Effects of flipped learning methodology utilising digital literacy on the critical thinking abilities and self-directed learning of South Korean nursing students: A quasi-experimental study

doi:10.21203/rs.3.rs-4845691/v1

Download PDF

Research Article

Effects of flipped learning methodology utilising digital literacy on the critical thinking abilities and self-directed learning of South Korean nursing students: A quasi-experimental study

https://doi.org/10.21203/rs.3.rs-4845691/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

The coronavirus disease (COVID-19) pandemic and the Fourth Industrial Revolution have transformed nursing education by incorporating online and digital technologies into instructional methods. Digital literacy is essential in information communication technology–based courses to train nursing students to adapt to new digital environments in their profession. Flipped learning effectively utilises digital literacy to help students engage in self-directed learning and develop critical thinking skills. This study aimed to investigate the impact of flipped learning utilising digital literacy on the critical thinking skills and self-directed learning of nursing students in South Korea.

Methods

A quasi-experimental study with a non-equivalent control group pre-test–post-test design was employed to examine effects of flipped learning using digital literacy on the critical thinking skills and learner autonomy of nursing students. Participants were third-year nursing students at P University, Korea. Flipped learning was administered to 36 students in the experimental group for 13 weeks, while traditional lecture-based instruction was provided to 35 students in the control group from September to December, 2023. Data were analysed using SPSS Statistics 27.0. Independent t-tests were conducted to compare the effects between the experimental and control groups. Pearson’s correlation coefficient was used to analyse the relationships between digital literacy, critical thinking skills, and learner autonomy.

Results

The post-test scores for critical thinking skills differed between the experimental and control groups, though not statistically significantly (t=-0.86, p = .391). However, the scores for learner autonomy showed a statistically significant difference in favour of the experimental group (t = 2.79, p = .042).

Conclusion

This study indicates that flipped learning using digital literacy effectively enhances learner autonomy. However, critical thinking skills require long-term follow-ups to ensure significant changes occur. This finding suggests that both the short- and long-term effects should be considered when evaluating educational outcomes.

learning

education

students

nursing

literacy

computer literacy

critical thinking

self-directed learning

1.1. Necessity of the Study

In the rapidly changing social environment influenced by the recent COVID-19 pandemic and the Fourth Industrial Revolution, educational methods that utilise diverse content are emerging. During the COVID-19 pandemic, most universities in Korea and worldwide interacted with students through online education instead of in traditional classroom settings [1]. This shift in educational modalities persists even after the pandemic. Information and communications technology (ICT) classes based on technologies frequently used by the younger generations, such as mobile phones, tablet PCs, and social networking services, have become prevalent [2]. The ability to accept and utilise these ICTs is referred to as ‘digital literacy’ [3]. In the recent times, digital literacy, a crucial competency for acquiring knowledge and information in modern society, is actively incorporated into university education using digital media–based learning methods [4].

The advancement and expansion of digital health has improved the quality of diagnosis and treatment; this has led digital literacy to become an essential component of medical and healthcare education and services [5]. In the nursing field, digital literacy is indispensable for accurately interpreting and managing diverse patient information while performing evidence-based nursing practice [6] This is because the rapidly evolving clinical environment driven by technological advancements demands high-level skills for information utilisation.

The American Association of Colleges of Nursing recommends incorporating nursing informatics into the nursing curriculum [7]. This reflects American nursing colleges’ proactive response to current societal demands for nursing competencies. In Korea, nursing education actively incorporates online content for learning [1] and explores various educational methods and programs and incorporates various platforms such as Zoom to achieve learning outcomes [8].

To train future healthcare professionals to adapt well to the new digital environment, it is necessary to employ educational methods that enable nursing students to leverage their digital literacy in acquiring nursing expertise [9]. Deviating from traditional lecture-based classes, these learning methods enhance digital literacy and promote a learner-centred educational environment [10]. Various educational methods such as flipped learning, blended learning, the jigsaw method, and habruta learning have been extensively explored in prior studies [11-13]. Among these, the flipped learning method or ‘inverted learning’ [14] involves pre-learning the course material through online sessions before the main class, in which students participate in discussions guided by the instructor [15]. This method appropriately utilises digital literacy and has four key features: a flexible environment, a shift in learning culture from instructor-centred to learner-centred, incorporation of student-centred active learning strategies, and utilisation of professional educational methods [14].

