NR-505: Advanced Research Methods: Evidence-Based Practice
NR-505: Advanced Research Methods.
NR-505
NR 505
Week 5: Research Literature, Design,
... [Show More] Sampling and Implementation
Chamberlain College of Nursing
NR-505: Advanced Research Methods: Evidence-Based Practice
Research Literature Support
The selected nursing concern that I have chosen is the education of millennial learners in undergraduate nursing to best develop their critical thinking skills. It is well-documented that modern day students are vastly different from those of years past, having grown up with the proliferous use of technology, the Internet, and the ability to instantly access information to answer questions and solve problems (Battersby, 2017; Tai, 2014; Revell & McCurry, 2010). Battersby noted that because of the way in which millennial learners process information, they prefer the addition of certain interactive learning modules into a traditional curriculum to best effectuate their learning (Battersby, 2017, p. 122).
The PICOT question associated with this proposal is as follows: In millennial nursing students (P), how does flipping the classroom (I) versus traditional teaching methods (C) affect the abilities of critical thinking (O) over the course of a nursing school semester (T)?
There have been a number of studies examining the effectiveness of flipping the classroom in the overall educational experience of today’s learners. Missildine, Fountain, Summers & Gosselin (2013) studied the effects of various teaching methods in undergraduate nursing students in Adult Health Nursing classes, measured by exam scores and student satisfaction surveys. This quasi-experimental study used three different teaching methods: a traditional lecture-only approach, traditional lecture supplemented by lecture capture (lectures electronically recorded and made available to students) and a flipped classroom utilizing lecture capture as well as interactive learning opportunities presented during classroom time. Quantitative data was gathered by use of average examination scores and student satisfaction surveys based on a four-point scale.
Missildine, Fountain, Summers & Gosselin (2013) concluded that, as expected, the students who were in the flipped classroom modality scored significantly higher on the examinations that those in the traditional lecture classroom and the traditional classroom supplemented with captured lecture. However, the authors were surprised to discover that the students in the flipped classroom modality were significantly less satisfied with their learning experience than students in the other two groups. A strength of this study was the relatively consistent demographics of the sample over the three-semester research period, and the fairly large sample size, which may increase the probability of generalization to larger populations. A limitation that was noted by the researchers suggested that there were problems with infrastructure such as accessibility of classrooms and internet connections by rural students.
Critz and Knight (2013) used the flipped classroom modality in a pediatric course in a graduate Nurse Practitioner program and studied the students’ responses on a questionnaire following the completion of the class. The purpose of the research was to determine whether the flipped classroom approach would energize and engage the students in a new and meaningful way after dissatisfaction with previous classes that were taught in the traditional format. This quantitative cross-sectional research design collected data by means of an anonymous survey that asked students to rate their experiences using a 5-point Likert scale assigning a value of 1 to “extremely worthwhile” and a value of 5 being “not at all worthwhile” (Critz & Knight, 2013, 211). The results as reported by the authors were that the flipped classroom model was an overwhelming success and student satisfaction was generally very positive. A strength of this study was that there was 100% response rate from students on the online questionnaire, which was entirely voluntary. A limitation of the study was the small size of the study, as well as the fact that there was no comparison between the effectiveness of the flipped classroom and the traditional classroom.
Geist, Larimore, Rawiszer & Al Sager (2015) conducted a study of nursing students enrolled in a Pharmacology II course, one of which was a traditional lecture approach, and the other which was a flipped classroom approach. The purpose of the study was to evaluate the effects of the flipped classroom on knowledge acquisition. The study was a quasi-experimental quantitative design. Data collection was achieved by means of three identical unit tests and a final comprehensive exam. The students in the treatment group (the flipped classroom) also were tested before the class began, and also completed a questionnaire, designed to measure student perceptions, after the class was completed. The results of this study demonstrated that the students in the flipped classroom performed better on the three unit tests, but that there was no significant difference in the test scores on the final comprehensive exam between the two courses. Additionally, the authors suggested that there were reportedly positive responses to the flipped classroom experience. (Geist, Larimore, Rawiszer & Al Sager, 2015)
One limitation of the study was the small scale of the study, and the authors noted that a next step would be to repeat the study on a larger scale in different educational institutions. A strength of the study was that because it provided quantitative evidence that supports the notion of the flipped classroom, it could form the basis for future research into this type of instruction.
