The Influence Of Different Teaching Methods In The Self-directed Learning Ability Of Nursing Students:A Network Meta-analysis

Objective:The purpose of this study is to compare the effectiveness of different teaching methods on improving self-directed learning ability of nursing students by using network meta-analysis,and the GeMTC soft was used to draw rank probability graph and table to reflect effects of different teaching methods on improving self-directed learning ability of nursing students.Providing reference for the choice of teaching methods for nursing teachers in the teaching process.Methods:According to the literature search stratery,databases of CNKI,Wan-fang,VIP,SinoMed were retrieved to download the domestic randomized controlled trails(RCTs)of the influence of different teaching methods on the ability of nursing students' self-directed learning.We search and download Foreign literature by PubMed,Web of science,EBSCO databases.Retrieval time for each database was up to December 31,2018.Importing the downloaded documents into EndNoteX9 soft-ware for deduplication,screening and sorting;After conforming the inclusion of the literature,the methodological quality of the included literature was evaluated according to the Cochrane 5.1.0 manual;Then use Review Manager5.3 software to directly compare the impact of different teaching methods on the self-directed learning ability of nursing students.Next is to do a network diagram of different teaching methods on the self-directed learning ability of nursing students by Stata14.0 software.Using the network meta-analysis method to combine direct comparison and indirect comparison results to evaluate the difference of the influence of different teaching methods on improving self directed learning ability of nursing students by representing with sorting probability map and sorting probability table made by GeMTC0.14.3 software.Results:(1)Literature search results.A total of 1233 articles were retrieved,there were 1027 articles after using EndNoteX9 to remove 196 pieces of duplicated articles,961 articles were excluded after browsing the topics and s,and 6 articles that could not obtain the original text were removed,and 60 articles that passed the preliminary screening were obtained.After reading the full text,34 articles(1 in Korean)were included with a total of 4637 nursing students.34 of which met the inclusion and exclusion criteria,there were twenty studies(73.5%)only referred to randomization and did not specify a specific random method,seven studies(20.6%)were grouped by lottery,one(2.9%)were grouped by random number table,one(2.9%)was grouped by coin-throwing;one(2.9%)studies showed that the allocation concealment at high risk,and the rest of the studies did not mention the allocation concealment and blind methods.There were no incomplete outcome data in all studies,no selective reporting was relied upon,and one study referred to selective bias and the quality of the included literature was grade B.(2)The meta-analysis results.In the aspect of improving nursing students' self-directed learning ability,flipped classroom teaching method[SMD=1.57,95%CI(0.93,2.22),P<0.00001],concept map teaching method[SMD=0.80,95%CI(0.64,0.97),P<0.00001],case based leaming(CBL)teaching method[SMD=0.64,95%CI(0.29,1.00),P=0.0004],scenario simulation teaching method[SMD=0.74,95%CI(0.35,1.12),P=0.0002],team based learning(TBL)teaching method[SMD=0.92,95%CI(0.28,1.57),P=0.005]were better than traditional teaching method;scenario simulation teaching method was better than CBL teaching method[SMD=0.53,95%CI(0.28,0.79),P<0.0001].(3)Network Meta-analysis results.In the aspect of improving nursing students' self-directed learning ability,flipped classroom teaching method[MD=-9.73,95%CI(-12.50,-6.77)],concept map teaching method[MD=-7.95,95%CI(-12.45,-3.60)],CBL teaching method[MD=-4.52,95%CI(-8.38,-0.70)],scenario simulation teaching method[MD=-7.09,95%CI(-10.93,-3.20)],TBL teaching method[MD=-9.48,95%CI(-13.91,-4.94]were better than traditional teaching method;flipped classroom teaching method was better than CBL teaching method[MD=5.22,95%CI(0.30,9.93)];There is no obvious statistical difference bet-ween the rest of teaching methods.(4)The inconsistency detection of network Meta analysis results.Using the node-split models to detect inconsistency,for the 1 and 4 teaching methods,direct effect is[MD=5.14,95%CI(0.75,9.62)],indirect effect is[MD=2.25,95%CI(-5.86,10.51)],P=0.53;land 5 teaching methods' direct effect is[MD=6.47,95%CI(1.97,10.92)],indirect effect is[MD=9.28,95%CI(0.96,17.45)],P=0.53;4 and 5 teaching methods' direct effect is[MD=4.10,95%CI(-2.86,10.95)],indirect effect is[MD=126,95%CI(-5.08,7.49)],P=0.55;This shows that the P value of each seg-mentation point was greater than 0.05 and there was no evidence to prove the network Meta analysis existed inconsistency in the design in improving nursing students' self-directed learning ability.(Re-mark:l:traditional teaching method;4:CBL teaching method;5:scenario simulation teaching method)(5)The rank probability results of network Meta-analysis.According to the rank probability graph and rank probability table,in the aspect of improving nursing students' self-directed learning ability,flipped classroom(the probability of Rank 1 was the highest,0.41)was best in improving self-directed learning ability,the second was TBL teaching me-thod(the probability of Rank 2 was 0.28),the third was concept map teaching method(the probability of Rank 3 was 0.31),the fourth was scenario simulation teaching method(the probability of Rank 4 was the 0.44),the fifth was CBL teaching method(the probability of Rank 5 was 0.76),the sixth was traditional teaching method(the probability of Rank 6 was 0.99).Conclusions:(1)Flipped classroom teaching method,concept map teaching method,CBL teaching method,scenario simulation teaching method and TBL teaching method can effectively improve the self-learning ability of nursing students.(2)The order of the effects of different teaching methods on nursing students' self-directed learning ability is flipped classroom teaching method,TBL teaching method,concept map teaching method,scenario simulation teaching method,CBL teaching method and traditional teaching method.According to the results of the study,it is suggested to use the flipped classroom teaching method to improve the self-directed learning ability of nursing students.(3)Teachers can choose reasonable and correct teaching methods according to students' edu-cational level,learning conditions and curriculum characteristics to improve the self-directed learning ability of nursing students in the process of nursing education.