The present research was a quasi-experimental study that was conducted on 56 undergraduate students of Nursing, Anaesthesiology, and Operating Room of Iranshahr University of Medical Sciences from September 2016 to January 2017. The participants were selected based on complete enumeration. The inclusion criteria were being a freshman of Iranshahr University of Medical Sciences and taking “Clinical Principles and Skills Course” and the only exclusion criterion was the absence in more than two sessions of the practical course.

With a confidence level of 95% and a statistical power of 90%, the sample size was calculated according to the following formula:

In each group, 20 individuals were estimated. A total of 56 subjects (28 nursing students, 14 anaesthesiology students, and 14 operating room students) were determined to increase the study validity and to achieve more generalisability. The sample size was calculated equal in all groups, since it was a pilot study. The samples were selected from among the first and second semester students. No sample was excluded during the study [Table/Fig-1].

[Table/Fig-1]:

Consort diagram of methodology

The data collection tools included a demographic form and a clinical skills checklist. Developed based on the research objectives and review of the latest articles, the demographic form consisted of eight items about individual and educational information. The clinical skills checklist included the control of vital signs including the measurement of pulse (nine items), respiratory rate (six items), body temperature (six items), and blood pressure (14 items) as well as wound dressing (17 items), gastric intubation (19 items), urinary catheterisation (28 items), intravenous catheterisation (20 items), and oxygen therapy and suction (24 items). In this checklist, a score of zero, one, and two is given to choices “Not done”, “Incompletely done”, and “Correctly done”, respectively [15]. The approach proposed by Lawshe was used to quantitatively determine the content validity. To this end, Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. The clinical skills checklist was given to 10 lecturers of Nursing and Midwifery Faculty of Iranshahr University of Medical Sciences and they were asked to evaluate each item by choosing one of the following choices: “Necessary”, “Useful but not necessary”, and “Not necessary”. The CVI was obtained by calculating the mean CVR of all items. All 10 lecturers selected the choice “Necessary” for all items of the checklist and the CVR was equal to 1 for all of the items. As a result, the CVI, as the mean CVR, was obtained equal to 1. The reliability of this checklist was assessed using the inter-rater agreement. Accordingly, clinical skills of 10 students were evaluated in Clinical Skills Centre of the studied university. Pearson correlation coefficient was obtained 0.87 for vital signs measurement, 0.92 for wound dressing, 0.94 for gastric intubation, 0.96 for urinary catheterisation, 0.92 for intravenous catheterisation, and 0.89 for oxygen therapy and suction.

The participants were equally divided into two groups of video preparation group training and supervised group training (28 students in each group). In order to provide similar skills training to the participants, one subgroup from the supervised group training and one subgroup from the video preparation group training formed a larger group, by drawing, to attend the practice lab for skill training and practice session at the same time. The six main nursing skills selected for training in this study included measurement of vital signs, wound dressing, oxygen therapy and suction, gastric intubation, urinary catheterisation, and intravenous catheterisation. The intervention was performed in 12 sessions and each sessions was of 90-minutes for each large group twice a week (one training session and one practice session). The intervention sessions were held in Clinical Skills Centre of Iranshahr University of Medical Sciences. The training session for each skill was attended by a subgroup of supervised training and a subgroup of video preparation. In these sessions, the desired skill was explained and practically performed on a moulage by the instructor and also the necessary tips were specified in detail. At the end of each session, participants of both groups were asked to complete the checklist of that skill. One week later, the same skill was simultaneously practised by the same groups in two separate rooms. Participants in the video preparation group collectively practised the skill and the instructor guided them whenever necessary. Then, they filmed the correct implementation of the skill by one of the participants using their mobile phone camera (in the presence of the instructor) and submitted the video to their instructor. The instructor reviewed the video in the presence of the participants and provided them with the necessary feedback. Participants in the group training also practised the skill supervised by the instructor. In the end, one of the participants performed the skill in the presence of the instructor and received feedback.

After training and practice of all skills, at the end of the semester, the participants took the Objective Structured Clinical Evaluation (OSCE), including six stations for the above-mentioned skills. At each station, an examiner (one of the instructors of Nursing and Midwifery Faculty. who was blind to the group and was not part of the research team and) assessed the participants based on the related skill checklist.

