Data Extraction for Systematic Reviews and Research

This chapter discusses the data extraction of the data from the chosen research articles through using valid tools. The JBI data extraction tool has been used to draw out the key information regarding the study settings, sample, method and outcomes.

Running head: NURSING EDUCATION SYSTEMATIC REVIEW
NURSING EDUCATION SYSTEMATIC REVIEW
Name of the student:
Name of the University:
Author note:

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Chapter 6: Data Extraction for Systematic Reviews and Research
In the following critical appraisal, eight randomised control trial of high methodological
quality have been chosen. This chapter will discuss the data extraction of the data from the
chosen research articles through using valid tools. The objectives of this data extraction is to
capturing all the essential data from the chosen studies considering the research questions,
results and methodologies (Pearson et al. 2007). It is the most essential part of the ssystamatic
review, where the information related to research questions has to be extracted and accurate
summary of research evidence could be provided (Oxman & Guyatt 1993). For this data
extraction the JBI (2008) data extraction tool has been used to draw out the key information
regarding the study settings, sample, method and outcomes. The JBI data extraction tool
requires and piloting toensure the right information is captured (Elamin et al. 2009). For this
study the optimum data extraction tool has been advised (CRC 2009). JBI (2008) tools
suggests many difficulties have to be overcome during the data extracting process from
studies involving differences in populations, interventions administered differently, different
outcomes studied. Besides, to minimise the chances of occurring an error the data extraction
form is used with specific design for each review (Pearson et al. 2007). In all these reviews
the studies are experimental design, which requires the JBI data extraction form for
experimental/observational studies. For more accuracy, two or more researchers should do
the data extraction independently to ensure clarity and minimise errors (JBI 2008). However,
because of the limited time the this review and data extraction was conducted by the author
and then reviewed by an independent reviewer in order to ensure the authenticity and
accuracy. The pilot extraction could be carried out in the first instance to testify the validly of
the chosen data extraction method(Elamin et al. 2009). However, because of conducting the
data extraction with this was not undertaken for this JBI data extraction form for original

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experimental studies , it can be considered as reliable method for extracting the data from
experimental research designs (Pearson et al. 2007).
6.1 JBI Data Extraction
Reviewer
Author Gita Sangestani, Mahnaz Khatiban,
Year 2013
Journal Nurse Education Today33: 791–795
Study Method Quasi-experimental study, Secondary research, Survey based primary research
Participants Setting:
Hamadan University of
Medical Sciences,
Population:
Undergraduate
midwifery students
From:
Hamedan, Iran.
Sample size LBL group: 28 Male and Female PBL group: 29
Interventions Randomly, one class (experimental group) received PBL in addition to LBL and
the other one (control group) received traditional LBL. “Pregnancy and
childbirth”, a 2-credit course, was selected for this purpose.
Scientific pre-test and post-tests were performed and satisfaction questionnaire
was filled in for both groups. A questionnaire to compare PBL and LBL was
filled in only for the experimental group. The instruments used in the study were
“Demographic data form”, “Students' learning progress test”, “Student's
satisfaction of teaching method”, and the “Teaching method evaluation”.
The control group received traditional didactic lectures throughout the semester
on the same content areas. Students had opportunities to ask questions and use
reference books and teaching materials. For the PBL group, the authors
developed four PBL course syllabi following the critical review of the
“Pregnancy and childbirth” course.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Demographic characteristics were compared
between the experimental and control groups
using the chi-squared and independent
sample t-test.
The “Demographic data form”
consisted of student's age,
marital status,
the number of children, the place
of living, employment status,
and the GPA of last semester. It

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was developed according to
Safari
et al. (2006) study's demographic
data form.
Pre- and post-test scores were compared
using paired t-test. ANOVA was also used to
control the effects of the pre-test scores on
the experimental and control groups differed
post-test mean scores as well.
The “Students' learning progress
test”: two parallel multiple
choice
questions pre- and post-tests.
These tests were designed by the
authors
based on the formal course
objectives to measure the
students'
achievements in the direction of
the course objective
Study Results
The results of the study indicates at the fact that the learning progress in the intervention group with
the problem based learning education intervention was far greater than the control group. PBL
improved application of theory lesson in clinical practice, along with that it also increased learning
motivation and enhanced educational activity in class. Furthermore, the level of satisfaction with
PBL method was also found to be greater.
Authors Conclusion:
Learning progress in PBL group was significantly more than control group. PBL improved
application of theory lesson in clinical practice, increased learning motivation and enhanced
educational activity in class.81.8% of students considered PBL the more suitable and better
method. PBL should be applied more in undergraduate midwifery courses. According to
these advantages, the quality of midwifery education can be improved via this method.
Reviewers Comment:
This study has shaded light on the scope of effective application of problem based learning
practice. This study presented a practical evidence based outcomes that encourage the nursing
system to make some changes for overall improvement. Besides, the sample size was small,
and the study period was only 16 weeks. The effect of PBL in clinical midwifery education
and practice was not done properly. The researcher were the tutors, which could affect the
preference of students.

