Byeongju Lee; Seon Young Hwang

doi:10.4069/kjwhn.2016.22.4.221

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Lee and Hwang: Class Experience of the Students on 『Pregnancy, Delivery and Puerperium』 Nursing Course through Flipped Learning: Mixed Method Research

Original Article

Korean Journal of Women Health Nursing 2016; 22(4): 221-232.

Published online: 27 December 2016

DOI: https://doi.org/10.4069/kjwhn.2016.22.4.221

Class Experience of the Students on 『Pregnancy, Delivery and Puerperium』 Nursing Course through Flipped Learning: Mixed Method Research

Byeongju Lee¹, Seon Young Hwang²

¹Department of Nursing Science, Andong Science College · Graduate School of Hanyang University, Andong, Korea.

²College of Nursing, Hanyang University, Seoul, Korea.

Corresponding author: Hwang, Seon Young. College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2220-0702, Fax: +82-2-2295-2074, seon9772@hanyang.ac.kr

Received 8 August 2016 Revised 12 October 2016 Accepted 25 October 2016

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the applicability of a flipped learning course in Women's Health Nursing for nursing students.

Methods

A total of 200 senior nursing students participated in flipped learning class of pregnancy, delivery and postpartum area, which included team-based learning and self-reflection for 8 weeks. One group pre-post test design was adopted and the changes in learning motivation and satisfaction were examined. In addition, reflective journals of the students were analyzed by making a qualitative content analysis.

Results

Students showed a significant increase in score of learning motivation in the posttest (t=-4.47, p<.001). They had a mean of 3.90 in learning satisfaction out of possible five points. As a result of content analysis, three themes were selected: ‘Improved attitude toward active learning’, ‘Burden caused by excessive workload’, and ‘Valuing to the team-based activity’ To be specific, six sub-themes were selected, with three positive and three negative categories: ‘improved class attention and understanding’, ‘positive class participation by preparing lessons in advance’, ‘peer interactions through discussion’, ‘A lot of time and effort consuming’, ‘stress caused by the burden of preparing lessons’, and ‘difficulties in cooperative activities’.

Conclusion

This study supports and confirms that the flipped learning can be a creative instructional model of positive teaching-learning strategy in clinical nursing courses to enhance students' learning motivation.

Keywords: Flipped learning, Nursing students, Motivation, Satisfaction

Figures and Tables

Table 1

Flipped-Learning Class Composition of ‘Pregnancy, Childbirth and Puerperium Nursing’

Stage	Instruction	Evaluation
Preinstructional activity ＜prerequisite learning＞	•Study with the printed materials posted on the blog or instructional materials stored in the MP3	•Prerequisite quiz •Case-type assignment
Instructional activities ＜team learning＞	•Team-based learning - The learners engage in a self-directed learning by discussing what they are learning, by asking questions, by getting feedback from the instructor and by referring to the core of the instructor's lecture. •Individual learning - The instructor asks oral questions and the learners send their answers via the smart app. The instructor checks their answers to find out whether they learned well or not and then gives a lecture. - Giving a lecture after making a quiz evaluation	•Self-management checklist (scoring oneself out of possible 10 points) - Class attitude - Degree of memory - Degree of attention •Problem-solving scenario •Questioning by the evaluator (using the smart app) •Quiz
Postinstructional activity ＜Keeping a reflective journal＞	•Keeping a reflective journal and sharing it on the blog.	•Journal - Presenting the selected learning objectives - Writing a solution for the given conflicting situation that the learners find during team-based learning - Writing how they felt while they had discussions and tried to solve the given problem. - Writing how they felt after they learned

Week	Learning topic	Instruction	Evaluation
1st~2nd	Orientation prerequisite subject arrangement	Element of childbirth Physiology of childbirth	Orientation prerequisite subject arrangement
3rd~4th	Childbirth nursing	Evaluation of the development process in each phase of delivery.	1) Team learning (discussion): solving the quiz 2) Instructor lecture
5th~6th	Postpartum bleeding	Nursing intervention proper for postpartum bleeding	1) Team learning (discussion): case-type debriefing 2) Feedback and the core of the lecture
7th	Half-time assessment
8th~9th	Maternity nursing	Nursing intervention of helping the physiological adaptation by body organ	1) Quiz (oral questions) 2) Instructor lecture
10th~11th	Postnatal infection	Kinds of postnatal infection, Intervention into postnatal infection	1) Team learning (discussion): case-type debriefing 2) Feedback and the core of the lecture
12th~13th	Hemorrhagic complication during pregnancy	Hemorrhagic disease in the first and second part of pregnancy Nursing intervention	1) Quiz (oral questions) 2) Instructor lecture
14th	Postpartum complications	Quiz evaluation related to prior quiz Other postpartum complications	1) Quiz test 2) Instructor lecture
15th	Final evaluation