Flipped learning using digital literacy can enhance critical thinking skills through active interactions and feedback during class discussions and questions. Moreover, it supports self-directed learning through pre-class digital literacy-based online preparation [16]. Critical thinking, one of the core competencies for future talent, as proposed by the Partnership for 21^st Century Skills (P21) [17], is defined as the motivation or desire to think critically for decision-making and problem-solving [18]. It is particularly crucial for clinical decision-making and performance in nursing practice [19], making it an essential competency for nursing students. Learner autonomy is a self-directed process in which learners diagnose their learning needs, set learning goals, select resources, implement appropriate learning strategies, and evaluate outcomes [20]. It is especially important for nursing students to build confidence in their professional performance and support lifelong learning in continuously changing clinical environments [21].

Previous studies that examined the effects of flipped learning on critical thinking skills and learner autonomy mostly involved lower-year nursing students and were conducted as single-group experimental studies, only assessing the pre- and post-effects of education. The duration of these studies varied from 3 to 7 weeks, but the intervention periods were relatively short, limiting the ability to attribute the observed effects solely to the flipped learning method. Additionally, these studies did not consider the digital competencies of the students.

In Korea, lower-year nursing students (freshmen and sophomores) typically study foundational subjects necessary for their major, while third-year students and above engage in clinical practice and begin to study major subjects in greater depth. Effective learning of these major subjects is crucial for enhancing competencies as nurses post-graduation, highlighting the need for various approaches to improve learning outcomes.

The current study aimed to assess the digital literacy of third-year nursing students and examine the effects of applying flipped learning methods on their critical thinking skills and learner autonomy.

1.2. Purpose of the Study

This study aimed to investigate the impact of flipped learning methods utilising digital literacy on the critical thinking skills and learner autonomy of nursing students.

1.3. Hypotheses

The study’s hypotheses are as follows:

The experimental group will have higher critical thinking skill scores than the control group.
The experimental group will have higher self-directed learning scores than the control group.

2.1. Study Design

This study employed a quasi-experimental design with a non-equivalent control group pre-test–post-test design to examine the effects of flipped learning methods utilising digital literacy on the critical thinking skills and learner autonomy of nursing students.

2.2. Participants

Third-year nursing students enrolled in an adult nursing course at Busan Institute of Science and Technology located in Busan Metropolitan City participated in this study. For this study, ‘nursing students’ are defined as individuals enrolled in a nursing college, nursing department, or nursing program at a four-year university or a four-year restructured college, accredited by the Korean Accreditation Board of Nursing Education in accordance with Article 7 of the Medical Service Act on nurse licensing [22, 23]. Students on a leave of absence or planning to withdraw from the study were excluded.

The sample size for this study was calculated using the G*power 3.1.9.4 program based on a previous study [15]. With an effect size of 0.7, a significance level of .05, and power of 0.8, the required sample size for each group was 23 participants. Considering an attrition rate of > 30%, the study aimed to recruit 30 participants per group for a total of 60 participants. The actual number of participants included in the study was 71, with 36 and 35 in the experimental and control groups, respectively.

2.3. Data Collection Tools

The tools used in this study included questionnaires on the general and learning-related characteristics (including digital literacy) of the participants, and those on critical thinking skills and learner autonomy. Instruments for measuring digital literacy, critical thinking skills, and learner autonomy were used with permission from their respective developers.

2.3.1 General Characteristics and Learning-Related Characteristics

The general characteristics of the participants were assessed using two items: sex and age. Learning-related characteristics included three items—GPA of the previous semester, voluntary selection of the nursing major, and satisfaction with the major—along with 17 items on digital literacy, totalling 21 items. Digital literacy was measured using the Digital Literacy Toward ICT for Learning tool [3], which was translated and standardised into Korean by Kim [24]. This tool comprises domains related to attitudes towards online learning, technical digital literacy skills, cognitive skills, and socioemotional skills. All items were rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with a total score ranging from 17 to 85. Higher scores indicated a more positive attitude towards online learning and higher digital literacy. The original tool’s reliability coefficients (Cronbach’s α) were .86 for online learning attitudes and .89 for digital literacy. The Korean version demonstrated reliability coefficients of .81 for online learning attitudes and .84 for digital literacy. The reliability coefficients for this study were .90 for online learning attitudes and .92 for digital literacy.