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Reviewer
Author Moon-Sook Yoo, Jin-Hee Park
Year 2014
Journal Nurse Education Today34: 47–51
Study Method quasi-experimental design using pre-test, intervention, and post-test with a non-
synchronized,non-equivalent control group
Participants Setting:
Large university hospitals
in Korea
Population:
new graduates without
any previous experience
as RNs
From:
Korea
Sample size Intervention group:
CBL group 94
Control group:
LBG group 96
Interventions The research used a simulated test consists of three cases, which depictcommon
clinical problems. Relevant questions were developed based on Performance Based
Development System (PBDS) as per the scenarios.
Traditional lecture-based education for the control group was conducted through
the traditional lecture style. The lectures lasted a total of 150 minutes and were
conducted over 3 sessions, one per week, 50 minutes per session.
Through discussions, graduate nurses were encouraged to compare and analyze the
source of the problems discussed, and to draw various results based on the
proposed/ discussed solutions.
The post-test was conducted 10 weeks after the education program to measure
objective problem-solving abilities and subjective problem-solving abilities.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Homogeneity of two group tested through
paired T-test
Age of the participants in different
working department and the year
educational level
Problem solving ability was tested through
pre-test paired T-test
Mean score in problem solving
test considering the both mean
value and SD fluctuation
After 10 weeks post test was analysed with
paired T-test.
Mean score in objective and
subjective problem solving test
considering the both mean value
and SD fluctuation
Study Results

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In problem solving ability Pre-test, objective and subjective problem solving test resulted the P value
of 0.409 an 0.865, which are higher than the probability value 0.05. In problem solving ability Post-
test, objective and subjective problem solving test resulted the P values, which are lower than the
probability value 0.05. Results of the study indicated that significant differences among the groups
were observed in their problem-solving abilities. The CBL group scores were determined to be
significantly higher compared with the lecture-based group scores on objective problem-solving
ability.
Authors Conclusion:
Subjective problem-solving ability was also significantly higher in CBL group than in the
lecture-based group. These results may suggest that CBL is a beneficial and effective
instructional method of training graduate nurses to improve their clinical problem-solving
ability.
Reviewers Comment:
The results of this study have valuable implications for teaching, learning and nursing
educational research, and offer an effective learning structure in the professional development
and education of graduate nurses in the workplace. Although, to criticize, the small sample size
of the article is needed to be considered, a very important limitation of the study. Similarly, the
study had been a quasi-experimental intervention which lacked the element of randomization,
which can affect the authenticity of the data due to personal bias.

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Reviewer
Author Kyung-Ah Kang, SungheeKim, Shin-Jeong Kim, Jina Oh and MyungnamLee
Year 2015
Journal Nurse Education Today
Study Method Comparison design using pre-test, intervention, and post-test with a non-
synchronized, non-equivalent control group
Participants Setting:
Nursing schools in Seoul
and Chuncheon, South
Korea
Population:
205 senior nursing
students
From:
South Korea
Sample size Intervention group:
PBL group 69
Control group:
No PBL group 74
Interventions The research used a problem based learning sessions for the first experiment
group to improve students' clinical performance and critical thinking skills.
The problem based learning was provided to be the intervention group with four
main learning objectives and five sub-objectives.
The problem based learning was provided with didactic lecture about ‘Care for
child with Bronchiolitis’
During simulation practice, three to four students participated as a team in each
session. Both control group and experimental group performed in this simulation
session.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Knowledge of patient care for children with
bronchiolitis was tested
A dichotomous scale developed
by the researchers which
incorporates three subcategories:
pathophysiology (3 items),
diagnosis and symptoms (7
items) and nursing care (10
items). Each item was scored as
either 0 (incorrect) or 1 (correct),
with higher scores indicating a
greater degree of knowledge.
Descriptive statistics, paired t-test, one-way
ANOVA, and post-hoc tests (Duncan test)
were performed.
Students' satisfaction with their
training was measured using a
Levett-Scale reflection (9 items),
clinical reasoning (5 items), and

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clinical learning (4 items)
Study Results
The results indicated at no significant difference in the baseline knowledge of the student regarding
patient care for patients with bronchiolitis. There were significant differences in the mean scores of
knowledge (F = 14.718, p b .001), CSP (F = 12.693, p b .001), and students' satisfaction (F =
93.471, p b .001) among the three groups.
Authors Conclusion:
The positive impact of PBL and a combined learning method is suggested to be an effective
approach in paediatric nursing practice. The results of the study provided an essential
template and starting point for educators introducing active learning approaches for paediatric
nursing courses.
Reviewers Comment:
The results of the study indicate at the effectiveness of a revolutionary technique in learning
of the nurses to improve clinical performance. Based on the data findings of this research
study, extensive large scale studies can uncover efficient techniques to incorporate PBL and
simulation assisted PBL in nursing education curriculum for continual improvement in
practice.

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Reviewer
Author Habib Farida; Delal Khalil Eshra; Jane Weaver; Wendy Newcomer, Charles
O’Donnell; Martha Neff-Smith
Year 1999
Journal Journal of Multicultural Nursing & Health
Study Method Comparison design using quasi-experimental non-concurrent group
Participants Setting:
High Institute of
Nursing, Menoufiya
University
Population:
Third year students of
Bachelor of Science in
Nursing
From:
Egypt
Sample size Intervention group:
Community Oriented Problem Based
learning (COPBL) group 54
Controlee group:
Traditional lecture based method
group 52
Interventions The problems and teaching materials were utilised in COPBL approach through
the period of nine months.
Evaluation of faculty performance by students in each group. Project
implementation consisting preparation, implementation and evaluation
Students were monitored over two semesters including fall 1997 and spring
1998. The approach used in 1997 was traditional teaching approach, which was
given throughout 15 weeks.
In 1998 the COPBL approach was used on students through conferencing,
problem based case studies, group discussion and clinical assignments.
At the beginning of the 1997 semester, a test was taken and after the semester,
another test was taken. At the beginning of the 1998 semester, students were
tested in multiple time throughout the semester to monitor the progress.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Evaluation of faculty performance has been
measured in Pre natal, Natal, Post natal,
Gynecology and Family planning topics
Mean value of COPBL and
Traditional group have been
measured by dividing the total
score ‘S’ by the number of
participants ‘n’ (S/n)
T-test has been conducted to test the
hypotheses
The critical probability variable
has been set to P=0.05 to test the
outcomes
Study Results
All three outcomes measures of the study showed that the COPBL group made a significant

