Flipped versus traditional classroom and student achievement and cognitive engagement in an associate degree nursing fundamental course

BackgroundThere is a call for instructional transformation in nursing education to include an innovative approach. This study aimed to investigate the effects of the flipped classroom method on student achievement and engagement in an associate degree nursing course. This study investigated associate degree nursing studies students’ achievement and cognitive engagement under traditional learning (n = 141) and flipped learning (n = 130). This study was conducted in two first-year cohorts enrolled in their nursing fundamental course, before and during the COVID-19 pandemic respectively at a Hong Kong community college.MethodA mixed methods approach was used with quantitative (examination scores) and qualitative (semi-structured focus group interview) measures applied.ResultsThere was a significant increase in final exam scores for the flipped classroom, all p < 0.01, with a medium-to-large (d = 0.60) effect size. Students commented flipped classroom method promoted their cognitive engagement and the benefits that contributed to such a positive student achievement included more peer interaction and more opportunity to apply their knowledge.ConclusionThis study contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education.     

心理情景剧翻转教学设计在《精神科护理学》混合式教学中的应用研究

目的 探析融入心理情景剧翻转教学的《精神科护理学》混合式教学效果。方法 采用对照试验的研究设计,以本科二年级护理学生对授课对象,以选课班为分组单位分成混合式教学试验组（42名）与传统课堂教学对照组（84名）。试验组采用线上线下混合式教学方案,包括12课时传统课堂教学、8课时在线学习、8课时翻转课堂,翻转课堂融入心理情景剧与以问题为导向学习的课堂设计。采用课程闭卷考核成绩反映学生的精神科知识掌握度,心理负荷量表评价课程学习难度与体验,课程满意度评价表评价学习满意度。结果 126位护理学生均完成课程学习和期末闭卷考核,试验组考核成绩为（27.99±4.05）分,对照组为（25.83±4.17）分,组间差异具有统计学意义（t=2.46, P =0.016）。课程学习心理负荷水平,试验组为（47.51±13.55）分,对照组为（58.83±11.10）分,组间差异具有统计学意义（t=-4.77, P <0.001）;课程满意度评价试验组为（52.98±7.93）,对照组为（52.96±7.29）,组间不具统计学差异（t=0.011, P =0.991）。结论 以心理情景剧翻转教学为核心设计的《精神科护理学》混合式教学在减轻学习负荷的同时可显著提高学生的成绩,具有良好的课程满意度。     

Basic Life Support Training for undergraduate nursing students: An integrative review

The aim of this review was to identify the role of basic life support training interventions in international undergraduate nursing education, that support optimal acquisition and retention of knowledge, psychomotor skills and resuscitation self-efficacy. Twenty-four articles were identified and analysed using an integrative review approach. Studies were reviewed for quality using a Critical Appraisal Skills Programme checklist. Common objective and standardised methods of basic life support education practice were identified: instructor led, simulation experiences, self-directed learning, skills training combined with clinical practicum, and computer-based training. Evaluation of competency was collected primarily from multiple-choice questionnaires or researcher-designed checklists, with a lack of objective performance data noted. Importantly, current teaching approaches do not guarantee acquisition or retention of basic life support skills. Objective feedback from technologies supporting cardiopulmonary resuscitation training may be useful in acquisition and retention of psychomotor skills, and therefore requires further exploration. Development of robust, psychometrically sound instruments are needed to accurately and consistently measure nursing students' skills performance.     

基于CiteSpace的翻转课堂在护理教育中应用的可视化分析

目的对比国内外翻转课堂在护理教育领域应用的研究热点,旨在为我国护理教育工作者进一步开展翻转课堂提供参考。方法应用CiteSpace软件对CNKI及万方数据库2015—2019年、Web of Science核心合集数据库2013—2019年收录的关于翻转课堂在护理教育中应用的文献进行可视化分析。结果筛选出中文文献135篇,英文文献114篇,发文量整体呈现逐年上升趋势,中文文献关键词网络密度不高,研究学者相对分散。结论中文文献主要以应用实践为主,应加强理论模式研究和本土化探索合作,促进翻转课堂在护理教育领域的深入发展。     

Nursing students learning transfer from classroom to clinical practice: An integrative review

AimThe aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.BackgroundAs nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students’ learning transfer has not yet been synthesized.DesignThis integrative review was conducted using the Whittemore and Knafl framework.Review methodsEight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute’s critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsTwenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students’ ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.ConclusionsThe information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students’ learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.     

