
Cooperative learning is a venue that affords increased
student engagement and learner satisfaction (Copp, 2002;
Goodfellow, 1995; Hanson & Carpenter, 2011; Huff,

Corresponding author. Tel.: +1 815 280 2857 (Office); fax: + 1 815

280 6710.
E-mail address: dfitzger@jjc.edu.

1997; Sandahl, 2010; Schell, 2006). The essential

principles of cooperative learning required for successful
implementation are interpersonal and small group skills,
positive interdependence, individual and group accountability, face-to-face interactions, and group processing (Johnson
& Johnson, 2003). Educators assume the role of facilitator
when students are engaged in cooperative and collaborative
learning activities (Myer, 2006). Recent publications by
Hanson and Carpenter (2011) and Sandahl (2010) support
the use of cooperation and collaboration in nursing for
testing purposes. These authors reported increased student
engagement, achievement, and satisfaction when cooperative and collaborative learning was employed.
The thinkpairshare method is a cooperative learning
technique created by Frank Lyman (1981) that the author
adapted for use in an associate degree nursing course. This
learning technique traditionally is implemented by the
educator posing a question to students, allowing a specified
amount of time for individual students to think of a response
and, then, directing students to pair with a neighbor to
discuss their responses. The final component of this
technique requires that the paired student teams share their

1557-3087/$ see front matter 2013 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.teln.2013.01.006

Employing thinkpairshare
collaborative responses with the entire class (McTighe &
Lyman, 1988).

1. Implementation
In response to marginal student performance in a
mental health course during the fall semester of 2010 (n =
95) where traditional lecturediscussion was implemented,
the author elected to modify instructional delivery to
increase student engagement for future semesters. Think
PairShare was employed during the spring semester of
2011 (n = 90) and the fall semester of 2011 (n = 88),
along with posting audio lectures for student access prior
to class sessions.
During fall of 2010 nursing students in the mental health
nursing course received course content via lecture during
each face-to-face class period. Students took notes, and
several used recorders to tape class lectures. Starting in
spring of 2011 with the implementation of thinkpairshare,
both educator and student roles changed. The nurse educator
created content outlines referred to as lesson guides and
audio lecture files of all mental health nursing lecture content
and posted them to the college intranet. Students were
requested to complete the lesson guides by listening to the
audio lecture files of theory content along with referencing
their textbook prior to each class session. At the beginning of
each face-to-face class session, students received a list of
questions on a sheet entitled thinkpairshare that covered
information from the audio lecture for that scheduled class.
Students were instructed to independently write answers to
each question without the use of any resource materials. The
allotted amount of time would be dependent on the number
of general questions varying from 15 to 20 minutes. Students
would then be instructed to partner with a neighbor and share
their individual responses. During this phase, students are
charged to reach consensus by creating a single answer to
each question. Approximately 1015 minutes is allotted for
this collaborative exchange. Students are then given 12
minutes to access any resource materials if desired during the
magicmoment period. At the end of this brief period, the
educator instructs students to put all materials away except
their list of related questions and collaborative answers. The
educator facilitates discussion of each question by calling on
select student pairs. Other students comment with agreement
or disagreement and are allowed to share their input if
additional elaboration is needed. The educator uses questioning techniques to engage all learners during the open
discussion period. In addition, the educator adds additional
depth about the content, moving students from knowledge
and comprehension to more application of the material. The
use of specific case questions, psychopharmacology-related
questions, or even role plays would be strategically woven
into the class discussion at specific points to assist students
with processing the information.

