Curationis

ISSN: (Online) 2223-6279, (Print) 0379-8577

Page 1 of 9 Original Research

Technology usage for teaching and learning in

nursing education: An integrative review

Authors: Background: The increasing availability of technology devices or portable digital assistant
Gopolang Gause1
devices continues to change the teaching-learning landscape, including technology-supported
Isaac O. Mokgaola1
Mahlasela A. Rakhudu1 learning. Portable digital assistants and technology usage have become an integral part of
teaching and learning nowadays. Cloud computing, which includes YouTube, Google Apps,
Affiliations: Dropbox and Twitter, has become the reality of today’s teaching and learning and has
1
School of Nursing, Faculty
noticeably improved higher education, including nursing education.
of Health Sciences,
North-West University, Objectives: The aim of this integrative literature review was to explore and describe technology
Mmabatho, South Africa
usage for teaching and learning in nursing education.
Corresponding author:
Method: A five-step integrative review framework by Whittemore and Knafl was used to
Gopolang Gause,
[email protected] attain the objective of this study. The authors searched for both empirical and non-empirical
articles from EBSCOhost (health information source and health science), ScienceDirect and
Dates: African Journals Online Library databases to establish what is already known about the
Received: 16 June 2021
keywords. Key terms included in literature search were coronavirus disease 2019 (COVID-19),
Accepted: 26 Apr. 2022
Published: 15 June 2022 digital learning, online learning, nursing, teaching and learning, and technology use.

How to cite this article: Results: Nineteen articles were selected for analysis. The themes that emerged from this
Gause, G., Mokgaola, I.O. & review were (1) technology use in nursing education, (2) the manner in which technology is
Rakhudu, M.A., 2022, used in nursing education, (3) antecedents for technology use in nursing education, (4)
‘Technology usage for advantages of technology use in nursing education, (5) disadvantages of technology use in
teaching and learning in
nursing education: An nursing education and (6) technology use in nursing education amidst COVID-19.
integrative review’,
Conclusion: Technology in nursing education is used in both clinical and classroom teaching to
Curationis 45(1), a2261.
https://doi.org/10.4102/ complement learning. However, there is still a gap in its acceptance despite its upward trend.
curationis.v45i1.2261
Contribution: The findings of this study contribute to the body of knowledge on the
Copyright: phenomenon of technology use for teaching and learning in nursing education.
© 2022. The Authors.
Licensee: AOSIS. This work Keywords: COVID-19; digital learning; online learning; nursing; teaching and learning;
is licensed under the technology use.
Creative Commons
Attribution License.

Introduction
Technology devices, such as smartphones, have become the first and the last thing that human
beings interact with on a daily basis (Alsayed, Bano & Alnajjar 2020:244). Consequently, the
authors add that this has created a strong bond between human beings and their technology
devices (Alsayed et al. 2020:244). The increasing availability of technology devices or portable
digital assistant (PDA) devices continues to change the teaching-learning landscape, including
but not limited to technology-supported learning (Forehand, Miller & Carter 2017:51). The use of
technology makes learning fun and exciting, and it cuts across all disciplines including nursing
education (Forehand et al. 2017:51). Technology usage in teaching and learning has risen to its
peak recently given the current coronavirus disease 2019 (COVID-19) pandemic and its social
distancing protocols. Higher education institutions including nursing education institutions
globally have resorted to online learning to continue teaching and learning amidst COVID-19
pandemic.

Technology usage plays a vital role in the facilitation of learning in higher education institutions
Read online: (Al-Hariri & Al-Hattami 2017:84). Portable digital assistants and technology usage have become
Scan this QR an integral part of contemporary teaching and learning (Hashim 2018:2). The authors add that
code with your cloud computing, which includes YouTube, Google Apps, Dropbox and Twitter, has become the
smart phone or
mobile device reality of today’s teaching and learning and has noticeably improved higher education, including
to read online.
nursing education. Similar to the context of this review, technology seems to be the backbone of