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differences in terms of learning ability, interpretation ability and implementation fluency. The P
value of Pre natal, Natal, Post natal, Gynecology and Family planning topics are 0.0001, 0.54, 0.19,
0.0001, 0.24 respectively. Most of the p value accepts the alternate hypothesis that stated that
COPBL group should get better score. The observation also showed that COPBL group also used
nursing library more frequently than the traditional group in order to solve their problem with their
own conceptualisations and knowledge.
Authors Conclusion:
Student who taught with COPBL approach improved their communication skills, self-
confidence and client education skill better than the students’ taught with traditional lecture
method. Therefore COPBL is a better approach for nursing education that can lead to higher
potentiality of achievement.
Reviewers Comment:
Due to the prior knowledge of the students in the chosen topics the results might be affected
and even biased. However, the study shades light on promoting the COPBL with adequate
evidences. This study will also help to develop a tool to increase the efficiency of teaching
practice and approaches in Nursing Training especially for 3rd year students.
Reviewer
Author Marta Arrue , Begoña Ruiz de Alegría, Jagoba Zarandona, Itziar Hoyos Cillero
Year 2017
Journal Nursing Education Today
Study Method Quasi-experimental study with pre-test and post-test design in experimental and
control group
Participants Setting:
The University
of the Basque Country
(UPV/EHU)
Population:
Third year Nursing under
graduate students
From:
Vizcaya, Spain
Sample size Intervention group:
Problem based learning group 55
Control group:
Traditional lecture based method
group 44
Interventions Pre-Test for both group was conducted to identify their knowledge and
comprehensiveness on the topic depression

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Both groups have been taught by individual technique during the first term of the
third year
The implementation of problem solving occurred on the topic of Mental Health
Nursing subject. This course was worth 6 credits and was taught in the first term
of the third year.
A few days after the previous sharing in class, and after a group activity done
outside of the classroom, the students presented and defended their solutions to
the problem with the rest of the class.
Post –Test for both group was conducted to identify the changes in their
comprehensiveness on the topic depression due to learning and teaching method
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Experimental group showed significant
difference in their knowledge in DK, AK
The score has been measured
through marks and the mean
value.
Control group did not show any significant
difference in their knowledge on DK and AK
The score has been measured
through marks and the mean
value.
Comparison of Probability value or P value P values have been formulated
by Friedman test
Study Results
The results obtained in the EG showed a significant improvement in the students' scores for LO.1
(Identifies depression) (p=0.000), LO.2 (Justifies the diagnosis of depression) (p=0.000), LO.3
(Identifies relevant data that can explain the problem) (p = 0.000) and LO.5 (Justifies nursing
strategies) (p = 0.000). The difference in pre and post test scores for PBL group was significantly
different, where the probability values were lower than 0.05. On the other hand, the pre and post
test score of control group did not have any significant differences that showed higher probability
values is most of the topics.
Authors Conclusion:
The PBL applied in the Nursing undergraduate degree courses is able to provide
opportunities to develop an argumentative ability in the students. With this teaching and
learning strategy students have showed much deeper understanding of what they have learnt.
Reviewers Comment:
This study is a very valuable evidence of different outcomes caused by PBL learning and
training strategy. At the same time, this study was focused on a specific group of student who
belonged from a particular educational system. Therefore, the result could be different

12NURSING EDUCATION SYSTEMATIC REVIEW
depending on the sample population and settings.
Reviewer
Author Piu Santra, Smritikana Mani
Year 2017
Journal International Journal of Nursing Education
Study Method Non-equivalent pre-test post-test design
Participants Setting:
Medical College &
Hospital and College of
Nursing, R.G.Kar
Medical College &
Hospital
Population:
Third year undergraduate
students of B.Sc in
Nursing
From:
Kolkata, India
Sample size Intervention group:
Problem based learning group 41
Control group:
Traditional Teaching group 42
Interventions Pre-Test for both group was conducted to identify their knowledge and
comprehensiveness on the topic depression
Both groups have been taught by individual technique during the first term of the
third year
Teaching session was conducted on TT group regarding VAP. PBL was
introduced to the groups with a set of problems. To solve the problems embers
of the each group discussed with each other along with experts.
The investigator conducted brainstorming session with each group. Structured
knowledge questionnaire was administered and self-reporting was used to collect
the data.
Post –Test for both group was conducted to identify the changes in their
comprehensiveness on the topic depression due to learning and teaching method
Clinical
Outcome
Outcome Description Scale/Measure
Experimental group showed significant The score has been measured

13NURSING EDUCATION SYSTEMATIC REVIEW
Measure difference in their knowledge through marks and the mean
value.
Control group did not show any significant
difference in their knowledge
The score has been measured
through marks and the mean
value.
T-test comparison for the scores in Pre and
Post test conducted on Traditional Teaching
and
P values have been formulated
calculating the frequency
distribution of scores
Chi-square Test Above and below median of the
number of the students between
two age groups hves been
measured
Study Results
Nursing students of PBL group acquired adequate knowledge (> 75%) in all areas except
pathophysiology. The changes of the score in PBL groups showed chi-squire value lower that 0.05
(p-value). On the other hand, the changes of the score in TT group shoed chi-squire value higher
than 0.05 (p-value). Therefore, the alternative hypotheses have been accepted. The mean post-test
knowledge score ( 24.10) of the students of PBL group is higher than the mean pre-test knowledge
score ( 13.56) with a mean difference of 10.44 which is statistically significant.
Authors Conclusion:
The PBL applied in the Nursing undergraduate degree courses is able to provide
opportunities to develop an argumentative ability in the students. With this teaching and
learning strategy students have showed much deeper understanding of what they have learnt.
The problem based learning strategy is better technique of developing the critical thinking
and argumentative perception among nursing students. It is found that PBL is more effective
to improve the knowledge regarding VAP rather than TT. In nursing education, PBL can be
adopted along with TT.
Reviewers Comment:
This study is a very valuable evidence of different outcomes caused by PBL learning and
training strategy. At the same time, this study was focused on a specific group of student who
belonged from a particular educational system. Therefore, the result could be different
depending on the sample population and settings. However, there can be still remain some
ambiguity associated with the improvement result of problem based learning for the study of
pathology.

