Electronic learning and constructivism: a model for nursing education

Human anatomy curriculum reform for undergraduate nursing students: An exploratory study

This study aims to cultivate students' independent learning capacity, promote the interdisciplinary integration of "nursing + anatomy," and establish a curriculum system to enhance applied nursing abilities based on project-based teaching reform of everyday clinical nursing operations. A total of 151 second-year (class of 2021) undergraduate nursing students at a Chinese university were selected for this study. By adjusting the curriculum, reconstructing the teaching contents, employing the "hybrid + flip" teaching method based on BOPPPS (bridge-in, outcomes, preassessment, participatory learning, post-evaluation, summary), and implementing a teaching system based on the "three re-three linkage," a Human Anatomy curriculum with a focus on basic anatomical knowledge was developed and connected with nursing clinical operation practice. The restructuring of the course content received unanimous recognition from both the teaching staff and the students. Notably, students in the class of 2021 achieved significantly higher grades than did students in the class of 2020, who received traditional face-to-face instruction (p < 0.01). These results indicate enhanced clinical application skills among the former group of students. following the implementation of instructional reforms during one semester, students exhibited notable improvements in motivation, program implementation, self-management, and interpersonal communication. A statistically significant increase in overall scores for self-directed learning capacities over the preinstructional period was observed (p < 0.05). Furthermore, the findings of the student satisfaction surveys reflected highly favorable perceptions of the enriched instructional format, high levels of course engagement, frequent faculty-student interactions, and augmented overall competence. The practical implementation of the reform in the context of a Human Anatomy course for undergraduate nursing students led to significant positive outcomes, thereby enhancing the effectiveness of teaching and learning. Students' clinical application abilities and self-directed learning capacities notably improved, while overall satisfaction with the course remained high.

Co-design and development of the sit-stand e-guide: An e-training program for the optimal use of sit-stand workstations

This paper describes the co-design and development process of an evidence-informed e-training program (Sit-Stand e-Guide) to support the safe and optimal use of sit-stand workstations from ergonomics and behavioural change perspectives. Using an instructional system design process, supported by a participatory design approach, data was collected through three workshops with workplace consumers (staff [n = 5] and managers [n = 5]), and subject matter experts (n = 5). Content and learning activities were developed based on behaviour change principles and optimal pedagogy. Key topics identified for the e-training were sedentary behaviour and health; workstation set-up; and strategies for behaviour change. Learning activities (scenarios and reflection) to enhance knowledge retention and skills implementation and an interactive one-page guide on completion were included in the e-training. The relevance and usefulness of the training prototype were reviewed through one-to-one think-aloud sessions with the workshop consumers (n = 5) and external health and safety professionals (n = 5) receiving positive feedback. The Sit-Stand e-Guide is readily available for workplace implementation and evaluation. This paper serves as a practical guide for future training development.

Integrative virtual nursing simulation in teaching cardiopulmonary resuscitation: A blended learning approach

BACKGROUND

Online learning resources facilitated educational development during the COVID-19 pandemic. This study focuses on the integration of online virtual simulation with interactive exercises and offline low-fidelity simulation for the first time to explore the impact on CPR skills.

METHODS

First year nursing students from a medical college participated as volunteers in this study. They were divided randomly into two groups with both having a cardiopulmonary resuscitation (CPR) lesson with the same timings and objectives. The experimental group (n = 36) adopted a blended learning method, with virtual simulation and low-fidelity simulation as resources; the control group (n = 36) used the same method without virtual simulation. The same lecturers taught both classes. Students' self-directed learning (SDL) and critical thinking skills were assessed before and after the intervention and their CPR skills were examined afterward.

RESULTS

The experimental group exhibited significantly greater improvement in their SDL abilities and CPR skills. By contrast, we found no statistical differences in their critical thinking abilities.

CONCLUSIONS

During CPR training, blended learning method was used to integrate virtual nursing simulation in teaching, which effectively improved students' SDL and CPR skills.

Development of an educational program for healthcare professionals who provide appearance care for patients with cancer: Feasibility study of an e-learning program

This study aimed to evaluate the feasibility and utility of an e-learning training program to improve healthcare professionals' knowledge about providing appearance care to patients with cancer. Healthcare professionals who provide appearance support were invited to participate voluntarily and complete a survey before and after the program. Participation request letters were distributed to 133 individuals, including 75 from four facilities invited via professional connections, and agreed to participate in the study and 58 participated in the National Cancer Center's appearance care training and indicated an interest in participating in the study. The 100 participants (75.2%) included 96 females, with an average age of 40.5 years. The participants reported high levels of satisfaction with the program, where more than 90% responded "satisfied" or "somewhat satisfied" and eager to use the content they learned in the program when they returned to their workplaces. However, the participants identified several barriers to applying their newly acquired knowledge including lack of knowledge (about 80%). Participant knowledge scores about appearance support were significantly higher after program participation. The survey results indicated the high feasibility of the e-learning program through improved knowledge about appearance care and high satisfaction with the program. The program needs further improvements for its practical utility.