2.3.2 Critical Thinking

Critical thinking skills were measured using a tool developed by Kwon et al. [18] to assess the critical thinking disposition of nursing students. This tool includes 35 items across eight domains: creativity, challenge, openness, prudence, objectivity, truth seeking, inquisitiveness, and analytical skills. Each item is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with a total score ranging from 35 to 175. Higher scores indicate higher critical thinking skills. The Cronbach’s α of the original tool ranged from .56 to .83 for individual factors and was .89 for the scale used in this study. In this study, the reliability coefficients for the individual factors ranged from .60 to .81, and the overall reliability coefficient was .73.

2.3.3 Self-Directed Learning

Learner autonomy was assessed using the SH-Self-Rating Scale of Self-Directed Learning (SH-SRSSDL) developed by Williamson [25] for nursing students; it was translated and standardised for Korean contexts by Jo et al. [26]. This tool comprises 30 items across five domains: awareness, learning strategies, learning activities, evaluation, and interpersonal skills; each item rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with a total score ranging from 30 to 150. Higher scores indicate greater learner autonomy. Williamson’s original tool demonstrated reliability coefficients (Cronbach’s α) of .79 for awareness, .73 for learning strategies, and .71 each for learning activities, evaluation, and interpersonal skills. The Korean version showed reliability coefficients of .90 for awareness, .92 for learning strategies, .93 for learning activities, and .94 each for evaluation and interpersonal skills. In this study, the reliability coefficients were .67 for awareness, .73 for learning strategies, .72 for learning activities, .61 for evaluation, .78 for interpersonal skills, and .88 for the entire scale.

2.4. Education Method and Data Collection

This study applied flipped learning in an adult nursing course for a period of 13 weeks, from September 1 to December 12, 2023 (excluding midterm and final exams). For the flipped learning approach, video content related to weekly topics was provided to the experimental group one week in advance. For this method, students were expected to watch and familiarise themselves with the content before attending class. Quizzes, discussions, and the introduction of new materials based on the pre-watched videos were conducted in the class. The control group received traditional lectures and was provided with the same video content after class completion. The video content, comprising two to three videos per week with a total viewing time of approximately 20 min, was sourced from reputable institutions such as domestic university hospitals and the Korea Disease Control and Prevention Agency to ensure high reliability. To facilitate digital literacy, content was made accessible online through the e-learning site (LMS) of the university, in which the participants were enrolled. To verify the pre-class viewing of the videos, quizzes based on the video content were administered at the beginning of each class, encouraging active participation in pre-learning activities.

2.5. Ethical Consideration

Prior to the study’s commencement, approval was obtained from the Institutional Review Board of the Pusan National University from which the researcher belongs (IRB No. PNU IRB/2023_118_HR). The researcher then sought cooperation from the relevant department to conduct the classes and collect data. The teaching methods were differentiated into flipped learning and traditional lecture formats, while all other course content and assessments remained identical, ensuring no disadvantages to the students, and written informed consent for the study was obtained before the commencement of the classes. No negative consequence based on their choice of teaching method was assured to the participants and they were allowed to choose voluntarily. Additionally, to align with flipped learning characteristics, the content provided to the experimental group before class was made available to the control group after class.

2.6. Data Analysis

Data were analysed using SPSS WIN 27.0. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to analyse the general and learning-related characteristics of the participants. Homogeneity tests of the participants’ characteristics and dependent variables between the experimental and control groups were conducted using independent t-tests and chi-squared tests. Pearson’s correlation coefficients were used to analyse the correlations between digital literacy, critical thinking skills, and learner autonomy. The effectiveness of the intervention was compared between the experimental and control groups by using independent t-tests.

