Action research on implementing the BOPPPS model in teaching mechanical prophylaxis techniques for deep vein thrombosis

Deep vein thrombosis (DVT) of the lower extremities is a critical complication frequently encountered in hospitalized patients. The annual incidence of first-time symptomatic DVT is estimated at 50 to 100 per 100,000 adults worldwide [1], with approximately 300,000 to 600,000 cases reported annually in the United States and Europe [2‐3]. In China, surgical inpatients face significant risk, with 32.7% classified as moderate risk and 53.4% as high risk for venous thromboembolism (VTE) [4]. To mitigate these risks and enhance patient safety, current clinical guidelines recommend a range of mechanical prophylaxis techniques—including ankle pump exercises, graduated compression stockings (GCS), venous foot pumps, and intermittent pneumatic compression (IPC) devices—tailored to individual patient risk levels [5‐7].

Nurses play a critical role in these interventions by conducting risk assessments, implementing prophylactic measures, educating patients, and monitoring outcomes [8‐9]. The competence and adherence of nursing staff to these protocols directly influence the overall incidence of DVT [10‐12]. Although most prior studies [13‐15] on DVT prevention training have focused on in-service healthcare professionals, Al-Mugheed [16] explored the flipped classroom method to enhance nursing students’ knowledge on VTE. However, a significant gap remains in nursing students’ training, as fundamentals of nursing textbooks offer limited coverage of these techniques.

To address this educational shortfall, our Nursing School integrated a specialized module on DVT mechanical prophylaxis techniques into the “Surgical Nursing” laboratory curriculum in 2021. This module was developed using the BOPPPS teaching model—a framework renowned for its effectiveness in student-centered clinical education [17‐18]. The model comprises six components: Bridge-in (engaging students by linking new content with prior experiences), Objectives (clearly articulating the learning goals), Pre-assessment (evaluating baseline knowledge), Participatory Learning (facilitating interactive and hands-on learning activities), Post-assessment (providing immediate feedback and reinforcing key concepts), and Summary (consolidating the session’s main points).

The implementation followed the “Plan-Act-Observe-Reflect” four-step process of action research [19‐20], and after three cycles, significant teaching outcomes were achieved.

The study aimed to evaluate the effectiveness of the BOPPPS teaching model and action research framework by assessing improvements in multiple domains: theoretical knowledge, practical competence, awareness, and attitudes toward DVT prevention.

The study was conducted from 2021 to 2023. We enrolled approximately 160 sophomore undergraduate nursing students annually. A total of 470 students students from the 2019–2021 cohorts were included (see Table 1). The inclusion criteria were as follows: (a) enrollment as an undergraduate nursing student in the specified cohorts; (b) successful completion of prerequisite theoretical courses in Pulmonary Embolism, Perioperative Nursing, and Deep Vein Thrombosis; (c) registration in the “Mechanical Prophylaxis Techniques for Deep Vein Thrombosis” course; (d) provision of informed consent in accordance with ethical guidelines. Students were excluded if they declined participation. Notably, no participants dropped out during the study period. This study was carried out in strict adherence to the ethical principles outlined in the Declaration of Helsinki.

This study took place at a medical college within a comprehensive university in eastern China. The institution enrolls approximately 240 undergraduate students in nursing and medical programs, 300 diploma-level nursing students, and 30 postgraduate students in nursing and medicine each year.

We collected data during the action research design implemented in three cycles. The first cycle was conducted from 04/01/2021 to 06/30/2021, the second from 03/01/2022 to 05/31/2022, and the third from 03/01/2023 to 05/31/2023.

The assessment is conducted in groups, guided by clinical cases and framed within holistic nursing, with a total score of 100 points. The breakdown includes 50 points for case analysis, which covers thrombosis risk assessment, selection of prophylaxis tools, operation complications, and health education; and 50 points for technical skills.

A self-designed “DVT prophylaxis Attitude Survey” was used, consisting of 20 items. The survey employs a Liker.

t 5-point scale, ranging from “Strongly Disagree” to “Strongly Agree,” with scores of 1 to 5 points, respectively. Higher scores indicate a more positive attitude towards DVT prevention among nursing students.

The group consisted of six members. The Deputy Director of the Nursing Department was responsible for developing the action research plan; the “Surgical Nursing” course lead organized collective lesson planning and evaluated teaching outcomes; two instructors with five years of teaching experience, both head nurses in orthopedics and surgery, were responsible for implementing the plan; two teaching assistants assisted with practical training, assessment, and data collection.

