An Integrative Review of Flipped Classroom Teaching Models in Nursing Education

Clinical teaching practices in maternal mental health care: An integrated review

WHAT IS KNOWN ABOUT THE TOPIC?: Mental health-related problems in pregnancy are now becoming a global health concern. However, most studies have reported that midwives are unable to assess and support maternal mothers due to poor preservice education. The findings of these studies needed to be explored further from the available literature to address the gap. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The paper has identified maternal mental health core competencies and innovative clinical teaching strategies that nurse educators can utilize when supporting students theoretically and during clinical practice so that students should be adequately prepared for maternal mental health practice. Challenges and recommendations for clinical teaching were also identified. However, there are still gaps in the literature related to the effectiveness of teaching strategies to promote competence acquisition in maternal mental health. WHAT ARE THE IMPLICATIONS FOR EDUCATION?: The study results can be used by nurse educators to develop effective clinical teaching practices in maternal mental health care. The findings can be used in the development of best clinical teaching guidelines for maternal or perinatal mental health to be used by nurse educators for the undergraduate midwifery training programmes. ABSTRACT: Introduction Maternal mental health problems are commonly experienced by women; however, they are usually not adequately recognized and treated by midwives in Malawi. Evidence suggests poor preservice education by nursing colleges which affects the development of essential maternal mental health competencies. Aim The aim of the study was to review existing evidence on clinical teaching practices by nurse educators in teaching student midwives maternal mental health care. Method Integrative review method was used, and various databases were searched. Out of 1768 articles, 27 research articles met the inclusion criteria. The critical appraisal skills programme checklist tools were used to assess data quality. Thematic analysis was done by comparing, grouping and integrating data. Results Six themes emerged, namely: core maternal mental health competencies, professional regulation, interactive teaching strategies, collaborative partnerships, capacity building and shortage of resources. Discussion Clinical teaching is an important aspect of midwifery education. Utilizing student-centred teaching approaches helps students acquire competencies in maternal mental health care. Further research is required to identify the effectiveness of the clinical teaching methods. The Implication to Practice The study results can assist nurse educators to provide comprehensive clinical teaching practices in maternal mental health care which will aid in the development of maternal mental health competencies among student midwives.

Transforming Nursing Education: Developing Augmented Reality Procedural Training

The shortage of nursing faculty and the scarcity of clinical placements have compelled researchers to investigate innovative solutions for procedural development to bridge the gap between didactic teaching and clinical experiences. This feasibility study uses augmented reality (AR) with Microsoft HoloLens2 and Dynamics 365 Guides to train graduate nursing students on advanced nursing procedures, focusing on lumbar puncture. A convenience sample of 24 nurse practitioner students participated in the study. The System Usability Scale, Acceptability Scale, and Engagement Scale were used to assess participant's experiences and perceptions. The results are positive for the feasibility and acceptance of AR technology for procedural training. Participants found the HoloLens2 device easy to use and showed confidence in its functionality. The step-by-step instructions provided by Microsoft 365 Guides were understandable, useful, and satisfactory. The students reported high levels of engagement and found the AR experience to be helpful and motivating for learning. Faculty time was significantly reduced using the HoloLens2 for procedural training compared to traditional methods. This study demonstrates the potential for AR as an effective and efficient modality for nursing education. The findings support the integration of AR technology to enhance procedural development, address the challenges of limited clinical sites, and provide students with an immersive and self-paced learning experience. Additional studies will need to explore the impact of AR on clinical competency, patient outcomes, and cost-effectiveness. Overall, the use of AR technology may be useful and effective for nursing pedagogy.

Educational Outcomes in Undergraduate Nursing: A Systematic Review

BACKGROUND

Baccalaureate nursing education has experienced tremendous challenges requiring new flexibility of moving among traditional classroom, online education, and other teaching modalities to improve student outcomes, combined with the pressing need for determining which educational methods deliver quality instruction while having a positive effect on outcomes. This systematic review explored different teaching modalities and measurable educational student outcomes in undergraduate baccalaureate education.

METHOD

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Of the 20 articles included in this systematic review, simulation, face-to-face, asynchronous, problem-based learning, gaming, flipped classrooms, reflective writing, tweets, and podcasts were represented. Three distinct educational outcomes that were identified included competence, confidence, and communication.

CONCLUSION

A variety of educational methodologies drives positive outcomes in educating the next generation of nurses to have increased competence, confidence, and improved communication. [J Nurs Educ. 2024;63(6):380-386.].

Japanese nurse academics' pedagogical development using collaborative action research

BACKGROUND

To meet contemporary professional standards, nurse educators must provide students with educational content that considers active learning strategies.

OBJECTIVE

This study explored the process and challenges faced by nurse academics working collaboratively to implement an online problem-based learning course.

DESIGN

Collaborative action research.

SETTING

This study was conducted with nurse academics at Yamaguchi University in Japan from May 2020 to April 2022.

PARTICIPANTS

Five Japanese nurse academics and two Australian academics participated in this study.

METHODS

Nurse academics met regularly online to discuss issues and plan, act, and reflect on their experiences using Norton's (2001) five-step process. The meetings were recorded, and structured and written reflections from each participant were collected throughout the process. Data collected from the meetings and structured reflections were analysed to identify key themes.

RESULTS

In Step 1, the key stakeholders were discussed and issues were identified. Step 2 included planning a short seminar for the convenience of student participants, Step 3 involved the conduct of an online nursing ethics course (four sessions) for the students, and Step 4 included the evaluation. One year after the academics had completed their teaching, a discussion of future directions was conducted (Step 5). Through the collaborative action research process, four themes were identified: (1) creating a shared understanding, (2) adopting new paradigms for teaching and research, (3) learning and experiences while practicing, and (4) looking back and moving forward.

CONCLUSIONS

Despite some challenges experienced, the action research approach enhanced the curriculum development process, provided collegial opportunities to explore and learn together, and led to increased changes in the educational practice of academics, even beyond the collaborative action research.

Using a Flipped Classroom Model to Deliver Cardiovascular Nursing Education: A Continuous Quality Improvement Study

The COVID-19 pandemic served as a catalyst to change a didactic class training series consisting of passive lecture-based learning to a flipped classroom model with active learning techniques for newly hired nurses to a cardiovascular center. The purpose of this quality improvement project is to measure if utilizing a flipped classroom model to teach new cardiovascular nurses elicits the same class evaluation measurements compared to a traditional in-person didactic learning model.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review

Background

The 'flipped classroom' approach is an innovative approach in educational delivery systems. In a typical flipped class model, work that is typically done as homework in the didactic model is interactively undertaken in the class with the guidance of the teacher, whereas listening to a lecture or watching course-related videos is undertaken at home. The essence of a flipped classroom is that the activities carried out during traditional class time and self-study time are reversed or 'flipped'.