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 Page 2 of 9 Original Research

teaching and learning wherein information searching,

teaching and learning, and assessment are all reliant on
Design and methods
technology. Students mainly use technology and technology This study followed an integrative literature review design to
devices for web browsing and class preparation and to explore and describe the existing evidence on technology
document and record class proceedings for referral (Alsayed usage for teaching and learning in nursing education.
et al. 2020:243). Several studies have highlighted the benefits Integrative literature review design is described as a review
of technology usage in nursing education that is associated method that aims to summarise theoretical or empirical
with its exponential growth (MacKay, Anderson & Harding evidence to generate a new understanding of a specific
2017:3; Márquez-Hernández et al. 2020:5; Subedi et al. phenomenon or a healthcare problem (Broome as quoted in
Whittemore & Knafl 2005:546). As Chalmers et al. (2014:156)
2020:73).
put it, integrative reviews are important in ensuring that new
primary research is generated from the full knowledge of the
According to Subedi et al. (2020:73), technology use in teaching
existing literature. Similar to this present review, researchers
and learning is flexible, minimises travelling and thus is cost-
intend to generate new knowledge from the existing literature
effective, and it allows family time as classes can be attended
on technology usage for teaching and learning in nursing
at the comfort of one’s home. However, some perceive the
education. A five-step integrative literature review framework
home environment as disruptive and less conducive for
by Whittemore and Knafl (2005:549) was used to attain the
teaching and learning. The benefits of technology usage in
aim of this review. The steps are presented in Figure 1.
teaching and learning are not only limited to classroom setting
or theoretical aspect of nursing education. In a study
conducted by Mackay Anderson and Harding (2017:3) and Step 1: Problem identification
Márquez-Hernández et al. (2020:5), students reported that Given the above background it is clear that a substantial
technology and PDAs allow them to have access to a range of amount of literature exists on the phenomenon in question.
websites that enables them to make on-the-spot and sound However, many of the studies conducted in subjects related
clinical decisions when placed at clinical facilities for work- to the use of technology in nursing education were conducted
integrated learning (WIL). Furthermore, integration of prior to COVID-19 pandemic, which necessitated the need
technology usage with clinical settings has proven to be the for technology use in higher education including nursing
driver of innovative ideas in making sound clinical decisions education. Given the current impact of COVID-19 pandemic
(DiMattio & Hudacek 2020:4). Despite the notable benefits of on teaching and learning in undergraduate nursing
technology use for teaching and learning in nursing education, education, integrative literature review is mandatory in order
there are still challenges that face this fast-growing modality to help nurse educators and researchers keep up-to-date with
of teaching and learning. a large and rapidly growing body of evidence on technology
use for teaching and learning in nursing education.
There are still nurse managers and educators who feel that
technology usage in nursing education is disruptive, especially The purpose of this review was to explore and describe the
when used at clinical settings (Alsayed et al. 2020:244). Some evidence that exists on literature regarding technology usage
nurse educators prefer traditional teaching and learning than for teaching and learning in nursing education. The variables
technology usage in teaching and learning (Al-Hariri & in this review are technology usage and teaching and
Al-Hattami 2017:84). In addition, hardware and software learning, and the population comprised articles retrieved
issues, connectivity, security and safety of personal from the initial search using the literature search strategy that
information, and lack of face-to-face interaction are some is explained below.
other challenges facing optimum use of technology in teaching
and learning (Dhir et al. 2017:875). Furthermore, non-
proficiency regarding the use of Information and
Step 2: Literature search
Communication Technology (ICT) and PDAs is also a The authors searched for both empirical and non-empirical
challenge for technology usage in nursing education and also articles from EBSCOhost (health information source and
a factor contributing to its counterproductivity (Forehand health science), ScienceDirect and African journals.
et al. 2017:51). This is seen mainly in students with little or no
exposure to the use of computer during their basic schooling.
Step 1: Problem Step 2: Literature Step 3:
identification search Data evaluation
Aim
The aim of this integrative literature review was to explore
and describe technology usage for teaching and learning in
nursing education. Step 5: Step 4:
Data presentation Data analysis

Integrative review question Source: Adapted from Whittemore, R. & Knafl, K., 2005, ‘The integrative review: Updated
methodology’, Journal of Advanced Nursing 52(5), 546–553. https://doi.org/10.1111/​j.1365-
What evidence exists on technology usage for teaching and 2648.2005.03621.x
learning in nursing education? FIGURE 1: Integrative review framework.