89

2. Outcomes
ThinkPairShare changed the climate in the classroom
from a quiet formal setting with mainly the educator voice
permeating the room to an open forum where all learners
became engaged. The energy generated from student
engagement was almost palpable during each class because
students defended their individual answers while in pairs.
The ATI end-of-course assessment was administered to each
student at the end of the mental health nursing course to
determine individual proficiency level. The assessment proficiency levels are determined based on individual student scores
ranging from below Level 1 to Level 3. Attainment of a
minimum Level 2 proficiency is the required benchmark by
the associate degree nursing program for all students.
In fall of 2010, 95 students were enrolled in the mental
health course, and less than 80% (n = 70) of students
achieved a Level 2 or higher proficiency level. Following the
first semester of employing the modified thinkpairshare
instructional delivery method with 90 students enrolled in
spring 2011, 90% (n = 81) scored Level 2 or higher on the
assessment (see Fig. 1). This was an almost 20% increase in
the number of students obtaining proficiency, and the
success continued in the fall of 2011 with 88 students
being enrolled in the mental health course and over 94% (n =
83) of students scoring Level 2 or higher on the end-ofcourse assessment. In addition to increased performance on
the end-of-course assessment, students provided positive
feedback verbally and on course evaluations.
Comments made on the end-of-course student evaluations
included the following:
ThinkPairShare was a great way to process information.
The ThinkPairShare tool was highly effective. I wish
EVERY instructor would use thisit reinforces content and
helps understand difficult content.
90
80
70
60
50
40
30
20
10
0
11
Below Proficiency

Fig. 1 Difference in student proficiency levels on a national endof-course assessment after thinkpairshare implemented in 2011.

90

D. Fitzgerald
The ThinkPairShare that was used was incredibly
effective. I recommend making it required for other
instructors to adopt it. It allowed for focused, coherent
studying and clear understanding of what will be tested on.
Great job conveying information between student interactions and our think-pair shares.
ThinkPairShare made me come prepared because I didn't
want to look dumb in front of my classmates. At first I didn't
like the extra work required but it made me learn the content.
All teachers should use it!

Employing thinkpairshare in the mental health course

improved overall student classroom engagement and outcomes on the proficiency assessments. An increase in student
preparation for class and student confidence was evident
because students worked collaboratively and celebrated their
knowledge. This cooperative learning technique has now
been adapted by medicalsurgical nursing educators in the
associate degree nursing program.
Incorporating instructional delivery strategies such as
thinkpairshare in associate degree nursing courses can
assist educators to increase student engagement and
create active learning communities where students work
collaboratively. Increased engagement of students has a
direct impact on learning outcomes and, thereby, programmatic outcomes.

References
Copp, S. L. (2002). Using cooperative learning strategies to teach implications
of the Nurse Practice Act. Nurse Educator, 27(5), 236241.
Goodfellow, L. M. (1995). Cooperative learning strategies: An effective
method of teaching nursing research. Nurse Educator, 20(4), 2629.
Hanson, M. J. S., & Carpenter, D. R. (2011). Integrating cooperative
learning into classroom testing: Implications for nursing education and
practice. Nursing Education Perspectives, 32(4), 270273.
Huff, C. (1997). Cooperative learning: A model for teaching. Journal of
Nursing Education, 36(9), 434437.
Johnson, D. W., & Johnson, F. P. (2003). Joining together: Group theory
and group skills, 8th ed. Boston: Pearson.
Lyman, F. T. (1981). The responsive classroom discussion: The inclusion
of all students. In A. S. Anderson (Ed.), Mainstreaming Digest
(pp. 109113). College Park, MD: University of Maryland Press.
McTighe, J., & Lyman, F. T. (1988). Cuing thinking in the classroom: The
promise of theory embedded tools. Educational Leadership, 1824.
Myer, S. (2006). Unlocking the knowledge age. Nursing Updates, 30(8),
4851.
Popkess, A. M., & McDaniel, A. (2011). Are nursing students engaged in
learning? A secondary analysis of data from the National Survey of
Student Engagement. Nursing Education Perspectives, 32(2), 8994.
Sandahl, S. S. (2010). Collaborative testing as a learning strategy in nursing
education. Nursing Education Perspectives, 31(3), 142147.
Schell, K. A. (2006). A Delphi study of innovative teaching in baccalaureate
nursing education. Journal of Nursing Education, 45, 439448.
Stanley, M. J., & Dougherty, J. P. (2010). A paradigm shift in nursing
education: A new model. Nursing Education Perspectives, 31(6),
378380.