When practice precedes theory - A mixed methods evaluation of students' learning experiences in an undergraduate study program in nursing

Comparison of blended learning and traditional lecture method on learning outcomes in the evidence-based medicine course: a comparative study

BACKGROUND

Blended learning comprised with flipped classroom (FC) and "internet plus" is a new learning strategy that reverses the position of teacher and students in class, and provides abundant learning resources before and after class. This study aimed to assess the impact of blended learning on learning outcomes in evidence-based medicine course, and compare with traditional learning method.

METHODS

The participants of the two groups were from two difference cohorts in Air force medical university in China. The two groups toke the same pre-test before class and then were given the teaching of same chapters of evidence-based medicine with two different learning strategy. In the blended learning group, the participants were required to create a debriefing slide about their learning outcomes and the answers of questions given in advance after study the learning material sent by teacher a week before class, and the teacher gave a detailed summary based on the common problems, and distributed multimedia resources for review. After the experiment was carried out, learning outcomes including mastering knowledge, learning satisfaction, and self-evaluation were compared.

RESULTS

37 and 39 participants were enrolled to blended learning and traditional learning groups, respectively, and no statistically significant difference were found in baseline information and pre-test grades. Statistically significant differences were found in learning outcomes including post-test score (t = 2.90, p = 0.005), changes of scores between pre-test and post-test (t = 2.49, p = 0.022), learning satisfaction (t = 12.41, p = 0.001), and self-evaluation of the two groups (t = 7.82, p = 0.001). Especially, the changes of scores between pre-test and post-test of blended learning and traditional learning groups were 4.05 (4.26), and 2.00 (2.85), respectively.

CONCLUSIONS

This study showed that compared with traditional learning strategy, blended learning can effectively enhanced participants' acquisition of knowledge, learning satisfaction, and self-evaluation in evidence-based medicine. Using blended learning method including "internet plus" and flipped classroom is recommended in the teaching of evidence-based medicine course.

Perspectives on self-directed learning in bioscience in nurse education - An integrative review

OBJECTIVES

There is a lack of synthesized knowledge on nursing students self-directed learning in bioscience and how to best support students' learning in this subject. The purpose of this integrative review is to synthesize current literature on perspectives on self-directed learning among nursing students studying bioscience to guide further research aiming to support students' learning more effectively.

METHODS

An integrative review in line with Whittemore & Knafl's modified framework containing five stages: problem identification, literature search, data evaluation, data analysis and presentation. A structured literature search was undertaken in the Web of Science, ERIC, Medline and CINAHL databases from November 2022 to January 2023. The inclusion criteria were nursing students enrolled in a bachelor programme, research addressing activities intended for learning bioscience, in addition to formal taught lectures and perspectives on self-directed learning in natural science subjects within nurse education such as views, actions, activities, habits and attitudes. Exclusion criteria were students in other education programs, research in formal learning contexts, and self-directed learning in other subjects than natural science subjects. Rigour of each included source was assessed using Whittemore & Knafl's suggested 2-point scale (high or low). A constant comparison method was used to synthesize results.

RESULTS

Of the initial 1143 sources, 12 articles were included after abstract and full-text screening: one pilot study for randomized controlled trial, one qualitative study, two mixed methods studies and eight quantitative studies. The sample size was from 23 to 563 participants.

DISCUSSION

This review identifies self-directed learning in bioscience understood as a continuum of teacher-directedness and self-directedness rather than as distinguished orientations. There seem to be no consistent definition of self-directed learning in bioscience, yet descriptions commonly imply metacognitive learning approaches. Nursing students value digital learning resources, yet technology might be secondary to the skill of self-directed learning.

How nurses perceive the gap between knowledge and practice

BACKGROUND

Identifying nurses' perceptions of the knowledge-practice gap is a critical step toward developing evidence-based practice. Currently, multiple factors contribute to the gap between nursing education and actual practice. Addressing this gap requires a new perspective, not yet adequately represented in the literature, that includes nurses' perceptions.

AIM

This study aims to describe nurses' perceptions of the knowledge-practice gap in the domains of knowledge, practice, environment, and learning. And it analyzes how nurses' professional characteristics are associated with their perceptions of the gap in each of these domains as well as the relationships between the domains themselves.

