An Integrative Review of Flipped Classroom Teaching Models in Nursing Education.

Nursing care is changing dramatically given the need for students to address complex and multiple patient comorbidities. Students experience difficulties applying knowledge gained from didactic instruction to make important clinical decisions for optimal patient care. To optimize nursing education pedagogy, innovative teaching strategies are required to prepare future nurses for practice. This integrative review synthesized the state of the science on flipped classroom models from 13 empirical studies published through May 2016. The purpose of the review was to evaluate studies conducted on flipped classroom models among nursing students using a validated framework by Whittemore and Knafl. Multiple academic databases were searched, ranging in scope including PubMed, Embase (Elsevier), CINAHL (Ebsco), Scopus, Web of Science, and Google Scholar, resulting in 95 unique records. After screening and full-text reviews, 82 papers were removed. Thirteen empirical studies were included in the final analysis and results provided (a) design and process information on flipped classroom models in nursing education, (b) a summary of the state of the evidence to inform the implementation of flipped classrooms, and (c) a foundation to build future research in this area of nursing education. To develop sound evidence-based teaching strategies, rigorous scientific methods are needed to inform the implementation of flipped classroom approaches.

Debriefing Practices in Nursing Education Programs: Results from a National Study.

AIM: The purpose of the study was to describe debriefing practices in nursing education programs in the United States. BACKGROUND: Despite the acknowledged importance of debriefing, little is known about debriefing practices. It is imperative that debriefing practices be examined in order to establish a baseline understanding of current practice. METHOD: The study design was a cross-sectional Internet-based survey. Surveys were sent to every accredited pre-licensure nursing program in the United States. Regression analysis determined variables that were associated with the use of theory-based debriefing. RESULTS: Data analysis determined that most debriefers do not have training in debriefing and that their competence was not assessed. Factors associated with the use of theory-based debriefing included the presence of a designated simulation administrator, training for debriefers, and competence assessment of debriefers. CONCLUSION: These results establish a baseline from which to prioritize faculty development in simulation-based education.

Communication education for pre-licensure nursing students: literature review 2002-2013.

OBJECTIVES: Effective communication skills are fundamental to good nursing care and required by certification bodies for nursing education. The purpose of this literature review was to update one done in 2002 of communication education to pre-licensure registered nursing students. That review concluded that it was unclear which interventions were most effective due to methodological and other quality issues. The goal of this review was to identify recent educational methods, frameworks, and evaluation tools and to assess the quality of this recent evidence. DESIGN: Literature review. DATA SOURCES: PubMed, CINAHL, and PsychINFO. REVIEW METHODS: Inclusion criteria were articles in English, 2002 to 2013, full text available, addressing nurse:patient communication, and educational interventions. Exclusion criteria were inter-professional interventions as they are not yet as widely available. Studies were evaluated using the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scale. This scale categorizes the levels of evidence and methodological quality. RESULTS: The search yielded 457 titles, 115 abstracts, and 38 articles. Twenty studies met inclusion and exclusion search criteria. They included a range of research designs, samples, and outcomes. In line with recent communication educational trends, the interventions all involved active learning. Using the JHNEBP scale, the quality of the 20 studies was low due to both research design and methodological issues. CONCLUSION: Despite the importance of communication in nursing education, the quality of evidence to support specific communication interventions continues to be low. Recommendations for future communication education research are to (1) explore the highest quality designs available and use randomization where possible; (2) more consistently use theoretical frameworks and their accompanying outcome measures; and (3) that tools be tested for evidence of reliability and validity.

Use of the seven principles of effective teaching to design and deliver an interactive hybrid nursing research course.

