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（Cls） with the standard deviation average（SMD） or weighted mean difference（WMD）. The heterogeneity was assessed using Cochran’s I;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’ selfdirected 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.

A model to facilitate transformative learning in nursing education

Objective:Transformative learning is a learner-centered process of learning.Learners are actively engaged through critical reflection and discourse to question assumptions and expectations.The purpose of this article is to describe a model to facilitate transformative learning in nursing education.Methods:A qualitative,exploratory,descriptive and contextual design for theory generation was selected in this study to describe a model to facilitate transformative learning in nursing education.Concept analysis of transformative learning was done in the first stage of the main study using Walker and Avant's eight step approach to clarify the conceptual identification and meaning.The results of concept analysis guided data collection in the second stage.Eleven individual agenda semi-structured interviews were conducted with nurse educators to explore and describe their perceptions regarding how transformative learning can be facilitated in nursing education.Matrix building approach was used to analyse the collected data.The third stage constituted the conceptualisation of findings from the second stage using relevant literature within the elements of practice theory.The fourth stage focused on the description and evaluation of a model to facilitate transformative learning in nursing education.Findings:Four themes and nine sub-themes emerged and were conceptualised within the six elements of practice theory namely the context,agent,recipient,dynamic,process and procedure and outcome.Conclusion:The relation statements provided the basis for model description.Reliable method was used to describe and evaluate the model.The refinement of the model by experts in model development andqualitative research was made.

Transformative learning in nursing education: A concept analysis

Objective:There is vast literature on transformative learning,which is an important aspect of nursing education,but its meaning remains unclear.It is therefore important to clarify the meaning of transformative learning,identify its attributes,antecedents and consequences to increase its use in nursing education,practice and research.Methods:Walker and Avant's method was used,and the process provided a structured way to analyse the concept of'transfonnative leaming'.Nursing education dictionaries,encyclopaedias,conference papers,research articles,dissertations,theses,journal articles,thesauri and relevant books through the database library and intemet searches were reviewed.One hundred and two literature sources were reviewed,and data saturation was reached.Results:The results of the concept analysis of transformative learning within the context of nursing education identified three categories,namely,1)Antecedents as cognitive and affective perspective,democratic education principles and inspiration;2)Process through three phases,namely i)awareness through self-reflection,ii)the meaningful interactive,integrative and democratic construction process,and iii)metacognitive reasoning abilities;and 3)Outcomes.A theoretical definition of transformative learning was formulated.Theoretical validity was ensured.Conclusion:The results of the concept analysis of transformative learning were used to describe a model to facilitate transformative learning within the context of nursing education.

Investigation of nursing students’ knowledge of and attitudes about problem-based learning

Purpose:To investigate nursing students’knowledge of and attitudes about problem-based learning(PBL).Methods:A total of 1200 students were surveyed at eight nursing colleges in Hunan Province.Results:In all,1037 valid questionnaires were returned,for an effective return rate of 86.4%.Some 54.4%of the students learned that PBL was a pedagogical method from teachers,and 27.8%of the students had participated in PBL courses.Almost all of students(97.6%)were interested in PBL,and 66.7%of survey participants believed that students who were not good at solving problems would have difficulty in PBL courses.Conclusion:Nursing educators should guide students to adapt to new learning approaches,and encourage students to participate in the teaching reform to promote students’autonomous learning ability,innovation ability,and comprehensive ability.

The Application of Problem Based Learning in Undergraduate Nursing Education: A Strategy for Curriculum Reform