Using the community of inquiry as a framework to promote online teaching and learning in advanced practice nursing education

ABSTRACT

As advanced practice nursing education continues to shift toward a distance and hybrid format, it is important that nurse educators engaged in distance learning create and facilitate an online environment that successfully incorporates critical thinking, problem-solving skills, collaboration, and a sense of community. Although many learning theories and frameworks exist, there is a lack of literature on the applicability of these theories and frameworks to online teaching and learning in advanced practice nursing education. The purpose of this article is to describe the Community of Inquiry (CoI) framework and how it can be applied to online teaching and learning activities in advanced practiced nursing courses. This CoI is an effective framework for online learning and has been successful in promoting student engagement, an important factor in and predictor of academic success.

Psychological therapists' perceptions of adolescent depression and its treatment: A mixed methods online survey

BACKGROUND

Challenges to implementating interventions for adolescent depression exist. Exploring the perceptions of key stakeholders in the treatment of adolescent depression is essential for improving implementation . This study aimed to explore psychological therapists' perceptions of, and experiences treating, adolescent depression to identify future avenues for exploration.

METHOD

Data were collected opportunistically via a survey integrated within an e-learning package about adolescent depression.

RESULTS

Participants believed that adolescent depression was characterised by adolescents' lack of understanding, isolation, and a lack of hope and knowledge. Participants overcame engagement barriers by building trust. Following the e-learning, participants expressed increased understanding of the risk factors associated with adolescent depression and of assessment using different measures. Several key areas for future research to explore were identified and discussed, including (1) whether clinicians of different modalities or at different career stages have difference perceptions, (2) how to meaningfully engage adolescents in treatment and (3) how to train clinicians on different modalities so patients have a choice over their treatment.

CONCLUSION

This study demonstrates the value of knowledge gained from understanding psychological therapists' perceptions and illustrates how this can contribute to the improved treatment of adolescent depression.

Highlighting Effects of Flipped Learning on Mental Health through Metaverse: Moderating Impact of e-learning and Cyber Resilience

Objectives: A metaverse refers to a virtual-reality platform in which users can interact with computer- generated environment, to socialize. It has really enhanced the internet-based and online education. The current study aimed to evaluate the effect of flipped learning on mental health through metaverse. There is a huge potential for expanding learning and knowledge through metaverse, and educational institutions worldwide are evolving to incorporate this concept. To explore the effects of flipped learning on mental health through the metaverse, the study examined the moderating influence of e-learning and cyber resilience by adopting interactive methods in the context of China. Methods: The study employed a quantitative design by conducting surveys from students in Chinese educational institutions. A sample of 350 questionnaires was distributed among the students, out of which 324 complete questionnaires were obtained for further analysis. Results: The findings showed a significant effect of flipped learning on mental health through metaverse. It also exposed the significance of the moderating effect of cyber resilience. In contrast, the moderating effect of e-learning was found to be insignificant between flipped learning through metaverse and students' mental health in Chinese educational institutions. Conclusion: The study provides insightful and practical guidelines for China's education and cybersecurity departments.

Theories informing technology enhanced learning in nursing and midwifery education: A systematic review and typological classification

BACKGROUND

Learning is a complex process involving internal cognitive processes and external stimuli from curricula, pedagogical strategies, and the learning environment. Theories are used extensively in higher education to understand the intricacies of adult learning and improve student outcomes. Nursing and midwifery education uses a range of technology enhanced learning (e-learning) approaches, some of which are underpinned by theoretical frameworks.

OBJECTIVE

Synthesise literature on theories that inform technology enhanced learning in nursing and midwifery education.

DESIGN

A systematic review.

DATA SOURCE

CINAHL, ERIC, MEDLINE and PubMed were searched for relevant studies (2000-2021). Reference lists of related literature reviews were hand searched.

REVIEW METHODS

Title and abstract, followed by full texts were screened by two reviewers independently using predefined eligibility criteria. Quality appraisal was not undertaken. Data were extracted and Merriam and Bierema's typology of adult learning theories used to categorise theories in each study.

RESULTS

Thirty-three studies were included, incorporating twenty-nine distinct learning theories from the behaviourist, cognitivist, constructivist, and social cognitivist domains, with constructivist being the most widely used. Kolb's Experiential Learning Theory and Driscoll's Constructivist Learning Theory were the most commonly reported theories. The population of learners were mainly undergraduate nursing students who used a range of online, mobile, blended or computerised learning, virtual reality, or digital forms of simulation, primarily in university settings. Theories were employed to inform the technology enhanced learning intervention or to help explain how these could improve student learning.

CONCLUSION

This review highlighted a range of theories, particularly constructivist approaches, that underpin research on technology enhanced learning in nursing education, by informing or explaining how these digital interventions support learning. More rigorous research that examines the myriad of theoretical frameworks and their effectiveness in informing and explaining technology enhanced learning is needed to justify this approach to pedagogical nursing research and practice.

Leveraging e-Learning technology to enhance pre-service training for healthcare trainees in Ghana: evidence from a pilot project and pointers to policy reforms

BACKGROUND

E-Learning solutions are increasingly being advocated to augment existing traditional teaching and learning efforts in health training institutions. Unfortunately, these emerging technologies rarely focus on health sciences education within the context of public universities, hence the need for this study. This project evaluated experiences of healthcare trainees with a pilot e-Learning project (SMART e-Learning project) initiated in one of Ghana's public universities in 2017. The study used a mixed methods cross-sectional approach among 363 healthcare trainees. Data collection was between 17th October, 2019 to 3rd December, 2019. Data was analysed descriptively and test for variable differences done using Pearson Chi-square and Fisher's Exact for categorical variables. Wilcoxon Mann-Whitney test was used to test for differences in the Likert scale items. Additionally, rotated varimax factor analysis was performed for the health trainees' rated satisfaction factors.