AIM: This study examined how applying the seven principles of effective teaching to designing and delivering an undergraduate nursing research course in a hybrid format affected course quality. BACKGROUND: Existing research does not adequately describe how the design and delivery processes of hybrid courses affect course outcomes or how these processes address informatics learning resources and students' varying levels of computer skills. METHOD: A hybrid nursing research course was designed and delivered to 105 nursing students using Blackboard and Tegrity systems. Using a mixed-methods approach, students' satisfaction with the course was measured and achievement was compared with those of a comparable previous cohort that had taken the same course in the traditional format. RESULTS: Students reported high satisfaction with the course and obtained significantly higher scores than students in the previous semester. Concerns included working in groups and the additional workload associated with the online component. CONCLUSION Applying the seven principles of effective teaching in design and delivery can improve the quality of hybrid courses.

Designing, delivering and evaluating a distance learning nursing course responsive to students needs.

BACKGROUND AND PURPOSE: The majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources. METHODS: Participants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured. RESULTS: The final sample included 25 students in the distance section and 35 in the hybrid section (N=60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p<.05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80±8.2) was significantly higher than the hybrid section (72.2±9.5), (t=3.5, p<.05). CONCLUSIONS: The use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.

Paradata: a new data source from web-administered measures.

Web administration of measures offers numerous advantages as well as some drawbacks; the efficiency of collecting data in this way is dramatic. An important by-product of Web administration of measures is the option of creating paradata that offer information about how respondents access a measure (server-side paradata) and navigate within the online environment (client-side paradata) to complete the measure. Paradata can play a critical role in developing and piloting measures as well as refining the measurement process. Uses of paradata in Web-administered measures include (1) informing the choice of response formats, (2) examining the extent of changing response options, (3) examining the extent of following a prescribed sequence in completing a measure, (4) tracking the response process, (5) aiding in designing a Web-administered measure and its layout, and (6) assisting in determining the most appropriate log-in procedure. Because of the potential value of this new type of useful data to researchers in nursing and health, this article focuses on paradata within the context of Web-administered measures. More specifically, the article focuses on the definition, generation, and uses of paradata, as well as the ethical issues and other concerns in obtaining and using paradata. Uses of paradata to test the usability of information systems used in nursing and health practices are also included.

Partner quality of life in the antiarrhythmics versus implantable defibrillators trial.

BACKGROUND AND OBJECTIVE: The quality of life (QOL) of patients with ventricular dysrhythmias is well studied, but less is known about the QOL of their partners. This study describes the QOL of partners of patients with serious ventricular dysrhythmias enrolled in the Antiarrhythmics Versus Implantable Defibrillators trial. SUBJECTS AND METHODS: A convenience sample of 124 partners of patients randomized to antiarrhythmic drugs (n = 59) or an implantable cardioverter defibrillator (n = 65) in the Antiarrhythmics versus Implantable Defibrillators trial was obtained. The Short Form-36 and Quality of Life Index were assessed at baseline (postrandomization) and at 3-, 6-, and 12-month follow-up. RESULTS AND CONCLUSIONS: The mean age of the partners was 62 years. Most were white and female. Their mean Short Form-36 scores were comparable to a normative age group. Partner and participant mean Short Form-36 and Quality of Life Index scores correlated modestly (range 0.25-0.36). The physical summary scores of partners using the Short Form-36 declined over time, whereas their mental summary scores remained stable. Partner concerns related to death, dysrhythmia recurrence, and the impact of dysrhythmias on enjoyment of life lessened from baseline to 12 months. Concern about implantable cardioverter defibrillator function remained stable over time. Although the sample size of this study was relatively small and limited by missing data for some assessments, it is the largest prospective study of QOL in partners of patients with serious dysrhythmias. The results offer a foundation for future research of the partners of patients with serious dysrhythmias in terms of identifying their needs, offering support, and maximizing QOL.

Use of genitourinary teaching associates (GUTAs) to teach nurse practitioner students: is self-efficacy theory a useful framework?

Self-efficacy theory guided an examination of the effect of an educational activity using genitourinary teaching associates (GUTAs) with beginning nurse practitioner students. Confidence in and comfort with learning and performing the examinations were evaluated prior to and immediately after the GUTA activity. Statistical analyses revealed significant increases in confidence following all activities with GUTAs, consistent with self-efficacy theory. Comfort levels also increased. The significant improvement in confidence supported the use of the theory, and the increase in comfort contributes to the competence of students as they begin working with real patients.