Harrington, Vanden Bosch, Schoofs, Beel-Bates and Anderson (2015) compared the learning outcomes of a traditional classroom and a flipped classroom using a first year medical-surgical nursing theory course. This study used an experimental quantitative design and data was collected based upon the results of course grades throughout the course. The results of this study showed no statistically significant differences in the students’ performance on exams between the traditional classroom and the flipped classroom. It did, however, demonstrate that the flipped classroom was an effective means of learning in an undergraduate nursing program. A strength of this study was that it was a randomized experimental study that compared the effectiveness of the two pedagogies. A limitation was that it involved a small sample size and therefore has questionable generalization to a larger population (Harrington et al., 2015)
In a study conducted in 2016, El-Banna, Whitlow & McNelis (2017) sought to evaluate the effectiveness of the flipped classroom in a pharmacology course offered to students in an Accelerated Bachelor of Science in Nursing (ABSN) program. This was a quantitative study utilizing the crossover repeated measure design and involved students in two pharmacology classes. Both started the course using traditional lecture methods for a period of six weeks, after which a baseline exam was given. Thereafter, while one class of students continued with traditional instruction, the other class utilized the flipped classroom approach for a period of three weeks, after which another exam (the first exam) was given. In the third section of the classes, the approaches were reversed for the two classes, and again, after a three-week period, another exam (the second exam) was given. Data collection was achieved by evaluating the scores on the three pharmacology exams, as well as through the use of questionnaires designed to measure student satisfaction based on a scale of one (never satisfied) to five (always satisfied). Finally, students were asked to voluntarily participate in focus groups after the flipped classroom experience.
The results of the study indicated that both the traditional and the flipped classroom approaches prepared the students for success on the pharmacology exams. However, those students who were exposed to the flipped classroom first did perform better on the first exam as opposed to those who continued with the traditional instructional approach. There was no appreciable difference in the scores on the second exam, after the approaches were switched. The student questionnaires indicated that the students were more satisfied with the traditional teaching method than the flipped classroom. The researchers concluded that the flipped classroom may be more effective in advanced classes where students possess a solid foundational knowledge coming into the course and should be utilized judiciously taking into consideration the other courses students may be taking at the same time. They also suggested that the flipped classroom approach should be introduced earlier in the classroom experience so that students were able to become accustomed to that technique and not be disrupted by alternating between different approaches. One strength of the El-Banna, Whitlow & McNelis (2017) study was that the two classes were demographically similar, and the researchers were able to limit the effects of any bias from previous learning experiences. A limitation of the study was the small sample size and the inability to control whether students shared information with each other during the course of the study. Therefore, the ability to generalize to a larger population was compromised. Additionally, as the two approaches were used while teaching different course material, some of which may have been more advanced, the comparison of the two could not be completely reliable (El-Banna, Whitlow & McNelis, 2017).
Hanson (2016) conducted a two-year study of undergraduate nursing students enrolled in a pharmacology course. The aim of the study was to elicit participants’ responses to a flipped classroom approach in the pharmacology class and to evaluate the impact of the flipped classroom on their understanding of drug science and its application to clinical practice. The study was qualitative in nature, consisting of a descriptive research method that used questionnaires as the method of data collection. The study found that the students perceived that the flipped classroom approach “increased their understanding of pharmacology concepts and their application to clinical practice (29%) and promoted deeper and wider thinking (14%)” (Hanson, 2016, p. 83). However, the study also indicated that a significant portion of the students voiced a preference for the traditional lecture teaching method. A strength of the study is that, despite a relatively small sample size, the analysis of the data revealed common themes that appeared throughout the data, perhaps adding to the reliability and credibility of the data. A limitation of the study was the low response rate (13%) despite the fact that the purpose of the study was explained to the students throughout the course. The author noted that this factor could potentially bias the results because those who were motivated to respond to the survey were likely also those who were motivated toward self-learning (Hanson, 2016).