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15NURSING EDUCATION SYSTEMATIC REVIEW
Reviewer
Author Eunyoung Choi, Ruth Lindquist, Yeoungsuk Song
Year 2013
Journal Nurse Education Today
Study Method quasi-experimental non-equivalent group pretest–posttest design
Participants Setting:
Nursing school of South
korea
Population:
First year undergraduate
students of Nursing
From:
South Korea
Sample size Intervention group:
Problem Based Learning group 46
Control group:
Interventions A nonequivalent control group pretest–posttest design was used
in this quasi-experimental study.
The research compared the effects of instruction with the usage of PBL strategies
versus traditional education on problem solving, critical thinking as well as self
directed learning ability of Korean nursing students.
Participants in two groups are comprised of first year nursing students from two
of the junior college nursing schools at various cities located in Korea in order to
prevent contamination.
A power analysis was used in order to determine that the required sample size
was 44 per group.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
The experimental group have demonstrated
significant difference in their knowledge.
The score has been measured
with the help of marks as well as
mean values.
However when it comes to control group, no
such significance difference in their
knowledge was observed.
The score has been measured
with the help of marks as well as
mean value.
ANCOVA test comparison for the sores in
Pre as well as Post test conducted on
traditional teaching.
P values were formulated for
calculating the frequency
distribution of scores.
Chi-square and t-test were employed for
comparing the baseline measurements of
demographic characteristics along with
dependent variables between two groups.
Above and below median of the
number of the students between
two age groups have been
measured.
Study Results

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The mean age in the PBL group was found to be 18.7 years in the PBL group and 18.6 years in the
traditional group. When it comes to prior education, more students were found to attend academic
high school rather than attending a vocational high school. ANCOVA using the pre-test was used in
order to compare the outcome between the two groups. While the critical thinking scores for
students after PBL increased by 2.20 points, it increase by 0.882 when it comes to traditional
points. Problem solving score got enhanced by 4.13. However, the problem solving score got
decreased by 1.30. No statistical significance was observed between two groups.
Authors Conclusion: From the above mentioned study, the author have come to the
conclusion that despite the learning outcomes demonstrated a trend to enhance more in the
PBL Group compared to the traditional group, no mention worthy difference was noticed.
Thus this study suggests no true difference. The correlations among critical thinking, problem
solving as well as self-directed learning were positive and significant. According to the
author, higher will be the self directed learning, better will be the critical thinking ability and
problem solving.
Reviewers Comment:
Like the previous study, this study can be considered to be a valuable evidence of various
outcomes that occurred by PBL learning as well as training strategy. Along with this, this
research has focused on a specific group of students who belongs to a particular educational
system. Thus there remains a probability of change in the result in cae the sample size and
setting can be differentiated.
Reviewer
Author Mohammad Gholami, Parastou Kordestani Moghadama, Fatemeh
Mohammadipoor, Mohammad Javad Tarahi b, Mandana Sak, Tahereh Toulabi,
Amir Hossein Hossein Pour
Year 2016

17NURSING EDUCATION SYSTEMATIC REVIEW
Journal Nurse Education Today
Study Method quasi-experimental, single group, pretest-posttest design
Participants Setting:
Khorramabad School of
Nursing
andMidwifery
Population:
Third year undergraduate
students of Nursing
From:
West Iran
Sample size Intervention group:
Problem Based Learning group 40
Control group:
Traditional Group 40
Interventions The critical thinking skills and metacognitive awareness of 40 third-year students
were assessed a week before the beginning of the semester.
After the pre-test was completed, the research team divided the full content of
the critical care nursing source which was scheduled for 32 hours sessions into a
lecture part along with a PBL part. During this random division of the course
content, 16 topics were allocated for teaching 16 topics.
Following the pretest, the second author held 32 h of lecture including a routine
Q&A part for four hours per week and for a total of eight weeks. By the end of
the lecture part of the course, which coincided with the students' midterm, the
researchers measured the students' critical thinking skills and meta-cognitive
awareness once again.
All the 40 students who had formerly made up the lecture group now formed the
experimental group to have a PBL educational intervention performed on them
and were randomly divided into four groups of ten.
Clinical
Outcome
Measure
Outcome Description Scale/Measure
Along with using descriptive statistics and
after ensuring the normal distribution of the
variables, the t-test compared the mean
scores and the changes in the score.
The score has been measured
through marks as well as through
the mean values.
Data was analysed in SPSS Paired t-test was used
No significant difference in score was seen
between the mean score obtained for critical
thinking and meta-cognitive awareness
skills.
Traditional lecture method was
performed.
Study Results
The mean score obtained from critical thinking skills as well as meta-cognative awareness where
9.74 and 2.5 at the beginning of the semester. When it comes to mean scores at the beginning of the

18NURSING EDUCATION SYSTEMATIC REVIEW
semester, it is 9.72 after lecture part of thee course and 2.47 before the PLB part. A significant
improvement was evidenced when it came to the results of the paired t-test as well as the
comparison of the mean changes in the pre and post intervention posts. The comparison of the
mean scores obtained from various dimensions of critical thinking after each of the lecture along
with PBL methods being implemented.
Authors Conclusion: According to the author, the PBL method has a statistically significant
effect on the development of metacogitive awareness as well as thinking skills in the nursing
students. However, the management of the class, along with the details of implementation of
PBL are essential for the further development of these skills.
Reviewers Comment:
In this research paper, the author have compared the effect of problem based learning as well
as the traditional lecture method on critical thinking skills and meta-cognitive awareness
in nursing students in a critical care nursing course. Considering the fact that the study
presented a practical evidence based outcomes, it possess the potential to make some changes
for the overall improvement.

