Applying team-based learning combined with empathy map to improve self-directed learning skills

Self-directed learning (SDL) is a crucial skill for upcoming graduates and is essential to nursing students’ professional development requirements [1, 2]. Academic achievement, learning satisfaction, self-evaluations, and professional nursing values are more likely to improve for first-year nursing students with stronger SDL skills [3, 4]. Therefore, appropriate teaching strategies should be implemented in educational settings to foster students’ learning responsibility and improve their SDL abilities. Team-based learning (TBL) has been prevalent in domestic and international professional healthcare education research for several years. Over 80% of these studies focused on the learning outcomes of students [5]. TBL is used to teach students to be accountable for their own learning and to instill them with SDL skills. Research demonstrates that TBL effectively improves the problem-solving and SDL skills of nursing students [6, 7], and its combination with flipped learning increases students’ engagement with lessons [8]. Students who received TBL performed better academically and were able to retain their knowledge longer than those who received traditional learning [9].

Knowles defined SDL as a process in which learners take the initiative and responsibility to identify their learning needs, goals, strategies, resources, and assessment methods, as well as having larger and more resolute motivations to apply what they’ve learned in their daily lives [10]. Loeng characterized SDL as a multidimensional concept in which the learner controls the status of their own learning activities with minimal assistance from others. In other words, SDL requires learners to be proactive and accountable for their own learning [11]. SDL should be viewed as a collaboration between teachers and students [12], and teachers should be learning promoters rather than communicators [11]. Lifelong learning is essential for developing responsible and autonomous nurses. Nurse preceptors should implement instructional strategies that foster SDL and lifelong learning skills in their students [13]. However, under the traditional framework for instruction, nursing students continue to rely on instructors and are unable to engage in SDL. Dialogic learning should be utilized to help students reflect on and deepen their comprehension of their own values [14].

Larry Michaelsen created team-based learning (TBL) in the late 1970s to facilitate small-group discussions in large classes. TBL improves students’ critical thinking, teamwork, and disciplinary knowledge comprehension and application [15]. In TBL, students first complete a learning assignment and then take a test to evaluate their basic learning outcome. The purpose of this study is to improve their foundational knowledge and readiness for advanced group projects. During team assessments, students deliberate and reach a consensus. They can also ask questions to interact with their peers and teacher, enhancing their sense of responsibility toward their team and their ability to participate in group discussions and communication [15]. TBL courses enhance the problem-solving abilities, SDL, and knowledge of nursing students [7]. Following the implementation of TBL in a fundamentals of nursing course, Kim found that students’ learning attitudes, motivations, and problem-solving skills improved [16]. A TBL course design also effectively improved the SDL skills of medical students [6]. In a psychiatric nursing curriculum, Park and Park combined TBL and flipped learning [8]. The results demonstrated that the students readily integrated diverse viewpoints through teamwork and were engaged in the lessons. The teacher acted as a facilitator who guided students to engage in SDL and enjoyable lesson immersion. Switching from teacher-centered to group-based learning activities increased the nursing students’ self-management, teamwork, and SDL skills [17].

Dave Gray developed the empathy map to help designers overcome their egocentric tendencies by analyzing and considering the user’s perspective [18]. By observing a user’s actual service experiences and opinions, this instrument enables designers to illustrate the needs of different customer groups [19]. An empathy map helps a designer consider the viewpoint of another individual. It is utilized frequently in group-based design thinking but infrequently in medical education. The only instance was when Cairns et al. incorporated empathy maps into a medical student communication skills training program [20]. The results revealed that the students’ perspectives on empathy and patient-centered care were influenced by empathy maps. Empathy maps are a cost-effective way to promote empathy and patient-centered care in medical education and other care-related professions.

Nurses must establish trustworthy nursing relationships with patients with mental disorders in order to gain an in-depth understanding of the patient’s inner world. Due to the lack of breadth and depth in their life experiences, it is difficult for nursing students to develop empathy, and traditional teaching approaches offer no assistance in meeting their needs in the affective component of learning [21]. An empathy map is a tool that assists a person to understand the perspective of others, and is therefore feasible for preliminary case analysis or empathy training [18]. And incorporating empathy into classroom instruction promotes teamwork and proactive collaboration among students [19]. Attempting to switch from teacher-centered to group-based learning activities should not only increase the teamwork spirit of nursing students, but should also be quite effective in improving SDL skills. Therefore, this study applied a method combining team-based learning and empathy mapping in a psychiatric nursing course to examine its effectiveness in improving nursing students’ SDL skills and academic performance.