METHODS

The study used a cross-sectional descriptive correlational design. A sample of 513 staff nurses recruited through a convenience sampling technique provided information on professional variables such as education and experience and completed a Likert-scale survey about their perceptions of the knowledge-practice gap.

RESULTS

Their answers were found to vary with educational level and history of workshop attendance. Items from the knowledge domain were positively and significantly correlated with items from the environment and learning domains, which were also positively and significantly correlated with each other. However, the knowledge and practice domains were not significantly correlated. In addition to showing correlations among the major domains (or aspects) of the knowledge-practice gap, the study highlights how nurses' professional characteristics contribute to differences in their perceptions of this gap.

CONCLUSION

These findings can guide hospital-specific measures for bridging the gap. In addition, the scale can be employed by leaders as a tool for the purpose of conducting assessments.

Implementation of a virtual student placement to improve the application of theory to practice

BACKGROUND

The primary aim of undergraduate, pre-registration nursing education is to prepare students to be nurses who can apply theory to practice, with clinical placements to support the practice element of the clinical programme. However, the theory-practice gap is a longstanding problem within nurse education, as nurses continue to practise with incomplete knowledge to support their actions.

PROBLEM

In April 2020, the COVID-19 pandemic caused a reduction in clinical placement capacity that affected student learning opportunities.

APPROACH

Based on Miller's pyramid of learning, a virtual placement was created using evidence-based learning theories and an array of multimedia technologies with the intention of replicating real-life experiences and promoting problem-based learning. Scenarios and case studies were collated from clinical experiences and mapped against student proficiencies to produce an authentic and immersive learning environment.

CONCLUSION

This innovative pedagogy provides an alternative to the placement experience while enhancing the application of theory to practice.

Perceived parenting style and Chinese nursing undergraduates' learning motivation: The chain mediating roles of self-efficacy and positive coping style

AIM

The aim of this study was to examine the chain mediating effects of self-efficacy and positive coping style on the relationship between parenting style and learning motivation in Chinese nursing students.

BACKGROUND

Despite the abundance of literature that focuses on learning motivation, there is a lack of research that accurately and thoroughly examines the factors that influence learning motivation among nursing students.

DESIGN

This study involved a cross-sectional design.

METHODS

In total, 677 Chinese undergraduate nursing students completed the parental bonding instrument, the general self-efficacy scale, the simplified coping style questionnaire, and the learning motivation scale. A structural equation model was performed with AMOS 26.0 to explore the influence paths of variables and the mediating effects of self-efficacy and coping style.

RESULTS

Parental care positively predicted intrinsic learning motivation directly or indirectly through the mediating effects of self-efficacy (B = 0.17, 95% CI: 0.12-0.23) and positive coping style (B = 0.03, 95% CI: 0.01-0.06), and this mediating effect contributed 54.06% of the total effect. Parental encouraging autonomy positively predicted intrinsic learning motivation indirectly through the mediating effects of self-efficacy (B = 0.17, 95% CI: 0.12-0.24) and positive coping style (B = 0.03, 95% CI: 0.01-0.06), and this mediating effect contributed 71.42% of the total effect. Parental control negatively influenced intrinsic learning motivation directly or indirectly through the mediating effects of self-efficacy (B = -0.10, 95% CI: -0.15 to -0.04) and positive coping style (B = -0.02, 95% CI: -0.05 to -0.01), and this mediating effect contributed 42.85% of the total effect.

CONCLUSION

Parents should provide more care and autonomy to nursing students and reduce control over them. Nurse educators should consider targeted improvement strategies to improve the level of self-efficacy and positive coping style of nursing undergraduates to enable them to maintain a more intrinsic learning motivation.

The Meaning and Application of Student-Centered Learning in Nursing Education: An Integrative Review of the Literature

AIM

The aim of this study was to review empirical articles to explore the meaning and the application of student-centered learning in nursing education.

BACKGROUND

Teachers in higher education are encouraged to adopt student-centered learning principles, but research shows that many still apply teacher-centered methods. There is therefore a need to clarify the meaning of student-centered learning, including how it is performed and the reasons to apply it in nursing education.

