What evidence exists on technology usage for teaching and learning in nursing education?

Given the above background it is clear that a substantial amount of literature exists on the phenomenon in question. However, many of the studies conducted in subjects related to the use of technology in nursing education were conducted prior to COVID-19 pandemic, which necessitated the need for technology use in higher education including nursing education. Given the current impact of COVID-19 pandemic on teaching and learning in undergraduate nursing education, integrative literature review is mandatory in order to help nurse educators and researchers keep up-to-date with a large and rapidly growing body of evidence on technology use for teaching and learning in nursing education.

The purpose of this review was to explore and describe the evidence that exists on literature regarding technology usage for teaching and learning in nursing education. The variables in this review are technology usage and teaching and learning, and the population comprised articles retrieved from the initial search using the literature search strategy that is explained below.

The authors searched for both empirical and non-empirical articles from EBSCOhost (health information source and health science), ScienceDirect and African journals. According to Whittemore and Knafl (2005:549), online databases have proved to be effective and efficient when coming to literature search stage of integrative review. The authors purposely chose the aforementioned online databases because of their potential to answer the review question as they publish health science-related articles. In addition, literature search was conducted only on electronic databases given the current risk of COVID-19 infection from contact with objects and surfaces. A Boolean search method was used to search for literature in the aforementioned databases using the following keywords: technology use, digital learning, online learning, nursing, and teaching and learning. Connecting words such as ‘and’ and ‘or’ were used to search for literature. For example, literature search was conducted as ‘“Technology use” or “Digital learning” or “Online learning”’. In order to enhance the literature search, synonyms such as e-learning for online learning and remote learning for digital learning were used to broaden the search of literature. The time frame was between 2016 and 2021. The rationale for including literature from 2016 was the fact that technology use has long been in the shores of nursing education. However, the authors acknowledge that the review was conducted in the COVID-19 era where technology use was at its peak. Therefore, the authors intended to explore and describe the evidence that exists on technology use in nursing education, without narrowing it to COVID-19, although acknowledging its impact on teaching-learning landscape. Specificity of literature search was ensured by the use of keywords that made the search specific to the aim of this integrative review. The use of synonyms and time frame ensured a comprehensive literature search. For each database, the authors applied filters such as ‘English’ and ‘full texts’ only to the retrieved articles in order to ensure that articles with a potential to answer the review question are subjected to screening process. An adapted PRISMA flow diagram from Stovold et al. (2014:3) was then used to further screen the studies for their relevance and potential inclusion in this present review (Figure 2). To ensure rigour, this integrative review was conducted under the supervision of experienced researchers.

Furthermore, Whittemore and Knafl (2005:549) emphasise that sampling decisions such as keywords and search terms and inclusion and exclusion criteria must be rationalised and documented. Therefore, the rationale for the inclusion and exclusion criteria is described in Figure 3.

Nineteen articles were finally selected for inclusion in this review. The authors adapted the quality appraisal criteria by Kangasniemi, Pakkanen and Korhonen (2015:1748) to appraise the quality of studies. Studies were appraised on four quality domains, namely, aims and objectives, study design, research methods and limitations. Studies were further evaluated on a three-point scale and were classed as ‘yes’, ‘poor’ or ‘not reported’ presented as ‘Y’, ‘P’ or ‘NR’, respectively (Table 1). The choice of this quality appraisal tool was based on its track record as it was used by Kangasniemi et al. (2015:1748) and later adapted by Moagi et al. (2021:4) in their study, thus making the tool valid and reliable. However, articles were not excluded based on data evaluation. Most articles that were included in this present review followed quantitative approach wherein the researchers used surveys and questionnaires for data collection. This was followed by qualitative approach with interviews as their main method of data collection. The remaining articles followed mixed methods approach.