3.1 General Characteristics, Learning-Related Characteristics, and Homogeneity Test of Variables

This study included 71 participants: 36 in the experimental group and 35 in the control group. In the experimental group, 83.4% of the patients were women, and 91.4% of the patients in the control group were women. Most participants were in their 20s (86.1% in the experimental group and 88.5% in the control group). Regarding learning-related characteristics, 80.6% of the experimental group and 85.7% of the control group had a GPA of 3.1 to 4.0 in the previous semester. Voluntary selection of nursing majors was reported by 94.4% and 82.9% of the experimental and control groups, respectively. Satisfaction with their majors was reported by 63.9% and 71.4% of the experimental and control groups, respectively. The average score for digital literacy was 3.80±0.67 out of 5 for both groups. The homogeneity test results indicate that the two groups were homogeneous across all items (Table 1).

Table 1. Homogeneity of General Characteristics, Learning-Related Characteristics and Dependent Variables Between the Experimental and Control Groups

Characteristics	Categories	Exp. (n=36)	Cont. (n=35)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	6 (16.6)	3 (8.6)	1.21	.478^*
Gender	Female	30 (83.4)	32 (91.4)
Age	20–29	31 (86.1)	31 (88.5)	0.46	1.000^*
Age	≥30	5 (13.9)	4 (11.5)
Average grade	2.1–3.0	4 (11.1)	5 (14.3)	3.36	.354^*
	3.1–4.0	29 (80.6)	30 (85.7)
	≥4.1	3 (8.3)	0 (0)
Voluntary selection of major	Yes	34 (94.4)	29 (82.9)	2.54	.151^*
Voluntary selection of major	No	2 (5.6)	6 (17.1)
Major satisfaction	Bad	1 (2.8)	2 (5.7)	6.29	.565^*
	Moderate	12 (33.3)	8 (22.9)
	Good	23 (63.9)	25 (71.4)
Digital literacy		3.80±0.67	0.06	0.06	.956
Critical thinking disposition		121.08±13.22	122.03±12.47	-0.31	.758
Self-directed learning		106.83±14.05	107.94±12.53	-0.35	.727

^*Fisher’s exact test; Exp. – Experimental, Cont. – Control

3.2. Hypothesis Testing

Hypothesis 1: The first hypothesis, ‘The experimental group will have higher critical thinking skill scores than the control group’, was tested. The critical thinking scores of the experimental group increased from a pre-test score of 121.08±13.22 to a post-test score of 123.57±14.47, showing an increase of 2.49±1.25 points. Conversely, the control group’s scores decreased from a pre-test score of 122.03±12.47 to a post-test score of 120.83±12.57, showing a decrease of 1.2±0.10 points. While a difference in the post-test critical thinking scores between both groups was observed, it was not statistically significant (t=-0.86, p=.391), leading to the rejection of Hypothesis 1 (Table 2).

Table 2. Differences in Dependent Variables Between the Experimental and Control Groups

Variables			Pre-test	Post-test	Difference	t	p
Variables			M±SD	M±SD	M±SD	t	p
Critical thinking disposition	Cont. (n=35)		122.03±12.47	120.83±12.57	-1.2±0.10	-0.86	.391
	Exp. (n=36)		121.08±13.22	123.57±14.47	2.49±1.25
		Intellectual	3.91±0.53	4.07±0.49	0.16±0.04	-1.32	.191
		Creativity	3.28±0.92	3.05±1.03	-0.23±0.11	1.02	.312
		Challenge	2.25±0.65	2.44±0.64	0.19±0.17	-1.29	.199
		Open-mind	3.68±0.81	3.93±0.66	0.25±0.15	-1.49	.142
		Prudence	3.56±0.64	3.38±0.51	-0.18±0.13	1.35	.181
		Objectivity	3.60±0.50	3.66±0.55	0.06±0.05	-0.48	.631
		Truth-seeking	3.57±0.75	3.93±0.54	0.36±0.21	-2.33	.023
		Inquisitiveness	3.43±0.80	3.42±0.82	0.01±0.02	0.06	.956
Self-directed learning	Cont. (n=35)		107.94±12.53	105.89±13.87	2.05±1.34	2.79	.042
Self-directed learning	Exp. (n=36)		106.83±14.05	113.57±13.01	6.74±1.04

Exp. – Experimental, Cont. – Control

Examining the sub-domains of critical thinking, a significant difference was found in the ‘Truth-seeking’ sub-domain in the experimental group pre- and post-intervention (t=-2.35, p=.022) (Table 2).

