Volume 5, No. 5 May, 2024
p ISSN 2723-6927-e ISSN 2723-4339
Differences
Between Discovery Learning And Case-Based Learning Using Animated Videos On
Critical Thinking Skills In Start Triage Among Undergraduate Nursing Students
Rystika
Angga Sari1, Retno Lestari2, Yati Sri Hayati3
1,2,3Faculty of
Health Sciences, Brawijya University, Malang, Indonesia
email: rystikaangga61@gmail.com1, retno.lestari.fk@ub.ac.id2, yshayati.fk@ub.ac.id3
Abstract
The 2004
disaster in Aceh underscores the need to strengthen disaster triage
preparedness. Triage would be more accurate when considering human resource
factors. Students are educated nurse candidates who will serve the community
through their ability to think critically. Innovative learning opens
opportunities to sharpen critical thinking in students' preparedness for
emergency disaster situations. This study analyzes the differences between
discovery learning and case-based learning on critical thinking in START Triage
among undergraduate nursing students. This quasi-experimental study used a pre-test
and post-test design involving 40 undergraduate nursing students selected
through purposive sampling and divided into two groups: control and
intervention. Data collection utilized the Critical Thinking Disposition
Inventory questionnaire. The results of the Paired T-test revealed differences
in critical thinking ability in START Triage before and after receiving
discovery learning and case-based learning. Furthermore, the independent T-test
results indicated a significant influence of case-based and discovery learning
on critical thinking ability in START Triage. Case-based learning utilizing
animated videos significantly impacted nursing students' critical thinking
ability in START Triage. Using animated videos as a basis for case-based
learning provides a foundation for educational institutions to integrate into
learning activities and disaster simulation exercises to enhance the quality of
Triage services.
Keywords:
Animated Videos, Critical Thinking, START Triage
INTRODUCTION
Disaster is an impossible phenomenon
for the whole world to avoid, thereby allowing damage and loss of life (Gustiani et al., 2021). According to 2018 World Risk Report
data, Indonesia is ranked 36th with a risk value of 10.36 out of 172 countries,
categorized as most vulnerable to natural disasters (Fariza & Handayani, 2022). Based on data from the National
Disaster Management Agency (BNPB), it is estimated that in 2021, there will be
around 3,093 disaster incidents in Indonesia. The number of disaster incidents
is estimated to have decreased by 33.5% from 2020. According to the BNPB study, although there
has been a decrease, the increase in frequency is found in the impact of
disasters. The number of victims who died increased by 76.9%, injured victims by
2180.5%, the number of victims who were displaced reached an increase of 24%,
and 116.3% of houses were damaged (Jamil et al., 2022). The above phenomena have shown that
Indonesia is a disaster-prone country that requires an integrated system to
deal with disasters appropriately.
According to (Khambali & ST, 2017), the most vital aspect of
disaster management is the prevention and mitigation. Prevention and mitigation
actions are efforts to reduce disaster risks through infrastructure regulation,
education, and training (Hardy & Calleja, 2019). Meanwhile, according to (Paquay et al., 2021), disaster management is
divided into four parts: learning how to Triage,
managing injured patients, enhancing preparedness, and improving disaster care.
Early preparation for disaster can be facilitated through education, training,
simulations, and increasing community capacity.
Triage learning is one
part of disaster preparedness to minimize patient classification errors that
can lead to disabilities (Bostick et al., 2008). The START Triage (Simple
et al.) is one disaster Triage
system used internationally and studied worldwide, used to classify patients
based on their urgency type quickly, accurately, and efficiently (Aubrion et al., 2022). In this study, the use
of START Triage
was chosen because, in several kinds of literature, it is recognized as a
disaster Triage
approach due to its ease of implementation and ability to provide rapid
assessment. Triage assessments that fail to handle a large number of patients
may result in over-triage and under-triage effects, even leading to deaths (Bhaumik et al., 2022).
Overtriage refers to the
decision to classify patients with lower or moderate severity levels as
requiring higher levels of emergency care than actually necessary (Ayenew et
al., 2022). Meanwhile, Undertriage is the condition where patients with severe
injury levels are deemed to require lower levels of emergency care than
actually necessary (Bazyar et al., 2019). In disaster management, overtime and Undertriage
pose challenges that need to be addressed in the Triage
assessment system to ensure accurate patient management in disaster situations.
(Chan, Man, & Lam, 2019) identified barriers in
disaster procedures related to human resources, particularly healthcare workers
who may lack optimal knowledge and disaster response abilities. Additionally,
students, as future healthcare professionals, have limited experience and
imagination regarding disasters (Kim & Lee, 2021). Therefore, education at
the university level can deepen the understanding of Triage-related knowledge to cultivate
disaster-ready professionals (Rofifah et al., 2019).
