An innovative approach of using online problem-based learning and case-based learning in teaching disaster nursing during the COVID-19 pandemic

Yin-Ji LIANG, Wei-Ju CHEN, Shuang ZHOU,Lin WANG, Qiu-Ying LIAO, Wan-Xian LU,Chen-Li LINDepartment of Nursing, School of Nursing, Jinan University,Guangzhou, Guangdong, China; Department of Transitional Care;Department of Cardiovascular Surgery; Department of Intensive Care Unit, The First Affiliated Hospital, Jinan University, Guangzhou,Guangdong, China; Department of Pathology, School of Medicine,Jinan University, Guangzhou, Guangdong, ChinaThese authors are contributed equally to this article

ABSTRACT

Objective: The objective of this study is to evaluate the learning experience effect of online problem-based learning (PBL) and case-based learning (CBL) in teaching disaster nursing.

Methods: According to the characteristics of online PBL and CBL, the revised curriculum experience questionnaire (CEQ) was used to evaluate the teaching quality. Cronbach’s coefficient and the reliability of the split-half reliability questionnaire were calculated. The exploratory factor analysis of 26 items was carried out by principal component analysis and maximum variance rotation method. Kaiser-Meyer-Olkin (KMO) and Bartlett’s tests were used to test the validity of the questionnaire. The comparison between groups was performed by one-way analysis of variance.

Results: A total of 191 questionnaires were issued and 183 copies were recovered, with a recovery rate of 95.8%. The Cronbach’s alpha coefficient of CEQ is 0.929, and the Cronbach’s alpha coefficient of each dimension is between 0.713 and 0.924. After factor analysis, the KMO value was 0.817. The 26 items finally returned to 6 principal components, and all factor load values were above 0.7, indicating good factor analysis effect. This study found that students who learned disaster nursing had an ideal online learning experience, and the average value of CEQ was 3.74 ± 0.42. In particular, male students, senior students or medical students had a higher curriculum experience score. In addition,compared with the national recruitment, the international students have higher curriculum experience score on the dimension of Appropriate Assessment Scale, indicating that the international students are more inclined to use online PBL and CBL.

Conclusions: Using the revised CEQ is an innovative approach to evaluate the effect of online PBL and CBL in teaching disaster nursing,which can improve students’ experience and curriculum quality.

Keywords: Case-based learning, curriculum experience,nursing, problem-based learning, satisfaction

INTRODUCTION

Undergraduate students around the world are experiencing a learning crisis due to the COVID-19 outbreak. Some developed and developing countries are better prepared to move to online learning, but teachers and students need to make great efforts and face many challenges. Especially for higher education, how to develop students’ ability to learn and solve problems independently during the COVID-19 pandemic is an important challenge.[1]Nurses are the largest group providing care and support during emergencies and disasters, yet a significant number lack the necessary training to play a full role in emergency and disaster response, particularly during mass casualty incidents.[2]The challenge now is to make nurses fully competent in the event of a disaster. Therefore, under the dual background of the development of new medical science and the impact of sudden disasters, the construction and reform of disaster nursing education system is particularly important in nursing education.[3]

In the past, problem-based learning (PBL) has been regarded as the most important teaching reform and innovation in nursing education.[4]PBL was developed to address the problem-solving skills lacking in medical students and is widely used in many medical, nursing and health-related curricula in combination with traditional methods.[5]PBL is a script based on the actual situation of existing cases.Under the guidance of the curriculum instructor, students practice how to “discover problems, analyze problems and solve problems” from the cases. Its purpose is to cultivate students’ active learning, lifelong learning, analytical and problem-solving abilities, and most importantly, interactive learning among nurses, patients, and society. Since humanistic and social aspects and interpersonal interaction are the focus of nursing education, communication, and coordination ability can be cultivated through + group communication and discussion.[6]Case-based learning (CBL)enables students to participate in the discussion of specific scenarios of similar or typical real cases. Similar to PBL, this method is also learner-centered, by which members engage in intense group interactive learning, construct their own knowledge framework, and study cases together as a team.[7]Therefore, online PBL combined with CBL is a new attempt to teach disaster nursing in the context of COVID-19 pandemic.The study finds that the evaluation method of students’learning often directly affects the attitude, way and result of students’ learning. Therefore, appropriate evaluation method should be adopted to encourage students to adopt deep learning method,[8]so as to promote the innovation and development of online PBL combined CBL teaching mode. In addition, educators have long neglected the study of student learning as the subject of higher education, and neglected to solve quality problems from the source of teaching.