DESIGN

This study employed an integrative review method, following Whittemore and Knafl's framework.

METHODS

The databases CINAHL, Education Database and Education Research Complete were searched for related literature published from 2010 to 2020. The initial search located 308 articles. After screening and checking for eligibility, 25 articles were critically appraised. Data were extracted from the articles and displayed in matrices to be categorized and compared.

RESULTS

Three themes with attendant sub-themes emerged through the analysis: foundation, using core concepts to define and explain student-centered learning, eligibility, enhancing student knowledge, developing student abilities and supporting student self-reliance and realization, learning in interaction with peers, learning individually and learning in interaction with the teacher.

CONCLUSION

Student-centered learning in nursing education is an approach where the teacher is a facilitator of student learning and students are empowered to take control of their own studies. Students study together in groups; they are listened to by the teacher and their needs are taken into consideration. The main reasons to apply student-centered learning are to enhance students' theoretical and practical learning; to improve their generic competencies, such as problem-solving and critical-thinking abilities; and to strengthen students' self-reliance.

Integration of Wearable Devices and English Teaching under Positive Psychology

Positive psychology, as a core subject to the study of people's positive power and positive quality, is intended to cultivate positive personality traits and positive emotions, and to promote the development of inspiring creativity, cooperation, and interest. The study of positive psychology provides a new perspective for our research in the field of education. The "New Curriculum Standards for Junior Middle School English" clearly states: "Students can only maintain the inner driving force of English learning and achieve results only if they have positive emotions in English learning. Negative emotions will not only affect the effect of English learning, but also affect students' long-term development. In English teaching, teachers should pay attention to students' emotions from beginning to end, and strive to create a relaxed, democratic, and harmonious teaching atmosphere. Therefore, how to infiltrate the theory of positive psychology into the frontline English teaching of junior high school becomes especially important. With the advancement of science and technology and the advent of the Internet era, various high-tech information technologies have gradually flourished, and the rapid development of information technology has promoted the reform and innovation of the teaching industry. Wearable technology is the current trend and direction of the information technology revolution. It realizes the interconnection and deep integration of people, machines and objects through the functions of collecting, sorting and analyzing mobile Internet and cloud data. The realization of wearable technology-based wearable technology not only can highly integrate educational resources, improve learning interest, but also enhance the pertinence of teaching, cultivate students' creativity, and realize personalized teaching in "full time, all-round, all fields." This article explores the integration of wearable devices and junior high school English teaching in the context of positive psychology. First of all, this paper introduces the theoretical basis of the integration of wearable devices with English teaching. Secondly, it introduces the research methods of this paper. Finally, through questionnaires and experimental comparison analysis, it tests the interest of students in learning through the auxiliary teaching of wearable devices, and whether the academic performance has a positive effect.

Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education

BACKGROUND

BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) is a student-centered modular teaching model that improves classroom teaching effectiveness. This study's primary aim was to explore whether the BOPPPS model has advantages over traditional instructional approaches in teaching lung cancer courses to clinical medical interns.

METHODS

A total of 88 students majoring in clinical medicine of Shandong First Medical University and Shandong University, who had clinical practice in thoracic surgery from January 2018 to December 2019, were divided into two groups, receiving the same lung cancer teaching content. The experimental group (n = 44) utilized the BOPPPS model, while the control group (n = 44) used the traditional instructional approach. A questionnaire was used to attain the students' satisfaction and self-evaluation of the course, and a post-study examination was used to assess end-of-course performance.

RESULTS

The experimental group's theoretical examination scores with the BOPPPS teaching model were significantly higher than those in the control group. Students preferred the BOPPPS model more than the traditional instructional approach in course satisfaction, student-teacher interaction, learning initiative, analytical ability, clinical thinking ability, and self-study ability (p < 0.05).

CONCLUSIONS

Compared with the traditional instructional approach. The BOPPPS model can better inspire clinical medical students' enthusiasm for thoracic surgery and enhance the students' comprehensive ability. In a word, the BOPPPS model has better teaching effectiveness in the clinical teaching practice of thoracic surgery, which is worthy of reference and popularization.

