Factors Affecting Learning Satisfaction in Face-to-Face and Non-Face-to-Face Flipped Learning among Nursing Students

Expectations and concerns about transitioning to face-to-face learning among Korean nursing students: A mixed methods study

Owing to the coronavirus disease pandemic, nursing education materials were developed for online use. However, as nursing involves working with human beings, the experience of face-to-face learning is important. This study investigated the learning satisfaction and anxiety experienced by nursing students based on their learning methods, expectations, and concerns about transitioning entirely to face-to-face learning. Using a mixed-methods design, 120 and 14 third- and fourth-year nursing students in Korea completed an online survey and individual interviews, respectively. Data were collected from July to August 2022 to assess nursing students' learning satisfaction, anxiety, expectations, and concerns based on their learning method. Learning satisfaction was 3.96±0.68 out of 5; the students who experienced "online lectures only" had significantly higher overall satisfaction (F = 3.22, p = .002), nursing lectures satisfaction (F = 2.01, p = .046), and nursing practicum satisfaction (F = 2.19, p = .031). Anxiety was measured using the Generalized Anxiety Disorder-7 tool and was evaluated at the "minimal level," with an average score of 3.46 ± 4.80 out of 21. From the qualitative results obtained through interviews, we derived three categories and nine subcategories. These categories include: the burden of unfamiliar learning situations that are difficult to predict, considerations about face-to-face learning needed to improve learning satisfaction, and the turning point that offsets the sense of deprivation during college life. The qualitative results provided evidence for determining specific goals for face-to-face learning that reflected the opinions of nursing students. To successfully transition to face-to-face learning, it is essential to consider a combination of student efforts, professors' attention, and university-level support to develop a learning approach that combines the strengths of both online and face-to-face learning. Maximizing the benefits of online learning, such as integrating face-to-face and online learning through repetitive reviews of recorded videos of face-to-face sessions at their own time, can effectively reduce students' burdens and anxiety and increase their learning satisfaction.

Emerging Digital Practices Supporting Student-Centered Learning Environments in Higher Education: A Review of Literature and Lessons Learned from the Covid-19 Pandemic

The aim of this paper is two-fold: firstly, to provide an overview of emerging digital practices that support collaborative learning, competency development, and digital literacy for student-centered learning environments in higher education during the rapid digital transition caused by pandemic-related lockdowns across the world, and secondly, to analyze and discuss how systematic reviews of generalized themes and trends can be combined with contextualized experiences and the lessons learned from the Covid-19 crisis to inform the digital transformation of higher education, with a particular focus on bridging the gap between campus-based teaching and online learning and on the identification of the digital competencies that teachers and students must acquire during the continuing shift into a 'new normal' for post-pandemic educational practices. This study was motivated by questions and findings emerging from an early reactive case study conducted by three of this paper's co-authors (Lyngdorf et al., 2021a). By reviewing the full texts of 18 articles, this study provides a systematic literature review which maps the general landscape of the online, hybrid, and blended digital practices applied in existing student-centered learning environments in higher education since the onset of the pandemic. Furthermore, this mapping is used to revisit data and findings from the earlier reactive study of emerging digital practices in a specific problem- and project-based learning (PBL) environment. This study's findings highlight critical factors and barriers related to emerging practices which support students' interactions with teachers, content, and each other, as well as the emerging competencies that these practices will require. The paper concludes with a discussion of the main findings and their implications for further research and practice.

The effectiveness of the fully online flipped classroom for nursing undergraduates during the COVID-19: Historical control study

AIM

Evaluate the fully online flipped classroom's effects during the pandemic.

DESIGN

A comparative descriptive study with historical control design.

METHODS

In an internal medicine nursing course, the fully online flipped classroom instruction was used with 53 undergraduates in 2020. Their final examinations were compared with the 50 students taught with traditional offline methods in 2019. Online interactions and students' experiences were described. Pass rates in both classes were over 90% (Χ²  = 0.276, p = 0.60), but the median score in 2019 was higher than in 2020 (Z = -2.491, p = 0.01). There were 996 online interactions and 734 valid interactions in total. All 49 students believed the online flipped classroom schedule was reasonable and all but three said it was helpful. However, 19 students (39%) felt traditional teaching is more effective.

CONCLUSIONS

The fully online flipped classroom method was fairly effective during the pandemic. This model also did increase class participation and sufficient faculty-student interactions in remote education. However, fewer students earned outstanding scores, with possible reasons including the online flipped classroom, lack of clinical practice, stress from COVID-19 and the shortened exam time. Overall, the method is worth recommending under public health emergencies like COVID-19, and future research exploring potential concerns about scores is necessary.