RESULTS

Out of 446 respondents who consented to participate in the study, 363 responses were complete and valid, representing a response rate of 81 %. Most frequently used e-learning facilities by healthcare trainees were: writing interim assessments (IAs) (82 %) while the least used function was live chating with faculty (5 %). Challenges associated with the e-learning pilot project were: limited workspace in the pilot computer laboratory (33 %), slow internet/intranet speed (29 %) and limited capacity of teaching and ICT staff to support users (28 %).

CONCLUSIONS

There is the need to engage relevant stakeholders at the University, ministries of health and education through policy dialogues to develop statutory e-Learning guidelines for health educational institutions of higher learning to complement existing traditional teaching and learning approaches.

Psychiatric mental health nurse practitioner student perceptions of integrated collaborative care

OBJECTIVES

To explore the outcomes of threading the Patient-Centered Integrated Behavioral Health Care Principles and Tasks Checklist (AIMS Checklist) into the curricula and experiential setting.

METHODS

A qualitative exploratory descriptive method with a constructivist epistemology was used to obtain in-depth student perspectives about their understanding, experiences, and process of applying Integrated Collaborative Care within the clinical setting.

RESULTS

24 Psychiatric Mental Health Nurse Practitioner Students (PMHNP) were divided into focus groups that yielded seven main themes and seven subthemes. Three of the identified themes emerged as opportunities for curriculum enhancement.

CONCLUSIONS

The checklist was found to be a valuable tool in not only evaluating collaborative care but in closing the gap between didactic and clinical education in fostering student-preceptor discussion.

Forcing a change: a learn-by-doing workshop on circadian rhythms to understand the complexities of human physiology

Physiology is an integrative science that requires an understanding of the organism as a whole to acquire a deep comprehension of its functions and avoid misconceptions that may impair further learning. Thus it is necessary to develop resources that promote the integrative vision that Physiology requires. Chronobiology is a challenging discipline and one of the least addressed concepts in Physiology curricula. The activity here presented proposes a workshop with a theoretical-practical perspective in the context of the Neuroscience Conferences held annually at our university. All conference presentations are neuroscience-related topics, in combination with practical activities, some of them analyzing variables of the students themselves. We chose to assess this informal teaching scenario to involve the students with a scientific perspective while learning and hoping to increase their appreciation for different topics related to neuroscience. Specifically for this activity on chronobiology, the evaluation was carried out via a survey study including quantitative and qualitative questions and semistructured personal interviews. In general, the results reveal a very positive opinion from students regarding aspects such as the teaching methodology, the organization before and during the activity or the added value of the experience for their future professional performance. Some of the students stated they were more aware of the importance of their circadian system and even changed some of their personal daily routines after the activity. Such positive feedback encourages us to continue working in this theoretical-practical format in the future, as it contributes to improving students' perception of their own learning.

The value co-creation behavior in learning communities: Comparing conventional learning and e-learning

With the rapid development of ICT, the present world is experiencing rapid changes in the field of education. Implementation of e-learning and ICT in the education system could allow teachers to upgrade and improve their lectures. However, from the perspective of value co-creation behavior in learning communities, conventional learning and e-learning classrooms may encounter different opportunities and challenges. Thus, a more in-depth investigation would be needed. Based on the S-O-R framework, this study identifies self-directed learning as a stimulus, perceived benefits as the organism, and value co-creation behavior as the response. By applying the multi-criteria decision-making techniques of DEMATEL, ANP, and VIKOR, this study explores the causal effects, influential weights, and performance ranking of the primary constructs in the framework as criteria. This study's theoretical and practical implications are discussed, and ways of improving learning performance are suggested.

Preregistration adult nursing students' experiences of online learning: a qualitative study

BACKGROUND

Online learning (OL) is widely used in UK preregistration nursing programmes and the latest Nursing and Midwifery Council professional education standards state digital technology must be embedded in the curriculum. An exploration of preregistration adult nursing students' experiences of OL considers how technology supports learning theory and practice, and assists in designing and delivering effective OL in future programmes.

AIM

This study aimed to explore preregistration adult nursing students' OL experiences.

METHOD

Two focus groups with students were held and thematic analysis carried out.

FINDINGS

Three main themes emerged regarding OL: advantages, disadvantages and preferences. The main advantages included time, accessibility and convenience, being able to revisit learning and the variety of approaches. Disadvantages included inadequate communication, support and interaction. Students preferred an adequate balance of OL with traditional teaching, more communication, synchronous OL, preparation and support.

CONCLUSION

OL is valuable to adult nursing students, providing convenience and flexibility. While it has advantages, the disadvantages and preferences require addressing to ensure future programmes are effective and meet nursing students' requirements.

Effects of a blended emergent research training programme for clinical nurses on nursing research competence and critical thinking (Part 2): A quasi-experimental study

AIMS AND OBJECTIVES

To evaluate the effects of a blended emergent research training programme for clinical nurses on research competence and critical thinking.

BACKGROUND

With the development of the nursing discipline and evidence-based nursing practice, nursing research competence is increasingly important for clinical nurses. Current nursing research training programmes cannot meet the needs of clinical nurses.

DESIGN

A quasi-experimental study.

