The effectiveness of problem-based learning on development of nursing students’ critical thinking: A systematic review and meta-analysis

Critical thinking and clinical skills by problem-based learning educational methods: an umbrella systematic review

INTRODUCTION

Problem-based learning (PBL), based on self-directed learning, is an instructional strategy that shifts the approach from the instructor to the student (student-centered). Notwithstanding its adoption in undergraduate and graduate medical education, its usefulness remains a topic of debate. This study aims to review current worldwide data on the efficacy and utility of critical thinking and clinical skills using PBL educational methods for teaching programs to undergraduate medical students, ursing students, dental students and medical residents.

METHODS

The search was conducted in June 2024 in PubMed, Cochrane, Embase, and Web of Science and included all publications regardless of the publication date, study design, or country of origin.

RESULTS

Thirteen meta-analyses and systematic reviews were compiled through database screening. The results showed that PBL effectively enhanced students' clinical skills and critical thinking abilities; nevertheless, further evidence is needed to confirm this finding.

CONCLUSION

PBL may be a successful and an effective instructional strategy, not only medical, but also nursing and dental education. Students can learn skills and acquire competencies useful for their medical professionalism through PBL in addition to their existing knowledge.

Impact of case-based learning on critical thinking dispositions in Chinese nursing education: a systematic review and meta-analysis

Background

Case-based learning (CBL) is recognized for its potential to enhance critical thinking in nursing education. This meta-analysis aimed to assess the impact of CBL alone or in combination with other methods on improving critical thinking dispositions among nursing students in China.

Methods

A systematic search was conducted in databases including PubMed, Embase, Cochrane Library, CINAHL and China National Knowledge Infrastructure from inception of the databases through June 1, 2024. Studies that utilized the Chinese Version of Critical Thinking Dispositions Inventory (CTDI-CV) and compared CBL with traditional teaching methods were included. Random-effects models were used to pool the mean differences (MD) in critical thinking scores, and subgroup analyses were performed based on participant types and intervention methods.

Results

Thirteen studies involving 1,396 participants were included. The pooled results indicated a significant improvement in critical thinking dispositions (MD = 26.39, 95% CI: 18.71 to 34.06). Subgroup analysis revealed that nursing interns and combinations of CBL with problem-based learning (PBL) reported higher improvements. Secondary outcomes showed significant gains in both theoretical knowledge and operational skills, with heterogeneity observed across studies (I 2 > 79%). The Egger's test (p = 0.95) suggested no significant publication bias.

Conclusion

CBL significantly enhances critical thinking among nursing students in China, particularly when integrated with PBL. Despite the observed heterogeneity, the findings support the incorporation of CBL into nursing curricula to foster critical analytical skills. Further research should explore the contextual factors that affect the variability in outcomes.

Clinical simulation in the teaching of cardiovascular physical examination with nursing students: a systematic review

OBJECTIVES

to highlight the effect of using clinical simulation in the training of undergraduate nursing students for the development of skills in cardiovascular health assessment.

METHODS

a systematic review was conducted in the PubMed/MEDLINE, LILACS, Scopus, EBSCO, Web of Science, and Science Direct databases from August to September 2023. Of the 685 articles identified, 6 were selected, consisting of 4 experimental studies and 2 quasi-experimental studies, all of good methodological quality according to the Joanna Briggs Institute.

RESULTS

clinical simulation increased nursing students' levels of knowledge and confidence. Most studies indicated that simulated practices improve learning compared to traditional methodologies.

CONCLUSIONS

clinical simulation requires more robust methodological designs, and more multicenter clinical trials on cardiovascular assessment in nursing need to be published.

Nursing postgraduates learning experience of professional curriculum in China: A qualitative study

AIM

This study adopted the qualitative research method, aiming to explore the learning experience of nursing graduate professional curricula in China from the perspective of students and provided a basis for the continuous improvement of nursing graduate training.

DESIGN

A qualitative study.

METHODS

A purposive sampling method was employed to conduct semi-structured in-depth interviews with 14 nursing master's students enrolled in professional curricula from September 03, 2021, to December 8, 2022. The Colaizzi seven-step analysis method was utilized for data analysis, summarization and extraction.

RESULTS

Four themes emerged from the study findings: (i) The study of professional curricula is the cornerstone of scientific research work, but it is relatively boring; (ii) The teaching methods and assessment methods of postgraduate education need to be diversified; (iii) The postgraduate education needs to increase the study time of specialized courses and highlight the specialty characteristics; (iv) the study of professional curricula can enhance the comprehensive ability of postgraduate students.

CONCLUSION

The study of professional curricula for post-graduate nursing students plays an important role in the development of post-graduate research and can statistically significant improve their comprehensive ability, but there are some problems such as boring courses, single teaching assessment methods and insufficient time. In the future teaching reform, it is necessary to highlight the specialty characteristics of nursing scientific research, optimize curriculum education and improve students' scientific research knowledge and thinking.

PATIENT AND PUBLIC CONTRIBUTIONS

We thank all participants for their valuable input throughout the study.

Collaborative project-based learning in global health: Enhancing competencies and skills for undergraduate nursing students

BACKGROUND

Despite the importance of collaboration and communication in global health, existing educational approaches often rely on traditional one-way instruction from instructor to student. Therefore, this study aimed to evaluate the effectiveness of a newly developed undergraduate curriculum on global health in enhancing nursing students' competencies in global health and communication, problem-solving, and self-directed learning skills.

METHODS

A 15-week course "Global Health and Nursing" was designed for undergraduate nursing students, and a collaborative project-based learning method was used. Study participants were undergraduate nursing students enrolled in the course. The study was a multi-method study and included quantitative and qualitative components. It employed a one-group pretest-posttest design to quantitatively assess the impact of the curriculum. Additionally, student experiences with the learning process were qualitatively explored through a focus group interview. A total of 28 students participated in this study, and 5 of them participated in the focus group interview.

RESULTS

The collaborative project-based learning method significantly improved global health competency (t = - 10.646, df = 22, p < 0.001), with a large effect size. It also improved communication skills (t = - 2.649, df = 22, p = 0.015), problem-solving skills (t = - 3.453, df = 22, p = 0.002), and self-directed learning skills (t = - 2.375, df = 22, p = 0.027). Three themes were found through the focus group interview: (a) Promoting global health competency; (b) Fostering life skills through collaborative projects; and (c) Recommendations for future classes. The focus group interview indicated that overall, the study participants were satisfied with the collaborative project-based method for global health education.

