Encyclopedia
Please note this is a comparison between Version 1 by Inhee Park and Version 2 by Bruce Ren.
This본 is a meta-analysis of the effect of the outcome variables of fragment learning in nursing education, such as clinical strength, critical thinking ability, self dominance and learning satisfaction항목은 간호교육에 적용된 플립러닝의 결과변수인 임상역량, 비판적 사고력, 자기주도성, 학습만족도의 효과크기를 확인하는 메타분석이다.
- clinical competence
- self-directedness
- critical thinking
- satisfaction
- meta-analysis
1. Introduction1. 소개
Recently, flipped learning education has been applied to increase the efficiency of education and learning processes due to rapid changes in the educational environment and to convert students into active learners [1][2].
Flipped learning is a learner-centered teaching method in which learners self-learn online before class, asking questions to the instructor and discussing the content with peers during class [3]. This provides a dynamic mutual learning environment for professors and allows students to focus creatively on their learning needs without time and space constraints [4]. In flipped learning, students manage the learning process through learning content before class, so students’ self-discipline and self-regulation can be improved [5]. Additionally, during this class, students can participate in various active learning activities, such as question-and-answer, discussion, group activities, problem-solving, and receiving immediate feedback [6]. A positive change in academic achievement levels has been observed in medical education with an increasing interest in flipped learning classes and reducing boredom [7].
The first study that applied flip learning in the field of nursing education was published in 2013 [8]. A flipped learning model has been applied in nursing education to reinforce nursing competence according to changes in the clinical environment. It is difficult to acquire sufficient knowledge within limited class hours and clinical practice with the existing teaching methods. This is due to the lack of both direct nursing experience in observation-oriented practice and a connection between the theory and clinical practice. Upon employment in a hospital, a gap is noticed in performing practical tasks in clinical nursing [9]. Thus, nursing educators applied flipped learning to improve the quality of education and prepare for complex nursing practice [1][6]. Flipped learning applied to nursing education has a large amount of learning and professional content, and students are inevitably passive in class. It helps students find lecture materials on their own, perform prior learning, and conduct self-directed learning through active learning in class [10]. It analyzes and integrates learning content and is applied to solve complex clinical situations by improving critical thinking skills [11][12]. Additionally, the learner’s perception of flipped learning also shows a positive response, and because they can watch the videos whenever they want, a high level of satisfaction with video lectures during pre-classes is observed [13]. A change in the teaching method of instructors was urged while emphasizing the importance of insight, situational awareness, critical thinking ability, and clinical reasoning to promote learning in nursing students [14].
Various studies have recently been conducted to identify the effectiveness of flipped learning in nursing education. Prior studies have influenced self-directed learning and learner satisfaction [11]. Critical thinking tendencies have significantly increased compared to conventional teaching methods [10]. Additionally, improved academic achievement [15], learning satisfaction, self-efficacy, knowledge, and communication ability [16] indicated positive effects. However, contradictory research results also exist. In clinical practice education, the experimental group that experienced flipped learning improved in clinical performance [11], as compared to the control group that received lecture-type instruction. While some studies outlined no significant results [17], others reported improved critical thinking tendencies [18]. There are limitations in understanding the effectiveness of flipped learning results, including studies in which thinking tendencies are not significant [19]. When the consistency of these individual research results is insufficient, a meta-analysis can be used to identify factors. Regarding the systematic review and meta-analysis of flipped learning applied to nursing education, two foreign studies have focused on the effects of theoretical knowledge and skill scores [20]. In Korea, no meta-analysis has been reported that systematically and quantitatively evaluated the results of flipped learning education. A meta-analysis was conducted because different educational systems and cultural differences in different countries can affect the effectiveness of flipped learning education [21].
Particularly,최근 이성을 상실 학습 교육으로 인해 교육 환경의 급격한 변화에 교육과 clinical학습 competence, critical thinking ability, and self-directedness과정의 효율성을 증가시키고 활성 학습자 [로 [12],학생들을 which변환 are적용되었습니다 the1 purpose, of2 f].