Objectives

The primary objectives of this review were to assess the effectiveness of the flipped classroom intervention for undergraduate health professional students on their academic performance, and their course satisfaction.

Search Methods

We identified relevant studies by searching MEDLINE (Ovid), APA PsycINFO, Education Resources Information Center (ERIC) as well as several more electronic databases, registries, search engines, websites, and online directories. The last search update was performed in April 2022.

Selection Criteria

Included studies had to meet the following criteria: Participants: Undergraduate health professional students, regardless of the type of healthcare streams (e.g., medicine, pharmacy), duration of the learning activity, or the country of study. Intervention: We included any educational intervention that included the flipped classroom as a teaching and learning tool in undergraduate programs, regardless of the type of healthcare streams (e.g., medicine, pharmacy). We also included studies that aimed to improve student learning and/or student satisfaction if they included the flipped classroom for undergraduate students. We excluded studies on standard lectures and subsequent tutorial formats. We also excluded studies on flipped classroom methods, which did not belong to the health professional education(HPE) sector (e.g., engineering, economics). Outcomes: The included studies used primary outcomes such as academic performance as judged by final examination grades/scores or other formal assessment methods at the immediate post-test, as well as student satisfaction with the method of learning. Study design: We included randomised controlled trials (RCTs), quasi-experimental studies (QES), and two-group comparison designs. Although we had planned to include cluster-level RCTs, natural experiments, and regression discontinuity designs, these were not available. We did not include qualitative research.

Data Collection and Analysis

Two members of the review team independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full text of selected articles. Discrepancies between the two investigators were settled through discussion or consultation with a third author. Two members of the review team then extracted the descriptions and data from the included studies.

Main Results

We found 5873 potentially relevant records, of which we screened 118 of them in full text, and included 45 studies (11 RCTs, 19 QES, and 15 two-group observational studies) that met the inclusion criteria. Some studies assessed more than one outcome. We included 44 studies on academic performance and eight studies on students' satisfaction outcomes in the meta-analysis. The main reasons for excluding studies were that they had not implemented a flipped class approach or the participants were not undergraduate students in health professional education. A total of 8426 undergraduate students were included in 45 studies that were identified for this analysis. The majority of the studies were conducted by students from medical schools (53.3%, 24/45), nursing schools (17.8%, 8/45), pharmacy schools (15.6%, 7/45). medical, nursing, and dentistry schools (2.2%, 1/45), and other health professional education programs (11.1%, 5/45). Among these 45 studies identified, 16 (35.6%) were conducted in the United States, six studies in China, four studies in Taiwan, three in India, two studies each in Australia and Canada, followed by nine single studies from Brazil, German, Iran, Norway, South Korea, Spain, the United Kingdom, Saudi Arabia, and Turkey. Based on overall average effect sizes, there was better academic performance in the flipped class method of learning compared to traditional class learning (standardised mean difference [SMD] = 0.57, 95% confidence interval [CI] = 0.25 to 0.90, τ 2: 1.16; I 2: 98%; p < 0.00001, 44 studies, n = 7813). In a sensitivity analysis that excluded eleven studies with imputed data from the original analysis of 44 studies, academic performance in the flipped class method of learning was better than traditional class learning (SMD = 0.54, 95% CI = 0.24 to 0.85, τ 2: 0.76; I 2: 97%; p < 0.00001, 33 studies, n = 5924); all being low certainty of evidence. Overall, student satisfaction with flipped class learning was positive compared to traditional class learning (SMD = 0.48, 95% CI = 0.15 to 0.82, τ 2: 0.19, I 2:89%, p < 0.00001, 8 studies n = 1696); all being low certainty of evidence.

Authors' Conclusions

In this review, we aimed to find evidence of the flipped classroom intervention's effectiveness for undergraduate health professional students. We found only a few RCTs, and the risk of bias in the included non-randomised studies was high. Overall, implementing flipped classes may improve academic performance, and may support student satisfaction in undergraduate health professional programs. However, the certainty of evidence was low for both academic performance and students' satisfaction with the flipped method of learning compared to the traditional class learning. Future well-designed sufficiently powered RCTs with low risk of bias that report according to the CONSORT guidelines are needed.

A comparison between the impacts of lecturing and flipped classrooms in virtual learning on triage nurses' knowledge and professional capability: an experimental study

BACKGROUND

The quality of triage in emergency department depends on regular evaluation of triage nurses' professional capabilities and development of programs to improve them. Flipped classrooms are a new approach to learning which can be employed to improve professional capabilities. The present study aims to compare the impact of lecturing to flipped classrooms in virtual learning on the knowledge and professional capabilities of triage nurses in the emergency departments of the state hospitals of Yazd province in south-western Iran in 2022.

METHODS

The present study is an experimental work of research. Seventy-four triage nurses participated in the study. Seventy-four triage nurses were randomly allocated to the two groups, including flipped classrooms (group B) and lecturing (group A). The data collection instruments were an emergency department triage nurses' professional capability questionnaire and a triage knowledge questionnaire. The collected data were analyzed in SPSS v.22 using independent t-test, chi-squared test, and repeated measures analysis of variance. Level of significance was set at p ≥ 0.05.

RESULTS

The participants' mean age was 33.1 ± 4.3 years. As measured one month after the education, the triage knowledge mean score of the nurses who were educated using the flipped classroom method (9.29 ± 1.73) was higher than that of the nurses who were educated via lecturing (8.45 ± 1.788), and the difference was statistically significant (p = 0.001). Also, measured one month after the education, the professional capability mean score of the nurses who were educated using the flipped classroom method (140.27 ± 11.744) was higher than that of the nurses who were educated via lecturing (132.84 ± 10.817), and the difference was statistically significant (p = 0.006).

CONCLUSION

There was a significant difference between the pretest and posttest knowledge and professional capability mean scores of both groups immediately after the education. However, measured one month after the education, the mean and standard deviation of the knowledge and professional capability scores of the triage nurses who had been educated via flipped classrooms were higher than those of the nurses in the lecturing group. Thus, virtual learning using flipped classrooms is more effective than lecturing in improving triage nurses' knowledge and professional capability in the long run.

The effect of blended task-oriented flipped classroom on the core competencies of undergraduate nursing students: a quasi-experimental study

BACKGROUND

The flipped classroom (FC) method is becoming increasingly popular in China's nursing education. It is an important breakthrough improvement in the quality of learning in nursing education reforms.

PURPOSE

This study aimed to determine the effects of blended task-oriented flipped classroom (TFC) on nursing students undertaking the Fundamentals of Nursing course.