METHODS

A total of 104 clinical nurses from two tertiary hospitals participated in this study. The intervention group received a blended emergent research training programme for clinical nurses, and the control group received no intervention. Nursing research competence and critical thinking were measured at baseline, after the intervention and three months after the intervention. The satisfaction with the training of clinical nurses in the intervention group was also measured after the intervention. Generalised linear mixed models were used to evaluate the effects of the intervention on outcome variables. Qualitative data were analysed by two researchers using the content analysis method. Our reporting complies with the TREND checklist.

RESULTS

The blended emergent research training programme for clinical nurses finally showed positive effects on nursing research competence and critical thinking. The effects lasted until three months after the training programme. 'Learner-centred Training', 'Skilled Trainers', 'Encouraging Training Environment' and 'Positive Outcomes' are the main categories generated from the qualitative data.

CONCLUSION

The blended emergent research training programme for clinical nurses could be used for clinical nurses' research education to improve their nursing research competence and critical thinking.

RELEVANCE TO CLINICAL PRACTICE

The blended emergent teaching method could be considered as an effective method to provide an encouraging learning environment and promote learner-centred teaching for clinical nurses. The blended emergent research training programme could be used to improve nursing research competence and critical thinking of clinical nurses which are important for evidence-based nursing practice.

The Relationship Between the Grading of Reflective Journals and Student Honesty in Reflective Journal Writing

AIM

The aim of this study was to examine the existence of a relationship between the grading of reflective journals and student honesty in reflective journal writing.

BACKGROUND

Journal writing is often used to gauge skills and knowledge. However, disagreement exists as to whether journals should be graded as students may embellish experiences or write what the instructor wants to read. If students are not engaged in honest reflection, the benefit of reflective practice is reduced.

METHOD

Data were collected using an anonymous online survey. The nonprobability sampling technique was used to examine the existence of a relationship between the grading of reflective journals and student honesty in reflective journal writing.

RESULTS

Findings indicated a statistically significant positive relationship between grading of reflective journals and student honesty.

CONCLUSION

Instead of grading the written component, the process of reflective practice should be assessed, possibly changing to a grade of complete/incomplete.

E-learning cultural competence for public health workers: A feasibility and pilot study

OBJECTIVE

To describe the development, feasibility, and preliminary efficacy of a seven-module e-learning for enhancing cultural competence of public health workers.

DESIGN

The study was based on the framework of the new Medical Research Council; a mixed methods design was used.

SAMPLE

A four-week pilot cluster-randomized controlled trial was conducted with 39 public health workers and 74 migrants in South Korea. Feasibility and preliminary efficacy were assessed according to initiation, retention, adherence, usability, acceptability, individual and organizational cultural competence, and migrant trust and satisfaction. Quantitative data were collected at baseline, 4 weeks, and 12 weeks. Focus group interviews were conducted with eight public health workers at 12 weeks.

RESULTS

Initiation, retention, and adherence rates were high. Participants agreed on acceptability, but exhibited mixed results on usability. Participants were satisfied with "well-structured content," "authentic case stories and videos," "increased interest in migrant care," and "opportunity for self-reflection." However, "flawless and trouble-free system," "screen design for easy navigation," "instructor's expertise," and "more situational cases and videos" were desired. Statistically significant differences were observed for individual cultural competence, migrant trust, and satisfaction.

CONCLUSION

Generally, the intervention seems feasible and has preliminary efficacy, yet usability improvement is necessary for full-scale randomized controlled trials.

A blended learning teaching strategy strengthens the nursing students' performance and self-reported learning outcome achievement in an anatomy, physiology and biochemistry course - A quasi-experimental study

In nursing, bioscience is regarded as one of the cornerstones of nursing practice. However, bioscience disciplines as anatomy, physiology and biochemistry are considered challenging for students and the failure rate is high. In this study we explore a blended learning teaching strategy in an anatomy, physiology and biochemistry course for first year Bachelor nursing students. In the blended learning teaching strategy, short narrated online digital resources of bioscientific terms and concepts were integrated into the teaching design along with digital metacognitive evaluations of learning outcomes. Results show that compared to students receiving traditional face-to-face teaching, the students with a blended learning approach performed better on their national exam with a small to medium effect size (Cohen's d=0.23). Student course evaluations supported the blended learning delivery with small to medium effect sizes. The students reported that the digital resources supported their learning outcome achievement, that they better understood the teacher's expectations and that they were more satisfied with their virtual learning environment. This study adds to the growing literature of blended learning effectiveness in higher education, and suggests the use of digital resources as an enrichment of teaching and enhancement of students' study experience.

Supporting culturally and linguistically diverse (CALD) undergraduate nursing students undertaking clinical placements in Australia: An exploratory qualitative study of clinical facilitator and CALD student perceptions

BACKGROUND

Internationalisation of higher education has contributed to the increasing number of culturally and linguistically diverse students in higher education programs worldwide. While there is some literature on the experiences and needs of these students, there is little evidence on what resources can be used to support these students when learning in the clinical setting.

AIM

This study aimed to evaluate the usefulness of an existing handbook developed for clinical facilitators to enhance culturally and linguistically diverse nursing students' learning, and to explore the facilitator and student perceptions of their clinical placement support needs.

DESIGN

This exploratory qualitative study, involving culturally and linguistically diverse Bachelor of Nursing students and clinical educators, was conducted in a multi-campus School of Nursing and Midwifery at Griffith University, Australia, in collaboration with health services. Focus groups and individual interviews with clinical facilitators and culturally and linguistically diverse nursing students were conducted. Activity theory provided the conceptual framework for this study and the qualitative data analysis was informed by grounded theory.