Greenwood and Mosca (2017) also studied the effects of flipped classroom instruction on nursing students in a quasi-experimental design study. The purpose of the study was to evaluate the relationship between a flipped classroom and exam scores in undergraduate baccalaureate nursing students in a medical-surgical class taken during the junior year. One class (spring 2013) received traditional lecture-based instruction, and two classes (fall 2013 and spring 2014) were instructed via the flipped classroom with the use of narrated PowerPoint. Data was collected by examination scores and satisfaction reports. The results of the study indicated that students in the flipped classroom courses tested significantly higher (an average of 8.04 points) than the students in the traditional classroom. However, like the results found in the Missildine, Fountain, Summers & Gosselin (2013) study, student satisfaction with the flipped classroom modality were lower than those in the traditional classroom.
A strength of this study is found in the fact that all students were tested with the same examination and the instructors were all the same. A limitation was noted in that the researchers acknowledged that the course orientation and rationale of the flipped classroom approach was ineffective. Greenwood and Mosca (2017) noted that the continued use of the flipped classroom was justified by the study, but improvement in the explanation of rationale behind the flipped classroom modality would be essential to increase student satisfaction with the new approach (Greenwood & Mosca, 2017)
Saunders, Green and Cross (2017) conducted an exploratory qualitative examination of students’ experiences in a flipped classroom that also utilized simulated learning. The purpose of the study was to determine whether this modality enhanced student learning regarding patient-centered care and better prepared students for introduction into the workplace. Data collection was accomplished by the use of surveys, interviews and focus groups. The results of the study indicated that the flipped education model, enhanced by simulations, resulted in increased student satisfaction scores and was effective both in teaching patient-centered care preparing students for their first professional position. The authors noted that a limitation of the study was due to its small size and the fact that it was conducted at only one educational institution and the results were self-reported. However, they noted that the similarities between the data sets reinforced the credibility and validity of the findings of the study (Saunders, Green & Cross, 2017, p.76).
Green and Schlairet (2017) studied the perceptions of students who experienced the flipped classroom and how that experience affected their learning dispositions. This study utilized a qualitative phenomenological approach, focusing on the characteristics of student learning. The initial purpose of the study was designed to evaluate the flipped classroom modality for inclusion in the curriculum; however, they soon recognized the potential value of the information to a broader nursing education audience. Qualitative data was collected by means of face-to-face interviews with participants inquiring about their experiences with the flipped classroom. The results of the study indicated that half (50%) of the participants reported a negative feeling about the flipped classroom, 14.3% of the participants reported a neutral feeling, while the remaining 35.7% reported a positive feeling about the flipped classroom experience. Students did report that they felt challenged by the new curriculum and noted difficulty in mastering unfamiliar nursing language and discerning what information was important and what information was superfluous in the course (Fundamental Concepts of Nursing). A limitation of the study is the small sample size (14 students), which makes generalization to a larger population less reliable. A strength of the study is that the researchers controlled for the infiltration of possible bias by using objective faculty who were not involved in a flipped classroom environment to conduct the interviews and collect the data (Green & Schlairet, 2017).
Dehghanzadeh and Jafaraghaee (2018) studied a group of Iranian nursing students to determine the effects of the flipped classroom modality on the development of critical thinking skills. This was a quasi-experimental study conducted using 85 subjects who had been randomly assigned to one of two groups, one which received traditional instruction and one of which received a flipped classroom experience. Data was collected by means of a demographic questionnaire and Ricketts' Critical Thinking Disposition Inventory. The students assigned to the flipped classroom were also asked to answer two questions regarding pros and cons of that method of instruction. The results of the study indicated that there was a significant increase in the mean scores measuring critical thinking of the students who were in the flipped classroom. The authors attributed these increases to the fact that the flipped classroom method utilized different, more student-centered activities and educational technologies, and encourages the students to use their knowledge in participatory activities. A strength of the study, according to the authors, was that the students were rotated through different collaborative groups throughout the study, so that they were better able to discuss concepts and work through problems as teams. A limitation noted by the authors was the need for advanced electronic technicians who could produce and monitor the flipped classroom component, as well as the large number of students in both classes (Dehghanzadeh & Jafaraghaee, 2018).
