Iranian Nursing Students' Experiences of Case-Based Learning: A Qualitative Study

Breaking the taboo of using the nursing process: lived experiences of nursing students and faculty members

BACKGROUND

Despite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students' active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information.

OBJECTIVE

The aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies.

DESIGN

A qualitative descriptive study.

PARTICIPANTS

9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops.

METHODS

This qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis.

RESULTS

After analyzing the data, a theme titled "Breaking Taboos in the Nursing Process" was identified. This theme consists of four categories: "Strengthening the Cognitive Infrastructure for Accepting the Nursing Process," "Enhancing the Applicability of the Nursing Process," "Assisting in Positive Professional Identity," and "Facilitating a Self-Directed Learning Platform." Additionally, thirteen subcategories were obtained.

CONCLUSION

The data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process.

Combination of concept maps and case-based learning in a flipped classroom: A mixed-methods study

AIM

This study aimed to evaluate the impact of a hybrid learning method on the academic achievements, learning skills and experiences of undergraduate nursing students.

BACKGROUND

Case-based learning is a student-centered approach that is commonly integrated into the flipped classroom model in nursing education. However, effectively combining the flipped classroom model and case-based learning into a hybrid learning format is challenging. To address this gap, this study integrated concept maps with case-based learning and the flipped classroom and evaluated the impact of this hybrid learning method on the academic achievements, learning skills and experiences of undergraduate nursing students.

DESIGN

A mixed-methods approach, including a quasi-experimental study and semi-structured interviews, was employed.

METHODS

A total of 277 undergraduate nursing students participated, with 136 students in the control group undergoing case-based learning and 141 students in the experimental group taught using the hybrid learning approach, which combined concept maps, case-based learning and a flipped classroom. The study assessed self-directed learning, critical thinking, learning strategy and curriculum grades in both groups before and after the intervention. Additionally, students in the experimental group participated in semi-structured interviews.

RESULTS

The quantitative findings indicated that both case-based learning and the hybrid learning method (combined concept maps, case-based learning and a flipped classroom) had similar impacts on the curriculum grades, self-directed learning, cognitive maturity and learning strategy of nursing students. The qualitative results further demonstrated how the hybrid approach facilitated integrated learning, promoted self-evaluation, aided adaptation to the flipped classroom and enhanced teacher-student interaction.

CONCLUSIONS

Combining case-based learning, a flipped classroom and concept maps is an effective learning approach for undergraduate nursing students. It may improve students' self-directed learning, cognitive maturity and learning strategy. Additionally, concept maps are a beneficial supplement to case-based learning and a flipped classroom in terms of guiding integrated learning, promoting self-evaluation, enhancing adaptation to a flipped classroom and increasing interaction between teachers and students and between classmates.

Modelling the case-based learning preferences of undergraduate nursing students using a discrete choice experiment in China

PURPOSE

To investigate the preferences for case-based learning programmes among undergraduate nursing students.

METHOD

A questionnaire was designed based on a discrete choice experiment, and 227 undergraduate nursing students were investigated. In STATA 15.0 software, the data were statistically analysed using a mixed logit model.

RESULT

All attributes in our study were found to have a significant influence on undergraduate nursing students' preferences for case-based learning programmes. The students' preference for the CBL programme was influenced by the clinical internship experience and type of university. Furthermore, the most ideal scenario was found to be video case modality, unfolding delivery, provided by academic experts and clinical instructors, group size 9-11, adequate feedback, and fragmented case content.

CONCLUSION

The undergraduate nursing students' preferences for case-based learning programmes were affected by the provider, case modality, modality, group size, feedback, and case content. Our results can provide useful information for nursing educators to gain insight into student preferences and formulate case-based learning programs.

Effects of a Modified Six-Sigma-Methodology-Based Training Program on Core Competencies in Rehabilitation Nurse Specialists

PURPOSE

Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation. Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform-a modified Six-Sigma-based training program-against a conventional educational program on rehabilitation specialist nurses' core competencies, post-training performance, and satisfaction.

METHODS

A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base's 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented.

RESULTS

Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05).

CONCLUSION

The modified training program strengthens rehabilitation nurses' base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

The effect of case-based e-learning on academic performance and problem-solving ability in nursing students: A pre- and post-test study

BACKGROUND

Case-based learning is a modern learning approach, aims to prepare students for practical skills. In the present study, we aimed to determine the effectiveness of case-based e-learning (CBEL) on the academic performance and problem-solving ability of nursing students.

