Blended learning in undergraduate nursing education - A scoping review

Blended learning: Exploring nurse educators' perspectives

Background

In a rapidly evolving educational landscape, blended learning is becoming an increasingly popular transition from traditional forms of learning and teaching to e-learning. It is therefore important that lecturers adapt their practice and transform their teaching in line with the online platform in use, as this has the potential to benefit students, lecturers and the institution alike. However, little research exists regarding the perspectives of nurse educators on the use of blended learning as a teaching method.

Aim

The study aimed to explore and describe the perspectives of nurse educators on the use of blended learning as a teaching method at the Faculty of Health Sciences at a university in Namibia.

Setting

The study was conducted at a public nurse education institution in Namibia.

Methods

A qualitative exploratory, descriptive design that was contextual was applied to collect data from a convenient sample of 15 lecturers using semi-structured interviews.

Results

Four themes emerged in this study, namely, understanding of blended learning, benefits of utilising blended learning, challenges of utilising blended learning, and recommendations to ensure effective use of blended learning.

Conclusion

The study findings identified potential areas of both strengths and shortcomings in nurse educators' use of blended learning as a teaching and learning strategy.

Contribution

These findings may be used to develop ongoing strategies and targeted interventions that can strengthen nurse educators' abilities to design learning environments that are conducive to blended learning.

Redesigning Competency Assessment: A Blended Approach of Clinical Education for Oncology Nurses

A train-the-trainer model of clinical education was redesigned in one National Cancer Institute-designated cancer center to introduce a blended model of learning. Program outcomes were for oncology nurse trainers to affirm program engagement; successfully complete a new, web-based specialized oncology curriculum, with 80% accuracy; complete one live 8-hour training event; acquire competency validation of required skills, with 100% accuracy; and communicate one strategy for training staff in their respective clinical settings.

Perspectives of clinical nurse educators on competency-based nursing teaching in blended learning environments during nursing internship: A descriptive qualitative study

AIM

To investigate the perspectives of clinical nurse educators regarding the challenges and essential elements of teaching competence in blended learning environments during nursing internships to inform the development of a competency-based teaching model.

BACKGROUND

Competency-based teaching and blended learning play important roles in enhancing the learning experience of nursing internship trainees. Internship trainees refer to nursing students undergoing supervised practical training in ‎clinical settings.‎ However, clinical nurse educators frequently encounter challenges in acquiring the necessary competence for successful implementation of blended learning strategies.

DESIGN

A descriptive‎ qualitative study.

METHODS

This study used semi-structured interviews with 11 certified nurse educators (CNEs) from diverse clinical disciplines in a tertiary hospital in China. Purposive sampling ensured diversity across key characteristics. Ethical approval was obtained and interviews were digitally recorded, transcribed and analyzed thematically. Theoretical saturation guided data collection, with precise measures taken to ensure confidentiality and anonymity. Thematic analysis, employing a constant comparison technique, systematically identified various themes related to blended teaching competence. This approach provided valuable insights into CNEs' perspectives and practices. The analysis involved theoretical sampling, line-by-line coding and comparative evaluation with supporting text materials.

RESULTS

The in-depth analysis of teaching competence among clinical nurse educators in blended learning settings during nurse internships revealed five key themes: professionalism, teaching literacy, subject expertise, information literacy and interpersonal communication.

CONCLUSION

These themes recognized clinical nurse educators' perspectives towards establishing a competency-based nursing teaching model for a blended learning environment for nurse internships. Moreover, these perspectives are also crucial in enhancing teaching literacy through effective instructional methods, engagement strategies and the promotion of critical thinking skills. Identifying these themes contributes to efforts to improve teaching effectiveness and enhance learning outcomes for internship trainees in a blended learning context.

Human anatomy curriculum reform for undergraduate nursing students: An exploratory study

This study aims to cultivate students' independent learning capacity, promote the interdisciplinary integration of "nursing + anatomy," and establish a curriculum system to enhance applied nursing abilities based on project-based teaching reform of everyday clinical nursing operations. A total of 151 second-year (class of 2021) undergraduate nursing students at a Chinese university were selected for this study. By adjusting the curriculum, reconstructing the teaching contents, employing the "hybrid + flip" teaching method based on BOPPPS (bridge-in, outcomes, preassessment, participatory learning, post-evaluation, summary), and implementing a teaching system based on the "three re-three linkage," a Human Anatomy curriculum with a focus on basic anatomical knowledge was developed and connected with nursing clinical operation practice. The restructuring of the course content received unanimous recognition from both the teaching staff and the students. Notably, students in the class of 2021 achieved significantly higher grades than did students in the class of 2020, who received traditional face-to-face instruction (p < 0.01). These results indicate enhanced clinical application skills among the former group of students. following the implementation of instructional reforms during one semester, students exhibited notable improvements in motivation, program implementation, self-management, and interpersonal communication. A statistically significant increase in overall scores for self-directed learning capacities over the preinstructional period was observed (p < 0.05). Furthermore, the findings of the student satisfaction surveys reflected highly favorable perceptions of the enriched instructional format, high levels of course engagement, frequent faculty-student interactions, and augmented overall competence. The practical implementation of the reform in the context of a Human Anatomy course for undergraduate nursing students led to significant positive outcomes, thereby enhancing the effectiveness of teaching and learning. Students' clinical application abilities and self-directed learning capacities notably improved, while overall satisfaction with the course remained high.

Student nurses' experiences of remote learning during Covid-19 pandemic: A qualitative evidence synthesis

AIM

To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic.

DESIGN

A qualitative evidence synthesis (QES).

REVIEW METHODS

A QES. Themes were organized using the 'best fit' framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research).

DATA SOURCES

Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021.

RESULTS

Nine qualitative and two mixed method studies were included in this 'best fit' framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education.

CONCLUSIONS

This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a 'Blending with Purpose: The Multimodal Model' with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction.

IMPLICATIONS FOR THE PROFESSION

Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education.

IMPACT

Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education. REPORTING METHOD: 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) for QES.

NO PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model

BACKGROUND

Self-directed learning (SDL) ability is the basis for cultivating nursing students' ability to find and solve problems, lifelong learning, and providing high-quality nursing talents for healthcare. The O-AMAS (Objective, Activation, Multi-learning, Assessment, Summary) model adheres to the teaching philosophy of student-centered, result-oriented, combines the advantages of online and offline teaching, enriching teaching resources and learning channels, diversifying teaching and evaluation methods, and emphasizing integrating and applying knowledge conducive to improving students' SDL ability and achieving teaching objectives. This study explored the course design, practical, and application effects under the O-AMAS effective teaching model in internal medicine nursing to provide a basis and reference for combining effective teaching models with blended teaching in future nursing courses.