Emotional intelligence and nursing: An integrative literature review

Aim

The purpose of this paper is to present findings of an integrative literature review related to emotional intelligence (EI) and nursing.

Background

A large body of knowledge related to EI exists outside nursing. EI theory and research within nursing is a more recent phenomenon. A broad understanding of the nature and direction of theory and research related to EI is crucial to building knowledge within this field of inquiry.

Method

A broad search of computerized databases focusing on articles published in English during 1995–2007 was completed. Extensive screening sought to determine current literature themes and empirical research evidence completed in nursing focused specifically on emotional intelligence.

Results

39 articles are included in this integrative literature review (theoretical, n = 21; editorial, n = 5; opinion, n = 4 and empirical, n = 9). The literature focuses on EI and nursing education, EI and nursing practice, EI and clinical decision-making, and EI and clinical leadership. Research that links EI and nursing are mostly correlation designs using small sample sizes.

Conclusion

This literature reveals widespread support of EI concepts in nursing. Theoretical and editorial literature confirms EI concepts are central to nursing practice. EI needs to be explicit within nursing education as EI might impact the quality of student learning, ethical decision-making, critical thinking, evidence and knowledge use in practice. Emotionally intelligent leaders influence employee retention, quality of patient care and patient outcomes. EI research in nursing requires development and careful consideration of criticisms related to EI outside nursing is recommended.     

Effectiveness of flipped classrooms in Chinese baccalaureate nursing education: A meta-analysis of randomized controlled trials

BackgroundIn recent years, the flipped classroom approach has been broadly applied to nursing courses in China. However, a systematic and quantitative assessment of the outcomes of this approach has not been conducted.ObjectiveThe purpose of the meta-analysis is to evaluate the effectiveness of the flipped classroom pedagogy in Chinese baccalaureate nursing education.DesignMeta-analysis of randomized controlled studies.Data sourceAll randomized controlled trials relevant to the use of flipped classrooms in Chinese nursing education were retrieved from the following databases from their date of inception through September 23, 2017: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, the China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Scientific Journals Database. Search terms including “flipp*”, “inverted”, “classroom”, and “nurs*” were used to identify potential studies. We also manually searched the reference lists of the retrieved articles to identify potentially relevant studies.Review methodsTwo reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane risk-of-bias tool was used to evaluate the quality of the studies. RevMan (Version 5.3) was used to analyze the data. Theoretical knowledge scores and skill scores (continuous data) were synthesized using the standardized mean difference (SMD) and 95% confidence interval (CI). The statistical heterogeneity of the included studies was analyzed by calculating the I² statistic and applying a chi-square test. Publication bias was assessed by funnel plots. The quality of the combined results was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsEleven randomized controlled trials published between 2015 and 2017 were selected. All the included studies had a moderate possibility of bias due to low methodological quality. The meta-analysis indicated that the theoretical knowledge scores and skill scores were significantly higher in the flipped classroom group than in the traditional lectures group (SMD = 1.06, 95% CI: 0.70–1.41, P < 0.001, and SMD = 1.40, 95% CI: 0.46–2.34, P < 0.001). There was no significant publication bias indicated in the primary analysis. Sensitivity analysis showed that the results of our meta-analysis were reliable. The evidence grades of the results regarding the theoretical knowledge and skill scores were low and very low, respectively.ConclusionFlipped classroom pedagogy is more effective than traditional lectures at improving students’ theoretical knowledge and skill scores. Given the limitations of the included studies, more robust randomized controlled trials are warranted in a variety of educational settings to confirm our findings.     