The research conducted by (Chen et al., 2011), which focuses on nursing education
programs, highlights the need for nursing graduates to engage in critical
thinking and evaluate information in their practice. However, several studies
indicate that critical thinking abilities among nursing graduates are
relatively low despite nursing educators in colleges facilitating critical
thinking methods (Syaznas & Jannah, 2022).
Based on preliminary studies conducted
by researchers on March 20, 2023, through the distribution of questionnaires
and interviews with eighth-semester nursing students at one of the nursing
colleges in Malang City, it was found that four out of fifteen students met the
criteria for critical thinking skills. A good understanding of the Triage concept is essential for patient
response skills (Natarianto et al., 2018). This suggests that students need to
be facilitated in critically thinking about patient responses, especially in Triage, which is an integral aspect of
emergency care.
The use of learning models needs to be
considered to support the success of the Triage learning
process. Discovery Learning (DL) can be applied to stimulate learners and is
one of the learning methods in education because it strengthens the concepts of
the material presented (Rahayu et al., 2023). However, there are still
shortcomings in the implementation of this learning model, such as abstract and
monotonous learning, which makes students less interested. Therefore, research
on innovative learning methods is needed.
Hence, the researchers compared it
with the Case Based Learning (CBL) model using animated videos. This innovative
model utilizes disaster scenario-focused animated videos on a case-by-case
basis. Case-based learning encourages students to actively solve problems as a
stimulus for critical thinking and decision-making individually or in groups (Aluisio et al., 2016). CBL learning with animated videos
also makes students more interested due to its dynamic nature, thus enhancing
their engagement with the content being delivered.
In this study, the tool for CBL
learning innovation takes the form of 3D animated videos based on Powtoon,
specifically designed for Triage topics.
The topics introduce definitions, history, objectives, principles of use, algorithms,
and documentation of Triage along
with a disaster case scenario. The 3D animated video is packaged as
attractively as possible by transforming imagination, ideas, concepts, and
visuals so that the contained context can be effectively conveyed. Therefore,
the researchers aim to determine whether there is a difference in critical
thinking abilities before and after the provision of START Triage using case-based and discovery
learning models among undergraduate nursing students.
The research contributes
to the existing body of knowledge by investigating the differences between
discovery learning and case-based learning using animated videos on critical
thinking skills in START Triage among undergraduate nursing students. This
study's novelty lies in its application of a quasi-experimental design to
assess the impact of these learning models on critical thinking skills in a
disaster triage context, which is crucial for effective disaster management.
The findings of this study can inform educational institutions on the most
effective methods to enhance critical thinking skills in nursing students,
ultimately improving disaster response and patient care outcomes.
RESEARCHED METHODS
The research design used in this
research is the Quasi-Experimental with a control and intervention group. The
sampling method used was purposive sampling. In the pretest-posttest design
method, namely, before the trial is carried out on two groups, an assessment is
carried out first on the two groups, and after the assessment or measurement is
carried out, the researcher provides the treatment. This research assesses
critical thinking first, and then researchers provide treatment in the form of
the START Triage learning model with case-based learning and discovery learning
models. Furthermore, another trial was carried out at the end of the research.
Researchers compared the differences between the two learning models on
critical thinking skills by providing learning models in the form of case-based
and discovery to two groups, A and B.
The data analysis technique used in
this research involves comparing the pretest and posttest scores of the two
intervention groups (case-based learning and discovery learning) to assess the
impact of the different learning models on critical thinking skills. This
comparison likely includes statistical methods such as paired t-tests or
analysis of variance (ANOVA) to determine if there are significant differences
in critical thinking skills between the groups after the intervention.
Additionally, the researchers may employ descriptive statistics to summarize
the characteristics of the sample and inferential statistics to draw
conclusions about the broader population of undergraduate nursing students in
semester VII.
According to Lemeshow, the minimum
sample in this study was 40 people. The sample in this research was
undergraduate nursing students in semester VII. In this study, two different
intervention groups were obtained. The total number of respondents in this
study was 40 respondents, so the total respondents were divided into two
intervention groups, of which 20 respondents used the case-based learning model
and 20 respondents used the discovery learning model. The instrument was
obtained from (Redhana, Karyasa, & Atrisa, 2017) research with the title Development
of Critical Thinking Disposition Inventory: its validity and reliability.
Researchers adopted this instrument to be given to nursing students in the
context of disaster Triage to
measure nursing students' ability to think critically.
RESULT AND
DISCUSSION
Description of Respondent Characteristics
based on Age and Gender
The number of samples in this research
was 40 respondents from regular undergraduate students who were in semester VII
at STIKes (Institute of Health Science) Widyagama Husada Malang. The following
is data on the frequency distribution of respondents based on age and gender.
