Stimulating Student Engagement with Social Annotation

In this issue of Changing Course we will examine how social annotation stimulates student engagement. Social annotation is a creative means to promote engagement with readings. It “is the digital process of highlighting, marking up, and zooming in on the component parts of a text in the company of classmates and colleagues” (McDaniel, 2021). Students insert comments, questions, images, videos, and links in the margins. They engage in discourse with each other (Aguiar et al., 2021). This interaction fosters collaborative learning through analysis. “Social annotation represents a paradigm shift from the traditional ways in which students and educators have interacted with texts” (Farber, 2019). Students engage with the evidence-in-action and are given the opportunity to view it in a different way, to see why the piece is important to class discussion, theory, clinical experiences, and life. Social annotation empowers students to share their thoughts in a safe space.

There are many tools for digital social annotations, including Hypothesis, NowComment, Perusall, and Diigo. I prefer Hypothesis. Hypothesis is a free open-source platform and can also be integrated into Learning Management Systems (LMS) such as Canvas and Blackboard. I use Hypothesis integrated in the Canvas LMS.

Sample Student Annotations using Hypothesis in Canvas

(Margolies & Brown, 2019)

Inclusive and Universal Design

The Hypothesis tool is compliant with Web Content Accessibility Guidelines 2.1 (WCAG 2.1). Social annotation’s inclusive design not only helps people with physical, cognitive, and other disabilities, it also takes into account factors like gender, culture, and age (French, 2022).

.  Examples of accessibility tools include: 

• Clearly defined buttons, text spacing 

• Timeout notifications 

• Ability to turn off animations 

• Enlarged pixels 

• Voice messages

Universal Design for Learning (UDL) is a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn (CAST, 2022). UDL focuses on multiple means of engagement, interaction, and expression (Aguiar et al., 2021).

1. Engagement: Social annotation focuses student reading and interpretation practices, giving students options for how they engage with the reading. Social annotation helps students frame reading as a cooperative endeavor, not a one-sided private practice and hunt for knowledge (Aguiar et al., 2021).

2. Interaction: Social annotation provides students with multiple ways to interact with the material. Students ask questions, share ideas, and collaborate in ways that meet the needs of diverse learners (Aguiar et al., 2021).

3. Expression: Social annotation fosters the creation of new knowledge, as students connect readings to theory and practice using text, video, and other methods (Aguiar et al., 2021).  

Deep Thinking

When used as a teaching strategy in nursing, social annotation encourages students to deepen their thinking. According to a systematic review by Ghardirian et al., social annotation is beneficial to meta-cognition and comprehension. It supports the process of knowledge building, understanding and collaboration (Ghadirian et al., 2018). Often, when a reading is assigned, though the student may read it, deep engagement is not present. With social annotation, students read and think together and a text becomes a richer learning object (Cornell, 2022). Intra and inter-personal learning is fostered. Students collaborate while annotating and make meaning of the reading together through informal conversation. In doing this, they deepen their understanding of the material.  

Thinking “Like a Nurse”

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 and rewire it to create new thinking patterns. Social annotation can be used as a method to help students do this. Tanner’s Clinical Judgment Model (2006) fits nicely with social annotation. This model explains how students should frame their thinking when approaching their readings. In Tanner’s Clinical Judgment Model, we look at Noticing, Interpreting, Responding, and Reflecting, and that is exactly what students are doing when participating in social annotation. Social annotation cultivates student thought processes as they progress toward their goal of passing the NCLEX and becoming a nurse.

 

(Liquid Margins, Clip 5, 2022).

Intentional Design

Social annotation pedagogy is intentionally designed to link thinking and the connection of relevant information to theory, practice, and life. Although students have the power to decide what is important when socially annotating, the instructor guides the conversation through article selection. In a discussion board, students are given prompts, but sometimes they stray off topic or do not answer the prompt appropriately. When a reading is completed as a social annotation assignment, the instructor controls the content and it is the student’s job to analyze it.  

To foster student engagement, intentional design is important. The type of reading chosen depends on the goal of learning. In nursing, there are different types of evidence or literature we would like to expose our students to like research, clinical practice guidelines, policies, and position statements. Social reading adds to the discussion and answers to the course outcomes. For example, the textbook may not go into detail on a particular topic that is an outcome of the course, but the concept can be linked through a social annotation assignment. An example would be diversity, LGBTQ+ health, social determinants of health and health equity. All of these topics are critical to nursing but may only be covered with broad strokes in a textbook. There are rich resources available on these subjects. With social annotation, we can engage students in the topic to meet learning outcomes. 