Research Approach and Design
The research approach of my proposed evidence-based practice project will be quantitative, and quasi-experimental in design. The quasi-experimental design is one in which the researchers cannot control for all variables and often, there is no randomization. Gliner and Morgan (2000) described the quasi-experimental research design that I would use as a pretest-posttest quasi-experimental research approach: “In these designs, for example, participants are already in intact groups, such as two different classrooms, prior to the study. Both groups are measured (pretest) prior to the introduction of the independent variable. One group receives the independent variable and the other group does not get the independent variable. At the end of the study, both groups are measured again (posttest)” (Gliner & Morgan, 2000, p. 67). I chose this research approach and design because I could certainly control for some, but not all variables that could affect the outcome of the research. Because I will be working with classrooms of individuals there will likely be no randomization in sampling, which is a feature of quasi-experimental design.
According to Dutra and Reis (2016), an advantage to the quasi-experimental design is found in the ease of application, as the rigid control of all variables that is required of a true experiment is not necessary in the quasi-experimental design. Therefore, the quasi-experimental design is more practical to implement. A disadvantage is that the validity of the results of the quasi-experimental design is somewhat limited, particularly because the researcher cannot control for potential bias. (Dutra & Reis, 2016, p. 2235).
Sampling
The target population for my proposed EBP project is millennial undergraduate nursing students. The sampling method that I would use would be probability sampling, as each student would have the same probability of being assigned to the control group (the traditional learning class) as the intervention group (the flipped classroom). (Aday & Cornelius, 2006, p. 131). The sample size would ideally be between 25 and 30 for each group. The criteria for inclusion in the study would be millennial learners (which I would identify for purposes of the study as being between the ages of 18 and 40) who were enrolled in an undergraduate nursing program, and who were scheduled to receive instruction in a Complete Adult Health course. Participants would be excluded if they had unsuccessfully taken the Complete Adult Health course in the past or if they fell outside the requisite age range. They would also be excluded if they had participated in a flipped classroom experience in the past. The type of probability sampling that I believe that I would use would be systematic sampling. An advantage of systematic probability sampling is that it is highly precise and the data collected from the sample is generally easy to analyze. A disadvantage of this type of sampling is that it may not be efficient and may introduce bias into the data. (Aday & Cornelius, 2006, p. 135).
Fouka & Mantzorou (2018) noted that informed consent is essential in research in order to protect individuals’ autonomy. Of equal importance is the need to protect the confidentiality and anonymity of the participants and ensure that no harm comes to the participants. (Fouka & Mantzorou, 2018). In my proposed EBP project, the identity of the participants would be known to the instructors of the traditional and the flipped classroom, but the data collection would not identify the participants. The Complete Adult Health Course is certainly a required course in an undergraduate nursing program; however, I would ensure that each student participating in the study would be fully informed about the nature of the study and asked to sign a “noncoercive disclaimer” indicating that their participation in the study was completely voluntary. I would also work with the educational institution to ensure that any individual wishing to opt out of the study would be permitted to do so without penalty and permitted to participate in the Complete Adult Health course at a later date. This project would not involve any foreseeable risk of harm to any participants, but I would insist that full disclosure as to the nature of the study be conveyed to the participants prior to obtaining their informed consent to avoid any malfeasance. (Fouka & Mantzorou, 2018). Data collection in the form of exam scores would be done in such a way that would preserve the participants’ anonymity, particularly regarding the surveys at the conclusion of the class that would measure student satisfaction with the flipped classroom experience. Analysis of the data would be accomplished by assigning each student a numerical identifier so that names and other personal information would never be disclosed.
