The Effectiveness of Blended and Problem-based Learning to Improve the Competence of Geriatric Nursing Students

Study Overview
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Brief Summary
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Medical ecology is a highly uncertain and high-pressure environment. Nurses must use their thinking to make critical judgments and decisions in a short time. Since the outbreak of the Covid-19 epidemic, many universities have produced a lot of innovative inf teaching styles. With the reduction of budget and the evaluation of teaching quality, the blended learning model is gradually being valued by educators. The aims of this study are to establish a teaching model that applies blended learning and problem-oriented teaching, and to explore the association and effectiveness of critical thinking and ethical competence of research subjects after this intervention in which shortens the gap in learning and practicing for increasing clinical nursing capabilities.

Detailed Description
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Medical ecology is a highly uncertain and high-pressure environment. Nurses must use their thinking to make critical judgments and decisions in a short time. Since the outbreak of the Covid-19 epidemic, many universities have produced a lot of innovative inf teaching styles. With the reduction of budget and the evaluation of teaching quality, the blended learning model is gradually being valued by educators. The aims of this study are to establish a teaching model that applies blended learning and problem-oriented teaching, and to explore the association and effectiveness of critical thinking and ethical competence of research subjects after this intervention in which shortens the gap in learning and practicing for increasing clinical nursing capabilities. After the implementation of this protocol, the participants would increase the critical thinking and ethical competence of nursing students in geriatric nursing. Also, the teacher can self-review the teaching effect and analyze the actual situation of the students in the construction of ethical competency as a teaching reference to improve or revise teaching strategies.

Official Title
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The Effectiveness of Blended and Problem-based Learning to Improve the Geriatric Nursing of Critical Thinking and Ethical Competence Among Nursing Students

Conditions
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Narrative Ethics

Intervention / Treatment
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* Other: The protocol of blended and problem-based learning
* Other: The traditional problem-oriented teaching model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The research object of this project will be the students in the nursing class of a university (third year students), and the students who have taken 2 credits each of  Profession and Ethicsin two working class. Exclusion Criteria: Students that have selected  Profession and Ethics but do not wish to participate in this study

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The protocol of blended and problem-based learning<br>The experimental group will accept the protocol of blended and problem-based learning in the professional ethics course, 2 hours /per week, for 18 weeks | Other: The protocol of blended and problem-based learning<br>* The protocol of blended and problem-based learnin: The online platforms used in this research are the school's iLMS platform, online digital learning, and online opinion exchange platform. It will use online resources (Google, open educational resources, YouTube copyrighted medical micro-movies, and audio-visual materials), and the theme will be elderly care or emerging Multimedia resources on infectious themes, as well as real-time interaction with kahoot or Slido electronic whiteboards, will be uploaded to the office3655The One website. Drive is provided by the school (the school account is used to store course resources) and the system of digital theoretical course concepts in advance. Broadcasting, video (such as: values and conflicts; ethics and morality; patient rights and responsibilities; nurses' rights and responsibilities; ethical theory; basic ethical principles; ethical dilemmas and ethical decision-making; etc.), pre-recorded and stored on the Internet Road platform iLMS.<br>* Other names: The experimental group will accept the protocol of blended and problem-based learning in the professional ethics course, 2 hours /per week, for 18 weeks;|
| Active Comparator: The traditional problem-oriented teaching model<br>The control group will accept the traditional problem-oriented teaching model in the professional ethics course, 2 hours /per week, for 18 weeks | Other: The traditional problem-oriented teaching model<br>* The traditional problem-oriented teaching model: There will be two PBL case introductions throughout the semester, with face-to-face teaching in physical classrooms.<br>* Other names: The control group will accept the traditional problem-oriented teaching model in the professional ethics course, 2 hours /per week, for 18 weeks;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Critical Thinking Disposition Inventory(CTDI-CV) | This scale is a scale commonly used in education to evaluate critical thinking assessments. There are 18 items in total. The overall internal consistency and retest stability coefficient both exceed 0.8. It has good reliability and validity. The total score ranges from 18 to 108, with higher scores indicating greater critical thinking ability. | Baseline (T0) | 
| Moral distress scale | This scale is the earliest measurement tool developed in the United States. It can effectively quantify the degree of moral distress generated by nurses when performing care activities. There are 11 questions in total. It can be used to simultaneously measure the frequency of incidents of moral and ethical distress during work and the range of scores. On a scale of 1 (never) to 5 (always), it is also possible to further assess the density of subjects faced with ethically distressing events, with scores ranging from 1 (never) to 5 (many), and when the two are multiplied, which is expressed as the degree of moral and ethical distress. The lower the score, the lower the moral and ethical distress experienced by the nurse in the experience of clinical practice, but the higher the score, the more painful the feelings caused by the moral and ethical distress. higher. | Baseline (T0) | 
| Nurses' Moral Courage Scale，NMCS | This scale is mainly used to measure the moral courage of clinical nurses' self-assessment. The scale consists of four dimensions and 21 items. They were: ethics (7 items), commitment to good patient care (5 items), compassion and genuine presence with patients (5 items), and ethical responsibility (4 items). Using the Likert 5-point scoring method, completely disagrees with me is 1 point, somewhat disagrees with me is 2 points, somewhat agrees with me is 3 points, somewhat agrees with me is 4 points, and meets me is 5 points. Completely agree is 5 points, and the total scale is 21 to 105 points. The higher the score, the greater the moral courage of the nurse. | Baseline (T0) | 
| The Critical Thinking Disposition Inventory(CTDI-CV) | This scale is a scale commonly used in education to evaluate critical thinking assessments. There are 18 items in total. The overall internal consistency and retest stability coefficient both exceed 0.8. It has good reliability and validity. The total score ranges from 18 to 108, with higher scores indicating greater critical thinking ability. | eighteen weeks after intervention(T1) | 
| Moral distress scale | This scale is the earliest measurement tool developed in the United States. It can effectively quantify the degree of moral distress generated by nurses when performing care activities. There are 11 questions in total. It can be used to simultaneously measure the frequency of incidents of moral and ethical distress during work and the range of scores. On a scale of 1 (never) to 5 (always), it is also possible to further assess the density of subjects faced with ethically distressing events, with scores ranging from 1 (never) to 5 (many), and when the two are multiplied, which is expressed as the degree of moral and ethical distress. The lower the score, the lower the moral and ethical distress experienced by the nurse in the experience of clinical practice, but the higher the score, the more painful the feelings caused by the moral and ethical distress. higher. | eighteen weeks after intervention(T1) | 
| Nurses' Moral Courage Scale，NMCS | This scale is mainly used to measure the moral courage of clinical nurses' self-assessment. The scale consists of four dimensions and 21 items. They were: ethics (7 items), commitment to good patient care (5 items), compassion and genuine presence with patients (5 items), and ethical responsibility (4 items). Using the Likert 5-point scoring method, completely disagrees with me is 1 point, somewhat disagrees with me is 2 points, somewhat agrees with me is 3 points, somewhat agrees with me is 4 points, and meets me is 5 points. Completely agree is 5 points, and the total scale is 21 to 105 points. The higher the score, the greater the moral courage of the nurse. | eighteen weeks after intervention(T1) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nursing students, blended model, problem-based learning, critical thinking, ethical competence