플립러닝(Flipped learning)은 학습자가 수업 전에 온라인으로 스스로 학습하고, 수업 중 강사에게 질문하고, 수업 중 또래와 내용에 대해 토론하는 학습자 중심 교수법이다[ 3 ]. 이것은 교수들에게 역동적인 상호 학습 환경을 제공하고 학생들이 시간과 공간의 제약 없이 자신의 학습 요구에 창의적으로 집중할 수 있도록 합니다[ 4 ]. 플립드 러닝에서는 학생들이 수업 전에 학습 내용을 통해 학습 과정을 관리함으로써 학생들의 자기 관리와 자기 규제를 향상시킬 수 있다[ 5 ]. 또한 이 수업 시간 동안 학생들은 질의응답, 토론, 그룹 활동, 문제 해결, 즉각적인 피드백 등 다양한 능동적 학습 활동에 참여할 수 있습니다. [ 6]. 플립러닝 수업에 대한 관심이 증가하고 지루함이 감소하면서 의학 교육에서 학업 성취 수준의 긍정적인 변화가 관찰되었습니다[ 7 ].
간호 교육 분야에서 플립러닝을 적용한 첫 번째 연구는 2013년에 발표되었다[ 8 ]. 간호교육에서는 임상환경의 변화에 따른 간호역량 강화를 위해 플립러닝 모델을 적용하였다. 기존 교수법으로는 제한된 수업 시간과 임상 실습으로 충분한 지식을 습득하기 어렵다. 이는 관찰 중심의 실습에서 직접적인 간호 경험이 and부족하고 이론과 임상 실습 간의 연결이 부족하기 때문입니다. 병원에 취직하면 임상간호에서 실무적인 업무를 수행하는데 있어 간극이 발견된다[ 9 ]. 이에 간호교육자들은 교육의 질을 높이고 복잡한 간호실무를 준비하기 위해 플립러닝을 적용하였다[ 1 ,6 ]. 간호교육에 적용되는 플립러닝은 많은 양의 학습과 전문적인 내용을 담고 있어 학생들은 수업시간에 소극적일 수밖에 없다. 수업시간에 능동적인 학습을 통해 학생들이 스스로 강의자료를 찾고 사전학습을 하고 자기주도적 학습을 할 수 있도록 도와준다[ 10 ]. 학습 내용을 분석 및 통합하고 비판적 사고 능력을 향상시켜 복잡한 임상 상황을 해결하는 데 적용됩니다[ 11 , 12 ]. 또한 학습자의 플립러닝에 대한 인식도 긍정적인 반응을 보이며, 원할 때마다 동영상을 시청할 수 있기 때문에 사전 수업 시간에 동영상 강의에 대한 높은 만족도가 관찰된다[ 13]. 간호대학생의 학습을 촉진하기 위해서는 통찰, 상황인식, 비판적 사고능력, 임상적 추론의 중요성을 강조하면서 강사의 교수법의 변화를 촉구하였다[ 14 ].
최근 간호교육에서 플립러닝의 효과를 확인하기 위한 다양한 연구가 진행되고 있다. 선행 연구는 자기 주도 학습과 학습자 만족도에 영향을 미쳤습니다[ 11 ]. 비판적 사고 경향은 기존 교수법에 비해 크게 증가했습니다[ 10 ]. 또한 학업성취도[ 15 ], 학습만족도, 자기효능감, 지식, 의사소통능력[ 16 ]의 향상은 긍정적인 효과를 나타냈다. 그러나 상반된 연구 결과도 존재한다. 임상 실습 교육에서 플립드 러닝을 경험한 실험군은 임상 성과가 향상 [ 11], 강의형 수업을 받은 대조군에 비해 일부 연구에서는 유의미한 are결과가 important in없다고 설명했지만[ nursing17 education], are 다른 연구에서는 비판적 사고 경향이 개선되었다고 보고했습니다[ 18 ]. 사고 경향이 유의하지 않은 연구를 포함하여 플립드 러닝 결과의 효과를 이해하는 데에는 한계가 있습니다[ 19 ]. 이러한 개별 연구 결과의 일관성이 충분하지 않은 경우 메타 분석을 사용하여 요인을 식별할 수 있습니다. 간호교육에 적용된 플립러닝에 대한 체계적 고찰과 메타분석과 관련하여 두 개의 외국 연구에서는 이론지식과 기술점수의 효과에 초점을 맞추어 왔다[ 20]. 국내에서는 플립러닝 교육의 contributing결과를 to the effect of flipped learning education체계적이고 정량적으로 평가한 메타분석이 보고된 바 없다. The국가마다 다른 교육 application of the flipped learning technique to clinical practice has a positive effect on learning시스템과 문화적 차이가 플립드 러닝 교육의 효과에 영향을 미칠 수 있기 때문에 메타 분석이 수행되었습니다[ satisfaction21 [16][22]].
