Examining the effect of training with a teaching for understanding framework on intravenous therapy administration’s knowledge, performance, and satisfaction of nursing students: a non-randomized controlled study

Intravenous (IV) infusion is a common nursing operation employed in various healthcare settings for managing fluid, electrolyte, and acid-base imbalances [1]. Studies report that more than 70% of inpatients are treated via peripheral intravenous catheters [2]. In China, the amount of IV infusion was as high as 13.692 billion bottles (bags) with the infusion rate of inpatients over 94% in 2014 [3]. Moreover, complications including tube blockage, tube disconnection, fluid extravasation, phlebitis, and infection, are also costly to the healthcare system [3, 4]. As most of the nurses will be involved in infusion care [5], improperly trained nurses have the potential to adversely affect patients [6‐8]. Nonetheless, complications were preventable when nursing students gained adequate training during their education [9]. Therefore, there is an urgent need for educational measures aimed at lowering the number of complications connected to infusion therapy.

Although infusion is frequently performed, nursing students receive little training or opportunity to practice the related skills [8, 10]. With the increase in the sense of authority in directing their medical care, patients may not want to be subjected to initial practical exercises by student nurses. As a result, nursing practitioners are not fully proficient in their skills as practical opportunities for clinical training are increasingly difficult to obtain.

Classroom sessions including lectures, case analysis, and training under the supervision of a teacher were provided in the teaching pedagogies conventionally. But the planning and implementation of intravenous infusions require clinical judgement, interpretation by the nurse, and modification according to the patient’s response [11]. Therefore, the flexibility and variability in clinical work can result in a gap between theory and practice. New instructional methods and modalities should be used to help nursing students to develop these skills.

Selecting a framework based on the conditions is one of the most important steps in educational planning [12]. The Teaching for Understanding (TfU) Framework advocates providing rich material learning environments, offering ample opportunities for interaction and engagement, and leading to further development, which was used to reach quality in education [13]. One of the TfU frameworks is “Putting Understanding Up Front” [14], which is a four-part framework that highlights four key concepts: generative topics, understanding goals, understanding performances, and ongoing assessment. The TfU framework emphasizes understanding and personalized assessment, promoting deep learning for students, but may require more time and resources and pose challenges to teacher skills. A review aimed to analyze the relationship between the European Competency and TfU framework conceived that the TfU framework proposes a structure with enough versatility to cover the needs of teachers and students regarding the classroom processes, and can improve the teaching-learning process [13]. In addition, a study conducted in gastrointestinal surgical department showed the use of the TfU framework can increase the core ability, knowledge, and performance of nurses, and ultimately extends the quality of treatment and patient safety [15].

Although nursing students get excellent theoretical instruction, the prevalence of issues related to patient safety and numerous students may make it challenging for them to develop these practical skills during clinical practice. It is time to reconsider conventional teaching methods and implement deliberate changes to the teaching-learning process. There are no previous studies about intravenous training with TfU framework in China.

Therefore, this study aimed to investigate in the effect of training with the four-part framework on IV therapy administration knowledge, performance, and learning satisfaction of nursing students.

Vascular access is crucial to the effective administration of medications and fluids for resuscitation. Providing health workers with training to use reliable methods was suggested before [19], and improving IV skill in trained nurses has significant effects on patient safety [20]. In the traditional teaching model, teachers demonstrate the workflow and emphasize the key points of steps through oral presentation, which makes it difficult to effectively teach the students. TfU is an approach to think about teaching and how to work with our students [13]. It provides teachers with a language and strategy for enhancing their effects to teach for greater understanding, and makes it much easier for teachers to organize and discuss their approach to a particular topic or an entire course.

