The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study

A systematic review of online team based learning approaches in health professional education

AIMS AND OBJECTIVES

The purpose of this study was to systematically review studies related to the use of online Team Based Learning (TBL) platforms with a focus on health professional education. The objectives were to identify best practices, highlight what technological platforms are effective for TBL processes and evaluate educational outcomes in terms of student experience, learning and preference.

DESIGN

A systematic review of published TBL research was undertaken between August and October 2021 and supplemented in September 2022.

DATA SOURCES

ERIC, PsycINFO, Scopus, Embase, Medline, and Cinahl databases were used. The keywords were identified from researchers' knowledge and PICO/PICo framework.

REVIEW METHODS

Titles and abstracts were screened individually by two reviewers for eligibility. Data extraction was undertaken by two researchers independently and checked for consistency by discussion between the two. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Out of 656 articles 14 were involved in the final review. All others were rejected due to duplication, ineligibility, or poor quality. The studies were from a range of countries and focussed on a range of health professionals including nursing. Inconsistencies in approaches for TBL, platforms used and mixed results in terms of outcomes were noted. There was no real consensus other than that TBL was equally as effective if carried out online or face-to-face, with no clear differences to outcomes related to satisfaction in online or traditional TBL approaches.

CONCLUSIONS

It is recommended that further research is carried out into the outcomes of TBL on learning and experiences of students in health professional courses. The development and appraisal of integrated TBL platforms should be invested in and infrastructure and resources are put in place to support this.

Biomedical students' self-efficacy and academic performance by gender in a flipped learning haematology course

INTRODUCTION

This study investigated the impact of flipped learning versus traditional instruction on medical students' academic performance and self-efficacy in a haematology course, and examined gender differences. Flipped learning is an instructional approach where students review pre-recorded lecture content at home, and active learning occurs in the classroom. Self-efficacy refers to students' beliefs in their ability to succeed and accomplish learning goals.

METHODS

A quasi-experimental study was conducted with 86 third-year Saudi medical students (46 males, 40 females) in a 10-week haematology course. Students were assigned to flipped learning group (n = 41) or traditional lecture group (n = 45). Both groups completed pre- and post-intervention academic tests and self-efficacy surveys. Data were analyzed using descriptive statistics and t-tests.

RESULTS

The flipped learning group showed an increase in academic scores (p <.05) and self-efficacy scores (p <.05) compared to the traditional group, but between group differences were not statistically significant. Female students in the flipped learning group showed the greatest increase in academic scores and self-efficacy. Most students perceived flipped learning positively for enhancing learning and preparation for class.

CONCLUSION

Flipped learning promoted self-efficacy compared to traditional lectures in medical students. Gender-specific benefits were observed, highlighting the need to design instruction to meet diverse student needs.

Effect of evidence-based nursing practices training programme on the competency of nurses caring for mechanically ventilated patients: a randomised controlled trial

BACKGROUND

Evidence-Based Practice (EBP) has been recognised worldwide as a standardised approach for enhancing the quality of healthcare and patient outcomes. Nurses play a significant role in integrating EBP, especially in Intensive Care Unit (ICU). Consequently, this study aims to examine the effect of an adapted evidence-based nursing practices training programme on the competency level of nurses caring for mechanically ventilated patients.

METHODS

A prospective open-label parallel 1:1 randomised controlled trial was conducted on 80 nurses caring for ICU patients at the National Hepatology and Tropical Medicine Research Institute, Egypt. The trial was carried out between November 2022 and February 2023 under the registration number NCT05721664. The enrolled nurses were randomly divided into intervention and control groups. The intervention group received the evidence-based nursing practice training programme (EBNPTP) in accordance with the Johns Hopkins EBP conceptional model, whereas the control group received traditional in-service education. Four assessments (one pre- and three post-assessments) were conducted to evaluate nurses' competency level over time using the adapted evidence-based nursing competency assessment checklist. The primary endpoint was an increase the competency levels among nurses caring for mechanically ventilated patients.

RESULTS

The current study results revealed statistically significant differences between intervention and control groups in relation to their level of competency across the three post-assessments, with (p <.001). The study also demonstrated that the nurses' competency level continued to decline significantly over time, with (p <.001). Additionally, a significant correlation was found between the nurses' pre-assessment and educational level, acting as independent variables (predictors), and the third endpoint assessment (p <.01), indicated by multiple linear regression.

