Development and Testing of a Mastery Learning Program of Nursing Skills for Undergraduate Nursing Students

SoMi Park; Hea Kung Hur; Ki Kyong Kim; Hee-Young Song

doi:10.4040/jkan.2017.47.4.526

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Park, Hur, Kim, and Song: Development and Testing of a Mastery Learning Program of Nursing Skills for Undergraduate Nursing Students

Original Article

J Korean Acad Nurs 2017;47(4):526-539.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.4.526

Development and Testing of a Mastery Learning Program of Nursing Skills for Undergraduate Nursing Students

SoMi Park, Hea Kung Hur, Ki Kyong Kim, Hee-Young Song

Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea

Address reprint requests to : Song, Hee-Young Department of Nursing, Wonju College of Medicine, Yonsei University, 20 IlSan-ro, Wonju 26426, Korea Tel: +82-33-741-0381 Fax: +82-33-743-9490 E-mail: songhy@yonsei.ac.kr

Received 10 March 2017 Revised 20 July 2017 Accepted 21 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was undertaken to develop and test a mastery learning program of nursing skills for undergraduate nursing students.

Methods

In this methodological study, first, the preliminary draft of a mastery learning program to provide training for nursing skills was developed based on Bloom's framework for mastery learning. Second, to test the developed program, a single-blinded, nonequivalent control group non-synchronized study was conducted on 50 senior nursing students in a University selected by convenient sampling. Thirteen students were assigned to a control group; 13, 12, and 13 of them were assigned to intravenous therapy, transfusion, and patient transfer groups, respectively. The achievement levels and performance scores of the selected nursing skills were measured before and after the completion of the program in all the groups. Lastly, the final program was confirmed based on the results of the program testing.

Results

Intravenous therapy, transfusion, and patient transfer were selected as essential nursing skills for the program based on the priorities rated by clinical instructors and staff nurses. The achievement levels of selected nursing skills were determined by Angoff scores. After participating in the program, the proportion of passers and performance scores of the nursing skills in the experimental groups were significantly higher than those in the control group. The final program was confirmed which included a diagnostic test, enrichment activities for the passers and three repetitions of corrective activities and formative assessments for non-passers.

Conclusion

The results suggest that a mastery learning program for undergraduate students can lead to better improvement and performance of essential nursing skills.

Keywords: Program development, Learning, Nursing student

References

1. Jung HJ. The development and effects of nursing simulation program based on the mastery learning model and peer feedback debriefing methods. Journal of Learner-Centered Curriculum and Instruction. 2016; 16(10):29–57. http://dx.doi.org/10.22251/jlcci.2016.16.10.29.

2. Sin KM, Kwon JO, Kim EY. Factors associated with new graduate nurses’ reality shock. Journal of Korean Academy of Nursing Administration. 2014; 20(3):292–301. http://dx.doi.org/10.11111/jkana.2014.20.3.292.

3. Korean Accreditation Board of Nursing. Essential nursing skills for accreditation [Internet]. Seoul: Author;2012. [cited 2016 December 05]. Available from:. http://www.kabone.or.kr/HyAdmin/upload/goodFile/120130201102332.pdf.

4. Chae YJ, Ha YM. Effectiveness of education program for core fundamental nursing skills using recording video with smart-phone and formative feedback. Journal of Digital Convergence. 2016; 14(6):285–294. http://dx.doi.org/10.14400/JDC.2016.14.6.285.

5. Blum CA, Borglund S, Parcells D. High-fidelity nursing simulation: Impact on student self-confidence and clinical competence. International Journal of Nursing Education Scholarship. 2010; 7:Article 18. http://dx.doi.org/10.2202/1548-923x.2035.

6. Guskey TR. Closing achievement gaps: Revisiting Benjamin S. Bloom’s “Learning for mastery”. Journal of Advanced Academics. 2007; 19(1):8–31. http://dx.doi.org/10.4219/jaa-2007-704.

7. Kim JW. The separate and combined effect size of the enhanced prerequisite learning, the use of organizers and the feedback-corrective procedures of mastery learning. The Journal of Educational Research. 1994; 32(5):235–253.

8. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Academic Medicine. 2011; 86(11):e8–e9. http://dx.doi.org/10.1097/ACM.0b013e3182308d37.

9. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Fein-glass J, et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. Journal of General Internal Medicine. 2006; 21(3):251–256. http://dx.doi.org/10.1111/j.1525-1497.2006.00341.x.

10. Wayne DB, Barsuk JH, O’Leary KJ, Fudala MJ, McGaghie WC. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. Journal of Hospital Medicine. 2008; 3(1):48–54. http://dx.doi.org/10.1002/jhm.268.