Background: Problem based learning (PBL) is an innovative way of delivering instruction in which problems are used as the basis of learning. Problem based learning was developed in the 1960s by Harold Barrows at McMaster University Medical School in Canada. Since then, PBL had been im-plemented as a teaching method in other reputable education institutions internationally, includ-ing nursing education. Curriculum reform is proposed through PBL in conjunction with patient simulation in undergraduate nursing education. The first author, Tan Kan Ku, PhD Candidate, MHS (Transcultural Mental Health—by Research) worked as a Registered Nurse for more than two decades internationally in England, New Zealand, Saudi Arabia and Australia, where she worked as a Case Manager in Community Mental Health Rehabilitation Program. Since 2001, she focused on nurse education and research into the stigma of mental illness from a cross-cultural perspective. Currently, she teaches Mental Health, Cultural Diversity and Research in the Diploma of Nursing course at Victoria University in Melbourne, Australia, while completing her PhD thesis for examination at Charisma University. The second author, Dr. Michael Ha, FSA, MAAA, CFA, CPA (Australia) FRM, PRM, LLM, is the Founding Director of the MSc Financial Mathematics programme at Xian Jiaotong-Liverpool University. He was previously Vice President of Strategic Business In-itiatives Units at ING Life Insurance in its Taiwan operation. Ninety percent of his students are enrolled in the Financial Mathematics programme. They learn not only mathematics and statistics theories but also their applications in the Finance and Investment areas, especially Portfolio Con-struction and Financial Risk Management. Creating a real-world Finance work environment in university lecture-halls embracing theories and practice, Dr. Ha strongly believes the PBL method can be employed in the Financial Mathematics training agenda so students can be better-prepared for work. Students are no longer instructed-learners but active thinkers and problem-solvers. Conclusion: Educators in fields such as Medical, Nursing, Engineering, Financial Mathematics, Ac-counting, Computing, etc., need to be prepared to change their teaching philosophy from didactic to problem solving for PBL to be implemented. Constructive alignment is recommended for curri-culum reform.

Results of the virtual simulation teaching method on autonomous learning competencies of undergraduate nursing students

Background:With the continuous development of information technology,most universities use mobile teaching platforms for classroom teaching.With the help of the national virtual simulation experimental teaching project sharing platform,students can enhance self-directed learning through the virtual simulation operations of the project.Purpose:To explore the application of virtual simulation experiment in teaching the fundamentals of nursing practice based on the Platform of the National Virtual Simulation Experiment Teaching Project during the COVID-19 pandemic analyze the impact of this teaching method on the autonomous learning ability of undergraduate nursing students.Methods:Convenience sampling was used to select 121 nursing undergraduates from Y University’s School of Nursing;the online teaching of fundamentals of nursing practice was conducted to the students.After taking the course,questionnaires were distributed to the undergraduate nursing students to collect their perceptions regarding the use of the virtual simulation experiment platform and autonomous learning competencies.Results:Most students expressed their preference for the virtual simulation teaching platform,and their satisfaction with the project evaluation was high 83.05%.They hoped to promote the application in future experimental teaching.Undergraduate nursing students believed that the virtual simulation teaching platform was conducive to cultivating clinical thinking ability,could stimulate learning interest,enhanced autonomous learning competencies.Conclusion:During the pandemic,the virtual simulation teaching platform for a lecture on in nursing education has achieved good results in both the aspects of teaching and student learning.Teachers efficiently used their training time and reduced their teaching burden.Moreover,the laboratory cost was also reduced.For undergraduate nursing students,the system was conducive to cultivating clinical thinking ability,stimulating their interest in learning,enhancing their learning and comprehension abilities and learning initiative.

Research progress on interdisciplinary cooperative learning in nursing

Multidisciplinary and interprofessional collaboration among medical staff is an effective way to reduce the incidence and complication of complex diseases and improve the quality of life.Therefore,it is very important to carry out interdisciplinary cooperative learning for nursing students in the education stage.This paper expounds the current situation of cross-disciplinary nursing education at home and abroad from the aspects of preparation and influencing factors of cross-disciplinary cooperative learning,teacher team building,teaching content and teaching methods,implementation time and place,in order to put forward suggestions for carrying out cross-disciplinary cooperative learning in college courses,and provide reference for many educators to carry out cross-disciplinary education and improve the comprehensive ability of nursing students.

The effects of the application of WeChat as a platform combined with problem-based learning in nursing teaching in China:a systematic review and meta-analysis