Table 1. Frequency
Distribution Table of Respondents Based on Age and Gender (N= 40)
No. |
Age |
Frequency |
Percentages |
1. |
20 years old 21 years old 22 years old 23 years old 24 years old 25 years old Total |
4 18 13 4 0 1 40 |
10% 45% 32,5% 10% 0% 2,5% 100% |
2. |
Gender |
|
|
|
Man Woman Total |
5 35 40 |
12,5% 87,5% 100% |
Table 1.1 above shows that of the
total respondents in this study, on average, almost half were 21 years old
(45%) among the 20-25 year age range, and on average, almost all were women
(87,5%).
Results of Analysis of Differences in Critical
Thinking in CBL and DSL Learning Groups
From the research results, it was
found that critical thinking increased after being given CBL learning in the
intervention group and DSL in the control group, which can be described as:
Table 2.
Paired Sample T-test Results on Critical Thinking between the Intervention
Group and Control Group (N=20)
Variable |
Group |
Mean |
Mean Different |
Std. Deviation |
P value |
Critical
thinking |
CBL Before
After |
118.70 145.45 |
26.750 |
10.388 11.889 |
0.000 |
DSL Before After |
117.90 135.15 |
17.250 |
8.071 8.869 |
0.000 |
Information:
CBL = intervention group, DSL = control group
Based on Table 1.2 above, in the
Paired Samples Test, it can be seen that there is a significant difference in
respondents' critical thinking after START Triage learning.
Where the significance value in the table for the intervention group and
control group both experienced significant (meaningful) changes, namely the p-value
of 0.000, which means this value is smaller than the α value (0.05). Even
though both experienced an increase, the results can be seen in the different
items in the mean, where a significant change occurred in the CBL group with a
mean value of 26.75, while in the DSL group, the mean value was 17,250. These
results indicate that learning using the CBL model is more effective in
improving respondents' critical thinking compared to the DSL learning model.
Results of analysis of the influence of
critical thinking after providing intervention in the CBL and DSL learning
groups
The independent t-test was carried out
to determine the difference in improvement in critical thinking variables
between the intervention group and the control group. The results obtained can
be described in :
Table 3.
Independent Sample T-test Results on Critical Thinking between the Intervention
Group and Control Group (N=20)
Variable |
Group |
Mean Difference in Pre-test and Post-test Scores |
Std. Deviation |
P value |
Critical
thinking |
CBL |
26.75 |
11.447 |
0.021 |
DSL |
17.25 |
13.451 |
Information: CBL = intervention group,
DSL = control group
Based on Table 1.3 above, in the
Independent Sample Test, it can be seen that there is a difference in
respondents' critical thinking between the CBL and DSL groups with a p-value of
0.021, which means this value is smaller than the α value (0.05), meaning
that there is a difference in the results of improving thinking. Critical after
being given intervention between the intervention and control groups. In the
group statistics results, it can be seen that the average (mean) value of
increasing critical thinking in the control group was 17.25, and the value of
increasing critical thinking in the intervention group was 26.75, which means
that the average result of increasing critical thinking after being given the
CBL learning model intervention was more dominant. Provide an influence
compared to the DSL learning model in the control group.
From the results of the differences in
critical thinking abilities between CBL and DSL, the research findings indicate
that there are significant differences in critical thinking skills before and
after participating in START Triage learning
with both CBL and DSL models. However, although differences are evident in the
DSL model, it also has weaknesses in the learning process compared to the CBL
model, as evidenced by the statistical results. The DSL model appears more
monotonous in its implementation, thus making it less engaging for the
respondents. The DSL model provides concept reinforcement stimuli, making
learning easier to process compared to static presentations (Grogans et al., 2023). The DSL model in this study utilized
PowerPoint media containing disaster-illustrating videos. DSL model, with
movement, color, sound, and text in the media, can significantly enhance
cognitive engagement.
Critical thinking is an individual's
tendency toward their ability to perform certain tasks or activities through
reasoning processes (Yasmini, 2021). This study measured critical
thinking by triaging seven indicators in the data collection questionnaire.
Respondents participating in CBL learning model activities will undergo
significant changes in educational dynamics, student roles, didactics for
knowledge transmission, and teaching-learning strategies (Boso, van der Merwe, & Gross, 2021). These changes revolve around
students actively participating in the learning process to achieve greater
development in critical thinking capacity, self-directed learning, and
self-evaluation.
As an essential foundation for
education, critical thinking skills involve efforts to acquire or seek,
analyze, and conceptualize information as a guide to developing thinking
processes to achieve a solution to a problem (Handayani, Budiarti, Kusmajid, & Khairil, 2021). In the CBL learning model, with the
assistance of animated videos and the case method, respondents are encouraged to
develop critical thinking skills, allowing them to integrate their knowledge as
future professionals in the context of Triage (Rahmawati, Rosida, & Kholidin, 2020). This critical thinking process also
fosters teamwork collaboration, thinking from different perspectives, and
encourages idea exchange in finding solutions together.