RESULTS

Clinical facilitator focus groups and interviews generated three themes: understanding culturally and linguistically diverse students' needs; supporting culturally and linguistically diverse students; and improving learning resources for facilitators and students. Student focus groups generated three themes: wanting to be more prepared for clinical placement; feeling supported by facilitators and interacting with others in a different context; and creating resources to support learning.

CONCLUSIONS

Supportive clinical environments are key to the work-integrated learning success of culturally and linguistically diverse nursing students. The findings of this qualitative research study, involving clinical educators and culturally and linguistically diverse Bachelor of Nursing students identify the pressing need to develop readily accessible resources to support the clinical learning of culturally and linguistically diverse students and their educators. Resources development should be attentive to complexities at the intersection of workplace culture and students' developing understanding.

Assessing the preparedness and feasibility of an e-learning pilot project for university level health trainees in Ghana: a cross-sectional descriptive survey

BACKGROUND

Ghana is challenged with shortage of critical human resources for health particularly nurses and midwives in rural hard-to-reach communities. This shortage potentially hinders efforts towards attaining universal access to basic healthcare. More importantly, poor quality of pre-service training for health trainees has the potential to worsen this predicament. There is therefore the need to leverage emerging digital innovations like e-learning to complement existing efforts. This study was conducted several months before the outbreak of COVID-19 to investigate the preparedness, acceptability and feasibility e-learning innovation for nursing and midwifery trainees.

METHODS

The study is a cross-sectional descriptive survey involving nursing and midwifery students (n = 233) in one of Ghana's public universities, located in the Volta region of Ghana. Simple random sampling technique was used to collect responses from eligible respondents using a structured questionnaire. Descriptive statistical analysis was done using STATA software (version 12.0).

RESULTS

It was found that nearly 100% of respondents owned smartphones that were used mostly for learning purposes including sharing of academic information. Over 70% of respondents particularly used social media, social networking applications and internet searches for learning purposes. Health trainees were however constrained by low bandwidth and lack of seamless internet connectivity within their learning environments to maximize the full benefits of these e-learning opportunities.

CONCLUSION

Respondents were predominantly prepared for an e-learning pilot project. These feability findings suggest e-learning is a huge potential that can be used to augment existing approaches for pre-service training of health trainees in Ghana, when implementation threats are sufficiently addressed. Compelling findings of this study are therefore timely to inform evidence-based policy decisions on innovative digitial solutions for pre-service training of health workforce even as the world adapts to the "new normal" situation induced by COVID-19.

Enhancing Teaching in Biomedical, Health and Exercise Science with Real-Time Physiological Visualisations

Muscle physiology constitutes a core curriculum for students and researchers within biomedical, health and exercise science disciplines. The variations between skeletal and smooth muscle, mechanisms underlying excitation-contraction coupling, as well as the relationships between muscle anatomy and physiology are commonly taught from illustrations, static models or textbooks. However, this does not necessarily provide students with the required comprehension surrounding the dynamic nature of muscle contractions or neuromuscular activities. This chapter will explore alternative methods of visualising skeletal and smooth muscle physiology in real-time. Various recording hardware, isolated tissues bath experiments, neurophysiological applications and computer-based software will be discussed to provide an overview of the evidence-based successes and case studies for using these techniques when assisting students with their understanding of the complex mechanisms underlying muscle contractions.

Attitudes and concerns of undergraduate university health sciences students in Croatia regarding complete switch to e-learning during COVID-19 pandemic: a survey

BACKGROUND

Croatia has closed all educational institutions after 32 cases of SARS-CoV-2 infection were confirmed and switched to exclusive e-learning. Health sciences university students may have been particularly affected with this change due to a lack of practical education. It is not known how health sciences students and schools have adjusted to exclusive e-learning. This study aimed to explore attitudes and concerns of health sciences students in Croatia regarding the complete switch to e-learning during the COVID-19 pandemic.

METHODS

Eligible participants were students from 9 institutions offering university-level health sciences education in Croatia enrolled in the academic year 2019/2010, and participating in e-learning. Data were collected with a questionnaire distributed via email during April/May 2020.

RESULTS

A total of 2520 students (aged 25.7 ± 7.7 years) responded to the questionnaire (70.3% response rate). General satisfaction with exclusive e-learning was rated with average grade of 3.7 out of 5. Compared with previous education, exclusive e-learning was rated with average grade of 3.2 out of 5. Compared to classroom learning, equal or higher motivation to attend exclusive e-learning was reported by 64.4% of participants. With a longer duration of exclusive e-learning, equal or higher motivation was reported by 65.5% of participants. Less than half of the students indicated they felt deprived or concerned due to the lack of practical lessons. Most participants indicated that in the future, they would prefer to combine classic classroom and e-learning (N = 1403; 55.7%).

CONCLUSIONS

Most health sciences students were satisfied with the exclusive e-learning, as well as their personal and institutional adjustment to it. Students' feedback can help institutions to improve the exclusive e-learning experience for students in the time of the pandemic.

