This pilot study used a one-group pre-test-post-test design to investigate the effects of DSL on team effectiveness, systems thinking, and proactivity in problem solving among nursing students. second year.
Fifty-three second-year nursing students signed an informed consent form to participate in the study. The sample size was determined using the G*power 3.1.2 program. For the difference from the constant (one sample case) with an effect size of 0.5, a significance level of 0.05, and a power of 0.90, the minimum sample size a was calculated to be 44. The sample size was determined to be 53, considering a 20% dropout rate. Students who completed the 15-week Foundational Nursing Course from March 4 to June 17, 2021 completed the study questionnaire. There are no incomplete questionnaires; all data from 53 students were included in the final analysis.
Development of the DSL-based nursing education program
To develop the basic nursing education program based on the DSL, the course syllabus and lesson flow chart were prepared. Thus, the five phases of the DSL model were applied, underpinned by the theoretical basis of basic clinical nursing skills and the objectives of the foundational nursing course (Table 1). The DSL model consists of five phases: phase 1 — presentation of the overall learning experience – sharing of pre-learning; phase 2 – component preparation – fishbone – problem identification, in which students reflect on the scenario through discussion; phase 3 – development of a screenplay – lines of writing, during which the pupils develop a draft screenplay; phase 4 – finalizing the script – applying the context, investigating the theoretical evidence and finalizing the storyboard, during which the students came to a consensus on the final script; and, phase 5 – re-finalization of the scenario – reformulation based on the discussion, during which the students examined and reflected on the interpretations of the initial scenario . The program has been designed as a 15-week, 2-credit (2-hour) course in accordance with the School of Studies curriculum. The program was developed by a panel consisting of three faculty with over 10 years of clinical nursing experience and 3 years of teaching experience in the foundational nursing course and three staff assistants with over 5 years of experience. clinical nursing experience.
At the stage of content development, four basic nursing skills (intermittent feeding by gastric tube, intradermal injection, subcutaneous injection and intramuscular injection) were selected from 20 basic nursing skills presented by KABONE, taking into account the student needs rate. The corresponding basic nursing skills assessment protocol was used. In addition, online video lectures were recorded and templates were prepared for the analysis of therapeutic communication and the development report of skills-based scenarios for the program.
Implementation of the DSL-based nursing education program
Of the total 15 weeks of foundational nursing courses, 3 weeks of orientation were conducted. After 4 weeks of courses by domains, learning activities were carried out to develop scenarios through phases 1 to 4 for 4 weeks. The participants were divided into five teams, and each team consisted of seven to eight people. During the 13th week, a video was made during a role play with the final scenario. In week 14, the instructor provided feedback using the Learning Objectives and Scenarios Assessment Tool through a presentation, and Phase 4 Learning Activities and 5 have been completed. The topic of the DSL-based nursing education program developed by each team is shown in Table 2. An example of the finalized scenario developed is shown in Table 3.
In this study, phase 1 of the DSL involved the sharing of initial learning experiences within the teams. The students viewed the video lectures, pre-read the studies related to basic nursing skills, and shared their understanding and interpretation of the learning material with their team during the course. In Phase 2, students developed a draft of their script through discussion. They have chosen a core nursing competency and defined their skill-based learning goals and events that may occur while administering the competency accordingly. They used a fishbone diagram to provide diversity and clarity of nursing issues that may arise when performing the skill. Phase 3 consisted of students developing the script project. They experimented with developing various scenarios by writing several possible cases of conversation scripts and analyses, integrating each event with the identified nursing problems, discussing them continuously with the team and looking for theoretical evidence. During phase 4, the students came to a consensus on the development of the scenario. They developed a scenario storyboard using the script chosen by the team members and reflecting the contextual characteristics of the patients involved. In phase 5, the students reviewed the interpretations of the initial scenario. They assigned themselves roles based on their team’s storyboard and acted out the role play. They filmed their role play for presentation and discussion during class. Additionally, they wrote a reflective journal to share and reflect on their experiences while developing scenarios.
The authors used the eight items of the team effectiveness subscale used in the Marshall and Lori study  and modified and validated by Kwon ; these were rated on a five-point Likert scale. The total score ranges from 8 to 40, and a higher score indicates greater team efficiency. The reliability of the tool was Cronbach’s α = 0.96 in Kwon’s study  and 0.88 and 0.95 before and after the intervention, respectively, in this study.
The tool developed by Lee et al.  has been used. This 20-item tool includes five domains, with four items each for systems thinking, personal competence, mental model, shared vision, and team learning. Each item is rated on a five-point Likert scale. The total score ranges from 20 to 100, and a higher score indicates greater systems thinking. The reliability of the tool was Cronbach’s α = 0.83 at the time of tool development and 0.81 and 0.86 before and after the intervention, respectively, in this study.
Proactivity in problem solving
From the five-factor scale for team skills developed by Marshall and Lori the authors used the eight adaptive factor items adapted by Kwon . Each item is rated on a five-point Likert scale. The total score ranges from 8 to 40, and a higher score indicates greater proactivity in problem solving. The reliability of the tool was Cronbach’s α = 0.77 in Kwon’s study  and 0.77 and 0.92 before and after the intervention, respectively, in this study.
Data collected was analyzed using IBM SPSS Statistics version 22.0 (SPSS New York, USA). The demographic characteristics of the participants were analyzed with the actual number and the percentage of mean and standard deviation. Additionally, changes in team effectiveness, systems thinking, and proactivity in problem solving after implementation of the DSL nursing education program were analyzed with paired t-tests. To investigate effect sizes (Cohen’s d), the authors calculated the mean difference in outcomes between pre- and post-intervention.