Hypothesis 2: On testing the second hypothesis, it was found that self-directed learning scores of the experimental group increased from a pre-test score of 106.83±14.05 to a post-test score of 113.57±13.01, showing an increase of 6.74±1.04 points. Conversely, the control group’s scores decreased from a pre-test score of 107.94±12.53 to a post-test score of 105.89±13.87, showing a decrease of 2.05±1.34 points. The analysis results indicated that self-directed learning scores were significantly higher in the experimental group than in the control group (t=2.79, p=.042), thus supporting Hypothesis 2 (Table 2).

3.3. Correlation Between Digital Literacy, Critical Thinking, and Self-Directed Learning

Correlation analysis revealed statistically significant positive correlations between digital literacy, critical thinking, and self-directed learning. There was a significant positive correlation between digital literacy and critical thinking (r=0.24, p=.041).

A significant positive correlation between digital literacy and self-directed learning (r=0.43, p<.001) was found.
A significant positive correlation between critical thinking and self-directed learning (r=0.51, p<.001) was found (Table 3).

Table 3. Correlations Between Digital Literacy, Critical Thinking Disposition, and Self-Directed Learning

Variables	Digital literacy	Critical thinking disposition	Self-directed learning
Variables	r (p)	r (p)	r (p)
Digital literacy	1	1
Critical thinking disposition	0.24 (.041)	1
Self-directed learning	0.43 (<.001)	1.51 (<.001)	1

This study examined the impact of digital literacy-based flipped learning methods on the critical thinking skills and self-directed learning abilities of Korean nursing students. The findings of this study are as follows:

The participants’ average digital literacy score was 3.85, indicating a relatively high level. This is consistent with previous research [24], which measured digital literacy among Korean nursing students using the same tool, and a study involving Turkish nursing students [27]. Similarly, a prior research involving Turkish healthcare students, including nursing students, reported high digital literacy, similar to our study results [28]

Other studies using different tools also reported high digital literacy among Korean nursing students. For instance, prior studies [2, 9] using a tool developed by Kim et al. (2014) and modified by Wang (2017), Yoon using a tool developed by Shin and Lee (2019) [29], and Kim [1] using a tool developed by Joo (2018), all found high digital literacy among nursing students, similar to our study.

Internationally, high digital literacy has been reported among nursing students in Turkey [27], Australia [30], and the UAE [31]. Martzoukou’s study found that nursing students indicated that younger students and freshmen had higher digital literacy than older and senior students [32]. Thus, it can be inferred that nursing students globally have high digital literacy capabilities. Consequently, it is essential for future nurses to continuously develop their ability to use evolving digital health technologies. Additionally, despite the variability in the number of items and the use of a 5-point Likert scale across different tools (Kim HW [2]; Kim EJ [4]; Park KM [9]; Erdat Y et al [27]; Yoon SJ [29]; Lokmic-Tomkms Z []), the differences in tools did not affect the study outcomes.

As per the study findings, the first hypothesis, ‘The experimental group will have higher critical thinking skill scores than the control group’, was not supported, although there was some improvement in the experimental group’s critical thinking skills. This contrasts with the findings of studies by Oak JW [33], who used flipped learning in nursing practice courses over six sessions over six weeks, and Kim [34], who conducted a 10-week course, both of which found significant improvements in critical thinking. Similarly, prior studies by Yang [35] involving five sessions of health assessment over 15 weeks, MH Lee [15] with five sessions of case-based learning over 15 weeks, and Kim YS [36] with four sessions of community health nursing over eight weeks all reported significant improvements in critical thinking, differing from our study.

Previous meta-analyses on flipped learning suggested that interventions lasting 7–8 weeks have the greatest effect size [37]. The longer intervention period used in our study may have contributed to the lack of significant changes. However, critical thinking skills are not merely enhanced through discussions conducted in the flipped learning approach but also require long-term education. Critical thinking involves deep and broad understanding of claims or viewpoints rather than accepting them blindly, allowing justified reasoning and decision-making [18]. In this age of information, critical thinking is vital for nurses to make informed, ethical, and legally sound decisions. Therefore, enhancing critical thinking skills in nursing students is crucial for managing patient care in complex healthcare environments.

