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This study proposed a robot-assisted digital storytelling approach to reduce hospitalized children's anxiety about intravenous injections and to improve their therapeutic communication and therapeutic engagement. In order to verify the effectiveness of the robot-assisted digital storytelling approach, a randomized controlled study was implemented. A total of 47 children from a regional hospital were randomly assigned to an experimental group (n = 21) and a control group (n = 26). The experimental group adopted the robot-assisted digital storytelling approach in health education for intravenous injections, while the control group received video-based health education. The study results indicated that the proposed robot-assisted digital storytelling approach not only reduced the children's anxiety, but also had positive effects on children's communication about intravenous injections, emotions during hospitalization, and therapeutic engagement. As a consequence, it is suggested that educators and researchers consider adopting robot-assisted digital storytelling to facilitate nursing clinical health education for children.

This study uses bibliometrics and social network analysis methods to investigate the characteristics of the most cited research papers in the Web of Science (WoS) database in virtual patient (VP) studies in interactive learning environments. We identify the most cited studies from the WoS database and then visualize and analyze the research data using bibliometric analysis and VOSviewer. The studies in the dataset were published in 294 different journals in 17 countries between 1989 and 2020. The highest-volume journal was found to be Medical Teacher, and the United States (US) was the country with the highest yield of published studies. The most frequent keywords were virtual patients, simulation, virtual reality, and medical education. The research results show that publishing articles in journals with high impact factors improves the quality of research. The trends in VP research further lay the foundation of bibliometrics for scholars and identify researchers, scientific journals, countries, hot topics, and relevant fields for VP literature. The most cited research uncovers new horizons in the field, providing research inspiration for investigators.

Artificial intelligence (AI) has been widely explored across the world over the past decades. A particularly emerging topic is the application of AI in e-learning (AIeL) to improve the effectiveness of teaching and learning in precision education. This study aims to systematically review publication patterns for AIeL research with a focus on leading journals, countries, disciplines, and applications. In addition, a co-citation network analysis was conducted to explore the invisible relationships among the core papers of AIeL to reveal directions for future research. The analysis is based on a total of 86 core AIeL papers accompanied by 1149 citations in follow-up studies obtained from the Web of Science. It was found that a majority of AIeL studies focused on the development and applications of intelligent tutoring systems, followed by using AI to facilitate assessment and evaluation in e-learning contexts. For field researchers, the visualized network diagram serves as a map to explore the invisible relationships among the core AIeL research, providing a structural understanding of AI-supported research in e-learning contexts. A further investigation of the follow-up studies behind the highly co-cited links revealed the extended research directions from the AIeL mainstreams, such as adaptive learning-based evaluation environments. Implications are discussed.

Training nursing students to make correct decisions when facing various nursing cases is an important and challenging objective. In the Objective Structured Clinical Examination (OSCE) program for nursing students, the educational aim is not only nursing skills, but also critical thinking for making correct decisions and treatments. In this study, a contextual game-based flipped learning approach (GBFL) is implemented to improve nursing students' learning performances and promoting their positive perceptions in an intravenous injection course. Moreover, a quasi-experiment was implemented to assess the effectiveness of the proposed approach. The subjects were 56 students from two classes of a nursing school. One class was assigned to the experimental group learning with the GBFL approach, while the other class was the control group learning with conventional flipped learning. From the experimental results, it was found that the students learning with the proposed approach showed better intravenous injection comprehension as well as higher learning achievement, learning motivation, learning attitudes, flow experience and critical thinking tendency than those learning with conventional flipped learning.

This study explores the trends of chatbots in education studies by conducting a literature review to analyze relevant papers published in the Social Science Citation Index (SSCI) journals by searching the Web of Science (WoS) database. From the analysis results, it was found that the United States, Taiwan and Hong Kong are the top three contributing countries or regions. In addition, most studies adopted quantitative methods in their research design, such as ANOVA (Analysis of variance), descriptive statistics, t test, and correlation analysis. ANCOVA (Analysis of covariance) was the most frequently adopted approach for comparing the performances or perceptions of different groups of students. From the analysis results, the greatest proportion of studies adopted guided learning, followed by no learning activities. It was determined that the studies related to chatbots in education are still in an early stage since there are few empirical studies investigating the use of effective learning designs or learning strategies with chatbots. This implies much room for conducting relevant research to drive innovative teaching in terms of improving the learning process and learning outcomes. Finally, we highlight the research gaps and suggest several directions for future research based on the findings in the present study.