CONCLUSION

The EBP training programme demonstrated a significant increase in the nurses' level of competency compared with traditional in-service education. This suggests that by training the nurses in various settings with the essential skills and knowledge for EBP, their competency level can be enhanced, leading to the delivery of effective care and improving patient outcomes. However, the long-term sustainability of the EBP adoptions was insufficient; further studies are needed to investigate the factors that affect the durability of EBP adoption.

TRIAL REGISTRATION

The study was registered with Clinical Trials.gov (Registration # NCT05721664) on 10/02/2023.

Impact of fully online flipped classroom on academic achievement in undergraduate dental education: An experimental study

INTRODUCTION

The last two decades have seen a shift towards blended learning in education due to technological advancements. This study focuses on dental education, comparing two blended learning models -enriched virtual and fully online flipped classroom - in terms of academic achievement, aligning with the Association for Dental Education in Europe's competencies.

MATERIALS AND METHODS

The research was modelled in a quantitative design with a pre-post-test control group experimental design. The study was conducted at Ege University Faculty of Dentistry in Turkey for 4 weeks with the experimental (n = 44) and control (n = 39) groups divided into two groups by impartial assignment. To the experimental group, the theoretical part of the course was tried to be conveyed before each lesson with video lessons prepared with EdPuzzle containing reinforcement questions and a question set consisting of case questions. The practical learning objectives of the course were tried to be gained through the discussion of the previously presented case questions in the online synchronous course. As tools for collecting data, a unique academic achievement test, a course evaluation form and a semi-structured qualitative data collection form were used.

RESULTS

It was seen that the flipped classroom model had a more positive effect on students' academic achievement than the enriched virtual classroom model. The general satisfaction levels of the participants regarding these two models are also higher in favour of the flipped classroom model.

CONCLUSION

This study provides significant findings for educational institutions, policymakers and educators about the impact of fully online teaching methods on academic achievement. In this context, the flipped classroom method can be preferred both in cases where education is blocked and in dental education institutions that want to ensure digital transformation efficiently and partially remotely.

The application of flipped classroom combined with team-based learning in the orthopedic clinical teaching

BACKGROUND

Medical education has evolved rapidly, with the development of flipped classrooms and team-based learning based on lecture-based learning, but the novel model of combining flipped classrooms with team-based learning has been poorly investigated in orthopedic education.

METHODS

A femoral neck fracture teaching mode was chosen to 109 clinical internship students to explore the effectiveness of flipped classroom combined with team-based learning in internship education. They were enrolled and randomly divided into either the flipped classroom combined with team-based learning group (FTG, n = 55) or the traditional lecture-based classroom group (n = 54). All students completed the learning according to the course flow and took before-class and after-class tests. The questionnaires were used to compare students perceptions and satisfaction with the different teaching methods and were utilized to assess the strengths and weaknesses of the 2 groups.

RESULTS

The post-class test scores of both groups significantly improved compared to pre-class test scores. Regarding the post-class test scores, FTG's was significantly higher than the traditional lecture-based classroom group's, mainly in clinical areas such as imaging analysis, fracture classification, treatment options, and management of postoperative complications, but there was no significant difference in the mastery of basic theoretical knowledge. The students were more satisfied with the FTG and believed that it improved their various competencies, but with significantly more time spent.

CONCLUSION

FTG is generally recognized as a promising option for training clinical interns and is worth spreading as it has outstanding merits in developing students clinical competence.

Self-efficacy in the context of nursing education and transition to practice as a registered practitioner: A systematic review

AIM

The aim of this systematic review is to identify, describe and synthesize evidence from experimental studies conducted to measure and conceptualize self-efficacy within the context of nursing education and the transition of nursing students to practice as a registered practitioners.

DESIGN

Systematic review.

METHODS

Papers were screened by four independent reviewers, and data were extracted using a standardized data extraction tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and checklists were used to guide this review.

RESULTS

The review included 47 studies, using a quasi-experimental pre-test-post-test design (n = 39) and randomized control trials (n = 8). Various teaching and learning interventions were used to enhance self-efficacy; however, there is no definitive conclusion to be drawn regarding the most effective educational interventions. Various instruments were used in the studies to measure self-efficacy. 10 of these were related to general self-efficacy, while 37 instruments measured self-efficacy in the context of specific skills.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review

Background

The 'flipped classroom' approach is an innovative approach in educational delivery systems. In a typical flipped class model, work that is typically done as homework in the didactic model is interactively undertaken in the class with the guidance of the teacher, whereas listening to a lecture or watching course-related videos is undertaken at home. The essence of a flipped classroom is that the activities carried out during traditional class time and self-study time are reversed or 'flipped'.