19NURSING EDUCATION SYSTEMATIC REVIEW
6.2 Data synthesis
After conducting the data extraction, the collected data needs to be synthesized and
organised properly to formulate the answer the review questions (Brown 2014). With this
regards, it can be said that the narrative synthesis is the most compatible data synthesising
method for this research, that depends on the similarity or homogeneity of the studies
(Groves et al 2013). Meta analysis is a very common method, which is also considered the
highest form of evidence as statistical findings are combined giving them greater strength and
meaning (Portney and Watkins 2014). The meta-analysis can only be feasible if the inclusive
studies would have extremely homogeneity. In this case the settings are significantly different
in various chosen studies the meta analysis could not be applied (Gerrish and Lathlean 2015).
Therefore, the direct meta analysis will not be feasible on heterogeneous data, which could
lead to sever anomaly (CRD 2009).
6.2.1 Introduction:
After data extraction, the data needs to be brought together to start to answer the
review question. Narrative synthesis is the common starting point and can sometimes be
followed by meta-analysis, depending on the similarity or homogeneity of the included
studies. The detailed guidance regarding narrative synthesis has four stages for the reviewer
to work through that includes Developing the theoretical model, Developing the primary
synthesis, Exploring the relationship within and between the studies, Assessing the
Robustness of the synthesis (Hatala et al., 2014).
6.2.2 Developing the theoretical model:

20NURSING EDUCATION SYSTEMATIC REVIEW
To develop the theoretical model considering the purposes of the studies is very
essential. As per the initial consideration and constrain choosing the research article it is
clear, that the purpose of this studies is to compare the effectiveness of traditional learning
process with learning based approach in nursing training process. However, in this case the
theory has been already developed that emphasise the process and the significance of
problem based learning. Therefore for data synthesis no additional theory development or
synthesis will be required. The problem based learning is an emerging learning as well as
teaching process that allows the students to gain their knowledge not only by theoretical
perception but also through implementable interventions (Cooper & Carver, 2012). Arguably
PBL is the most advance way of learning method that can eliminate all the limitations of
traditional lecture based learning process. The earliest explanations of the benefits of PBL
were drawn from information processing theory
From this perspective, a key benefit of PBL is that group discussion helps learners to
activate prior knowledge. In addition, PBL discussions provide opportunities for learners to
elaborate upon their understanding and connect their new learning to knowledge stored in
long-term memory. Beyond these mechanisms, a key idea from information processing is the
notion of transfer appropriate processing, which states that when people learn in a problem
solving context, they should be able to retrieve that information when it is needed. In PBL the
knowledge is encoded in a problem-solving context, students should be more likely to
retrieve that knowledge when faced with future problems, something that is especially
important to professional education. In these settings, students are often learning foundational
disciplines (e.g., basic sciences for medicine and psychology in teacher education). The goal
for learning is often not to learn these disciplines in isolation, but to apply disciplinary
knowledge to problem solving.

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6.2.3 Developing preliminary synthesis:
In the preliminary synthesis phase the paper discusses the interventions of the chosen
studies and their results. At the same time, this section also helps to find the preliminary
pattern of the outcomes from the chosen studies. In this discussion of nursing training and
learning approach and the effectiveness of Problem Based Learning approach, the study
design as well as the formulated outcomes can help to develop preliminary synthesis.
Settings:
In this section the study settings and timeline have been synthesised in tabular form.
Frome the selected studies the settings and the participants can be identified and presented as
below:
Study Settings
Sangestani, Khatiban, 2013 Hamedan, Iran.
Yoo, Park, 2014 Korea
Kang et al., 2015 South Korea
Farida et al., 1999 Egypt
Arrue et al., 2017 Vizcaya, Spain
Santra, Mani, 2017 Kolkata, India
Choi, Lindquist, Song, 2017 South Korea
Gholami et al., 2016 West Iran
Table 1: Comparison of setting
Participants

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In this section the study settings and participants choice have been presented in tabular form.
The purpose of this section is to synthesise the sampling strategy of the chosen studies.
Study Sample size Age group Experimental
group
Control Group
Sangestani,
Khatiban, 2013
57 Undergraduate
students
29 (PBL) 28 (LBL)
Yoo, Park, 2014 190 Newly nursing
graduates
94 (CBL) 96 (LBG)
Kang et al., 2015 145 Senior nursing
students
69 (PBL) 74 (LBI)
Farida et al., 1999 106 3rd year
undergraduate
nursing students
54 (COPBL) 52 (TLBL)
Arrue et al., 2017 99 3rd year nursing
undergraduate
nursing students
55 (PBL) 44 (TLBL)
Santra, Mani, 2017 83 3rd year nursing
undergraduate
nursing students
41 (PBL) 42 (TLBL)
Choi, Lindquist,
Song, 2017
90 1st year nursing
undergraduate
nursing students
46 (PBL) 44 (TLBL)
Gholami et al.,
2016
80 3rd year nursing
undergraduate
nursing students
40 (PBL) 40 (TLBL)
Table2: Study Participants
Study Design and Intervention
In this section the study design and Intervention patterns of chosen studies have been
synthesised to formulate the primary synthesis results.