The Ethics Committee affiliated with Iranshahr University of Medical Sciences approved the conductance of this study as well as the consent procedure (Medical Ethic No: IR.IRSHUMS.REC.1394.12). Then verbal agreement of the participants was obtained, and they were ensured in terms of confidentiality and anonymity of the data as well as voluntary participation in the study. Informed consent was implied from returning the completed questionnaires.

The statistical analysis was done using SPSS version 16.0. The mean and standard deviation were calculated for quantitative data and independent t-test was used to compare the two groups in terms of the pre- and post-intervention scores on the clinical skills. The confidence interval and the significance level were determined to be 95% and 0.05, respectively.

The participants were aged 18-21 years with a mean of 18.9±0.8 years. In terms of gender, 10 (35.7%) of the participants in the supervised training group and 15 (53.6%) in the video preparation group were male. Most of the participants (17) (60.7%) in the supervised training group and 23 (82.1%) in the video preparation group) were residing in a dormitory. In terms of major, 26, 16, and 14 participants were studying Nursing, Anaesthesiology, and Operating Room, respectively. In addition, 27 (96.4%) participants in the supervised training group and 26 (92.9%) in the video preparation group were married. Regarding the background variables, the results indicated no significant difference between the two groups [Table/Fig-2].

The mean total score of clinical skills was 15.8±0.7 in the supervised training group and 17.0±0.4 in the video preparation group. The independent t-test showed a significant difference between the two groups in this regard, as the mean total score in the video preparation group was significantly higher than the training group (p≤0.001) [Table/Fig-3].

As shown in [Table/Fig-3], the mean score of participants in the video preparation group in all studied clinical skills presented an increase compared to that of the training group. This increase was equal to 0.7 in measurement of vital signs, 1.7 in wound dressing, 1 in gastric intubation, 1.2 in oxygen therapy and suction, 1.3 in urinary catheterisation, and 1.5 in intravenous catheterisation. The results of the independent t-test indicated a significant difference between the two groups in the mean score of all clinical skills. In addition, analysis of covariance demonstrated that there was no significant difference between the two groups in terms of the mean score of all clinical skills considering the background variables.

The findings of the present study showed that the mean score of clinical skills in the video preparation group was significantly higher than that of the supervised training group. This indicates the positive impact of video preparation group training on the clinical skills of nursing students. Due to the innovative nature of this technique, there was no similar study to investigate its effects on the clinical skills of students. Therefore, the findings were compared to studies that used other CL methods.

The results of Hoke MM and Robbins LK, showed that CL in small groups increases the clinical skills of nursing students in caring for cardiovascular patients [10], which is consistent with the findings of the present study. As an explanation of this finding, it can be stated that since students who were under CL could collaborate with members of their group and they presented with higher self-motivation and desire for learning.

In a study conducted by Bambini D et al., on 112 nursing students, it was found that CL can significantly increase students’ self-efficacy in performing postpartum and newborn care [16]. This is consistent with the findings of the present study.

The results of the present study are also consistent with the previous findings who concluded that practice-based learning in small groups increases the knowledge and skills of nursing students and improve the quality of patient care [17-20].

The findings of Mahram M et al., Dusold R and Sadoski M, and Fischer RL et al., demonst rate that there was no significant difference between traditional methods and student-centered methods [21-23], which is not consistent with the findings of the present study.

Although active learning methods are an effective educational intervention for medical students, teacher-centered methods dominate the educational system and student-centered methods, such as problem-solving, group discussion, and peer learning, are not as familiar to teachers and they need mental readiness to adopt such methods. The similarity of the reliability results can be attributed to students’ attempt to learn and master the content taught in both methods in order to obtain a good mark. Roseth CJ et al., also found that CL does not always outdo other learning approaches in learning level development, it creates a great sense of success in students and positive outcomes in their learning styles that make for lifelong learning [24].

Sampling from only one faculty reducing the generalisability of findings, small sample size, and impossibility of measuring long-term learning were the main limitations of the current study.

The present study findings indicate the effect of group video training on promoting students’ practical learning. The findings can be employed to teach the principles and clinical skills of nursing faculties. It also suggested that future studies should be conducted with a larger sample size in other departments and in different practical courses and longer follow-up periods by employing this method of teaching.

The study findings also demonstrate the effectiveness of CL in promoting nursing students’ practical learning in the “Principles and Skills” course. Accordingly, the use of active educational methods is recommended to broaden the students’ participation in the training process and promote their learning level.