Estrategias de metodologías activas de aprendizaje en la formación del enfermero: revisión integrativa de la literatura

Ghezzi, Joyce Fernanda Soares Albino; Higa, Elza de Fátima Ribeiro; Lemes, Monike Alves; Marin, Maria José Sanches

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Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0130 copiar

Estrategias de metodologías activas de aprendizaje en la formación del enfermero: revisión integrativa de la literatura

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar evidencias científicas sobre las estrategias de metodologías activas de aprendizaje utilizadas en la formación del enfermero, así como sus contribuciones y obstáculos.

Métodos:

revisión integrativa de la literatura realizada con 33 artículos seleccionados en las bases de datos Medical Literature Analysis and Retrieval System Online, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de Datos de Enfermería, Scopus, Web of Science y Education Resources Information Center.

Resultados:

entre las estrategias, se destacaron la simulación, aprendizaje basada en problemas y clase invertida. La búsqueda activa, la integración teoría y práctica y el trabajo en equipo fueron ejemplos de contribuciones para la formación del enfermero. Aunque, la falta de preparo y de suporte estructural contribuyen para insatisfacción de los estudiantes.

Consideraciones Finales:

la metodología de aprendizaje activa coloca el estudiante en el núcleo del proceso de aprendizaje, favorece el pensamiento crítico y la habilidad de tomar decisiones.

Descriptores:
Aprendizaje Basada en Problemas; Educación en Enfermería; Enfermero; Aprendizaje; Revisión

Database	Keywords	Total of references	Total after discarding of duplicity by Endnote	Analyzed abstracts	References for reading in full	References for Integrative Review
MEDLINE	(active learning) and ((nurse training) or (teaching nurse)	544	543	151	81	13
LILACS +BDENF	(active learning) or (active learning)) and ((training or teaching) and nurse))	5	4	3	3	2
Scopus	(active learning) and ((nurse training) or (teaching nurse)	37	34	34	15	1
WOS	(active learning) and ((nurse training) or (teaching nurse)	136	70	66	34	17
Eric	(active learning) and ((nurse training) or (teaching nurse)	9	9	6	1	0
TOTAL		731	660	260	134	33