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 Page 3 of 9 Original Research

According to Whittemore and Knafl (2005:549), online present review (Figure 2). To ensure rigour, this integrative
databases have proved to be effective and efficient when review was conducted under the supervision of experienced
coming to literature search stage of integrative review. The researchers.
authors purposely chose the aforementioned online
databases because of their potential to answer the review Furthermore, Whittemore and Knafl (2005:549) emphasise
question as they publish health science-related articles. In that sampling decisions such as keywords and search terms
addition, literature search was conducted only on electronic and inclusion and exclusion criteria must be rationalised and
databases given the current risk of COVID-19 infection from documented. Therefore, the rationale for the inclusion and
contact with objects and surfaces. A Boolean search method exclusion criteria is described in Figure 3.
was used to search for literature in the aforementioned
databases using the following keywords: technology use, Step 3: Data evaluation
digital learning, online learning, nursing, and teaching and
Nineteen articles were finally selected for inclusion in this
learning. Connecting words such as ‘and’ and ‘or’ were used
review. The authors adapted the quality appraisal criteria by
to search for literature. For example, literature search was
Kangasniemi, Pakkanen and Korhonen (2015:1748) to
conducted as ‘“Technology use” or “Digital learning” or
appraise the quality of studies. Studies were appraised on
“Online learning”’. In order to enhance the literature search,
four quality domains, namely, aims and objectives, study
synonyms such as e-learning for online learning and remote
design, research methods and limitations. Studies were
learning for digital learning were used to broaden the search
further evaluated on a three-point scale and were classed as
of literature. The time frame was between 2016 and 2021.
‘yes’, ‘poor’ or ‘not reported’ presented as ‘Y’, ‘P’ or ‘NR’,
The rationale for including literature from 2016 was the fact
respectively (Table 1). The choice of this quality appraisal
that technology use has long been in the shores of nursing
tool was based on its track record as it was used by
education. However, the authors acknowledge that the
Kangasniemi et al. (2015:1748) and later adapted by Moagi
review was conducted in the COVID-19 era where
et al. (2021:4) in their study, thus making the tool valid and
technology use was at its peak. Therefore, the authors
reliable. However, articles were not excluded based on data
intended to explore and describe the evidence that exists on
evaluation. Most articles that were included in this present
technology use in nursing education, without narrowing it
review followed quantitative approach wherein the
to COVID-19, although acknowledging its impact on
researchers used surveys and questionnaires for data
teaching-learning landscape. Specificity of literature search collection. This was followed by qualitative approach with
was ensured by the use of keywords that made the search interviews as their main method of data collection. The
specific to the aim of this integrative review. The use of remaining articles followed mixed methods approach.
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 Step 4: Data analysis
articles in order to ensure that articles with a potential to Articles were analysed independently by the authors
answer the review question are subjected to screening following six steps of thematic analysis, namely,
process. An adapted PRISMA flow diagram from Stovold familiarisation, coding, generating themes, reviewing
et al. (2014:3) was then used to further screen the studies themes, defining and naming themes, and writing up.
for their relevance and potential inclusion in this 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,
Studies retrieved from online Studies retrieved from
databases search (n = 3585) manual sources search (n = 0) themes were then generated from the pattern of the codes
Search results

which were identified in the literature. Fourthly, the authors

checked the accuracy of the themes to ensure that they are a
Records filters applied on (n = 2863) Duplicate records true representation of the included studies. Fifthly, the
(n = 3585) were removed
authors labelled each theme, and this was succeeded by the
(n = 660) Records were
Records who’s tles and removed whose tles and
abstracts were screened (n = 722) abstracts had no potenal to Inclusion criteria Exclusion criteria
Screening

answer the review queson • •

English because they were costly to
(n = 43) Full text studies published in other languages. translate to English.
Records who’s full texts where
were removed for not • •
screened (n = 62)
meeng eligibility criteria 2021 to obtain recent data. authors could not get the detailed

- • Conference reports because they do

Included studies in the review
Inclusion

(n = 19) and therefore could not be assessed

for rigour.
- •
usage and teaching and learning in
other disciplines than nursing because
Source: Adapted from Stovold, E., Beecher, D., Foxlee, R. & Noel-Storr, A., 2014, ‘Study flow
diagrams in Cochrane systematic review updates: An adapted PRISMA flow diagram’,
Systematic Reviews 3(1), 1–5. https://doi.org/10.1186/2046-4053-3-54
FIGURE 2: PRISMA flow diagram. FIGURE 3: Inclusion and exclusion criteria.