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Study Study design Interventions
Sangestani,
Khatiban, 2013
Quasi-experimental study A questionnaire to compare PBL and LBL was
filled in only for the experimental group.
Yoo, Park, 2014 Comparison design using
pre-test, intervention, and
post-test with a non-
synchronized, non-
equivalent control group
The post-test was conducted 10 weeks after the
education program to measure objective
problem-solving abilities and subjective
problem-solving abilities.
Kang et al., 2015 Comparison design using
pre-test, intervention, and
post-test with a non-
synchronized, non-
equivalent control group
The problem based learning was provided to be
the intervention group with four main learning
objectives and five sub-objectives. The problem
based learning was provided with didactic
lecture about ‘Care for child with
Bronchiolitis’. During simulation practice,
three to four students participated as a team in
each session.
Farida et al., 1999 Comparison design using
quasi-experimental non-
concurrent group
Evaluation of faculty performance by students
in each group was measured. Project
implementation consisting preparation,
implementation and evaluation were conducted
Arrue et al., 2017 Quasi-experimental study
with pre-test and post-test
design in experimental and
control group
Pre-Test on both groups was conducted to
identify their knowledge and
comprehensiveness on the topic of depression.
Post –Test for both group was conducted to
identify the changes in their comprehensiveness
Santra, Mani, 2017 Non-equivalent pre-test
post-test design
Pre-Test on both groups was conducted to
identify their knowledge and
comprehensiveness on the topic of depression.
Both groups have been taught by individual
technique during the first term of the third year.
Choi, Lindquist,
Song, 2017
quasi-experimental non-
equivalent group pretest–
posttest design
Participants in two groups are comprised of
first year nursing students from two of the
junior college nursing schools at various cities
located in Korea in order to prevent
contamination. A power analysis was used in
order to determine that the required sample size

24NURSING EDUCATION SYSTEMATIC REVIEW
was 44 per group.
Gholami et al., 2016 quasi-experimental, single
group, pretest-posttest
design
During this random division of the course
content, 16 topics were allocated for teaching
16 topics. Following the pretest, the second
author held 32 h of lecture including a routine
Q&A part for four hours per week and for a
total of eight weeks.
Table 3: Study design and intervention
Outcome measures
In the following section the outcomes of the studies has been synthesised. In order to
do so, the tabular presentation has considered both results and conclusions as their
accumulated outcomes. Scientific pre-test and post-tests were performed and satisfaction
questionnaire was filled in for both groups. The research used a simulated test consists of
three cases, which depictcommon clinical problems. Relevant questions were developed
based on Performance Based Development System (PBDS) as per the scenarios. Evaluation
of faculty performance by students in each group was measured. Project implementation
consisting preparation, implementation and evaluation were conducted. Pre-Test on both
groups was conducted to identify their knowledge and comprehensiveness on the topic of
depression. Post –Test for both group was conducted to identify the changes in their
comprehensiveness on the topic depression due to learning and teaching method. A power
analysis was used in order to determine that the required sample size. After the pre-test was
completed, the research team divided the full content of the critical care nursing source which
was scheduled for 32 hours sessions into a lecture part along with a PBL part. In this section
the parameters which were utilised to detect the learning ability of the students and their
feasibility of their knowledge are compared side by side. The purpose of this comparison is to

25NURSING EDUCATION SYSTEMATIC REVIEW
find out the similarities and differences of different selection of parameters and their potential
results.
Study Critical
thinking
skill test
Problem
Solving
test
Descriptiv
e
Knowledge
test
Cognitive
test
Student
satisfaction
test
Simulation
based test
Likert
scale
Survey
test
Sangestani,
Khatiban,
2013
NO YES NO NO YES NO YES
Yoo, Park,
2014
NO YES NO NO NO YES YES
Kang et al.,
2015
YES NO YES NO YES YES YES
Farida et
al., 1999
NO YES YES YES YES NO YES
Arrue et
al., 2017
YES YES YES NO NO YES YES
Santra,
Mani, 2017
NO NO YES NO NO NO YES
Choi,
Lindquist,
Song, 2017
YES YES YES YES NO YES YES
Gholami et
al., 2016
YES YES NO YES NO NO YES
Table 4: Component and Outcome Measures of the Studies
Study Results and conclusion
Sangestani, Khatiban, 2013 Learning progress in PBL group was significantly more than control
group. PBL improved application of theory lesson in clinical
practice, increased learning motivation and enhanced educational
activity in class.81.8% of students considered PBL the more suitable

26NURSING EDUCATION SYSTEMATIC REVIEW
and better method.
Yoo, Park, 2014
Arrue et al., 2017
Santra, Mani, 2017 The PBL applied in the Nursing undergraduate degree courses is able
to provide opportunities to develop an argumentative ability in the
students. With this teaching and learning strategy students have
showed much deeper understanding of what they have learnt.
Choi, Lindquist, Song, 2017
Gholami et al., 2016
Table 5: Results and Conclusion of the Studies
6.2.4 Exploring relationship between studies
The purpose of this section is to compare all the studies with different perspectives to
finding out their differences and similarities accordingly. Therefore, this section includes the
comparison of teaching strategies utilised in various studies. Apart from that the parameter
that are used to determine the significant of primary variables are also compared to test their
integrity and viability.
Critical Thinking
Gholami : The results of the paired t-test and the comparison of the mean changes in
the pre and post intervention scores obtained in the lecture and PBL groups showed a
significant improvement in the students' overall mean scores of critical thinking (P = 0.002)
and metacognitive awareness (P = 0.000) after performing the PBL. T Choi : however this
difference was not statistically significant (F = 3.364, df = 1, p = .070).

