Cognitive changes with psychomotor skill acquisition through blended learning among nursing students : A qualitative study

Aim: This study described nursing students' cognitive changes as they acquire psychomotor skills through blended learning.Background: Deliberate practice, including feedback from teachers, is vital for acquiring psychomotor skills. Blended learning, a program that allows students to deepen their learning and improve their skills even when students and faculty are physically separated has attracted significant attention in recent years. Although blended learning has been used for learning in the cognitive domain, no study has examined its effectiveness in the acquisition of psychomotor skills. Understanding how students' cognition changes as they acquire skills in a blended learning environment could be a valuable resource for effective teaching.Design: An inductive, qualitative description approach was adopted.Methods: The program involved a basic nursing skill: making an occupied bed. Eleven second-year nursing students participated. The participants attended face-to-face lectures and e-learning courses comprising self -study content that was designed for easy and frequent reference. Students practiced for a skill test, which was conducted one month after the first lecture. Two interviews were conducted approximately one month apart. Before each interview, the participants' current practices were videotaped. During the interviews, they explained their thought processes and conscious awareness of their actions as they watched the videos. This study was conducted between April and May 2019.Results: Six categories related to changes in participants' cognitive processes while acquiring the skill of making an occupied bed were identified: feeling that it is easy to acquire, practicing without much thought, real-izing the difficulty in translating thoughts into practice, experiencing a sense of purpose in each technique, gaining a perspective to evaluate one's skills, and developing one's unique approach.Conclusions: In a blended learning environment, where a practice environment and audiovisual materials were provided, students could practice and improve their skills at their own pace even without the instructor's frequent advice. The findings show that metacognitive skills are essential to the development of psychomotor skills in a blended learning program because this program requires practicing while monitoring one's skills. Metacognitive skills affect the development of psychomotor skills and the ability to provide care. Therefore, initiatives that address the development of metacognitive skills, such as the current program, during the early stages of basic education programs can contribute to the development of nursing students' practical skills