MATERIALS AND METHODS

In this pre- and post-test study, census sampling method was used to select 128 nursing students who had nutrition courses during 2015-2017 at (blinded). Before and after the educational intervention, the students completed the problem-solving inventory including problem-solving confidence (PSC), approach-avoidance style (AA), and personal control (PC) and a scientific test for evaluating academic function. Continuous variables before and after the intervention and categorical variables were analyzed using paired t-test and Chi-square test, respectively.

RESULTS

The mean scores of PSC, AA, and PC decreased after the intervention (P < 0.001). The mean scientific score of the students improved after the intervention (P < 0.001).

CONCLUSION

This study showed that the CBEL method had a positive effect on the ability to solve the learning problems and the academic performance of the students and can be used to train nurses to improve their ability to confront clinical problems in the future.

The experiences of nursing master's students with dialogic case-based learning in an evidence-based nursing course: A qualitative study

BACKGROUND

Evidence-based nursing (EBN) is a complex subject for teachers and students due to the abstract concepts involved. It requires combining theory with practice and is included in the major courses required for a master's education in many countries. Case-based learning (CBL), which is a student-centred teaching method, has been widely used in numerous disciplines because it can bridge the gap between theory and practice and foster critical thinking and communication skills. However, to adapt CBL to EBN coursework for a Master of Nursing degree, improve evidence-based practice (EBP) and enhance core competencies, the case design and operational procedures of CBL need to be further examined.

OBJECTIVES

To explore nursing master's students' experiences of dialogic CBL and case design and operational procedures regarding dialogic CBL.

DESIGN

A descriptive-qualitative study design was used.

SETTING AND PARTICIPANTS

The study was carried out in the nursing master's programme at a university in China. Twenty first-year nursing master's students who completed a 10-week EBN course were recruited using purposive sampling.

METHODS

Data were collected between September and December 2020 via in-depth semistructured interviews. The data were analysed using thematic analysis.

RESULTS

Four themes were identified: (1) 'learning theoretical EBN knowledge'; (2) 'improving clinical nursing ability'; (3) 'enhancing core competencies'; and (4) 'barriers to implementing dialogic CBL'.

CONCLUSIONS

The study provided a standardised CBL procedure based on students' experiences, which included preparation, group discussions, presentations, and teachers' feedback following the presentations, and these operational procedures were shown to be indispensable. The student experiences in this study should be referenced by nursing educators who apply this teaching method in other graduate and undergraduate nursing courses such as surgical nursing and nursing research.

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

OBJECTIVE

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

BACKGROUND

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of hot and cold debriefing in simulation with case-based learning

AIM

For successful simulation-based learning (SBL), a structured interactive and bidirectional debriefing should be a prerequisite. The purpose of this study is to identify the effects of instructor-led hot debriefing (debriefing immediately after simulation) and cold debriefing (debriefing occurring after a certain period following simulation) in simulation with case-based learning (CBL).

METHOD

This study used a nonequivalent control group pretest-posttest design. A sample of 59 fourth-year nursing students in South Korea were invited and randomly divided into two groups, a post-simulation hot debriefing (PSHD, male = 4, female = 26), and cold debriefing (PSCD, male = 3, female = 26). We used clinical performance competency, satisfaction with CBL and SBL, and debriefing tools. The study period was from October to December of 2019. We analyzed the data with SPSS 23.0 software, using descriptive statistics and the t test.

RESULTS

Clinical performance competency means that the scores of both groups were significantly improved in the posttest (PSHD = 33.13 ± 5.11, PSCD = 34.10 ± 4.15) as compared to those in the pretest (t = -7.010, p < .001). The knowledge (t = -12.689, p < .001) and skill (t = -5.338, p = .001) scores of clinical performance competency in the PSCD were higher than those in the PSHD. The mean satisfaction scores of the PSHD group with CBL (4.53 ± 0.60) and debriefing (4.66 ± 0.55) was higher than for those in the PSCD group.

CONCLUSION

As a result of this study, PSHD and PSCD led by an instructor improved student clinical performance competency. The PSHD method, in particular, might be a positive influence on learner satisfaction with CBL, SBL, and debriefing.

Nursing Students' Experiences Related to Operating Room Practice: A Qualitative Study

PURPOSE

The purpose of this study was to examine the experiences of nursing students concerning operating room (OR) practice.

DESIGN

A qualitative design was used in this study.

