Abstract
A video production activity utilizing a flipped-classroom approach was used in a public health nursing course to educate undergraduate nursing students about infectious diseases. After reviewing an audio-recorded lecture at home, students were divided into small groups to create short video clips on selected infectious diseases. Four themes emerged from the subsequent participant survey: engagement, in-depth understanding but concerns for new knowledge acquisition, practical, and room for improvement. The flipped classroom approach with video production encouraged students to engage in their public health nursing class and provided them with an opportunity to practice important communication skills.
Keywords
Competency II of the National League for Nursing's (NLN) eight core competencies to promote excellence among nurse educators recognizes the importance of creating a supportive learning environment that facilitates students ‘desired cognitive, affective, and psychomotor learning outcomes (NLN, 2019). Novice nurses need to transition smoothly from their academic preparation that in the past had been mostly a hospital-based environment to a community-based environment that is interdisciplinary. A paradigm shift in pedagogical methodology and learning environment emphasizes the use of active learning models, including team-based learning, and the use of interactive technologies and clinical resources. The “flipped classroom approach” has been found to increase students ‘engagement and academic performance (Busebaia & John, 2020; Ward et al., 2018), utilizing instructional materials and lectures before class to free up classroom time for problem-solving and advancing knowledge through collaborative activities (Hotle & Garrow, 2016).
Using a flipped learning approach in conjunction with digital media production is particularly effective in higher education (Pierce & Fox, 2012). A video production provides opportunities to enhance teamwork skills as students work together to create a short clip using an electronic device (Hakkarainen, 2009). Moreover, it supports an interactive educational curriculum that engages students by drawing them into the experience and providing learning stimuli (McCormick et al., 2013) for Net generation students, a term often used to describe younger students who are more inclined towards participatory digital technologies (Clark et al., 2009). A video production requires students to act as knowledge producers incorporating a variety of techniques such as story-making, video footage, and sound effects (de Castro & Levesque, 2018) and facilitates teamwork among students (Hakkarainen, 2009).
Despite the growing interest in the use of digital media in higher education, there is no evidence that this type of instruction could help undergraduate nursing students build knowledge and enhance classroom learning. This study examined how digital media can be used when flipping the classroom in a public health nursing class. The aim of this study was to explore students ‘perceptions of the video production in an undergraduate public health nursing course.
Method
Video Production Procedure and Product
A teaching plan was consistent with the course syllabus, which included community-acquired and infectious diseases. The main objectives of the class were identification of different infectious diseases and concepts learned from class; engagement in group discussions and activities; defining and describing different communicable diseases; and raising questions and concerns as future nurses. The aim of the activity was to enhance students ‘learning outcomes via a video production with a flipped-classroom approach as an educational intervention in public health nursing education.
A paradigm shift in pedagogical methodology and learning environment emphasizes the use of active learning models, including team-based learning, and the use of interactive technologies and clinical resources.
Prior to attending the class, students reviewed two textbook chapters (Stanhope & Lancaster, 2014) on a number of communicable diseases, and watched an audio-recorded slide lecture with an introduction followed by sections on the transmission, prevention, and surveillance of specific reportable communicable diseases: pertussis, influenza, Salmonella, human papillomavirus (HPV), Hepatitis A, and Lyme disease. A quiz was distributed to all students during the first 10 minutes of the in-person class to assess the level of knowledge the students had acquired from the reading. Following completion of the quiz, the instructor provided detailed instructions on the activity and assigned students into groups of four to six according to their clinical assignment. One person from each group drew a random disease category from a bag containing slips of paper, each with the name of one of the six communicable diseases. The students were then asked to create 3-minute video clips about their designated disease with either a computer, phone, or camera, using the genre of their choice (e.g., short drama, campaign, direct education) to educate the public about it. Students could use information from the course textbook and from a list of trustworthy internet sites recommended by the instructor.
Study Design, Setting, and Sample
A total of 48 baccalaureate students enrolled in a public health nursing course participated in the study. The study setting was a classroom in an academic institution in the Eastern U.S. The students had begun their clinical rotations in public health settings during the semester. Institutional review board approval from the university was received to conduct this study, and the requirement for written informed consent was waived.
