Research design
This pilot study adapted a mixed methods research design consisting of two distinct phases, a retrospective quantitative phase and a prospective qualitative phase.
Study settings
The pilot study was conducted at Hubei University of Traditional Chinese Medicine, a comprehensive university of traditional Chinese medicine. The University's Institutional Review Board granted ethical authority to access course archiving data from both the College of Nursing.
Rehabilitation Nursing of TCM is a core course set up by the TCM Nursing Teaching Group on the basis of TCM theory combined with health and rehabilitation methods. The TCM Nursing Teaching Group finalized the curriculum content in 2017 after two rounds of Delphi expert consultation [22]. Includes module one “Theory overview” and module two “Application in common chronic diseases”, as shown in Table 1.
Prior to this pilot project the primary mode of learning for the course was LBL, as determined by the course teaching team. Based on the most recent research evidence[12, 23], the TCM Nursing Teaching Group decided to carry out this EBL-based pilot project in 2020.
Table 1
The content and framework of the Rehabilitation Nursing of TCM
Content of courses
|
Percentage of teaching hours
|
Classroom Teaching
|
Experimental Teaching
|
Module one Theory overview
|
40.0
|
20.0
|
Theoretical basis
|
4.0
|
2.0
|
Research progress
|
4.0
|
2.0
|
Huangdi neijing thought of health rehabilitation
|
4.0
|
2.0
|
Nourishing Yin(阴) and Yang(阳)
|
4.0
|
2.0
|
Nourishing qi(气) and blood(血)
|
4.0
|
2.0
|
Nourishing the heart and brain
|
4.0
|
2.0
|
Nourishing liver and gallbladder
|
4.0
|
2.0
|
Nourishing spleen and stomach
|
4.0
|
2.0
|
Nourishing lung health
|
4.0
|
2.0
|
Nourishing kidney health
|
4.0
|
2.0
|
Module two Application in common chronic diseases
|
30.0
|
10.0
|
Total 54 teaching hours, 2430 minutes
|
Participants
This study included all students who took the Rehabilitation Nursing of TCM course between the academic years 2017–2021. The students who were studying in the academic year 2020–2021 were included in the experimental group because the course used the EBL learning model during this period(n = 16); the students who were studying in the academic year 2017–2020 served as the control group because they used the LBL learning model during this period(n = 17).
Intervention
In order to implement EBL learning mode more strictly, we set three stages for the project clearly, as shown in Fig. 1. At each stage, students must complete the corresponding target for that stage.
The first stage focuses on the discovery of the research problem. Students need to combine the content of module one and follow the guidance of the tutor to find the topic of clinical problems that fit their interests. At this stage, teachers should guide students to focus on practical problems and provide some scientific research resources and guidance suggestions.
The second stage is the key embodiment of “enquiry”. This stage requires students to conduct an in-depth research investigation of the target disease based on the clinical questions found in the first stage. Exercise students' ability of self-study, literature research, clinical case analysis, and another scientific research.
The third stage is the summary and feedback stage, including a PowerPoint report and paper assessment. Students are required to report their detailed process of problem finding, problem-solving and follow-up thinking in EBL learning mode to form a closed loop of course learning. Class discussions will be held throughout. Students will complete a learning report during Module 2, and the teacher will provide guidance and commentary as students discuss the nursing research questions they have identified. This enables students to understand the problems and shortcomings in their scientific research practice, further, review the theoretical knowledge, reflect on each EBL process, and exercise students critical thinking.
Instruments
Quantitative phase
Retrospective anonymized data were obtained from archived records of the School of Nursing, Hubei University of Chinese Medicine. The faculty management port provides permanent access to primary source data. Data collected include course performance score and course satisfaction scores for nursing postgraduates from September 2017 to September 2022.
Course performance scores is based on multi-faceted assessment, including Classroom participation, Profile inquiry, Project report, Practical training, Curriculum paper. The full score for each assessment is 100 points, and the five assessments accounted for 5%, 10%, 20%, 25%, and 40% of the final grade, respectively.
Course satisfaction scores are derived from the EBL feedback forms we have developed, and is scored by students according to course experience. The feedback form is used to evaluate the clarity of course objectives, the scientific of content, the rationality of methods, and the experience of the process. It has 12 items in four dimensions, liker level 5 scoring method was adopted, and 1 ~ 5 points were assigned from "completely disagree " to "completely agree" (Supplementary material 1). The higher the score, the better the student's overall experience of the course.
Qualitative phase
In order to understand the real thoughts of students independently, the qualitative analysis was carried out by means of an open-ended questionnaire in the impediments of the COVID-19[24]. All students in the experimental group were invited because they were taught using the EBL model, and all of them volunteered to participate anonymously. The open-ended questionnaire included 2 areas, including students' attitudes, suggestions and specific experiences with EBL model (Supplementary material 2). The open-ended questionnaire consisted of 3 areas and investigated what students thought about the advantages, limitations and suggestion of the EBL model when applied. The open-ended questionnaire gives students the opportunity to report on feelings that they did not fully cover in the close-ended statements during the quantitative phase.
Data analysis
SPSS version 25 was used for descriptive and inferential statistical analysis on Windows. The descriptive statistics included percentages, means, and the standard deviations (SD) of items with difficulty levels. The Shapiro-Wilk test investigated the normality of the data. After testing for normal distribution, an independent sample t-test [2-tailed] was used to calculate the mean test scores and SD in the two groups of questions. A p-value of < 0.05 was statistically significant.
Data derived from the free-text responses to the open-ended questionnaire were summarized by two authors using NVivo version 11. One author (BD) coded the text, and another team member (NSY) checked the coding, and disagreements were resolved by discussion with the corresponding author (HH). The thematic analysis made use of direct quotes from students.