2.  The theory to practice gap continues to be an issue for nursing students (Kalb, 2010; May et al, 1999).  Impact observed on clinical decision making and formation of clinical judgment (Galloway, 2009).  Creative and innovative teaching strategies recently incorporated into classroom (Guhde,2010).

4.  How best to address this gap in the students' learning and experience?  What strategies can nursing programs adopt to impact this gap or possibly eliminate it?  What is the missing link to facilitate the utilization of theory into the novice nurses' nursing practice?  What changes in the approach to clinical instruction can be changed to facilitate a richer, deeper clinical experience for nursing students?

5.  What is the effect on student learning outcomes and patient care of integrating student-centered learning strategies based on intentionality into the student nurses' clinical experience?

6.  S LO and ultimately patient care outcomes are directly impacted.  Intentionality: raise rigor, promote critical thinking, analysis, and problem solving, and foster the student's ability to forge connections between theory or knowledge and practice.  Varied clinical experience promotes:  student learning  opportunities to make clinical decisions  continue the development of clinical judgment (Chappy, Jambunathan, & Marnocha, 2010; Leonard, Shuhaibar, & Chen, 2010).

7.  Guidance and mentorship support the student throughout the process.  Previous studies:  this design has not been used  evidence non-conclusive  no comparisons studies have been completed.

8.  Quantitative approach is most appropriate for this research question  Purpose drives the design  The purpose of study to determine the effectiveness of an implemented program of student-centered intentional strategies designed to increase synthesis and integration of theory and clinical practice.  The study seeks to examine a relationship and determine causality amongst the variables  Uses logistic, deductive reasoning to make a generalization Research Approach and Design

9.  A quasi-experimental comparison study design with repeated measures of a interrupted time series of nonequivalent comparison groups- an experimental group and control group, two sections of a nursing course.  This design affords the greatest control and meaningful results  Inclusion of a control group -  ability to detect real differences between the groups  strengthens the validity of the findings (Burns & Grove, 2009)  Differences between groups/trends examined over the time period of the 15 week semester.

10.  Variables are clearly defined  student learning outcomes  patient care (outcomes)  student-centered learning strategies  student nurses' clinical experience  clinical decision making  clinical judgment.  intentionality explicitly defined  Sampling:  convenience sample as students enrolled in A or B sections  randomly assigned to clinical groups

11.  Measures:  Pretests (evaluation instruments, mock NCLEX) administered to both sections at course onset  Interrupted time tests given concurrently to groups (quizzes, unit tests, case studies, mid-term evaluations)  Post tests given to all students at the conclusion of the course (final exam, HESI or similar standardized test, and final clinical evaluation instrument).

12.  Results of all “tests” will be statistically analyzed  to identify if statistically significant differences exist between the two approaches to clinical education in this sample  if a higher degree of learning occurred as a result of the experimental clinical education plan  Identification of a more effective clinical education teaching strategy  consider program alterations

13.  Instruments lack reliability  Internal consistency to be est. by expert panel  Variability: in clinical instructors  personalities, approaches, education, enthusiasm, and experience  Orientation of all instructors involved is necessary to limit variations in approaches and expectations.

14.  Both groups will have equal cumulative clinical hours  Control group:  students enrolled in section A of the course  receive the 'standard practice' or 'usual treatment' of clinical education  Experimental group:  students in section B;  receive the 'experimental clinical experience‘

15.  Experimental clinical experience includes:  variety of patient conditions and situations, unfolding case studies, actor simulated experiences, mentored clinical situations working in tandem with an experienced nurse/maintain consistent assignment, multiple patient assignments, reflective assignments, team building exercises, 60 second situational assessment (QSEN),and journaling.  Section B clinical instructors engage in group seminar prior to course start:"Reframing Constructive Criticism Using Reflection Based on QSEN Competencies" (Altmiller, 2012)

17. Altmiller, G. (2010), Reframing constructive criticism using reflection based on QSEN competencies. Retrieved from http://www.qsen.org/teachingstrategy.php?id=133http://www.qsen.org/teachingstrategy.php?id=133 Burns, N. & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence, 6th ed. St. Louis, Missouri: Saunders Elsevier. Chappy, S., Jambunathan, J., & Marnocha, S. (2010). Evidenced-based curricular strategies to enhance BSN graduates' transition into practice. Nurse Educator, 35(1), 20-24. Galloway, S. J. (2009). Simulation techniques to bridge the gap between novice and competent healthcare professional. The Online Journal of Issues in Nursing, 14(2). doi:10/3912/OJIN.Vol14No02Man03 Guhde, J. (2010). Using online exercises and patient simulators to improve students' clinical decision making. Nursing Educational Perspectives, 31(6), 387-389. Leonard, B., Shuhaibar, E., & Chen, R. (2010). Nursing students perceptions of intraprofessional team education using high-fidelity simulation. Journal of Nursing Education, 49(11), 628-631. doi10.3928/01484834-20100730-06 May, B.A., Edell, V., Butell, S. Doughty, J. & Langford, C. (1999). Critical thinking and clinical competence: A study of their relationship in BSN seniors. Journal of Nursing Education, 38(3), 100-110. Stanley, M.J. & Dougherty, J.P. (2010). A paradigm shift in nursing model: A new model. Nursing Education Perspectives, 31(6), 378-380.