Objectives

The primary objectives of this review were to assess the effectiveness of the flipped classroom intervention for undergraduate health professional students on their academic performance, and their course satisfaction.

Search Methods

We identified relevant studies by searching MEDLINE (Ovid), APA PsycINFO, Education Resources Information Center (ERIC) as well as several more electronic databases, registries, search engines, websites, and online directories. The last search update was performed in April 2022.

Selection Criteria

Included studies had to meet the following criteria: Participants: Undergraduate health professional students, regardless of the type of healthcare streams (e.g., medicine, pharmacy), duration of the learning activity, or the country of study. Intervention: We included any educational intervention that included the flipped classroom as a teaching and learning tool in undergraduate programs, regardless of the type of healthcare streams (e.g., medicine, pharmacy). We also included studies that aimed to improve student learning and/or student satisfaction if they included the flipped classroom for undergraduate students. We excluded studies on standard lectures and subsequent tutorial formats. We also excluded studies on flipped classroom methods, which did not belong to the health professional education(HPE) sector (e.g., engineering, economics). Outcomes: The included studies used primary outcomes such as academic performance as judged by final examination grades/scores or other formal assessment methods at the immediate post-test, as well as student satisfaction with the method of learning. Study design: We included randomised controlled trials (RCTs), quasi-experimental studies (QES), and two-group comparison designs. Although we had planned to include cluster-level RCTs, natural experiments, and regression discontinuity designs, these were not available. We did not include qualitative research.

Data Collection and Analysis

Two members of the review team independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full text of selected articles. Discrepancies between the two investigators were settled through discussion or consultation with a third author. Two members of the review team then extracted the descriptions and data from the included studies.

Main Results

We found 5873 potentially relevant records, of which we screened 118 of them in full text, and included 45 studies (11 RCTs, 19 QES, and 15 two-group observational studies) that met the inclusion criteria. Some studies assessed more than one outcome. We included 44 studies on academic performance and eight studies on students' satisfaction outcomes in the meta-analysis. The main reasons for excluding studies were that they had not implemented a flipped class approach or the participants were not undergraduate students in health professional education. A total of 8426 undergraduate students were included in 45 studies that were identified for this analysis. The majority of the studies were conducted by students from medical schools (53.3%, 24/45), nursing schools (17.8%, 8/45), pharmacy schools (15.6%, 7/45). medical, nursing, and dentistry schools (2.2%, 1/45), and other health professional education programs (11.1%, 5/45). Among these 45 studies identified, 16 (35.6%) were conducted in the United States, six studies in China, four studies in Taiwan, three in India, two studies each in Australia and Canada, followed by nine single studies from Brazil, German, Iran, Norway, South Korea, Spain, the United Kingdom, Saudi Arabia, and Turkey. Based on overall average effect sizes, there was better academic performance in the flipped class method of learning compared to traditional class learning (standardised mean difference [SMD] = 0.57, 95% confidence interval [CI] = 0.25 to 0.90, τ 2: 1.16; I 2: 98%; p < 0.00001, 44 studies, n = 7813). In a sensitivity analysis that excluded eleven studies with imputed data from the original analysis of 44 studies, academic performance in the flipped class method of learning was better than traditional class learning (SMD = 0.54, 95% CI = 0.24 to 0.85, τ 2: 0.76; I 2: 97%; p < 0.00001, 33 studies, n = 5924); all being low certainty of evidence. Overall, student satisfaction with flipped class learning was positive compared to traditional class learning (SMD = 0.48, 95% CI = 0.15 to 0.82, τ 2: 0.19, I 2:89%, p < 0.00001, 8 studies n = 1696); all being low certainty of evidence.

Authors' Conclusions

In this review, we aimed to find evidence of the flipped classroom intervention's effectiveness for undergraduate health professional students. We found only a few RCTs, and the risk of bias in the included non-randomised studies was high. Overall, implementing flipped classes may improve academic performance, and may support student satisfaction in undergraduate health professional programs. However, the certainty of evidence was low for both academic performance and students' satisfaction with the flipped method of learning compared to the traditional class learning. Future well-designed sufficiently powered RCTs with low risk of bias that report according to the CONSORT guidelines are needed.