11. Barsuk JH, Cohen ER, Vozenilek JA, O’Connor LM, McGaghie WC, Wayne DB. Simulation-based education with mastery learning improves paracentesis skills. Journal of Graduate Medical Education. 2012; 4(1):23–27. http://dx.doi.org/10.4300/jgme-d-11-00161.1.

12. Barsuk JH, Cohen ER, Mikolajczak A, Seburn S, Slade M, Wayne DB. Simulation-based mastery learning improves central line maintenance skills of ICU nurses. The Journal of Nursing Administration. 2015; 45(10):511–517. http://dx.doi.org/10.1097/nna.0000000000000243.

13. McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Medical Education. 2014; 48(4):375–385. http://dx.doi.org/10.1111/medu.12391.

14. Kwon EO, Shim MY, Choi EH, Lim SH, Han KM, Lee EJ, et al. The effects of an advanced cardiac life support simulation training based on the mastery learning model. Journal of Korean Clinical Nursing Research. 2012; 18(1):126–135.

15. Kim BH, Chang SJ, Choi JS. The development and evaluation of a clinical practice nursing students’icrobiology program based on the mastery learning model. Journal of Korean Biological Nursing Science. 2013; 15(2):90–98. http://dx.doi.org/10.7586/jkbns.2013.15.2.90.

16. Bloom BS. Mastery learning. Block JH, editor. Mastery learning: Theory and practice. New York, NY: Holt, Rinehart, and Winston;1971. p. 47–63.

17. Cusimano MD. Standard setting in medical education. Academic Medicine. 1996; 71(10 Suppl):S112–S120.

18. Downing SM, Tekian A, Yudkowsky R. Procedures for establishing defensible absolute passing scores on performance examinations in health professions education. Teaching and Learning in Medicine. 2006; 18(1):50–57. http://dx.doi.org/10.1207/s15328015tlm1801_11.

19. Griswold-Theodorson S, Ponnuru S, Dong C, Szyld D, Reed T, McGaghie WC. Beyond the simulation laboratory: A realist synthesis review of clinical outcomes of simulation-based mastery learning. Academic Medicine. 2015; 90(11):1553–1560. http://dx.doi.org/10.1097/acm.0000000000000938.

20. Polit DF, Beck CT. The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing and Health. 2006; 29(5):489–497. http://dx.doi.org/10.1002/nur.20147.

21. Lee EO, Lim NY, Park HA, Lee IS, Kim JI, Bae J, et al. Nursing research and statistics. Paju: Soomoonsa;2009.

22. Tang WE, Dong L. Applying mastery learning in a clinical skills training program for primary care nurses. Journal of Continuing Education in Nursing. 2013; 44(12):535–541. http://dx.doi.org/10.3928/00220124-20131015-13.

23. Durham CF, Alden KR. Enhancing patient safety in nursing education through patient simulation. Hughes RG, editor. Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008. p. 1364–1403.

24. Shin SJ. A study on the implementation of clinical performance examination for nurses. National Health Personnel Licensing Examination Board. Proceedings of the public hearing on national certification examination for registered nurse. Seoul: National Health Personnel Licensing Examination Board of the Republic of Korea;2014. p. 37–67.

25. Cook DA, Brydges R, Zendejas B, Hamstra SJ, Hatala R. Mastery learning for health professionals using technology-enhanced simulation: A systematic review and meta-analysis. Academic Medicine. 2013; 88(8):1178–1186. http://dx.doi.org/10.1097/ACM.0b013e31829a365d.

26. Cason ML, Gilbert GE, Schmoll HH, Dolinar SM, Anderson J, Nickles BM, et al. Cooperative learning using simulation to achieve mastery of nasogastric tube insertion. The Journal of Nursing Education. 2015; 54(3 Suppl):S47–S51. http://dx.doi.org/10.3928/01484834-20150218-09.

27. Hunter T. Mastery learning in nursing education. The Oklahoma Nurse. 2012; 57(3):11.

Figure 1.

Process of mastery learning.

Table 1.

Angoff Scores on the Intravenous Therapy, Transfusion, and Patient Transfer by Clinical Instructors (N=13)