The study findings supported the second hypothesis, ‘The experimental group will have higher self-directed learning scores than the control group’. This aligns with the findings of Yang et al. [35], Kim YS [36], and Fan et al. [38], who reported improved self-directed learning abilities in nursing students through flipped learning. By engaging students in pre-class content reviews and in-class activities like quizzes, discussions, and participation, flipped learning fosters self-directed learning. Therefore, further research is needed to develop clinical case-based content and to explore various instructional methods to enhance active participation among nursing students.

The current study also revealed significant correlations among digital literacy, critical thinking, and self-directed learning. Prior studies indicated correlations between digital literacy and communication skills, self-efficacy, and major satisfaction [4, 9], suggesting the utility of digital literacy in nursing education. Further research is thus required to explore the relationship between digital literacy and various learning variables to guide the development of educational programs.

This study is significant because it applied flipped learning using digital literacy to a core nursing theory course for third-year nursing students in South Korea, demonstrating its effectiveness in enhancing self-directed learning and the positive correlations between digital literacy and learning-related variables. However, as this study did not differentiate between interventions based on digital literacy levels, future research should consider tailored interventions based on digital literacy levels.

4.1. Study Limitation

While this study considered the digital literacy of nursing students, it did not differentiate between interventions based on individual digital literacy levels, and only confirmed homogeneity between the experimental and control groups. Given the impact of digital literacy on self-directed learning, future research should explore interventions tailored to different levels of digital literacy.

This study applied a flipped learning approach in which students used digital literacy to engage in pre-online class learning and actively participate in class, rather than solely delivering content in a traditional lecture format. The study findings demonstrated that the flipped learning method was more effective than the conventional lecture format in enhancing self-directed learning. However, the findings also highlighted the fact that critical thinking skills are not easily altered in the short term and require long-term observation and development.

Furthermore, when selecting educational delivery methods and evaluating their effectiveness, it is important to consider both short-term effects such as knowledge improvement and long-term effects such as the enhancement of critical thinking skills. This approach ensured a comprehensive evaluation of educational interventions based on learners’ digital literacy levels.

The flipped learning utilizing digital literacy is expected to help nursing students adapt well to rapidly changing learning environments and based on this improve learning-related competencies which will likely which will likely lead to an enhancement in the quality of patient care in the future.

ICT

information and communications technology

SH-SRSSDL

SH-Self-Rating Scale of Self-Directed Learning

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Pusan National University (IRB No. PNU IRB/2023_118_HR). This study was performed following the Declaration of Helsinki.

Before the class, the purpose and methods of the research were explained to the participants, and written informed consent was obtained.

Consent for publication

No applicable

Availability of data and materials

The data supporting this study’s findings are available on request from the corresponding author. The data are not publicly available as they contain information that could compromise research participant privacy/consent.

Competing interests

The authors declare that they have no competing interests.

Funding

The authors received no financial support for this article’s research, authorship, and/or publication.

Authors' contributions

ML: Conceptualization; Data Curation; Investigation; Formal Analysis; Methodology; Validation; Writing – original draft; Writing – review and editing

IK: Conceptualization; Data Curation; Investigation; Formal Analysis; Methodology; Validation; Writing – review and editing

Acknowledgements

Not applicable.