Educators have indicated the need to foster students' ability to solve problems by acquiring up-to-date knowledge as well as promoting their competences for making decisions from diverse perspectives based on the acquired knowledge. Traditional courses mainly use lecture-based instruction without providing sufficient opportunities for students to practice and interact with the teacher; therefore, it is difficult to deliver such up-to-date knowledge via traditional instruction, not to mention fostering students' critical thinking. In this study, the Mobile technology-supported Decision, Reflection and Exercise (MDRE) model is proposed to address this problem. Moreover, a learning system is developed based on the proposed approach. To evaluate the effectiveness of the proposed approach, a quasi-experiment was conducted in a university with a two-group pretest posttest design to assess participants' learning achievement, critical thinking and learning satisfaction. The participants were two classes of undergraduate students. One class with 37 students was the experimental group learning with the MDRE learning approach, whereas the other class with 37 students was the control group learning with the conventional technology-based learning approach. Analysis of covariance was performed to evaluate the effect of the intervention on the target outcomes. It was found that the experimental group showed better learning achievement, critical thinking and learning satisfaction than the control group. This implies that the MDRE approach has good potential in helping learners think from diverse perspectives and promoting their learning performance and engagement, which is important in higher education aimed at fostering students' competence of acquiring up-to-date knowledge for solving problems.

Objective This study uses a systematic review with bibliometric analysis methods to investigate the characteristics of the most cited research papers in the field of nursing fatigue and pregnancy. Methods In the Web of Science (WoS) database. We used the keywords 'fatigue' and 'pregnancy' to search for articles published from 2000 to 2020, limited to SSCI and Science Citation Index (SCI) journal-type articles. This study identifies the most cited studies in the WoS database based on PRISMA guidelines (Preferred reporting items for systematic reviews and meta-analyses). These studies form the research data, then visualized and analyzed using a retrospective bibliometric analysis and VOSviewer. Results The studies in the dataset were analyzed in 319 different journals in 51 countries between 2000 and 2020. The study was found that the United States (US) was the country with the highest yield. The most frequent keywords were postpartum, depression, sleep, and postpartum depression. Conclusion The research results further laid the foundation of bibliometrics for scholars and identified researchers, scientific journals, countries, and hot topics for fatigue-related pregnancy literature. Journals with high impact factors contain the most cited research and open new horizons for research in the nursing field of pregnancy-related fatigue, thus providing research inspiration for investigators in this field., Author(s): Chin-Lan Yang [sup.1] , Ching-Yi Chang [sup.2] Author Affiliations: (1) grid.412146.4, 0000 0004 0573 0416, Department of the Nursing, Hsin Sheng Junior College of Medical Care and Management, Department [...]

Issues relevant to smartphone-supported mobile learning have been extensively discussed and investigated over the past years. Unlike general mobile devices, the advantages of smartphones, such as recording learning and portability, can cross formal and informal education. Smartphones can promote communication between health professionals; however, there is still a lack of systematic analysis of the application and development trends of smartphone use in medical education. The present study systematically reviewed research articles published in international academic journals from 2007 to 2016, analyzed the application domains, subjects, and adopted learning strategies, and investigated the research issues of smartphone-supported medical education. The findings revealed that the application of smartphones in medical education and training has not gained much popularity over the past years. In addition to the changes in the software technology in smartphones and the rising number of studies on mobile learning in medical education, research issues have become increasingly diverse in recent years. Smartphone-supported learning has mainly been implemented to develop basic concepts of biomedical information and in information technology environments; moreover, applying smartphones in medical education did not extensively adopt such learning strategies as inquiry-based learning, contextual mobile learning, mindtools, game-based learning, or synchronous sharing. This indicates that most of the studies adopting smartphones focused on skills training and basic knowledge acquisition rather than on the development of learners' higher-order thinking, for example, problem solving or critical thinking. On the other hand, it was found that the number of experimental studies related to smartphones has increased recently. The majority of research adopted questionnaire surveys and reported learners' cognitive performances and concepts, while learning behaviors were seldom analyzed. Therefore, this study indicates the research trends and potential research issues of integrating smartphones into medical education, and provides suggestions and references for researchers, medical teachers, and decision-makers.

Fostering students' abilities to deal with practical problems is an important objective of professional training. To enable students to have more practicing time under the supervision of trainers in class, flipped learning has been adopted to shift the lecture time to the before-class stage, and hence more time is available for in-class practicing. Although flipped learning has been recognized by scholars as an effective teaching mode, researchers have also indicated the challenges of implementing it; in particular, many students have difficulty learning before the class on their own. In this research, a self-regulated flipped learning approach was proposed to cope with this problem by guiding students to set their learning goals, and supporting them in monitoring their learning status in five stages, namely, goal setting, flipped learning (including pre-class video-based instruction and in-class discussion), task sharing, self-evaluation, and self-regulation feedback. In addition, an experiment was conducted in a professional training program to examine the effectiveness of the proposed approach. From the experimental results, it was found that the approach significantly improved the students' learning achievement, self-efficacy, self-regulation, and critical thinking, which could be a good reference for future research related to flipped professional training.

