NURSE EDUCATOR

Volume 30, Number 5, pp 203-207

2005 Lippincott Williams & Wilkins, Inc.

Strategies to Scaffold Student

T he shortage of nursing faculty and
rising faculty-to-student ratios in the
classroom and clinical areas have con-
tributed to a resurgence of interest in
pedagogical strategies to optimize stu-
dent learning.1 The effective nurse ed-
ucator is aware of learning theories
and identifies teaching strategies to
support learning. Vygotskys Zone of
Proximal Development (ZPD)2 and
scaffolding techniques such as model-
ing, feedback, questioning, instruct-
ing, and cognitive structuring3 move
the learner to increased independence
in learning and practice.
Vygotskys Theory
Learning
Applying Vygotskys Zone of
Proximal Development
Debra Sanders, MSN, RN
Dorette Sugg Welk, PhD, RN
Teaching strategies like modeling, feedback, questioning, instructing,
and cognitive structuring are applications of Vygotskys Zone of
Proximal Development. These strategies scaffold student learning from
assistance by others to self-learning toward the goal of internalization.
This higher-order learning stems from interactions with those who have
more knowledge than the learner. Practical applications of Vygotskys
theory to any basic nursing education program are presented.

Lev Vygotskys Sociocultural Develop-

ment Theory2 proposes that social in-
teractions lead to cognitive develop-
ment. As a constructivist, Vygotsky
believed that construction of knowl-
edge occurs in an interplay between
the learner and others,4 with the inter-
dependence between the social milieu
and the individual as key to a higher-
order learning process. The social and
mental interactions between faculty
and student become internalized
within the student. The student actively
participates in the learning process by
using speech, memory, and writing.
Essentially, Vygotsky believed that
learning is a developmental process as
compared to Piaget5 who believed that
development precedes learning.
Central to Vygotskys theory is the
ZPD. Vygotsky defined the ZPD as
the distance between the actual de-
velopmental level as determined by
independent problem solving and the
level of potential development as de-
termined by problem solving under
Authors Affiliation: Instructor of Nursing
(Ms Sanders); Faculty Emeritus (Dr Welk),
Department of Nursing, Bloomsburg Uni-
versity of Pennsylvania, Bloomsburg, Pa.
Corresponding Author: Ms Sanders,
Bloomsburg University, 400 E Second St,
Bloomsburg, PA 17815 (dsanders@bloomu.
edu).
adult guidance or in collaboration
with more capable peers.6(p86) The
role of the educator is to stimulate
and support the student and, in a col-
laborative process, to encourage the
student to expand or reach toward
higher levels in the zone through
scaffolding techniques that can be
constructed or gradually diminished
based upon student needs in the
learning process.
Learning and transformation
within the ZPD occurs in 4 stages.6 In
stage 1, performance is other-assisted
by more capable others like teachers,
peers, or experts in the practice area.
The developmental task of this stage is
to move from other-regulated to
self-regulated. In stage 2, perfor-
mance is self-assisted as control is
passed from the others to self where
the responsibility for the learning is
self-directed. In stage 3, learning has
been internalized and consistent reli-
able performance is developed; assis-
tance from others is no longer required
and, in fact, may be detrimental. Stage
4 occurs when what was previously
learned is no longer automatic (deau-
tomization), such as after stress,
trauma, major life events, or even envi-
ronmental changes, causing the learner
to return to earlier ZPD stages.
Scaffolding Strategies
Assisted performance is a term that in-
corporates the activities of the teacher
as the student transitions from other-
assistance to self-assistance to unas-
sisted internalized learning. The various
means of assisted performance include
modeling, feedback, instructing, ques-
tioning, and cognitive structuring.3
Table 1 displays teaching strategies for
types of assisted performance.
Modeling
As role models, faculty provide verbal
or nonverbal behaviors that students
can imitate. The 2 characteristics that
most distinguish best and worst
clinical teachers are being a good role
model and encouraging a climate of
mutual respect.7-9 In a climate of mu-
tual respect, students can view inci-
dental teacher-assistance positively10
as well as appreciate that the teacher
doesnt know everything. As exam-
ple, when we model on-the-spot use
of resources like the Internet, we
show students how quickly they can
find information needed for safe prac-
tice. This serves as a scaffold to sup-
plement their knowledge and provide
a teacher-to-student interaction for

NURSE EDUCATOR Volume 30, Number 5 September/October 2005 203

 Table 1. Scaffolding Strategies for Classroom and Clinical Settings
Type Strategies