특히 플립러닝의 목적이자 Therefore간호교육에서 중요한 임상적 능력, 비판적 사고력, 자기 주도성 [ 12 the]이 플립러닝 교육의 효과에 기여하고 있다. 플립드 러닝 기법을 임상에 적용하면 학습 만족도에 purpose긍정적인 of this study영향을 미친다 [ was16 to, confirm22]. the따라서 effect size on clinical competence, critical thinking ability, self본 연구의 목적은 임상적 역량, 비판적 사고력, 자기주도성, 학습만족도에 미치는 효과크기를 확인하는 것이다. 이러한 결과를 바탕으로 본 연구는 플립러닝의 필요성과 타당성을 평가하기 위한 과학적 근거를 제공한다. 이는 다양한 문화적 배경을 가진 교육 시스템 및 연구자를 위한 기초이며 간호에서 교수-directedness학습 방법으로서 플립드 러닝 모델의 효과를 평가합니다.
2. 간호교육에서 플립러닝 효과에 대한 메타분석
본 연구에서는 플립러닝이 간호교육에 적용되는 임상적 역량, 비판적 사고력, 자기주도성, and학습만족도에 미치는 영향을 체계적으로 검토하고 메타분석하여 통합적이고 객관적인 방법으로 그 효과를 제시하고자 한다. 따라서 주요 연구 결과는 learning다음과 satisfaction같습니다.
선정된 Based18개 on these results, this연구는 플립러닝을 개입집단으로, 전통적인 강의식 학습을 통제집단으로 고려하였다. 이 중 2건(11.1%)의 study무작위 provides a scientific basis for evaluating the necessity and validity of flipped대조 대조 설계 전 및 후 연구에서 RCT 설계를 사용하여 해외에서 수행되었습니다. learning16개(88. It9%)는 NRCT 설계를 사용하여 동등하지 않은 대조군에 대한 사전 사후 설계였으며, 6개는 해외, 10개는 국내에서 수행되었습니다.
논문의 is방법론적 a basis for educational systems and질 평가에서 RoB가 높거나 RoB가 불확실한 항목을 고려하여 선택편향이 있는 7편(38%)의 논문을 무작위로 배정하지 않았다. reseParchers with diverse cultural backgrounds, evaluatingt 2(12.5%)에서는 무작위 배정 순서를 생성하는 구체적인 방법을 제시하지 않았으며, Part 3(16.6%)에서는 할당 순서를 숨기지 않았습니다. 따라서 연구자는 개입 그룹을 예측할 수 있습니다. 또한 성과 편향의 경우 14편의 논문(77.7%)에서 연구 참여자와 연구자의 눈을 멀게 하는 구체적인 방법이 제시되지 않았습니다. 플립드 러닝에서는 강사의 개입이 필요하기 the때문에 effectiveness of flipped learning models as a teaching–learning method in nursing.참여자와 연구자를 가리는 데 한계가 있어 메타 분석 결과에 영향을 미칩니다. 플립드 러닝에서 RCT 연구 방법의 한계에도 불구하고 학습 방법의 질을 검증하기 위한 다양한 접근이 모색되어야
한다.
2. Meta analysis of reading effect in nursing teaching
This entry will systematically study the effects of clinical power, critical thinking ability, self-dominance and learning satisfaction applied to nursing education, and conduct meta-analysis to put forward its effect with a comprehensive and objective method. Therefore, the main results are as follows.
The 18 selected studies took fleas as as the intervention group and traditional instructional learning as the control group. Two of them (11.1%) were studied before and after the randomized controlled design, and the RCT design was used overseas. 16 (88.9%) were the pre event and post event design of Da Zhao Qun who used NRCT design, 6 overseas and 10 at home.
In the methodological quality evaluation of papers, considering Rob's high or uncertain projects, 7 papers (38%) with selective bias were not randomly arranged. Part 2 (12.5%) did not propose a specific method to generate random allocation order, and Part 3 (16.6%) did not hide the allocation order. Therefore, researchers can predict the intervention group. In addition, in the case of biased results, 14 papers (77.7%) did not propose specific methods to blind research participants and researchers. Because the instructor's intervention is needed in flip learning, the distinction between participants and researchers is limited, which will affect the results of meta-analysis. In flip learning, despite the limitations of RCT research methods, a variety of methods need to be explored in order to verify the quality of learning methods.