Effects of a Self-Directed Clinical Practicum on Self-Confidence and Satisfaction with Clinical Practicum among South Korean Nursing Students: A Mixed-Methods Study

In self-directed learning, students take the initiative to identify learning goals, choose learning strategies, and evaluate learning outcomes. This study aimed to explore the effects of a self-directed clinical practicum on nursing students' self-confidence and satisfaction with the clinical practicum. This mixed-methods study used a non-equivalent control group with a pre- and post-test quasi-experimental design and content analysis. Participants were 111 nursing students (experimental group = 55, control group = 56). Quantitative (self-confidence and satisfaction with the clinical practicum) and qualitative (reflective diaries) data were collected. The experimental group had significantly increased scores for self-confidence and satisfaction with the clinical practicum compared with the control group. Four themes regarding the experience of the self-directed clinical practicum were identified: perceived linking of academic knowledge and practice, perceived development of nursing competency, enjoying the clinical practicum, and establishing nursing identity as a student. The self-directed clinical practicum developed as part of this study was found to be an effective education method for nursing students.

The relationships between the types of learning approaches used by undergraduate nursing students and their academic achievement: A systematic review and meta-analysis

Identifying and promoting an appropriate learning approach among nursing students is important in nursing education. The objective of this study was to examine the relationship between undergraduate nursing students' approaches to learning and their academic achievement. A systematic review with a quantitative synthesis was conducted. Abstract searches of CINAHL, MEDLINE, PubMed, ERIC and Scopus were conducted in November 2020 to identify the relevant publications. In total, 11 studies involving 12 cohorts were identified as eligible for the meta-analysis. Based on nine studies with 10 cohorts (N = 1830), a significant positive relationship between the deep approach to learning and academic achievement was identified, with the summary effect size of r = 0.259 [95% CI: 0.184, 0.330]. In addition, based on 11 studies with 12 cohorts (N = 2138), a significant negative correlation between the surface approach to learning and academic achievement was found, with the summary effect size of r = -0.247 [95% CI: -0.318, -0.174]. Higher education institutions should encourage the use of the deep approach and discourage the surface approach to learning by utilising appropriate educational instructions and assessment methods.

Keeping the Nurse in the Nurse Practitioner: Returning to Our Disciplinary Roots of Knowing in Nursing

Nurse practitioners are a vital and growing body of primary healthcare providers. The ever-changing advancements in science and technology and the increasing complexities in health care delivery are significant factors culminating in the expanding role of nurse practitioner-led care. Nurse educators are striving to develop nurse practitioner curricula to keep pace with the increasingly sophisticated knowledge and competencies nurse practitioners must possess to render safe quality care as independent primary health care providers. However, nursing theory is losing its place as a formative foundation in nurse practitioner curricula. Multiple factors such as content-laden, competency-based, medically focused education have caused a diminishing presence of nursing theory, shrinking the philosophical basis for nursing in nurse practitioner education. The loss of the central unifying focus of the discipline and discipline-specific knowledge (nursology) risks losing the very identity that forms the basis and relevance for nurse practitioner practice. Moreover, the loss of the nurse in the nurse practitioner unmoors nurse practitioner practice from its theoretical and scientific basis, losing discipline-specific attributes that lead to higher levels of patient satisfaction and improved patient outcomes. Keeping the nurse in the nurse practitioner is a moral imperative in nurses' ethical and social contract with society. This article discusses relevant literature and offers recommendations to keep the nurse in the nurse practitioner.

Influence of Perceived Helicopter Parenting, Critical Thinking Disposition, Cognitive Ability, and Learning Motivation on Learning Behavior among Nursing Students

The purpose of this study was to determine the influence of perceived helicopter parenting, critical thinking disposition, cognitive ability, and learning motivation on learning behavior in nursing students in South Korea. The participants in this study were 149 sophomore nursing students from two universities using convenience sampling. The two universities were similar in terms of type, curricula, and size. Data were collected from October to November 2017 using self-reported questionnaires. The collected data were analyzed using descriptive statistics, Pearson correlation coefficients, and hierarchical multiple regression with SPSS 22.0. The mean score of perceived helicopter parenting was 3.06 ± 0.65 out of six points. The levels of critical thinking disposition, cognitive ability, learning motivation, and learning behavior were medium. Factors affecting learning behavior were learning motivation (β = 0.40, p < 0.001), cognitive ability (β = 0.26, p = 0.001), and critical thinking disposition (β = 0.25, p = 0.001). These variables explained 32% of the variance in learning behavior (F = 18.21, p < 0.001). Teaching methods are necessary to increase the critical thinking disposition and learning competence of nursing students. In addition, it is important to consider the learning motivation of nursing students for effective learning.