Student engagement in flipped classroom in nursing education: An integrative review

AIM

To summarize the effect of the flipped classroom method (FCM) on student engagement in nursing education and provide the implications for future practice.

BACKGROUND

Technological advancement of learning approaches including flipped classroom has become increasingly popular in nursing education. However, no integrative review has been published that specially explore the behaviour engagement, cognitive engagement and emotional engagement of flipped classroom use in nursing education.

METHODS

Population, Intervention, Comparison, Outcomes and Study (PICOS) strategies were implemented to investigate the literature from published peer-reviewed papers from 2013 to 2021 in CINAHL, MEDLINE and Web of Science.

RESULTS

The initial search identified 280 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 16 articles were considered for the final review. Most of articles targeted on undergraduate nursing students and were conducted in the USA and Australia. The review primarily identified positive learning outcomes among nursing students in term of student engagement. However, a few studies reported contrasting findings, possibly due to students are still dependent on traditional lecture-based classroom.

CONCLUSION

This review suggests that use of the FCM in nursing education could promote students' behavioral engagement and cognitive engagement but yield a mixed outcome in emotional engagement. This review contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education, the strategies for promoting student engagement in future flipped classroom practice and recommendation for future research on flipped classroom.

Design principles for fully online flipped learning in health professions education: a systematic review of research during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, some instructors transitioned their courses into a fully online environment by adopting flipped learning. In this context, this review examined the challenges to fully online flipped learning and identified useful course-design elements for practicing this instructional approach in health professions education.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for selecting relevant articles. Thirty-three empirical studies (with 32 unique interventions) published between 2020 and 2021 (i.e., the first 2 years of the pandemic) were selected for analysis.

RESULTS

When the instructors in the reviewed studies designed and implemented their online flipped courses, numerous challenges emerged, which could be broadly categorized into student-related challenges (e.g., unfamiliarity with online flipped learning; N = 5), faculty challenges (e.g., increased workload; N = 8), and operational challenges (e.g., students' technical problems; N = 9). Nevertheless, we identified various useful elements for online flipped learning practice and organized them based on the following components of the Revised Community of Inquiry (RCoI) framework: cognitive presence (e.g., application of knowledge/skills; N = 12), social presence (e.g., peer interaction; N = 11), teaching presence (e.g., instructors' real-time demonstration/facilitation; N = 17), and learner presence (e.g., care and emotional support; N = 4).

CONCLUSIONS

Based on the findings from the review and the RCoI framework, we developed nine principles for the effective practice of online flipped learning. These principles appear crucial for sustaining quality health professions education in a fully online flipped learning environment.

Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial

BACKGROUND

In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario.

METHODS

A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received.

RESULTS

Significant differences were observed for the statements "I felt more confident in donning after receiving this training" (p = 0.029) and "I felt more confident in doffing after receiving this training" (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004).

CONCLUSIONS

Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.

Instructional design and educational satisfaction for virtual environment simulation in undergraduate nursing education: the mediating effect of learning immersion

BACKGROUND

Schools were closed after the onset of COVID-19, with non-face-to-face practices or distance education in nursing education replacing video learning or simulation classes in nursing education clinical practicum. This led to an increase in interest in virtual environment simulation education. While technology-based teaching methods might feel new and intriguing to learners, it is necessary to evaluate learner satisfaction with such an educational method beyond its novelty value. Therefore, this study examined the mediating effect of learning immersion on the relationships between instructional design and educational satisfaction, for virtual environment simulation.

METHODS

A descriptive cross-sectional research design was used. The study sample included students in the third or fourth year of the nursing curriculum in South Korea. The participants were 164 nursing students, who had an experience with virtual environment simulation practices during the past year, prior to September 2021. Data were collected using an online questionnaire. The questionnaire addressed the characteristics of nursing students, instructional design, learning immersion, and educational satisfaction. The collected data were analyzed using path analysis.

RESULTS

The indirect effect of the path between instructional design and educational satisfaction, mediated through learning immersion in virtual environment simulation was found to be significant. Furthermore, the direct path was also statistically significant.

CONCLUSION

Educational content, based on virtual environment simulation, should be implemented based on instructional design. It is necessary to recognize the importance of instructional design that can promote learning immersion in virtual environment simulation, as well as to prepare consistent standards for such design.