METHODS

A pre-and post-test quasi-experimental design was adopted. This study was conducted in the Autumn semester, 2021 academic year in a Chinese university. Using cluster sampling technique, this study enrolled second-year undergraduate nursing students from six classess who were studying Fundamentals of Nursing course. A blended TFC was developed and implemented with three classes (experimental group: n = 152). In-class traditional lectures were applied to the other three classes (control group: n = 151). The Self-Directed Learning Instrument, Problem-Solving Inventory, and California Critical Thinking Disposition Inventory were used to evaluate students' learning outcomes, and final examinations were conducted at the end of after course. In addition, students in the flipped classroom group were required to answer five open-ended questions concerning their flipped classroom learning experiences.

RESULTS

Students in the experimental group showed significant improvement in academic performance compared to those in the control group (p = 0.001). Considering total scale and factors, students in the experimental grouped recorded significantly higher scores in self-directed learning ability, problem-solving skills, and critical thinking ability compared to those in the control group (p < 0.05). Furthermore, improved abilities and skills such as team cooperation, communication, presentation, identifying /solving clinical problems, and accountability were reported.

CONCLUSION

A blended TFC teaching approach positively impacted students' core competencies and improved learning outcomes in the Fundamentals of Nursing course.

Exploring the lived experience of student nurses perspective of racism within education and clinical practice: Utilising the flipped classroom

BACKGROUND

The experiential learning gained by student nurses and educators using flipped classroom principles, in conjunction with data from a subsequent study, are explored in this paper. It facilitated a deeper understanding of the 'lived experiences' of racism for Black African-Caribbean student nurses at university and within the clinical practice environment.

METHOD

The qualitative approach of 'Conversations with a purpose', using recorded focus group discussions was utilised as a pragmatic research methodology to explore perspectives of nursing students.

RESULTS

Direct and indirect racism was experienced by student nurses in both, practice, and educational environments. Common issues that arose centred on patient's refusal of care, poor support of students, discomfort or denial of staff in addressing sensitive issues, questioning of students' clinical competencies, and educators using 'otherness' (ethnicity, and related stereotypes) to emphasise limitations of certain groups of students.

DISCUSSION

The flipped classroom can be one way of creating inclusive safe spaces for discussing sensitive topics pertaining to racism, inequity, and social injustice. Nurse educators need to engage in providing awareness around these subjects, that are perceived as uncomfortable and unspoken. Without this, no significant paradigmatic shifts can be made around supporting our students in their lived experience of racism and discrimination.

Empirical research of emerging trends and patterns across the flipped classroom studies using topic modeling

This study presents topic modeling based bibliometric characteristics of the articles related to the flipped classroom. The corpus of the study consists of 2959 articles published in the Scopus database as of the end of 2021. In addition to the bibliometric characteristics of the field, research interests and trends were also revealed with the study, which was based on the topic modeling-based bibliometric analysis method. According to the results of the study, an increase in the number of publications has been observed since 2015. Nearly one-third of the studies are of United States origin. According to the findings of the topic analysis in which the research interests and trends in the studies were revealed, the articles in this field were gathered under 16 topics. Considering the number of publications of the topic, it was seen that the three most voluminous topics were "Performance and perception", "Nursing education" and "Effectiveness and motivation", respectively. It is thought that the results of the study will provide a general perspective to the researchers in this field and provide important outputs in the context of monitoring the issues that may become prominent in the future.

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

BACKGROUND

Tube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training.

AIM

To compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students.

METHODS

This was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses’ evaluation of their training, and related indicators of tube quality management were evaluated.

RESULTS

The average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰.

CONCLUSION

The combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses’ active learning abilities and clinical thinking, and improving the safety of the procedure.

Examining effects of the flipped classroom approach on motivation, learning strategies, urinary system knowledge, and urinary catheterization skills of first-year nursing students

AIM

In nursing education, innovative approaches are crucial to enhancing students' competence and preparing them to respond to the complex healthcare needs of society. The aim of the current study was to compare the efficacy of the flipped classroom and traditional educational approaches on the acquisition of urinary system knowledge and skill level, and on the motivation and learning strategies of first-year nursing students.

METHODS

This study was implemented with a single blind and randomized controlled design in the nursing department of a university's faculty of health sciences between December 2018 and December 2019, with 94 first-year undergraduate nursing students (47 in the experimental group adopting a flipped classroom approach, 47 students in the traditional approach control group). The study was conducted over pre-test and posttest phases for both groups.

RESULTS

The experimental group had higher mean scores than the controls in intrinsic goal orientation, task value, self-efficacy, rehearsal, elaboration, and organization and effort regulation, but lower scores in test anxiety (p < 0.001). The theoretical and skill exam scores of the experimental group were higher than those of the control group (p < 0.001).

CONCLUSION

The flipped classroom approach was effective for improving urinary system knowledge and skill level, and for the motivation and learning strategies of nursing students. This innovative education approach can be recommended as a student-centered method in nursing education for teaching theoretical knowledge and evidence-based practices.

Associations of university student life challenges with mental health and self-rated health: A longitudinal study with 6 months follow-up

BACKGROUND

Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health.

METHODS

In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals).

RESULTS

Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6).

DISCUSSION

Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students.

A qualitative exploration of nursing undergraduates' perceptions towards scaffolding in the flipped classroom of the Fundamental Nursing Practice Course: a qualitative study

BACKGROUND

Although the benefits of using a flipped classroom in nursing education have been reported, there are few published studies attempting to understand students' subjective experiences with scaffolding in a flipped classroom and the challenges they face as a result of this type of educational change. The purpose of this study was to describe students' perspectives of scaffolding in the Flipped Classroom of the Fundamental Nursing Practice Course (FNPC-FC).

METHODS

Thirty-four undergraduates were recruited and separated into four groups in the study. The data was collected through semi-structured focus group interviews. Thematic analysis was conducted to analyze the data in order to determine the themes in the interview transcriptions.

RESULTS

The research revealed two primary themes with associated sub-themes: 1) challenging learning experience, and 2) teacher-student interaction.

CONCLUSIONS

Students will confront substantial challenges as scaffolding strategies are implemented in the flipped classroom. On the other hand, scaffolding in the flipped classroom can successfully train students to be self-directed learners and equip them with nursing skills when students are given appropriate support.

Effectiveness of flipped classroom among nursing students on venous thromboembolism (VTE)

Background

Modern innovative education approaches are crucial to be incorporated into nursing education that leads to improving evidence-based teaching strategies, and closes the gap between theory and practice, as well as to prepare the nursing students to their future workplaces.