CONCLUSIONS

This study confirms that project-based learning significantly boosts the competencies and skills of students, recommending its broader adoption in nursing education. Nursing instructors should consider adopting this teaching approach for global health education at the undergraduate level. Future studies may employ a longitudinal design to assess the prolonged effects of the collaborative project-based learning approach, particularly focusing on the long-term retention of skills and the broader applicability of this model across different educational settings.

Effectiveness of Problem-Based Learning on Development of Nursing Students' Critical Thinking Skills: A Systematic Review and Meta-analysis

BACKGROUND

Problem-based learning (PBL) is a student-centered approach to teaching that has been applied in medical and nursing education. The effectiveness of PBL in promoting critical thinking in nursing students has been studied extensively with mixed results.

PURPOSE

The meta-analysis aimed to investigate the impact of PBL interventions on critical thinking skills of nursing students.

METHODS

PubMed, Embase, Cochrane, and CINAHL databases were electronically searched. Methodological quality was examined using the Newcastle-Ottawa Scale and version 2 of the Cochrane risk-of-bias tool. Data were analyzed with 95% confidence intervals based on random-effect models.

RESULTS

Nineteen studies involving 1996 nursing students were included in the analysis. The results of the analysis demonstrated greater improvement in critical thinking skills compared with the control group (overall critical thinking scores: standardized mean difference [SMD] = 0.47, 95% CI = 0.33-0.61, P < .01).

CONCLUSIONS

The meta-analysis indicates that PBL can help nursing students to improve their critical thinking.

Nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course: a qualitative study

BACKGROUND

Problem-based learning (PBL) is a student-centred approach that triggers learning by presenting problems cenarios early in the learning process.Flipped classrooms have been used in various disciplines using various models.Pre-class e- learning in aflipped classrooms can enrich knowledge acquisition in PBL teaching. This study was conducted to explore nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course.

METHOD

This descriptive qualitative study was conducted between January and June 2022.Semi-structured interviews were conducted with nursing students who were participated in flipped classrooms combined with PBL teaching in a paediatric nursing course at Soochow university in China. Nursing students were selected using a purposive sampling method until no new data were generated (n = 16).

RESULTS

We identified ten sub-themes and four higher-order themes based on these sub-themes: (1)stimulating interest in learning and enhancing autonomous learning,(2)improving independent thinking and problem-solving skills,(3)cultivating team work spirit, and (4) gaining knowledge and improving skills.The findings of our research contribute to show the effectiveness of the flipped classroom combined with PBL in a paediatric nursing course.

CONCLUSION

The flipped classroom combined with PBL in a paediatric nursing course can enhances communication and cooperation abilities among nursing students, promoting common progress and the comprehensive development of nursing students.

Nurse Education in Care of Delirium: Achieving a Change from Transcription and Translation to Interpretation for Reduced Strain

How to cite this article: Gopaldas JA. Nurse Education in Care of Delirium: Achieving a Change from Transcription and Translation to Interpretation for Reduced Strain. Indian J Crit Care Med 2024;28(2):95-96.

Effects of problem-based learning on delivering medical and nursing education: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

There is still a lack of high-level evidence on the effects of problem-based learning (PBL) in general medical and nursing education.

AIMS

We aimed to summarize current evidence on the effects of PBL in delivering medical and nursing education from randomized controlled trials (RCTs).

METHODS

A systematic search was performed in MEDLINE, EMBASE, Cochrane Central Library, and CINAHL Complete. RCTs that assessed the effects of a PBL module in delivering medical education were eligible. Outcomes included knowledge, performance, and satisfaction. The risk of bias was assessed according to Cochrane handbook guidelines. Standardized mean differences with 95% confidence intervals of each outcome between PBL and control groups were pooled using a random-effects model.

RESULTS

In all, 22 RCTs with 1969 participants were included. Both pooled analyses of changes in scores compared with baseline and absolute post-interventional scores favored PBL module in knowledge and performance. The satisfaction degree was also higher in participants receiving PBL methods. Publication bias might exist in satisfaction; however, not in knowledge and performance. Eleven of the 22 studies were assessed as having a high risk of bias.

LINKING EVIDENCE TO ACTION

Compared with traditional lecture-based modules, PBL delivered medical education in different medical science specialities more efficiently from both theoretical knowledge and practice skill perspectives. The feedback from participants receiving PBL methods was more positive than that from those receiving traditional methods. However, the high heterogeneity and low quality of the included studies prevented drawing definite conclusions.

Nursing Students' Self-rated Nurse Professional Competence at the End of an International Collaborative Education Program and Follow-up 1 Year Later

BACKGROUND

International collaborative programs and student active learning are encouraged; yet, little is known about them.

PURPOSE

To compare nursing students' self-rated nurse professional competence (NPC) and general self-efficacy between those enrolled in an international collaborative program, which focused on student active learning, and those enrolled in a traditional lecture-based program at the end of graduation and 1 year later.

METHODS

This prospective comparative study distributed a questionnaire to 137 nursing students enrolled in the 2 bachelor-level programs at a university in southeastern China.

RESULTS

At the end of graduation, students enrolled in the international collaborative program reported higher scores for NPC factors, medical and technical care and general self-efficacy, than those enrolled in the traditional lecture-based program. One year later, they reported higher scores for total NPC, value-based nursing care, medical and technical care, care pedagogics, documentation and administration of nursing care, and general self-efficacy than others.

CONCLUSION

This study found that the nursing students enrolled in the international collaborative program reported higher self-rated competence.

Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study

BACKGROUND

In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings.

METHODS

This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays.

RESULTS

First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme.

CONCLUSIONS

The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Emotional intelligence is more important than the learning environment in improving critical thinking

PURPOSE

To examine the association of critical thinking (CT) and emotional intelligence (EI) versus CT and learning environment (LE) in order to investigate which has the greatest influence EI or LE.

MATERIALS AND METHODS

A cross-sectional study was conducted with 340 s-year healthcare university students in two nursing and one medical schools from three universities in Greece, between October and December 2020. Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence Questionnaire-Short Form were administered. Hierarchical multiple linear regression analysis, with five steps, was used to compare the associations of CT and EI to CT and LE.