Bringing Abstract Concepts to Life

Social annotation engages students by bringing abstract concepts in complex readings to life. Social annotation is a form of experiential learning in which students are the creators of information, rather than just consumers of it. Students synthesize the reading with additional text generating new meaning and connections (Brown & Croft, 2022). One invaluable affordance of social annotation activities lies in the way students collaboratively focus on the practice of reading itself, rather than approaching reading merely as a means to an end or a straightforward process of decoding or receiving information (McDaniel, 2021). 

Evidence-in-Action

One of my goals is to get students to read the evidence, process the knowledge, and gain literacy skills. With social annotation, students get exposure to evidence-in-action. Sometimes when we talk about evidence-based practice to nursing students, it can seem like an abstract concept. Through collaboration, students hone their interpretation skills and simultaneously work toward the specific learning objectives of their course (McDaniel, 2021). Students immerse themselves into unfamiliar concepts and types of evidence, resulting in active exploration of course content through rich sources. 

Empowering Learners

With social annotation, students get to decide what is important, or what stood out to them about the reading and they get to explain why. It is the Socrative method-in-action and also fosters student empowerment. With social annotation, students get to decide what is important; they get to explain why together, which encourages critical thinking and empowerment. In social annotation, the equitable distribution of responsibility among students can make the process of reading complex text impactful and students report that engaging in social annotation feels intuitive and low-stakes, akin to casual conversation or texting (McDaniel, 2021). 

Supporting Difficult Dialogue

(Liquid Margins, Clip 2, 2022)

Demonstrating Mastery

Social annotation provides a means for educators to assess mastery of nursing competencies and supports meeting the American American Association of Colleges of Nursing’s (AACN) Essentials (AACN, 2021) competencies across many domains. Mastery is linked to the assigned reading. For example, a social annotation assignment using the American Nurses Association Position Statement The Ethical Responsibility to Manage Pain and the Suffering it Causes crosses several domains (Table 1).

Table 1

Domain	Competency (Sub-Competencies)
Knowledge for Nursing Practice	1.1b,d; 1.2a,b,c,e; 1.3a,b,c
Person-Centered Care	2.1a,b,c; 2.2a,b,d,f; 2.3f; 2.5dg; 2.7c
Population Health	3.1c,i; 3.5a
Scholarship for the Nursing Discipline	4.1e; 4.2c
Quality and Safety	5.1a,b
Interprofessional Partnerships	6.2d; 6.4a,c
Systems-Based Practice	7.1d; 7.3d
Informatics and Healthcare Technologies	8.1c,e; 8.3a; 8.5b
Professionalism Personal, Professional, and Leadership Development	9.1a, c; 9.2c; 9.3a,f,g; 9.4b; 9.5b,c,e; 9.6a,b,c 10.2a; 10.3g,i

(AACN, 2021)

Examples

In Table 2, the excerpt the student identified from the article is on the left and under it the students’ reflection on the passage. On the right are snippets from the conversation. Of particular note we see advocacy (when the student supports “changing dialogue”), connection to class (“One of the things that we have learned in class is to not let our personal biases get in the way.”) , and previous learning (“Yes!! I feel like this is a perfect example of the application of cultural competency principles.”). 

Table 2

Original annotation

Responses

Article excerpt: Bandura’s work (2002, 2016) on moral disengagement illustrates several mechanisms that can impede the ethical and professional duty to manage pain and may include: blaming and dehumanizing patients for health problems like substance use disorder, e.g., opioid addiction;   Annotation: “I think that this is a major problem relating to biased pain management within the health care industry. The opioid epidemic is running strong through our country and along with this is the epidemic of stigma. Addiction is a chemical imbalance that happens in the brain and is considered a disease and not a matter of choice. However, there are many people, some that exist in the health care industry, that view it from a more judgmental, harsh view point . . . a national standpoint would be very helpful in changing the dialogue and stigma that surrounds addiction and would hopefully lead to more equal and unbiased pain management.”

#1: “I agree that sending this message nationally could make a huge impact. One of the things that we have learned in class is to not let our personal biases get in the way. This lesson is especially important when it comes to healthcare workers who view addiction as a choice.”   #2: “Yes!! I feel like this is a perfect example of the application of cultural competency principles. Although those who abuse substances aren’t a culture per se, the principles of cultural competency still apply. It’s important that we examine our inherent biases when working with any patients–patients in pain in this context–so that we are providing adequate care. If we assume things about a patient and their lifestyle, we are more likely to be mistaken about what we should assess, diagnose, plan, implement, and evaluate.”

