Search results
The flow and number of studies examined at each stage of this systematic review are presented in Figure 1. A total of 486 articles were retrieved through various searches. After removing duplicates, 436 remained, and eight met the inclusion and exclusion criteria.
Characteristics of the studies
The included articles were published in English between 2016 and 2020. One study was conducted in a low-income country [3], and seven studies were conducted in four middle-income countries [28–34]. Five studies focused on teaching and learning of specific subjects such as ethics and deontology [28], research course [34], clinical ear examination [29], health information management, gerontology nursing [30], international classification of nursing practice [32]. The other three studies evaluated, in a global way, the effects of the use of ICT, more particularly e-learning in learning and the realization of certain pedagogical activities such as learning assessment [3,31,34].
The modes of intervention examined by the eight studies involved synchronous and/or asynchronous online learning. Of the eight studies, four used quantitative methods [28,30,31,34], one used qualitative methods [29] and three used mixed methods [3,32,33]. Almost all studies specified the methodological approach used. Of the eight included studies, two used the quasi-experimental approach [28,30], two used the descriptive approach [31,34], two used the sequential mixed approach [29,33], one used the qualitative descriptive approach, and one used the convergent mixed approach [3].
Seven included studies focused exclusively on nursing students as participants [28–32,34]. One study included faculty, information and communication technology managers, and campus managers [3].
Individual results of the included studies
In the article by Chao et al. [28], a quasi-experimental study was conducted to develop and implement an interactive situational e-learning system, integrate ethical nursing decisions into a nursing ethics course, and evaluate the effects of this course on nursing students' ethical decision-making competence. Comparing the experimental and control groups before and immediately after each aspect of ethical decision-making indicated that the experimental group showed significant growth in all six dimensions. The control group showed significant growth in four aspects of competence, including "comparing differences," "talking about oneself," "acting," and "identifying implications." Regarding the impact of the experimental intervention on students' ethical decision making ability and assessment of the effectiveness of the online course, the results show that only two dimensions, "raising ethical questions" and "recognizing differences," showed significant differences between the groups, with the experimental group showing more significant growth in these areas than the control group.
Harerimana et al [3] used a mixed-method with a convergent design to analyze e-learning in selected nursing campuses in Rwanda. Most students reported that they have good or very good ability to use the Internet. Furthermore, they said that they use ICT tools for various reasons such as: accessing learning resources, following the course at any time without necessarily being in school, searching for information on diseases even when they are on clinical placement. The majority of the nurse educators indicated that students understand what they are learning more easily and feel more independent. In addition, the nurse educators reported a somewhat positive impact of the use of ICT on student learning by indicating that ICT improves the classroom climate, students focus more on their learning, students try more challenging to learn, ICT makes it much easier for students to work collaboratively, and students remember what they have learned more easily. In addition, the study indicates that students have a positive perception of the results of e-learning. Participants in this study revealed that online learning promotes self-directed learning. Students who participated in the study revealed that online learning saves time in travelling and attending regular classes. They say they can also receive messages from peers and teachers without necessarily being in school. In addition, they can access resources without being limited by time and space.
The qualitative study by Willemse et al. [29] explored the experiences of undergraduate nursing students who participated in an authentic act of mobile learning to enhance their learning experiences. The study reports that student engagement improved with mobile learning. Besides the mobile learning experience, students are perceived as a modern, informative, and easily accessible method of communication that provided a "clear understanding of how to do a clinical examination." Students indicated that mobile learning facilitates group work and that group work facilitates and enhances their learning. The online mobile learning initiative improved communication between group members, and students completed their tasks without face-to-face contact.
Kawther et al. [30] undertook a quasi-experimental study to evaluate the impact of online distance education on the learning process of nursing students through the study of two courses: health information management in the 6th semester and gerontology nursing in the 4th semester. The majority of students rated themselves as incompetent or having poor skills in using the Internet. More than half of the students found that the online learning interaction made them motivated, also more than two-thirds found that group participation in completing tasks was better than individualized tasks. The effectiveness of the respective teacher-student relationship and rapport was reported by over three-quarters of the students. While more than half of the students reported that the system is contemporary, their responses regarding whether the online system can replace traditional face-to-face learning were distributed in approximately equal percentages on both sides of the scale.