Student curriculum experience questionnaire (CEQ) is a scientific and reliable curriculum quality assessment tool based on students’ learning experience,[9]which is widely used in Australia and the UK.[10]The research results of students’ CEQ can provide key information, pointing out how to improve the satisfaction of curriculum experience,especially the satisfaction related to teaching quality.[11]As mentioned above, traditional teaching evaluation methods only focus on students’ knowledge structure and ignore students’ evaluation of curriculum experience, while effective curriculum experience evaluation can ensure that students can get the maximum benefit from online PBL.[12]Therefore,according to the characteristics of online PBL and CBL teaching, we make appropriate changes to students’ CEQ,to scientifically evaluate online CBL and PBL method in the disaster nursing curriculum for students’ learning experience effect, thus to improve the development of targeted suggestions for the questionnaire and online curriculums teaching quality.

METHODS

Subjects and research content

The electronic questionnaires were distributed to students in two classes of disaster nursing. Based on the online PBL combined with CBL teaching method, the revised CEQ was adopted to evaluate the teaching quality of the curriculum [Table 1]. Students’ CEQ involves six dimensions with 26 items: Good teaching evaluation (5 items), a clear goal evaluation (4 items), basic skills evaluation (6 items),appropriate learning burden (2 items), the appropriate evaluation method (3 items), and the overall satisfaction evaluation (6 items). At the same time, Likert grading method is adopted, with 5 points for each item (1-strongly disagree,2-disagree, 3-uncertain, 4-agree, 5-strongly agree).

Table 1: Indicators and items of revised students’ curriculum experience questionnaire

Statistical methods

Cronbach’s alpha coefficient and the reliability of the split-half reliability questionnaire were calculated. The exploratory factor analysis of 26 items was carried out by principal component analysis and maximum variance rotation method. Kaiser-Meyer-Olkin (KMO) and Bartlett’s tests were used to test the validity of the questionnaire. The comparison between groups was performed by analysis of variance (ANOVA), bilateral test, and the test level = 0.05.

Ethic considerations

Questionnaire was completed under the uniform guidance by the researcher. The questionnaire is anonymous and just used to do this study. Informed consent was obtained from all participants. The study was approved by the institutional review board of Jinan University.

RESULTS

Basic information of respondents

A total of 191 questionnaires were issued and 183 copies were recovered, with a recovery rate of 95.8%. There were 183 valid questionnaires, with an effective rate of 100%.There were 66 (36.1%) male students and 117 (63.9%) female students; 119 (65.0%) are junior students (Grade 1–2) and 64 (35.0%) are senior (Grade 3–4); 84 (45.1%) medical students and 99 (54.1%) nonmedical students; 113 (61.7%) national students and 70 (38.3%) international students.

Questionnaire factors and reliability and validity analysis

As can be seen from Table 2, Cronbach’s alpha coefficient was used to calculate the internal consistency reliability of the questionnaire. The overall Cronbach’s alpha coefficient of the questionnaire is 0.929, and the Cronbach’s alpha coefficient of each dimension ranges from 0.713–0.924.When the coefficient is >0.7, the scale has acceptable reliability; when the coefficient is >0.8, the reliability is very good. After factor analysis, the KMO value was 0.817,thePvalue of Bartlett spherical test was at the significance level of 0.000, and the test effect was good. The 26 items finally returned to 6 principal components, and all factor load values were above 0.7, indicating good factor analysis effect [Table 3]. Finally, according to the result of factor analysis, the principal components are consistent with the dimensions of the original questionnaire, which constitute a formal questionnaire for the evaluation of PBL students’ CEQ.

Table 2: Reliability and validity test analysis

Table 3: Factor loading matrix after rotation

Results of students’ curriculum experience

In order to further study the influence of curriculum on gender, grade, specialty and student’s origin on the learning experience of online PBL and CBL curriculum, relevant categorization variables were selected for comparative analysis. With gender, grade, specialty and student’s origin as grouping variables, and the mean value of the questionnaire population and each dimension as dependent variables,one-way ANOVA was conducted according to the number of groups defined by grouping variables to study the differences in online curriculum learning experience of students from different groups.

Comparison of curriculum experience scores between different genders

This research was found that male students’ experience of disaster nursing online PBL and CBL curriculum was better than female students, but there was no statistical difference in the total score of curriculum experience (P= 0.057). Further analysis and comparison of scores of each dimension shows that students of different genders have significant differences in curriculum experience results in two dimensions (AWS)Appropriate Workload Scale and Generic Skills Scale (GSS)(P< 0.05), and male students have better curriculum experience than female students, while the differences of curriculum experience results are not significant in the other four dimensions (P> 0.05) [Table 4].