Effectiveness of the flipped classroom methodology on the learning of evidence-based practice of nursing students: Quasi-experimental design

BACKGROUND

International organizations recognize the importance of evidence-based practice (EBP) for nurses. The objective of teaching EBP in the Nursing degree is to train future nurses on this subject. Different teaching models exist for this, from less active traditional models to more active ones such as the flipped classroom.

OBJECTIVE

To compare the degree of EBP competence of undergraduate nursing students after an EBP course, through the application of a traditional methodology versus a flipped classroom methodology.

DESIGN

Quasi-experimental study of non-equivalent groups.

SETTING

The study was composed by a group of students who received training on EBP with the traditional model (face-to-face), and another intervention group with whom the flipped classroom model was utilized, using the online teaching platform EBP-eToolkit.

PARTICIPANTS

The study was conducted with 4th-year Nursing degree students enrolled in the course evidence-based practice, in academic years 2019/20 and 2021/2022.

METHODS

Before and after the course, the students completed a questionnaire about EBP competence (EBP-COQ), and an objective test was given at the end of the year.

RESULTS

A sample of 152 students in the face-to-face group (control), and 143 students in the flipped classroom group (intervention) participated. The intervention group significantly improved its competence on attitude (p = 0.01, η² = 0.022), skills (p = 0.019, η² = 0.018), and global competence in EBP (p = 0.003, η² = 0.030), with respect to those who were taught using the traditional method. However, there were no significant differences in the impact on knowledge, neither through the self-report dimension of the EBP-COQ (p = 0.188) nor the final test score, control group 6.89 (SD: 1.35) and flipped classroom group 7.12 (SD: 1.53) (p = 0.206).

CONCLUSIONS

The flipped classroom model is adequate for the teaching of EBP to undergraduate nursing students. It produced a slight increase in attitude, as well as in skills and global competence in EBP. Nevertheless, this increase was not significantly different from face-to-face learning in terms of impact on EBP knowledge.

The effect of blended task-oriented flipped classroom on the core competencies of undergraduate nursing students: a quasi-experimental study

BACKGROUND

The flipped classroom (FC) method is becoming increasingly popular in China's nursing education. It is an important breakthrough improvement in the quality of learning in nursing education reforms.

PURPOSE

This study aimed to determine the effects of blended task-oriented flipped classroom (TFC) on nursing students undertaking the Fundamentals of Nursing course.

METHODS

A pre-and post-test quasi-experimental design was adopted. This study was conducted in the Autumn semester, 2021 academic year in a Chinese university. Using cluster sampling technique, this study enrolled second-year undergraduate nursing students from six classess who were studying Fundamentals of Nursing course. A blended TFC was developed and implemented with three classes (experimental group: n = 152). In-class traditional lectures were applied to the other three classes (control group: n = 151). The Self-Directed Learning Instrument, Problem-Solving Inventory, and California Critical Thinking Disposition Inventory were used to evaluate students' learning outcomes, and final examinations were conducted at the end of after course. In addition, students in the flipped classroom group were required to answer five open-ended questions concerning their flipped classroom learning experiences.

RESULTS

Students in the experimental group showed significant improvement in academic performance compared to those in the control group (p = 0.001). Considering total scale and factors, students in the experimental grouped recorded significantly higher scores in self-directed learning ability, problem-solving skills, and critical thinking ability compared to those in the control group (p < 0.05). Furthermore, improved abilities and skills such as team cooperation, communication, presentation, identifying /solving clinical problems, and accountability were reported.

CONCLUSION

A blended TFC teaching approach positively impacted students' core competencies and improved learning outcomes in the Fundamentals of Nursing course.

Evaluation of Urinary Catheterization Competency and Self-Efficacy in Nursing Students Using the Flipped Classroom Approach

Urinary catheterization is a complex procedure. Traditional teaching in classroom, such as using a simulator, is not enough to guarantee the necessary learning outcomes. It is therefore necessary to implement new active learning approaches such as the flipped classroom. The aim of this study was to examine the effect of the use of the flipped classroom on the level of self-efficacy and the assessment of clinical competencies in nursing students performing the urinary catheterization procedure. A quasi-experimental study of a single group with pre-/post-testing measures. A convenience sample of 139 nursing students. A flipped classroom approach was implemented. Measurements were taken pre and post intervention. This study followed the consolidated criteria for quality of nonrandomized evaluations studies (TREND) checklist. Regarding self-efficacy, statistically significant differences were found between the pre-test and post-test (Z = -14.453; p < 0.05). With respect to knowledge level, statistically significant differences were found when comparing pre-/post-test results (Z = -14,480; p < 0.05). Furthermore, statistically significant differences were found on the ability scale depending on pre-/post-test (Z = -10.277; p < 0.005); in all cases, obtaining a higher score in the post-test. The flipped classroom could be an effective educational tool for the development of clinical skills, specifically urinary catheterization. This method has been shown to improve the knowledge, skills, and self-efficacy in urinary catheterization of nursing students.