Bullying and the nursing profession in Australia: An integrative review of the literature

BackgroundBullying in nursing remains unacceptable with reports of bullying and harassment increasing.AimThis article discusses the current state of knowledge about bullying in the nursing profession in Australia.MethodsThe review was informed by the approach described by Whittemore and Knafl. A literature search was conducted using thefollowing search terms: ‘nurse OR nursing OR nurses’ AND ‘bullying OR bully OR violence OR harassment’ AND ‘Australia’.FindingsThe findings highlight the many ways in which the experience of bullying in the nursing profession can be manifested and the implications for the profession as a whole.DiscussionThe culture, prevalence and impact of bullying described in this paper raises concerns for practitioners, educators and policy makers.ConclusionIn order to develop effective strategies for both nurses and organisations to address the problem of bullying in nursing in Australia, the contributing factors that allow the problem to persist must first be examined.     

The educational gaps of nurses in entrepreneurial roles: An integrative review

Nurse entrepreneurship remains a foreign concept in education, forcing nurses to turn to graduate degrees in business and finance or otherwise, learn ‘as they go’. Before addressing the question ‘Why does nursing curricula exclude business content and skill development?’, one must evaluate the perceived educational gaps of current nurse entrepreneurs; the purpose of this integrative review. An initial total of 2485 articles was generated in September 2016, of which 15 methodologically-diverse studies, published between 1977 and 2015, were appraised using the QATSSD tool. Perceptions of business-related educational gaps were categorized into 4 leadership skillsets: cognitive, interpersonal, business and strategic. Cognitive skills were further subdivided into self-regulation, professional know-how, and grasping the larger context; Interpersonal skills consisted of networking and selling your services, dealing with contextual resistance, and communicating clearly; Business skills were regrouped into mitigating and managing risk, marketing, financial and operations management; and lastly, Strategic skills were all related to knowing how to start a business. Business mindedness is not readily integrated into our collective professional identity resulting in an exclusion of this content from nursing curricula. To address service gaps, nurses should be introduced to entrepreneurial concepts during initial training with an option of further specialization for those considering a business career.     

Formative online multiple-choice tests in nurse education: An integrative review

AimThe aim of this integrative review is to explore how formative online multiple-choice tests used in nurse education promote self-regulated learning and report on pedagogies that support their design.BackgroundOnline multiple-choice tests are widely used as learning and formative assessment tools in a range of educational contexts. However, little is known about how these tools are used to promote patterns of learner self-regulation. It is important that nurses and nursing students develop the capability to self-regulate learning to be effective lifelong learners and navigate complex and unfamiliar practice environments.DesignA five-stage approach guided this integrative review: problem identification, literature search, data evaluation, data analysis and presentation.MethodA systematic search of ERIC, Web of Science, Ovid Medline, Scopus, PubMed, Embase and CINAHL was conducted in February 2021. Seventeen peer-reviewed papers were identified that discussed formative online multiple-choice tests in nurse education. Purposive sampling and ancestry searching identified an additional paper. Articles were analysed and sorted into themes of outcomes (presented as components of self-regulated learning theory) and pedagogy.ResultsFormative online multiple-choice tests are used with good effect in nurse education as measured by knowledge gain and exam performance, increased confidence and learner satisfaction. There was no literature that explored metacognitive outcomes and minimal literature considered behavioural outcomes. Pedagogy supporting the implementation of multiple-choice tests was lacking in most articles.ConclusionsFormative online multiple-choice tests are widely used with good effect in nurse education. However, opportunities for further research on how these tools can encourage metacognition and self-regulatory behaviours is warranted.     