Developing professional education for primary healthcare providers about nutrition

Nutrition care is an important component of primary health care as a way to promote positive lifestyle behaviours and reduce risks of chronic disease. Despite this, it appears that primary healthcare settings, including antenatal care, miss opportunities to deliver nutrition care. Time constraints, lack of nutrition knowledge and lack of confidence have been identified as barriers for primary healthcare providers in delivering nutrition care. Nutrition training to upskill primary healthcare providers to deliver nutrition care in a timely manner therefore appears warranted. This forum article discusses models and methods of continuing professional development (CPD) and the effectiveness of nutrition CPD for primary healthcare professionals. It includes a case study as an example of developing nutrition CPD for midwives using adult learning theory and concludes with implications for developing nutrition education resources for primary healthcare providers.

Translating facilitated multimodal online learning into effective person-centred practice for the person living with dementia among health care staff in Australia: an observational study

BACKGROUND

This paper aims to identify whether health care staff perceive a 12-week online facilitated, multimodal, person-centred care, dementia education program influences their knowledge, skills, behaviour and practice improvement activities in dementia care. In particular it will examine a dementia education program 'Positive Approach to Care of the Older Person with Dementia' (The Program).

METHODS

Three clusters of online questions were developed. Participants completed the first cluster at course completion (N = 1455;2013-2016). The second cluster was added into the 2015-2016 exit-surveys to measure clinical practice improvement (CPI) activities implementation (N = 520). Thirdly, all participants were invited to a 2018 follow-up survey (N = 343). The Program was also matched with key factors that are likely to result in effective online dementia education programs.

RESULTS

The Program had a 78% completion rate. At course completion (2013-2016, N = 1455), 62% felt that the online forums generated useful discussion and 92% thought their work would support implementing their new knowledge and skills. In 2015-16, participants (N = 520) reported that The Program had influenced their practice in terms of new knowledge (87%), understanding (87%), awareness (88%), and new ideas about delivering dementia care (80%). Almost all (95%) participants indicated they had changed 'an aspect of their own professional practice'. Sixty-three percent had planned to develop a CPI activity. Of those (N = 310), 40% developed a new or improved tool and 21% planned to deliver education or create new resources. The most common CPI activities reported in the 2018 follow-up survey (N = 343) included education (49%) and role modelling of new behaviour (47%). Additionally, 75% indicated their CPI influenced their practice and had influenced patients (53%) and colleagues (53%). Fifty-seven percent reported their projects were sustained for 12 months or more.

CONCLUSION

The Positive Approach to Care of the Older Person with Dementia education program can potentially improve training the dementia workforce. Participants perceived that a multimodal online platform facilitated by clinical champions influences knowledge transfer, skills and behaviour, encourages workplace CPI activities. Further effort could be directed towards empowering and supporting care staff on system, procedure and practice change and engaging management to translate training activities into practice.

Promoting student engagement and academic achievement in first-year anatomy and physiology courses

Students from three undergraduate programs at James Cook University, Queensland, Australia, studying combined first-year anatomy and physiology courses, showed different academic achievement in physiology. Physiotherapy students were more active and social when completing learning tasks and achieved significantly higher grades in physiology compared with students enrolled in Sport and Exercise Science and Occupational Therapy programs. To promote academic engagement and achievement by all three groups, discussion questions, case studies, and study guides were included. The aim of this study was to investigate the effectiveness of using these modified resources to promote active learning, enhance academic social interactions, and provide a supportive learning environment. The occupational therapy students showed increased academic achievement (from 57.9 to 66.5%) following implementation of the new resources, but there was no change in the already high-performing physiotherapy students (73.1%) and, more concerningly, the sport and exercise science students (from 54.6 to 56.7%). Fewer sport and exercise science students had prior learning in chemistry (30.4% of participants) and also spent little time outside class studying (8 h/wk), compared with the physiotherapy cohort (70.0% chemistry; 13 h/wk studying). Findings of this research demonstrate that creating a supportive and active learning environment are important factors in promoting the learning of physiology for some cohorts. Background knowledge, academic self-regulatory skills, and the experience of teaching staff are factors that must be considered when endeavoring to increase student academic achievement. Future studies should examine the effect of students' academic self-regulation and the use of remedial chemistry classes when learning physiology.

Theoretical foundations of educational strategies used in e-learning environments for developing clinical reasoning in nursing students: A scoping review

E-learning environments expand opportunities for the use of educational strategies that may contribute to the development of clinical reasoning in nursing students. The purposes of this scoping review were the following: 1) to map the principles of cognitive companionship and the theoretical foundations underlying the design and implementation of educational strategies used in e-learning environments for developing clinical reasoning in nursing students; and 2) to identify the types of educational strategies used in e-learning environments for developing or assessing clinical reasoning in nursing students. A scoping review was conducted and was based on the Joanna Briggs Institute Framework. Bibliographical databases were searched for studies published between January 2010 to July 2017. Out of 1202 screened articles, 18 met eligibility criteria and were included in this review. Principles of cognitive companionship in e-learning environments provide key clues from a learning support perspective, such as integrated feedback, interactive group discussion, gaming, and questioning. However, theoretical foundations underlying educational strategies in e-learning environments are poorly documented and insufficiently associated with cognitive learning models. E-learning environments must have solid theoretical foundations to provide support for the development of CR in nursing students.

Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning

Background

With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes.

Objective

The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students’ learning outcomes on interprofessional competencies.

Methods

A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities—Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)—after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students’ learning outcomes on interprofessional competencies.

Results

A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence “WI-VR-SE” as their top preference.

