The application of problem-based learning in Chinese baccalaureate nursing education.

ONE-WAY COMMUNICATION via classroom lectures is the typical method of teaching nursing in China (Lee, Wong, & Mok, 2004). Students have a passive role, receiving, rather than searching for, information. They are provided little opportunity to experience group collaboration and to define, reflect on, and solve problems within a realistic situation (Cui, Zheng, Ding, Gu, & Sun, 2004). In a rapidly changing, contemporary health care environment, professional nurses need to be able to focus on relevant aspects of various situations, simultaneously solving problems and making decisions in nursing care. Nursing education that helps students integrate the theory and practice of nursing is critical in transforming a nursing student into a professional nurse (Jerlock, Falk, & Severinsson, 2003). In China, baccalaureate nursing graduates are expected to identify the actual and potential health needs of clients, act in a professional and ethical manner when faced with complex situations, demonstrate professional knowledge and skills, and be responsible for their own personal and professional development (Li, Deng, & Chert, 2009). This is a challenge for nurse educators. It is time to reappraise existing educational strategies and explore alternative, adult learning approaches that help students develop advanced skills in self-directed learning, problem solving, decision-making, and critical thinking (Xu, Xu, & Zhang, 2000). Active learning that requires students to assume greater responsibility in their own education is needed. Problem-Based Learning Peer teaching allows students to attain their highest potential in nursing while developing a deep understanding of nursing knowledge (Jerlock et al., 2003). Problem-based learning (PBL) is a form of peer teaching whereby students work cooperatively in small groups to seek solutions to problems (Rideout & Carpio, 2001). Together, students must try to understand the problem, reformulate the problem in such a way that they can explain it to others, and determine what information they need to solve the problem. PBL allows students to make sense of the material in their own way, integrating newly acquired knowledge with prior knowledge and experiences. Students are more active in learning and generally value the opportunity to handle given situations and problems. They also value the comments given to them for their work (Wood, 2004). Application of PBL to nursing education can prepare students to deal with real-life problems while helping them see the ambiguity that often exists. PBL leads to a sound understanding of knowledge and the ability to critique information (Williams, 1999). Successful implementation of PBL entails designing a learning environment that stimulates constructive, self-directed, collaborative, and contextual learning and fosters the ability to work as a member of a group and collaborate effectively with others (Dolmans, Wolfhagen, Vleuten, & Wijnen, 2001). Learning Method The PBL approach was adopted during a one-semester course at a university in Shanghai. Twenty-three second-year baccalaureate nursing students were voluntarily divided into two PBL tutorial groups. Each group consisted of 11 or 12 students and a tutor. Students did small-group work with five learning packages over 36 learning hours, two hours per week for 18 weeks. Each learning package consisted of a core concept map, learning goals, a scenario, and trigger questions. The process unfolded as follows: 1. GROUP CLARIFICATION The students clarified what happened in the scenario, defined the problems, and wrote down unclear terms or concepts. The tutor helped the students think about the scenario, discuss it, and arrive at an understanding. 2. BRAINSTORMING The students applied previous knowledge, as well as their own ideas, to produce possible explanations that allowed them to evaluate the knowledge and skills they needed to deal with the situation. …