Ters Yüz Sınıf Modelinin Hemşirelik Öğrencilerinin Yaşamsal Belirti Becerileri Üzerindeki Öğrenme Etkileri: Yarı Deneysel Bir Çalışma

Amaç: Bu çalışmanın amacı, ters yüz sınıf sınıf öğrenme modeli ile verilen eğitimin hemşirelik psikomotor, bilişsel ve becerilerine etkisini değerlendirmektir.Yöntem: Çalışmada yarı deneysel deney (n=40) ve kontrol gruplu (n=40), ön son test ölçümleri olan bir bir tasarım kullanıldı. Deney grubu yaşamsal bulgular modülünde teorik ve pratik öğretimde ters yüz eğitim modeli ile eğitim alırken, kontrol grubunda sadece geleneksel öğretim modeli ile eğitim aldılar. Öğrenci performanslarını değerlendirmek için bir bilgi testi ve beceri kontrol listesi kullanıldı.Bulgular: Post-test bilgi sınavı ve beceri sınavlarında en yüksek puanları ters yüz sınıf eğitimi alan öğrenciler aldı (sırasıyla X̄ =62.15±16.55; X̄ =45.25±14.77). Ayrıca gruplar arası psikomotor beceri sınavı post-test toplam puanları incelendiğinde, deney grubunun kontrol grubuna göre daha yüksek puanlar aldığı bulundu (sırasıyla X̄=38.92±0.85, X̄=30.79±1.41).Sonuç: Ters yüz sınıf modelinin hemşirelik eğitiminde kullanılmasının hem teorik bilgileri hem de psikomotor beceri kazanımını olumlu yönde etkilediği bulundu.

Effectiveness of Digital Flipped Learning Evidence-Based Practice on Nurses' Knowledge, Attitude, and Practice: A Quasi-Experimental Trial

Background: Evidence-based care has become critical in raising the quality of medical facilities. The implementation of evidence-based practice helps medical practitioners make better clinical decisions. Objective: The objective of this study was to investigate whether the innovative flipped teaching model could be as effective as the conventional teaching model in terms of knowledge, attitude, and practice and to confirm the continuous effect. Design: A quasi-experimental design using the flipped and conventional learning groups concurrently with repeat measurements was used. Setting: The setting was a 475-bed regional teaching hospital in Taiwan, from March to July 2020. Participants: The study included 114 licensed nurses who had worked longer than three months, with 57 participants each in two groups. Methods: The participants were assigned to two groups using a block randomization method. All participants completed questionnaires related to knowledge, attitude, and practice of EBP at four-time points: pre-test (T0) and immediately after intervention (T1), at month 1 (T2), and at month 3 (T3). Analysis of repeated generalized estimating equations was used. Results: The flipped and conventional learning groups had significant differences in knowledge, attitude, and practice at the T0 and T1 (p < 0.05). The flipped group was higher than the conventional group at T3 in the knowledge score (p = 0.001) and lower than the conventional group at T2 in the attitude score (p = 0.010). There were no significant differences between the two groups’ practice scores at different time points. There were no significantly different score changes for knowledge, attitude, and practice (p > 0.05). The interaction term only at T3 vs. T0 in the knowledge score was slightly different (p = 0.049) in primary outcome. Conclusion: The intervention methods of both groups were effective. Flipped learning is more flexible and has more time for discussion, which nurses favor. Under the policy promoted in the hospital, EBP combined with the nursing advancement system was standardized, and conventional learning also improved the learning effect.