RESULTS

Participants' mean age (years) was 20.9 (6.6 SD); 82.6% female; 86.8% studying nursing. Students mean scores were moderate to high for CT disposition (44.7 ± 4.68). The general characteristics (age, gender, and school) were not significantly associated with CT (p > 0.05). However, CT was positively associated with LE (UCB = 0.064 & p < 0.001) and EI (UCB = 1.522 & p < 0.001). Moreover, CT seems to be associated in a higher degree (R² change adj = 0.036 & p < 0.001) with emotional intelligence (UCB = 1.522) than with learning environment (UCB = 0.064).

CONCLUSIONS

Our findings suggest a different more optimal pathway for educators to improve the CT of their students through EI and not with LE as believed till now. By focusing on improving EI, educators may help their students become critical thinkers, who will provide better quality of care.

Virtual simulation and problem-based learning enhance perceived clinical and cultural competence of nursing students in Asia: A randomized controlled cross-over study

BACKGROUND

Both clinical and cultural competencies are of paramount importance in ensuring patients' safety and high-quality care. While problem-based learning (PBL) is a widely applied pedagogy in nursing education, an emerging technology-based pedagogy, virtual simulation provides a realistic clinical learning experience for students. It can be an effective solution for continuing clinical and cultural learning across countries in the era of the pandemic.

OBJECTIVES

This study aimed to compare the effectiveness of virtual simulation and PBL on the perceived clinical and cultural competence for nursing students.

DESIGN

A randomized controlled cross-over study design was used.

SETTINGS AND PARTICIPANTS

Sixty-one undergraduate and postgraduate nursing students from five Asian regions were selected for participation.

METHODS

Participants were randomized to receive either virtual simulation (group A) or PBL (group B) for one day, followed by another intervention on the second day. Three self-reported questionnaires were used: Clinical Competence Questionnaire (CCQ), Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV), and demographic questionnaire.

RESULTS

The results revealed that students in both arms had significant improvements in CCQ total score (A: d = 21.500, P < 0.001; B: d = 16.710, P = 0.001), nursing professional behavior (A: d = 8.233, P < 0.001; B: d = 6.323, P < 0.001), and advanced nursing skills (A: d = 2.533, P = 0.008; B: d = 2.129, P = 0.029) after two interventions. In addition, both arms demonstrated significant improvements in IAPCC-SV total score (A: d = 3.467, P = 0.037; B: d = 4.032, P = 0.010) and cultural skills (A: d = 0.767, P = 0.012; B: d = 1.000, P = 0.001). No significant differences were observed between the two arms.

CONCLUSIONS

The findings indicated that both virtual simulation and PBL were effective in promoting students' perceived clinical and cultural competence. As both education modes have their own uniqueness and effectiveness in both outcomes, the combination of both could enhance the variability of learning modalities. Notably, the use of virtual simulation first could engage students better in learning and achieve better educational outcomes.

Linking Learning Environment and Critical Thinking through Emotional Intelligence: A Cross-Sectional Study of Health Sciences Students

Background: Health sciences educators should increase the critical thinking of their students as this may improve the quality of care. However, this is rarely considered as a critical point in teaching, despite studies identifying factors such as the learning environment and emotional intelligence as increasing critical thinking at an undergraduate level. Thus, there is a need to better explore these factors and investigate interrelations and ways of improving critical thinking, especially in the critical field of healthcare students (nursing and medicine). Objectives: The present study aimed to examine the potential relationships between critical thinking with emotional intelligence and the learning environment. Method: This was a descriptive cross-sectional study with 208 first year health sciences university students of two nursing departments and one medicine department from three universities in Greece. The Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence-Short Form questionnaires were used to assess critical thinking, the education environment, and emotional intelligence, respectively. Results: The results demonstrate that critical thinking was positively related to emotional intelligence (β = 0.82, p < 0.001), but not to the learning environment (β = 1.06, p = 0.30). However, a structural equation modeling analysis supported the indirect relationship between the learning environment and critical thinking through emotional intelligence (M = 1.10, CI = 0.13–2.17, p < 0.05). Conclusions: Emotional intelligence may be the underlying mechanism for achieving critical thinking if it is well applied and cultivated in a learning environment. Therefore, universities could modify their curricula and place emotional intelligence at the epicenter of teaching.

Evaluating and comparing critical thinking skills of residents of Tehran University of Medical Sciences

BACKGROUND

Today's complexities and diversity in the clinical setting have revealed the need to pay attention to strengthening critical thinking (CT) skills. The present study aimed to evaluate and compare CT skills in the residents of the Tehran University of Medical Sciences.

METHODS

This is a cross-sectional study. The study's statistical population included 284 residents in orthopedic, internal medicine, and surgery groups studying in the PGY1 to PGY4 years of residency. The data collection tool was the California Critical Thinking Skills Test (CCTST) form B. The collected data were entered into SPSS-16 software and analyzed using descriptive (mean and standard deviation) and inferential (one-way ANOVA) statistics. The significant level in all tests was considered at P < 0.05.

RESULTS

189 out of 284 residents completed and returned the questionnaire, and the response rate was 66%. The mean CT skill score of residents (M = 13.81, SD = 3.52) was lower than the optimal level (M = 17.1 SD = 5.0). Comparing the mean CT skill scores of the residents separately for the residency year revealed a significant decrease in CT scores in the 4 years. A significant difference was found between the CT skill scores in the three groups (internal medicine, general surgery, and orthopedic surgery).

CONCLUSION

The CT skills of the residents of Tehran University of Medical Sciences were generally below the optimal level. The CT score of the residents show an increase in PGY2, but a decrease in PGY3 and PGY4. Due to the emphasis of accreditation institutions, the World Federation for Medical Education, and other international educational institutions on the importance of critical thinking, it is recommended to pay more attention to the factors related to the promotion and development of CT skills in residency programs.

Outcomes of problem-based learning in nurse education: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of problem-based learning (PBL) in nursing students, including recently reported trials.

DESIGN

Meta-analysis was performed to obtain summary conclusions on the influence of PBL on nursing students' learning outcomes.

DATA SOURCES

Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Web of Science were searched for relevant studies from the period between database inception and March 3, 2022.

REVIEW METHODS

A random-effects model was used to generate pooled standardized mean differences (SMD) for critical thinking, problem-solving, and self-confidence. The heterogeneity of each variable in the pooled estimate was determined using a random-effects model.

RESULTS

Overall, PBL had a greater positive effect than traditional learning on critical thinking (SMD: 0.44; 95 % CI: 0.14-0.73), analysis (SMD: 0.72; 95 % CI: 0.84-1.25), and evaluation (SMD: 0.33; 95 % CI: 0.05-0.61). However, the impact of PBL on problem-solving and self-confidence need further investigation.