METHODS

This study is a self-controlled before-after trial. The participants were 76 nursing undergraduates from Hunan Normal University. This study utilizes the O-AMAS effective teaching model to design internal medicine nursing courses and implement blended online and offline teaching. Main links: The overall course design and application are student-centered, after clarifying macro and micro multi-dimensional learning objectives, with online and offline blended teaching environments activated students' learning behavior and diversified teachers' teaching activities, then based on instant and dynamic provide effective feedback; finally, students take the initiate to make a brief and potent summary under the teacher guidance. After the course, a unified assessment of the learning effect of nursing students was conducted, including the evaluation of the SDL ability of nursing students, a final comprehensive evaluation grade, and a teaching satisfaction survey.

RESULTS

The nursing students' SDL ability scores are higher than before teaching, and the results were statistically significant (P < 0.05). The final average comprehensive evaluation grade of nursing students was 78.38 ± 7.12. More than 96% of the students are satisfied with this course.

CONCLUSION

Applying for internal medicine nursing blended teaching integrated with the O-AMAS effective teaching model is conducive to improving nursing students' SDL ability, academic grades, and teaching satisfaction.

Pursuing Success in a Hybrid PhD Nursing Program

BACKGROUND

Little is known about hybrid PhD nursing students' experiences.

METHOD

The purpose of this study was to describe and analyze the experiences of PhD nursing students in a hybrid program using a convergent mixed methods design. Recent nursing PhD alumni (n = 18), and current PhD students (n = 4) were recruited at a research-intensive university in the southwestern United States.

RESULTS

Four metainferences were identified: (1) the facilitator of faculty as both advisors and mentors; (2) the facilitator of peers as support, motivation, and a source of advice that preceded advisors; (3) the barrier of receiving conflicting feedback from advisory and dissertation committees; and (4) the barrier of not understanding the PhD student process.

CONCLUSION

Peer support is fundamental for hybrid PhD nursing student success; conflicting feedback and not understanding the process are significant barriers. Strategies are recommended to mitigate barriers to facilitate hybrid PhD nursing students' success. [J Nurs Educ. 2024;63(5):328-331.].

Developing effective In-Service Education for intensive care nurses: Exploring the views of clinical stakeholders in the Kingdom of Saudi Arabia

BACKGROUND

Evidence-based in-service education (ISE) in the intensive care unit (ICU) is essential to maintaining nurse skill and competence in this complex clinical area. However, there has been limited research that has focused on developing and optimising the specialised training required by ICU nurses working in trauma care.

OBJECTIVES

To explore the perspectives of ICU clinical stakeholders regarding their needs and preferences for ISE to inform the future development and implementation of effective educational interventions.

DESIGN

A qualitative, multiple-case study supported by the "Empowering Education" theoretical framework, which emphasises the importance of stakeholder involvement in education development.

SETTINGS

Adult ICUs in three major hospitals located in two geographical areas in Saudi Arabia.

PARTICIPANTS

Forty clinical nurses, twelve nurse managers, nine nurse leaders and seven clinical educators participated.

METHODS

Data were collected through semi-structured interviews followed by focus groups. Framework analysis was used for data analysis.

FINDINGS

Stakeholders wanted ISE and training by subject experts characterised by: (i): relevant educational content; (ii): a range of educational techniques and (iii) flexible delivery and format. Nurses also identified factors that encouraged them to participate in ISE including adequate resources and a supportive work environment, whilst heavy workloads, cost and scheduling issues hindered engagement.

CONCLUSION

This paper highlights the importance of considering staff needs and local context when developing in-service ICU education to support nurses' competence. Further recommendations and a proposed framework to develop future ISE in the ICU are provided.

TWEETABLE ABSTRACT

The key to effective in-service education for ICU nurses is understanding stakeholders' needs and motivational drivers, whilst addressing barriers to successful implementation.

Integrative virtual nursing simulation in teaching cardiopulmonary resuscitation: A blended learning approach

BACKGROUND

Online learning resources facilitated educational development during the COVID-19 pandemic. This study focuses on the integration of online virtual simulation with interactive exercises and offline low-fidelity simulation for the first time to explore the impact on CPR skills.

METHODS

First year nursing students from a medical college participated as volunteers in this study. They were divided randomly into two groups with both having a cardiopulmonary resuscitation (CPR) lesson with the same timings and objectives. The experimental group (n = 36) adopted a blended learning method, with virtual simulation and low-fidelity simulation as resources; the control group (n = 36) used the same method without virtual simulation. The same lecturers taught both classes. Students' self-directed learning (SDL) and critical thinking skills were assessed before and after the intervention and their CPR skills were examined afterward.

RESULTS

The experimental group exhibited significantly greater improvement in their SDL abilities and CPR skills. By contrast, we found no statistical differences in their critical thinking abilities.

CONCLUSIONS

During CPR training, blended learning method was used to integrate virtual nursing simulation in teaching, which effectively improved students' SDL and CPR skills.

Educating nursing students for sustainable future rural health-care services: An umbrella review

BACKGROUND

Rural nursing education stands as a way to contribute to a sustainable nurse workforce in rural areas. Different approaches to organizing rural nursing education are described in the existing literature.

OBJECTIVE

To explore scientific reviews about rural nursing education and synthesize current knowledge as "best practice" recommendations for rural nursing education regarding the required organization of rural nursing education programs, what are the competencies required to function as a nurse in rural health-care settings, and the key environmental features for learning in rural nursing education programs.

DESIGN

An umbrella review.

PARTICIPANTS

Nursing students, newly graduated nurses, and clinical supervisors involved in nursing education in rural areas.

DATA SOURCES

A systematic literature search was conducted. Of the 276 review articles found, 93 were screened by title and abstract and 27 were screened in full text. The period searched was 2000-2022, and the literature search was peer-reviewed and published.

REVIEW METHODS

The Joanna Briggs Institute (JBI) methodology for umbrella reviews guided the design, search, and the reporting of the findings of the included reviews. Four reviewers screened for inclusion and exclusion using Covidence in a double blinded process. The analysis was guided by the JBI guidelines for umbrella review syntheses. Two reviewers conducted the analysis.

RESULTS

Sixteen reviews were included; eight scoping reviews, six integrative reviews, one narrative review, and one rapid review. The synthesis of current evidence provides the following "best practice" suggestions: (a) fostering context-sensitive and collaboratively designed education environments is recommended; (b) integrating curricula tailored for the nursing role and rural practice is recommended (c) establishing a supportive learning environment that encourages students' motivation and academic success; and (d) clinical placements in locally developed learning settings address the educational needs required for practice in the rural workforce.

CONCLUSIONS

Rural nursing education needs to be properly aligned with the context and health-care development, to educate nurses who can meet the community's needs today and in the future. A well-functioning collaboration between university faculty and local community stakeholders in a co-creation process stands out as vital to build a sustainable, flexible, rural nursing education program.

TWEETABLE ABSTRACT

Umbrella review: Flexible, co-created education might be "best practice" in rural undergraduate nursing programs.