Title and Reference	Year Country	Design/ Number of students	Strategies	Main results
Flipping the Classroom Strategies for Psychiatric-Mental Health Course⁽¹⁰10 Burden ML, Carlton KH, Siktberg L, Pavlechko G. Flipping the Classroom Strategies for Psychiatric-Mental Health Course. Nurse Educ. 2015;40(5):233-6. doi: 10.1097/NNE.0000000000000162 https://doi.org/10.1097/NNE.000000000000... ⁾	2015 UNITED STATES OF AMERICA	Experience report n =359	Flipped classroom	The students realized that they were well prepared for active involvement in the classroom
The beneﬁts of active learning: Applying Brunner's discovery theory to the classroom: Teaching clinical decision-making to senior nursing students⁽¹¹11 Costello M. The benefits of active learning: applying Brunner's Discovery Theory to the classroom: teaching clinical decision-making to senior nursing students. Teach Learn Nurs. 2017;12(3):212-3. doi: 10.1016/j.teln.2017.02.005 https://doi.org/10.1016/j.teln.2017.02.0... ⁾	2017 UNITED STATES OF AMERICA	Experience report n = not specified	Flipped classroom	Students felt more prepared to think critically, not just to memorize
Enhancing Student Engagement: Innovative Strategies for Intentional Learning⁽¹²12 Docherty A, Warkentin P, Borgen J, Garthe KA, Fischer KL, Najjar RH. Enhancing Student Engagement: innovative strategies for intentional learning. J Prof Nurs. 2017;34(6):470-4. doi: 10.1016/j.profnurs.2018.05.001 https://doi.org/10.1016/j.profnurs.2018.... ⁾	2018 UNITED STATES OF AMERICA	Descriptive study n = not specified	Simulation	Nursing students had better engagement scores measured by active and collaborative learning.
The Living Family Tree: Bridging the Gap Between Knowledge and Practice in a Family Nurse Practitioner Program⁽¹³13 Ellis KK, Anderson KM, Spencer JR. The living family tree: bridging the gap between knowledge and practice in a Family Nurse Practitioner Program. J Nurs Pract. 2015;1(5):487-92. doi: 10.1016/j.nurpra.2015.03.014 https://doi.org/10.1016/j.nurpra.2015.03... ⁾	2015 UNITED STATES OF AMERICA	Descriptive study n = 266	Problem Based Learning: Living family tree	Students improved clinical reasoning and problem-solving skills, ease of clinical practice, greater control and autonomy in their learning process.
The use of a game-based learning platform to engage nursing students: A descriptive, qualitative study⁽¹⁴14 Gallegos C, Tesar AJ, Connor K, Martz K. The use of a game-based learning platform to engage nursing students: a descriptive, qualitative study. Nurs Educ Pract. 2017;27:101-6. doi: 10.1016/j.nepr.2017.08.019 https://doi.org/10.1016/j.nepr.2017.08.0... ⁾	2017 UNITED STATES OF AMERICA	Descriptive study n = 57	Virtual strategies	The time to learn how to use the platform was limited. The implementation of the strategy could have been better received if an information technologist had provided guidance and assistance in solving problems.
Critical thinking cards: An innovative teaching strategy to bridge classroom knowledge with clinical decision making⁽¹⁵15 Holland C, Ulrich D. Critical thinking cards: an innovative teaching strategy to bridge classroom knowledge with clinical decision making. Teach Learn Nurs. 2016;11(3):108-12. doi: 10.1016/j.teln.2016.01.005 https://doi.org/10.1016/j.teln.2016.01.0... ⁾	2016 UNITED STATES OF AMERICA	Experience report n = 66	Critical Thinking Cards	It helped students apply the content and improved clinical judgment. Students demonstrated a desire for more questions to improve critical thinking and reasoning, as well as the application of this activity in other disciplines.
Implementing Collaborative Learning in Prelicensure Nursing Curricula Student Perceptions and Learning Outcomes⁽¹⁶16 Schoening AM, Selde MS, Goodman JT, Tow JC, Selig CL, Wichman C, et al. Implementing Collaborative Learning in Prelicensure Nursing curricula student perceptions and learning outcomes. Nurs Educ. 2015;40(4):183-8. doi: 10.1097/NNE.0000000000000150 https://doi.org/10.1097/NNE.000000000000... ⁾	2015 UNITED STATES OF AMERICA	Action Research n = 346	Cooperative Learning	The activity contributes to the understanding of the content, responsibility with the self-preparation for classroom. There were difficulties to work in group and to know if the content was being understood in the right way, which generated anguish.
Back to the Basics and Beyond: Comparing Traditional and Innovative Strategies for Teaching in Nursing Skills Laboratories⁽¹⁷17 Staykova MP, Stewart DV, Staykov DI. Back to the Basics and Beyond: comparing traditional and innovative strategies for teaching in Nursing skills laboratories. Teach Learn Nurs. 2017;12(2):152-7. doi: 10.1016/j.teln.2016.12.001 https://doi.org/10.1016/j.teln.2016.12.0... ⁾	2016 UNITED STATES OF AMERICA	Mixed study n = 39	Simulation	Instructor demonstrations and the impact on learning and confidence were considered important.