Aim

Aim of the study was evaluation the effectiveness of the flipped classroom method among nursing students regarding VTE basic knowledge, risk factors, and prophylaxis.

Subjects and Methods

This study was implemented in a Faculty of Nursing in Northern Cyprus at Nicosia, and used pre-test and post-test, and interventional design. A total of 100 bachelor-degree nursing students were composed the sample of the study. The Implementation of the study was conducted in three phases including pre-test, educational intervention, and post-test. Data were evaluated using the independent-sample t test.

Results

The findings of the study showed statistically significant improvement in the overall mean scores of all VTE after the educational intervention through flipped classroom. Students classified the strength points with four themes; deep motive learning, technology support, team-based learning, and satisfaction.

Conclusions

Our results support the effectiveness of the flipped classroom method in nursing education; the method may be useful for developing of educational strategies in nursing.

Virtual pedagogical strategies and HESI student outcomes in response to COVID-19

BACKGROUND

To maintain curricular integrity in response to COVID-19, nurse educators are increasingly required to transition from traditional (face-to-face) to virtual pedagogy.

OBJECTIVES

The purpose of this analysis was to compare the HESI scores based on a traditional pedagogy with the HESI scores following implementation of virtual pedagogy during Spring 2020.

METHODS

Student (n = 115; 81% female; mean age = 25.71 years) HESI scores were compared after each eight-week session using the Mann Whitney U test, permutation test and Wilcoxon rank test. Logistic regression was used to identify students achieving at least 850. Chi-square test was used to determine the relationship between pedagogy and students meeting 850 HESI scores. Fall 2019 Exit HESI scores were also compared with Spring 2020 Exit HESI scores.

RESULTS

Students from diverse backgrounds (53.9% White; 27.8% Hispanic; 10.4% Asian; 5.2% Black; 1% Unknown) increased (p = 0.022) M_HESI scores following virtual pedagogy in Fundamentals, although no difference was found in Maternity (p = 0.311), Psychiatric (p = 0.129) or Medical Surgical Nursing (p = 0.692). Wilcoxon rank test revealed significant differences in M_HESI scores in same cohort of students between traditional (Psychiatric) and virtual strategies (Medical-Surgical) (p < 0.01); and traditional (Medical-Surgical) and virtual (Psychiatric) strategies (p = 0.023). White students' M_HESI scores were higher than Asian students', as revealed by Logistic regression with no differences based on gender. Spring 2020 and Fall 2019 Exit HESI scores were comparable (p = 0.499). Chi-square analysis revealed no relationship between pedagogy and achieving at least 850 on HESI (χ² = 0.027, p = 0.871).

CONCLUSIONS

Based on the exit HESI scores, virtual pedagogy was as effective as traditional pedagogy for maintaining student competency in a community college associate degree nursing program. Future analyses of the effectiveness of virtual pedagogy in meeting curricular outcomes is warranted, regardless of exit degree option.

Using Augmented Reality to Foster Clinical Readiness and Critical Thinking in Nursing Education

ABSTRACT

This pilot study utilized augmented reality (AR) case scenario posters in foundational coursework to determine if the use of AR posters is an effective teaching strategy when compared with traditional paper case studies. Seventy-nine students participated in this descriptive, comparative study. Overall, the number of correct student responses increased from the pretest to the posttest in all groups; the experimental group was very satisfied with the AR teaching methodology. Because of the increase in knowledge and high student satisfaction, findings suggest that AR posters may be useful in the education of nursing students.

Effectiveness of flipped classroom teaching models in nursing education: A systematic review

OBJECTIVES

The purpose of this systematic review was to reveal the evidence of how the method of flipped classroom was applied in nursing education and examine the results associated with this teaching method.

DATA SOURCES

Peer-reviewed studies published from 2013 to 2020 were selected from the PubMed, Web of Science, and Science Direct databases.

REVIEW METHODS

A systematic review was conducted according to the PRISMA Statement Guidelines. Electronic databases were searched using a range of keywords, and the findings were integrated into a narrative synthesis. Quality appraisal was undertaken.

RESULTS

In total, 7470 articles were retrieved including the 24 paper those were finally selected for the systematic reviews. The themes identified were: academic performance outcomes, student perceptions, activities, and structures.

CONCLUSIONS

It was determined that the flipped classroom method supported learning effectively and increased the quality of teaching. Nursing courses are suggested to be structured as flipped classrooms.

Validation of a questionnaire on the use of Interactive Response System in Higher Education

OBJETIVO

this study aims to design and validate a questionnaire to measure the students' perception of the use of IRS as a technopedagogical resource in the classroom.

METHOD

a 24 items questionnaire (Interactive Response System for the Improvement of the Teaching-Learning Process) was designed ad hoc for this research and applied to 142 university students.

RESULTS

both the exploratory and confirmatory factorial analysis yielded 3 dimensions: classroom environment, teaching-learning processes and learning assessment. The results obtained both in reliability (Cronbach's alpha= 0.955) and in the Confirmatory Factor Analysis (χ2/df=1.944, CFI=0.97; GFI=0.78; RMR=0.077; RMSEA=0.08) reveal highly satisfactory indices.

CONCLUSION

statistical analyses confirm that this instrument is a valid, reliable, and easy-to-apply tool for professors to evaluate the student perception of student-centred learning.

Innovative Classroom Upgrade: Simulating an Intensive Care Unit Environment in an Undergraduate Academic Classroom

ABSTRACT

There are limited opportunities for undergraduate nursing students to take part in hands-on critical care. A course was developed to expose students to the critically ill patient in the intensive care unit environment and introduce skills that students may not have the opportunity to engage in during their clinical hours. Led by two faculty currently practicing in critical care, this course used multiple learning modalities, including high-fidelity simulation; didactic teaching; online discussion; and narrative, reflective writing, to teach critical care concepts and entry-level skills.

A Comparison of Teaching Methods for a Baccalaureate Nursing Health Assessment Course

New teaching methods are designed and implemented to ensure student success and application of knowledge. One of these designs is the flipped classroom. Nursing programs are also integrating technology, including simulation, into nursing education in order to enhance student engagement. Although several research studies support flipped classroom methodology, no studies have compared traditional and flipped classroom teaching methods, as well as the use of a technology-enhanced classroom, in a baccalaureate nursing health assessment course. The purpose of this study was to compare learning outcomes and student satisfaction in an undergraduate health assessment course across three teaching methods: traditional lecture, flipped classroom, and a technology-enhanced interactive flipped classroom. All three methods incorporated virtual patient simulation. Using a quasi-experimental design, formative and summative assignment grades were compared. Student course evaluations were compared to assess satisfaction with each teaching method. Significant differences in mean grades were found in 12 of the 23 assignments. The technology-enhanced interactive flipped classroom section outperformed the traditional and flipped classroom sections on most of these assessments. Only one difference was noted in student satisfaction. The results showed that a technology-enhanced interactive flipped classroom design supported student learning. A longitudinal analysis of student performance is recommended.