Digital literacy in undergraduate pharmacy education: a scoping review

OBJECTIVES

Conduct a scoping review to identify the approaches used to integrate digital literacy into undergraduate pharmacy programs across different countries, focusing on methods for education, training, and assessment.

MATERIALS AND METHODS

Following the Joanna Briggs Institute methodology, we searched 5 electronic databases in June 2022: MEDLINE (Ovid), PubMed, Embase, Scopus, and CINAHL. Three independent reviewers screened all articles; data extraction was conducted by 2 reviewers. Any discrepancies were arbitrated by 2 additional reviewers.

RESULTS

Out of 624 articles, 57 were included in this review. Educational and training approaches for digital literacy in undergraduate pharmacy programs encompassed a theoretical understanding of health informatics, familiarization with diverse digital technologies, and applied informatics in 2 domains: patient-centric care through digital technologies, and the utilization of digital technologies in interprofessional collaboration. Blended pedagogical strategies were commonly employed. Assessment approaches included patient plan development requiring digital information retrieval, critical appraisal of digital tools, live evaluations of telehealth skills, and quizzes and exams on health informatics concepts. External engagement with system developers, suppliers, and other institutes supported successful digital literacy education.

DISCUSSION AND CONCLUSION

This scoping review identifies various learning objectives, teaching, and assessment strategies to incorporate digital literacy in undergraduate pharmacy curricula. Recommendations include acknowledging the evolving digital health landscape, ensuring constructive alignment between learning objectives, teaching approach and assessments, co-development of digital literacy courses with stakeholders, and using standardized guidelines for reporting educational interventions. This study provides practical suggestions for enhancing digital literacy education in undergraduate pharmacy programs.

Factors influencing college students' self-regulated learning in online learning environment: A systematic review

OBJECTIVE

Drawing on the control value theory, this study aims to identify the pertinent factors of self-regulated learning in the online learning environment for college students. The analysis will inductively examine how these factors impact self-regulated learning, thereby furnishing a reference for educators and online learning platform developers to create more efficacious online learning and teaching modes.

DESIGN

Systematic review.

DATA SOURCES

In March 2023, electronic databases of PubMed, Web of Science, Embase, EBSCO, Cochrane and Scopus were searched, and there was no time limit for publication.

REVIEW METHODS

The inclusion criteria were: (1) Includes both online learning environment and self-regulated learning variables. (2) The research object is college students. (3) The research focuses on online teaching. Assessment of risk of bias for all included studies using a mixed-methods assessment tool.

RESULTS

After screening, 31 articles were finally included. Including 24 quantitative studies, 2 qualitative study and 5 mixed studies. According to the control value theory, the factors affecting self-regulated learning in online learning environment are divided into seven aspects, namely cognitive quality, motivational quality, autonomy support, goal structures and social expectations, feedback and considerations of achievement, perceived control and perceived value.

CONCLUSIONS

Teachers should exercise reasonable management over the number of assignments and provide timely and supportive feedback, as well as actively create interactive learning environments to facilitate peer-to-peer communication. Developers of online learning platforms should improve the functions of the platforms according to students' needs, and provide training for teachers and students when necessary. Learners should adapt their learning status in a timely manner to realise efficient learning and improve learning outcomes.

Nursing Undergraduate Students' Experiences and Perceptions of Blended Learning in Pediatric Nursing: A Mixed Methods Study

Introduction

Blended learning is a teaching approach that integrates online self-learning and classroom teaching. It emphasizes students' self-directed learning, actively engaging, as well as communication and collaboration. Blended learning develops the qualities in nursing undergraduate students with problem-solving ability, clinical thinking, and communication skills as nurses have. Currently, learners' experience has become an important factor in determining the success of blended learning.

Aim

To learn about the experiences and perceptions of undergraduate nursing students regarding blending learning in pediatric nursing.

Methods

A mixed methods design beginning with a quantitative data collection and analysis phase to inform the subsequent qualitative phase was utilized. This study was conducted among undergraduate nursing students at one university in China. In the quantitative study phase, a convenience sample of 59 students completed the online survey while the qualitative study phase included nine students recruited by purposive sampling. The qualitative data were collected using individual semistructured in-depth interviews. Audio data were transcribed and subjected to thematic analysis. The findings from those two phases were integrated into the final analysis.

Results

The majority (89.8%) of students reported satisfaction with blended learning. Among various teaching methods, case-based learning (CBL) was the most preferred (98.3%). Regarding the qualitative data, students reported positive experiences with blended learning including well-organized course structure, resourceful course content, and high teacher quality. They stated that blended learning improved the learning outcomes such as improving problem-solving ability and developing clinical thinking. They also provided suggestions for achieving better learning outcomes, including providing stressful learning activities, optimizing online course design, and improving the quality of group learning.

Conclusions

The blended learning model of pediatric nursing based on the Community of Inquiry framework provides a positive learning experience for nursing undergraduate students. However, ongoing assessment and improvement of the blended learning process are also needed.

"Balancing two worlds": a constructivist grounded theory exploring distributed/decentralised nursing education in rural and remote areas in Canada and Norway

A challenge confronting northern nursing is delivery of equitable and culturally competent nursing education. Advances in technology support distributed approaches for decentralised learning and enhance the feasibility of nursing education in rural and remote regions. However, there is limited scholarship on distributed/decentralised technologies in nursing education, particularly in northern and circumpolar regions. The purpose of this constructivist grounded theory research was to develop an enhanced understanding of the unique experiences of students, faculty and administrators who use distributed/decentralised methods and technology. Open-ended interviews were completed in 2015-17 with nursing students (n = 8), faculty and administrators (n = 6) at two universities using distributed/decentralised educational strategies in northern and circumpolar regions. Interviews, journal entries, field notes and memos, were analysed using grounded theory procedures. Findings indicated that distributed/decentralised programs offered rural and remote students educational possibilities that "fit" which would not have otherwise existed. However, Balancing Two Worlds created a collision of roles resulting in the potential loss of balance. Students rectified the Fear of "Falling Off" of their program through four subprocesses: Being Disciplined, Having Realistic Expectations, Planning Ahead and Staying Motivated which provided structure and predictability. Findings support the development of empirical knowledge regarding distributed/decentralised technologies in nursing education and a foundation for future research.

Innovations in teaching during the COVID-19 pandemic: comparisons of the impacts of different teaching approaches in psychiatric nursing on undergraduate nursing students

BACKGROUND

Psychiatric nursing education was significantly impacted during the COVID-19 pandemic, and innovative teaching can be challenging. This study aims to compare the effectiveness of four approaches to psychiatric nursing education in the context of the pandemic.

METHODS

A quasi-experimental design was adopted. Students were subjected to different teaching designs: face-to-face teaching (Class A in 2021), blended teaching with flipped classroom using roleplay (Class B in 2021), live broadcast teaching (Class A in 2022), and online blended teaching with flipped classroom using case studies (Class B in 2022). Multivariable logistic regression was used to analyse the outcomes in terms of academic performance and course workload.

