| BackgroundEmergency and Critical Nursing, which is based on the modern medicine and nursing professional theory, is to save lives, improve the successful rate of rescue and improve the quality of life, and it is a comprehensive applied science researching first-aid and special care of emergency and critical patients. At present, emergency care education is generally facing the contradiction between large teaching contents and limited teaching resources and little teaching hours. Nursing students entering the job can not apply their mastered knowledge and skills of first-aid to clinical practice, lack the awareness and capacity of active learning, critical thinking and creative awareness. The team-based learning (TBL) is officially proposed by Michaelsen LK of the Oklahoma University in the late1970s. TBL is a new adult teaching model which is helpful for promoting teamwork spirit of learners, focusing on human creativity, flexibility, and practical characteristics, and it transfers teachers from leaders to instructors and participants, and changes students’ passive learning to active learning. A team is composed of5to7persons, focusing on heterogeneity within a group, homogeneity between groups. Such teams compose big groups with dozens or even hundreds of people, in which teachers determine the teaching contents and the key points for students to read and prepare in advance and classroom teaching time is used for individual readiness assessment tests (iRAT)、team readiness assessment tests (tRAT)、application-focused activity and feedback. In the United States, Canada and other developed countries, TBL has been widely accepted and adopted, and Chinese TBL is at the preliminary stage, with a small number of scholars using it in nursing education. Studies have shown that TBL has some incomparable superiorities than problem-based learning(PBL), and avoids unsystematic knowledge, group irrationality, evaluation imperfections and other defects of PBL. TBL is a guiding teaching method to promote active learning, focusing on the understanding and application of theoretical knowledge, promote teamwork, improve teaching effectiveness, but there is no report on the learning effect of nursing first-aid skills of TBL in domestic and foreign literatures, and no quantitative evaluation of critical thinking skills and independent learning ability, thus, TBL teaching effectiveness needs further trials for definitude. Course feedback of Emergency and Critical Nursing demonstrates that there are much more teaching contents in our college, and students can not immediately grasp the relevant concepts and skills. However, the course requires students not only to acquire the relevant concepts, but also to have a strong sense of first-aid and have the ability to treat the acute and critical patients preliminarily. It can clearly be seen that the curriculum reform is inevitable. Therefore, this study is to apply TBL in the Emergency and Critical Nursing course of vocational nursing students, to verify effectiveness of TBL, especially its’impact on nursing students’practical skills, critical thinking ability and independent learning ability, understand TBL deeply from nursing students’point of view and provide basis for the nursing education reform in the future.PurposeTo compare the application effects of TBL and LBL in the teaching of Emergency and Critical Nursing among vocational nursing students, and study the students’evaluation feedback on TBL.MethodUse pilot-study. Class9with52nursing students and class10with50nursing students in grade2009in Ningbo College of Health Sciences were selected as subjects through cluster sampling, and they were drawn lots to divide into intervention group(class9) and control group (class10). Informed consent was obtained and baseline measurements was carried out before intervention, including the general information of the two groups, enrollment score, score of relevant basic courses, critical thinking ability and independent learning ability. In the18-week teaching period of Emergency and Critical Nursing, teachers used TBL pedagogy in the intervention group, and took LBL pedagogy in the control group. Feedback was collected from the intervention group on TBL at the end of the4th week. At the end of teaching, researchers took theory test, skills assessment and scenario simulation assessment on the two groups, collected evaluation and feedback of the two groups on the Emergency and Critical Care course, and again applied the Chinese version of critical thinking ability measurement scale(CTDI-CV) and nursing students’ self-directed learning ability measurement on the two groups, and took semi-structured interviews on teachers to study class performance of the two groups at the same time.Results1.BaselineThere was no significant difference(P>0.05)between the two groups in general information, admission grades, grades of the related basic courses, critical thinking skills and self-directed learning ability.2. After the Intervention(1)Comparison of students’achievement In the end of intervention,scores of the intervention group in both of theory examination and the discussion question were higher than those of the control group, the differences were statistically significant (P <0.05), and there was no significant difference (P>0.05) between the two groups in scores of the multiple-choice questions, filling in the blank questions, glossary and short answers. The practical skills assessment of the intervention group was better than that of the control group, the difference was statistically significant (P<0.05).(2) Comparison of the self-directed learning ability①The indexes and total scores of the intervention group’s self-directed learning ability were higher than those of the control group and the differences were statistically significant(P<0.05).②Self-directed learning ability score of the intervention group after TBL Teaching was higher than that before the intervention (P<0.01); There was no significant difference (P>0.05) in the learning motivation score, while the differences were statistically significant in scores of the planning and implementation, self-monitoring and interpersonal communication before and after the intervention(P<0.01).③Self-directed learning ability score of the control group after LBL teaching was higher than that before (P<0.01); The study of each dimension showed that there was no significant difference (P>0.05) in the learning motivation score, while the differences were statistically significant in scores of the planning and implementation, self-monitoring and interpersonal communication before and after the intervention(P<0.05).(3) Comparison of critical thinking ability①CTDI-CV total score of the intervention group was higher than that of the control group (P<0.01)); there were significant differences between the two groups in scores of all dimensions (P<0.05) but’seeking the truth’and’cognitive maturity’(P>0.05).②CTDI-CV total score of the intervention group after the TBL intervention was higher than that before (P<0.01)); The study of each dimension showed that systematic ability score was found to be improved, but there was no significant difference (P>0.05), scores of other dimensions were higher than those before the intervention (P<0.05).③CTDI-CV total score of the control group after the LBL teaching was higher than that before (P<0.01)); The study of each dimension showed that there were significant differences in scores of all dimensions (P<0.05) but"systematic ability" and "cognitive maturity"(P>0.05).(4) Results of the course feedback①The intervention group wrote feedback on TBL Teaching at the end of the4th week. The results showed that nursing students generally agreed with TBL model which could optimize the teaching and improve teaching effectiveness. But there are also some questions such as learning pressure, key points uncertainty, the evaluation system unreasonable and group discussion inconvenience.②After the intervention, the two groups filled in the evaluation form of Emergency and Critical Care Course feedback. The results showed that scores of the intervention group were higher than those of the control group (P<0.05)in the course contents, teachers’ factors, assessment evaluation and the total evaluation, while there was no significant difference between the two groups in teaching methods, students’factors and overall satisfaction score (P>0.05). The open-ended questions of nursing students showed that they generally thought that the learning process of the "novel-treason (pressure)- accept-like-fortunate-gratitude" had improved their overall quality, helped them truly understand the meaning of team.(5)Teacher-InterviewsTeachers generally agreed with and supported TBL mode. The feedback showed that the control group was worse than the intervention group in the preview initiative, the level of activity of the classroom atmosphere and the discussions with teachers after school. The TBL model can maintain the teachers’enthusiasm and motivation.ConclusionCompared with LBL, TBL is able to play the effectiveness of teamwork, enhance teacher-student interaction and interaction between students and improve the effectiveness of learning. This pedagogy not only focuses on the learning of theoretical knowledge, but also can promote the clinical application of first-aid skills, improve nursing students’self-learning ability and critical thinking ability, change the learning attitude of nursing students and improve the teachers’professional level. |
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