Flipping the Graduate Nursing Classroom: An Integrative Review

BACKGROUND

This integrative review examined whether academic performance and student satisfaction increased in graduate nursing students when using a flipped classroom (FC) modality compared with traditional classroom methods. The FC model is an instructional design in which students perform traditional learning activities at home via an online platform in preparation for performing higher order in-class activities. This model has been proven efficacious in many disciplines but has been studied only recently in graduate nursing education.

METHOD

A literature search identified five articles. Articles were evaluated, and themes were identified.

RESULTS

Articles were analyzed for rigor using standards outlined by Shavelson and Towne. No one operational definition of an FC was identified in graduate nursing education. Most studies reported positive trends in student performance; however, student and faculty satisfaction varied.

CONCLUSION

Current evidence on FC in graduate-level nursing education demonstrates an overall lack of rigor. The FC model has been inconsistently operationalized in graduate-level nursing, prohibiting comparison among studies. This limits the ability of evidence-based experts to reproduce studies. [J Nurs Educ. 2020;59(6):305-310.].

Exploring the pedagogical design features of the flipped classroom in undergraduate nursing education: a systematic review

Background

In recent years, technological advancement has enabled the use of blended learning approaches, including flipped classrooms. Flipped classrooms promote higher-order knowledge application – a key component of nursing education. This systematic review aims to evaluate the empirical evidence and refereed literature pertaining to the development, application and effectiveness of flipped classrooms in reference to undergraduate nursing education.

Methods

A PRISMA systematic review protocol was implemented to investigate the literature pertaining to the development, implementation and effectiveness of flipped classroom pedagogy in undergraduate nursing education. Seven databases (Scopus, PsycINFO, CINAHL, ERIC, MEDLINE, Cochrane, Web of Science) were utilised to survey the salient literature. Articles were appraised with respect to their level of evidence, the origin of study, study design, the aims/s of the study, and the key outcomes of the study. A qualitative synthesis was then conducted to summarise the study findings.

Results

The initial search identified 1263 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 27 articles were considered for the final review, most of which were conducted in the USA and South Korea. A range of research designs were applied to measure or discuss the outcomes and design features of the flipped classroom pedagogy when applied to undergraduate nursing education. The review indicated that a common operational flipped classroom model involves three key components, namely pre-classroom activities, in-classroom activities and post-classroom activities, guided by two instructional system design principles. The review predominantly identified positive learning outcomes among undergraduate nursing students, after experiencing the flipped classroom, in terms of skills, knowledge and attitudes. However, a few studies reported contrasting findings, possibly due to the incompatibility of the flipped classroom pedagogy with the traditional learning culture.

Conclusions

Current evidence in this systematic review suggests that incorporating the flipped classroom pedagogy could yield positive educational outcomes in undergraduate nursing education. There are promising pedagogical models available for adapting or developing the flipped classroom pedagogy in undergraduate nursing education.

Flipped learning: A shift in graduate nursing education

ABSTRACT

The coronavirus (COVID-19) pandemic has caused a shift in education. Nursing education must respond to these changing times by redesigning classroom instruction. Flipped learning (FL) is a proposed method for teaching advanced practice nurses that is student-centered and engaging, both critical areas for contemporary learners. This qualitative study explored the perspectives and experiences of the family nurse practitioner faculty and the family nurse practitioner nursing students who participated in FL. The type and level of FL practices faculty can apply to support students coming to class prepared to engage in active learning activities was also investigated. The study used an insider action research design. There were two arms of the study, faculty and student. Ten faculty-led learning circles with four faculty and three family nurse practitioner student focus groups, each with six students, were held over the course of the study. Thematic findings were developed from both student and faculty data. The results revealed that family nurse practitioner students had a positive attitude toward FL. Many expressed FL provided perceptions of gained confidence, personalized learning, increased engagement, and preparedness for classroom instruction. Overall, faculty preferred FL over traditional teaching approaches. Several active learning activities were used by faculty with clinical case studies being the most preferred by student participants. This study confirms FL is a plausible and promising approach to traditional classroom instruction. However, more robust studies are needed to determine its benefits in advanced practice nursing education.

Introducing a flipped classroom in a pharmacology course

BACKGROUND

Flipped classroom pedagogy has been shown to improve nursing students' academic performance.

AIM

The study aimed to determine the effect of a flipped classroom approach on students' pharmacology assessment scores in a school of nursing in Karachi, Pakistan.

METHODS

A retrospective chart review was performed. The pharmacology test scores of the BSc nursing cohort of 2020, when flipped classroom pedagogy was used, was compared with those of the BSc nursing cohort of 2019, where traditional pedagogy was employed. Students' summative evaluation for the course and their verbal feedback were analysed.

RESULTS

The median continuous assessment test score of the 2019 cohort was 35 (interquartile range (IQR) 32-38), while that of the 2020 cohort was 38 (IQR 35-41). The difference in the score was statistically significant (P<0.001).

CONCLUSION

The study gives an insight into a relatively novel pedagogy that was found to improve pharmacology knowledge test scores among nursing students.

Changing Student Outcomes Without Sacrificing Student Satisfaction

BACKGROUND

Faculty teaching a large class size implemented evidence-based teaching strategies (EBTS) to improve mastery of core concepts in an accelerated undergraduate pediatric nursing course.

METHOD

Pre- and poststudent outcomes were analyzed using data from course assessments and American Technologies Institute (ATI) concept mastery testing to evaluate the effectiveness of course revisions. ATI designates three proficiency levels to determine mastery. A proficiency of level two exceeds the minimum expectations for mastery, whereas a proficiency level of three suggests students exceed NCLEX-RN standards of content.

RESULTS

Data indicated implementation of new EBTS facilitated improvement in student content mastery. Students exceeded the minimum expectations for NCLEX-RN standards of pediatric content. Course revisions resulted in all students achieving benchmark on ATI concept mastery testing with a three-fold increase in students achieving the highest level of proficiency.

CONCLUSION

EBTS can be adapted for a large class size learning environment with improved learning outcomes. [J Nurs Educ. 2021;60(3):169-171.].

Undergraduate nursing students' experience of learning respiratory system assessment using flipped classroom: A mixed methods study

BACKGROUND

Knowledge and skill acquisition to perform an accurate respiratory system assessment is a key competency expected in undergraduate nursing students. Learning physical assessment requires the integration of multiple knowledge bases and skills; hence, applying an innovative teaching approach, such as the flipped-classroom (FC) approach, fosters an active and student-centered learning environment for physical assessment class.