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 Page 4 of 9 Original Research

TABLE 1: Quality appraisal of articles.

No. Author(s) Purpose Design Highlights of key findings Quality appraisal criteria (Scale: Y =
year, yes, P = poor, NR = not reported
Country
1. Barisone To explore the Qualitative Clinical learning is fundamental to prevent and know how to manage (Y) Aims and objectives clearly
et al. (2019), perception and descriptive study risky situations. described.
Italy effectiveness of (Y) Study design adequately described.
web-based Therefore, it is important to facilitate the learning of gestural skills (Y) Research methods appropriate.
learning in facilitating and can be effectively done with the support of technology. (Y) Limitations presented.
the development of These learning instruments, which are easy to use and access, could
clinical skills reinforce the knowledge development process by acting as a bridge
in undergraduate between theory and practice.
nursing students.
2. Chang and To understand the Qualitative Most students expressed that because the virtual reality (P) Aims and objectives clearly
Lai (2021) experience of nursing exploratory environment was responsive to hand touch, the gestures were easier described.
students in using descriptive design to learn. (Y) Study design adequately described.
virtual reality skill (Y) Research methods appropriate.
learning process. By enabling learners who are unfamiliar with the technology to (NR) Limitations presented.
understand the comprehensive process, the system can assist in the
learning process.
Furthermore, the system provides learning resources on demand,
thus creating an independent and stress-free learning environment.
3. Coopasami To assess the Quasi-experimental Less than half (47%) initially knew what e-learning was and this (P) Aims and objectives clearly
Knight and students’ readiness interrupted time improved to 75% post-intervention. described.
Pete (2017), to make a shift from series (Y) Study design adequately described.
South Africa traditional learning to Just less than half (46%) of the participants thought that e-learning (Y) Research methods appropriate.
the technological could lead to social isolation, but most DUT nursing students live in (Y) Limitations presented.
culture of e-learning residence and enjoy an active social life.
at a university in Turning to the overall e-learning readiness score, most (72%) of the
Durban. participants were categorised as ‘proceed with caution’.
4. Foronda Evaluation of vSIM for Descriptive, Respondents reported that the content of the virtual simulation was (Y) Aims and objectives clearly
et al. (2016), Nursing: A Trial of mixed-methods directly relevant to their role as a nurse (61% strongly agree and 39% described.
United States Innovation. design agree). (Y) Study design adequately described.
of America (Y) Research methods appropriate.
Nearly, all the nursing students who participated recommended vSIM (Y) Limitations presented.
for future use, suggesting that the virtual simulation experience was
a positive one.
5. Harerimana To explore nursing Cross-sectional The students perceived that technology was used by educators to (Y) Aims and objectives clearly
and Mtshali students’ perceptions descriptive deliver instructions (3.77 ± 1.19), to maintain students’ attention described.
(2019), and expectations quantitative (3.77 ± 1.19) and to make connections to the learning process (Y) Study design adequately described.
South Africa regarding the use of research through audio or video material (3.64 ± 1.36). (Y) Research methods appropriate.
technology in nursing (NR) Limitations presented.
education. Nursing students reported that educators use technology for various