Perceptions about the Self-Learning Methodology in Simulated Environments in Nursing Students: A Mixed Study

The self-learning methodology in simulated environments (MAES©) is an active method of education. The aim of this study was to analyze the perceptions and opinions of undergraduate and graduate nursing students about the self-learning methodology in simulated environments. A mixed, cross-sectional, descriptive study based on a survey tool made ad hoc (quantitative approach) and an open questionnaire (qualitative approach) was carried out. A sample of 149 undergraduate and 25 postgraduate nursing students were tested. The score was high for all the variables of the questionnaire analyzed: for perception of simulation performance, M = 73.5 (SD = 14.5), for motivation, M = 23.9 (SD = 5.9), for the opinion about facilitators, M = 25.9 (SD = 4.5), and for the promotion of team work, M = 16.9 (SD = 3.4). Five dimensions were identified and evaluated in the qualitative research. The students were pleased with MAES© and had a positive perception, since they considered that MAES© increased their learning.

Strategies for bridging the theory-practice gap from the perspective of nursing experts

The gap between education and the clinical practice has always been challenge for educational experts in the field. This article aims to explore the perspective of Iranian nursing experts about strategies used for coordinating education and clinical performance in nursing. This qualitative study was conducted by using a conventional content analysis approach; individual interviews were conducted at the participants’ work place; while focus group discussions took place at the Nursing and Midwifery Faculty of Iran University of Medical Sciences. Participants in this study included nursing instructors, educational supervisors and nursing managers with a clinical background and teaching experience of at least five years. In addition, a graduate nursing student and a nursing PhD candidate were also interviewed to ensure data saturation. Purposive sampling was conducted between April 2016–October 2017 among scholars and nursing professional experts who were highly experienced in this field. The two focus groups, obtained the views of nursing managers and educational supervisors working in educational hospitals. Analysis involved open stepwise coding with an emphasis on continuous comparison of data, and reference to written notes of the interviews. The analysis process was carried out in three main phases of preparation, organization, and reporting. The results of this study were classified in three main categories: developing context base curriculum, interactive collaboration among nurses and faculties, the Design and Implementation of a Standard Clinical Guideline. It seems that strong intention and active participation of all beneficiaries are needed to bridge the gap between theory and practice. Creating an appropriate context for nurses and nursing trainers for mutual learning along with the use of pragmatic language in the form of clinical guidelines can help decrease this gap.

Characterization of breast imaging education and insights from students, radiographers and teaching staff about its strengths, difficulties and needs

INTRODUCTION

The study aimed to characterize breast imaging education and identify its strengths, difficulties and needs across five European countries according to student, radiographer and teaching staff perspectives.

METHODS

An observation grid was used to collect data regarding breast imaging education and three questionnaires targeted to key-participants were developed/applied to collect data on strengths, difficulties and needs. Descriptive statistics and thematic analysis were performed according to the nature of the questions.

RESULTS

Breast imaging curricula varied within and between countries. Response rate for questionnaires also varied (13-100%). More than one-third of the teaching staff (37.5%) was involved in breast research projects. This was identified as the main strength in breast imaging education followed by collaborations between hospitals and academia. Difficulties with their education program identified by the 97 students surveyed included teaching issues (45), breast positioning (18), variety of image evaluation strategies (10) and human interaction (6). The need to provide an explanation to the patient about the role of the student in the mammography setting, and performing exams and teaching at the same time (22.6%) was identified as difficult by radiographers. The need for education and training in communication, practice and technological developments was identified.