RESULTS

The number of valid data points was 270. The results indicated that compared with Class A in 2021, the two classes in 2022 achieved significantly higher academic performance scores, and Class B in 2021 exhibited a significantly lower workload. Compared with Class A in 2022, Class B in 2021 exhibited a significantly lower workload. Compared with Class B in 2022, Class B in 2021 exhibited a significantly lower workload and achieved lower academic performance scores.

CONCLUSION

This study demonstrated that innovative teaching designs for psychiatric nursing offer advantages with regard to either facilitating academic performance or optimizing learners' task loads. Furthermore, blended learning is a promising teaching approach in the context of the COVID-19 pandemic. Future teaching initiatives could adopt student-centred constructive learning designs and ensure feasible teaching.

Cognitive engagement of nursing undergraduates in blended learning: A parallel mixed method study

BACKGROUND

Blended learning is being integrated into undergraduate nursing education at all levels and from all directions. Cognitive engagement is not only an embodiment and guarantee of students' engagement into the curriculum from a cognitive level, deep engagement and high-level thinking, but also an important indicator of whether students are effectively engaged in the blended learning curricula. However, no studies have been seen to investigate the cognitive engagement of nursing undergraduates in the blended learning curricula and its influential factors.

OBJECTIVES

To explore nursing undergraduates' cognitive engagement during the blended learning curricula and its influential factors.

DESIGN

A convergent parallel mixed-methods was used. Data were collected between November 2021 and May 2022, inclusive.

SETTINGS AND PARTICIPANTS

The study was carried out in the nursing school at a university in China. Participants including students undertaking entry to the blended learning curricula.

METHODS

In the quantitative component (n = 142), participants' cognitive engagement was investigated and factors associated with it were examined using univariate analysis, correlation analysis and multiple regression analysis. During this period, personal, semi-structured interviews were conducted with a subset of these participants (n = 15) to understand participants' cognitive engagement experiences.

RESULTS

The cognitive engagement of nursing undergraduates was at a moderate level and the cognitive engagement experiences were reflected in the four themes of Reconstitution, Connection, Elaboration and Retention. The influential factors of cognitive engagement were learning activities (β = 0.226, p = 0.004), autonomy (β = 0.158, p = 0.047), academic self-efficacy (β = 0.311, p < 0.001, β = 0.271, p < 0.001) and social interaction (β = 0.358, p < 0.001).

CONCLUSIONS

The cognitive engagement of nursing undergraduates in the blended learning curricula needs to be improved. To maximize promote cognitive engagement of nursing undergraduates in the blended learning curricula, educators should design diverse learning activities, engage in high quality social interactions with students, and maximize students' autonomy and self-efficacy.

Effectiveness and learning experience from undergraduate nursing students in surgical nursing skills course: a quasi- experimental study about blended learning

BACKGROUND

Blended learning is increasingly being adopted, and yet a gap remains in the related literature pertaining to its skill performance, learning engagement and inner experience in undergraduate surgical nursing skills course.

OBJECTIVES

To investigate the changes in skills performance and learning engagement in the application of blended learning, and what it actually brings to nursing students.

DESIGN

The study uses a historical control, two-armed, mixed and quasi-experimental design.

METHODS

The blended learning version of the course was offered to the 2019 class of 334 nursing undergraduates. Quantitative and qualitative data were collected after the course to obtain a comprehensive understanding of the course effects compared with the 304 nursing undergraduates of grade 2017 who adapted traditional learning. Quantitative data were analyzed by descriptive and inferential statistics using IBM SPSS 26.0, and qualitative data were encoded using Nvivo11.0.

RESULTS

There were significant differences in skill performance and learning engagement between the class of 2017 and 2019 (p < 0.001). Combined with further analysis of the interview data, 3 first-level nodes and 8 secondary nodes were determined. Students' opinions, comments and suggestions on the application of blended learning are refreshing.

CONCLUSION

Moving forward with blended learning: opportunities and challenges go hand in hand. Researchers need to continually modify their research designs to respond to variable educational environments.

Design and evaluation of blended teaching in the smart classroom combined with virtual simulation training in basic nursing courses

OBJECTIVE

This study explored the application effect of smart classrooms combined with virtual simulation training in basic nursing courses for nursing undergraduates.

METHODS

In this quasi-experimental study, a total of 135 undergraduate nursing students in the 2021 matriculating cohort were selected as the research subjects. The experimental group of Class 1 had 71 students, and a blended teaching design utilizing a smart classroom and virtual simulation training was adopted. The control group of Class 2 had 64 students, and traditional lecture-based teaching design was adopted. After the course, the independent learning ability scale, test scores and teaching effectiveness questionnaire were used to evaluate the teaching effect. All tests had a maximum score of 100.

RESULTS

Nursing undergraduates in the experimental group had scores of 86.32 ± 8.25 for virtual simulation training and 84.82 ± 9.04 for peer-assisted learning. The scores of the theoretical examination, experimental examination, and subjective questions in the experimental group were significantly higher than those in the control group (P < 0.05). The approval rate of nursing undergraduates in the experimental group was significantly higher than that of the control group for four items (Ps < 0.05). Among the 71 students, most students (91.55%) claimed that the use of instructional designs increased the fun of the classroom. In addition to the dimension of information literacy, the total score of independent learning ability and the other three dimensions of the experimental group were significantly higher than those of the control group (P < 0.05).

CONCLUSION

The teaching design combining smart classrooms and virtual simulation training can be applied to realize online blended teaching and classroom informatization, improving the academic performance and independent learning ability of nursing undergraduates, and thus achieving good teaching effects.

Blended learning and simulation in nursing education: A quasi-experimental study on a nursing institute

BACKGROUND

The nursing module teaches basic nursing principles and procedures to undergraduate nursing students. This course is important for the acquisition of procedural and psychomotor skills. The aim of the present study is to evaluate the influence of blended training on the acquisition of practical skills related to gastric insertion tubes.

MATERIALS AND METHODS

A quasi-experimental study was undertaken, containing three groups: The blended group benefited from e-learning, followed by simulation), while the two groups benefited from theoretical teaching and procedural simulation. Then, the degrees of acquisition of declarative and procedural knowledge and the time of completion were measured.

RESULTS

The declarative knowledge grade was higher in the Simulation (16.07) and Blended (15.21) groups than in the Traditional Group (11.66), with a statistically significant difference (P < 0.001). The results also showed a statistically significant difference between the procedural knowledge grades of the three groups (P < 0.001). A statistically significant correlation was detected between declarative and procedural knowledge scores (r = 0.58, P < 0.001) and a negative correlation between procedural knowledge and the time of completion (r = -0.422, P < 0.001).