Table 4: Comparison of curriculum experience scores of different genders

Comparison of curriculum experience scores of students of different grades

The results show that different grades have certain influence on students’ curriculum experience scores. Senior students’experience of disaster nursing online PBL and CBL curriculum was significantly better than that of junior students, and the difference of curriculum experience score was statistically significant (P= 0.041). Further analysis and comparison of scores of each dimension shows that students of different grades have significant differences in curriculum experience results in AWS dimension (P< 0.05), and senior students have higher curriculum burden experience than junior students,while the other five dimensions have no significant differences among students of different grades (P> 0.05) [Table 5].

Table 5: Comparison of curriculum experience scores of students of different grades

Comparison of curriculum experience scores of students of different majors

It is found that different majors have certain influence on students’ experience scores. Medical students’ experience of disaster nursing online PBL and CBL curriculum was better than that of nonmedical students, but there was no statistical difference in the curriculum experience score (P= 0.059).Further analysis and comparison of the scores of each dimension shows that students of different majors have significant differences in curriculum experience results on the AWS dimension (P< 0.05), and medical students have higher learning burden experience than nonmedical students, while the remaining five dimensions have no significant differences among students of different majors [Table 6].

Table 6: Comparison of curriculum experience scores of students from different majors

Comparison of curriculum experience scores of students from different places of origin

This survey indicated that different places of origin had little influence on the overall score of students’ curriculum experience. The national students’ experience of disaster nursing online PBL and CBL curriculum was similar to that of international students, and there was no statistical difference in the curriculum experience score (P= 0.526). Importantly,further analysis and comparison of scores of all dimensions shows that the curriculum experience of national recruited students is higher than that of international recruited students in both the GTS and the OSS dimensions, with statistically significant differences. In addition, the curriculum experience results of international recruiting students in two dimensions of AWS and AAS are better than those of national recruiting students, with significant differences (P< 0.05) [Table 7].

Table 7: Comparison of curriculum experience scores of students from different places of origin

DISCUSSION

Opportunities and challenges of nursing education in the Guangdong-Hong Kong-Macao greater bay area

The Guangdong-Hong Kong-Macao Greater Bay Area (GBA)refers to a city cluster consisting of Guangzhou, Foshan,Zhaoqing, Shenzhen, Dongguan, Huizhou, Zhuhai, Zhongshan,Jiangmen, and Hong Kong and Macao Special Administrative Regions. The integrated innovation of higher education in the GBA is an important part of the construction of the GBA.[13]The GBA of Guangdong, Hong Kong and Macao is a bay area for talents. Creating a first-class bay area requires first-class talents, and the introduction and training of first-class talents require first-class higher education.[14]The development of GBA’s higher education should focus on providing “first-class disciplines” and “first-class curriculums” for students from Guangdong, Hong Kong and Macao. Known as “the highest institution of higher learning for Overseas Chinese”, Jinan University actively implements the school-running policy of “facing overseas, facing Hong Kong, Macao and Taiwan”.Since its establishment, it has cultivated more than 300,000 talents from more than 170 countries from five continents and Hong Kong, Macao and Taiwan.[15]As a “double first-class”institution of higher learning for Overseas Chinese, Jinan University plays an important role in cultivating talents in the GBA. Chinese nurses, including 28,600 in Hubei, have been at the forefront of the special battle against COVID-19.The pandemic has prompted us to think deeply about how to vigorously promote the construction of nursing talents in China, especially in the GBA, in the context of public health emergencies and surging demand for normal health services.[16]

Innovation and practice of online problem-based learning and case-based learning teaching mode

The disaster nursing curriculum will be offered to all undergraduates (including students from Hong Kong,Macao and Taiwan). First, this curriculum emphasizes PBL method to cultivate undergraduates’ ability of independent learning and group learning. Second, this curriculum promotes the cross penetration of different disciplines such as medicine, nursing, psychology, management, and law. And then, this curriculum enhances the humanistic quality and scientific quality of undergraduates, and guides students to understand the latest frontier of disaster nursing and the rich connotation, development trend and latest research results of humanitarian relief. It helps students achieve the following goals through the course of study. First of all, let students get familiar with the current situation and development of disaster care, understand the characteristics of various disaster relief organizations.Secondly, students should be familiar with the emergency treatment and nursing techniques for common diseases and disasters, and the treatment and rehabilitation techniques for rescue workers and survivors after disasters. Finally,the active participation of students should be emphasized to cultivate their ability of independent exploration and innovative thinking.