academic purposes.
Overall, the majority of the nursing students had high expectations for
nurse educators to use Moodle (88.7%), search tools (75.3%), published
electronic resources (70.7%) and early-alert systems designed to catch
potential academic trouble as soon as possible (70.0%).
6. Maboe To determine how the Quantitative Computers and cell phones with Internet access allow students (Y) Aims and objectives clearly
(2017), discussion forum as descriptive study access to the discussion forum on the website of an ODL institution. described.
South Africa an online interactive (Y) Study design adequately described.
tool be used in an ODL Thirty-four (39.5%) of the respondents agreed that the online (Y) Research methods appropriate.
institution to enhance discussion forum allows them to study with their peers; 28 (32.5%) (Y) Limitations presented.
student-to-student strongly agreed; and 17 (19.8%) were unsure.
and student-to-lecture About 20.0% of the respondents indicated that they get no support
online interactions. from lecturers and fellow students when they interact online.
7. Mackay et al. To describe the Qualitative The use of the iPad enabled a rich range of resources to be available (Y) Aims and objectives clearly
(2017), New process of introducing descriptive study to both the lecturer and the student. described.
Zeeland teaching innovation (Y) Study design adequately described.
and to explore clinical The lecturers were very positive about the immediate and portable (Y) Research methods appropriate.
lecture perceptions connectivity to a rich range of resources. (NR) Limitations presented.
and experience of the There were reports that it enhanced the students’ critical thinking.
use of mobile smart
devices to support
student learning.
8. Mawere, The paper explores Participatory action One of the critical findings in this paper is that most rural institutions (Y) Aims and objectives clearly
Mukonza the experiences faced research method are not ready or rather lack capacity to cater for disadvantaged described.
and Kugara by first students. (Y) Study design adequately described.
(2021), entering students (Y) Research methods appropriate.
South Africa from rural-based The other significant finding was the absence of devices to connect (Y) Limitations presented.
institutions on the use for digital learning.
of digital learning
during the coronavirus
pandemic in
South Africa.
9. O’Connor To understand the Quantitative Of note there was an upward trend in those who used educational (Y) Aims and objectives clearly
and Andrews perspectives cross-sectional apps in practice. described.
(2018) of nursing students in descriptive design (Y) Study design adequately described.
relation to using Although many students did not actively use apps to help them learn (P) Research methods appropriate.
smartphones and clinical settings, when asked if they would consider doing so, the (Y) Limitations presented.
mobile apps to majority said ‘yes’.
enhance learning in Compared to other approaches, students ranked mobile apps as the
clinical environments. third most useful source of information for learning in practice.
10. O’Connor To describe how Case study A wider evaluation of the new nursing informatics curricula and (P) Aims and objectives clearly
and LaRue health informatics is pedagogic framework is currently underway to determine its described.
(2021), being integrated into a usefulness in giving nursing students the competencies they need to (P) Study design adequately described.
United Bachelor of Nursing become skilled in digital health. (Y) Research methods appropriate.
Kingdom programme in the (NR) Limitations presented.
United Kingdom.
Table 1 Continues on the next page→