CONCLUSIONS

The results of this experimentation confirm the positive effect of the blended learning approach on the acquisition of declarative and procedural knowledge as well as the time management allocated to teaching.

Educational strategies used in master's and doctoral nursing education: A scoping review

BACKGROUND

Advanced practice nurses and future nursing researchers must be adequately educated with the best available evidence. However, we know little about educational strategies and their characteristics used explicitly to educate advanced practice nurses and future researchers.

METHOD

A scoping review was used to map the latest educational strategies used in master's and doctoral nursing education between 2011 and 2021. Components of educational strategies were extracted based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching and the Saskatchewan Education Department Framework of Professional Practice. The New World Kirkpatrick Model was used to categorize the associated learning outcomes. A narrative description approach was used to synthesize the findings.

RESULTS

A total of 56 studies were included. Several information was missing regarding the theoretical foundations of the educational strategies. A total of 158 educational strategies were identified. Individual work (e.g., homework) was the most popular educational strategy. Most studies assessed learning outcomes related to reactions (e.g., satisfaction) or learning (e.g., knowledge).

CONCLUSION

More studies should be done using interactive instruction or multimodal approaches, while the authors should better describe intervention components. A systematic review of effectiveness needs to be conducted to evaluate the best educational strategies in the master's and doctoral nursing education.

Telesimulation in healthcare education: A scoping review

OBJECTIVES

To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education.

DESIGN

A scoping review.

DATA SOURCES

A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022.

REVIEW METHODS

Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised.

RESULTS

29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies.

CONCLUSION

Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.

Exploring Nursing Undergraduates' Experiences with a Redesigned Blended Learning Course: A Descriptive Qualitative Study

AIM

To explore the experience of nursing undergraduates with a blended course, that was redesigned using the Community of Inquiry framework.

DESIGN

The Obstetrics and Gynaecology Nursing Course was redesigned using blended learning pedagogy, which starts from the creation of teaching presence, plays the intermediary role of social presence and aims at realizing cognitive presence.

METHODS

After the course completion, we conducted a qualitative descriptive study and collected data using focus group interviews and field notes.

RESULTS

The findings comprised three main themes including role promotion, passive and selective learning and recommendations. Teachers and peers reportedly played the supervisors, facilitators and coordinators in learning promotion. Some students experienced difficulties in adapting to the blended learning environment due to passive learning habits, character flaws and academic pressure. However, a majority of them supported the application of the model.

The Use of Educational Technology in Undergraduate and Postgraduate Nursing and Midwifery Education: A Scoping Review

Technology has become integral to our personal and professional lives. Its use is increasing in healthcare, both in clinical and educational settings, with healthcare institutions and regulatory bodies recognizing that technology is ever-present. The aim of this scoping review was to examine and quantify the current evidence concerning the use of educational technologies in undergraduate and postgraduate nursing and midwifery education. This review was guided by the JBI methodology for scoping reviews. A tailored search strategy was developed with a research librarian and a number of databases were searched. A total of 19 638 literature sources were screened by three reviewers. Literature published from January 2016 to December 2020 was included and limited to the English language. The reporting of the review process is guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews checklist. This review provides an overview of the current use of educational technologies within nursing and midwifery education; it provides a list of the technologies used, the research methodologies and designs undertaken, and the educational theories, models or frameworks considered. The review highlights the wide range of technologies in use and the paucity of studies that are guided by an educational theory, model or framework.

Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review

Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.

An international exploration of blended learning use in pre-registration nursing and midwifery education

AIM

To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.

BACKGROUND

The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.

DESIGN

Cross-sectional, sequential, mixed methods study PARTICIPANTS/SETTINGS: Nursing/nurse education leaders from across International Council of Nurses regions METHODS: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.

RESULTS

Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.

CONCLUSIONS

Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.

TWEETABLE ABSTRACT

Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.

Meta-analyses of differences in blended and traditional learning outcomes and students' attitudes

The sudden outbreak of COVID-19 has made blended learning widely accepted, followed by many studies committed to blended learning outcomes and student attitudes. Few studies have, however, focused on the summarized effect of blended learning. To complement this missing link, this study meta-analytically reviews blended learning outcomes and student attitudes by including 30 peer-reviewed journal articles and 70 effect sizes. It concludes that blended learning outcomes are significantly higher than the traditional learning outcomes with a medium effect size, and learners hold significantly more positive attitudes toward blended learning than traditional learning with a medium effect size. Blended learning may be promising, and information technology scientists may focus on the development of more advanced and effective devices to improve blended learning effectiveness.

The effect of simulation-based flipped classroom on acquisition of cardiopulmonary resuscitation skills: A simulation-based randomized trial

BACKGROUND

Cardiopulmonary resuscitation (CPR) is an essential skill required by critical care nurses. Evidence has shown that the use of a novel method called simulation-based flipped classroom (SBFC) can save training time in nursing laboratories and, to some extent, enhance social distancing during the current COVID-19 pandemic.

AIM

To evaluate the effects of SBFC on nursing students' acquisition of CPR skills.

STUDY DESIGN

A two-parallel prospective, single-centre, simulation-based, randomized, controlled trial.

METHODS

The total sample size was 326 students. A CPR video was recorded and uploaded on Microsoft Teams channel for the SBFC group only. Thereafter, both groups demonstrated and redemonstrated the CPR procedure. Both groups were then compared according to the simulation experience satisfaction scale and CPR skills acquisition checklist.

RESULTS

Two equally randomly selected groups of 163 undergraduate nursing students completed the study. The SBFC group had a significantly better satisfaction with the simulation experience than the traditional simulation (TS) group (p = 0.03). As regards the mean score of the CPR checklist after simulation, the SBFC group had a significantly higher score than TS group (p = 0.01).

CONCLUSIONS

SBFC using a pre-recorded video can be an effective method that can reduce the time needed for CPR clinical simulation and can be used for the CPR simulation among critical care nurses.

RELEVANCE TO CLINICAL PRACTICE

This study provides critical care nursing educators with a deep understanding regarding the benefits and value of utilizing the SBFC method in the clinical training of CPR skills. SBFC can be used to increase critical care nurses' satisfaction and skill acquisition during CPR training.

Nursing Students’ Perceived Learning Outcomes, Motivation to Learn and Grade Achieved in a Digital Blended Learning Course: A Norwegian Cross-Sectional Study

The COVID-19 pandemic forced educational institutions to move online, and it is important to understand how students perceive learning in a digital learning environment. We aimed to investigate students’ perceived learning outcomes in a digital learning environment and associations between perceived learning outcomes and grades achieved. An anonymous electronic survey was used (n = 230, response rate 34%). A significant linear relationship between overall perceived learning outcome and grade achieved was found (B 0.644, 95% CI 0.52 to 0.77). Of the different learning activities, attending digital seminars were positively associated with grades (B 0.163, 95% CI 0.002 to 0.32). In particular, participating in voluntary colloquium group (B 0.144, 95% CI 0.03 to 0.26) and motivation to learn (B 0.265, 95% CI 0.13 to 0.41) predicted the students’ grades. Intrinsic motivation was positively associated with grades (B 0.285, 95% CI 0.12 to 0.45), and extrinsic motivation was negatively associated with grades (B-0.213, 95% CI-0.35 to -0.07). Nursing students’ perceived learning outcomes and grades were positively associated. Of the different learning activities, attending digital seminars predicted higher grades. Additionally, attending colloquium groups and being motivated to learn predicted higher grades, while high extrinsic motivation was associated with lower grades.