Modeling Serve as a role model who demonstrates clinical skill and judgment, while encouraging a climate
of mutual respect
Serve as a role model with consistent verbal and nonverbal behavior
Demonstrate immediate expert modeling if students are struggling in situations that exceed their
current knowledge, attitudes, or skills
Create specific classroom or simulation modeling activities any time student behavior or lack of
understanding shows need
Prepare students to expect some teacher interaction in the classroom or clinical setting so that it
is not viewed as a student deficiency
Capitalize on situations where neither student or faculty have an answer through on-the-spot use
of resources for mutual learning
Feedback Cite a standard, for example, page in textbook, reference to class notes, so the student can use
it to supplement or extend knowledge
Require that the student self-grade an assignment and compare it to the grading rubric so as to
increase student reliance on internal judgment of standards
Inquire about student thinking (think-aloud); if the student pauses more than 15 s, interview
to gain insight into mental processes
Appraise students in advance of the benefits of feedback techniques like think-aloud so that it is
not viewed as grilling or drilling
Engage students in collaborative activities with peers and healthcare providers to broaden their
views of others who can help them learn and solve problems
Instructing Use guided notes with videotapes, CDs, and computer-assisted instruction to provide academic
voices for later student recall and application
Create outlines, charts, forms, etc, that initially provide support for student learning but eventually
are not required to elicit the same level of performance
Support use of student-made personal note cards or commercial pocket-type summaries as
temporary scaffolds of learning
Questioning Use a variety of questions from faculty and students themselves to assess where assistance in
learning is needed
Promote metacognition by asking students to share new clinical experiences from which
they learned that might also help others learn
Meet promptly with students with low test scores to identify where knowledge is insufficient so
that erroneous understanding is not carried to clinical practice
Provide students with a supervised review of all unit exams prior to the final exam to help them
develop a study plan
Cognitive structuring Vary concept map purposes, styles, and directions to explore student knowledge and thinking as
assessments for assistance
Promote tutor selection whereby the tutor can stress both the learning process as well as the content
Hold a faculty-student-tutor meeting to help analyze the learning situation for individualized student
progress toward self-assistance

mutual learning. The best educator
has the ability to overtly demonstrate
clinical skill and judgment,7-9 with em-
phasis on demonstrate. Faculty, as
good health professional role models,
consistently should show verbal and
nonverbal behaviors that the student
would consider good, compassion-
ate, empathetic, and humanistic.
Nurse educators need to be alert for
situations when a role modeling activ-
ity is needed.10 When the teacher
takes charge, it is usually a time
when the students ability to do so is
not apparent.11,12 For example, the
student is not intervening appropri-
ately with a hysterical patient and the
faculty immediately models an effec-
tive nursing intervention.
We initiated a modeling activity
when 2 senior students conferred on a
regular insulin order, erroneously
reading the order for 7u as 70. While
no patient was harmed, it was obvious
that the students had not had enough
experience with giving insulin to make
a judgment that this dosage was un-
usually high. In another incident, a se-
nior student seemed flustered about
how to organize and give 8 oclock
medications to 2 patients when a vari-
ety of routes was involved. To model
these behaviors, we devised simulated
laboratory exercises to give students
experience with this content.
Feedback
To help students transition from
other-assistance to self-assistance,
feedback is most effective when their
work is compared to a standard.3
This feedback has to go beyond ver-
bal or written responses like nursing
interventions disorganized or more
detail is needed, such as, see text
page 10 for comprehensive care plan
ideas.