Regarding the subject types that applied flipped learning, practical subjects were the highest, with nine studies (50%), followed by seven theoretical subjects (38.9%) and two theory and practical subjects (11.1%). The theoretical subjects were critical thinking, nursing process, pathophysiology, health assessment, and patient safety, and the practical subjects were simulation practice, basic nursing practice, and clinical nursing practice.
Among the analysis papers, when applying flipped learning in practical subjects, nursing techniques cannot be directly performed. Thus, the methods and procedures of nursing techniques are repeatedly learned through audio-visual data [11]. Video content was used [19] or developed and applied by the instructor [23][31]. As the learning experience provided by the medium is different, the instructors set a clear goal through flipped learning, and the curiosity and motivation of learners were met.
As a result of the meta-analysis of flipped learning studies applied to 18 studies, the overall average effect size was 0.68, corresponding to the median effect size. This is similar to the study showing the median effect size of 0.58 as the overall average effect size of the learning effects of domestic flipped learning [24][40] and the study showing a median effect size of 0.59 as the effect size of flipped learning on domestic college students [25][41]. It was confirmed that flipped learning was more effective than traditional lecture-style classes when applied to nursing education.
As a result of comparing the effect sizes of the flipped learning outcome variables in this study, they were found in this order of critical thinking ability, learning satisfaction, clinical competence, and self-direction.
The critical thinking ability had a Hedges’ g of 0.87, showing a large effect size and a high level of heterogeneity. In five studies, the experimental group to which flipped learning was applied showed improved critical thinking ability compared to the control group. It can be predicted that flipped learning, which allows students to ask questions and solve problems on their own through prior learning and to improve critical thinking skills through discussion with other students during class in the classroom [26][42], is effective in nursing education. Additionally, a previous study [19] showed that although it is possible to acquire knowledge and skills, there is a limit to critical thinking. Instructors must grasp the learner’s disposition, attitude, and learning strategy and find and search for information rather than memorize knowledge; based on this, it is necessary to develop a running program.
As a result of analyzing the effect of flipped learning on learning satisfaction, the intermediate effect size was found to be Hedges’ g = 0.79. When learning flipped learning, information was provided to students, such as videos, animations, and images of clinical cases, inducing interest and resulting in positive responses. Satisfaction was high, as this allowed flexibility to learn at a desired speed and time [27][28][43,44]. However, there have also been studies with low learning satisfaction due to tasks assigned from prior learning during flipped learning, online environmental problems for learning, and adaptation to new teaching methods [8]. The instructor should consider the learner’s learning environment when developing flipped learning activities. It is necessary to consider avoiding a learning gap, such as understanding the infrastructure for watching videos and prior learning, and it is necessary to analyze the learning conditions in detail per the learning goal. In other words, it is necessary to promote understanding of learning by providing students with a plan for the learning content and learning method of flipped learning in advance so that they can familiarize themselves with the content to be learned. Additionally, the learner’s learning process was constantly monitored. A strategy for linking the content of prior learning and offline activities is needed by providing feedback on prior learning in the classroom.
As a result of analyzing whether flipped learning is more effective than traditional methods in improving nursing students’ clinical nursing skills, the effect size of clinical competence had a Hedges’ g of 0.53, showing a medium-sized effect. This confirmed that learning the procedure and techniques through videos was effective [29][45], and it was also confirmed by another study [30][46] that the clinical performance was improved by flipped learning in clinical practice. Nursing is a practical study. Direct nursing skills and repetitive practice are required to acquire and improve such skills. However, it is difficult to obtain qualitative improvement because of the inability to perform direct skills during flipped learning. When flipped learning is applied in practical classes, nursing skills and nursing theories are learned based on evidence, and in classroom sessions, the contents of prior learning can be directly performed. Additionally, it effectively improves students’ nursing skills through immediate feedback from instructors [31][47]. Factors for achieving clinical performance include interpersonal relationships and communication, nursing process, critical thinking, nursing intervention, creative thinking, basic nursing, and problem-solving ability [32][48]. These are improved by applying flipped learning to the subject in the corresponding domain, helping them to effectively perform the clinical nursing skills corresponding to the detailed elements.