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 Page 5 of 9 Original Research

TABLE 1 (continues...): Quality appraisal of articles.

No. Author(s) Purpose Design Highlights of key findings Quality appraisal criteria (Scale: Y =
year, yes, P = poor, NR = not reported
Country
11. Oducado To examine nursing Descriptive, This is an expected finding during this uncertain and unprecedented (Y) Aims and objectives clearly
and Soriano students’ attitudes cross-sectional time of crisis and as the educational system transition from the described.
(2021), towards e-learning in research design traditional delivery of instruction to a more flexible yet unpopular (Y) Study design adequately
Philippines two selected nursing modality of teaching and learning. described.
schools in (Y) Research methods appropriate.
the Philippines. The nursing students may be unfamiliar with and not fully prepared (Y) Limitations presented.
for the new modality in learning.
12. Singh et al. To provide Quantitative online Computer and Internet usage and availability of dedicated space at (P) Aims and objectives clearly
(2021), preliminary data to survey home (where there are no environmental distractions) to attend described.
India the stakeholders online classes determine the feasibility or practicability (P) Study design adequately
regarding the of e-learning. described.
feasibility and (Y) Research methods appropriate.
acceptability of Seamless Internet connectivity is of paramount importance to (NR) Limitations presented.
e-learning. attend classes without interruption.
Network-related issues were frequently reported by a significant
percentage of students.
13. Suliman To investigate the Qualitative A combination of the following platforms was used to facilitate the (Y) Aims and objectives clearly
et al. (2021) experiences exploratory OL of the participants: E-learning (12 students), Microsoft Team described.
of undergraduate descriptive design (seven students), Zoom (16 students), Skype (seven students), (Y) Study design adequately
nursing WhatsApp (15 students), YouTube (eight students) and Facebook described.
students during their (11 students). (Y) Research methods appropriate.
first uses of OL to (NR) Limitations presented.
increase the Most study participants reported having poor skills in using OL
understanding technology.
of their encountered Half of the students reported that they had episodes of Internet
opportunities and failure whilst attending classes, taking quizzes or submitting
challenges. assignments, which provoked feelings of helplessness and
contributed to their dissatisfaction with the online experience.
14. Toothaker To assess the Mixed-method The qualitative results reflect positive perception of millennial (Y) Aims and objectives clearly
(2018), millennial design nursing students’ use of clickers. described.
Pennsylvania perceptions and (Y) Study design adequately
attitudes of clickers Ninety-one percent of the students agreed or strongly agreed that described.
on learning during the use of clickers helped them to develop a better understanding of (Y) Research methods appropriate.
traditional lecture the subject matter when compared to traditional lecture-based (NR) Limitations presented.
series. classes.
Eighty-nine per cent of the nursing students felt that the clicker
question provided the professors to respond to concepts not
understood in the classroom.
15. Uprichard To explore both the Qualitative One of the clear benefits of using e-learning to deliver training is the (P) Aims and objectives clearly
(2020), benefits of and exploratory flexibility of the location and time it needs to be completed. described.
Manchester barriers to descriptive study (P) Study design adequately
e-learning. One of the main barriers to the use of e-learning is technical described.
difficulty. (P) Research methods appropriate.
Another barrier to the use of e-learning is technological illiteracy. (NR) Limitations presented.
16. Van Vuuren, The perceptions of Quantitative Low and medium fidelity simulators are widely utilised in both -
Goon and nurse educators descriptive classroom and clinical settings.
Seekoe regarding the use of research design
(2018), high fidelity The fact that most participants agreed that high fidelity simulators
South Africa simulation in nursing help to reduce errors and improve teaching shows that patient
education. safety is also a priority.

17. Verkuyl and Virtual Simulations in Arksey and The participants in the review in general exhibited enthusiasm for -
Mastrilli Nursing Education: A O’Malley’s scoping virtual simulation as a teaching strategy in nursing.
(2017), Scoping Review. methodology
Canada These findings are encouraging to faculty members who are
exploring innovation in technology and provide support for further
development and implementation of virtual simulations.
18. Willemse To explore the Qualitative Challenges experienced with data/airtime/Wi-Fi, impaired (Y) Aims and objectives clearly
Jooste, and experiences of contextual design communication because of poor network access and use of mobile described.
Bozalek undergraduate devices in practice perceived as unprofessional. (Y) Study design adequately
(2019), nursing students who described.
South Africa participated in an (Y) Research methods appropriate.
authentic mobile (NR) Limitations presented.
learning enactment
aimed at enhancing
their learning
experiences.
19. Zarandona To characterise the Quantitative cross- Overall, 23.3% of participants admitted to having used their (Y) Aims and objectives clearly
et al. use of smartphones sectional smartphone for personal reasons at least once during their described.
(2019), by nursing students descriptive study practicum. (P) Study design adequately
Spain and to assess their described.
opinions about the Most students (98.3%) used their smartphones for accessing social (Y) Research methods appropriate.
use of such phones networks, followed by university resources (42.3%). (Y) Limitations presented.
as a distracting factor Other cited uses were as a tool for communication and
during clinical coordination with other team members (19.4%) and for accessing
practicum and apps to support patient care (13.4%).
smartphone
restriction policies.
Source: Adapted from Kangasniemi, M., Pakkanen, P. & Korhonen, A., 2015, ‘Professional ethics in nursing: An integrative review’, Journal of Advanced Nursing 71(8), 1744–1757. https://doi.
org/10.1111/jan.12619
vSIM, virtual simulation; ODL, open distance learning; DUT, Durban University of Technology; OL, online learning.