27NURSING EDUCATION SYSTEMATIC REVIEW
Study Intervention Control Pvalu Test of p
value
Gholami et al.,
2016
Critical
thinking
Mean deference
SE
1 (0.29)
−0.054 (0.25) 0.002⁎⁎ t-test Effective
Choi SD 53.41(5.46) 57.54(5.31) .070 ANCOVA Not
effective
From the data synthesis, it can be seen that the hypothesis testing variable P value
(0.002) is less than 0.05. Therefire, Gholami et al., 2016 found that the critical thinking has
been changed effectively, for the experimental group of problem solving learning. The study
of Choi found P value of 0.07, which is higher than test value. Therefore, this study found
that the problem based learning is not effective for critical thinking.
Problem Solving
Choi There were no statistically significant differences between two groups (F = .604,
df = 1, p = .439). Moon Results of the present study indicate that significant differences
among the groups were observed in their problem-solving abilities. The CBL group scores
were determined to be significantly higher compared with the lecture-based group scores on
objective problemsolving ability (Table 3) in the post-test (p = .003)
PBl Control P valu
Choi 116.28 (15.30) 125.65 (17.03) .439 Not effective
Moon Mean63.87 Mean 61.05 .003 Effective

28NURSING EDUCATION SYSTEMATIC REVIEW
SD
5.60
SD7.10
From the data synthesis, it can be seen that in the study of Choi, the hypothesis testing
variable P value (0.439) is higher than 0.05. Therefore, Choi found that the Problem Solving
has been changed effectively, for the experimental group of problem Based learning. The
study of Moon found P value of 0.03, which is lower than test value. Therefore, this study
found that the problem based learning is verry effective for problem solving skill.
According to Yoo, Park, (2014), Subjective problem-solving ability was also
significantly higher in CBL group than in the lecture-based group. These results may suggest
that CBL is a beneficial and effective instructional method of training graduate nurses to
improve their clinical problem-solving ability. According to Arrue et al. (2017), the PBL
applied in the Nursing undergraduate degree courses is able to provide opportunities to
develop an argumentative ability in the students. With this teaching and learning strategy
students have showed much deeper understanding of what they have learnt. Santra, Mani,
(2017), suggested that the PBL applied in the Nursing undergraduate degree courses is able to
provide opportunities to develop an argumentative problem solving ability in the students.
With this teaching and learning strategy students have showed much deeper understanding of
what they have learnt.
Knowledge
Kang . There was a significant difference in the mean score of knowledge (difference
between post-test and pre-test scores) among E1 (.07 ± .12), E2 (.08 ± .10), and C groups
(−.01 ± .13) (F = 14.718, p b .001)

29NURSING EDUCATION SYSTEMATIC REVIEW
Sanngestini The mean level of changes in total scores of pre and post tests of the
students' which demonstrated the learning progress in the experimental group (12.32±1.73)
was significantly higher than that of the control group (10.12±1.61) (F=23.55, pb0.001)
Habib it was found that student mean knowledge score in the PVL group 16.44was
statistically higher than the mean score of cpntrol group
Arrue
Santra The mean post-test knowledge score is significantly higher among nursing students
who undergone PBL than those who undergone TT regarding VAP at 0.05 level of
significance.
Pbl Control
Kang .07(.12) -.01(.13) <.001 Anova
Sangestini 12.32-1.73 10.12-1.61 <0.001 t-test. ANOVA
Habib 16.44 14.1 0.0001 t-test
Arrue 4.24 (0.52) Mean 0.80 SD
(0.26)
0.000 Wilcoxon
Santra 24.10,3.12 16.33-2.06 <0.05 t-test
All the significant variables are lower than the test variable 0.05. Hence, in all above
listed studies the problem based learning group shows significant improve in their
knowledge.
Teaching strategy for experiential group

30NURSING EDUCATION SYSTEMATIC REVIEW
In this section the teaching strategies of the chosen studies have been compared
considering the tools, topic, duration and other essential factors.
Study Chosen Topic Demographic
analysis
Study
Duration
Time before
Post test
Experimental
group also
received
studies of CG
Sangestani,
Khatiban,
2013
Pregnancy and
childbirth
YES 2 weeks, 16
session
10 days NO
Yoo, Park,
2014
Not available YES 150 minute, 3
session
10 weeks YES
Kang et al.,
2015
Knowledge of
patient care for
children with
bronchitis
NO Not available Not
applicable
YES
Farida et al.,
1999
Maternal-chid
health
NO Not available Not available NO
Arrue et al.,
2017
Depression and
mental health
NO 2 month Not available YES
Santra, Mani,
2017
VAP related
studies
YES Not available Not available YES
Choi,
Lindquist,
Song, 2017
Musculoskeletal
disorders
YES 32 hours Not available NO
Gholami et
al., 2016
Not available NO Not available Not available YES
Table 5: Component and Process Comparison of the Studies

31NURSING EDUCATION SYSTEMATIC REVIEW
6.2.5 Assessing the robustness
The studies are diverse and robust in terms of their timeline and settings. Considering
the timeline of the studies it can be said that, the studies have been conducted from 1900 to
2017. At the same time, the settings of the studies are also diverse. At the same time, In most
of the studies the duration of the studies as well as the internal gap between tests were not
clearly mentioned. Only Choi, Lindquist, Song, (2017), tested most of the outcomes of a
learning approach. On the other hand in Santra, Mani, (2017), only the knowledge has been
tested that made the projected result inadequate and partially biased. Besides, three studies
were conducted in Korea and 3 studies were conducted in Middle East.