Background:Recently,WeChat application has been widely applied in the field of nursing education in China.Among them,WeChat as a platform combined with problem-based learning(PBL)teaching method is a commonly used method in nursing teaching,however,no unanimous consensus on the effectiveness of the application of nursing teaching.Purpose:The purpose of this meta-analysis is to systematically evaluate the effectiveness of WeChat as a platform combined with PBL teaching method in nursing teaching for Chinese nursing students from four aspects:nursing students'performance,ability,learning interest and teaching satisfaction.Methods:The following English and Chinese databases were searched for relevant articles:PubMed,Embase,Cochrane library,Web of Science,China National Knowledge Infrastructure(CNKI),WanFang Database,VIP Database and Chinese Biomedical Literature Database(CBM).The search timeframe was set fromthe establishment of these databaseto August 2021.Two reviewers separately screened records,abstracted data,and assessed risk of bias in trials included.Review Manager Software 5.3 was used to analyze data.Results:A total of 11 randomized controlled trials(RCTs)were included.The results of this meta-analysis showed that WeChat combined with PBL teaching method can significantly improve theory examination(SMD=2.50,95%CI:1.69 to 3.30,P<0.001),operation skill(SMD=2.32,95%CI:1.47 to 3.18,P<0.001),comprehensive ability(SMD=3.18,95%CI:1.59 to 4.76,P<0.001),and learning interest(SMD=3.08,95%CI:1.44 to 4.72,P<0.001)in Chinese nursing students,and increase nursing students on teachers'teaching satisfaction(SMD=2.64,95%CI:0.39 to 4.89,P<0.001).Conclusion:WeChat combined with PBL teaching method can significantly enhance Chinese nursing students'knowledge mastery and application,improve their comprehensive ability and learning interest,and improve classroom teaching effect.College nursing educators should consider adopting WeChat combined with PBL teaching method in nursing education to fully demonstrate its application value.

The problem-based learning integrated with simulation to improve nursing students’ self-efficacy

Introduction: The purposes of this study were to describe the simulation integrated with problem-based learning (SIM-PBL) module to educate the nursing process for clients with hypertension and to evaluate its effectiveness on nursing students’ self-efficacy (SE). Methods: This study was a one group pre- and post-test design. Twenty five students received a 5-hour SIM-PBL program focused on nursing care of clients with hypertension. A newly developed self-report questionnaire was used to assess SE in four areas of the nursing process with a scale of 0 (not at all confident) to 10 (totally confident). The four areas were subjective data assessment, physical examination, prioritizing nursing care and health promotion advices. Results: At baseline, students’ SE ranged from 5.5 ± 1.4 (prioritizing nursing care) to 7.6 ± 1.4 (subjective data assessment). After SIM-PBL education, all areas of nursing process presented statistically significant improvements of SE. The improvements were most noticeable in prioritizing nursing care. Conclusion: The SIM-PBL module was effective in improving the students’ self-efficacy in the nursing process for patients with hypertension. Further studies are recommended in developing SIM-PBL modules for diverse nursing topics and evaluating their effectiveness in various aspects of students’ competency.

Impacts of Online Remote Education on the Learning Process among Nursing Students

The period of existence and spread of Corona virus has led to the use of all means of remote education as an urgent necessity for all educational facilities, especially universities. Aim: Therefore, it was necessary to study the impacts of online remote education on the learning process among nursing students through studying of two courses;health information management at 6th semester and gerontology nursing course at 4th semester. Tool of Data Collection: A modified questionnaire comprised of forty statements was used through paper-based survey and online survey. Sample: A total samples (224) of nursing students were participated in the survey who enrolled in 2019 and 2020 spring semesters. Setting: The field of study was the nursing department of Applied Medical Science at Misr University for Science and Technology. Results: Induced positive impacts of online education on the learning process for nursing students experience were proven as more than half of the students (53.9%) had prior experience on online system use, and more than two thirds (62.5%) were competent in mobile/computer applications. Almost, two thirds (59.3%) agreed about online assessment experience, except that the online exam was anxious, and the time was insufficient to answer all questions. Also, more than two thirds (64.7%) agreed about the learning process of the two nursing courses. Conclusion: The study concluded that there were positive impacts of online education system on the learning process for nursing students except that the students were not able to decide that the remote online education system can replace traditional face-to-face learning as the clinical experience was not evaluated through this study. Recommendation: This study is recommended to be repeated on a large scale of participants to assess the possibility of achieving clinical experience through online remote education if Corona virus still coexists.

Do the Application of Problem-Based Learning on Undergraduate Nursing Students’ Is Effective? A Case Study Review

Objectives: The study’s aims to determine and assess the application of problem-based learning to undergraduate nursing students. Background: Nursing students are the upcoming health care delivery system;according to their standard of learning, it will affect their clinical training. Method: The study design is a case study review, the data was collected using many articles related to problem-based learning collected from E-books and E-journals websites like CINAHEL, Google Scholar, etc. After that, the data was analyzed and evaluated related to the application of problem-based learning on undergraduate nursing students. Result: The result appeared that most of the research proved and supported that the application of problem-based learning is effective for undergraduate nursing students, and students can solve patients’ problems in a better way. Conclusion: In conclusion, problem-based learning is an essential part of the nursing diagnosis process that will increase knowledge, and performance, and merge it with the nursing concepts.