OBJECTIVES

This study evaluated FC's feasibility in delivering respiratory system assessment content in a health assessment course and explored the changes in nursing students' perceptions regarding student-centeredness and active learning environments before and after applying FC.

DESIGN

A single group pre- and post-test concurrent mixed-methods design was used.

SETTINGS

This study was conducted in a private nursing college in South Korea.

PARTICIPANTS

A convenience sample of 91 second year undergraduate nursing students enrolled in a health assessment course.

METHODS

FC was offered at one didactic session of a physical assessment course. In the FC, students completed a self-directed pre-class activities using online lecture videos and reading materials prior to the class and participated in interactive team-based learning activities inside the classroom. Skills lab practicum took place after the FC. Students' perceptions regarding student-centeredness and active learning environments, in terms of teaching, social, and cognitive presences were measured before (T1) and after (T2) conducting the FC. Qualitative data were obtained at T2 using free-response questions, which required students to comment on their FC experience.

RESULTS

Participants' perceptions of student-centeredness significantly increased from T1 to T2. Although student-perceived teaching and social presence in their learning environment showed upward trends from T1 to T2, these changes were not statistically significant. Students considered FC an acceptable approach to foster active learning in a supportive learning environment.

CONCLUSIONS

This study revealed that incorporating FC to deliver respiratory system assessment content was feasible and considered acceptable by undergraduate nursing students.

The development and evaluation of an integrated virtual patient case study and related online resources for person-centred nursing practice

Ensuring students develop person-centred practice for diverse groups of people across health care settings is an important outcome of undergraduate nursing education. This paper presents the development and evaluation of a learning innovation, an integrated virtual patient case study and complementary online resources for person-centred nursing practice. The virtual patient case study of an Australian Aboriginal woman diagnosed with breast cancer was integrated within four core subjects of a Bachelor of Nursing program, for a total of 600 second-year students. The evaluation of this learning strategy was encouraging. Students reported that the online learning activities were engaging, particularly due to the level of realism, their understanding of Aboriginal Peoples' healthcare needs increased, and they developed therapeutic communication skills, applicable in a variety of healthcare contexts. Staff concerns about student wellbeing when learning sensitive content online were unfounded. When carefully planned, a virtual patient case study and online learning resources can support students to enhance their person-centred nursing practice. Further evaluation, including student outcomes through assessment, is an important next step.

Flipped classroom improves Omani nursing students performance and satisfaction in anatomy and physiology

BACKGROUND

Nursing students struggle with anatomy and physiology course because of the complicated terminology and the difficulty in handling large amounts of information. New, innovative instructional strategies must be integrated into nursing education to improve nursing students' performance in this challenging bioscience course. The aim of this study was to determine the impact of an innovative teaching strategy, the flipped classroom, on the performance and satisfaction of Omani nursing students in an anatomy and physiology course.

METHODS

A quasi-experimental design was used with two classes of 112 first-year nursing students at the College of Nursing, Sultan Qaboos University, Oman. Online videos and active-learning activities about the respiratory system were developed and implemented in an anatomy and physiology course with 53 first-semester nursing students. The control group consisted of a previous cohort of 59 students enrolled in the same course but taught with a traditional lecture approach. The impact of the flipped classroom strategy was measured by students' performance on the final examination and students' self-reported satisfaction. Wilcoxon signed-rank and Mann-Whitney U tests were used to compare students' academic performance.

RESULTS

Our results showed that the performance of the flipped classroom group was better than that of the traditional lecture group. The mean scores of students instructed with the flipped classroom method on the respiratory system items in the final examination were significantly higher than those of the control group, U = 1089.00, z = - 2.789, p < .005. Moreover, the results of a survey showed that nursing students were satisfied with the flipped classroom method. Overall, 68 to 78% of students agreed or strongly agreed that the flipped classroom method improved their learning and increased their interest in the course.

CONCLUSION

Compared with the didactic lecture format, flipped classroom strategy improved Omani nursing students' performance in and satisfaction with an anatomy and physiology course. These results show that the flipped classroom is an important teaching strategy in nursing education.

Effectiveness of flipped classroom vs traditional lectures in radiology education: A meta-analysis

BACKGROUND

With the convert of educational concept, flipped classroom has been adopted gradually in radiology courses as a new teaching mode. Considering no evidence has been concluded to illustrate the effectiveness of of flipped classroom over traditional instructor-centered lectures in radiology education, this meta-analysis was conducted to provide empirical evidence for the reform of pedagogical.

METHODS

Studies were retrieved from six databases, including Pubmed, Embase, Web of Science, Wanfang Data, CNKI, and VIP, from their inception to 16 February 2020. Literature selection and data extraction were completed by two reviewers independently. The effect size of each index was expressed as the odds ratio (OR) for a categorical variable and standard mean difference (SMD) for a continuous variable, each with corresponding 95% confidence interval (95% CI).

RESULTS

A total of 19 studies with 2114 participants were deemed to be eligible for inclusion. The results of this meta-analysis indicated that: the newly emerged flipped classroom represented significant advantage versus traditional lecture in improving theoretical performance (SMD 1.12, 95% CI 0.61-1.63, P < .001), as well as in cultivating students' practical skills (SMD 2.59, 95% CI 1.69-3.59, P < .001). In the subjective findings of investigation, more positive responses were attained in students who took radiology subjects in flipped classroom, covering course satisfaction (OR 1.70, 95% CI 1.35-2.14, P < .001), improvement of teamwork ability (OR 1.80, 95% CI 1.21-2.67, P = .004), self-directed learning and reflection (OR 1.98, 95% CI 1.31-2.97, P = .001), and subjective cognition on consolidation of knowledge mastery (OR 1.38, 95% CI 1.19-1.60, P < .001).

CONCLUSION

Flipped classroom displays multiple advantages versus traditional lecture-based teaching mode, which is well worth further promoting and applying in the process of radiology education.

Effects of Simulation Practicum Using Flipped Learning for Korean Nursing Students

This study aimed to examine the effects of simulation practicum using flipped learning on nursing competency, core basic nursing skill (subcutaneous injection) performance, self-efficacy, and learning satisfaction of Korean nursing students. This study used a quasi-experimental pretest-posttest control group design. The samples used were from 101 nursing students (Intervention 1: n = 34; Intervention 2: n = 34; Control: n = 33) over 20 years old in G provinces, Korea. For the experimental interventions, participants in the intervention group 1 were applied by simulation practicum using flipped learning, and those in intervention group 2 were applied by simulation practicum. Participants in the control group were applied by lecture-based practicum using a model. The measures were the study participants’ general characteristics survey, the nursing competency scale, the core basic nursing skill (subcutaneous injection) performance scale, the self-efficacy scale, and the learning satisfaction scale. There were statistically significant differences in nursing competency, core basic nursing skill (subcutaneous injection) performance, self-efficacy, and the learning satisfaction among the three groups. It was seen in this study that simulation practicum using flipped learning was the most effective teaching and learning method for the nursing practicum of Korean nursing students. The simulation practicum using flipped learning can be useful in providing nursing practicum to nursing students.

