Study design and aim
This descriptive observational study was conducted in 2019 at the School of Nursing and Midwifery in Ilam to determine the effectiveness of CBL in teaching specialized nursing courses on the learning and satisfaction of nursing students.
Setting and sample
All 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing who had selected the elderly/adult nursing unit and critical care nursing and were willing to participate in the study were enrolled in the study using a census method.
Data collection tools in this study included a demographic information questionnaire (age, gender, marital status and semester) and a researcher-made 20-item questionnaire to compare the features of the CBL method and lecture-based learning using 5-point Likert scale questions including strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. Finally, a question was included to determine the level of satisfaction with the CBL method on a scale of 0 to 10. The face validity of questionnaires was determined with the help of 20 nursing students. In addition, the content validity ratio (CVR) and content validity index (CVI) of the questionnaires were assessed by 10 faculty members of the nursing faculty. The reliability of the tool was based on Spearman correlation coefficient.
Participants and comparison of the two methods
In this study, to compare students' satisfaction with CBL and lecture-based learning, students were assigned into different groups based on semester. 3rd, 4th and 5th semester students chose “Adult and Geriatric Nursing” 2 and 3 and “Critical Care Nursing” courses, respectively. Accordingly, based on the experience of researchers as lecturers, two topics were selected for teaching based on CBL and lecture-based learning for each group of students, respectively. Thus, the topics MI and heart failure for 3rd semester students, stroke and multiple sclerosis for 4th semester students, and acute and chronic kidney failure were adopted for 5th semester students. The topics of each group were presented based on CBL and lecture-based learning in one session, respectively, and each topic took about 45 min. Kaddoura method was used for CBL which includes five steps of case presentation, presentation of different questions by the teacher, creating a free and comfortable atmosphere for learners, participation of all learners in discussions and summarization of contents by the teacher . Thus, first the objectives of teaching and then a specific case was presented and the symptoms of the disease and its clinical manifestations were described to the students and the diagnostic tests including graphs and related blood and urine tests were explained and the students were asked to diagnose the disease. All students were asked to take an active part in the discussions. Then, the disease was diagnosed step by step based on the guidance and participation of students, and at each stage, the symptoms and treatment methods of the disease were discussed at the beginning of the session, and these symptoms and care were matched to that specific case. Various questions were constantly asked about the presented case, and the students gradually became familiar with this case of disease. This situation lasted for 45 min and at the end, the final conclusion was made by the lecturer. In the second part of the session, the teacher taught the second topic to the students for 45 min based on lecture-based learning. At the end of the session, students were asked to complete the study questionnaire.
The ethics committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1398.034) approved the study. This study was carried out in accordance with the declaration of Helsinki. Participants entered the study voluntarily, consciously and with satisfaction after were provided with both verbal and written information about the study. In addition, informed consent was obtained from all subjects. Their information remained confidential.
After completing the questionnaires, the extracted data were entered into SPSS Statistics 22. The significance level was considered P < 0.05. Descriptive statistics were reported as mean (standard deviation) for quantitative variables and as frequency (percentage) for qualitative variables.
The Chi-square test was used to examine the relationship between the features of the CBL method in each of the questions based on gender, and semester. The normality of quantitative variables was evaluated using Kolmogorov–Smirnov test. This test is used to evaluate the null hypothesis according to which a set of data comes from a normal distribution. An independent t-test was used to examine the relationship between the mean score of students' satisfaction and gender based on the CBL method. However, the ANOVA test was used to examine the relationship between satisfaction scores and semester.