Articles were analysed independently by the authors following six steps of thematic analysis, namely, familiarisation, coding, generating themes, reviewing themes, defining and naming themes, and writing up. Firstly, the authors went through included articles before analysis. Secondly, the authors highlighted phrases of the texts which described the content of such texts. Thirdly, themes were then generated from the pattern of the codes which were identified in the literature. Fourthly, the authors checked the accuracy of the themes to ensure that they are a true representation of the included studies. Fifthly, the authors labelled each theme, and this was succeeded by the sixth step which is writing up. An inductive approach of thematic analysis was used. This implies that the authors allowed data to generate themes as explained earlier. As six themes emerged: (1) technology use in nursing education, (2) the manner in which technology is used in nursing education, (3) antecedents for technology use in nursing education, (4) advantages of technology use in nursing education, (5) disadvantages of technology use in nursing education and (6) technology use in nursing education amidst COVID-19.

Ethical clearance to conduct this study was obtained from the North-West University Health Research Ethics Committee (NWU-HREC) (number: NWU-02071-20-A1). Ethical standards for conducting the research were followed in this article, even though it was a review and not conducted with human, plant or animal participants. Studies that had ethical approval were included.

In this section, the authors outline and discuss the results of this integrative review.

The first theme discusses the frequency of technology use for teaching and learning in both classroom and clinical nursing education.

Information and communication literacy, information systems management and citizen digital health literacy are amongst the individual descriptors of learning that students should achieve in each of the key areas (O’Connor & LaRue 2021:3). This implies that digital literacy is amongst the critical cross-fields for every graduate. As a result, the increase in the number of people who use computerised devices such as smartphones is relatively proportional to the amount of time spent on these devices (Zarandona et al. 2019:70). For the students belonging to the millennial generation, technology devices have become the important tool for interaction (Willemse et al. 2019:72). This is no exception in nursing education wherein the use of technology devices both in the class and in clinical placements is an order of the day. The use of mobile applications (apps) in nursing education has been ranked top in comparison to peer learning and clinical placement coordinators (O’Connor & Andrews 2018:174). The authors further highlighted that an upward trend in technology use for teaching and learning continues to be noticed, especially in clinical nursing education.

This theme discusses the manner in which technology is used for teaching and learning both in clinical and classroom settings.

For technology use in teaching and learning to be effective, there are several antecedents that need to be in place. In this theme, the antecedents or enablers of technology for teaching and learning are discussed.

There are several studies that have reported the advantages of technology usage in nursing education (Barisone et al. 2019:59; Mackay et al. 2017:3; Toothaker 2018:82). This theme explores the advantages of technology use in nursing education concurrently with its benefits.

This theme discusses the disadvantages of technology use in both clinical and classroom nursing education. The disadvantages are discussed concurrently with the challenges.

It is almost impossible to divorce technology use in nursing education with COVID-19 pandemic, especially in this era. This pandemic has indeed changed the teaching–learning landscape by navigating it to an abrupt online modality of teaching and learning, thus making technology use in nursing education unpopular and unfamiliar to nursing students because of a lack of preparation for its introduction (Oducado & Soriano 2021:8). Although the main purpose for the shift to fully use technology for teaching and learning amidst the COVID-19 pandemic was mainly to safe the academic year, several researchers reported mainly on the challenges that were brought about the implementation of this modality of teaching and learning (Mawere et al. 2021:53; Oducado & Soriano 2021:8; Singh et al. 2021:6). Such challenges included (1) the lack of training for both students and educators on technology-supported teaching and learning, (2) the lack of infrastructure that enables technology-supported teaching and learning and (3) the lack of devices that are necessary for technology-supported teaching and learning. The challenges were mainly owing to its abrupt introduction and the disparities that exist between the ‘haves’ and the ‘have-nots’. As Singh et al. (2021:6) and Mawere et al. (2021:53) put it, infrastructure for technology use for teaching and learning, including lack of capacity to use technology devices, is a huge challenge facing rural education institutions and disadvantaged students. Nevertheless, the upward trend of technology use remains in the shores of nursing education.