204 NURSE EDUCATOR Volume 30, Number 5 September/October 2005

 Students who tend to depend on
faculty feedback may benefit from
first having the teacher review the as-
signment compared to the standard or
grading rubric. This is followed by the
student using those comments for self-
grading of the same assignment.11 Stu-
dents become more focused on setting
up high standards for themselves and
more reliant on their internal judgment
whether or not they met these stan-
dards.13 Positive feedback should be
balanced with needs improvement
comments.14 When students do not in-
dependently show effective use of
feedback toward improvement, we
add the scaffold of a required face-
to-face meeting so that the standards
can be enforced.
The timing of the feedback, that is,
before, during, and following student
action, is important to ensure safe nurs-
ing practice.15 To address this in the
clinical area, we use a planned proac-
tive approach to discuss each students
practice numerous times throughout
the day, not depending on visual cues
that things are going well.
Think-aloud feedback strategies
help students articulate their inten-
tions, their rationales, and means for
action, thus providing a key moment
for faculty feedback. Only a 15-second
pause should occur without interview-
ing students about what they are
thinking. Beyond the brief 15-second
period, students may have shifted
attention to several considerations
and would not be able to give a true
accounting of the thinking process.16
Hypothesizing, cue logic, reflexive
comparison, and prototype considera-
tions are common cognitive strategies
students might use.17 We appraise stu-
dents of this feedback technique in
advance when we use it so that they
do not misinterpret our behavior as
impatient or nonsupportive. Students
with a think-aloud self-assistance
strategy tend to be more metacogni-
tive about their own learning needs
and seek less support from other au-
thorities.18 Students need reliable
feedback, but the more they are able
to gain it directly from themselves, the
more quickly they will move to the
self-assistance performance level.
Faculty do not need to be in-
volved in assisted performance as
long as some individuals have more
knowledge or skill than the student in
NURSE EDUCATOR Volume 30, Number 5
the situation.19,20 Each of our senior
students plans and conducts a patient-
centered conference, collaborating
with other healthcare providers and
his or her peers. The nurse educator is
present for evaluation purposes but
the learning takes place in the collab-
orative conference activity as students
assist one another and learn from the
contributions of others.
Instructing
The faculty members actual voice in a
lecture or demonstration is an effec-
tive scaffold for some learners. Stu-
dents may benefit from recalling the
educators voice when applying the
information needed at a given mo-
ment as the student moves to self-
assistance in performance.3 Video-
tapes and computer-assisted programs
with guided questions may serve as
reliable, accurate voices in instruc-
tion as supplements to other types of
learning strategies.21
Scaffolded writing is an instruc-
tional technique to support written
work.22 It is not intended to make the
task easier but rather to make it pos-
sible for the student to accomplish
writing with less assistance. The edu-
cator initially provides external sup-
ports for writing like printed outlines
or charts with categories to be com-
pleted. Eventually, the student is ex-
pected to verbalize and act upon what
would have been written without the
external support. We use a single-
page 2-sided form, called Making
Connections. This form promotes the
students critical thinking process re-
lated to the client condition, patho-
physiology, diet, laboratory studies,
pharmacology, nursing diagnoses,
and nursing management. Senior stu-
dents use the form for 4 weeks during
an acute care rotation.
When they progress to a regis-
tered nurse (RN)-caseload rotation,
they do not complete the form in hard
copy but they are expected to verbal-
ize the form contents to make impor-
tant connections. The external scaf-
fold of writing is resumed if the
student cannot verbalize these con-
nections. Other scaffolds can include
use of personal note cards or com-
mercial pocket-type summaries. Even-
tually, however, we expect students to
recall commonly used information
September/October 2005
(like hemoglobin and hematocrit val-
ues) for immediate use in understand-
ing shift reports, for example, as they
move to self-assistance in learning.
Questioning
Questioning in ZPD and scaffolding
fall into 2 categories: those that assess
and those that assist.3 Unlike the brief
15-second time limit previously noted
for the think-aloud strategy, waiting is
appropriate depending on the depth
of thinking required to answer a ques-
tion.23,24 To know where the student is
in the ZPD or how much learning as-
sistance is needed, faculty may wish
to progress through various types of
faculty or student-generated ques-
tions. These types may include close-
ended, open-ended, convergent (one
answer), and divergent (many an-