Irinoye et al. [31] conducted a descriptive survey-type study to examine nursing students' attitudes and perceptions toward using information and communication technology tools in distance education. Many respondents reported fair or poor skills in the use of ICT. In response to the question about how often they surf the Internet, most students said they sometimes surf the Internet. In terms of owning a personal desktop or laptop computer, most reported not owning a personal desktop or laptop computer. More than half had no formal computer training. The majority of respondents agreed/strongly agreed that face-to-face classes improve student understanding than the online virtual classroom.
Avelino et al. [32] used a mixed-method research design to evaluate the teaching-learning process of undergraduate students and nursing professionals on the International Classification of Nursing Practice (ICNP®) through a course Moodle platform. Participants rated their level of knowledge obtained high after completing the course. In addition, the majority of students would like to use the virtual learning environment as a teaching and learning strategy in other courses. Even at a distance, the forum resource allowed interaction between students, enabling a collective construction of knowledge about the nursing process and the CPCI. However, for some participants in the study, mainly undergraduate students, the distance learning modality is still a new experience, causing some apprehension at first contact.
Using a mixed-methods research design, Luo et al. [33] examined nursing students' responses and learning based on their participation in an online research course across two technology-enhanced tasks. Students reported that the assignments were helpful in their learning and their research skills met the expected learning outcomes of the course. After completing the assignments, participants felt more confident in using different forms of technology.
Bello et al. [34] conducted a descriptive cross-sectional study to assess the pattern and use of information and communication technologies among undergraduate nursing students at Tanta University, Egypt. The majority of the sample used a desktop or laptop computer and the Internet, respectively. Few students had access to medical journals or online learning resources. In terms of the number of times they accessed the Internet, the study found that slightly more than half of the students accessed the Internet 1 to 3 times per day. About half of the respondents spend an average of 1 to 3 hours on the Internet per day. In addition, just under half of the students reported that they only used the computer/Internet once a week for scientific research. About half of the students reported having good computer skills.
Table 1 : Individual study characteristics and outcomes
1st author, year, and country of origin
|
Methods
|
Participants
|
Modality of use of ICT
|
Main results
|
Chao, 2017
Taiwan
|
Quasi-experimental study
|
Nursing students (n=100)
|
Blended e-learning
|
- - The control group showed significant growth in four aspects of competence
- - The experimental group showed greater growth in two areas than the control group.
|
Harerimana, 2016
Rwanda
|
Parallel mixed method of convergence
|
Nursing students (n=227), Nurse educators (n=44), ICT managers and Campus managers (n=17).
|
E-learning
|
- - Students understand what they are learning more easily and feel more empowered in their learning.
- - ICT improves the classroom climate; students are more focused on their learning, they try harder to learn.
- - ICT greatly facilitates collaborative work among students
- - Students are more likely to remember what they have learned a lot.
- - Students have a positive perception of the results of e-learning.
- - E-learning promotes self-directed learning.
- - E-learning saves time in terms of travel and attending regular classes.
- - Students can receive messages from their peers and teachers without necessarily being in school.
- - Students can access resources without being limited by time and space.
|
Willemse, 2017
South Africa
|
Contextual qualitative method
|
Undergraduate nursing students (n=101)
|
Blended e-learning with smartphone
|
- - Student engagement has improved with mobile learning.
- - Students perceive the mobile learning experience as a modern, informative, and easily accessible method of communication that provided a "clear understanding of how to take an exam."
- - Mobile learning facilitates group work, and that group work facilitates and enhances their learning.
- - The online mobile learning initiative improved communication among group members, and students completed their tasks without face-to-face contact.
|
Kawther, 2020
Egypt
|
Quasi-experimental study
|
Nursing students (n=224)
|
Synchronized and asynchronized distance learning
|
- - Students rated themselves as incompetent or having poor skills in using the Internet.
- - More than half of the students found that the online learning interaction made them feel motivated,
- - More than two-thirds found that group participation in task completion is better than individualized tasks.
- - The effectiveness of the respective teacher-student relationship and rapport was reported by over three-quarters of the students. While more than half of the students reported that the system is contemporary, their responses regarding whether the online system can replace traditional face-to-face learning were distributed in approximately equal percentages on both sides of the scale.
|
Irinoye, 2016
Nigeria
|
Descriptive study of survey type
|
Nursing students (n=305)
|
Online distance learning
|
- - Students reported having fair or poor skills in using ICT.
- - The majority of students sometimes surf the Internet.
- - Most reported not owning a personal desktop or laptop computer. More than half had no formal computer training.