Can nursing students' conﬁdence levels increase with repeated simulation activities?⁽¹⁸18 Cummings CL, Connelly LK. Can nursing students' con?dence levels increase with repeated simulation activities?. Nurse Educ Today. 2016;36:419-21. doi: 10.1016/j.nedt.2015.11.004 https://doi.org/10.1016/j.nedt.2015.11.0... ⁾	2015 UNITED STATES OF AMERICA	Experience report n = 54	Simulation	The simulations promote critical thinking, active learning in a real world environment, group coexistence and reflection on their performance.
Large Group Simulation: Using Combined Teaching Strategies to Connect Classroom and Clinical Learning1⁽¹⁹19 Moyer SM. Large Group Simulation: using combined teaching strategies to connect classroom and clinical learning. Teach Learn Nurs. 2016;11(2):67-73. doi: 10.1016/j.teln.2016.01.002 https://doi.org/10.1016/j.teln.2016.01.0... ⁾	2015 UNITED STATES OF AMERICA	Experience report n = 46	Simulation	The students evaluated the experience positively, for having more confidence in their skills and starting to think more critically.
Comparing the effects of traditional lecture e and flipped classroom on nursing STUDENTS' critical thinking disposition: A quasi-experimental study⁽²⁰20 Dehghanzadeh S, Jafaraghaie F. Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: a quasiexperimental study. Nurse Educ Today. 2018;71:151-6. doi: 10.1016/j.nedt.2018.09.027 https://doi.org/10.1016/j.nedt.2018.09.0... ⁾	2018 IRAN	Quasi experimental study n = 85	Flipped classroom	Facilitates memorization.
The effect of blended training (Programmed and Lecture-Based Training) on learning health status assessment course among nursing students⁽²¹21 Jafarizadeh H, Rahmani A, Habibzadeh H, Amiri S, Moghaddam AS, Moradi Y. The effect of blended training (Programmed and Lecture-Based Training) on learning health status assessment course among nursing students. Bali Med J. 2017;6(3):606-10. doi: 10.15562/bmj.v6i3.688 https://doi.org/10.15562/bmj.v6i3.688... ⁾	2017 IRAN	Quasi experimental study n = 60	Virtual strategies	The average course scores were higher than those of the control group.
Comparing the effects of problem-based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course⁽²²22 Gholamia M, Moghadam PK, Mohammadipoor F, Tarahib MJ, Sak M, Toulabia T, et al. Comparing the effects of problem-based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course. Nurse Educ Today. 2016;45:16-21. doi: 10.1016/j.nedt.2016.06.007 https://doi.org/10.1016/j.nedt.2016.06.0... ⁾	2016 IRAN	Quasi experimental study n = 40	Problem Based Learning	Increases students' critical skills and acceptance of divergent views.
A comparison of educational strategies for the acquisition of nursing student's performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies)⁽²³23 Zarifsanaiey N, Amini M, Saadat F. A comparison of educational strategies for the acquisition of nursing student's performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies). BMC Med Educ. 2016;16(1):294. doi: 10.1186/s12909-016-0812-0 https://doi.org/10.1186/s12909-016-0812-... ⁾	2016 IRAN	Quasi experimental study n = 40	Simulation	The experimental group obtained a higher performance score, however this training method did not fully strengthen the students' capacity for critical thinking, according to all the cognitive requirements of critical thinking.
Teaching and learning strategies in hospital nursing internship of an integrated curriculum⁽²⁴24 Moraes A, Alves JB, Alves RM, Guariente MHDM. Strategies for teaching and learning in the hospital nursing school of an integrated curriculum. Rev Enferm UFPE. 2017;11(11):4289-97. doi: 10.5205/reuol.23542-49901-1-ED.1111201703 https://doi.org/10.5205/reuol.23542-4990... ⁾	2017 BRAZIL	Descriptive study n = 18	Group discussion; Problem-situation; Spoken newspaper; Portfolio; Group dynamics; Exhibition-dialogue; Movies/videos	More critical, reflective learning. As weaknesses, the individual overload in group work; difficulties in educating students; coercive teaching posture; dynamics outside the theoretical context; films not didactic, outdated and out of the reality experienced.
Perception of undergraduate nursing students on realistic simulation⁽²⁵25 Costa RRO, Medeiros SM, Martins JCA, Cossi MS, Araújo MS. Percepção de estudantes da graduação em enfermagem sobre a simulação realística. Rev Cuid. 2017;8(3):1799-808. doi: 10.15649/cuidarte.v8i3.425 https://doi.org/10.15649/cuidarte.v8i3.4... ⁾	2017 BRAZIL	Descriptive study n = 37	Simulation	Approach with various contexts of practice. Previous experience is reverted into knowledge and generates security. Simulation both enhances the practice of clinical skills and allows for critical thinking and analysis of the various practical situations.
Active teaching methodology in nurse training: innovation in basic care⁽²⁶26 Hermida PMV, Barbosa SS, Heidemann ITSB. Metodologia ativa de ensino na formação do enfermeiro: inovação na atenção básica. Rev Enferm UFSM. 2015;5(4):683-91. doi: 10.5902/2179769216920. https://doi.org/10.5902/2179769216920... ⁾	2015 BRAZIL	Experience report n = 8	Problematization	Encourages interest and initiative for the integration of knowledge, favouring the teaching-learning process.