In this study, the students trained with TfU framework have significantly better performance than those without (P < 0.05). A study investigated the effect of TfU framework on the development of nursing students’ knowledge and practice skills, and the results revealed that the knowledge and skills scores of the students trained with TfU framework were significantly higher than those trained with regular methods [15]. This study suggests that TfU framework is successful in transferring the skills acquired in the training to clinical practice. Err permission, the chance to practice, and feedback in time may prevent the repetition of mistakes on real patients [21]. The inclusion of simulators is effective way to develop students’ self-confidence, increase their self-efficiency levels [22]. Teaching aids such as a simulator for tube sealing and flushing could strengthen the students’ understanding of the operations of flushing and sealing tubes, which helped improve their operation skills. Skill-specific simulation training and other interventions may help medical students in obstacles to develop proficiency in the clinical setting and improve their skill development [23].

The mean scores of SPL, SPA, SSSP, and total DREEM were significantly higher for those trained with TfU framework. Medical education environment is the sum of all subjective and objective factors related to medical teaching [24], which can directly affect learning effects [25, 26]. TfU framework cultivates a safe learning environment, which enhances teamwork and optimizes learning [27]. The intervention group experienced a learning environment where they could communicate with standardized patients (SPs) and had fidelity with the simulator. Simulation, as one of the understanding performances, provides a low-stakes environment for skills education without exposing patients to risks associated with traditional clinical procedural training [28]. The introduction of new pedagogical practices (SPs, simulation) can improve students’ experience as practice on patients may increase the fear and restriction of students and lead to dissatisfaction among patients. By creating an operation scene similar to clinical practice, students can experience a three-dimensional environment close to clinical practice in advance. Teachers can interrupt the practice at any time, revise students constantly, and give assistance properly. Therefore, students can find their own problems in time.

The results showed that the learning satisfaction scores of students trained using TfU framework are statistically higher. Similarly, other studies have concluded that TfU framework increased the learning satisfaction scores of nursing students [15, 18, 29]. It’s probably because students from the intervention group have better training experience and closer relationships with the teachers. Study indicates that new nurses choose teachers who are open to their questions and assist them to develop proper clinical judgement and practice knowledge [30]. The relationship between students and teachers in training using TfU framework can be described as a two-way partnership between people, based on continuing support, aiming at tackling the needs, issues, and blockages identified by the students. Teachers using TfU framework to conduct the instructional design can draw upon the skills of coaching, questioning, and counselling to lead students, build up their capacity, help them discover their own wisdom, and encourage the students to achieve their goals.

The Teaching for Understanding (TfU) framework offers a valuable teaching approach that emphasizes student understanding and active learning, supported by personalized assessment and feedback. However, its implementation may demand additional time, resources, and teacher expertise. Advantages include its emphasis on deep understanding, promotion of diverse learning environments, and personalized assessment. On the other hand, challenges include increased time and resource requirements, the need for teacher expertise and skills, and operational challenges related to adaptability and flexibility.

We recommend TfU framework to all teachers. Simultaneously, there are some important things to notice about ongoing assessment in the framework. First, the assessment should not take place only at the end of the student’s placement but should be an ongoing practice akin to the nurse process approach of assessing, planning, implement, and evaluation. Assessment can be done on a one-to-one basis, or with the team, aiming to identify gaps in learning. Second, give feedback about the points the nursing students closely focus on during their work [31]. The timing of feedback is important. To encourage timely reflection, offer feedback as soon as possible after evaluating the student’s performance. Concentrate on the student’s strengths first when offering feedback, and discuss with the student how their strengths can be perfectly applied in both the present and future and how to avoid poor performance. Finally, end the feedback session with the most positive aspects of the student’s performance. In other words, criticism is sandwiched between positive and supportive news. Offer specific feedback (on strengths or weaknesses) which is descriptive rather than evaluative, and objective rather than subjective.

Using TfU framework, we have successfully trained students to enhance the learning effect and improve the educational environment. The students’ learning satisfaction level has been demonstrated to be high. This indicates that the nursing education approach with TfU framework represents an effective educational strategy that increases students’ learning satisfaction and fosters students’ skill development. TfU framework calls for teachers who possess communication skills, problem-solving abilities, the ability to identify priorities, the utilization of decision-making strategies, and the capacity to provide learning opportunities for both students and teachers. Teachers should employ this framework to promote positive learning and set higher demands on their professional expertise in order to prepare for the revolution of teaching models and methods.