The transition from nursing student to practicing nurse: An integrative review of transition to practice programs

The transition from student to novice is a difficult time. Although the novice nurse is excited to start working, the nurse struggles with acclimating to a new role with new responsibilities and the need to reconcile disparities between what was taught in school and what is practiced in the real world. To lessen the impact of the transition experience, health care organizations have implemented transition-to-practice programs including orientations, preceptorships, and residencies. Despite these efforts, if the novice nurse does not find these programs helpful, there is still a risk that the transition experience will not conclude with successful results. This integrative review examined qualitative studies that explored the transition-to-practice experience of novice nurses who participated in a transition-to-practice program provided by their place of employment. Thirteen articles met the criteria for this integrative review; seven themes emerged from the commonalities in the studies: socialization, professional growth, feeling supported, transition challenges, reflections, transition shock, and feelings. Though the transition period includes unique experiences for each novice nurse, the common feelings and needs identified in these studies require nurse educators and the healthcare organizations to ensure that novice nurses are prepared and given the tools to successfully transition to professional nursing practice.     

Effectiveness of the combination of workshops and flipped classroom model to improve tube fixation training for nursing students

BACKGROUNDTube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training.AIMTo compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students.METHODSThis was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses’ evaluation of their training, and related indicators of tube quality management were evaluated.RESULTSThe average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰.CONCLUSIONThe combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses’ active learning abilities and clinical thinking, and improving the safety of the procedure.     

Ethical global health in nursing education: An integrative review

AimThe purpose of this integrative review is to provide a comprehensive review of ethical considerations for host communities and nursing programs in planning, implementing and evaluating global health experiences for nursing students.BackgroundGlobal health experiences for nursing students are proliferating rapidly across university settings while at the same time decreasing the average time spent in the host country engaged with local communities. Global health experiences are an area where students can experience ethics as it is applied across varied contexts including resource limited international settings. As nursing education expands its global programming, exploring the ethical implications of designing, implementing and evaluating GHEs becomes pivotal to build respectful, sustainable relationships with global partners and best prepare nursing students for ethical professional practice in an interconnected world.DesignWe conducted an integrative review to examine ethical considerations in development of ethical global health experiences that benefit, rather than harm, host communities and participating nursing student guests.MethodsThe search included articles published in English language, peer-reviewed journals between 1998 and 2021 that discussed ethics in the context of nursing students traveling internationally for global health experiences. Eighteen articles met criteria for review.ResultsOverall, findings demonstrate relatively little research specific to ethical engagement in global health experiences. The articles in this integrative review discussed a range of ethical attributes including reciprocity or collaboration, respect, sustainability or commitment, justice and openness. Recommendations based on research and non-research articles are provided.ConclusionsEthical comportment in global health experiences requires careful planning, implementation and evaluation to assure an equitable and sustainable partnership between host community, faculty and nursing student guests.     

标准化病人结合翻转课堂教学法在康复护理教学中的应用效果评价

目的 探讨标准化病人结合翻转课堂的教学方法在康复护理教学中的应用效果。方法 选取广州新华学院2018级护理专业301名学生作为研究对象,以班级为单位随机分为试验组和对照组。试验组采用标准化病人结合翻转课堂进行教学,对照组采用传统教学方法。在教学前后对两组学生进行理论知识前测、后测,在理论课结束后1周对两组学生进行标准化病人参与的实操考试。结果 试验组和对照组学生的理论知识后测得分均显著高于前测得分(P<0.05)。两组学生的理论知识和实操考试得分组间比较差异无统计学意义(P>0.05)。标准化病人和教师对试验组学生的实操考试评分上差异有统计学意义(P<0.05)。学生对标准化病人结合翻转课堂在教学和考试中的应用满意度较高,标准化病人对自己参与教学和考试的评价较高。结论 采用标准化病人结合翻转课堂教学能显著提高学生的学习兴趣、团队合作能力、自主学习能力和沟通表达能力,达到与传统教学一样的教学效果,标准化病人作为指导者和评估者的规范化培训仍需加强。     

The meaning and application of student-centered learning in nursing education: An integrative review of the literature

AimThe aim of this study was to review empirical articles to explore the meaning and the application of student-centered learning in nursing education.BackgroundTeachers 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.DesignThis study employed an integrative review method, following Whittemore and Knafl’s framework.MethodsThe 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.ResultsThree 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.ConclusionStudent-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.