Holistic nursing clinical practice experiences of nursing students in medical-surgical clinics: A qualitative study

PURPOSE

This study was conducted to examine the experiences of nursing students in holistic nursing clinical practice.

DESIGN

Twenty senior nursing students participated in this study. Data were collected through focus group interviews with a qualitative approach followed by thematic data analysis.

FINDINGS

Four themes were obtained holistic care, barriers to holistic care, the contributions of holistic nursing internship, and students' expectations.

PRACTICE IMPLICATIONS

The participants stated that they believe that physical care is sufficient enough in the care they provide to patients and their families in clinical practice and that they only provide physical care. However, they stated that they became aware of the importance of holistic care with this practice and gained better insights into their professional requirements.

Effects of an Interaction and Cognitive Engagement-Based Blended Teaching on Obstetric and Gynecology Nursing Course

An interaction and cognitive engagement-based blended teaching mode was applied to obstetrics and gynecology nursing course to examine the effects on nursing students’ competency, self-directed learning level. A randomized controlled trail design was designed. The experimental group engaged with the blended teaching, and the control group was assigned a usual teaching. The level of competency, self-directed learning was compared between two groups. The total score and scores of each dimension of core competence and self-induced learning ability in intervention group were all higher than those in control group (p < 0.05).

Detecting latent topics and trends in blended learning using LDA topic modeling

With the rapid application of blended learning around the world, a large amount of literature has been accumulated. The analysis of the main research topics and development trends based on a large amount of literature is of great significance. To address this issue, this paper collected abstracts from 3772 eligible papers published between 2003 and 2021 from the Web of Science core collection. Through LDA topic modeling, abstract text content was analyzed, then 7 well-defined research topics were obtained. According to the topic development trends analysis results, the emphasis of topic research shifted from the initial courses about health, medicine, nursing, chemistry and mathematics to learning key elements such as learning outcomes, teacher factors, and presences. Among 7 research topics, the popularity of presences increased significantly, while formative assessment was a rare topic requiring careful intervention. The other five topics had no significant increase or decrease trends, but still accounted for a considerable proportion. Through word cloud analysis technology, the keyword characteristics of each stage and research focus changes of research were obtained. This study provides useful insights and implications for blended learning related research.

An eLearning module is comparable to face-to-face teaching in a nursing human pathophysiology subject

BACKGROUND

Human pathophysiology is important in undergraduate nursing education to help students develop clinical reasoning skills. Traditionally pathophysiology education in undergraduate nursing is taught face-to-face. However, eLearning in nursing curricula may provide flexible delivery options.

OBJECTIVE

With increased inclusion of technology enhanced learning in nursing curricula, a hematology eLearning module was evaluated in a pathophysiology subject to determine whether it was comparable to face-to-face learning.

DESIGN

Single-blind randomized pre-test/post-test controlled trial.

SETTING

School of Health and Behavioural Sciences, University of the Sunshine Coast.

PARTICIPANTS

A total of 271 second-year undergraduate students enrolled in Human Pathophysiology were included in the study. Students were from three bachelor programs: Nursing Science; Paramedic Science; and Clinical Exercise Physiology. Students were randomly allocated to either the experimental group (n = 85) or the control group (n = 186).

METHODS

A hematology eLearning module was designed to be self-directed and learner-centered, guided by constructivist learning theories for delivery in the human pathophysiology subject. The experimental "eLearning" group completed the module independently, and the control "face-to-face" group completed equivalent paper-based activities facilitated by a tutor. All students completed a pre-test assessment and two post-test assessments two weeks after the intervention and at the end of the subject.

RESULTS

There was no significant difference in assessment scores between the experimental and control groups, or between nursing and other programs.

CONCLUSION

eLearning was comparable to face-to-face teaching in this study. We recommend further research to strengthen the links between pathophysiology theory to clinical reasoning skills using eLearning.

Universal Design for Learning: A Framework for Blended Learning in Nursing Education

BACKGROUND

Blended learning (BL), the combining of face-to-face and online learning, is gaining prominence in nursing education in response to advances in evidence-based learning using technology, the diverse and evolving needs of nursing learners, and unpredictable events impacting nursing education.

PROBLEM

Blended learning requires nursing learners and educators to adapt to new modalities and educators to re-envision learning environments. However, BL lacks an educational framework to guide implementation and is not well explored in the nursing literature.

APPROACH

Universal design for learning (UDL) is applied as a framework for BL in nursing education.

CONCLUSIONS

Universal design for learning provides a framework for BL to enable nursing educators, learners, and educational institutions to reimagine teaching and learning in novel ways that incorporate emerging evidence and address new challenges. Blended learning, within the context of UDL, offers opportunities for diverse and inclusive learning. Research is needed to guide the implementation of BL best practices within a UDL framework.

Virtual accreditation visits for pharmacy programs in light of the COVID-19 pandemic: Team members' perspective

PURPOSE

This wisdom of experience commentary, from peer academic reviewers serving on accreditation teams, will discuss benefits and challenges of international and national virtual accreditation visits (VAVs) using a "What? So What? Now What?" reflective model.

DESCRIPTION

Onsite accreditation reviews for health professional education programs require investments in time, effort, and money to maintain program alignment with accreditation standards and continuously generate quality practitioners. When COVID-19 entered the accreditation world, reviewers had to pivot modalities to a VAV format.

ANALYSIS/INTERPRETATION

Adaptation and expectations of VAVs present several challenges. Barriers and advantages will be discussed as well as implications for the future. While medical and pharmacy education standardization has long been established, the authors propose national and international accrediting bodies will utilize the ingenuity of emergency COVID-19-driven onsite accreditation alternatives to develop protocols for novel accreditation methodology.

CONCLUSIONS

Whether the continued mutation of COVID-19 prevents the return to previous accreditation visits or not, the experiences gained from the emergency-driven VAV, can inform and enrich accrediting bodies knowledge, theories, and practices of future VAVs.

IMPLICATIONS

Higher-education institutions, accreditation bodies, and government entities will use experiences during COVID-19 to transform and improve academic requirements and future practices. Even if there is a full return to onsite reviews, such guidelines or improved versions of them can be applied to situations where immobility or restricted mobility is an issue, such as in illness, pregnancy, travel, war, etc. It is crucial for educators and accrediting bodies to evolve as we navigate these unprecedented times.