sixth step which is writing up. An inductive approach of education, (2) the manner in which technology is used in
thematic analysis was used. This implies that the authors nursing education, (3) antecedents for technology use in
allowed data to generate themes as explained earlier. nursing education, (4) advantages of technology use
As six themes emerged: (1) technology use in nursing in nursing education, (5) disadvantages of technology use

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 Page 6 of 9 Original Research

in nursing education and (6) technology use in nursing Theme 2: Manner in which technology is used in
education amidst COVID-19. nursing education
This theme discusses the manner in which technology is used
Ethical considerations for teaching and learning both in clinical and classroom
Ethical clearance to conduct this study was obtained settings.
from the North-West University Health Research Ethics
Committee (NWU-HREC) (number: NWU-02071-20-A1).
Manner in which technology is used in classroom nursing
education
Ethical standards for conducting the research were followed
According to Harerimana and Mtshali (2019:6), technology in
in this article, even though it was a review and not conducted
nursing education is primarily used for communication of
with human, plant or animal participants. Studies that had
instructions to the students to enhance their creativity and
ethical approval were included.
critical thinking skills and also for building relationships
with stakeholders in nursing education. The authors add that
Step 5: Data presentation technology in nursing education is used to maintain student
In this section, the authors outline and discuss the results of attention in the classroom and to corroborate theoretical
this integrative review. learning through the use of audio virtual aids. Teaching and
learning in classroom is achieved through the use of mediums
such as Microsoft Teams, Skype and Zoom together with a
Results range of available social media platforms. Using those
The key results of this integrative review are described in mediums, teaching and learning is then facilitated either
this section under the following themes: (1) technology synchronously or asynchronously through the use of
use in nursing education, (2) the manner in which PowerPoint presentations, didactic lectures, video-based
technology is used in nursing education, (3) antecedents for learning, case-based learning, prerecorded lectures, quizzes
technology use in nursing education, (4) advantages of or online whiteboards (Singh et al. 2021:4). Moreover,
technology use in nursing education, (5) disadvantages of technology in classroom nursing education can also be used
technology use in nursing education and (6) technology to manage academic dishonesty through the use of software
use in nursing education amidst COVID-19. The results of such as Turnitin (Harerimana & Mtshali 2019:9).
this study included surrogate terms for technology usage
for teaching and learning, such as ‘online learning’,
Manner in which technology is used in clinical nursing
education
‘technology use in teaching and learning’, ‘e-learning’ and
‘virtual learning’. Technology use in clinical teaching can be split into two
entities which are interlinked, namely, the clinical placement
for WIL and simulation lab. Generally, there has been a
Theme 1: Technology use in nursing education notable increase in the use of technology applications for
The first theme discusses the frequency of technology use for teaching and learning in clinical nursing education of late
teaching and learning in both classroom and clinical nursing (O’Connor & Andrews 2018:174). According to O’Connor
education. and Andrews (2018:174) and Zarandona et al. (2019:69), the
most common uses of technology at the clinical placement
Information and communication literacy, information for WIL include the use of software to access applications
systems management and citizen digital health literacy are such as calculators, drug reference guide, disease and
amongst the individual descriptors of learning that students disorder books, and medical dictionary. This allows students
should achieve in each of the key areas (O’Connor & LaRue to get the comfort of accessing instant references in their
2021:3). This implies that digital literacy is amongst the pocket when they need to make clinical decisions. On the
critical cross-fields for every graduate. As a result, the same breath, there is a fraction of students who have been
increase in the number of people who use computerised reported to misuse technology at the clinical facilities. In
devices such as smartphones is relatively proportional to their study, Zarandona et al. (2019:69) found that about 23%
the amount of time spent on these devices (Zarandona et al. of participants admitted to having used technology for their
2019:70). For the students belonging to the millennial own personal gain whilst at the clinical services, whereas
generation, technology devices have become the important 98% admitted that they begin with accessing their social
tool for interaction (Willemse et al. 2019:72). This is no media prior to university resources. Consequently, some
exception in nursing education wherein the use of technology nurses at the clinical facilities for WIL perceive technology
devices both in the class and in clinical placements is an use by nursing students at the clinical services as
order of the day. The use of mobile applications (apps) in unprofessional (Willemse et al. 2019:72).
nursing education has been ranked top in comparison to
peer learning and clinical placement coordinators (O’Connor The above perception by nurses at WIL facilities is different
& Andrews 2018:174). The authors further highlighted from that of nurse educators at institutions of higher learning
that an upward trend in technology use for teaching and or simulation lab. There seems to be an increasing interest by
learning continues to be noticed, especially in clinical nurse educators and students to adopt technology use in
nursing education. teaching and learning in simulation lab (Foronda et al. 2016:131;