Strategies adopted by undergraduate teaching assistants in physiology and biophysics education during the COVID-19 pandemic

The COVID-19 pandemic affected almost all aspects of our lives, including the education sector and the way of teaching and learning. In March 2020, health authorities in Brazil imposed social isolation and the interruption of on-site activities in schools and universities. In this context, the Federal University of Minas Gerais (UFMG), one of the largest universities in Brazil and Latin America, developed an emergency remote learning (ERL) plan that allowed the return of classes in an online format and supported students to obtain access to equipment and internet network. Within this new perspective, the Undergraduate Teaching Assistant (UTA) program of the Department of Physiology and Biophysics (DFIB) explored strategies to minimize the impact of the absence of face-to-face classes. Using different available tools in online platforms and social media such as Microsoft Teams, YouTube animated video classes, and Instagram, the UTA program assisted >500 undergraduate students and strongly supported professors during ERL. In just over a year, our video classes on YouTube Channel reached ∼40,000 views. Most of the students reported that their questions were fully and quickly solved by the UTA program. Collectively, our results indicate that the strategies implemented by the UTA program helped the undergraduate students and professors to adapt to a remote learning format.

Effect of a Short Course on Improving the Cadres' Knowledge in the Context of Reducing Stunting through Home Visits in Yogyakarta, Indonesia

Background: Stunting is primarily a public health concern in Low- and Middle-Income Countries (LMIC). The involvement of Integrated Health Service Post (Indonesian: Posyandu) cadres is among the strategies to combat stunting in Indonesia. Objective: This study aimed to determine the effect of a short course on cadres' knowledge. Method: A single group pre-test post-test design was conducted in Yogyakarta, Indonesia, from March to May 2022. Thirty cadres were selected based on the following criteria: willingness to participate, the number of stunted children in their Posyandu, able to read and write, and full attendance at the short course. The knowledge scores were measured by a questionnaire using true and false answers after a short course (post-test 1) and 4 weeks later (post-test 2). We apply STATA 16 to calculate the Mean Difference (MD) using a t-test and a Generalized Estimated Equation (GEE). Furthermore, the adequacy of the short course was evaluated with in-depth interviews. Result: GEE analysis showed that after controlling for age, education, occupation, and years of experience, the short course improved cadres' knowledge significantly on post-tests 1 and 2, i.e., knowledge regarding Children Growth Monitoring (CGM) (Beta = 6.07, 95%CI: 5.10-7.03 and Beta = 8.57, 95%CI: 7.60-9.53, respectively), Children Development Monitoring (CDM) (Beta = 6.70, 95%CI: 5.75-7.65 and Beta = 9.27, 95%CI: 8.31-10.22, respectively), and Infant Young Children Feeding (IYCF) (Beta = 5.83, 95%CI: 4.44-7.23 and Beta = 11.7, 95%CI: 10.31-13.09, respectively). Furthermore, the short course increased their self-efficacy, confidence, and ability to assist stunted children through home visits. Conclusion: The short courses consistently and significantly boosted cadres' knowledge of CGM, CDM, and IYCF, and appropriately facilitated cadres in visits to the homes of stunted children's home.

Influencing Factors on Nursing Students' Learning Flow during the COVID-19 Pandemic: A Mixed Method Research

PURPOSE

This study aimed to investigate the factors affecting nursing students' learning flow in COVID-19 pandemic situations through mixed-method research.

METHOD

Of the 245 nursing students participating in the survey, 20 participated in a focus group interview. Quantitative data were analyzed using stepwise multiple regression analysis. Qualitative data were analyzed using content analysis.

RESULTS

The factors affecting the learning flow of nursing students during the COVID-19 pandemic were their self-regulated learning ability (β = .24, p = .001); learning motivation (β = .23, p = .001); self-efficacy in clinical practice (β = .14, p = .014); and lecture type, or a mixture of recorded and real-time video lectures (β = .13, p = .022). As a result of the qualitative study, eight categories and 22 subcategories were derived. The eight categories are: a lack of preparation in the starting of virtual classes, adapting and growing in a new learning environment, enhancing nursing knowledge and skills through virtual clinical training, self-regulation difficulties when studying alone due to social distancing, difficulty concentrating when learning online, disadvantages of virtual learning, concerns about academic performance, and missing opportunities to enjoy college life.

CONCLUSION

Students attempted to discover their own learning expertise through virtual learning while concerned that they would be unable to fully establish their competence to work as actual hospital nurses due to a lack of clinical practice. In such a learning environment, systematic support and strategies are needed to increase the learning flow of nursing students.