The Effectiveness of Creative Teaching Strategies

1The Effectiveness of Creative Teaching Strategies in theTeaching Protocol of Nursing Concepts to RN-BSN Students’ Creative ThinkingYa-Lie Ku Chi-Hui Kao Lo * Kuei-Min Chen ** Jing-Jy Wang *** Jane Lee Hsieh ****BackgroundBecause of the growing complexity of health care system, creative thinking isessential for delivering and maintaining high quality of nursing care (Biester, Duggan,Perkins, Powers, & Classick, 1999; Gilmartin, 1999). The professional nurses musthave the ability of creativity to overcome the uncertain health problems of the patients.Professional nurses also should design problem-solving strategies deliberately byutilizing creativity in clinical situations (Forrest, 1999; Wood, 1996). However, manynurses routine work in clinical practice has been changeless so that have wrapped upthe original creativity.Nursing education plays on crucial role to cultivate the creativity of nurses. It isimperative to build knowledge and creativity in the process of educating nursingstudents as the scholars (Elberson, & Williams, 1996). Curriculum design in the levelof bachelor nursing education should develop the scholarly abilities, such as creativity,reflection, critical thinking, critical analysis, and openness to new thinking forstudents (Ribbons, & Vance, 2001). Although Taiwan has developed the Republic ofCreativity (R.O.C.) 2002 as the foundation for the future education of creativity(Department of Education, 2002), it has not been encouraged by nursing faculty. Thepurpose of this study is to evaluate the implementation of a teaching protocol of

2nursing concepts by utilizing creative teaching strategies to promote creativity inRN-BSN students.Literature ReviewThe literature in creative thinking is originally started from the field of education.Guilford (1950s) proposed the first theory of the Structure of Intellect (SI model) forthe creativity. Following Guilford, Parnes (1960s), Williams (1970s) andTorrance(1980s), are all devoted into the study of creativity. In Taiwan, Chen during1990s developed the ATDE (asking, thinking, doing, evaluation) model for thecreative teaching. Other researchers such as Wu (1980s), Chang (1999), Mao, Kuo,Chen, and Lin (2000) are also involved into the area of creative studies. However,only some teaching strategies of creativity in nursing literature were introduced. Areview of literature on creative thinking is divided into two sections as follows:一 、General EducationGuilford, a psychologist, first developed the theory of the Structure of Intellect(SI model) during 1950s. Guilford explained that the SI Model is the process ofintegrating with 4 contents (figure, symbol, verbalism, behavior), five operations(cognition, memory, divergent thinking, convergent thinking, evaluation), and sixproducts (unit, category, relation, system, transformation, application). Only divergentthinking and transformation are related to the creativity. Divergent thinking is to think

3broadly from different perspectives that can derive various problem-solving methods.Transformation is to reform the original data into the new definition.Parnes, a behaviorist, during 1960s proposed the factors influencing thecreativity of students. Teachers must help students to remove some internal factorsinhibiting their developing creativity such as habit behaviors, dependent behaviors,insecurity, and impulse. Also teachers should reinforce students’ actions of creativitysuch as improving students’ knowledge background, imagination, critiquing slowly,and inspire students’ attitudes of exploration. Yang and Chen (1993) also addressedthe factors disturbing the developing of creativity from students. For instance,students are used to have the standard answers and afraid of having differentresponses from teachers. Teachers should prepare a safe, acceptable, and some rulesof environments to enforce the creativity of students.Williams during 1970s designed a creative plan and proposed the creativityconsisting of cognitive and affective behaviors. Williams developed 18 teachingstrategies to cultivate the cognitive behaviors of students’ creativity such as fluency,flexibility, and originality and affective behaviors such as curiosity, imagination, andtake adventures. During 1980s, Torrance also provided 16 principles of creativeteaching to train students to aware the problem and design the solving strategies.Torrance emphasized the needs of improvement for the content and method of