METHODS

Data were collected from second-year nursing students using the semistructured interview form including open-ended questions about their OR experiences. Perspectives of phenomenological approach including existentials of lived body, lived relations, lived space, and lived time were used in data analysis.

FINDINGS

The study data regarding experiences of nursing students concerning OR practice were organized under three themes, namely, "OR environment," "emotions," and "career plans after graduation." Nine subthemes emerged: educational experience, teamwork, and communication, excitement, enjoyment, anxiety, fear, different emotions, working as a surgical nurse, and working in departments other than OR.

CONCLUSIONS

In clinical environments, student nurses should be supported by staff and instructors to facilitate learning and create meaningful learning experiences.

Case-based learning combined with science, technology, engineering and math (STEM) education concept to improve clinical thinking of undergraduate nursing students: A randomized experiment

Aims

The present study was conducted to apply and examine case-based learning (CBL) and Science, Technology, Engineering, and Math (STEM) education concept in the training of nursing student's clinical thinking.

Design

A randomized experimental design with non-equivalent group pretest-posttest.

Methods

Participants were requested to participant in either of the two programmes: traditional education programme as a control group or CBL combined with STEM education concept (the STEM group). Questionnaires of critical thinking, self-directed learning, self-efficacy were administered before and after the experiment.

Results

Differences between the STEM group and control group were observed in critical thinking, self-directed learning, self-efficacy and career choice over one semester. Accordingly, CBL combined with STEM education concept enhanced the nursing student's clinical thinking.

Teaching Professionalism: Comparing Written and Video Case-Studies

PURPOSE

Professionalism is a difficult concept to teach to healthcare professionals. Case-studies in written and video format have demonstrated to be effective teaching tools to improve a student's knowledge, but little is known about their impact on student behaviour. The purpose of this research study was to investigate and compare the impact of the 2 teaching tools on a student's behaviour during a simulation.

METHOD

A 3-stage mixed method study was conducted with senior Medical Laboratory Science (MLS) undergraduate students. All students were randomly divided into a Written Group or Video Group to attend a mandatory professionalism workshop focused on bullying and gossip. Twenty-six students completed the voluntary assignment and 21 students participated in the voluntary group simulations. Thematic analysis was performed on the assignments and simulation. Frequencies of themes were calculated. A Group Simulation Assessment Rubric was used to score simulations and calculate an adjusted group performance average (AGPA).

RESULTS

The assignment demonstrates that students from both groups obtained a theoretical understanding of how to resolve gossip and bullying. From the Written Group and Video Group, 70%/18% of students discouraged/resolved gossiping and 80%/63% prevented bullying. The mean AGPA for the Written Group and Video Group was 5.4 and 4.9 respectively (t ₍₅₎ = 1.5, P = .2).

DISCUSSION

Students can successfully apply knowledge they have gained in written and video case-studies focused on the professionalism topics of bullying and gossip to a hypothetical situation. However, a discrepancy in their actions was found during the simulations. The data from the study suggests that written and video case-studies do not have different impacts on a student's behaviour.

How does video case-based learning influence clinical decision-making by midwifery students? An exploratory study

BACKGROUND

Clinical decision-making skills are essential for providing high-quality patient care. To enhance these skills, many institutions worldwide use case-based learning (CBL) as an educational strategy of pre-clinical training. However, to date, the influence of different learning modalities on students' clinical decision-making processes has not been fully explored. This study aims to explore the influence of video and paper case modalities on the clinical decision-making process of midwifery students during CBL.

METHODS

CBL involving a normal pregnant woman was provided for 45 midwifery students. They were divided into 12 groups; six groups received the video modality, and six groups received the paper modality. Group discussions were video-recorded, and focus groups were conducted after the CBL. Transcripts of the group discussions were analysed in terms of their interaction patterns, and focus groups were thematically analysed based on the three-stage model of clinical decision-making, which includes cue acquisition, interpretation, and evaluation/decision-making.

RESULTS

The students in the video groups paid more attention to psychosocial than biomedical aspects and discussed tailored care for the woman and her family members. They refrained from vaginal examinations and electric fetal heart monitoring. Conversely, the students in the paper groups paid more attention to biomedical than psychosocial aspects and discussed when to perform vaginal examinations and electric fetal heart monitoring.