Use of a flipped classroom in ophthalmology courses for nursing, dental and medical students: A quasi-experimental study using a mixed-methods approach

BACKGROUND

Traditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine.

OBJECTIVE

The aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students.

DESIGN

A quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach.

SETTING

A university in China.

PARTICIPANTS

A total of 200 students were included.

METHODS

Students' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom.

RESULTS

Students' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors 'learning goals', 'self-efficacy and social learning' and 'problem-solving'. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology.

CONCLUSIONS

Use of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.

Undergraduate nursing students' use of video technology in developing confidence in clinical skills for practice: A systematic integrative literature review

AIMS AND OBJECTIVES

This review examines the current evidence of the effectiveness of the use of video or video podcast technology produced either commercially or in-house in developing nursing students' confidence in clinical skills for practice.

BACKGROUND

The ability of graduates to provide safe, quality, nursing care is the core of any nursing education curriculum. Developing teaching and learning strategies to enhance skills development and confidence is challenging for educators, particularly with contemporary and diverse student populations requiring student-centred, technology-enhanced learning.

DESIGN

An integrative review framework.

REVIEW METHODS

A systematic search was conducted using the following eight databases: CINAHL, MEDLINE, ProQuest, PubMed, ERIC, Scopus, EMBASE, and Google Scholar. Selection criteria included: published in English, involving undergraduate nursing students, measuring confidence in relation to skills development, and using video or video podcasts.

RESULTS

Four studies met the inclusion criteria, with six themes identified. Four themes emerged: Pedagogy; Skills performance and competency; Student satisfaction and confidence in relation to skills development; Technical constraints. Two additional themes related to the impetus for introducing video podcasts: first, time as an institutional, curricular, and academic/student challenge; and second, meeting the generational needs of students.

CONCLUSION

This review demonstrates that video technology teaching methods and traditional teaching methods used in conjunction with each other create the most positive learning environment. Although video technology methods provide a flexible teaching option for the contemporary student population, developing and delivering videos in a clinical skills program need to be conceptualised within an appropriate pedagogical approach to ensure a purposeful and meaningful learning experience. Whilst student confidence was embedded within other evaluations, it is not clearly reviewed or understood; therefore, further research is required in this area.

Why Flip the Medical Resident Classroom? A Pilot Study in Singapore

This chapter on the flipped classroom in Residency teaching was written before the the outbreak of the COVID-19 pandemic. Technology in teaching can no longer take a backseat. As software and tools evolve , they provide for greater interactivity and authenticity in remote learning. Although medical education in the acute care setting is now even more challenging, here is an example of effectively flipping the classroom and recommended best practices for teachers and learners.

Impact of educational games on academic outcomes of students in the Degree in Nursing

Objective

The aim of using the game-based tool Kahoot! was to evaluate and reinforce the contents taught in the subject of Management and Administration of Nursing, Ethics and Health Legislation Services included in the Degree in Nursing, during the 2016–2017 academic year.

Methods

A prospective quasi-experimental study was carried out on a sample of 116 students. 10 multiple-choice questions were designed, with only one possible correct answer and a 20-second-limited response time for each of the questions. Four of these questions previously answered in the classroom using this game were chosen (20% of the exam). Each one of them corresponded to one unit of the topics taught in the subject.

In order to participate in the educational game, students needed their smartphones or electronic devices. After completing the game, the students’ satisfaction level derived from its use was assessed.

Results

The correct answer rate in the educational game was greater than 50% for all questions except for one, in which the rate was 28.8% (P<0.05). Response time as related to score presented statistically significant differences, and higher scores for those questions with lower response time (P<0.001).

The questions included in the final test which had been previously answered using Kahoot! showed a significantly higher difficulty index than the rest of the final exam questions (P<0.05). Question 3 was the easiest, while being the one in which the highest-scoring students obtained more wrong answers.

For the students this tool was easy to use (89.6%) and they positively valued the content acquisition and comprehension, as well as the teacher-student interaction (P<0.05).

Conclusion

The implementation of educational games which consider response time and correct answers favors competitiveness and motivates students to actively participate in their learning process.

Undergraduate nurse educators' transition to flipped classroom: A qualitative study

The flipped classroom continues to garner increasing interest in nursing education; however, few research studies fully document faculty experiences with its implementation. This study's purpose was to explore undergraduate nurse educators' transition from traditional teacher-centered, content-driven strategies to the flipped classroom and describe perceived successes and challenges during the process. A qualitative approach using interpretive description gave voice to a purposive sample of sixteen undergraduate nurse educators across the United States and Canada. Semistructured interviews, audio-recorded and transcribed verbatim, yielded a set of experiential themes. Participants revealed marked challenges as they rethought classroom design in relation to evidence-based educational principles, and met a surprising level of resistance from students and faculty colleagues. Still, faculty observations reflected increased student problem solving, self-determination and a greater correlation between teacher-made and standardized test scores. Participants advocated continued integration of flipped classrooms into nursing curricula and recommended greater collegial and administrative support from academic environments.

The Sandbox: Development and Implementation of a Technology-Enhanced Classroom

Based on the call to transform nursing education, many nursing programs have begun to integrate more active learning strategies into the traditional classroom setting. Many educators have found successful integration requires an improved learning space that allows students to interact and work collaboratively. This article discusses a new innovative trend in higher education called the active learning classroom (ALC), how one college developed an ALC, and the impact of the ALC on the use of active learning strategies and student learning outcomes in the nursing education department.

The use of flipped classroom as an active learning approach improves academic performance in social work: A randomized trial in a university

Background

The flipped classroom (FC) is a pedagogical approach that means that the activities that have traditionally taken place within the classroom are carried out outside the classroom. Fundamentally it implies the way in which the student studies the subject. This change of perspective in teaching—learning has raised many questions regarding its effectiveness and student satisfaction in the university studies in the degree of Social Work.

Objective

The main objective of this study was to evaluate the effectiveness of a Flipped Classroom methodology in the academic performance of students of the Social Work Degree.