Active methodologies in nursing graduation: a focus on care for the elderly⁽²⁷27 Souza EFD, Silva AG, Silva AILF. Active methodologies for graduation in nursing: focus on the health care of older adults. Rev Bras Enferm. 2018;71(2):920-4. doi: 10.1590/0034-7167-2017-0150 https://doi.org/10.1590/0034-7167-2017-0... ⁾	2017 BRAZIL	Experience report n = 10	Simulation	It articulates theoretical and practical knowledge, provides experiences similar to situations observed in reality and develops skills related to problem solving, communication, decision making.
Quasi-experimental study on the effectiveness of a ﬂipped classroom for teaching adult health nursing⁽²⁸28 Park EO, Park JH. Quasi-experimental study on the effectiveness of a flipped classroom for teaching adult health nursing. Jpn J Nurs Sci. 2017;15(2):125-34. doi: 10.1111/jjns.12176 https://doi.org/10.1111/jjns.12176... ⁾	2017 SOUTH KOREA	Quasi experimental study n = 81	Flipped classrom	Improvement in critical thinking, creativity, cognitive skills and academic performance.
Comparison of knowledge, conﬁdence in skill performance (CSP) and satisfaction in problem-based learning (PBL) and simulation with PBL educational modalities in caring for children with bronchiolitis⁽²⁹29 Kanga KA, Kimb S, Kimc SJ, Ohd J, Lee M. Comparison of knowledge, con?dence in skill performance (CSP) and satisfaction in problem-based learning (PBL) and simulation with PBL educational modalities in caring for children with bronchiolitis. Nurse Educ Today. 2015;35(2):315-21. doi: 10.1016/j.nedt.2014.10.006 https://doi.org/10.1016/j.nedt.2014.10.0... ⁾	2015 SOUTH KOREA	Descriptive study n = 205	Problem Based Learning and Problematization	The Problem Based Learning group and the combination of simulation results combined obtained higher confidence and knowledge scores than the traditional learning methods group. Students suggest that the Problem Based Learning and a blended learning method are more effective in improving knowledge, confidence and satisfaction. In simulation alone, students did not feel so confident.
Concept mapping to promote meaningful learning, help relate theory to practice and improve learning self-eﬃcacy in Asian mental health nursing students: A mixed-methods pilot study⁽³⁰30 Bressington DT, Wong WK, Lam KKC, Chien WT. Concept mapping to promote meaningful learning, help relate theory to practice and improve learning self-e?cacy in Asian mental health nursing students: a mixed-methods pilot study. Nurse Educ Today. 2018;60:47-55. doi: 10.1016/j.nedt.2017.09.019 https://doi.org/10.1016/j.nedt.2017.09.0... ⁾	2018 CHINA	Mixed study n = 70	Conceptual Mapping	The conceptual mapping approach can be useful for assessing your learning, promoting reflective learning, and encouraging the integration of theoretical knowledge with clinical knowledge, to a deeper level of understanding.
Student peer reviewers' views on teaching innovations and imaginative learning⁽³¹31 Chan ZC. Student peer reviewers' views on teaching innovations and imaginative learning. Nurse Educ Today. 2016;39:155-60. doi: 10.1016/j.nedt.2016.02.004 https://doi.org/10.1016/j.nedt.2016.02.0... ⁾	2016 CHINA	Experience report n = 18	Imaginative learning with poetry, songs and role-plays	LFT provides better conditions for learning, critical thinking, decision-making and communication skills; and if this methodological strategy is joined with other activities, learning becomes even more significant.
Students take the lead for learning in practice: A process for building self-efficacy into undergraduate nursing education⁽³²32 Henderson A, Harrison P, Rowe J, Edwards S, Barnes M, Henderson S, et al. Students take the lead for learning in practice: a process for building self-efficacy into undergraduate nursing education. Nurs Educ Pract. 2018;31:14-9. doi: 10.1016/j.nepr.2018.04.003 https://doi.org/10.1016/j.nepr.2018.04.0... ⁾	2018 AUSTRALIA	Descriptive study n = 431	Check-in e Check-out	The Check-in e Check-out process can be an effective tool for active engagement and learning in clinical learning spaces. It promotes learner empowerment and engagement in their own learning experiences.
CaseWorld: Interactive, media rich, multidisciplinary case based learning⁽³³33 Gillham D, Tucker K, Parker S, Wright V, Kargillis C. CaseWorld(tm): Interactive, media rich, multidisciplinary case based learning. Nurs Educ Pract. 2015;15(6):567-71. doi: 10.1016/j.nepr.2015.10.003 https://doi.org/10.1016/j.nepr.2015.10.0... ⁾	2015 AUSTRALIA	Descriptive study n = 197	Case study	The case study benefits learning. Real-life scenarios give a holistic view of learning.
Using technology to enhance nurse practitioner student engagement⁽³⁴34 Carley A. Using technology to enhance nurse practitioner student engagement. Nurs Pract. 2015;40(7):47-54. doi: 10.1097/01.NPR.0000465119.04536.0e https://doi.org/10.1097/01.NPR.000046511... ⁾	2015 No information	Experience report n = not specified	Simulation	Simulation-based learning offers the opportunity for experiential learning in a safe and risk-free environment.