Table 2

Differences in Learning Motivation Before and After Applying the Flipped Learning Method (N=200)

Variables	Before	After	Range	t	p
Variables	M±SD	M±SD	Range	t	p
Learning motivation	3.52±0.40	3.70±0.42	25~125	−4.67	<.001
Attention	3.39±0.51	3.64±0.55	8~40	−4.67	<.001
Relevance	3.75±0.50	3.92±0.50	9~45	−3.64	<.001
Self-confidence	3.38±0.40	3.52±0.35	8~40	−3.51	<.001

Table 3

Levels of Learning Satisfaction following the Flipped Learning (N=200)

Variables (number of question)	M±SD	Range	Skewness	Kurtosis
Learning satisfaction level (20)	3.90±0.63	20~100	−1.19	6.86
Learner attitude (1)	4.18±0.77	1~5	−1.44	4.78
Learner satisfaction (3)	3.52±0.91	3~15	−0.12	−0.57
Suitability for the learning contents (4)	4.16±0.61	4~20	−0.72	2.52
Learning achievement (6)	3.97±0.59	6~30	−0.10	0.75
Adequacy of the learning evaluation (6)	3.87±0.69	6~30	−0.08	−0.51

Table 4

Learners' Experience of a Flipped-Learning Class

Theme cluster	Sub-themes	Meaningful statements
Improved attitude toward active learning	Improved class attention and understanding	• I definitely better understood what I learned in class as I prepared my lessons, and it's good not to forget it soon. • I could find out what's hard to understand because I did prerequisite learning, and that made me more alert in class.
Improved attitude toward active learning	Preparing lessons and subsequent positive class participation	• I could be more active in class as I prepared my lessons. • I was motivated well thanks to prior learning, and that stimulated me to study on my own. • The kind of environment that encouraged class preparations was helpful for me to prepare for the exam.
Burden caused by excessive workload	A lot of time and effort consuming	• It was quite time-consuming and difficult to study what I haven't learned yet. • It took a lot of time and effort. • There was much to be desired such as a shortage of time ecause it was the frist time for me to learn in group. • I couldn't pay attention to details due to time constraints as he class moved toward its end.
Burden caused by excessive workload	Stress caused by pressure for class preparations	• I think flipped learning is good, and it seems better to start doing it in the first or second year instead of confining it to the senior year only. • It wasn't helpful in the week when I had to do lots of assignments from my major courses because I couldn't prepare in advance. • I didn't know what's important, and it was hard to prepare it all. It was hard.
Valuing team-based activity	Peer interaction through discussions	• I could better realize what I was wrong while I talked with my team. • There was something I could4't understand, and that gave me a hard time, but it seemed a little easier to solve it when I discussed and worked hard on it with my group members. • It seemed helpful to foster critical thinking when we checked each other's assignments and discussed and looked up a rationale in books together.
Valuing team-based activity	Difficulties in cooperative activities	• It rather affected negatively when there was someone who was totally indifferent to the group activities. • It's likely not to gain the right knowledge if someone talks something unrelated to the theme or if every group member got poor grades. • It was awkward when I wasn't close to my team members or when they didn't participate a lot.

Summary Statement

▪ What is already known about this topic?

Flipped learning is a method when learners acquire knowledge by engaging in learning activities in class, for example, team activity that utilizes instructional strategies provided by their teachers in advance.

▪ What this paper adds?

This study aimed at developing a clinical case about a particular problem situation to help learners who have to take a course in women's health nursing. Students took team-based flipped learning classes had increased scores in their learning motivation and learning satisfaction.

▪ Implications for practice, education and/or policy

As nursing education is directly associated with post-graduation nursing skills, nursing education should apply the kind of teaching methods that can help nursing students to accurately grasp diverse and complicated scenarios that creatively respond to foster superb decision-making and problem-solving skills.

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