Proposed Implementation with a Change Model
The PDSA Change Model is a model for learning and change management. (Donnelly & Kirk, 2015). PDSA stands for “Plan, Do, Study Act,” a four-part model for arriving at solutions to problems. The PDSA Change Model is an instructive method for developing and implementing a plan of study or other research. In fact, Coury, Schneider, Rivelli, Petrick, Seibel, D’Agostini, … and Coronado (2017) noted that “the PDSA cycle may prove useful in adapting and implementing research-based interventions, particularly where its incorporation into every-day care is a central question.” (Coury et al., 2017, p. 2). Because the transition to the flipped classroom is a change to the traditional educational program found in most nursing programs, I believe the PDSA change model will be instructional in developing the intervention for my EBP project. In addition to its ease of use, the PSDA model is something with which many institutions are already familiar, so I would think that implementing the change on a large scale after completion of the project would be more readily accepted.
Applying the PDSA Change Model to my proposed EBP project, the first step would be to PLAN the intervention by ascertaining its aim or purpose by identifying the problem that is believed to exist (Donnelly & Kirk, 2015). My EBP project is premised on the notion that millennial students learn in a different manner than do their predecessors. As millennial students currently comprise the majority of undergraduate nursing students today, it would be logical that a change in curriculum from a traditional lecture-based format to a flipped classroom, as supplemented by simulation labs, would result in enhanced learning and improved development of critical thinking skills.
The second step is DO, where the intervention will actually be implemented. (Donnelly & Kirk, 2015). In my proposed EBP project, a flipped classroom version of the Complete Adult Health Care course would be developed and would be run simultaneously with a traditional lecture-based version of the same class. Throughout the pendency of the class, identical exams would be given to students in both classes to evaluate mastery of the materials. Additionally, students in both classes would be evaluated through the use of hands-on simulations to test the critical thinking skills developed in both classes. Finally, students in the flipped classroom would be asked to participate in a voluntary survey designed to determine student satisfaction with the flipped classroom modality.
The third step, STUDY, will analyze the data collected to determine whether the outcome of the intervention (the flipped classroom) was as anticipated. If there were problems noted in the application of the intervention, it is in this step that they will be identified. (Donnelly & Kirk, 2015). The various aspects of the flipped classroom would be evaluated to determine how future applications of the flipped classroom can be replicated or modified to best achieve the outcome that is desired. The two data sets that will be particularly relevant will be the comparison of the exam scores and the performance on the simulations, and the student satisfaction scores measuring the students’ experiences and perception of the flipped classroom.
The final component of the PDSA Change Model is ACT. Here, I would use the results of the data analysis to further refine the flipped classroom curriculum to achieve the goal of improving the nursing education experience for millennial learners so that nurses entering the workforce have the critical thinking skills necessary to effectuate patient care and safety. (Donnelly & Kirk, 2015).
One foreseeable barrier to the use of the EBP results from this project would be reluctance on the part of the educational institutions to move to a flipped classroom curriculum because of the amount of self-centered independent student work that is integral to this modality. One solution to this problem would be to develop and make online webinars and tutorials available to the students that could be accessed on demand, as many times as desired by the individual students. Because my future practice setting will focus on nurse education, it is my hope that any educational institution in which I would work would recognize the importance of evidence based practice and the need for all nursing students to be trained in the principles of evidence based practice. By illustrating how the development of the flipped classroom and the need to improve the critical thinking skills of undergraduate nursing students are both founded on solid notions of evidence based practice, I would hope to help foster an environment which supports the need for evidence based practice in nurse education as well as clinical practice.
References
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Sin, M. and Bliquez, R. (2017). Original article: Teaching evidence based practice to undergraduate nursing students. Journal of Professional Nursing, 33. 447-451. doi:10.1016/j.profnurs.2017.06.003. Retrieved from: https://www-sciencedirect-com.chamberlainuniversity.idm.oclc.org/science/article/pii/S8755722316301077?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb
Tai, W.A. (2014). Millennial learners. Stanford University Teaching Commons. Retrieved from: https://teachingcommons.stanford.edu/teaching-talk/millennial-learners [Show Less]