Can active learning techniques simultaneously develop students' hard and soft skills? Evidence from an international relations class

PURPOSE

In recent decades, educators have pushed to implementing active learning techniques that can advance students' competences. Universities are increasingly required to develop knowledge measured in terms of grades (hard skills) and inter-personal, social, and communication abilities (soft skills). Nevertheless, within the field of active learning, educators often focus on how these techniques can improve students' hard skills and their satisfaction. Few have analysed whether and how these techniques might improve students' soft skills. Moreover, among these few studies, the majority has analysed hard and soft skills separately, measuring whether different active learning techniques may or may not improve them. Virtually no one has studied whether students' hard and soft skills can converge or diverge in an active learning format. This study allows us to understand the relations between these two sets of variables, for example, whether an improvement (or deterioration) in the hard skills corresponds to an improvement (or deterioration) in the soft skills, and vice versa.

METHOD

In our experiment, we analyse the impact of a specific active learning format, such as the Flipped Classroom (FC), on both students' hard and soft skills, by comparing it with a traditional class integrated with other active learning techniques, such as presentations, debates, and teamwork activities. First, we use Pearson correlations to measure the relation between students' hard skills, understood in terms of grades, and a set of soft skills, such as critical thinking, self-efficacy, teamwork, and perception of learning. Second, we use canonical correlations to analyse whether hard and soft skills converge or diverge in an FC format, in comparison with a traditional teaching format integrated with the other active learning techniques.

RESULTS AND CONCLUSIONS

Our main finding is that the FC per se neither improves nor worsens students' performance in terms of hard and soft skills.

A Survey of College Students on the Preference for Online Teaching Videos of Variable Durations in Online Flipped Classroom

In the spring semester of 2020, online flipped classroom was used to replace offline face-to-face teaching of the physiology course at Xiangya School of Medicine. In order to analyze the preferences and utilization of different teaching resources by students, registered questionnaire was applied to investigate the preference divergence of the students on the duration of different teaching videos used in the online flipped classroom model. One hundred forty-seven students of clinical medicine in grade 2018 of Xiangya School of Medicine were selected as the research objects. Three formal surveys were conducted in total. The results showed that there were significant divergences in preference of students for different durations in the first two surveys. 56.43 and 50.00% of the students preferred 15 min mini-video, whereas 43.57 and 50.00% preferred 45 min complete video. Meanwhile, students showed a significant preference for mini-video in active learning before class, with 65.00 and 59.29% watched only mini-video, 17.14 and 25.71% watched only complete videos, and 17.86 and 15.00% watched both mini and complete videos. Although most students preferred to watch mini-video in active learning before class, there was a significant proportion of students who watched complete video before class. The results suggested that the individualization of student in the online flipped classroom is prominent. Multiple logistic regression analysis showed that the selection of videos with different durations at different time points (before, in and after class) was significantly associated with the characteristics of the videos themselves. Therefore, the construction of online teaching resources and the application of teaching methods should consider the requirements of different student groups and provide a variety of online curriculum resources.

The effect of Flipped Classroom through Near Peer Education (FC through NPE) on patient safety knowledge retention in nursing and midwifery students: a solomon four-group design

INTRODUCTION

Selecting an appropriate teaching methodology is one of the key stages in education. This study is an attempt to delve into the effect of FC through NPE on patient safety knowledge retention in nursing and midwifery students.

METHODS

A randomized controlled trial, using the Solomon design, was conducted in 2019 on 82 nursing and midwifery students enrolled from Bushehr nursing and midwifery school. The Subjects were then allocated to four groups via block randomization. The Subjects in both intervention groups studied the educational content online for 2 weeks and subsequently attended the FC through NPE. Both control groups merely received education based on conventional method. The post-test was once administered to the four study groups immediately after completing the program and once again 2 months after it.

RESULTS

The posttest mean scores of knowledge retention in both intervention groups remained the same (P = 0.1), while they were higher in the control groups (P < 0.05). The changes in the mean scores of the post-test in the intervention and follow-up groups did not demonstrate a statistically significant difference between the four study groups (P = 0.130, F = 1.941).

CONCLUSION

The use of the FC through NPE increased the knowledge mean scores; however, it failed to affect knowledge retention. Given the infancy of this pedagogical approach, further studies are needed to investigate its effects on various learning outcomes.

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic

Background

The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness.

Methods

This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software.

Results

There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07).