Authors' information

ML: PhD Candidate, Department of Nursing, Pusan National University

IK: Professor, Department of Nursing, Pusan National University

Kim KM. The effect of the replacement of online lecture on the motivation, attitude and online class satisfaction of university students by COVID-19. Korean Assoc Learner-Centered Curric Instr. 2022a;22:329–39. https://doi.org/10.22251/jlcci.2022.22.1.329.
Kim HW. The digital literacy, awareness, and educational needs of virtual reality among nursing students. J Korean Acad Soc Nurs Educ. 2023a;29:17–26. https://doi.org/10.5977/jkasne.2023.29.1.17.
Ng W. Can we teach digital natives digital literacy? Comput Educ. 2012;59:1065–78. https://doi.org/10.1016/j.compedu.2012.04.016.
Kim EJ. A study on the relationship between digital literacy and major satisfaction of nursing students: Intermediary role of LMS learning effects. J Converg Cult Technol. 2022b;8:27–35.
Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019;293:294–6. https://doi.org/10.1016/j.ijcard.2019.06.039.
Bergren MD, Maughan ED. Data and information literacy: A fundamental nursing competency. NASN Sch Nurse. 2020;35:140–2. https://doi.org/10.1177/1942602X20913249.
American Association of Colleges of Nursing (AACN). The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, District of Columbia: American Association of Critical Care Nurses; 2008.
Park JY. The effect of self-directed learning strategies on e-learning pre-learning of nursing students: Focusing on the flow experience. J Korean Acad Fundam Nurs. 2020;27:52–63. https://doi.org/10.7739/jkafn.2020.27.1.52.
Park KM. A Study on the digital literacy of nursing students. J Ind Converg. 2023;21:111–7. https://doi.org/10.22678/JIC.2023.21.8.111.
Chang MO, Jung MY. The study of awareness and preparation of college student for the era of 4th Industrial Revolution. J Korea Content Assoc. 2019;19:47–57.
Kweon YR, Choi BS. Effects of a psychiatric nursing education using flipped learning on learning transfer motivation and learning self-efficiency of nursing college students. Korean Data Anal Soc. 2020;22:447–60. https://doi.org/10.37727/jkdas.2020.22.1.447.
Kim MG, Park SH, Kim HW. The effects of jigsaw cooperation learning on communication ability, problem solving ability, critical thinking disposition, self-directed learning ability and cooperation of nursing students. J Korean Acad Soc Nurs Educ. 2019;25:508–16 + 516. https://doi.org/10.5977/jkasne.2019.25.4.508.
Ahn MN, Kim HJ, Lee EY. Quality of the Home Environment According to the Type of Adaptability of Children. J Learn-Centered Curriculum Instruction. 2022;22:17–29. https://doi.org/10.22251/jlcci.2022.22.13.1.
Flipped Learning Network; 2023.08.01. https://flippedlearning.org
Lee MH, Park MS. The effect of case-based learning based on flipped learning for nursing students. J Korean Acad Soc Nurs Educ. 2021;27:107–16. http://doi.org/10.5977/jkasne.2021.27.2.107.
Jung MR, Jeong E. Effects of e-book-based flipped learning education on critical thinking disposition, academic self-efficacy, and major satisfaction of nursing students. J Korea Contents Assoc. 2018;18:490–501. https://doi.org/10.5392/JKCA.2018.18.02.490.
Battelle for kids; 2024.01.15. https://www.battelleforkids.org/insights/p21-resources
Kwon IS, Lee GE, Kim GD, Kim YH, Park KM, Park HS, et al. Development of a critical thinking disposition scale for nursing students. Taehan Kanho Hakhoe Chi. 2006;36:950–8. https://doi.org/10.4040/jkan.2006.36.6.950.
Heo HJ. Effects of Nursing Students’ Self-initiated Learning, Tendency of Critical Thinking and Clinical Decision Making Ability on Their Clinical Competence. The Journal of humanities and social sciences 21. 2022;13(2):675-688. http://dx.doi.org/10.22143/HSS21.13.2.48.
Slusarski SB. Enhancing self-direction in the adult learner: Instructional techniques for teachers and trainers. New Dir Adult Contin Educ. 1994;1994:71–9. https://doi.org/10.1002/ace.36719946411.
Chu MS. The relationship between communication, problem solving, self-directed learning and Nursing process confidence of nursing students before graduation. J Korea Acad-Ind Coop Soc. 2022;23:387–97. https://doi.org/10.5762/KAIS.2022.23.4.387.
Korea Nursing Association; 2023.08.22. http://www.koreanurse.or.kr/resources/be_nurse.php