(American Nurses Association, 2018).

Table 3 is an example of creating a safe space for learning and supporting difficult dialogues.

Table 3

Article excerpt:	Annotation
Without adequate training, nurses may think that the “I treat all my patients the same” approach will help LGBTQ patients feel safe and welcome. It does not.	“The statement ‘I treat all my patients the same’ is tone deaf at the very least and does not acknowledge the special medical attention and care a person of the LGBTQIA community my require.”

(Margolies & Brown, 2019)

Table 4 provides an example of evidence-in-action.

Table 4

Article passage highlighted:

Annotation

Nursing care is the cornerstone of CAUTI prevention.

“Approximately 70% of CAUTIs are preventable by using evidence based prevention measures. The four essential components that can contribute to the prevention of CAUTIs is avoiding unnecessary placement of indwelling catheters, using aseptic techniques and evidence-based guidelines, and removing catheters as early as possible. To me, it seems as if these four guidelines to prevent CAUTIs seems very basic and easy to do. Based on this information, I think it is critical for nurses to put a personal focus on their patients with catheters and make sure they are doing what they have to do to remove the catheters as soon as possible.”

(McNeill, 2017)

Try it!

Choose the social annotation tool that will work best for you. Hyperlinks to tools are provided above. With Hypothesis, my preferred platform, getting started is easy:

• Create a free account

• Add Hypothesis to your browser

• Choose your first source to annotate

• Share your link with others

• Start annotating (Hypothesis, n.d).

You can also check if a social annotation tool is integrated into your LMS. Here is an example of an annotation exercise I started using Hypothesis in a browser: https://via.hypothes.is/https://sites.rutgers.edu/changing-course/rethinking-the-nursing-care-plan/

Click on the link and give it a try. Start annotating, noticing, interpreting, responding, and reflecting. Let’s create new knowledge together!

Coming up in the summer edition of Changing Course . . . Creating Connections with Digital Stories.

References

Aguiar, C., Elshobokshy, F., and Huron, A. (2021). Bringing theories to practice: Universal design principles and the use of social annotation to support neurodiverse students. Faculty Focus. https://www.facultyfocus.com/articles/effective-teaching-strategies/bringing-theories-to-practice-universal-design-principles-and-the-use-of-social-annotation-to-support-neurodivergent-students/​

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

American Nurses Association. (2018). The ethical responsibility to manage pain and the suffering it causes. Position Statement. ANA Center for Ethics and Human Rights. 1-9.​

Brown, M., and Croft, B. (2020). Social annotation and an inclusive praxis for open pedagogy in the college classroom. Journal of Interactive Media in Education, 1(8), 1-8.​

CAST. (2022). About Universal Design for Learning (UDL).  https://www.cast.org/impact/universal-design-for-learning-udl​

Cornell University. (2022). Social annotation. Center for Teaching Innovation. https://teaching.cornell.edu/learning-technologies/collaboration-tools/social-annotation​

Farber, M. (2019). Social annotation in the digital age. Edutopia. https://www.edutopia.org/article/social-annotation-digital-age​

French, Franny. (2022). Everyone included: Hypothesis accessibility reaches WCAG 2.1. Blog. Hypothesis. https://web.hypothes.is/blog/everyone-included-hypothesis-accessibility-reaches-wcag-2-1/

Ghadirian, H., Salehi, K, and Ayub, A. (2018). Social annotation tools in higher education: a preliminary systemic review. International Journal of Learning Technology, 13(2), 130-162.  https://www.researchgate.net/publication/325524543_Social_annotation_tools_in_higher_education_A_preliminary_systematic_review​

Hypothesis. (n.d.). Get started. Hypothesis. https://web.hypothes.is/start/

Liquid Margins 026 l Clip 2 l Bodies of Knowledge. (2022). [YouTube]. https://www.youtube.com/watch?v=NWMT-eUx4aE&t=2s

Liquid Margins 026 l Clip 5 l Bodies of Knowledge.(2022). [YouTube]. https://www.youtube.com/watch?v=UOK9ss6zrxQ&t=68

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

McDaniel, S. (2021). Social annotation and the pedagogy of Hypothes.is. The University of Chicago Academic Technology Solutions. https://academictech.uchicago.edu/2021/03/03/social-annotation-and-the-pedagogy-of-hypothesis/​

McNeill, L. (2017). Back to basics: How Evidenced-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37(4). 204-206.

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

Disclaimer

I have not been paid to promote any of the products listed and will not receive commission, payment, or gifts of any kind if you click on a link in this blog.

 

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