Using the Jigsaw Technique to Examine the RaDonda Vaught Case

Nursing faculty strive to expand curricular capacities to support student learning through teaching strategies. This study adopted the jigsaw technique (JT) to enhance student engagement and understanding of the RaDonda Vaught case.1 This multisite study examined the effectiveness of an experiential, collaborative case study using the JT for senior-level undergraduate and graduate nursing students related to the criminalization of medical errors. The study's goal was to encourage students to take responsibility for their own learning and to instill the importance of adhering to the fundamental principles of safe nursing practice. This article describes the students' responses to selected qualitative questions. Teaching Strategy Description Jigsaw technique is a cooperative learning and organization method for classroom activities that promotes learning. In this method, students gather information in groups and then teach one another, piece by piece, like solving a jigsaw puzzle. JT is student-centered and improves student engagement and knowledge retention.2 Students actively participate in the learning process through participatory learning and interaction with their peers. Multiple studies have indicated that the JT is an effective pedagogy for various subjects and academic levels.3 In one study, JT was studied to examine learning and retention in a graduate school-level education leadership course.3 This qualitative case study revealed that the students learned more effectively when they learned collaboratively, with smaller parts of the topic.3 In JT, individual students are assigned into small groups, commonly 4 to 6 students per group. Each group focuses on becoming an expert on their assigned topic. They may be assigned to answer questions and explore various concepts regarding their topic. The faculty member develops and assigns the questions based on the researched topic.4 Once students have become experts on the topic, they are regrouped so that there is one expert per topic in the new groups. Each member explains their topic so all members of the new group become knowledgeable about each topic.4 RaDonda Vaught Case On March 25, 2022, a former Vanderbilt University Medical Center nurse, RaDonda Vaught, was found guilty of criminally negligent homicide and gross neglect of an impaired adult by a Tennessee jury. The criminally negligent homicide charge resulted from a medication error in which the muscle relaxant vecuronium was inadvertently substituted for the sedative midazolam. The gross negligence charge resulted from allegations that the patient was not correctly monitored after administering the medication.1 The prosecutor stated that Vaught "recklessly ignored" her training and was culpable in the patient's death and that there were multiple chances for her to "just pay attention." The defense argued that the error constituted an honest mistake rather than a conscious, criminal act of reckless homicide.1(p2241) Methods This study used the Vaught trial as a case study for an active learning strategy using the JT. Students were randomly sorted into small discussion groups, taking them out of their comfort zones of working with more familiar study groups. They researched the Vaught case cooperatively and created a timeline from the day she passed nursing boards until today. Students could use any online platform to create their timeline, including news outlets and social media outlets like Twitter™, TikTok™, Facebook™, and Instagram™. Each group was then handed a card with a unique term: role of the state board of nursing, malpractice versus criminal law, nursing code of ethics, just culture and transparency, confidential peer review and root cause analysis, highly reliable organizations, errors of omission and errors of commission, discoverable documentation and incident reporting systems, sentinel, adverse, and near miss events, autonomy, beneficence, non-maleficence, and justice. On completion of the Vaught timelines, groups then researched their assigned term and discussed those terms through the lens of the case to create a new expertise to present to the larger group. Due to the sensitive nature of the case and limited time, groups were given 1 hour to complete the assigned tasks and asked to find a quiet place with minimal distractions to promote mutual respect, collaboration, and accountability. Students returned to the classroom after 1 hour with chairs huddled together to create a safe and intimate environment for discussion. A group was randomly chosen to present the timeline of what they discovered in the case. The rest of the class was then invited to fill in gaps from their small group's research on the trial, creating a shared and complete case timeline. Once the class was pleased with the timeline, each group was invited to present their terms by giving definitions and facilitating a class discussion through the case lens. Students were given a separate study information sheet with a link to the optional anonymous Institutional Review Board-approved survey. Demographic information collected included 3 programs: traditional bachelor of science in nursing (BSN), accelerated BSN, and master of science in nursing (MSN), age range, and health care experience. Ten nominal-level questions with options of strongly disagree to strongly agree were included to measure the participant's perception of the knowledge gained in the areas in the case study. Open-ended questions asked the participants to discuss 3 key takeaways from the case study: how they assumed accountability for their learning, how the case study alleviated or decreased concerns about learning, and how the case study alleviated or decreased concerns about their nursing practice. Results After multiple sessions, 185 students answered the optional, anonymous survey. The following question, answered by 147 students, was analyzed to evaluate the effectiveness of JT as an education strategy, "Describe how you took ownership and accountability of your learning during this case study experience." The following themes were identified: (1) Conducting research and gathering information from reputable sources; (2) Participating and collaborating in group work, including discussing, presenting, and sharing information; and (3) Reflecting on and applying ethical concepts, including high-reliability organizations, code of ethics, and criminalization of medical errors. Students were invited to comment on how the case study impacted their learning. The following are 2 comments about the learning activity: "I like how we dove into the Vaught case for the first time in the program. We have discussed it in prior courses, but we never went in-depth with it like we did in this activity. I think it's very important information for new grads to know," and "…this opened my eyes to really investigate a hospital I want to work for. Also to prioritize myself in some instances." Implications for Nursing Education The JT is an effective means to encourage nursing students to assume responsibility for their education. In this case, it was used to provide education on medication errors, specifically the Vaught case. It could be used in a health informatics course to explore computer applications. In a medical/surgical, mental health, or maternity course, JT would help examine disease processes and available care options and resources. A community health instructor would find the JT a valuable tool for students to identify available resources for housing and other resources.