4teaching to promote the motivation of students to be creative.Based on the Guilford’s SI model, Chen during 1990s developed an ATDE(asking, thinking, doing, evaluation) model to cultivate the divergent thinking ofstudents. For asking, ten methods of asking questions using “If”, “List”, “Besides”,“Compare”, “Similar”, “Replace”, “Imagine”, “Possible”, “Constitute”, “6W” caninspire students to think divergently. For thinking, teachers must allow students tothink at least three seconds for answers. For doing, teachers can choose a guider todirect group discussion consisting of 5-10 students through brainstorming. Forevaluation, teachers should encourage students to do self-evaluation by following twoprinciples, “critique slowly” and “accept more”.Regarding the definitions of creativity, Guilford has defined creative thinking asfluency, flexibility, originality, sensitivity, and elaboration (Guilford, 1956). In 1970,Williams addressed that creativity should include fluency, flexibility, originality, andelaboration. Demetrulias and Shaw (1985) later work supported inclusion fluency,flexibility, associative thinking, and originality in creativity. Then Dowd (1995)proposed that creativity should consist of fluency, flexibility, and originality. Finally,Chen (1998) and Chang’s (1999) definition of creativity was fluency, flexibility,originality, and elaboration.Overall, fluency, flexibility, and originality are the most frequently recognized as

5the components of creativity. Because Torrance’s (1974) Tests of Creative Thinking(TTCT) are the most popular instrument used to test the creativity in the field ofeducation, Wu (1985) has applied the Torrance’s definition of creativity into theresearch of general education. According to Torrance (1974), fluency is the totalnumber of responses students report, flexibility is the number of different categoriesof responses students report. Originality is defined as the numbers of responses thatoccurred with a frequency of 5% or more among the total responses in the data setwere scored 0 for originality; those with a frequency of 2% to 4.99% were scored 1,and those with a frequency less than 2% were scored 2.二 、Nursing EducationRecent nursing literature has continuously emphasized the innovation andcreativity because nurses must have creativity, flexibility, independence, criticalthinking, and collaboration to meet the demands in the healthcare (Lewis, Brand,Duckett, & Fairbanks, 1997; Potgieter, 1999). Also, it is imperative to buildknowledge and creativity in the process of educating nursing students as the scholars(Elberson, & Williams, 1996). The University education is to develop the scholarlyabilities of nursing students such as creativity, reflection, critical thinking, criticalanalysis, and openness to new thinking (Ribbons, & Vance, 2001). Creativity in thenursing literature can be divided into two categories: clinical and educational sections.

6In the clinical practice, a study by Berg and Hallberg (1999), twenty-two nursesin a general psychiatric ward were tested before, during, and after one year ofsystematic clinical supervision. Results identified that systematic supervision ofclinical nursing care can improve the creativity of nurses and the organizationalclimate (Berg, & Hallberg, 1999). Titchen and Binnie (1995) suggested threesupervision strategies such as using a clinical story to demonstrate each demand fromthe supervisor and the offers from the nurses that can nurture the creativity of nursingstaffs.Except for the systematic supervision, Webster (1998) introduced an innovativeprocess to teach adult nursing staff and spur their creativity, team working, andindividual accountability. The use of creative teaching strategies in nursing staffdevelopment can inspire enthusiasm for learning (Geyer, & Korte, 1990). Anderson(1998) also suggested that matching the teaching style of nursing preceptors with thelearning style of new nursing staffs with the orientation creatively can maximize theirjob satisfaction. The factors for job satisfaction has been ranked by the directors ofnursing staff as the intrinsic variables such as creativity, moral values, social service,ability utilization and responsibility (Rehtz, 1995).Besides, Robbins (1997) suggested nurses to use Nursing InterventionsClassification (NIC) into a nursing care plan of tertiary acute care facility by utilizing