Nursing Student Satisfaction with the Teaching Methodology Followed during the COVID-19 Pandemic

Background: Halfway through the 2019−2020 academic year, the entire university system was affected by an exceptional situation caused by the COVID-19 pandemic. Online learning was globally implemented for all degrees to finish the course and to meet academic objectives. This unforeseen change in teaching and subsequent evaluations meant teachers and students had to invest significant effort. Student satisfaction is used to measure the evaluation of teaching/learning processes in higher education. Our objective was to know and compare the satisfaction of nursing students taught at a Spanish public university after making changes to the teaching methodology. Methods: A descriptive observational study that measures student satisfaction. Study population: 240 students registered in academic years 2019−2020 and 2020−2021 answered the survey. The survey contained 30 items answered on a Likert-type scale. The main variables: the learning methodology (online or blended) was the independent variable; student satisfaction was the dependent variable. Descriptive and bivariate analyses were performed. Results: A response rate between 37.4% and 41.2%. Overall satisfaction was 2.75 points (SD 0.56) and 2.94 points (SD 0.49) with online learning and bimodal learning, respectively (maximum score 4 points) (p < 0.004). Conclusions: Student satisfaction was moderate−high for both learning methodologies. Students found that the b-learning methodology was the most valued.

E-Learning and Blended-Learning Program in Wound Care for Undergraduate Nursing Students

BACKGROUND

Due to an increasing number of undergraduate students in a Bachelor of Nursing Science program, the existing teaching modalities in wound care were shifted into blended- and e-learning units. The aim is to present the development and implementation of a blended- and e-learning wound care curriculum in an actual nursing program.

METHOD

The development of the blended- and e-learning units is based on literature reviews and expert discussions. The process was guided by the learning outcomes defined by the European Wound Management Association. The implementation was planned for 3 years.

RESULTS

All 14 learning units were developed and implemented using 12 blended and two e-learning units. Flipped classrooms using asynchronous e-learnings and workshops with clinical wound care specialists were used for blended learning.

CONCLUSION

Blended and e-learning are valuable modalities to provide flexibility and deliver learning units based on the latest evidence. The effectiveness of this curriculum needs to be investigated. [J Nurs Educ. 2022;61(1):53-57.].

Nursing students' insights of learning evidence-based practice skills using interactive online technology: Scoping review

This scoping review aims to explore nursing students' insights of learning evidence-based practice skills through the use of interactive online technology. Studies were obtained from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Dissertations and Theses Global) until May 2021. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and was guided by the Arksey and O'Malley framework (Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 2005, 8(1), 19-32). Findings were analyzed using thematic analysis. Three themes were derived from the 22 included studies: (1) embracing new changes, (2) challenges to tackle, and (3) towards future improvement. Many nursing students reported positive learning experiences of evidence-based practice skills using interactive online technology. The challenges faced by students and suggestions for improvement were discussed. Future online evidence-based practice courses should consider blended pedagogies, providing students with effective scaffolding (step-by-step guidance) and allowing students to choose their preferred instructional strategies. Thorough planning, testing, and orientation should be conducted before the programs' implementation. Lastly, future studies should aim to achieve higher study rigor to obtain more accurate results.

Undergraduate Nursing Students Endorse Education Standards in Blended e-Learning Theory Teaching during COVID-19 Pandemic

Aim:

The aim of this study was to survey student learning perspectives as measured by ‘student satisfaction’ following the rapid introduction of remote blended e-learning into the existing undergraduate nursing curriculum at Umm Al-Qura University, Saudi Arabia.

Background:

National legislation resulting from the spread of Covid-19 required all theoretical and practical nurse training to move immediately to online provision using an unfamiliar e-learning environment and associated tools.

Objective:

The objective of this study was to use a validated satisfaction questionnaire developed elsewhere, but within a similar educational context involving both theoretical and practical components, for the purpose of checking that educational objectives were being satisfactorily achieved across five relevant domains of educational enquiry, and to use survey findings to improve the online delivery of the nursing program in future academic years.

Methods:

A validated 35 item questionnaire was circulated online to all male and female nursing students in their 2nd, 3rd and 4th years of study. The questionnaire content was subdivided into the five domains of ‘Interaction’, ‘Instruction’, ‘Instructor’, ‘Course Management’ and ‘Technology’. Descriptive and comparative statistics were used to compare levels of satisfaction between genders and among undergraduate years of study, and against findings from undergraduate information technology undergraduates.

Results:

199 female and 84 male students completed the questionnaire (response rate 59.2%). Mean satisfaction scores for male and female nursing undergraduates were significantly greater than 3 (neutral score) in all domains of enquiry, indicating good satisfaction with blended e-learning (p<0.001). However, multivariate regressions of domain satisfaction scores taking gender and year of study as explanatory variables had poor resolving power. Domain scores were also significantly greater than those of a comparator study in three of the five domains (p<0.030) and similar in the domains of course management (p=0.717) and technology (p=0.677). Levels of satisfaction in males and females were similar in 80% of the survey questions, but in females, satisfaction was significantly lower in some questions concerning technology (p<0.003), willingness to interrupt the instructor (p=0.021), comparison of blended learning and face-to-face teaching (p=0.002) and timely feedback on tests and assignments (p=0.031). Fourth-year students showed the highest levels of satisfaction across all five domains.

Conclusion:

Undergraduate nursing students reported above-average satisfaction levels across all five domains of education provision. Despite an unfamiliar blended e-learning curriculum environment, they demonstrated compatible technological skills, satisfactory interaction with teachers and other students and engagement in the learning process. A number of recommendations identified in the literature as underlying a successful program of blended e-learning are recorded for the benefit of readers.

Comparison of blended versus traditional classrooms among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Blended learning is a relatively new educational approach that has been introduced into higher education in Palestine. While it has many advantages, there is no empirical evidence, nor any case studies from Palestine to support the use of blended learning over traditional classroom.

OBJECTIVES

To compare students' learning outcomes, learning perceptions of their educational environment, and satisfaction of blended learning versus traditional classroom.

DESIGN

A quasi-experimental study.

SETTING

A public university in Palestine.

PARTICIPANTS

102 Bachelor of Science in nursing students enrolled on the maternal health course.

METHODS

Students freely chose to register for the blended teaching section (49 students) or traditional classroom (53 students), then the teaching method for each section was assigned. Student demographics, course component grades, perceptions of the educational environment, measured by the Arabic version of Dundee Ready Education Environment Measurement (DREEM) inventory, and degree of satisfaction were collected in this study. Descriptive statistics and the Independent Sample t-test were used to analyze the data.