Conclusions

This study shows that the instructional sequence of a blended learning approach can have a significant impact on students’ learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students’ learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.

Use of online asynchronous discussion boards to engage students, enhance critical thinking, and foster staff-student/student-student collaboration: A mixed method study

BACKGROUND

The ongoing challenges of managing large student enrolments and increasing demand from students for online learning platforms and teaching strategies has helped drive tertiary implementation of asynchronous online discussion boards (AOD). However, supporting and assessing students in such a forum remains contentious.

METHODS

This explorative, mixed methods study examined and evaluated the usage and perceptions of a unique form of AOD used in a postgraduate nursing course. Student survey and semi-structured interviews with staff (n = 3) were used to explore the structures, processes and outcomes of inclusion of an AOD in this online course. Triangulation of themes emerging from the staff interviews, survey outcomes, and student free text responses enabled appraisal of AOD, focusing primarily on its contribution to course content and assessment.

RESULTS

Students' survey responses (approx. 24% of the cohort; n = 34) were largely positive. Themes that arose from the qualitative data included i) AOD to build a sense of student community, ii) AOD to encourage interaction with and deliberation of course content, iii) stimuli and challenges around assessing the discussion board, and iv) easy to use IT interface made it a more positive experience. Student responses suggested that scaffolding, feedback and sufficient time allocation were required. Many factors impacted on student interaction with the AOD, including a lack of time due to paid work and other coursework and assessments.

DISCUSSION

Overall, staff and students reported the assessed AOD was a positive course component. It encouraged engagement with staff, other students and the subtleties of complex course content, critical appraisal and discussion of evidence, and application to clinical practice. Exemplars and explicit marking criteria setting out the need for informed contributions were considered crucial by all stakeholders.

The 360-degree evaluation model: A method for assessing competency in graduate nursing students. A pilot research study

BACKGROUND

The 360 Degree Evaluation Model is one means to provide a comprehensive view of clinical competency and readiness for progression in an online nursing program.

OBJECTIVES

This pilot project aimed to evaluate the effectiveness of implementing a 360 Degree Evaluation of clinical competency of graduate advanced practice nursing students.

DESIGN

The 360 Degree Evaluation, adapted from corporate industry, encompasses assessment of student knowledge, skills, behaviors and attitudes and validates student's progression from novice to competent.

SETTINGS

Cohort of advanced practice nursing students in four progressive clinical semesters.

PARTICIPANTS

Graduate advanced practice nursing students (N = 54).

METHODS

Descriptive statistics and Jonckheere's Trend Test were used to evaluate OSCE's scores from graded rubric, standardized patient survey scores, student reflection and preceptor evaluation.

RESULTS

We identified all students passed the four OSCEs during a first attempt or second attempt. Scaffolding OSCE's over time allowed faculty to identify cohort weakness and create subsequent learning opportunities. Standardized patients' evaluation of the students' performance in the domains of knowledge, skills and attitudes, showed high scores of 96% in all OSCEs. Students' self-reflection comments were a mix of strengths and weaknesses in their self-evaluation, demonstrating themes as students progressed. Preceptor evaluation scores revealed the largest increase in knowledge and learning skills (NONPF domain 1), from an aggregate average of 90% in the first clinical course, to an average of 95%.

CONCLUSIONS

The 360 Degree Evaluation Model provided a comprehensive evaluation of the student and critical information for the faculty ensuring individual student and cohort data and ability to analyze cohort themes.

Using reusable learning objects (RLOs) in wound care education: Undergraduate student nurse's evaluation of their learning gain

BACKGROUND

Both nationally and internationally concerns have been expressed over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. This project describes the educational evaluation of a series of Reusable Learning Objects (RLOs) as a blended learning approach to facilitate undergraduate nursing students learning of wound care for competence development. Constructivism Learning Theory and Cognitive Theory of Multimedia Learning informed the design of the RLOs, promoting active learner approaches. Clinically based case studies and visual data from two large university teaching hospitals provided the authentic learning materials required. Interactive exercises and formative feedback were incorporated into the educational resource.

METHODS

Evaluation of student perceived learning gains in terms of knowledge, ability and attitudes were measured using a quantitative pre and posttest Wound Care Competency Outcomes Questionnaire. The RLO CETL Questionnaire was used to identify perceived learning enablers. Statistical and deductive thematic analyses inform the findings.

RESULTS

Students (n=192) reported that their ability to meet the competency outcomes for wound care had increased significantly after engaging with the RLOs. Students rated the RLOs highly across all categories of perceived usefulness, impact, access and integration.

CONCLUSION

These findings provide evidence that the use of RLOs for both knowledge-based and performance-based learning is effective. RLOs when designed using clinically real case scenarios reflect the true complexities of wound care and offer innovative interventions in nursing curricula.

Conventional vs. e-learning in nursing education: A systematic review and meta-analysis

BACKGROUND

By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce.

OBJECTIVES

The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning.

METHODS

A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome.

RESULTS

Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large.

CONCLUSIONS

The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.

Use of Social Media By Nurse Educator Students: An Exploratory Survey

BACKGROUND

Information and Communication Technology (ICT) opens up new possibilities for introducing innovative teaching and learning methods to deliver education in different educational areas. Use of internet and social media has grown rapidly and is a key way in how nurses and nurse educator students find information. However, the evidence is still lacking how nurse educator students use social media.

