Effectiveness of flipped classroom in nursing education: A systematic review of systematic and integrative reviews.

BACKGROUND: The flipped classroom is an active methodology that has been implemented for many years in the training of nursing students with multiple studies published on this subject to date. AIM: This study sought to answer the question: is flipped classroom effective for improving nursing education? DESIGN: A systematic review of systematic and integrative reviews focused on studies that applied flipped classroom in the teaching of nursing students. DATA SOURCES: Exhaustive literature searches were performed using five electronic databases: Medline, Cochrane, CINAHL Plus, Scopus and Web of Science. REVIEW METHODS: In total, 670 studies were identified, published from 2010 until 2020. Data were collected by two reviewers following the predesigned extraction form. Quality was assessed with the modified AMSTAR scale. A narrative synthesis of the findings has been used to present the results. RESULTS: 15 reviews (9 integrative reviews and 6 systematic reviews) were selected, comprising 274 studies, and providing a sample of 34,608 students. Most of the studies were conducted in China and the United States. A great heterogeneity and a medium-low methodological quality were detected. In the pre-class stage, individual instruction of students through reviews of articles and textbooks or electronic books is highlighted. In class, group activities were most frequently used, including assignments, presentations, projects, or discussion of topics, and in the post-class stage, course evaluation and self-study. The post-class stage was only recorded in two of the systematic reviews selected. When comparing the flipped classroom with the traditional methodology, better results were obtained in performance (k = 122), competencies (k = 92) and satisfaction (k = 10). CONCLUSION: The results suggest that the use of the flipped classroom in nursing education increases performance and is satisfactorily evaluated by both students and faculty. However, more studies are needed that meet methodological quality standards to consolidate the evidence.

Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study.

Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND: Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS: Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS: In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.

Experiences of nursing students participating in end-of-life education programs: A systematic review and qualitative metasynthesis.

OBJECTIVE: The aim of this review was to explore the experiences of nursing students participating in end-of-life education programs. DESIGN: A systematic review. DATA SOURCES: Exhaustive literature searches were performed using seven electronic databases: Medline, Scopus, Web of Science, CINAHL Plus, Dialnet Plus, Eric and Cuiden Plus. REVIEW METHODS: In total, 6572 studies published from 2008 until 2018 were examined. The Critical Appraisal Skills Program was used to assess the quality of the studies included in the review. The findings were synthesized using meta-aggregation. RESULTS: Seventeen studies were included in this systematic review, representing a sample of 606 nursing students. Simulation methods were most common among the educational programs analyzed. The analysis of qualitative data allowed us to identify 260 illustrations which were grouped into 14 categories and three themes: feelings and emotions during the performance of the pedagogical activity, end-of-life education among nursing students and competencies acquired on death and end-of-life. The most highlighted communication skills were learning to listen and building confidence to speak with the patient, family and the general public. CONCLUSIONS: End-of-life programs generally helped students acquire communication skills, learn concepts and improve the administration of this type of care. In addition, they perceived the experience as an opportunity to learn more about oneself, gain trust and support critical thinking. Nonetheless, the evidence available in this field is limited due to the small number of studies, plus the limited data reported. Thus, further studies on this subject are necessary.