Based on the Technology-Based Learning Model, the present study reviewed open online language learning research published in the Scopus database from 2009 to 2018, with a focus on research design, sample size, learning devices, target languages, language skills, the learners' education level, the learners' language proficiency level, learning methods, and the foci of investigation. In terms of research design, quantitative empirical studies accounted for the most, followed by mixed method studies. As for the target languages, English was investigated the most, with few studies focused on other languages. In terms of language skills, the number of studies related to vocabulary and speaking was less than those concerning reading and writing. With regard to learning methods, self-directed learning, blended learning, and peer review were the most commonly adopted. There was little research on collaborative learning, flipped classrooms, adaptive learning, or thematic-oriented learning. As for the foci of investigation, motivation, interest, and satisfaction were the focus of the majority of the studies. On the other hand, little research was found to examine self-efficacy or confidence. A discussion based on the analytic results is presented along with proposed suggestions for future research directions.

The aims of nursing training include not only mastering skills but also fostering the competence to make decisions for problem solving. In prenatal education, cultivating nurses' knowledge and competence of vaccine administration is a crucial issue for protecting pregnant women and newborns from infection. Therefore, obstetric vaccination knowledge has become a basic and essential training program for nursing students. However, most of these training programs are given via the lecture-based teaching approach with skills practice, providing students with few opportunities to think deeply about the relevant issues owing to the lack of interaction and context. This could have a negative impact on their learning effectiveness and clinical judgment. To address this problem, a mobile chatbot-based learning approach is proposed in this study to enable students to learn and think deeply in the contexts of handling obstetric vaccine cases via interacting with the chatbot. In order to verify the effectiveness of the proposed approach, an experiment was implemented. Two classes of 36 students from a university in northern Taiwan were recruited as participants. One class was the experimental group learning with the proposed approach, while the other class was the control group learning with the conventional approach (ie, giving lectures to explain the instructional content and training cases). The results indicate that applying a mobile chatbot for learning can enhance nursing students' learning achievement and self-efficacy. In addition, based on the analysis of the interview results, students generally believed that learning through the mobile chatbot was able to promote their self-efficacy as well as their learning engagement and performance.

The childbirth education training course aims to help nurses establish the basic ability to care for pregnant women. However, in traditional teaching, it is often difficult for learners to distinguish the meaning of different childbirth signs. While virtual reality (VR) may be connected in most people's minds with videos designed for immersive entertainment, in fact its early purpose was for nursing education. Initial forms of Spherical Video-based Virtual Reality (SVVR) were used to prepare and train nursing students, pilots, and military personnel. In this paper, an exploratory study using social learning theory embedded in SVVR for childbirth education training is presented; moreover, the learning performances of nursing students who participated in SVVR classroom learning and those who learned with the traditional approach were compared. The experimental results show that, compared with the traditional instruction, the learning motivation and learning satisfaction of the students who learned with SVVR were better, showing the potential of this powerful medium for enhancing nursing students' learning performance in the context of childbirth education.

Conventional nursing courses have solely adopted lecture-based instruction for knowledge delivery, which tends to lack interaction, rehearsal, and personalized feedback. The development of chatbot technologies and their broad application have provided an opportunity to solve the abovementioned problems. Some knowledge-based chatbot systems have been developed; however, it is still a challenging issue for researchers to determine exactly how to effectively apply these chatbot technologies in nursing training courses. Intending to explore the application mode of chatbot technologies and their effectiveness in nursing education, this study integrated a knowledge-based chatbot system into the teaching activities of a physical examination course, using smartphones as the learning devices, and guiding students to practice their anatomy knowledge in addition to analyzing their learning efficacy and pleasure. A quasi-experiment was conducted by recruiting two classes of university students with nursing majors. One class was the experimental group learning with the knowledge-based chatbot system, while the other class was the control group learning with the traditional instruction. Based on the experimental results, the knowledge-based chatbot system effectively enhanced students' academic performance, critical thinking, and learning satisfaction. The results indicate that the application of chatbots has great potential in nursing education.