International Law Information Center. Medical service act (effective March 5, 2023) [act No. 17787, December 29, 2020, partial amendment].; 2023.08.22. https://www.law.go.kr/LSW/lsInfoP.do?efYd=20230305&lsiSeq=225385#0000.
Kim SS, Jeon JH. Factors influencing eHealth literacy among Korean nursing students: A cross-sectional study. Nurs Health Sci. 2020;22:667–74. https://doi.org/10.1111/nhs.12711.
Williamson SN. Development of a self-rating scale for self-directed learning. Nurse Res. 2007;14:66–83. https://doi.org/10.7748/nr2007.01.14.2.66.c6022.
Jo HY, Choi MS, Yi HY. A validation study of the Korean self-rating scale of self-directed learning performance indicator for learners: Focusing on S university students. Korean Assoc Learner-Centered Curric Instr. 2021;21:289–310.
Erdat Y, Sezer Ceren RE, Ozdemir L, Uslu-Sahan F, Bilgin A. Influence of technical, cognitive and socio-emotional factors on digital literacy in nursing students assessed using structural equation modeling. Nurse Educ Today. 2023;130:105937
Aydınlar A, Mavi A, Kütükçü E, Kırımlı EE, Alış D, Akın A, et al. Awareness and level of digital literacy among students receiving health-based education. BMC Med Educ. 2024;24:38. http://doi.org/10.1186/s12909-024-05025-w.
Yoon SJ. The Effect of Nursing Students’ Digital Literacy Ability on Learning Presence and Learning Satisfaction in Online Classes’. J Next-Gener Converg Technol Assoc. 2022;6:2400–12. https://doi.org/10.33097/JNCTA.2022.06.12.2400.
Lokmic-Tomkins Z, Choo D, Foley P, Dix S, Wong P, Brand G. Pre-registration nursing students’ perceptions of their baseline digital literacy and what it means for education: A prospective COHORT survey study’. Nurse Educ Today. 2022;111:105308. http://doi.org/10.1016/j.nedt.2022.105308.
Ibrahim RK, Aldawsari AN. Relationship between digital capabilities and academic performance: The mediating effect of self-efficacy. BMC Nurs. 2023;22:1–11. http://doi.org/10.1186/s12912-023-01593-2.
Martzoukou K, Luders ES, Mair J, Kostagiolas P, Johnson N, Work F, et al. A cross-sectional study of discipline-based self-perceived digital literacy competencies of nursing students. J Adv Nurs. 2024;80:656–72. https://doi.org/10.1111/jan.15801.
Oak JW. Effects of flipped-learning teaching-learning model for the competencies enhancement on fundamental nursing practice. Int J Adv Appl Sci. 2022;9:113–21.
Kim HS. The Effect of Fundamental nursing practice class with Flipped Learning on self-efficacy and Critical Thinking Disposition of Nursing students. J Converg Cult Technol (JCCT). 2021;7:277–84. http://doi.org/10.17703/JCCT.2021.7.3.277.
Yang JW. The effect of flip learning method on self-directed learning ability, critical thinking disposition, and academic self-efficacy of nursing students. J Korea Converg Soc. 2021;12:467–73. http://doi.org/10.15207/JKCS.2021.12.11.467.
Kim YS. Effect of flip learning-based community nursing education on learning motivation, learning-related self-direction, self-efficacy, critical thinking disposition, problem-solving ability, and learning satisfaction. J Learn-Centered Curriculum Instruction. 2023b;23:311–24.
Cho BR, Lee JM. A meta analysis on effects of flipped learning in Korea. J Digit Converg. 2018;16:59–73.
Fan J-Y, Tseng Y-J, Chao L-F, Chen S-L, Jane S-W. Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: A quasi-experimental study. BMC Med Educ. 2020;20:317. https://doi. https://doi.org/10.1186/s12909-020-02240-z.

No competing interests reported.

Download PDF

Editor assigned by journal
07 Aug, 2024
Submission checks completed at journal
07 Aug, 2024
First submitted to journal
02 Aug, 2024

You are reading this latest preprint version

Effects of flipped learning methodology utilising digital literacy on the critical thinking abilities and self-directed learning of South Korean nursing students: A quasi-experimental study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

1. Introduction

1.2. Purpose of the Study

1.3. Hypotheses

2. Method

2.1. Study Design

2.2. Participants

2.3. Data Collection Tools

2.3.1 General Characteristics and Learning-Related Characteristics

2.3.2 Critical Thinking

2.3.3 Self-Directed Learning

2.4. Education Method and Data Collection

2.5. Ethical Consideration

2.6. Data Analysis

3. Results

3.1 General Characteristics, Learning-Related Characteristics, and Homogeneity Test of Variables

3.2. Hypothesis Testing

4. Discussion

4.1. Study Limitation

5. Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1