swers) question styles.25 Other ques-
tioning styles involve an increasingly
higher level of reasoning and knowl-
edge or provide a consistent inductive
or deductive reasoning process.26 A
random, unplanned array of questions
may not result in either teacher or
learner progress in assessing or assist-
ing in the learning process.
We use questioning techniques to
model collaboration in preconference
and postconference. This strategy
avoids the impression that each stu-
dents contribution, in a mere round-
robin approach, is separate from an-
other students comments and patient
situations. We ask, what did you ex-
perience today that others might not
have experienced but could gain from
your experience and reflection? We
use study guideline questions to ac-
company class units; in course evalu-
ations students have commented pos-
itively that the guides help them focus
their learning activities.
Test questions also offer a scaf-
folding opportunity. Strategies to indi-
vidualize student learning based on
wrong answers may be an untapped
assisted performance strategy. We
provide an immediate postexam re-
view of the correct responses. In ad-
dition, we hold a review session for
all unit exams just prior to the final
exam so that students can note the
areas where questions were incorrect
and direct their final exam studying
accordingly. However, a more forma-
tive activity at the time of the individual
205
exam would represent a scaffolding
strategy as students may be taking er-
roneous information into clinical prac-
tice. We are now requesting that stu-
dents with low test scores meet with
us to better address this issue. Faculty
may be reluctant to develop a large
enough test bank that could allow for
release of exams to students for for-
mative remediation. However, such a
strategy may be more appropriate in
terms of student learning.
Cognitive Structuring
Cognitive structuring refers to how stu-
dents organize information in memory
for use in future thinking and action. It
is the most difficult for faculty in terms
of assisted performance.3 Concept
mapping and tutoring may help the
teacher discern a students knowledge
so that performance may be assisted
appropriately. Concept maps help stu-
dents organize their knowledge and
show what is significant and not signif-
icant.27 As a student-oriented construc-
tivist strategy, concept maps allow fac-
ulty to see the students cognitive
structuring and discern what the stu-
dent knows and does not know to in-
clude as evidence of existing knowl-
edge and its organization. Concept
maps vary depending on whether they
are drawn without any references (eg,
an individual or group activity as a
type of pretest in class) or with refer-
ences (eg, preparation for clinical ex-
perience in advance).
In both instances, however, the
educator and student gain some in-
sight from the words and connections
the student has chosen to include or
exclude. This insight can be used to
assist performance. There is some ten-
dency to use external scaffolds with
the same directions repeatedly. How-
ever, faculty can easily alter concept
maps in terms of focus or design (eg,
related to the clients emotional or
teaching needs) for a broader or dif-
ferent picture of cognitive structur-
ing.28 These strategies may give more
information for assisted performance
than mere repetition of the same ap-
proach each week.
Tutoring is an assisted perfor-
mance strategy that, like questioning,
both assesses and assists learning. Ef-
fective tutors rank high in ability to
elaborate, direct, integrate, and stimu-
206
late interaction and student account-
ability. Tutors are more effective when
they stress the learning process rather
than only content.29 Tutors also need
to explore student differences since
one approach will not work for or ben-
efit all students.30 One strategy is to
help students unpack problems they
are having in a course or with testing
so that knowledge can be redirected or
constructed.31 We have expanded our
suggestion for studying with a peer
or tutor to include an initial meeting
with the faculty member as well. In this
meeting, students try to determine
where the difficulty lay when they an-
swered questions incorrectly in a simi-
lar unpacking strategy. With such an
effort, better learning strategies pat-
terns can be reinforced.
Conclusions
The social context and interactive as-
pect of nursing education interfaces
well with constructivist learning per-
spectives in both the classroom and
clinical arenas. By partnering with the
learner in the educational process, the
teacher can optimize the learners
growth, development, and socializa-
tion in professional nursing. Collabo-
rating with learners in the ZPD can fa-
cilitate the learners growth toward
higher levels of potential. In stages 1
(other-assistance) and 2 (self-assistance)
of the ZPD, the role of the teacher is
to construct, reframe, and, eventually,
remove scaffolds to support the
learner in the educational process. Ap-
proaches to assisted performance such
as modeling, feedback, instructing,
questioning, and cognitive structuring
can heighten the learning process. For
the learner to reach stage 3 (internal-