RESULTS

The sample included 49 students in the blended teaching section and 53 students in the traditional section. Overall DREEM scores, Student Perceptions of Learning, and Student Perceptions of Teachers were significantly higher for students taught with the blended method compared to traditional classroom settings. The total DREEM scores were between 101 and 151 for both sections, indicating that all students, regardless of teaching method, had more positive than negative perceptions of their educational environment. Moreover, there was no significant difference in scores and total course GPA (Grade Point Average), both with and without assignment grades, or between blended and traditional learning in first, second and final exams. However, students taught with the blended format scored significantly higher in assignments than students taught the traditional classroom.

CONCLUSIONS

Blended learning can be a useful educational approach in nursing education and Palestinian universities may consider using it for nursing courses.

Factors affecting the adoption of the Community of Inquiry Framework in Australian online nursing education: A transition theory perspective

OBJECTIVES

This paper aims to understand the factors influencing the adoption of teaching, social and cognitive presence in online nursing education and explain the novice nurse academics journey in adopting these aspects.

BACKGROUND

The quality of the online/blended courses is about the content and a need for suitable pedagogical design, clear instructions and a collaborative environment based on a valid and reliable theoretical framework.

DESIGN AND SETTINGS

A qualitative study involves semi-structured interviews with 11 nurse academics from three Australian Universities and thematic analysis was conducted.

RESULTS AND CONCLUSIONS

The Community of Inquiry framework informed three themes including several factors in each from the interviews: (1) Teaching Presence (TP): the lack of understanding of educational theory use, the inadequate course evaluation and the resources scarcity found to be the factors affecting the adoption of TP in online nursing education; (2) Social Presence: the engagement difficulty and creating a learning community affected the adoption of SP; and (3) Cognitive Presence: the variety in learning styles and formative assessment and discussion forums found to be affecting the adoption of CP. This study paper is unique because it uses the Community of Inquiry framework and Meleis's Transition Theory and provides insight on how to facilitate the transition [from role insufficiencies to role supplementation to role mastery] of nurse academics' journey in adopting teaching, social and cognitive presence for online higher education.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation: a Delphi consensus study†

Objective

This study is aimed to develop student simulated patient (SSP) training content and evaluation indicators, and further explores their validity and reliabilities.

Methods

Delphi consultations with 20 nursing experts were conducted. The weights of indicators were calculated through the analytic hierarchy process. SSP training was conducted with a high-fidelity nursing simulation.

Results

The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation. The expert authority coefficient was reported as 0.87. The training included role and responsibility of simulated patient (SP), script interpretation, plot performance, and training for a rater, with a total of 17 indicators. SSP evaluation consisted of disease knowledge, role portrayal, and performance fidelity and since being a rater, it consists of 20 indicators in total. The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918. The content validity of SSP evaluation indicators was 0.95. The inter-rater reliability was reported as 0.866, and the internal consistency established using Cronbach’s α was 0.727.

Conclusions

Students as SPs should have first-hand knowledge and experience within the simulated scenarios. SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process. The evaluation indicators were valid and reliable, and provided the objective and quantifiable measurements for SSP training in nursing.

A blended learning teaching strategy strengthens the nursing students' performance and self-reported learning outcome achievement in an anatomy, physiology and biochemistry course - A quasi-experimental study

In nursing, bioscience is regarded as one of the cornerstones of nursing practice. However, bioscience disciplines as anatomy, physiology and biochemistry are considered challenging for students and the failure rate is high. In this study we explore a blended learning teaching strategy in an anatomy, physiology and biochemistry course for first year Bachelor nursing students. In the blended learning teaching strategy, short narrated online digital resources of bioscientific terms and concepts were integrated into the teaching design along with digital metacognitive evaluations of learning outcomes. Results show that compared to students receiving traditional face-to-face teaching, the students with a blended learning approach performed better on their national exam with a small to medium effect size (Cohen's d=0.23). Student course evaluations supported the blended learning delivery with small to medium effect sizes. The students reported that the digital resources supported their learning outcome achievement, that they better understood the teacher's expectations and that they were more satisfied with their virtual learning environment. This study adds to the growing literature of blended learning effectiveness in higher education, and suggests the use of digital resources as an enrichment of teaching and enhancement of students' study experience.

The acceptance and impact of Google Classroom integrating into a clinical pathology course for nursing students: A technology acceptance model approach

Background

Google Classroom (GC) is a free web-based instructional platform rarely used for nursing student education. The acceptance, intention to use, and learning outcomes of GC remain unclear in Taiwan. We sought to identify the technology acceptance level and factors affection the intention to use GC. We also explored how integrating GC into traditional teaching affects learning satisfaction and academic achievement among nursing students in Taiwan.

Methods

In this randomized controlled study, based on a technology acceptance framework, 74 nursing students were randomly assigned in clusters to experimental (n = 39) and control (n = 35) groups during the spring semester of 2018. In Weeks 3–18, each member of the experimental group received one hour of traditional and GC teaching per week. The control group received two hours of traditional teaching per week. Both groups were asked to complete questionnaires to evaluate learning satisfaction and academic achievement during weeks 10 (mid-semester) and 18 (end-of-semester). The experimental group additionally completed technology acceptance questionnaires in both situations.

Findings

In the experimental group, the overall end-of-semester technology acceptance score was high (141.8 out of 155); their perceived ease of use, intention to use, and technology acceptance scores increased significantly compared to mid-semester (p<0.05). At the end-of-semester, perceived playfulness and perceived usefulness explained 63.5% of the variance in intention to use. Regardless of whether the assessment was administered mid-semester or at the end-of-semester, the experimental group had higher learning satisfaction and academic achievement scores than the control group. However, the degree of progress on learning satisfaction and academic achievement demonstrated no significant between-group differences.

Conclusions

The experimental group demonstrated high acceptance of GC. Playfulness and usefulness positively influenced nursing students’ intention to use GC. Blended learning—in combination with GC and traditional methods—resulted in similar learning satisfaction and academic achievement when compared to traditional learning. More research is needed to explore the effectiveness of blended learning through the GC platform with different courses and ethnic groups.

Effectiveness of Blended Learning in Nursing Education

Currently, teaching in higher education is being heavily developed by learning management systems that record the learning behaviour of both students and teachers. The use of learning management systems that include project-based learning and hypermedia resources increases safer learning, and it is proven to be effective in degrees such as nursing. In this study, we worked with 120 students in the third year of nursing degree. Two types of blended learning were applied (more interaction in learning management systems with hypermedia resources vs. none). Supervised learning techniques were applied: linear regression and k-means clustering. The results indicated that the type of blended learning in use predicted 40.4% of student learning outcomes. It also predicted 71.9% of the effective learning behaviors of students in learning management systems. It therefore appears that blended learning applied in Learning Management System (LMS) with hypermedia resources favors greater achievement of effective learning. Likewise, with this type of Blended Learning (BL) a larger number of students were found to belong to the intermediate cluster, suggesting that this environment strengthens better results in a larger number of students. BL with hypermedia resources and project-based learning increase students´ learning outcomes and interaction in learning management systems. Future research will be aimed at verifying these results in other nursing degree courses.