Intravenous therapy			Transfusion			Patient transfer
Items	Number of experts who agreed	I-CVI	Items	Number of experts who agreed	I-CVI	Items	Number of experts who agreed	I-CVI
1	13	1.00	1	13	1.00	1	13	1.00
2*	13	1.00	2	13	1.00	2	13	1.00
3	11	0.85	3*	13	1.00	3*	13	1.00
4*	13	1.00	4	13	1.00	4
5*	13	1.00	5	12	0.92	5*	12	0.92
6*	12	0.92	6	12	0.92	6*	13	1.00
7	10	0.77	7*	13	1.00	7	11	0.85
8	11	0.85	8	13	1.00	8*	13	1.00
9*	13	1.00	9	13	1.00	9*	10	0.77
10	12	0.92	10*	13	1.00	10*	13	1.00
11	13	1.00	11*	12	0.92	11*	11	0.85
12	10	0.77	12	10	0.77	12*	13	1.00
13	11	0.85	13*	12	0.92	13*	10	0.77
14*	13	1.00	14*	13	1.00	14*	13	1.00
15	13	1.00	15*	13	1.00	15*	12	0.92
16*	13	1.00	16*	13	1.00	16	13	1.00
17*	13	1.00	17*	13	1.00	17	13	1.00
18*	13	1.00	18*	13	1.00	18*	13	1.00
19	10	0.77	19*	13	1.00	19
20	12	0.92	20*	13	1.00	20
21	12	0.92	21*	13	1.00	21	13	1.00
22	13	1.00	22*	13	1.00	22	13	1.00
23*	13	1.00	23*	13	1.00
24*	13	1.00	24	9	0.70
25	9	0.70	25	9	0.70
26*	13	1.00	26	13	1.00
27	13	1.00	27
28	13	1.00	28
			29
			30	12	0.92
			31
S-CVI/Ave		0.94			0.95			0.95
Angoff score		92			94			95

I-CVI=Item content validity index; S-CVI/Ave=Scale content validity index/average.

^*essential items suggested by Korea Accreditation Board of Nursing.

items excluded because they require verbal explanation only.

Table 2.

The Priority of Nursing Skills Ranked by Preceptors and Staff Nurses (N=32)

Level	Items of nursing skills	1st		2nd
		n (%)	rank	n (%)	rank
High (6)	CPR/Defibrillator	17 (53.1)	1	5 (15.6)	4
	Intravenous therapy	11 (34.4)	2	12 (37.5)	1
	Intradermal injection	1 (3.1)	4	2 (6.3)	5
	Foley catheterization	1 (3.1)	4	6 (18.8)	3
	Endotracheal suction	2 (6.3)	3	7 (21.9)	2
	Tracheostomy care	0 (0.0)	6	0 (0.0)	6
Middle (10)	Transfusion	14 (43.8)	1	1 (3.1)	8
	Pulse oximetry/EKG monitor	6 (18.8)	2	7 (21.9)	2
	Intramuscular injection	4 (12.4)	3	3 (9.4)	5
	Hypodermal injection	0 (0.0)	8	2 (6.3)	6
	Tube feeding	3 (9.4)	4	4 (12.4)	3
	Nelaton catheterization	0 (0.0)	8	9 (28.2)	1
	Enema	0 (0.0)	8	0 (0.0)	9
	Preoperative care	1 (3.1)	6	0 (0.0)	9
	Postoperative care	1 (3.1)	6	4 (12.4)	3
	Admission care	3 (9.4)	4	2 (6.3)	6
Low (6)	Vital sign check	19 (59.5)	1	7 (21.9)	2
	Patient transfer	5 (15.6)	2	8 (25.0)	1
	Special mouth care	1 (3.1)	5	2 (6.3)	6
	Isolation precautions	1 (3.1)	5	4 (12.4)	5
	Nasal cannula	2 (6.3)	4	6 (18.8)	3
	Oral medication	4 (12.4)	3	5 (15.6)	4

Table 3.

Testing the Effectiveness of Mastery Learning Program for Nursing Skills

Table 3-A. Comparison of the Distribution of Pass and Non-pass between the Groups and after the Intervention

		Intravenous therapy			Transfusion			Patient transfer
		Exp. (n=13)	Cont. (n=12)	χ²	Exp. (n=12)	Cont. (n=12)	χ²	Exp. (n=13)	Cont. (n=12)	χ²
		n (%)	n (%)	(p)	n (%)	n (%)	(p)	n (%)	n (%)	(p)
Pretest*	P	2 (15.3)	4 (33.3)	1.12	0 (0.0)	1 (8.3)	1.43	3 (23.1)	4 (33.3)	.33
	NP	11 (84.7)	8 (66.7)	(.378)	12 (100.0)	11 (91.7)	(>.999)	10 (76.9)	8 (66.7)	(.673)
Formative assessment 1	P	4 (36.3)	-	NA	4 (33.3)	-	NA	12 (92.3)	-	NA
	NP	7 (63.6)	-		8 (66.7)	-		1 (7.7)	-
Formative assessment 2	P	5 (71.4)	-	NA	7 (87.5)	-	NA	1 (100.0)	-	NA
	NP	2 (28.6)	-		1 (12.5)	-		0 (0.0)	-
Formative assessment 3	P	2 (100.0)	-	NA	1 (100.0)	-	NA	-	-	NA
	NP	0 (0.0)	-		0 (0.0)	-		-	-
Post test*	P	12 (92.3)	6 (50.0)	5.96	11 (91.7)	4 (33.3)	9.56	12 (100.0)	7 (58.3)	8.71
	NP	1 (7.7)	6 (50.0)	(.030)	1 (8.3)	8 (66.7)	(.009)	0 (0.0)	5 (41.7)	(.015)

Exp.=Experimental group; Cont.=Control group; P=Passer; NP=Non-passer; NA=Not applicable.