CONCLUSIONS

PBL appears to improve nursing students' critical thinking skills, especially their ability to analyze and evaluate. The findings of this study may be used as evidence of PBL being a more effective method than traditional/conventional learning techniques for increasing students' critical thinking.

Implementation of the Flipped Classroom Combined with Problem-Based Learning in a Medical Nursing Course: A Quasi-Experimental Design

Background: Medical Nursing is one of the most important core courses in nursing education, and the emergence of the flipped classroom has made up for the shortcomings of traditional teaching and improved the effectiveness of teaching. However, it is worth exploring how to maximize the effect of students’ self-study before class while making full use of classroom teaching to promote the cultivation of students’ abilities, so that the flipped classroom can have a maximal teaching effect. Therefore, this study explored the effect of a flipped-classroom teaching mode based on a small private online course (SPOC) combined with problem-based learning (PBL) in a course of Medical Nursing. Methods: Nursing undergraduates from the years 2018 (control group) and 2019 (experimental group), respectively, used the traditional lecture method and the flipped-classroom teaching mode based on a SPOC combined with PBL. The teaching effect was evaluated by teaching-mode-recognition evaluation, critical thinking measurement, and academic achievement. Results: The scores of teaching-mode recognition evaluated by the students in the experimental group were higher than those in the control group in the following five aspects: “helping to improve learning interest” (p = 0.003), “helping to improve autonomous learning ability” (p = 0.002), “helping to improve communication and cooperation ability” (p < 0.001), “helping to cultivate clinical thinking” (p = 0.012), and “helping to promote self-perfection and sense of achievement” (p = 0.001). Compared with the control group, the score on the “analytical ability” dimension of the Critical Thinking Disposition Inventory in the experimental group was higher (p = 0.030). The excellent rates of the final theoretical examination (p = 0.046) and comprehensive case analysis (p = 0.046) in the experimental group were higher than those in the control group. Conclusions: The flipped-classroom teaching mode based on a SPOC combined with PBL can promote students’ abilities of autonomous learning, communication and cooperation, and clinical and critical thinking; improves their academic performance; and is recognized and welcomed by them. However, to extend the flipped-classroom teaching model of a SPOC combined with PBL to other nursing education courses, more optimization and evaluation are required.

Effects of Problem-Based Learning Strategies on Undergraduate Nursing Students' Self-Evaluation of Their Core Competencies: A Longitudinal Cohort Study

To respond to patients' increasing demands and strengthen nursing professionals' capabilities, nursing students are expected to develop problem-solving skills before they enter the workforce. Problem-based learning (PBL) is expected to provide effective simulation scenarios and realistic clinical conditions to help students achieve those learning goals. This article aims to explore the effects of PBL strategies on nursing students' self-evaluation of core competencies. This longitudinal cohort survey study evaluated 322 nursing students attending Chung Shan Medical University, Taiwan, in 2013 and 2014, where PBL teaching strategies are used in all four undergraduate years from freshman to senior. Based on their undergraduate academic levels, students were categorized into three groups- one-year PBL exposure, two-year PBL exposure, and three-year exposure. A core competency questionnaire was administered twice to ask participants to self-assess five professional competencies: learning attitude, problem identification, information analysis, execution, and life-long learning. The results showed that students with the longest exposure to PBL (Group 3) had higher self-evaluated scores for all core competencies than the other groups, except for the execution competency. The mean total competency score increased by 0.12 points between the pre-and-test. In addition, the mean score increased significantly more in Group 3 than in Groups 1 and 2. These trends were consistent for the information analysis, execution, and life-long learning competencies. In conclusion, the changes in the self-evaluated scores between groups indicate PBL strategies effectively improve nursing students' core competencies. The longest exposure group reported higher self-evaluated core competency scores than the other groups, especially for the information analysis, execution, and life-long learning competencies.

An e-Problem-Based Learning Program for Infection Control in Nursing Homes: A Quasi-Experimental Study

Infection is a significant factor adversely affecting the health of nursing home (NH) residents, potentially even leading to death. Therefore, educating NH staff to think critically is necessary to prevent and control infection. In this study, we developed an electronic problem-based learning (e-PBL) program using the Network-Based Instructional System Design model to enhance South Korean NH staff's critical thinking competencies; subsequently, its effectiveness was evaluated. This study utilized a quasi-experimental nonequivalent pretest-post-test design. The participants (n = 54) were randomly allocated into an experimental group (n = 28) and a control group (n = 26). The results indicate that the e-PBL program significantly improved the critical thinking disposition in the experimental group compared with in the control group.

A Technology-Supported Guidance Model to Support the Development of Critical Thinking among Undergraduate Nursing Students in Clinical Practice: A Concurrent, Exploratory, Flexible, Multi-Method Feasibility Study (Preprint)

BACKGROUND

There is widespread recognition and acceptance of the need for critical thinking in nursing education, as it is necessary to provide high-quality nursing. The Technology-Supported Guidance Model (TSGM) intervention was conducted during clinical practice among undergraduate nursing students and aimed to support the development of critical thinking. A major element of this newly developed intervention is an app, Technology-Optimized Practice Process in Nursing (TOPP‑N), combined with the daily guidance of nursing students from nurse preceptors and summative assessments based on the Assessment of Clinical Education.

OBJECTIVE

The main objective of this study was to assess the feasibility of a newly developed intervention, TSGM, among undergraduate nursing students, nurse preceptors, and nurse educators. Further objectives were to assess the primary and secondary outcome measures, recruitment strategy, and data collection strategy and to identify the potential causes of dropout and barriers to participant recruitment, retention, intervention fidelity, and adherence to the intervention.

METHODS

This study was designed as a concurrent, exploratory, flexible, and multimethod feasibility study of the TSGM intervention that included quantitative and qualitative data from nursing students, nurse preceptors, and nurse educators. The primary outcome measures were the feasibility and acceptability of the intervention. The secondary outcomes included the suitability and acceptance of the outcome measures (critical thinking, self-efficacy, clinical learning environment, metacognition and self-regulation, technology acceptance, and competence of mentors); data collection strategy; recruitment strategy; challenges related to dropouts; and hindrances to recruitment, retention, and intervention fidelity and adherence.