- - The majority of respondents agreed/strongly agreed that face-to-face classes improve student understanding than the online virtual classroom.
|
Avelino, 2018
Brazil
|
Mixed method
|
Nursing students (n=51)
|
Blended e-learning
|
- - Participants rated their knowledge level as high after completing the course.
- - The majority of students would like to use online learning as a teaching and learning strategy in other courses and subjects.
- - Even at a distance, the forum resource allowed interaction between the students, allowing for collective construction of knowledge on the nursing process and the CPCI.
- - The distance modality is still a new experience for undergraduate students, which causes some apprehension at first contact.
|
Luo, 2018
China
|
Integrated explanatory sequential mixed method
|
Nursing students (n=9)
|
Asynchronous e-learning
|
- - The assignments were helpful for student learning, and their research skills met the expected learning outcomes of the course.
- - After completing the assignments, participants felt more confident in using different forms of technology.
|
Bello, 2017
Egypt
|
Descriptive cross-sectional study
|
Nursing students (n=504)
|
Blended e-learning
|
- - The majority of students respectively a desktop or laptop computer and the Internet.
- - Few students had access to medical journals or online learning resources.
- - Just over half of students accessed the Internet 1-3 times per day.
- - About half of students spend an average of 1 to 3 hours on the Internet per day.
- - Slightly less than half of the students reported that they only used the computer/Internet once a week to search for scientific knowledge.
- - About half of the students reported having good computer skills.
|
Narrative synthesis
How are information and communication technologies used in learning?
Information and communication technologies (ICTs) are used in various ways in teaching/learning generally and in nursing teaching/learning specifically. All eight articles included in this systematic review address the use of information and communication technologies as a medium for distance or online teaching/learning [3,28-34]. These articles describe different models of online learning. Four articles describe the blended e-learning modality, i.e., integrating face-to-face learning experiences with online learning [28,29,32,33]. One article described the blended online learning model using a smartphone [32]. One article described the e-learning model in a synchronized and asynchronized environment [30], and another article described the e-learning model in an asynchronized environment [34]. Two articles discussed online learning without further details [3,31].
- Access to ICT
Access to a computer and connection is the first requirement for using information and communication technology in learning [3]. In terms of owning a desktop or laptop computer, most nursing students reported not owning a personal desktop or laptop computer [31]. However, most students report using a desktop or laptop computer and the Internet for learning [29]. In terms of Internet access, slightly more than half of the students accessed the Internet 1 to 3 times per day [29]. In addition, about half of the students spent 1-3 hours on the Internet per day [29].
- Capacity to use ICT
Most students have poor or lacking skills in using the Internet [30]. Some have moderate or no computer skills [29]. This could be because many nursing students do not receive formal computer training. Therefore, many cannot use computer application software very well [31].
- Student motivation
The use of ICT in teaching and learning motivates nursing students [30]. This motivation is reflected in an improved classroom climate, increased student focus on learning, etc. [33]. Several factors could explain students' motivation to use ICT in their learning. Indeed, students find that they save time in travel, especially when they have to attend classes regularly. In addition, students indicate that they can receive messages from their peers and teachers without necessarily being at school. They also mention that the use of ICT in learning facilitates collaborative work among students [3].
- Autonomy in learning
The use of ICT in learning promotes autonomy in learning. Indeed, the use of ICT allows students to take courses at any time without necessarily being at school. In addition, students have access to learning resources anywhere and anytime [3]. However, few students had access to online medical journals or other online learning resources [29].
- Meaningful acquisition of knowledge and skills
The use of ICT in learning improves the acquisition of knowledge and skills. It promotes the improvement of students' performance and professional skills [31]. Indeed, the use of ICT promotes a clear understanding of the course [32], makes it easy to understand the learning object [28], and the level of knowledge acquisition high [33]. Moreover, the forum resource allows, even at a distance, an interaction between students favouring a collective construction of knowledge [33].
- Perception of usefulness
Nursing students have a positive perception of the outcomes of using online learning. Respondents' perceptions of the outcomes of online learning were broken down into 12 items, which are: online peer support was helpful; the course project is in line with their expectations; they gained more knowledge about technology; they gained skills in using the Internet; developed new ICT skills, changed their attitude; be able to use the new skill throughout their career; applied the new knowledge in their life; initiated new ideas from the new knowledge; interactive exchanges were essential in the course [3]. In addition, students have a sense of confidence in using different forms of technology [34]. However, some students, mainly undergraduates, find the distance modality still a new experience, which causes some apprehension [33]. Teachers believe that online learning improves the quality of memorization. Indeed, students easily remember what they have learned [3].