Discussion

Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

Interprofessional Suicide Prevention Education

The COVID-19 pandemic has raised concerns regarding possible spikes in suicidal behavior in light of heightened risk factors such as social isolation and financial strain; thus, comprehensive suicide prevention training for emerging health service providers is increasingly vital. This article summarizes an interprofessional education (IPE) suicide prevention course delivered in-person in Spring 2020. Pilot data demonstrate that despite the impact of COVID-19 on higher education, this course had long-term impacts on trainee suicide prevention efficacy, IPE attitudes, and use of course content in practice. Discussion serves to address enhancements for interprofessional and suicide prevention education during and after the pandemic. Emphasis is placed on adaptable training strategies, considerations in the delivery format, guidelines for intensive virtual meetings with trainee teams, and future directions in IPE suicide prevention training research.

Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study

BACKGROUND

The unprecedented abrupt shift to remote online learning (OL) within the context of the national lockdown due to the 2019 coronavirus disease (COVID-19) highlights the importance of addressing students' preparedness in managing their first experiences with OL.

PURPOSE

To investigate the experiences of undergraduate nursing students during their first uses of OL to increase the understanding of their encountered opportunities and challenges.

DESIGN

A descriptive qualitative design guided by a phenomenological approach was used.

METHODS

The study used a purposive sampling technique to recruit 18 undergraduate nursing students from two universities. Data were collected using two focus group discussions, and the discussions with participants were audio/video recorded through the online platform Zoom due to the national imposed curfew. Content analysis employed Colaizzi's steps to derive the themes/categories.

RESULTS

The study revealed four themes: experience of helplessness, burdens, and burnout; the need for social and technical support to manage OL; the propensity to consider OL as a positive opportunity; and the deficiency of OL in fulfilling the educational outcomes of clinical courses.

CONCLUSIONS

Abrupt remote OL was a challenge to clinical encounters. This format was very stressful; however, it was also useful. The current study highlighted the need for further research on the effectiveness of remote OL platforms in regard to the achievement of the intended learning outcomes of clinical courses.

Use of a flipped classroom "Leadership in Nursing" course on nursing students' achievement and experiences: A quasi-experimental study

BACKGROUND

Providing the undergraduate "Leadership in Nursing" course using an innovative approach is regarded to be very important in terms of enhancing leadership skills.

PURPOSE

The purpose of this study was to evaluate the effect of using the "flipped classroom" strategy on nursing students' learning achievements and to describe their experiences of this technique.

METHOD

The course of "Leadership in Nursing" was delivered in flipped classroom format for 20 students while another 19 were exposed to traditional teaching methods. Therefore, the study was completed with 39 students. Data was collected using "Student Introductory Information Form", "Exams (a midterm exam, a final exam and 4 assignments)", "In-Class Observation Form" and "Student Feedback Form".

FINDINGS

Students in the flipped classroom group had obtained significantly higher scores than the students in the traditional teaching group regarding the assignments, the final exam, and overall grade. Concerning the flipped classroom, students reported flexibility as the most positive aspect and problems related to the system infrastructure as the most negative aspect.

CONCLUSION

The usage of a flipped classroom for nursing students in the leadership course provided valuable results in terms of the students' exam scores and achieving course objectives. The flipped classroom strategy for the "Leadership in Nursing" course was shown to be effective in improving abilities such as distinguishing leadership skills, visioning, developing a new perspective, willingness to share experiences regarding leadership, also enabling students to work in harmony in group activities and to participate in classroom discussions, which are all essential elements of leadership.

Effectiveness of an Evidence-Based Practice Educational Intervention among School Nurses

The evidence-based practice (EBP) approach to high-quality care is designed to improve patient outcomes. However, little research has been conducted to determine how EBP is adopted and implemented among school nurses in Taiwan. This study evaluated an EBP training program implemented among school nurses in Taiwan to determine whether and how effectively it improved their knowledge levels, attitudes, skills, and self-efficacy. A pretest-posttest research design was employed. Participants were recruited via convenience sampling from among 193 primary schools throughout Tao-Yuan and New Taipei City in Taiwan. The EBP program implemented both mobile learning technology and the flipped classroom format. The learning outcomes were evaluated before, immediately after, and at a 3-month follow-up. In this regard, the data were collected using the School Nurse Evidence-Based Practice Questionnaire. The results showed that the participant scores for the items of knowledge and self-efficacy significantly increased over the study period. Somewhat differently, scores for the skill items significantly increased from the pre-test to the immediate post-test, but significantly decreased from the immediate post-test to the final follow-up. Overall, however, the EBP program led to marked improvements in knowledge, skills, and self-efficacy. These findings can help guide the development of a creative evidence-based school nursing curriculum.