OBJECTIVE

The aim of this study is to describe nurse educator students' use of social media and the ways in which their educational needs are related to social media.

METHOD

The data were collected using a structured questionnaire that included one open question. Altogether, 49 nurse educator students completed and returned the questionnaire (response rate 96%). The quantitative data were analysed using statistical programme SPPS and content analysis.

RESULTS

While many nurse educator students reported using the tools of social media, others claimed that they do not use social media at all. Facebook was most common (53% use it every day) and YouTube (17%) the second most common form of social media used to support daily living. The participants reported using YouTube (6% use it every day) and Facebook (4%) most often as support in their studies. They reported using Second life as virtual reality form of social media, the least. The most common educational needs of nurse educator students include receiving more in-depth information about how to use social media, as well as more practice in using it.

CONCLUSION

In the future, the education of the nurse educator students should include even more in-depth information about the forms of social media and about the advantages of using it in teaching. The education should encourage nurse educator students and provide them with more possibilities to train and make use of the benefits of social media as support in their daily lives and studies. There is need for more robust evidence of social media use in nurse educator students education.

Learning Theory Support of Simulation to Improve Nurses' Care of Critically Ill Patients

Simulation, as a conduit to apply both adult and constructivist learning theory, is an important educational modality in nursing professional development. The use of simulation is well studied in the academic setting, but evidence supporting its use in the practice environment is lacking. This educational quality improvement project provides a road map for designing and implementing simulation to meet the educational needs of practicing nurses.

Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study

BACKGROUND

Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers.

OBJECTIVE

The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses' perceived brief MI skills and self-reported clinical use of brief MI.

METHODS

We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients' motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session.

RESULTS

We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%-91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0-7), perceived ease of use (mean 6.16, SD 0.78; scale 0-7), and system quality (mean 6.15, SD 0.58; scale 0-7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10-50). Other results were nonsignificant.

CONCLUSIONS

Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx).

A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

OBJECTIVE

The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital.

DESIGN

Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting.

SETTING AND PARTICIPANTS

Senior medical students at an international medical school in the Middle East.

RESULTS

Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside.

CONCLUSIONS

Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner.

Effectiveness of the training material in drug-dose calculation skills

AIM

The aim of study was to evaluate the effectiveness of the training material based on low-level environmental fidelity simulation in drug-dose calculation skills in senior nursing students.

METHODS

A quasi-experimental design with one group. The sample included senior nursing students attending a nursing school in Turkey in the period December 2012-January 2013. Eighty-two senior nursing students were included in the sample. Data were obtained using a data collection form which was developed by the researchers. A paired-sample t-test was used to compare the pretest and post-test scores.

RESULTS

The difference between the mean pretest score and the mean post-test score was statistically significant (P < 0.05).

CONCLUSION

This study revealed that the training material based on low-level environmental fidelity simulation positively impacted accurate drug-dose calculation skills in senior nursing students.

How can students contribute? A qualitative study of active student involvement in development of technological learning material for clinical skills training

Background

Policy initiatives and an increasing amount of the literature within higher education both call for students to become more involved in creating their own learning. However, there is a lack of studies in undergraduate nursing education that actively involve students in developing such learning material with descriptions of the students’ roles in these interactive processes.

Method

Explorative qualitative study, using data from focus group interviews, field notes and student notes. The data has been subjected to qualitative content analysis.

Results

Active student involvement through an iterative process identified five different learning needs that are especially important to the students: clarification of learning expectations, help to recognize the bigger picture, stimulation of interaction, creation of structure, and receiving context- specific content.

Conclusion

The iterative process involvement of students during the development of new technological learning material will enhance the identification of important learning needs for students. The use of student and teacher knowledge through an adapted co-design process is the most optimal level of that involvement.

Access to, interest in and attitude toward e-learning for continuous education among Malaysian nurses

BACKGROUND

Continuous nursing education (CNE) courses delivered through e-learning is believed to be an effective mode of learning for nurses. Implementation of e-learning modules requires pre-assessment of infrastructure and learners' characteristics. Understanding the learners' needs and their perspectives would facilitate effective e-learning delivery by addressing the underlying issues and providing necessary support to learners.

OBJECTIVE

The aim of this study was to examine access to computer and Internet facilities, interest in and preferences regarding e-learning, and attitudes toward e-learning among nurses in Peninsular Malaysia.

DESIGN

The study utilized a cross-sectional descriptive survey.

SETTING

Government hospitals and community clinics in four main regions of Peninsular Malaysia.

PARTICIPANTS

A total of 300 registered nurses.

METHOD

Data were collected using questionnaires, which consisted of demographic and background items and questions on access to computer and Internet facilities, interest and preferences in e-learning, and attitudes toward e-learning. Descriptive analysis and a chi-squared test were used to identify associations between variables.

RESULTS

Most Malaysian nurses had access to a personal or home computer (85.3%, n=256) and computer access at work (85.3%, n=256). The majority had Internet access at home (84%, n=252) and at work (71.8%, n=215); however, average hours of weekly computer use were low. Most nurses (83%, n=249) did not have an e-learning experience but were interested in e-learning activities. Most nurses displayed positive attitudes toward e-learning. Average weekly computer use and interest in e-learning were positively associated with attitudes toward e-learning.

CONCLUSION

Study findings suggest that organizational support is needed to promote accessibility of information and communications technology (ICT) facilities for Malaysian nurses to motivate their involvement in e-learning.