7the creative teaching strategies. Through NIC with using creative teaching strategies,the clients with multiple sclerosis (MS) can use open communication and creativity todeal with the problems of fatigue, impotence, decreased vaginal lubrication,dysfunction of bladder and bowel (Weiss, 1992).For clinical teaching, the central essential elements of nursing students’expectations of faculty guidance activities in the clinical laboratory are criticalthinking, professional judgement, application of knowledge, and fostering creativity(Heims. 1991). Gross, Aysse, and Tracey (1993) designed a creative education modelfor the first-semester students’ clinical practicum. Students are paired in a one to onerelationship with a staff nurse who will be served as a role model. Responses to thismodel from students’, nursing staffs’ and faculty’s perspectives indicate that thepaired model has worked in improving creativity of beginning nursing students in aclinical setting.Anthony (1998) utilized an artistic expression model by teaching Haiku (anancient Japanese poetry) to encourage the nursing beginning students to verbiage theirperceptions in relation to the clients through writing an ancient Japanese unrhymedform of poetry. Through the poems, the nursing beginning students can create thedifferent kind of writings to identify their major concerns about their clients. Mueller,Johnston and Bligh (2001) also introduced a mind mapping as the alternative nursing

8care plans to stimulate creativity of the nursing students.In the educational studies, nursing education literature emphasizes theimportance of teaching students to think creatively to meet the challenges of 21 stcentury health care delivery (Le Storti et al., 1999). Creativity is the character ofteaching resulting in empowerment between students and teachers (Chally, 1992). Forinstances, Greiner and Valiga (1998) have proposed that nurse educators can use somecreative teaching strategies such as stories, analogies, parables, and metaphors(Trunnell, Evans, Richards, Grosshans, 1997) to fulfill students’ health promotionresponsibility.Also, a nursing portfolio is a creative way for traditional nursing or RN studentsto document their achievements, past works, and life experiences without taking astandardized test (Alexander, Graft, Baldwin, Beers, & McDaniel, 2002). Besides,individualization as the creative teaching strategy for mater’s prepared nursingstudents to develop the home health care experiences of creativity (Alley, Donckers,King, 1992).Additional writings support case method, seminar format, and workshop weregood ways to improve nursing students’ creativity. Wade (1999) utilized the casemethod approach to help nursing students understand the complexity of patients’real-life situation to encourage their flexibility, creativity, change, and risk taking in

9providing care. Seminar format teaching increased the skills of traditional RNstudents in creativity, autonomy, and flexibility (Rains, Richardson, & Fowler, 1999).A group of nursing students have developed creativity workshops for the parents withthe preterm babies under risk at the University of Sao Paulo Hospital (Brunherotti,Pereira, de Souza, Nogueira, & Scochi, 2000).Finally, the assignments nursing faculty designed can inspire nursing students’creativity. Slaninka (1999) applied creative teaching strategies in a course of nursingtheory and derived the outcomes of the students’ presentation and term paperassignments creatively. Also, Olivet and Jones (1997) used the telecommunicationtechnology for innovation and creativity in nursing graduate education. Besides,nursing instructors designed the assignments with technology-assist can encouragestudents to collaborate with one another to promote their abilities of solving problemscreatively (Mastrian, & McGonigle, 1999). Additionally, nursing educators have usedtelevision games as effective teaching strategies to help students to developimagination and creativity (Youseffi, Caldwell, Hadnot, Blake, 2000).Definition of Terms1. Fluency: The total number of problem-solving strategies in clinical situationsreported by the students.

102. Flexibility: The number of different categories of problem-solving strategies inclinical situations reported by the students.3. Originality: The number of novel, elegant, or unusual problem-solving strategiesin clinical situations reported by the students. Responses that occurred with afrequency of 5% or more among total responses in the data set were scored 0 fororiginality; those with a frequency of 2% to 4.99% were scored 1, and those with afrequency less than 2% were scored 2.DesignThis study design is a time series and two groups experiment utilized multipleinstitutions of treatment to measure the creativity of 52 two-year and 69 three-yearRN-BSN students at four different points in time. The research protocol consists ofthree semester courses including 12 credits lectures and 9 credits practicum. Ateaching model of creativity with various strategies included the process of asking,thinking, doing, and evaluation are applied into each of teaching protocol of nursingconcepts to improve both groups of RN-BSN students’ fluency, flexibility, andoriginality.SampleThe purposive sample includes 52 two-year and 69 three-year RN-BSN studentswho had registered nursing licenses and worked for at least one year in a clinical