This study demonstrates that after
participating in the CBL learning model with animated video combinations,
respondents have the ability to develop critical thinking, which can be useful
in both simple and complex situations. This learning model, combined with animated
videos featuring text features in each explanation, aids respondents in
managing the information received with their verbal abilities. The animated
videos also include interactive 3D images to help respondents enhance critical
thinking regarding START Triage through
their spatial visual abilities. This study offers a CBL learning model with the
assistance of a combination of animated videos and case studies, where there
has been no previous research attempting to apply this model specifically in disaster
nursing education. Previous studies have mainly applied simulation methods or
game-based learning. Therefore, this research focuses on learning with animated
videos centered on students (student-centered).
The improvement in critical thinking
abilities between CBL and DSL groups has a significant influence on their
critical thinking abilities after receiving START Triage education. In this study, the CBL
group or treatment has a higher difference or influence value compared to the
DSL group or control group, possibly due to the integration of the learning
model with a combination of animated video media and case studies. Thus,
cognitive processes will be actively and organizedly involved in problem
identification, evaluation of acquired information, searching for evidence to
solve problems, and drawing conclusions (Hasnah et al., 2024).
The learning process in CBL is
superior because it requires respondents to think, recall previously acquired
knowledge, connect initial knowledge learned in disaster cases, and interpret
and analyze to solve cases or problems in the context of disasters depicted in
animated videos (Chiang et al., 2021).
Statistical analysis results show that
in critical thinking after receiving CBL and DSL learning models, both groups
have higher mean difference values in the CBL group, meaning that the use of the
CBL learning model has a greater impact on critical thinking in respondents. In
this study, the use of 3D animated videos in the CBL model provides
opportunities for interaction in the learning context to be more easily
understood and accepted. This model is more effective and makes the learning
process more interesting and enjoyable compared to the DSL model with
PowerPoint media, even though they share the student-centered principle.
The development of this CBL model with
animated videos considers moving images, audio, text, and appealing colors in a
unified manner that reflects the clarity of the learning context, thus
providing its own attraction for respondents even though the learning context
is quite complex (Hwang et al., 2018). However, animated videos can stimulate
the brain to remember information longer than explanations in static DSL
learning. Animated videos combined with the case study method facilitate the
presentation of dynamic visual material, allowing viewers to visualize abstract
ideas. This can facilitate respondent understanding and encourage critical
thinking.
CONCLUSION
Based on the results of research to
determine the difference between the use of the START Triage learning model between CBL and DSL on
critical thinking in undergraduate nursing students at STIKes Widyagama Husada
Malang, it can be concluded as follows: There was a difference in critical
thinking before and after providing START Triage education
using the case based learning model to undergraduate nursing students. There
was an influence of critical thinking after providing START Triage education between the case-based and
discovery learning groups for undergraduate nursing students. CBL learning,
which is supported by technology-based animated video media, can be considered
for use as a support for the existing learning process, especially on disaster
topics, which not only focus on students but can also be used in services
without being constrained by space and time. The need for a detailed critical
thinking process in nursing that is really good at every element by students
and health workers can help in considering the pros and cons of providing
health services, especially in disaster management, and involving many human
resources who take part in it. For future research, it would be beneficial to
explore the long-term effects of utilizing different learning models, such as
case-based learning (CBL) and discovery learning (DSL), on critical thinking
skills among undergraduate nursing students. Longitudinal studies could track
the development of critical thinking abilities over time, assessing not only
immediate post-intervention effects but also whether these skills are sustained
and transferable to real-world nursing practice. Additionally, comparative studies
could investigate the effectiveness of integrating various educational
technologies, such as animated video media, into different learning models.
This could help identify the most effective combination of instructional
methods and technology-enhanced resources for promoting critical thinking in
nursing education. Furthermore, research could delve deeper into the specific
elements of critical thinking that are most enhanced by different learning
approaches. Understanding which aspects of critical thinking are most impacted
by CBL, DSL, or other instructional methods can inform the development of
targeted interventions to strengthen these skills in nursing students. Lastly,
exploring the application of critical thinking skills in specific healthcare
contexts, such as disaster management, as mentioned in the study, could provide
valuable insights into the practical implications of enhanced critical thinking
abilities for healthcare professionals. This could involve simulation-based
training or observational studies in real-world healthcare settings to assess
how critical thinking influences decision-making and patient outcomes during
crisis situations.
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Copyright Holder: Rystika Angga Sari1, Retno Lestari2, Yati Sri
Hayati3 (2024) |
First
Publication Right: Jurnal Health Sains |
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