Application of Microteaching Combined with Problem-Based Learning(PBL)Teaching Model in Teaching Clinical Nursing Interns in Otorhinolaryngology Department

Objective:To explore the application effect of microteaching combined with problem-based learning(PBL)teaching mode in teaching clinical nursing interns in otorhinolaryngology department.Methods:A total of 72 nursing students who interned in our hospital from June 2022 to February 2023 were selected,and all of them were comprehensively trained in basic theoretical knowledge as well as practical skills before the beginning of their learning tasks.The students were randomly divided into the control group and the experimental group,with 36 students in each group.The control group was taught using the traditional clinical nursing teaching mode,and the experimental group was taught using microteaching combined with the PBL teaching mode,subsequently comparing the differences between the two groups of interns in the degree of mastery of theoretical knowledge,hands-on skills,teamwork ability,patient satisfaction,and other aspects.Results:In terms of mastery of theoretical knowledge,the interns in the experimental group(97.22%)were significantly better than that of the control group(75.00%)(P<0.05);the interns in the experimental group had significantly better practical skills(77.78%)than that of the control group(55.56%)(P<0.05);the interns in the experimental group had significantly better teamwork ability than the control group(P<0.05);through the questionnaire survey,it was found that students’satisfaction with teaching in the experimental group(97.22%)was also significantly higher than that in the control group(75.00%)(P<0.05).Conclusion:The application of microteaching combined with PBL teaching mode in the teaching of clinical nursing interns in otorhinolaryngology department achieved significant results.It can not only improve the professional knowledge and application ability of nursing students,but also cultivate their independent thinking,problem-solving skill,as well as teamwork ability.It can also improve the teaching quality and patient satisfaction,and contribute positively to the development of medical education.

Engagement in clinical learning environment among nursing students: Role of nurse educators

Student engagement in a clinical learning environment is a vital component in the curricula of pre-licensure nursing students, providing an opportunity to combine cognitive, psychomotor, and affective skills. This paper is significant in Arab world as there is a lack of knowledge, attitude and practice of student involvement in the new clinical learning environment. The purpose of this review article is to describe the experiences and perspectives of the nurse educator in facilitating pre-licensure nursing students’ engagement in the new clinical learning environment. The review suggests that novice students prefer actual engagement in clinical learning facilitated through diversity experiences, shared learning opportunities, student-faculty interaction and active learning. They expressed continuous supervision, ongoing feedback, interpersonal relationship and personal support from nurse educators useful in the clinical practice. However, the value of this review lies in a better understanding of what constitutes quality clinical learning environment from the students’ perspective of engagement in evidence-based nursing, reflective practice, e-learning and simulated case scenarios facilitated by the nurse educators. This review is valuable in planning and implementing innovative clinical and educational experiences for improving the quality of the clinical teaching-learning environment.

Practices of caring for nursing students: A clinical learning environment

Objective:The purpose of this study was to explore,describe and illuminate nursing students'best encounters of caring in the clinical learning environment.Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.Methods:Qualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry(AI)methodology.Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council(SANC)were purposively sampled from 3 private hospitals within the Western Cape.Data was analysed using Giorgi's method.Results:The main theme included the best and'least best'caring practices embedded in the centrality of the heart.The subthemes comprised of the nursing students'experiences of caring literacy and caring illiteracy.The second theme included the creation of best caring practices within a conducive clinical learning environment.Within this theme,the subthemes comprised of the caring attributes required in reflecting best caring practices,as well the creation of a clinical learning environment to optimise caring.Conclusions:The significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants.Caring was equated to the heart as the core to the nursing students'being.Recommendations for nursing education,management,practice and research were therefore specifically formulated to enhance caring towards nursing students.