11setting. It was assumed that one year’s experience after completing a junior collegeprogram would enable them to think conceptually about patient’s problems. Bothgroups of RN-BSN students have completed the courses in the teaching protocol ofNursing Concepts within three semesters and the teaching strategies of creativity areapplied into each of teaching units.Instrument一 、Creativity in the application of the Nursing Process ToolThe instrument “Creativity in the application of the Nursing Process Tool(CNPT)” integrating the nursing process designed by Emerson (1988) was used in thisstudy. The steps in nursing process as defined by Marriner (1983) include assessment,planning, implementation, and evaluation. The content validity of English-versionCNPT was .83 including eight major questions. The question number one, for instance,is “List all the consequences to health care if people have only black and whitevision.” In this study, the CNPT was translated into Chinese. Five experts who haveinvolved in the research of creativity assessed the content validity of Chinese-versionCNPT. As a result, question number 3 was irrelevant for measuring the fluency,flexibility, and originality and was deleted. Finally, the content validity index ofChinese-version CNPT approached at 0.79.二 、Coding GuideChinese-version CNPT includes seven major questions within 20 open-ended

12questions. Narrative answers from the randomly selected 5 questionnaires were readand classified into the different categories by two nursing researchers. Ten nursingeducation experts were invited to assess the relevance of each category in the clinicsas well as the accurate and appropriate items under each category. The coding guideswere modified following the process of coding when two nursing researchers havefound the new categories. Within 20 open-ended questions, 6 to 19 categories weredeveloped as coding guides.Data Collection and AnalysisFifty-two two-year and 69 three-year RN-BSN students of a southern Universitywere invited to participate in this study. Due to various scheduling problems, only 30two-year and 44 three-year RN-BSN students have completed the four times tests,giving a 58% and 64% returned rate. Both groups of RN-BSN students weremeasured by their fluency, flexibility, and originality before the first semester and theend of each semester from March, 1999 to May, 2001.The investigator explained the purpose of this study to 52 two-year and 69three-year RN-BSN students while collecting data. Also, each student was given asmall gift as an incentive for participating in this study. Two researchers coded thedata by following the coding guides. Inter-coder reliability between the twoinvestigators was .84. Data were then analyzed by utilizing SPSS Paired t statistics to

13compare the fluency, flexibility, and originality from pretest to test III.Result一 、DemographicsThe average age of the sample is from 21 to 30 years old; however, thethree-year RN-BSN students were older than the two-year students’ significantly. Themajority of both groups (89% and 78%) were not married and graduated from 5-yearnursing program (65% and 68%). Almost half of two-year RN-BSN students wereeither nurses or registered nurses (48% and 48%); however, the majority of three-yearRN-BSN students were registered nurses (54%). In working experiences, three-yearRN-BSN students (6-10 years) worked longer than the two-year students’ (1-5 years)significantly. The majority of both groups (67% and 81%) worked either in themedical unit or surgical unit. The demographics of two-year and three-year RN-BSNstudents were indicated in the Table 1.二 、Fluency、Flexibility、OriginalityThe results indicated that the creativity of both groups in the fluency andflexibility tend to be improved after the second semester and the improvement hadbecome significantly in the third semester. The fluency and flexibility of two-yearRN-BSN students tend to be better than the three-year students’. However, originalityin both groups tends to be declined, but three-year RN-BSN students seem to perform