In this study, the effect size of self-directedness was small (Hedges’ g = 0.37). The most important aspect of flipped learning is to increase the degree of self-directedness, and in many research results, self-directedness was improved through flipped learning [33][34][49,50]. Learners watched video lectures on pre-learning to familiarize themselves with the learning content, and the activities in the classroom were focused on learners. Notably, the self-directedness is improved due to the increased sense of responsibility and activeness in all learning processes [35][51]. Self-directedness is an important variable affecting learning outcomes, such as learning motivation, academic achievement, and satisfaction [36][52]. Through flipped learning, the instructors foster the learner’s learning ability and act as facilitators such that learners can have flexibility and develop lifelong learning habits for self-directedness [37][53]. Accordingly, when the learner’s characteristics and teaching methods are matched, self-directedness is achieved successfully. When designing a flipped learning curriculum, it is necessary to develop educational methods to improve self-directedness ability by focusing on learner-centered education.
Other variables related to the subject type and pre-learning method were the modulating variables that explained the difference in effect size. As a result of meta-ANOVA using the subject type as the moderator variable, the following were practical subjects, theory and practice mixed design subjects, and theory subjects.These results showed a significant difference in the flipped learning effect according to the subject type (Q = 13.59, p ≤ 0.001), and it was confirmed that the effect of a flipped learning class was higher in practical subjects. In a practical subject, flipped learning helps one experience knowledge integrated with observation and experience [12]. The interaction between the instructor and students increases, and the nursing skills gradually improve [8]. Studies have confirmed this effect. Additionally, the effect size value was calculated by classifying the learning methods into video method (15 episodes) and the method where video and lecture books were given (five episodes) simultaneously, indicating that the learning by the video method was higher but not statistically significant (Q = 1.22, p = 0.269). This could be because when the video and lecture book were given simultaneously, the number of assignments to be learned increased, consequently increasing the learning burden, and the lack of time and grade were not reflected. It is necessary for the instructor to explain in advance how the pre-learning videos are related to the lecture contents in order for the students to plan an appropriate amount of pre-study.
It was difficult to measure various variables because there were differences in the specific research methods such as the flip learning education method applied to each study, the number of applications, and the time. In future research, it is necessary to improve the quality of research by describing specific research methods for teaching and learning designs applied to flipped learning classes, such as the characteristics of instructors and learners and the learning process.각 연구에 적용되는 플립러닝 교육 방식, 지원 횟수, 시간 등 구체적인 연구 방법에 차이가 있어 다양한 변수를 측정하기 어려웠다. 향후 연구에서는 교수와 학습자의 특성, 학습과정 등 플립러닝 수업에 적용되는 교수학습 설계에 대한 구체적인 연구방법을 기술하여 연구의 질적 향상이 필요하다.
Critical thinking, clinical reasoning, and clinical performance are required for nursing students to adapt to the rapidly changing nursing environment [14]. Applying flipped learning to equip self-directedness ability, students learn how to acquire abilities and competencies by applying various information rather than simply accumulating knowledge and facing problems in a medical nursing environment.간호대학생이 급변하는 간호환경에 적응하기 위해서는 비판적 사고, 임상적 추론, 임상적 수행이 요구된다[ 14 ]. 자기주도적 능력을 갖추기 위해 플립러닝을 적용하여 의료 간호 환경에서 단순히 지식을 축적하고 문제에 직면하는 것이 아니라 다양한 정보를 적용하여 능력과 역량을 습득하는 방법을 배웁니다.
The limitations of this study are as follows. An extensive search on flipped learning was performed using flipped learning keywords and a series of other relevant keywords. However, the possibility of publication bias cannot be excluded because the publication languages are limited to English and Korean.본 연구의 한계는 다음과 같다. 플립러닝에 대한 광범위한 검색은 플립러닝 키워드와 일련의 기타 관련 키워드를 사용하여 수행되었습니다. 다만, 출판 언어가 영어와 한국어로 제한되어 있어 출판 편향 가능성을 배제할 수 없다.
This study selected RCT and NRCT research among the studies related to flipped learning applied to nursing education to increase the reliability of the research results. The academic significance included confirming the magnitude of the effect on clinical Competence, critical thinking ability, self-directedness, and learning satisfaction as outcome variables, an effect that was determined to exist.본 연구는 연구결과의 신뢰도를 높이기 위해 간호교육에 적용된 플립러닝 관련 연구 중 RCT와 NRCT 연구를 선택하였다. 학문적 의의는 임상적 능력, 비판적 사고력, 자기주도성, 학습만족도에 미치는 영향의 크기를 결과변수로 확인하는 것으로, 효과가 존재한다고 판단하였다.