Methods

An educational study, with two parallel groups was developed. The randomization was carried out by class groups. Group 1 was assigned an active teaching methodology of Flip Teaching and it was implemented during theoretical teaching hours. The other group of students, Group 2, was assigned a traditional lecturer-based learning (LB) methodology. The participants were all the students of the morning shift who studied the subject Social Work with Groups of the Social Work Degree during the academic year 2017–2018. The sample was composed of 110 subjects, with 60 subjects who developed an active teaching methodology and 50 subjects who received a LB.

Results

In terms of the academic performance result variable, the FT group had a mean of 6.56 (SD: 1.58) and the LB group had a mean of 5.42 (SD: 1.97) (p-value: 0.002). The FT group also had a higher percentage of students receiving merit and outstanding scores (34.5% and 6.9% respectively) and a lower percentage of students who failed (19%) as compared to the LB group in which 20.9% and 2.3% of the students received merit or outstanding grades and 46.5% failed (p-value = 0.025). No significant differences were found with regards to satisfaction with the subject and the methodology used, long-term learning and time spent preparing for the exam.

Conclusions

The FC teaching methodology in comparison with the LB methodology has shown to be a more effective tool regarding academic performance evaluated in a quantitative and qualitative way with regards to Social Work education at university level.

How to Flip the Classroom to Improve Learner Engagement

Providing effective nursing professional development that meets the needs of a variety of learners, promotes critical thinking skills, and results in application in clinical practice is challenging. The flipped classroom was successfully implemented at a large Midwestern teaching hospital to address these challenges. This article explores flipped classroom exemplars including descriptions of prework, active learning strategies, and recommendations for successful implementation of the flipped classroom.

Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature

OBJECTIVE

In this systematic review we describe best practices for teaching pharmacology to undergraduate baccalaureate nursing students based on the available evidence. Numerous teaching strategies employed in undergraduate pharmacology courses for nursing students have been summarized and compared for their impact on pharmacology knowledge retention, application of pharmacology theory to practice, and student satisfaction. Future directions for research are discussed.

DESIGN

The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

DATA SOURCES

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Academic Search Complete, Education Resources Information Center (ERIC), and Education Source and Health Reference Centre Academic were searched using key search terms and phrases. Twenty studies, conducted between 2001 and 2017, met the inclusion criteria.

METHOD

Quality assessment was made in accordance with two appraisal tools: Kirkpatrick's framework and the Medical Education Research Quality Instrument (MERSQI) for quantitative studies.

RESULTS

Online, simulation, and integrated methods of teaching pharmacology were most beneficial for pharmacology knowledge acquisition and student satisfaction. Traditional lecture, problem-based learning, and a flipped classroom were least effective strategies for teaching pharmacology to undergraduate students.

CONCLUSIONS

This systematic review will contribute to the body of knowledge used by nurse educators who teach in undergraduate nursing programs, may be particularly useful for undergraduate nursing program directors/administrators who are considering undergoing curricular changes, and may be a conduit for future researchers who wish to design studies aimed at improving teaching and learning within undergraduate nursing education.

Effectiveness of the flipped classroom on the development of self-directed learning in nursing education: a meta-analysis

Objectives

To examine the best practice evidence of the effectiveness of the flipped classroom (FC) as a burgeoning teaching model on the development of self-directed learning in nursing education.

Data sources

The relevant randomized controlled trial (RCT) and non-RCT comparative studies were searched from multiple electronic databases including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) from inception to June 2017.

Review methods

The data were independently assessed and extracted for eligibility by two reviewers. The quality of included studies was assessed by another two reviewers using a standardized form and evaluated by using the Cochrane Collaboration’s risk of bias tool. The self-directed learning scores (continuous outcomes) were analyzed by using the 95% confidence intervals (CIs) with the standard deviation average (SMD) or weighted mean difference (WMD). The heterogeneity was assessed using Cochran’s I 2 statistic.

Results

A total of 12 studies, which encompassed 1440 nursing students (intervention group = 685, control group = 755), were eligible for inclusion in this review. Of 12 included studies, the quality level of one included study was A and of the others was B. The pooled effect size showed that compared with traditional teaching models, the FC could improve nursing students’ self-directed learning skill, as measured by the Self-Directed Learning Readiness Scale (SDLRS), Self-Directed Learning Readiness Scale for Nursing Education (SDLRSNE), Self-Regulated Learning Scale (SRL), Autonomous Learning Competencies scale (ALC), and Competencies of Autonomous Learning of Nursing Students (CALNS). Overall scores and subgroup analyses with the SRL were all in favor of the FC.

Conclusions

The result of this meta-analysis indicated that FCs could improve the effect of self-directed learning in nursing education. Future studies with more RCTs using the same measurement tools are needed to draw more authoritative conclusions.

Toolbox of teaching strategies

A teaching strategy is a method, which can help students to gain knowledge, deliver information, and improve their learning. Different learning environments, such as clinical teaching, online teaching, and face-to-face traditional learning environments, require different teaching strategies for students. Choosing teaching strategies for a course is very important for nurse educators because various factors should be taken into account to make students meet the learning outcomes. The use of modern technologies in teaching strategies can improve students’ competencies and confidences. The purpose of this article is to create a toolbox integrating ten teaching strategies that can be used in different teaching environments.

Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: A quasi-experimental study

BACKGROUND

One of the most principal key aims of nursing education is to promote nursing students' and nurses' critical thinking. Therefore, nursing education needs to develop an appropriate curriculum and use effective instructional strategies for critical thinking promotion. Flipped classroom is a teaching method which substitutes individual learning for group learning in a dynamic, interactive environment where the teacher guides students to understand and use concepts.

OBJECTIVES

The present study aimed to compare the effects of traditional lecture and flipped classroom on Iranian nursing students' critical thinking disposition.

METHODS

This nonequivalent control group pretest-posttest quasi-experimental study was done in 2016 on 85 second-year bachelor's nursing students who had signed up for the Musculoskeletal Medical-Surgical Nursing theoretical training course. Because of their large number, students had been divided at the beginning of the first semester of their four-year program into two 42- and 43-student groups and attended separate theoretical training classes. These two classes were randomly allocated to either a traditional lecture or a flipped classroom group. The instructional strategies in these groups were the traditional lecture and the flipped class strategies, respectively. A demographic questionnaire and Ricketts' Critical Thinking Disposition Inventory were used for data collection.

RESULTS

After the intervention, the mean scores of critical thinking disposition and its engagement domain in the flipped class group were significantly higher than the traditional lecture group (P < 0.0001).

CONCLUSIONS

This study shows the positive effects of flipped classroom on nursing students' critical thinking disposition. It is recommended that future studies assess the effects of flipped classroom on other nursing education outcomes.