ization), the teacher needs to recog-
nize when to diminish or remove scaf-
folds so that the learner can practice
independently. Scaffolding strategies
may enhance facultys teaching skills.
Faculty can then better prepare quality
nursing professionals in light of diffi-
cult and complex challenges facing
the nursing profession today.
References
1. American Association of Colleges of Nurs-
ing. AACN white paper: faculty shortages
in baccalaureate and graduate nursing
programs: scope of the problem and
strategies for expanding the supply. 2003.
NURSE EDUCATOR Volume 30, Number 5
Available at: http://www.aacn.nche.edu/
Publications/WhitePapers/FacultyShort-
ages.htm. Accessed August 30, 2004.
2. Vygotsky L. Mind and Society: The Devel-
opment of Higher Mental Processes.
Cambridge: Cambridge University Press;
1978.
3. Dunphy B, Dunphy S. Assisted perfor-
mance and the zone of proximal (zpd):
potential framework for providing surgi-
cal education. Available at: http://www.
newcastle.edu.au/journal/ajedp/archives/
papers/v3-dunphy-dunphy.pdf. Accessed
September 13, 2004.
4. Jones M, Brader-Araje L. The impact of
constructivism on education: language,
discourse, and meaning. Am Commun J.
2002;5(3):1.
5. Piaget J. The Origins of Intelligence in
Children. New York: International Uni-
versities Press Inc; 1952.
6. Tharp R, Gallimore R. Rousing Minds to
Life. Cambridge: Cambridge University
Press; 1988.
7. Kotzabassaki S, Panou M, Dimou F,
Karabagli A, Koutsopoulou B, Ikonomou
U. Nursing students and faculty percep-
tions of the characteristics of best and
worst clinical teachers: a replication
study. J Adv Nurs. 1997;26:817-824.
8. Knox E, Mogan J. Important clinical
teaching: perceptions perceived by uni-
versity faculty, students, and graduates. J
Adv Nurs. 1985;10(1):25-30.
9. Nehring V. Nursing clinical teacher effec-
tiveness inventory: a replication study of
best and worst clinical teachers as
perceived by nursing faculty and stu-
dents. J Adv Nurs. 1990;15:934-940.
10. Kroenke K, Omori D. Bedside teaching.
South Med J. 1997;90:1069-1075.
11. Wright S, Carrese J. Excellence in role
modeling: insight and perspectives from
the pros. Can Med Ass J. 2002;167:638-643.
12. Fehser J. Teaching professionalism: a stu-
dents perspective. Mt Sinai J Med.
2002;69:412.
13. Jarzab A. Alternatives to traditional adult
approval. Teach Professor. 2004;18:1.
14. Gallagher L. Positive reinforcement in clin-
ical teaching. Nurs Educ. 1992;17(4):35-36.
15. Greenwood J. Some considerations
concerning practice and feedback in
nursing education. J Adv Nurs. 1993;18:
1999-2002.
16. Offredy M. Decision-making in primary
care: outcomes from a study of patient
scenarios. J Adv Nurs. 2002;40:532-541.
17. Fowler L. Clinical reasoning strategies
used during care planning. Clin Nurs Res.
1997;6:349-361.
18. Price B. Academic voices and the chal-
lenges of tutoring. Nurse Educ Today.
2003;23:628-637.
19. Wells G. The zone of proximal develop-
ment and its implications for learning
and teaching. In: Wells G, ed. Dialogic
September/October 2005
 Inquiry: Towards a Sociocultural Practice
and Theory of Education. New York: Cam-
bridge University Press; 1999. Available at:
http://tortoise.oise.utoronot.ca/~gwells/
resources/ZPD.html. Accessed September
13, 2004.
20. Peer S, McClendon R. Sociocultural learn-
ing theory in practice: implications for
athletic training educators. J Athl Train.
2002;37:136-140.
21. Kreiner D. Guided notes and interactive
methods for teaching with videotapes.
Teach Psychol. 1997;24:183-185.
22. Bodrova E, Leong D. Scaffolding emergent
writing in the zone of proximal develop-
ment. Literacy Teach Learn. 1998;3(2):1-18.
23. Wilen W. Refuting misconceptions about
classroom discussion. Social Studies. 2004;
95(1):33-39.
NURSE EDUCATOR Volume 30, Number 5
24. Cashin W. Answering and asking
questions. Center for Faculty Evaluation
and Development, #31. 1995. Available
at: http://www.idea.ksu.edu. Accessed
September 13, 2004.
25. McClure N. Idea item #2: found ways to
help students answer their own questions.
POD NetworkIDEA Center Notes [serial
online]. 2004. Available at: http://www.
idea.ksu.edu. Accessed September 19,
2004.
26. Sellappah S, Hussey R, Blackmore A,
McMurray A. The use of questioning
strategies by clinical teachers. J Adv Nurs.
1998;28:142-149.
27. Harpaz M, Balik C, Ehrenfeld M. Concept
mapping: an educational strategy for ad-
vancing nursing education. Nurs Forum.
2004;39(2):27-30.
September/October 2005
28. All A, Huycke L, Fisher J. Instructional
tools for nursing education: concept
maps. Nurs Educ Perspect. 2003;6:
311-317.
29. De Grave W, Dolmans D, van der Vleuten
C. Profiles of effective tutors in problem-
based learning: scaffolding student learn-
ing. Med Educ. 1999;33:901-906.
30. Potolsky A, Cohen J, Saylor C. Academic
performance of nursing students: do pre-
requisite grades and tutoring make a dif-
ference? Nurs Educ Perspect. 2003;24:
246-250.
31. Gluck R, Draisama K. Mentoring: a rich
source of information to network and
align student and teacher needs. Avail-
able at: http://cedir.uow.edu.au/CEDIR/
overview/overviewv4n2/index.html. Ac-
cessed September 13, 2004.
207