RESULTS

Nursing students, nurse preceptors, and nurse educators had varied experiences with the TSGM intervention. We identified factors that make the intervention feasible and challenging and may influence the feasibility, acceptability, dropout rate, adherence, and fidelity of the intervention. We also identified areas for future improvement of the intervention.

CONCLUSIONS

The use of a newly developed intervention, TSGM, is feasible and accepted by undergraduate nursing students, nurse preceptors, and nurse educators; however, refinement and improvement of the intervention and the TOPP‑N app, improvement in intervention management, and mitigation of negative factors are necessary before a randomized controlled trial can be performed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31646.

Concept maps as a novel assessment tool in medical education

Background: Concept Maps (CMs) have been used in a Problem-Based Learning (PBL) setting as  complementary tools to current educational techniques for enhancing medical student knowledge and critical thinking. We conducted a pilot study that used CMs in a PBL-setting to introduce a measure from the field of graph theory and investigate its usefulness as a means of CM quantitative quality assessment. Methods: Participants were first-year medical students with no or minor prior CM experience. All participants completed questionnaires (demographic information and assessment of learning style) to establish a baseline measure against which the change in clinical and critical thinking was assessed. They were asked to prepare CMs for three PBL cases, and following the submission of the CMs they completed semi-structured critical and clinical thinking questionnaires. A clinical expert also created corresponding “benchmark” CMs for comparison. Qualitative (Wordclouds) and quantitative (graph theory) analysis provided a summary of the key concepts and quantified the CM quality respectively, compared to the “benchmark” CMs. Results: It was  found that graph-theoretical measures (graph density, modularity) were suitable for distinguishing between CMs that captured more in-depth knowledge, compared to CMs that contained simpler associations. Questionnaires also revealed that CMs helped students recall information, organize material in a concise manner, prepare better for their PBL session and provided a good revision tool. Conclusions: We have shown that a graph-theoretical approach to quantitative CM assessment is feasible using measures such as graph density and modularity.

Concept maps as a novel assessment tool in medical education

Background: We conducted a pilot study to investigate the use of Concept Maps (CMs) in a Problem-Based Learning (PBL) setting as a complementary tool to current educational techniques for enhancing medical student knowledge and critical thinking. The main focus of the pilot was to introduce a measure from the field of graph theory and investigate its usefulness as a means of CM quantitative quality assessment. Methods: Participants were first-year medical students with no or minor prior CM experience. All participants completed questionnaires (demographic information and assessment of learning style) to establish a baseline measure against which the change in clinical and critical thinking was assessed. They were asked to prepare CMs for three PBL cases, and following the submission of the CMs they completed semi-structured critical and clinical thinking questionnaires. A clinical expert also created corresponding “benchmark” CMs for comparison. Qualitative (Wordclouds) and quantitative (graph theory) analysis provided a summary of the key concepts and quantified the CM quality respectively, compared to the “benchmark” CMs. Results: Questionnaires revealed that CMs helped students recall information, organize material in a concise manner, prepare better for their PBL session and provided a good revision tool. It was also found that graph-theoretical measures (graph density, modularity) were suitable for distinguishing between CMs that captured more in-depth knowledge, compared to CMs that contained simpler associations. Conclusions: We have shown that it is possible to quantify CM quality using graph-theoretical measures, such as graph density and modularity.

Factors Influencing Problem-Solving Competence of Nursing Students: A Cross-Sectional Study

Problem-solving ability is an important competency for nursing students to enable them to solve various problems that occur in dynamic clinical settings. The purpose of this cross-sectional study was to identify the factors that affect the problem-solving ability of nursing students. The subjects of this study were 192 nursing college students in their second year or beyond. The research tool consisted of an online questionnaire, with a total of 91 items regarding general characteristics, metacognition, and communication competence. Data collection was conducted from 10 to 30 March 2022. An online survey link was uploaded to the student group of a social network service from two nursing colleges that permitted data collection. Subjects who agreed to participate directly accessed and responded to the online survey. The collected data were analyzed using descriptive statistics, and the factors associated with the problem-solving ability of nursing students were examined using hierarchical multiple regression analysis. The subjects’ mean problem-solving ability score was 3.63 out of 5. Factors affecting problem-solving ability were age, communication competence, and metacognition, among which metacognition had the greatest influence. These variables explained 51.2% of the problem-solving ability of nursing students. Thus, it is necessary to provide guidance to improve metacognition and to develop educational methods to improve communication competence in curricular and non-curricular courses to improve the problem-solving ability of nursing students.

Concept maps as a novel assessment tool in medical education

Background: We conducted a pilot study to investigate the use of Concept Maps (CMs) in a Problem-Based Learning (PBL) setting as a complementary tool to current educational techniques for enhancing medical student knowledge and critical thinking. We also introduced a measure from the field of graph theory as an objective means of CM quality assessment. Methods: Participants were first-year medical students with no or minor prior CM experience. All participants completed questionnaires (demographic information and assessment of learning style) to establish a baseline measure against which the change in clinical and critical thinking was assessed. They were asked to prepare CMs for three PBL cases, and following the submission of the CMs they completed semi-structured critical and clinical thinking questionnaires. A clinical expert also created corresponding “benchmark” CMs for comparison. Qualitative (Wordclouds) and quantitative (graph theory) analysis provided a summary of the key concepts and quantified the CM quality respectively, compared to the “benchmark” CMs. Results: Questionnaires revealed that CMs helped students recall information, organize material in a concise manner, prepare better for their PBL session and provided a good revision tool. It was also found that graph-theoretical measures (graph density, modularity) were suitable for objectively distinguishing between CMs that captured more in-depth knowledge, compared to CMs that contained simpler associations. Conclusions: We have shown that it is possible to quantify CM quality using graph-theoretical measures, such as graph density and modularity.

Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: A Mixed Methods Systematic Review (Preprint)

Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)

The Promise of the New Educational Strategy for Curriculum Development (SPICES) Model on the Development of Students' Clinical Reasoning Ability. A Comparative Cross-Sectional Study

INTRODUCTION

Clinical reasoning skills are a core competency that must be taught at all levels of health-care education. In the last decade, several health professional education curricula in Ethiopia have been redesigned with the goal of improving student competence in key health-care delivery skills. Despite the fact that some academic programs followed the conventional educational strategy, a significant number of academic programs adopted a new educational strategy for curriculum development: Student-centered, Problem-based, Integrated, Community-based, Elective, and Systematic (SPICES) model. More empirical evidence, however, is required to determine whether the new curricular approach is effective in improving students' clinical reasoning. The purpose of this study is to determine whether the new educational strategy for curriculum development improves the clinical reasoning ability of midwifery students when compared to a peer institution that follows a traditional curriculum.