Immersing learners in authentic scenarios to prompt them to apply what they have learned to problem solving is an essential learning approach in medical and nursing education. However, nurses often do not have the opportunity to experience many specialized or emergency situations in the real world, such as providing grief counseling to terminally ill patients and their families. Therefore, this study proposed a model of Problem-Based Learning (PBL) in Virtual Reality (VR) which allowed learners to experience the sorrowful scenario of dealing with families facing a “patient nearing end of life,” and to learn grief counseling strategies. To validate the effectiveness of this learning method, a quasi-experimental design was conducted in a nurse preceptor training course in a teaching hospital. The participants were 34 nurses from a teaching hospital in Taiwan, randomly assigned to two groups; the experimental group adopted a Spherical Video-based Virtual Reality-integrated Problem-Based Learning (SVVR-PBL) model, while the control group utilized a Conventional PBL (C-PBL) model. Experimental results indicated that the SVVR-PBL model can better enhance nurses’ professional knowledge in palliative care, and supports superior memory retention. Simultaneously, in terms of attitudes toward palliative care, problem-solving orientation, and perceived value, it also significantly outperformed the C-PBL model. [ABSTRACT FROM AUTHOR]

Educators have recognized the importance of providing a realistic learning environment which helps learners to not only comprehend learning content, but also to link the content to practical problems. Such an environment can hence foster problem-solving skills in nursing training. However, when learners interact in a virtual environment with rich learning resources, they might encounter difficulties if there is a lack of proper guidance, clinical sense, or a well thought-out instructional design process. Hence, this work developed a maternity VR-based situated learning system (MVR-SLS) based on the experiential learning theory to support professional courses in obstetrics. A quasi-experiment was conducted to verify the impacts of this method on learners' learning achievement, OSCE (Objective Structured Clinical Examination) competency, problem solving skills, learning engagement, and teaching effectiveness. The experimental results indicate that the new method improved learners' learning achievement, OSCE competency, problem-solving ability, and recognition of learning engagement. Moreover, the learners who learned with the new method showed more active learning behaviors compared to the learners in the control group. Findings of the present study offer concrete suggestions for implementing effective virtual reality (VR)-based learning strategies for medical and nursing textbooks. [ABSTRACT FROM AUTHOR]

In language education, the development of writing capability is an important and challenging teaching objective. Writing performance is related not only with students' comprehension and expression of texts, but also their experience and perceptions of the contexts. Descriptive article writing is a basic writing activity; the content includes concrete understanding and perceptions of space, time, and contexts. However, in the traditional language teaching activities, there is usually no chance for students to have in-depth feelings about the contexts of a topic. This usually results in low learning motivation and limited expression during the writing process. Therefore, the present study attempted to adopt spherical video-based virtual reality (SVVR) to enable students to have in-depth experience and perceptions and to facilitate their learning effectiveness. Based on this approach, a Chinese writing SVVR learning system was developed and a quasi-experiment was conducted to compare the effects of the proposed approach and the conventional technology-supported learning approach in a senior high school writing class. The findings show that the proposed SVVR writing approach could improve students' writing performance in terms of content and appearance as well as their creativity tendency and writing self-efficacy, while also reducing their cognitive load.

The Electrocardiogram (ECG) is one of the important tools for diagnosing myocardial infarction. The ECG training course aims to help nurses establish basic competence in interpreting ECG readings. However, in traditional instruction, learners usually have difficulty memorizing the meanings of different ECG wave forms, which could represent clinical symptoms, or even life-threatening conditions/arrhythmia. Some serious problems could cause death if the nursing staff do not make correct judgments in time. This paper reports an explorative study which investigated a novel pedagogy for nursing school students' ECG learning performance using a contextual game. A 2 week experiment was conducted to compare the learning performances of the nursing students who played the ECG contextual game and those who learned with traditional instruction. The experimental results show that the students learning with the contextual game showed better learning performance, attitude, motivation, and critical thinking tendency than those who received the traditional instruction.

In various case-based training courses, such as engineering, science and medical courses, students need to learn not only the skills to deal with problems, but also the knowledge to identify problems and make correct decisions. Such educational objectives have been recognized by educators as being important but challenging. In this study, an RSI (Recognize, Summarize, Inquire)-based flipped classroom is proposed to achieve this aim. Moreover, an explorative study was designed to probe the effectiveness of the proposed approach in a nursing case-based training course. The case-handling performances of the students trained with the RSI-based flipped classroom and those trained with the conventional flipped classroom were compared. The findings reveal that the RSI-based flipped classroom promoted the students' learning achievement, self-efficacy, critical thinking, and satisfaction more than the conventional case-based training did.

The Advanced Cardiac Life Support (ACLS) training aims to help nurses establish the basic competence of the comprehension of electrocardiograms (ECG/ EKG). However, learners usually have difficulty memorizing the meanings of different EKG waveforms, which could represent clinical symptoms or even the feeling of dying, via traditional instruction. Some serious problems could lead to death if the nursing staff do not make correct judgments and provide timely treatment. Thus, this paper reports an explorative study investigating the effects of a flipped classroom approach on nursing staffs' ACLS learning achievement. A 2-week experiment was conducted to compare the learning achievement of the nursing staff who learned with the ACLS situation-based flipped classroom approach to those who learned with the ACLS traditional flipped approach. The experimental results show that the nursing staff who learned with the proposed approach had better learning achievements, motivation, and satisfaction than those who learned with the ACLS traditional flipped approach.