Effects of blended learning on undergraduate nursing students’ knowledge, skills, critical thinking ability and mental health: A systematic review and meta-analysis

Abstract

Aim: This study aimed to evaluate the effects of blended learning on nursing students. The primary outcomes include knowledge and skills, and the secondary outcomes include critical thinking ability, mental health, blended learning design, and nursing students' attitudes toward blended learning. Background: Blended learning combines the advantages of online learning and traditional face-to-face learning, and makes up for the disadvantages of simple online learning or traditional learning. The effects of blended learning on the knowledge, skills, critical thinking ability, and mental health of nursing students were unknown. Design: Systematic review and meta-analysis. Methods: The present systematic review and meta-analysis was applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Publications were searched in PubMed, Web of Science, EMBASE, ERIC, CINAHL and the Cochrane's Library before February 2023. Two researchers independently retrieved articles and evaluated quality. The meta-analysis was performed using Stata 12.0 software according to PRISMA guidelines. The risk of bias in the selected studies was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used as effective indicators. Results: A total of 26 studies involving 2823 nursing students were included in the present study. The results showed that blended learning courses were designed based on learning theory. Blended learning was more effective on the knowledge (SMD = 0.73, 95%CI [0.37, 1.09]) and skills (SMD = 0.86, 95% CI [0.35, 1.37]) compared with non-blended learning for nursing students. Critical thinking ability improved significantly through BL (SMD = 2.23, 95% CI [0.85, 3.61]). In addition, blended learning had a positive impact on nursing students' mental health. Nursing students were very satisfied with blended learning. Conclusions: The results of this study indicated that blended learning had a positive impact on nursing students. In the future, the optimal ratio of online to offline learning in blended learning should also be explored.