METHODS

A comparative cross-sectional study was conducted to compare the clinical reasoning skills of midwifery students who completed the new curricular approach versus students who completed a traditional curriculum. A Script Concordance Test (SCT) was used to collect data. The mean SCT score and an independent two-sample t-test were calculated to see if the two groups differed significantly in terms of clinical reasoning skills in managing Post-Partum hemorrhage (PPH).

RESULTS

A total of 77 final-year midwifery students participated (38 from the new and 39 from the traditional curriculum approach). Midwifery students who completed the new and conventional curriculum approaches had mean clinical reasoning SCT scores of 0.7 (SD = 0.35) and 0.53 (SD = 0.37), respectively. There was a statistically significant difference in the overall mean SCT score between the two study groups in terms of clinical reasoning skills (p = 0.008).

CONCLUSION

Our study found that the new SPICES model curricular approach is promising in fostering the development of clinical reasoning skills of Midwifery students in managing PPH.

Examining the relationship between solution-focused thinking skills and self-efficacy levels of nursing students in Turkey

BACKGROUND

Learning and developing communication skills fundamental to solution-focused thinking increases the confidence of nursing students towards individuals and improves their self-efficacy, thereby enabling these students to plan appropriate care.

PURPOSE

To evaluate solution-focused thinking skills and self-efficacy levels of nursing students and to determine the factors affecting these variables as well as the relationship among them.

METHOD

This was a descriptive and correlational study. The study was conducted between March and June 2019 with 337 nursing students from two universities with different curricula. Data were collected using a "personal information form," the "solution-focused inventory," and the "self-efficacy scale."

RESULTS

A statistically significant positive relationship was observed in the total scores on the solution-focused inventory and self-efficacy scale and the mean scores on the completing behavior and dealing with obstacles on the self-efficacy scale. In addition, a moderate relationship (r = 0.447, p < 0.01) was observed between the total solution-focused inventory scores and mean scores of completing behavior on the self-efficacy scale.

CONCLUSIONS

The nursing students had above-average mean scores on the solution-focused inventory and self-efficacy scales. However the students can further enhance their problem-solving ability by improving their solution-focused skills and self-efficacy.

A scoping review of clinical reasoning research with Asian healthcare professionals

Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

Problem-based learning and case-based learning in dental education

Background

Numerous novel teaching methods have been developed in recent times for use in medical education. Of these methods, problem-based learning (PBL) and case-based learning (CBL) have attracted the most attention. We evaluated and compared the efficiency of these two teaching methods in dental education and discussed the importance of teachers to these courses. This study aims to evaluate the efficiency of PBL and CBL in dental education, and discuss the importance of teachers to the courses.

Methods

In this study, 28 students enrolled in a seven-year program at the College of Stomatology at Shanghai Jiao Tong University were chosen as participants. In the fourth year, PBL combined with independent learning was used to teach students the theory of oral mucosal diseases. During the internship, CBL was used to present specific cases. Both methods were carried out with group discussion. After the PBL course, teachers assessed its effect by the students’ class performance, their ability to collect data, and group cooperation. After the CBL course, its effect was assessed by the students’ ability in history-taking, diagnosis and antidiastole, and case analysis. In addition, the teachers’ roles in both methods were assessed by both the students and the teachers themselves. Data was collected by questionnaire survey and statistically analyzed with SPSS Statistics 20.

Results

PBL significantly improved students’ self-learning abilities in the theory course. CBL helped students make diagnoses and develop treatment plans for actual cases in the internship. Both students and teachers thought that teachers were indispensable to both PBL and CBL. There was no difference between student and teacher views.

Conclusions

Although PBL and CBL have different focuses, their combination may enhance teaching effectiveness in dental education. Additionally, teachers play an important role in the application of both these teaching methods.

Effects of blended versus offline case-centred learning on the academic performance and critical thinking ability of undergraduate nursing students: A cluster randomised controlled trial

OBJECTIVE

This study aimed to compare the effect of blended and offline case-centred learning on medical nursing education for undergraduate nursing students.

BACKGROUND

Technological advancements are rapidly changing nursing education in higher educational settings. Educational reform, especially regarding methods of teaching, has been the focus of nursing educators in recent years.

DESIGN

The research was conducted between September 2018 and July 2019 in China.

METHODS

Second-year undergraduate nursing students in two classes were enrolled for this study by cluster sampling. The study outcomes were academic performance and critical thinking ability, measured using the Critical Thinking Disposition Inventory-Chinese Version.

RESULTS

Students in the experimental class showed significantly higher improvements in academic performance than those in the control class. Compared with the control class, the pre-post difference in competency in critical thinking self-confidence in the experimental class was significantly greater (p = 0.037). In the experimental class, there was a significant improvement over the baseline in the dimension of critical thinking self-confidence (p = 0.022). In the control class, there was a significant improvement over the baseline in the total score (p = 0.029) and two of the seven dimensions: truth-seeking (p = 0.016) and systematicity (p = 0.005).

CONCLUSIONS

The use of blended case-centred learning showed promising results in improving students' academic performance. Both blended and offline case-centred learning were indicated to be effective educational approaches to improve the critical thinking ability of undergraduate nursing students and could be implemented for other nursing subjects in the future.

Does problem-based learning education improve knowledge, attitude, and perception toward patient safety among nursing students? A randomized controlled trial

Background

Patient safety is a top priority for any health care system. Most universities are looking for teaching methods through which they would be able to enhance students’ clinical decision-making capabilities and their self-centered learning to ensure safe and quality nursing care. Therefore, this study aimed to determine the effect of patient safety education through problem-based learning (PBL) on nursing students’ knowledge, attitude, and perceptions toward patient safety.

Methods

This randomized, controlled trial was conducted from September 2019 to January 2020. A total of 78 fourth-year nursing students participated in this study. The participants were randomly assigned to either the intervention group or the control group. In the intervention group, the educational materials were presented to the students using the PBL method during eight sessions of 45–60 min. In each control group, nursing students received eight education sessions through lectures and discussing the same educational content. Data were gathered 1 month after the intervention using demographic information and knowledge, attitudes, and perception questionnaires. Data were analyzed in SPSS ver. 22.0 using descriptive (mean and standard deviation) and inferential (chi-square test, independent t-test, paired t-test, and analysis of covariance (ANCOVA)) statistics.