The Learning Preferences among Nursing Students in the King Saud University in Saudi Arabia: A Cross-Sectional Survey⁽³⁵35 Alharbi HA, Almutairi AF, Alhelih EM, Alshehry AS. The Learning Preferences among Nursing Students in the King Saud University in Saudi Arabia: a cross-sectional survey. Nurs Res Pract. 2017;2017:3090387. doi: 10.1155/2017/3090387 https://doi.org/10.1155/2017/3090387... ⁾	2017 SAUDI ARABIA	Descriptive study n = 56	Visual strategies; active method; sequential and verbal	According to their preferences, students chose visual style (67.9%) as their teaching strategy, followed by the active (50%) and sequential (37.5%) method. The verbal style was the least chosen (3.6%).
Clinical education Improvement of learning domains of nursing students with the use of authentic assessment pedagogy in clinical practice⁽³⁶36 Chong EJ, Lim JS, Liu Y, Lau YY, Wu VX. Clinical education Improvement of learning domains of nursing students with the use of authentic assessment pedagogy in clinical practice. Nurs Educ Pract. 2016;20:125-30. doi: 10.1016/j.nepr.2016.08.002 https://doi.org/10.1016/j.nepr.2016.08.0... ⁾	2016 SINGA PURE	Quasi experimental study n = 54	Pedagogy of authentic evaluation	It helped to improve the domains of learning and critical thinking skills. Allows a closer sequencing of theory and practice, so that students better understand their ability and safety.
Influence of Co-teaching on Undergraduate Student Learning: A Mixed-Methods Study in Nursing⁽³⁷37 Lock J, Rainsbury J, Clancy T, Rosenau P, Ferreira C. Influence of co-teaching on undergraduate student learning: a mixed-methods study in nursing. Teach Learn Inq. 2018;6(1):38-51. doi: 10.20343/teachlearninqu.6.1.5 https://doi.org/10.20343/teachlearninqu.... ⁾	2018 CANADA	Mixed study n = 65	Cooperative Learning	Develops self-confidence to work collaboratively within interprofessional teams and to support patient-centered care. The ability to question and reflect on one's own learning is a key element to being a successful learner.
Practice and effectiveness of web-based problem-based learning approach in a large class-size system: A comparative study⁽³⁸38 Ding Y, Zhang P. Practice and e?ectiveness of web-based problem-based learning approach in a large class-size system: a comparative study. Nurs Educ Pract. 2018;31:161-4. doi: 10.1016/j.nepr.2018.06.009 https://doi.org/10.1016/j.nepr.2018.06.0... ⁾	2018 MEXICO	Descriptive study n = 328	Problem Based Learning	The Problem Based Learning encourages student involvement and encourages the use of prior knowledge in small group environments.
Developing a Serious Game for Nurse Education⁽³⁹39 Johnsen HM, Fossum M, Vivekananda-Schmidt P, Fruhling A, Slettebø Å. Developing a Serious Game for Nurse Education. J Gerontol Nurs. 2018;44(1):15-9. doi: 10.3928/00989134-20171213-05 https://doi.org/10.3928/00989134-2017121... ⁾	2018 NORWAY	Descriptive study n = not specified	Simulation	Allows you to practice clinical reasoning and your decision-making skills in a realistic and safe environment.
Case-based learning: What traditional curricula fail to teach Lina⁽⁴⁰40 Kantar LD, Massouh A. Case-based learning: what traditional curricula fail to teach. Nurse Educ Today. 2015;35(8):e8-14. doi: 10.1016/j.nedt.2015.03.010 https://doi.org/10.1016/j.nedt.2015.03.0... ⁾	2015 LEBANON	Descriptive study n = 16	Case study	Helps to recognize the details of a clinical situation, understand patient data, inform decisions and reflect on the situation.
Theory and practice in the construction of professional identity in nursing students: A qualitative study⁽⁴¹41 Arreciado Marañóna A, Isla Perab MP. Theory and practice in the construction of professional identity in nursing students: a qualitative study. Nurse Educ Today. 2015;35(7):859-63. doi: 10.1016/j.nedt.2015.03.014 https://doi.org/10.1016/j.nedt.2015.03.0... ⁾	2015 SPAIN	Descriptive study n = not specified	Problem Based Learning	Helps deal with new problems, manage your knowledge, take responsibility for events, make decisions, reflect and develop critical thinking
Self-directed Learning Readiness Is Independent of Teaching and Learning Approach in Undergraduate Nursing Education⁽⁴²42 Qamata-Mtshali N, Bruce JC. Self-directed learning readiness is independent of teaching and learning approach in undergraduate nursing education. Nurse Educ. 2017;43(5):277-81. doi: 10.1097/NNE.0000000000000493 https://doi.org/10.1097/NNE.000000000000... ⁾	2017 SOUTH AFRICA	Comparative quantitative crosssectional study n = 159	Problem Based Learning	The overall results show that while Problem Based Learning is effective in self-directed learning, there is no difference between Problem Based Learning and traditional learners.

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[1] Corresponding author: Joyce Fernanda Soares Albino Ghezzi. E-mail: jo.albino1988@gmail.com