32NURSING EDUCATION SYSTEMATIC REVIEW
Chapter 7: Discussion
7.1 Introduction:
In this section, the major components of the chosen studies will be discussed while
considering their results and strategic intervention. After all data extraction and data synthesis
the goal of this section is to discuss practical significance of these research and the further
scope of implementing problem based learning approach in Nursing teaching and training
course. Through this discussion the major attributes of the learning procedure namely critical
thinking, problem solving and knowledge will be evaluated.
7.2 Critical Thinking
Critical thinking is a major attribute of the nursing education that defines the ability of
criticising any information collected from external sources through utilising the rational
thinking skill. According to Gholami et al., (2016), the PBL method has a statistically
significant effect on the development of meta-cognitive awareness as well as thinking skills
in the nursing students. Several strategies can be utilized by the nursing educators, which
includes concept mapping, questioning. Reflective writing, journaling, dynamic group
session and case based interventions in their performing of PBL. On the other hand, Choi,
Lindquist, Song, (2017) argued that, Despite the learning outcomes demonstrated a trend to
enhance more in the PBL Group compared to the traditional group, no mention worthy
difference was noticed. Thus, this study suggests no true difference. The correlations among
critical thinking, problem solving as well as self-directed learning were positive and
significant.
7.3 Problem solving
Problem Solving is another essential attribute of the nursing education that defines the
ability to use logical reasoning to solve any situation or contextual problem. In professional

33NURSING EDUCATION SYSTEMATIC REVIEW
filed, a nurse has to use his or her problem solving skill to make decision about treatment
procedure as well as to mitigate any potential risk. Kang et al. (2015), explains the significant
difference in problem solving skill after providing problem based learning. According to
Button, Harrington & Belan, (2014), Problem Based Learning is the most effective technique
to boost the cognitive awareness and the problem solving capability of the nursing student. It
has been also found that PBL can also encourage novice caregivers to be involve in a
emergency situation where problem solving and decision making would be required. Choi,
Lindquist, Song (2017), clearly found from the post test evaluation that the problem solving
ability has been changed significantly with very high significant value of the nursing
students. However, Glen, (2017), argues that problem solving capabilities can only be
increased through traditional learning. On the contrary, through the high significant value
Farida et al. (1999), proved that wrong with the two quasi-experimental nursing groups.
7.4 Knowledge
Knowledge is a base of any education system. Before utilising the critical reasoning
ability, knowledge is the ultimate guide that shows the path of thinking. According to Oh,
Jeon & Koh (2015), knowledge is a foundation of both problem solving and critical thinking
ability. However, from the post test on experiential group in the study of Choi, Lindquist,
Song (2017), no significant difference is found in knowledge. The only difference that was
found is ability to implement the knowledge in a problematic situation. According to
Papathanasiou, Tsaras and Sarafis (2014), in nursing practice the knowledge has nothing to
do with practice situation if the caregivers do not have enough expertise to utilise the
knowledge. Farida et al. (1999), has found some significant differences in the descriptive
knowledge of the nursing student after comparing the experimental group with the control
group. According to Kang et al., 2015, there were significant differences in the mean scores
of knowledge and student satisfaction. The positive impact of PBL and a combined learning

34NURSING EDUCATION SYSTEMATIC REVIEW
method is suggested to be an effective approach in paediatric nursing practice. On the other
hand Farida et al. (1999) stated that student who taught with COPBL approach improved
their communication skills, self-confidence and client education skill better than the students’
taught with traditional lecture method. Sangestani, Khatiban (2013), supported that learning
progress in PBL group was significantly more than control group. PBL improved Knowledge
of theory lesson in clinical practice, increased learning motivation and enhanced educational
activity in class.81.8% of students considered PBL the more suitable and better method.
7.5 Limitation
There are many limitations found in this article review. The searching strategy was
very comprehensive, which made it crucial for the systematic review. Due to wide time range
and various publication in different geographic locations, the conclusive outcomes could be
influenced. On the other hand, since the study was included only the studies written in
English the language biasness cannot be neglected. Besides, in this research the articles are
chosen through the level of hierarchy of evidence. Due to the prior knowledge of the students
in the chosen topics the results might be affected and even biased. Besides, focusing on the
under graduate nursing students the outcomes are only viable for that particular student
group. The lower and higher nursing studies and the impact of utilising the problem based
learning on them cannot be found from this analysis and discussion. It can clearly reflect the
obligatory biasness to some extent. At the same time, the narrative synthesis has been
conducted by one person, that can increase the bias within the review with the CRD.
Moreover, it can be said that in many perception this study has some risk of having a biased
conclusion.

35NURSING EDUCATION SYSTEMATIC REVIEW
7.6 Implication,
Acceding to Glen (2017), the problem based learning strategy should be used in
nursing teaching and learning practice for its better technique of developing the critical
thinking and argumentative perception among nursing students. Several strategies can be
utilized by the nursing educators that includes concept mapping, questioning. As per Oh et
al. (2014), Reflective writing, journaling, dynamic group session and case based interventions
in their performing of PBL. At the same time, CBL was more effective in the development of
problem solving abilities for graduate nurses than traditional lecture-based Education.
Besides, COPBL is also a better approach for nursing education that can lead to higher
potentiality of achievement. The problem based learning strategy is better technique of
developing the critical thinking and argumentative perception among nursing students.
7.6 Conclusion
As per the outcomes of most of the studies it has been found that PBL or problem
based learning is effective than other traditional learning approaches. Considering the fact
that all the studies presented the practical evidence based outcomes, it can be concluded that
the Problem Based Learning either simulation based, or discussion based or community
oriented can provide better conceptualisation, problem solving ability, decision making
capacity, descriptive knowledge to the nursing students. The problem based learning strategy
is better technique of developing the critical thinking and argumentative perception among
nursing students.

36NURSING EDUCATION SYSTEMATIC REVIEW
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