Data Collection and Analysis
Using Qualtrics, an open-ended questionnaire consisting of seven items was distributed via email following the completion of all components of the activity (See Figure 1). The students provided feedback on what they valued and/or disliked about the video production as a teaching strategy, and whether it helped them learn about infectious diseases, enhanced their competencies, and/or prepared them to become better community health/public health nurses compared with other instruction methods.
Open-ended questionnaire distributed to students
A descriptive qualitative approach (Elo & Kyngas, 2008) used an investigator-developed open-ended questionnaire to evaluate student perceptions of a video production activity. The students ‘responses were collaboratively coded for attributes and patterns by two different coders who were not involved in the course.
Results
Of the 48 students participating in the activity, 12 (25%) responded to the questionnaire. Students ‘responses revealed their perceptions of the perceived benefits and barriers of using a video production as a teaching strategy in a public health nursing class. Four themes emerged: engagement; in-depth understanding but concerns for new knowledge acquisition; practical; and room for improvement (See Table 1).
Themes and Sample Comments Supporting Students ‘Perceptions of Video Production
Discussion
The flipped classroom strategy using video production clearly helped the students engage with the subject matter, providing an in-depth understanding of the content. This activity required students to research topics, synthesize knowledge through creating scenarios, and deliver important knowledge to create the final product, providing opportunities to develop an in-depth understanding of the subject matter. The current finding is consistent with those of previous studies that used flipped classroom and/or video production approaches. Hotle and Garrow (2016) found that most students in the flipped classroom felt that they were able to absorb the material better than they would have in a traditional classroom. Flipped learning enables students to actively partake in learning and advocating for community health issues (Khanova et al., 2015). Similarly, students have reported that creating public health-related stories using digital media helped them learn public health concepts (de Castro & Levesque, 2018). The current study extended these findings by incorporating video production in a public health nursing course using a flipped classroom approach.
Each student small group created a 3-minute video clip about their designated infectious disease, using the genre of their choice (e.g., short drama, campaign, direct education) to educate the public about it.
The Quad Council Coalition Competency Review Task Force is a public health nursing organization formed to address priorities for public health and nursing education. They developed Community/Public Health Nursing Competencies to equip students for future careers in public health nursing, stressing the importance of providing a range of educational opportunities to help students master and practice varying skill sets based on well-integrated related content and educational methods (Quad Council Coalition Competency Review Task Force, 2018). Utilizing video production activities in a flipped classroom provides undergraduate students with opportunities to enhance vital competencies such as communication and leadership skills, and cultural and global knowledge. Teamwork and collaboration are required to create videos in group-based learning. Additionally, communication skills are needed for creating skit-based video clips, while cultural competency skills can be enhanced through considering the diverse characteristics of populations and finding ways to deliver culturally relevant public health nursing education for diverse groups of individuals and families.
Although the current study focused on teaching students about infectious and community-acquired diseases, this type of educational approach, with suitable modifications, can also be applied to other topics such as disaster planning or community assessment in public health nursing (Holmes et al., 2013). Acquiring video-producing skill also enables nurses to educate the communities they serve about relevant health issues and to provide important health promotion messages to the public. Video production can be further adapted by using smartphone apps depending on course objectives, serving as an innovative educational tool that supports student engagement, knowledge building, and online education in the near future.
Limitations
The results of this study are based on a relatively small sample recruited from one school of nursing, which limits generalizability. Although all students in the class participated in the activity, only 12 (25%) completed the questionnaires, which may introduce response bias.
In addition, in the authors ‘interpretation of the students ‘perceptions of the video production activity, there is potential bias in favor of the activity. The first (MK) and second authors (MG) were not directly involved in the course or the activity, minimizing bias when coding data and conducting analysis.
Conclusion
This study contributes to the dialogue on effective ways to enhance undergraduate nursing student engagement in public health nursing education. The study provides a useful example of how digital technology can be used interactively to reach beyond the standard lecture format by flipping the classroom.
Footnotes
Disclosure. The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.
Funding. The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.
Misol Kwon, BS, RN, (she/her), is a doctoral student at the SUNY University at Buffalo School of Nursing, New York, USA.
Mary Rose Gaughan, MS, RN, CNE, (she/ her), is a doctoral student at the SUNY University at Buffalo School of Nursing, New York, USA.
Eunhee Park, PhD, RN, PHNA-BC, (she/ her), is an assistant professor at the SUNY University at Buffalo School of Nursing, New York, USA.