Quality of life in older patients with atrial fibrillation.

This review summarizes what is known about quality of life (QOL) in older patients with atrial fibrillation (AF). The studies reviewed in this paper represent an increasingly broad repertoire of therapies for the treatment of AF and suggest that QOL in older patients does improve with treatment. The most dramatic improvements in QOL are noted in patients who are highly symptomatic and have poorer QOL at baseline. The data from studies where ablation and pacing therapy is used for treatment in patients with refractory AF vividly demonstrate this statement. There is also evidence of improvement in QOL in those with less severe symptoms, though it is extremely challenging to measure improvements in older patients who are asymptomatic (e.g., silent AF) or mildly symptomatic. Recommendations about new knowledge needed to optimize outcomes, particularly QOL, in patients with AF are based on these findings and the gaps in existing knowledge.

Quality of life in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.

OBJECTIVE: The objective of this prespecified substudy of the AFFIRM study, in which no differences in survival or event rates were found in patients with atrial fibrillation (AF) randomized to either rate control or rhythm control, was to test the null hypothesis that quality of life (QoL) is equal with rate- versus rhythm-control treatment strategies in AF. METHODS: Fifty-six (25%) of AFFIRM sites were randomly selected to recruit AFFIRM patients for the QoL substudy. Instruments used in the QoL assessment were (1) Perceived Health; (2) the Cantril Ladder of Life; (3) the Short Form 36 survey; (4) the QoL Index; and (5) the Symptom Checklist: Frequency and Severity. Data were collected at baseline, 2 months, 12 months, and annually; data are reported through 4 years of follow-up. RESULTS: Baseline characteristics of the AFFIRM QoL patients (n = 716) were generally similar to those of the rest of AFFIRM patients. Quality-of-life scores were similar in rate- and rhythm-control assignment groups at all time points. Quality-of-life scores were similar whether the actual rhythm was sinus or AF. Scores increased from baseline to subsequent time points similarly for both groups; these improvements were not additive over time. CONCLUSIONS: Quality of life was comparable between rate- and rhythm-control treatment strategies. In addition, QoL was similar with sinus rhythm versus AF. Attempts to improve QoL by restoring sinus rhythm will usually be unsuccessful.

Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks.

BACKGROUND: Implantable cardioverter defibrillator (ICD) use reduces mortality in patients with serious ventricular arrhythmias compared with antiarrhythmic drug (AAD) use. However, the relative impact of these therapies on self-perceived quality of life (QoL) is unknown. METHODS AND RESULTS: Three self-administered instruments were used to measure generic and disease-specific QoL in Antiarrhythmics Versus Implantable Defibrillators trial participants. Generalized linear models were used to assess the relationships between self-perceived QoL and treatment (AAD versus ICD) and adverse symptoms and ICD shocks. To minimize the impact of missing data, only patients surviving 1 year were included in the primary analyses. Baseline characteristics among QoL participants (n=905) and nonparticipants (n=111) were similar, but participants who survived 1 year (n=800) were healthier at baseline than nonsurvivors (n=105). Of the 800 patients in the primary analysis, characteristics of those randomized to AAD (n=384) versus ICD (n=416) were similar. Overall, ICD and AAD use were associated with similar alterations in QoL. The development of sporadic shocks and adverse symptoms were each associated with reduced physical functioning and mental well-being and increased concerns among ICD recipients, whereas development of adverse symptoms was associated with reduced physical functioning and increased concerns among AAD recipients. CONCLUSIONS: ICD and AAD therapy are associated with similar alterations in self-perceived QoL over 1-year follow-up. Adverse symptoms were associated with reduced self-perceived QoL in both groups, and sporadic shocks were associated with reduced QoL in ICD recipients.