14better in the originality than the two-year students’. The study findings were indicatedin the Table 2.DiscussionAccording to the literature, no research has done about the creativity includingfluency, flexibility, and originality in nursing students. Only some teaching strategieshave been introduced for nursing faculty to help students to develop the creativity.This study has applied the definition of fluency, flexibility, and originality from theTorrance’s (1974) and transformed them into the nursing. Also, Chen (1990)’s ATDEmodel was used in this study to cultivate RN-BSN students’ creativity.The fluency and flexibility of both groups tended to decline after the firstsemester that indicate RN-BSN students may have the difficulties to take the teachingprotocol of Nursing Concepts at the initial time. As Anthony’s (1998) Haiku andJohnston and Bligh’s (2001) mind mapping, nursing faculty have requested studentsto write the daily journals to express their opinions about the teaching protocol ofNursing Concepts. Through various ideas from the daily journals, nursing faculty canunderstand inhibits from the RN-BSN students to develop the creativity in theteaching protocol of Nursing Concepts. As Parnes’ (1960s) suggestions, teachers musthelp students to remove internal factors inhibiting them to develop the creativity.Nursing faculty can prepare the open, free, and safe environment as Yang and Chen’s

15(1993) advices to encourage students to have different opinions from the teachers.Not until the third semester, have the fluency and flexibility of both groupsimproved significantly. The study of Berg and Hallberg (1999) has emphasized thefunction of systematic supervision to improve nurses’ creativity. Similarly, this studyhas spent three semesters to supervise RN-BSN students’ creativity systematically.The results indicate that the fluency and flexibility of both groups have declined afterthe first semester; however, the improvement of fluency and flexibility started fromthe second semester and continue to become significantly after the third semester. Thecultivation of RN-BSN students’ creativity does take time.Since the originality of both groups has declined, nursing faculty may designteaching strategies more special on the originality. Trunnell, Evans, Richards, andGrosshans (1997) have suggested to use stories, analogies, parables, and metaphors toimprove nursing students’ creativity. Also, nursing portfolio was introduced as thecreative way for RN-BSN students to record the past experiences (Alexander, Graft,Baldwin, Beers, & McDaniel, 2002). Nursing faculty can create the unusual clinicalsituations within the analogical concepts during case analysis and lead studentsbrainstorming by using metaphors. In addition, nursing faculty can suggest students toinquiry experts from the other field for the ideas of different nursing interventionsbeing transformed.

16In compared with both groups, the fluency and flexibility of 2-year students wasbetter than the 3-year students’. On the other hand, the originality of 3-year studentsperformed better than the 2-year students’. Because three-year students were olderand work longer than the 2-year students’, three-year students may think special andunique ideas often. However, the 2-year students were younger and had less workingexperiences so that they have more chance to inspire the imagination. Therefore,two-year students may report many ideas.LimitationFive limitations are explored in this study. First, this study was lack of twopretests as compared to the posttests within the second and third semesters so thatmaturation existed to affect the internal validity of this study. Also, this study did nothave a control group to compare to in terms of research results. Besides, a teachingprotocol of nursing concepts is used in this study by applying critical, creative,problem-solving, integrate teaching strategies to improve RN-BSN students’ fourabilities of critical and creative thinking, problem-solving, and integration. This studydid not have control group and used mixed teaching strategies so that research resultscould not be explained exclusively from the effect of creative teaching strategies.In addition, subjects in this study were purposively selected from two-year andthree-year RN-BSN students so that the findings could not be generalized to other

17nursing student populations. Finally, the returned rate in this study is only 58% and64% that a small sample size (N=30 and N=44) might impact the results of statisticalanalysis.AcknowledgementsUpon completing this study, I would like to give special thanks to our NationalScience Council to support this study, Kuei-Lan Yang and Shih-Tau Hwang havedeveloped the proposal, Ling-Huang Wang and Huey-Shyan Lin worked on the datacoding and analysis, Yu-Chu Yeh and ten nursing education experts have helped torevise the questionnaire as well as built the coding guides.ReferencesAlexander, J. G., Craft, S. W., Baldwin, M. S., Beers, G. W., & McDaniel, G. S.(2002). The nursing portfolio: a reflection of a professional. Journal of ContinuingEducation in Nursing, 33(2), 55-59.Anderson, J. K. (1998). Orientation with style: matching teaching/learning style.Journal for Nurses in Staff Development, 14(4), 192-197.Anthony, M. L. (1998). Teaching tools. Nursing students and haiku…simpleunrhymed Japanese verse. Nurse Educator, 23(3), 14-16.Berg, A., & Hallberg, I. R. (1999). Effects of systematic clinical supervision onpsychiatric nurses’ sense of coherence, creativity, work-related strain, job satisfactionand view of the effects from clinical supervision: A pre-post test design. Journal ofPsychiatric & Mental Health Nursing, 6(5), 371-381.Biester, D. J., Duggan, M., Perkins, M., Powers, L. K., & Classick, S. (1999).Quality care in an era of retrenchment. Journal of the Society of Pediatric Nurses, 4(4),