CONCLUSION

This study clarified that video and paper case modalities have different influences on learners' clinical decision-making processes. Video case learning encourages midwifery students to have a woman- and family-centred holistic perspective of labour and birth care, which leads to careful consideration of the psychosocial aspects. Paper case learning encourages midwifery students to have a healthcare provider-centred biomedical perspective of labour and childbirth care, which leads to thorough biomedical assessment.

Improving nurses' organizational commitment by participating in their performance appraisal process

AIMS

To promote the nurses' organizational commitment by their participation in the improvement of the performance appraisal process.

BACKGROUND

Organizational commitment is one of the factors that secures safe and high-quality care of patients. It also enhances motivation among nurses, which affected by various factors such as performance appraisal.

METHOD

A participatory action research study was undertaken (March 2015 to February 2018) with 39 intensive critical care nurses and nurse managers in Social Security Hospital in Iran, using a complete enumeration sampling method. The data were collected using organizational commitment and job satisfaction questionnaires, focus groups, semi-structured interviews and Delphi technique.

RESULTS

Three major themes emerged including inappropriate performance appraisal system, inefficient instruments and unskilled evaluators. There were significant differences between organizational commitment and job satisfaction with performance appraisal process before and after the change in appraisal process.

CONCLUSIONS

Nurses' involvement in revising and improving the process of their performance appraisal leads to higher commitment.

IMPLICATIONS FOR NURSING MANAGEMENT

Maintaining a committed nursing workforce is vital for high-quality health care. Nurse Managers can improve the process of nurses' appraisal to make more motivation among them and prevent some problems such as job dissatisfaction.

Effects of peer-led debriefing using simulation with case-based learning: Written vs. observed debriefing

BACKGROUND

Peer-led written debriefing (PLWD) and peer-led observed debriefing (PLOD) are types of peer-led debriefing. Despite their advantages, these methods are sparingly used among debriefing experts.

OBJECTIVE

To identify effects of peer-led debriefing (written versus observed) using simulation with case-based learning (CBL) and compare levels of satisfaction with CBL, debriefing, and simulation-based learning (SBL) between the two groups.

DESIGN

Quasi-experimental study used a pretest-posttest non-equivalent control group.

SETTING

Department of Nursing in C province, South Korea.

PARTICIPANTS

Sixty-nine third-year undergraduate nursing students (PLWD, n = 33; PLOD, n = 36).

METHODS

Differences in clinical performance competency, and satisfaction of CBL, SBL, and debriefing between the PLWD and PLOD groups were determined.

RESULTS

Clinical performance competency scores of posttest in both the PLWD and PLOD groups were significantly higher than those of pretest. There were no significant differences in any item except for item of 'communication' (t = -2.150, p = .047) between the PLWD and PLOD groups. There were no significant differences in satisfaction with CBL (t = -0.874, p = .385), simulation (t = -0.701, p = .485), or debriefing (t = -1.024, p = .309) between the two groups.

CONCLUSION

This study suggests that both the PLWD and PLOD could be used to achieve students' learning outcomes when debriefing experts are unavailable.

Case-Based Learning in Dermatology

IMPORTANCE

The instruction of dermatology can be challenging due to its large scope, heavy clinical nature, and limited curriculum space. Case-based learning (CBL) is an emerging education paradigm and has no current literature on its use in dermatology.

OBJECTIVES

Assess CBL in undergraduate dermatology medical education.

METHODS

Case-based learning was implemented in the preclerkship dermatology curriculum at the University of Toronto to 3 student cohorts (totaling 710 students and 93 tutors) between May 2016 and April 2017. We analyzed assignment performance, pre- and post-CBL knowledge test scores, and experience surveys on students and tutors. Surveys were evaluated using aggregate descriptive statistics for quantitative data and thematic data analysis for qualitative data. All assessments were anonymous and voluntary.

RESULTS

We received strong positive feedback on the CBL experience, with no score less than 3.8 on a 5-point scale (where 5 indicated strongly agree with a positively phrased question). Thematic data analysis revealed several key themes, including positive comments for a specialist tutor, the use of visual media, and the "mini-cases" style of CBL, while challenges included a lack of motivation. Group assignments scored high, ranging from 88.9% to 99.3%. Tracked pre- and post-CBL knowledge test scores showed a 32% (from 42% to 74%) increase in scores after the CBL experience. Conclusion and Relevance: CBL in dermatology medical education was well received by students and tutors, with high scores in content evaluation and knowledge assessment. Future studies should examine optimal delivery methods and its long-term effects on knowledge retention.