Nursing students’attitudes toward mobile learning:An integrative review

Purpose:This study aimed to explore whether the attitudes of nursing students toward the use of mobile learning are positive or negative and to identify the factors influencing their attitudes by reviewing the literature.Methods:Electronic search of six databases,including PubMed,the Cumulative Index of Nursing and Allied Health Literature,ProQuest,Web of Science,EMBASE,and Cochrane Library,was conducted,and relevant references within articles were manually searched.Retrieval time was from inception to October 21,2020.The literature review was conducted in accordance with the PRISMA guidelines and the integrative review method.The Mixed Method Appraisal Tool(MMAT)was used for quality assessment.Results:A total of 316 articles were identified,and 18 English-language studies were finally included by reviewing titles,abstracts,and full text.Six quantitative,five qualitative,and seven mixed-method articles related to nursing students’attitudes toward the use of mobile learning were identified.The results showed that most nursing students had positive attitudes toward mobile learning.Although students expressed strong intentions for mobile learning,the actual usage rate in practical settings was low.Several advantageous factors included usefulness,convenience,and ease of use,whereas disadvantageous factors included hardware facility,updated content,and software stability.Conclusion:Most nursing students have positive attitudes and willingness to mobile learning,but the actual use rate remains low.Advantageous and disadvantageous factors coexist.Further studies are needed to assess how mobile learning improves nursing students’clinical knowledge and improves patient care.

Self-directed learning readiness and nursing competency among undergraduate nursing students in Fujian province of China

Aims:We examined the relationship between self-directed learning readiness(SDLR)and nursing competency among undergraduate nursing students.Background:There is little evidence-based data related to the relationship between selfdirected learning(SDL)and nursing competency.Methods:A descriptive correlational design was used.We conducted convenience sampling of 519 undergraduate nursing students from three universities during their final period of clinical practice.We investigated SDL according to the SDLR scale for nursing education(Chinese translation version),and used the Competency Inventory for Registered Nurses to evaluate nursing competency.Results:The mean SDLR score of the students was 148.55(standard deviation[SD]18.46),indicating intermediate and higher SDLR.The mean score for nursing competency was 142.31(SD30.39),indicating intermediate nursing competence.SDLR had a significant positive and strong relationship with nursing competency.Conclusion:SDLR is a predictor of nursing competency.

The Outcomes of Integrating Concept Mapping in Nursing Education: An Integrative Review

Purpose: The purpose of this review was to investigate the current state of knowledge about the effectiveness of concept mapping in nursing education. Methods: An integrative review adapted a systematic approach. Also, after an extensive search from different databases, ten articles were retrieved and fully reviewed. Results: The ten reviewed articles were adopted quantitative, qualitative, and mixed method designs. Four main themes were identified: 1) from passive to active learners, 2) establishing new knowledge, 3) improving cognitive abilities, and 4) self-confidences in clinical work. Conclusion: Nursing literature supports the importance of including concept maps in nursing education. Educators believe that concept mapping is a motivating teaching strategy, hence, it is fostering the long-term and meaningful learning. Also, the findings of this study might encourage nursing educators to evaluate the current teaching strategies, also, this review might initiate future studies with larger sample

Complexity-Based Pedagogy for E-Learning: Description of Emergence in a Graduate Nursing Program

This paper describes the kind of engagement and emergent learning that happened in three different sections of a graduate nursing course. Three nursing educators used an e-learning platform called Daagu that was developed by faculty guided by complexity pedagogy. A total of 43 students were enrolled in the full credit foundations course in theory and philosophy. Authors describe two specific instances of emergent learning: one was expressed by students in relation to a particular resource (article, TedTalk, YouTube, Poem) or discussion, and the second is in relation to specific “aha moments” or shifts in understanding that changed student attitudes and actions. Quotes of emergent learning provide a source of narrative data for conversing about and developing quality e-learning platforms for students and educators.

Learning outcomes of nursing curriculum in Turkey:a cross-sectional study

Objective:To assess the nursing curriculum and point out learning outcomes in Turkey.Methods:A cross-sectional design was used in this study.This study was conducted between May and June 2017 from 23 undergraduate nursing schools'education programs for one education and academic year's curriculum.The public information of the universities collected from their web sites and learning outcomes of the schools were classified as cognitive,psychomotor,and affective domains.Results:It appears that half of the basic nursing courses are in the psychomotor domain,and the majority of basic medical sciences courses are in the cognitive domain.Learning outcomes about the affective domain mostly take place in basic nursing courses.Conclusions:The findings of the results of this study can provide insight into current nursing education and guide new curricula to be developed.

Is Distance Education the Answer to the Nursing Shortage?

This study examined the effectiveness of distance education compared with campus based learning among nursing students. Distance education in nursing curricula is increasing. Academic nurse leaders must demonstrate the effectiveness of distance learning. This study is unique in that two cohorts, distance learners and campus learners, were taught synchronously by the same faculty member. Quantitative measures of student learning outcomes were compared using SPSS. There were no significant differences in learning outcomes between distance learners and campus learners. This study provides empiric support for distance education as a means to address the nursing shortage.