18141-145.Brunherotti, M. R., Pereira, F. L., de Souza, M. I., Nogueira, F. S., & Scochi, C.G. S. (2000). Recreational activities for parents of preterm babies: an experience at theUniversity of Sao Paulo Hospital. Revista Brasileira de Enfermagem, 53(3), 435-442.Chally, P. S. (1992). Empowerment through teaching. Journal of NursingEducation, 31(3), 117-120.Chang, U. C. (1999). The strategies of asking questions for teachers. Taipei:Psychology.Chen, L. A. (1990). [Asking, Thinking, Doing, Evaluation] the development andtesting a teaching model of creativity. Unpublished doctoral dissertation, NationalTaiwan Normal University, Taipei.Chen, L. A. (1998). Theory and practice of creative thinking teaching. Taipei:Psychology.Demetrulias, D. M., & Shaw, R. J. (1985). Encouraging divergent thinking.Nurse Educator, 10(6), 12-17.Department of Education. (2002). Republic of Creativity. Taipei, TW: Jiang TianPublication.Dowd, S. (1995). Teaching methods to foster creative thinking. RadiographyToday, 61(697), 19-20.Dunbar, S. B., & Hooper-Kyriakidis, P. (1998). Discover, teacher, friend: Atribute to Marguerite Kinney, Journal of Cardiovascular Nursing, 12(2), 56-64.Elberson, K. L., & Williams, S. A. (1996). Innovative strategies for promotingclinical scholarship: a holistic approach. Holistic Nursing Practice, 10(3), 33-40.Emerson, R. J. (1988). Design and validation of an instrument for themeasurement of creativity in the application of the nursing process. Unpublisheddoctoral dissertation, Gonzaga University: Spokane, WA.

19Forrest. S. (1999). Creativity on the edge of chaos. Seminars for Nurse Managers,7(3), 136-140.Geyer, K. A., & Korte, P. D. (1990). Creativity in nursing staff development.Journal of Nursing Staff Development, 6(3), 112-117.Gilmartin, M. J. (1999). Creativity: The fuel of innovation. NursingAdministration Quarterly, 23(2), 1-8.Greiner, P. A., & Valiga, T. M. (1998). Creative educational strategies for healthpromotion. Holistic Nursing Practice, 12(2), 73-83.Gross, J. W., Aysse, P., & Tracey, P. (1993). A creative clinical education model:Three views. Nursing Outlook, 41(4), 156-159.Guilford, J. P. (1956). The structure of intellect. Psychological Bulletin, 52,267-293.Heims, M. L. B. (1991). An exploration of nursing students’ expectations offaculty guidance-related essential elements in the clinical laboratory. Unpublisheddoctoral dissertation, Portland State University, U.S.A.Kao, C. H. (2001-2002). NANDA nursing diagnosis handbook. Taipei, TW:Hua-Xin Publication.Le Storti, A. J., Gullen, P. A., Hanzlik, E. M., Michiels, J. M., Piano, L. A.,Ryan, P. L., & Johnson, W. (1999). Creative thinking in nursing education: Preparingfor tomorrow’s challenges. Nursing Outlook, 47(2), 62-66.Lewis, M. L., Brand, K. P., Duckett, L., & Fairbanks, D. (1997). Preparingnurses for tomorrow’s reality: strategies from an honors program. Nurse Educator,22(1), 12-16.Mao, L. W., Kuo, Y. G., Chen, L. A., & Lin, C. T. (2000). Research of creativity.Taipei: Psychology.Marriner, A. (1983). Unification of nursing education and service. Nursing