Both PBL and CBL teaching methods are commonly used in higher education. Both are based on constructivism theory and emphasize the subject status of learners in the learning process. Students are processors of new knowledge rather than passive receivers. Previous studies have shown that PBL and CBL can significantly improve students’ learning effect.[17]During the COVID-19 pandemic, all curriculums at Jinan University are conducted in the form of “independent learning and distance learning”. In this new teacher-student relationship, how to carry out teaching activities with high quality and high efficiency is the proposition in front of every educator. In this study, 191 students from two classes of disaster nursing were selected to participate in the online PBL and CBL teaching method. Among various online teaching technology platforms, massive open online course (MOOC),rain classroom and QQ group teaching platform are selected as teaching means in this study to carry out teaching activities.First, online CBL teaching should be carried out by using MOOC. A typical disaster case is selected and a series of questions are proposed based on the case. The content of each part is divided into three parts: Predisaster prevention, rescue in disaster and reconstruction after disaster. The content of each part is handed to the students in the study group 1 week in advance for self-study, consulting and searching for answers.Second, QQ group is used for online PBL learning. When carrying out PBL teaching, usually one teaching plan is divided into two times, about 1–2 lessons each time. Before each lesson plan is discussed, a student is elected as the chairman to guide the group learning process. The process includes: (1)Problem scenario, (2) Exploring the problem, (3) generating ideas, (4) discussing current knowledge, (5) identifying learning issues, (6) suggesting learning resources, (7)self-directed learning, (8) team learning, (9) re-discussing problem and sharing new knowledge, and (10) evaluating performance. Third, combined with the rain classroom learning evaluation, and aiming at the online PBL and CBL method, the revised student CEQ was adopted to evaluate the curriculum teaching experience.

Curriculum experience evaluation is an important part of online problem-based learning and case-based learning teaching

In this study, it is found that most students believe that the online PBL and CBL method of Disaster Nursing curriculum is better than the traditional teaching method, and that it is superior to the traditional teaching-based medical education model. Most students are satisfied with many of the objectives of PBL that are fully described in the modules designed by the tutor and finalized by the expert. By clearly defining educational outcomes in a behaviorally measurable way, we can change how teachers teach and how students learn. Due to differences in cultural background and social status, education in China and abroad is bound to be very different. Meanwhile, a revised students’ CEQ[18]is also referred to. The revised questionnaire in this study includes six indicators consisting of 26 items. The survey showed that the students of disaster nursing had an ideal online learning experience, and the average value of the overall learning experience was 3.74 eri. 42 (score 1–5), especially the male students, senior students or medical students had a higher curriculum experience score. In addition, compared with the national students, the international students (mainly including students from Hong Kong and Macao) have a higher curriculum experience score in the dimension of“AAS,” indicating that the international students have a higher evaluation satisfaction with the current online PBL and CBL teaching method of this curriculum. In other words,the international students are more inclined to use the online PBL and CBL teaching method. The CEQ used in this study is a reliable tool to analyze curriculum quality from the perspective of student experience and emphasizes the importance of students as subject of curriculum value and evaluation.[19]This study preliminarily is found that the CEQ is applicable to the online PBL and CBL teaching practice of disaster nursing. In the future, blended online and offline PBL teaching mode organically combines online PBL and CBL curriculums with traditional classes, and has outstanding characteristics in terms of learning environment, curriculum content and teaching organization.[20]First of all, practical online open curriculums should make full use of technologies such as augmented reality and virtual reality to create a situational learning environment.[21]The rapid development of virtual reality technology has been able to provide learners with more similar real experience to real life, and its presentation mode is similar to computer games, which is easy to arouse students’ interest in learning. Secondly, the curriculum tutor can choose the appropriate mixed teaching mode according to the characteristics of the curriculum.[22]After the students finish the independent learning of the online open curriculum, the teacher will guide them to carry out skill training in the traditional classroom, thus achieving good teaching effect through the cooperation of different teaching means. Therefore, the results of this study are helpful for universities and teachers to better carry out mixed PBL and CBL teaching and improve students’ experience and curriculum quality.

CONCLUSIONS

Therefore, under the dual background of the development of new medical science and the impact of sudden disasters,comprehensive utilization of online CBL and PBL teaching method, choose MOOC, Rain Classroom, and QQ group teaching platform as a means of teaching, the revised student CEQ is used to scientifically evaluate the effect of online PBL and CBL method in the learning experience of disaster nursing is a new attempt to construct and reform the education system of disaster nursing. This will improve students’ experience and curriculum quality and guide significance for the realization of offline and online mixed teaching mode in the future.

Financial support and sponsorship

This work was supported in part by the 22ndBatch of Teaching Reform Research Projects of Jinan University (JG2020080),Teaching Quality and Teaching Reform Project of Undergraduate University of Guangdong in China (2017,2020), Undergraduate Training Programs for Innovation and Entrepreneurship of Jinan University in China (no. CX20157,CX20145), Traditional Chinese Medicine Bureau of Guangdong in China (no. 20161065 and 20201075), and National Health and Family Planning Commission of Guangdong in China (no.A2016583, A2017228, A2017140 and A2020137).

Con flicts of interest

There are no conflicts of interest.