Research [23‐25] conducted in recent years has highlighted concerns regarding the accuracy rates of nursing students in applying key DVT prophylaxis measures. Specifically, one study [26] reported accuracy rates of 16.0%, 24.1%, and 29.7% for three major prophylaxis methods, including the use of the Caprini Risk Assessment Scale. This indicates the need for undergraduate nursing students to better master DVT prophylaxis knowledge and skills during classroom teaching. This study, based on the BOPPPS teaching model, primarily relies on constructivism and emphasizes student-centered, teacher-assisted participatory practice teaching.

By introducing pre-class case studies, the model stimulates students’ motivation to learn. The pre-assessment phase helps understand students’ learning foundations and clarifies teaching objectives. During participatory learning, students work in groups to complete practice tasks based on real case information. They actively engage in the practice process. This approach fosters habits of self-directed learning and critical thinking. The post-assessment phase provides timely feedback on operational issues and enhances students’ self-evaluation abilities.

Nursing students’ learning attitudes directly influence the growth of their practical abilities. Through various forms of education, theory and practice are effectively integrated. This helps develop students’ abilities to systematically analyze problems. It improves nurse-patient communication skills. It also increases students’ motivation for DVT prophylaxis. Table 2 shows that the overall scores in practical training for DVT mechanical prophylaxis techniques and prophylaxis awareness of students from the 2019–2021 cohorts have significantly increased each year, demonstrating statistical significance. effectively enhances nursing students’ knowledge and skills in DVT mechanical prophylaxis. This aligns with findings from similar studies [27‐28], suggesting that the BOPPPS model is beneficial and should be adopted and promoted.

Nursing students must master comprehensive professional knowledge, solid operational skills, clinical thinking abilities, humanistic care awareness, and communication skills [29]. Professional ethics serve as a fundamental guideline for university teachers in teaching, educating, and addressing doubts [30‐31]. Existing studies [32‐34] show that integrating professional ethics into the BOPPPS model helps enhance teaching effectiveness. This study refined the teaching objectives for professional ethics in DVT mechanical prophylaxis techniques. We thoroughly explored and integrated ethical elements throughout the BOPPPS teaching process.

In the Bridge-in phase, we posed questions based on real lung cancer nursing scenarios to help students connect prior learning with new course content, thereby enhancing critical thinking skills. During Participatory Learning, we subtly integrated professional ethics education into nursing technique operations. Teachers emphasized empathy and privacy protection during demonstrations, while students practiced to strengthen their humanistic care awareness and communication skills. In the Summary phase, students applied scientific thinking to solve health problems, internalizing and enhancing their ethical standards and professional qualities. This approach shaped their professional values and sense of responsibility, effectively integrating value shaping, knowledge transmission, and ability cultivation. Consequently, professional courses and ethical education proceeded in parallel, achieving the goal of moral and talent cultivation, and making nursing laboratory teaching more meaningful.

The scientific and standardized design of courses determines the quality and implementation effectiveness. The teaching design of newly introduced experimental projects requires continuous improvement. Action research is a participatory method where researchers and participants collaboratively engage in practical problem-solving through self-reflective inquiry in real-life situations [35‐37]. This approach integrates the research process with addressing practical issues, allowing for immediate application and iterative learning.

This study followed the four steps of action research—Plan, Act, Observe, Reflect—to continuously achieve the integration of knowledge, skills, and attitude objectives, improve the teaching process of DVT mechanical prophylaxis techniques, and enhance the dual-role teacher team’s curriculum design and teaching quality management capabilities. Based on the issues identified in each round of implementation, expert consultation and collective lesson planning were conducted to develop improvement measures and apply them in the next cycle. This not only helps ensure teaching effectiveness but also promotes the awareness and dissemination of course quality improvement, enhancing teachers’ leadership in the curriculum.

Despite the positive outcomes observed, this study has several limitations. First, the study was conducted within a single nursing school, which may limit the generalizability of the findings to other institutions or student populations. Second, the duration of the study was relatively short, and the long-term retention of the knowledge and skills acquired by the students remains uncertain. Additionally, the self-assessment method used to evaluate students’ attitudes towards DVT prevention may be subject to bias, as students might overestimate their understanding or confidence.