^*Fisher’s exact test.

Table 3-B.

Comparison of the Scores of Nursing Skills between the Groups before and after the Intervention

	Intravenous therapy			Transfusion			Patient transfer
	Exp. (n=13)	Cont. (n=12)	z	Exp. (n=12)	Cont. (n=12)	z	Exp. (n=13)	Cont. (n=12)	z
	Median (IQR)	Median (IQR)	(p)	Median (IQR)	Median (IQR)	(p)	Median (IQR)	Median (IQR)	(p)
Pretest	78.80 (18.65)	85.70 (17.76)	1.75	66.12 (33.06)	79.02 (15.79)	1.68	95.20 (11.89)	90.47 (9.52)	0.44
			(.087)			(.101)			(.689)
Posttest	96.42 (5.36)	91.85 (9.81)	2.03	96.77 (5.65)	90.32 (16.93)	2.51	100.00 (2.38)	95.23 (4.76)	3.21
			(.043)			(.012)			(.002)
Difference between	17.62 (23.21)	8.93 (8.00)	2.45	29.03 (29.02)	11.30 (14.40)	2.52	4.80 (14.28)	4.76 (4.76)	1.79
pretest and posttest			(.014)			(.010)			(.077)

IQR=Interquatile range; Exp.=Experimental group; Cont.=Control group.

Table 3-C.

Changes in the Score of Nursing Skills during Mastery Learning in the Experimental Group

	Intravenous therapy (n=13)		Transfusion (n=12)		Patient transfer (n=13)
	Median (IQR)	z (p)	Median (IQR)	z (p)	Median (IQR)	z (p)
Pretest	78.80 (18.65)	2.94	66.12 (33.06)	2.81	95.20 (11.89)	1.65
Formative test	96.40 (4.35)	(.003)	93.54 (5.45)	(.005)	95.23 (4.77)	(.098)
Formative test	96.40 (4.35)	0.42	93.54 (5.45)	0.94	95.23 (4.77)	2.12
Posttest	96.42 (5.36)	(.678)	96.77 (5.65)	(.348)	100.00 (2.38)	(.034)

IQR=Interquatile range; Exp.=Experimental group.

Table 4.

Summary of the Final Revised Program of the Study

	Commponent	Strategy	Contents	Materials	Time^† (min)
Diagnostic		Skilled lab testing	• Assessment of participants’ baseline levels of selected	Model	10~15
Assessment			nursing skills
			Passer Self directed learning with	Work book
			workbook & practice	(intensifying)
			Non-passer Participating repeated learning 1
Corrective	Repeated	Lecture	• Clarification of learning objectives	PPT	30
Activity 1	Learning 1		• Theoretical knowledge related to selected nursing	Work book (basic)
			skills with work book
		Online resource	• Learning nursing skills using video clips	Mosby nursing skills	30
		Q & A	• Questions and answers for students		-
	Formative		Passer Self-directed learning with	Work book	10~15
	Assessment1		workbook & practice	(intensifying)
			Non-passer Participating in repeated learning 2
Corrective	Repeated	Skilled lab	• Paired practice	Video mode on the	30
Activity 2	Learning 2	with peers	• Nursing skill trials and filming with personal cellular	cellular phone
			phones
		Feedback	• Peer feedback by comparing the checklists and the	Cellular	40
			clips filmed by personal cellular phones for each	phone video
			nursing skill
		Self reflection	• Self-reflection based on the feedbacks from peers	Self reflection diary
		Informing	• Informing scores and the level of achievement of
		achievement	nursing skills and encouraging further learning
		Correction	• Instructions on standardized nursing records	PPT	10
		Instruction	• Corrections of nursing records done with peers	Nursing record
	Formative		Passer Self directed learning with	Work book	10~15
	Assessment 2		workbook & practice	(intensifying)
			Non-passer Participating in repeated learning 3
Corrective	Repeated	Individualized	• Demonstrations using models for each nursing skill	Model	30
Activity 3	Learning 3	instructions	• Practicing the nursing skils
			• Feedback and correction by comparing the checklist
			of each nursing skil
	Formative		Passer Self directed learning with	Work book	10~15
	Assessment 3		workbook & practice	(intensifying)
			Non-passer Continuing instructions up to the level
			of achievement for students who did
			not achieve
Closing		Debriefing	• Sharing the learning experiences

All formative assessments consisted of prioritizing nursing skills from the given scenarios for each nursing skill, evaluating the performance of the priority nursing skill and communication skill with standardized patient, and informing the scores and the level of students’ achievement.

^†Total running time of the program varied from 210 to 230 minutes according to the individual level of mastery.

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