CONCLUSIONS

A bridge between academia and clinical practice is extremely important in order to overcome recognized gaps between theory and practice. The development of a European education program covering the needs identified by the participants could be a possible solution to improve knowledge and access, and also to harmonize education and training across Europe.

Effectiveness of the flipped classroom on the development of self-directed learning in nursing education: a meta-analysis

Objectives

To examine the best practice evidence of the effectiveness of the flipped classroom (FC) as a burgeoning teaching model on the development of self-directed learning in nursing education.

Data sources

The relevant randomized controlled trial (RCT) and non-RCT comparative studies were searched from multiple electronic databases including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) from inception to June 2017.

Review methods

The data were independently assessed and extracted for eligibility by two reviewers. The quality of included studies was assessed by another two reviewers using a standardized form and evaluated by using the Cochrane Collaboration’s risk of bias tool. The self-directed learning scores (continuous outcomes) were analyzed by using the 95% confidence intervals (CIs) with the standard deviation average (SMD) or weighted mean difference (WMD). The heterogeneity was assessed using Cochran’s I 2 statistic.

Results

A total of 12 studies, which encompassed 1440 nursing students (intervention group = 685, control group = 755), were eligible for inclusion in this review. Of 12 included studies, the quality level of one included study was A and of the others was B. The pooled effect size showed that compared with traditional teaching models, the FC could improve nursing students’ self-directed learning skill, as measured by the Self-Directed Learning Readiness Scale (SDLRS), Self-Directed Learning Readiness Scale for Nursing Education (SDLRSNE), Self-Regulated Learning Scale (SRL), Autonomous Learning Competencies scale (ALC), and Competencies of Autonomous Learning of Nursing Students (CALNS). Overall scores and subgroup analyses with the SRL were all in favor of the FC.

Conclusions

The result of this meta-analysis indicated that FCs could improve the effect of self-directed learning in nursing education. Future studies with more RCTs using the same measurement tools are needed to draw more authoritative conclusions.

Instruments evaluating the self-directed learning abilities among nursing students and nurses: a systematic review of psychometric properties

BACKGROUND

Modern healthcare institutions are continuously changing, and Self-Directed Learning (SDL) abilities are considered a prerequisite for both nursing students and nurses in order to be proactive about these demanding challenges. To date, no systematic reviews of existing instruments aimed at detecting and critically evaluating SDL abilities have been published. Therefore, the aims of this review are: 1) identify the instruments for assessment of SDL abilities among nursing students and nurses; 2) critically evaluate the methodological studies quality; and 3) compare the psychometric properties of the available instruments.

METHODS

A psychometric-systematic-review was performed. CDSR, CINAHL, ERIC, MEDLINE, PROSPERO, SCOPUS databases were searched without restrictions in time and setting. All primary studies involving nursing students or nurses, written in English and aimed at validating SDL assessment tools, were included. Studies retrieved were evaluated according to the COnsensus-based-Standards for the selection of health Measurement-INstruments (COSMIN) panel. Study inclusion, data extraction and quality assessment were performed by researchers independently.

RESULTS

Eleven studies were included and four tools based on Knowles's theory have emerged: 1) the Self-Directed Learning Readiness Scale; 2) the Self-Directed Learning Readiness Scale for Nursing Education; 3) the Self-Rating Scale of Self-Directed Learning, and 4) the Self-Directed Learning Instrument. A few psychometric properties have been considered in each study, from two to four out of the ten required. The quality of the methodologies used was in general, from fair to poor with the exception of one instrument (the Self-Directed-Learning-Instrument). The psychometric proprieties that emerged across the tools were good in general: the Cronbach α was from 0.73 to 0.91; structural validities have also reported good indexes both in the explorative and in the confirmative factor analyses.

CONCLUSIONS

On the basis of the findings, the Self-Directed-Learning-Instrument can be recommended for the assessment of SDL abilities among nursing students and nurses, given the excellent methodology quality adopted in estimating the psychometric properties. However, rigorous study designs aimed at estimating psychometric properties of tools in wide samples of nursing students and nurses across different stages of professional life, from undergraduate education to professional maturity, in different cultural, educational, and work settings, are strongly recommended.