Using mobile learning to enhance nursing students’ competence and confidence in performing basic physical assessment skills: An exploratory sequential mixed methods study

Abstract

Background: Nurses can use physical assessment skills (PAS) to monitor and assess the patient’s clinical situation, identify care needs, and detect changes, as well as a possible deterioration. Internationally, PAS are acknowledged as an important part of fundamental nursing care and are based on four examination techniques: inspection, auscultation, palpation, and percussion. PAS has not been taught systematically in nursing education in Norway, but in 2015, PAS was implemented at the University of South-Eastern of Norway. Based on empirical research, 30 skills (of a total of 126) were regarded as central to teach at the bachelor’s level.

These skills were called ‘basic physical assessment skills’ (B-PAS). A Progression Model – a novel pedagogical approach for teaching B-PAS – was also developed to support students’ learning based on the principles of scaffolding and spaced repetition. In contrast to teaching the skills in a block approach, as is often done internationally, the Progression Model entailed a different approach by teaching B-PAS in each educational year; here, the emphasis is on the importance of nursing students learning to confidently and competently perform B- PAS. In Norway, there is also increased interest in exploring the possibilities for higher education offered by digital technologies, regarding enhancing students’ learning and supporting the transfer of knowledge and skills.

Aim: This dissertation is a synthesis of four individual studies and has three overall aims: (a) to explore the role of B-PAS in overall competence in nursing and person-centred fundamental nursing care, (b) to explore how and to what extent a Suite of mLearning Tools may contribute to developing students’ competence and confidence in performing B-PAS, and (c) to evaluate the usefulness of the Progression Model for students’ confidence in performing B-PAS.

Methods: This dissertation has a complex mixed methods exploratory sequential design, including convergent and emergent components. Quantitative and qualitative research represent an equal status methods that were applied independently or in combination. Study I was a mixed methods study, in which 363 nursing students from all three educational years participated. Data were collected via a questionnaire and focus group interviews, then analysed with descriptive statistics, effect size, and content analysis. Study II was a qualitative study with a longitudinal participatory design approach. Nursing students (n = 20) from all 3 educational years participated in the co-design of a Suite of mLearning Tools. The data were collected in eight co-design workshops and analysed with content analysis. Study III was a quantitative pre-/post-test cohort study in which 171 nursing students from the second and third educational years participated. The data were collected with a pre–post questionnaire and analysed with descriptive statistics, effect size, and linear regression. Study IV was a convergent mixed methods study, in which both nursing students and faculty members participated. The data were collected with a questionnaire (n = 24), individual interviews (n = 3), and a focus group interview (n = 3). The data were analysed using descriptive statistics and content analysis. In line with the overall mixed methods design, a qualitative synthesis of all four studies was performed, in which the three overall aims guided the integration processes, and the visualization of the synthesized results were presented in new models.

Results: Novel results show that overall confidence in performing B-PAS is an important part of overall competence in nursing, measured with the Nurse Professional Competence Scale Sort Form (NPC-SF). B-PAS were also shown to be a part of fundamental care; however, contextual factors in the clinical rotation greatly influenced students’ performance and use of B-PAS. A Suite of mLearning Tools co-designed with the nursing students was experienced as a useful support in learning B-PAS and using the skills in clinical rotation. The research synthesis underlines that the learning and utilization of B-PAS is a complex learning process for the students, due to the transition between academic and clinical contexts. The Suite of mLearning Tools also supports the transfer of skills and knowledge between learning contexts. The virtual simulation as a facilitated learning activity was experienced by both students and faculty members as a meaningful way to explore the coherence between professional knowledge and the students’ own actions, as well as to help students learn to catch clinical cues and develop clinical reasoning skills. The Progression Model seemed to be useful for increasing students’ confidence in performing B-PAS.

Discussion: Supporting students in developing confidence and competence during their nursing education is the shared responsibility of key stakeholders in the academic and clinical contexts. This is an important aspect in the learning and use of B-PAS as a systematic approach for patient assessment and to provide fundamental nursing care. By performing B-PAS, nursing students gain a valuable understanding of how these skills can provide the foundation for a good nurse–patient relationship. And increased focus should be on strategies that are suitable for building students’ confidence, such as role modelling and constructive feedback, and on how these can be applied in the academic and clinical contexts. The Suite of mLearning Tools can support seamless learning processes between academic and clinical contexts and thus support students’ performance of B-PAS.

Conclusion: This dissertation contributes new knowledge about students’ development of competence and confidence in performing B-PAS. Systematic patient assessment such as B-PAS is an important aspect of overall competence in nursing and fundamental nursing care. Supporting students in developing competence and confidence in performing B-PAS needs to be is the mutual responsibility of key stakeholders in the academic and clinical contexts. The Progression Model for teaching B-PAS seems to hold promise for building student confidence, together with the Suite of mLearning Tools. Also, utilizing digital technology in higher education as new pedagogical strategies are in line with national guidelines and recommendations and can better meet students’ learning preferences.