20Administration Quarterly, 8(1), 58-64.Mastrian, K. G., & McGonigle, D. (1999). Using technology-based assignmentsto promote critical thinking. Nurse Educator, 24(1), 45-47.Mueller, A., Johnston, M., & Bligh, D. (2001). Mind-mapped care plans: aremarkable alternative to traditional nursing care plans. Nurse Educator, 26(2),75-80.Olivet, L. W., & Jones, T. C. (1997). Electronic education: Collaborativeteaching: a strategy for interactive telecourses. Nurse Educator, 22(1), 6-8.Parnes, S. J. (1967). Creative behavior guidebook. New York: Charles Scribner’sSons.Potgieter, E. (1999). The whole brain creativity model: implications for nursingeducation and practice. Curationis, 22(4), 41-48.Rains, J. W., Richardson, V., & Fowler, B. A. (1999). Combining traditional andRN students in a senior capstone experience: The student perspective. Journal ofContinuing Education in Nursing, 30(2), 52-55.Rehtz, C. J. (1995). Job satisfaction of directors of nursing staff development inteaching hospitals. Unpublished doctoral dissertation, The University of Rochester.Ribbons, R., & Vance, S. (2001). Using e-mail to facilitate nursing scholarship.Computers in Nursing, 19(3), 105-113.Robbins, B. T. (1997). Application of nursing intervention classification (NIC)in a cardiovascular critical care unit. Journal of Continuing Education in Nursing,28(2), 78-82.Slaninka, S. C. (1999). Nursing theories: creative teaching strategies make thiscourse come alive. Nurse Educator, 24(3), 40-43.Song, H. G., Chen, G. I., & Lee, C. I. (1996). Nursing InterventionClassification (NIC). St. Louis, MO: Mosby-Year Book.

21Titchen, A., & Binnie, A. (1995). The art of clinical supervision. Journal ofClinical Nursing, 4(5), 327-334.Torrance, E. P. (1974). The Torrance Tests of Creative Thinking: Technicalnorms manual. Bensenville, IL: Scholastic Testing Services.Torrance, E. P. (1988). The nature of creativity as manifest in the testing. In R. J.Sternberg (Ed.), The nature of creativity. Cambridge: Cambridge University Press.Trunnell, E. P., Evans, C., Richards, B., & Grosshans, O. (1997). Factorsassociated with creativity in health educators who have won university teachingawards: a modified qualitative approach. Journal of Health Education, 28(1), 35-41.Wade, G. H. (1999). Using the case method to develop critical thinking skillsfor the care of high-risk families. Journal of Family Nursing, 5(1), 92-109.Webster, M. R. (1998). Documentation in the land of perfect charts: how to turnyour frogs into princes. Journal for Nurses in Staff Development, 14(6), 283-285.Weiss, J. (1992). Multiple sclerosis: will it come between us? Sexual concernsof clients and their partners. Journal of Neuroscience Nursing, 24(4), 190-193.Williams, F. (1970). Classroom ideas for encouraging thinking and feeling.New York, NY: D.O.K.Wood, M. (1996). President’s view. Creative thinking is a “thriving” skill.Registered Nurse Journal, 8(3), 12.Wu, J. J. (1985). The creativity of young, Central Journal, 10(10), 41-45.Yang, L. L., & Chen, S. L. (1993). Applying creative thinking in nursingteaching. Journal of Chang Gung Nursing, 4(2), 6-11.Youseffi, F., Caldwell, R., Hadnot, P., & Blake, B. J. (2000). Recall Rummy:learning can be fun…a card game to reinforce proper skill techniques. Journal ofContinuing Education in Nursing, 31(4), 161-162.