Results

The results indicated that the difference in the mean scores of knowledge, attitudes, and perceptions of the nursing students about patient safety was statistically significant between the two groups after the PBL education (p = 0.001). The mean scores of students’ knowledge, attitude, and perceptions of patient safety increased significantly in the intervention group.

Conclusions

Implementing patient safety education through PBL positively affects knowledge, attitudes, and perceptions of patient safety among nursing students. Thus, the research team recommended the PBL method to be used by nursing professors to improve nursing students’ clinical skills and cognitive abilities to ensure safe patient care.

Trial registration

IRCT20190925044881N1; October 17, 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00588-1.

Nursing students' experiences of what influences achievement of learning outcomes in a problem-based learning context: A qualitative descriptive study

Aim

This study aimed to describe nursing students' experiences of what facilitate or impede the achievement of learning outcomes in PBL‐based nursing education.

Design

A qualitative descriptive design was used.

Methods

Data were collected from individual semi‐structured interviews with 18 undergraduate nursing students in Sweden and were analysed using Burnard's qualitative content analysis.

Results

The results were organized into three categories: (a) understanding of the required level of knowledge depth (b) tutor's engagement and (c) student base group interactions. These categories represent essential components of PBL that could either facilitate or impede students' achievement of learning outcomes in nursing education. To improve the students' opportunities to achieve the learning outcomes, proper introduction of and a continuous education on PBL as a pedagogical method provided both to students and tutors should be considered important.

The use of structured debate as a teaching strategy among undergraduate nursing students: A systematic review

BACKGROUND

Nurse educators are required to prepare graduates for the increasing complexities of the practice environment. Debate is an active teaching strategy long recognised in many disciplines to promote student-centred learning by enhancing the development of communication skills, collaboration, and critical thinking, all of which are essential skill for future nurses.

OBJECTIVES

The aim of this study was to compare in-class university structured debate implementation methods among undergraduate nursing students, and to identify the effect of such debate methods in the students' learning.

DESIGN

A systematic review of the literature.

DATA SOURCES

Publications in English identified in multiple databases (PubMed, CINAHL, Web of Science, Medline and ERIC) from the launch of the database until 26th November 2019.

REVIEW METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies that investigated the use of in-class debate among undergraduate nursing students as a pedagogical tool were eligible. Information related to the study design, debate process characteristics, evaluation method of the teaching strategy and results were collected.

RESULTS

We identified 14 relevant studies describing structured implementation of debate, 11 of which were instructional design and 3 quasi-experimental studies. Heterogeneity was found across the papers regarding topics, timing schedules, group formation and positioning. Most of the studies evaluated implementation using satisfaction questionnaires or subjective observations. Three quasi-experimental studies reported that implementation of debating improved declarative capacity, argumentative capacity, idealistic moral judgment, and realistic moral judgment.

CONCLUSIONS

Current studies do not provide enough evidence to understand the scope of structured debating as an instrument to develop personal competences needed in nursing. However, based on the evidence reviewed, we have identified elements to establish a debate-based learning format that might enhance student's learning and future studies.

Reflection on career choices in clinical neurosciences

Medical faculties are responsible for high-level training, not only on clinical skills but also on scientific research and medical advances. There is an evident need to promote academic careers to ensure the continuity and improvement of top-notch health care. Even if Switzerland is one of the countries with the highest medical density per inhabitant, the lack of interest for academic careers has increased, resulting in difficulties to form clinician-scientists and ensure succession. In this article, we reflect on the challenges and the potential solutions in the training of an academic career.

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BACKGROUND

Critical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.

OBJECTIVES

The purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).

DESIGN

A quantitative causal-comparative methodology with a pretest/posttest design.

SETTING

A private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.

PARTICIPANTS

Baccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).

METHODS

This research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.

RESULTS

A repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).

CONCLUSIONS

The use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.

Learning Delegation Through Role-Play: A Problem-Based Learning Activity for Nursing Students

ABSTRACT

According to the American Nurses Association and National Council of State Boards of Nursing 2019 guidelines, teaching strategies are needed to engage students in the application of delegation knowledge and skills. Students need opportunities to gain experience with delegation decision-making in a safe, risk-free environment. This article describes the instructional design and evaluation of an innovative role-play activity to engage senior-level nursing students in delegation decision-making.

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Toward an Integrative Nursing Curriculum: Combining Team-Based and Problem-Based Learning with Emergency-Care Scenario Simulation

Objective: The study intended to combine team-oriented, problem-based learning (PBL) with emergency-care simulation to investigate whether an integrative intervention could positively impact the core nursing competencies and teacher performance of nursing students. Methods: The study belonged to the domain of action research, which aimed to address the weaknesses of traditional teacher-led, lecture-based learning. An 18-week, single-case experimental design, in which 58 senior nursing students at a medical university in central Taiwan participated, was conducted to test the possible benefits of the intervention. The measures included the Scale of Core Nursing Competencies and the Teacher Performance Evaluation Scale. Results: The research results showed that nursing students who received integrative training that combined team-based PBL with emergency-care scenario simulation had stronger mastery over core nursing competencies. At the same time, they also evaluated both the “Emergency Care” course for which the curriculum was used and the teachers’ performance in that course more highly. Conclusions: The findings suggest that an integrative curriculum combining team-based PBL with scenario simulation is worth pursuing. Compared with traditional teacher-led, lecture-based teaching, this curriculum may be more effective in helping nursing students develop core competencies in their field.

Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors

Critical thinking affects patient safety in critical situations. Nurses, in particular, intensive care unit (ICU) nurses, need to develop their critical thinking skills. The present article seeks to compare the level of critical thinking in medical-surgical and ICU nurses and investigate the factors explaining it. A cross-sectional study was conducted on 120 medical-surgical and ICU nurses (60 per group). Data were collected using the California Critical Thinking Skills Test and analyzed in SPSS-16 using independent samples t-test, ANOVA, and the regression analysis. The mean critical thinking score was 8.68 ± 2.84 in the ICU nurses and 9.12 ± 2.99 in the medical-surgical nurses. No significant differences were found between the two groups in terms of the critical thinking score and the scores of its domains. The results of the regression analysis showed that demographic variables explain only 8% of the variations in critical thinking score, as only gender explains nurses' critical thinking score. The results revealed poor critical thinking scores in the nurses working in medical-surgical wards. Investigating the reasons for the poor scores obtained and using educational strategies such as PBL, conceptual map, participation in interdisciplinary rounds, the development of clinical guidelines and participation in continuing education conferences are recommended for developing critical thinking skills in nurses.

Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis

OBJECTIVES

Simulation can serve as an effective educational method to provide experience and opportunities to learn about the nursing management of clinical cases in a secure environment. Numerous debriefing methods have been used in simulation in nurse education to improve clinical competencies and learning outcomes. However, there is insufficient evidence to identify the debriefing methods that are most effective in improving learning outcomes. In this systematic review and meta-analysis, the focus is on debriefing methods and learning outcomes in simulation in nurse education.

DESIGN

This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.

DATA SOURCES

Studies published from January 1995 to December 2016 were identified from PubMed, Embase, MEDLINE, PsycINFO, Web of Science, CINAHL, the Cochrane Library, and Korean databases.

REVIEW METHODS

Experimental studies that used debriefing methods in simulation in nurse education were included as review studies. Studies that used identical validated measurement tools were included in the meta-analysis. We applied a random-effects model with subgroups. Effect sizes for learning outcomes according to debriefing methods were calculated using standardized mean differences.

RESULTS

A total of 18 studies were selected through systematic review and 7 studies were included in the meta-analysis using four types of scales measuring learning outcomes after debriefing. The overall effect size of the learning outcomes, according to the type of debriefing method, was 0.31. The results regarding debriefing methods were statistically non-significant in the learning outcomes (95% CI [-0.33-0.96], Z = 0.95, p = 0.34). A symmetric shape indicated a lack of publication bias.

CONCLUSIONS

The study findings indicated that structured debriefing helped to improve learning. Future studies are needed to provide effective debriefing strategies with larger sample sizes.

Critical Thinking Skills of RNs: Exploring Demographic Determinants

BACKGROUND

Previous studies of nurses' critical thinking skills that included demographic characteristics as determinants have been inconclusive. This study explored demographic determinants of critical thinking skills among nurses from public hospitals in Peninsular Malaysia.

METHOD

This cross-sectional study included 549 nurses recruited via multistage cluster sampling. Nurses completed the demographic questionnaire and Health Sciences Reasoning Test (HSRT).

RESULTS

The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (SD = 3.4). Educational qualifications (p = .003) and clinical specialties (p = .022) were significantly related to nurses' critical thinking skills. Years of clinical experience, age, and job ranking were not significant CONCLUSION: The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. [J Contin Educ Nurs. 2020;51(3):109-117.].

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.

Strategies for inclusion of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) education throughout pharmacy school curricula

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others (LGBTQIA+) patients face stigma and barriers to health care, including a lack of health care professionals' knowledge and confidence in treating this patient population. Pharmacists are in prime position to decrease this health disparity. United States pharmacy schools have limited LGBTQIA+ content, continuing the concern of recent graduates without knowledge and confidence. This commentary discusses potential barriers to introducing LGBTQIA+ content into school of pharmacy curricula and presents five strategies currently in use by nursing, medical, and pharmacy schools. Schools of Pharmacy should consider proactive incorporation of this content to graduate practitioners able to provide quality care to LGBTQIA+ patients.

A review to identify key perspectives in PBL meta-analyses and reviews: trends, gaps and future research directions

In the past 50 years, the original McMaster PBL model has been implemented, experimented, revised, and modified, and is still evolving. Yet, the development of PBL is not a series of success stories, but rather a journey of experiments, failures and lessons learned. In this paper, we analyzed the meta-analyses and systematic reviews on PBL from 1992 to present as they provide a focused lens on the PBL research in the past 5 decades. We identified three major waves in the PBL research development, analyzed their impact on PBL research and practice, and offered suggestions of research gaps and future directions for the field. The first wave of PBL research (polarization: 1990-mid 2000) focused on answering the question "Does PBL work?" and the outcomes. The results were conflicting. The researchers took polarizing positions and debated over the merits of PBL throughout this wave. However, the contradictory results and the debates in fact pushed the researchers to look harder for new directions to solve the puzzle. These efforts resulted in the second wave (from outcomes to process: mid 2000-mid 2010) that focused on the question "How does PBL work?" The second wave of PBL research targeted at investigating the effects of implementation constituents, such as assessment formats or single versus curriculum wide implementations. The third wave (specialization: mid 2010 and onward) of PBL research focused on "How does PBL work in different specific contexts?" These research widened our perspectives by expanding our understanding of how PBL manifests itself in different contexts. Given the diversification of PBL and more hybrid PBL models, we suggest "Why does PBL with particular implementation characteristics for specific outcomes work or not work in the condition where it is implemented?" to be the question to answer in the next wave of PBL research.

Facilitating learning of community-based rehabilitation through problem-based learning in higher education

BACKGROUND

The quality of community-based rehabilitation (CBR) personnel is one of the key factors that contributes to the success of CBR programs. Integrating knowledge and practical skills in various stages of the learning process is essential in community-based rehabilitation. Problem-based learning (PBL) is a pedagogical strategy that uses real-world situations as the basis for developing knowledge and problem-solving skills. Through PBL, learners are guided and facilitated in assuming active problem-solving roles in real-world situations. This study developed and tested a framework and a PBL protocol for use in teaching community-based rehabilitation (CBR) in higher education.

METHODS

Part I of this study focused on the development of a framework and a protocol for PBL. An initial framework for the development of this protocol was formed based on a review of relevant literature. Concrete guidelines were delineated to describe the application, process, and delivery of teaching and learning. PBL was implemented in three CBR related courses. Students were facilitated to learn CBR in passing various stages of PBL through a self-directed learning process. The cumulative efforts of each group were compiled, recorded, and displayed using e-portfolios. In Part II, the processes and outcomes of using this new learning mode were evaluated using a case study approach to examine the protocol's efficacy. Focus group interviews, a questionnaire, and a detailed examination of the e-portfolios were administered for evaluation.

RESULTS

One hundred thirty-three students from three CBR related courses were recruited. PBL was regarded as an effective, realistic and practical method that enables critical thinking in CBR. Practicality was addressed by covering context-related materials with the use of real cases or examples. Participants were actively engaged in the learning process and their CBR competence was enhanced.

CONCLUSIONS

Through the new protocol, the students were equipped with active learning, critical thinking, and problem-solving skills that should facilitate success in CBR.