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Van Vuuren et al. 2018:16). Virtual online learning platforms critical cross-field outcomes. In addition, in a study conducted
such as virtual reality have been incorporated into simulation by Maboe (2017:225), about 40% of the respondents agreed
lab to provide immersive learning experience for nursing that online discussion forums allowed them to study with
students (Chang & Lai 2021:5). A study by Van Vuuren et al. their peers, whereas 20% of the respondents reported
(2018:15) demonstrated that the use of high-fidelity simulators receiving no support from facilitators when engaged in
contributes positively to the reduction of errors in nursing online learning. This can be substantiated by the fact that
care, thus improving teaching and learning and prioritising when using technology for teaching and learning, tasks are
patient safety. The use of technology in simulation lab was usually completed at their own time and pace and that
further reported to be user-friendly by students (Foronda et al. facilitates learner independence. As Uprichard (2020:272)
2016:131). However, successful implementation of technology and Coopasami et al. (2017:305) suggest, the one clear benefit
use in nursing education heavily relies on cooperation by all of technology usage in teaching and learning is its flexibility
stakeholders involved, such as institutional management,
of the location and time when completing tasks. This implies
willingness by educators and willingness by students (Verkuyl
that teaching and learning can happen at any time when
& Mastrilli 2017:45).
either party is at the comfortable location because it is neither
time nor space bound.
Theme 3: Antecedents for technology use in
nursing education
Advantages of technology use in clinical nursing education
For technology use in teaching and learning to be effective,
In clinical nursing education, the use of technology has risen
there are several antecedents that need to be in place. In this
recently at an alarming rate (O’Connor & Andrews 2018:174).
theme, the antecedents or enablers of technology for teaching
The use of applications, such as virtual reality and virtual
and learning are discussed.
patients, is perceived to be convenient, speed up the skills
Antecedents for technology use in classroom nursing learning process and create a stress-free learning environment
education (Chang & Lai 2021:5). However, at times, nurse educators
As much as there are still challenges to adapt to technology find it hard to get relevant audio virtual materials to support
use in nursing education, especially given the current learning of such clinical skills (Barisone et al. 2019:58). Thus,
COVID-19 pandemic, it remains a reality that nursing equipping nurses with technological skill through the use of
education is shifting to online rather than face-to-face technology in clinical nursing education can go a long way in
platform. There are several enablers that need to be in place to improving the marketability of nursing. This is vital as many
achieve the goal of technology use in nursing education. nursing education institutions and health establishments are
Internet facilities, computer hardware and software, students slowly going green and require technological skills in their
and educator competence in computer and Internet usage are
potential incumbents.
basic antecedents for the use of technology in teaching and
learning (Singh et al. 2021:2). On the same breath, senior
management and ICT department support is equally an
Theme 5: Disadvantages of technology usage in
important antecedent for technology use in nursing education
nursing education
(Mackay et al. 2017:03). This is supported by Coopasami This theme discusses the disadvantages of technology use
et al. (2017:304) who found that psychological readiness, in both clinical and classroom nursing education. The
technological readiness and equipment readiness play a disadvantages are discussed concurrently with the challenges.
critical role as enablers of technology use in nursing education.
Therefore, it can be summed up that simply owning a Disadvantages and challenges of technology use in
smartphone or a computer with access to Internet does not classroom nursing education
imply that one is ready for technology use for teaching and The shift to virtual approach of teaching and learning from
learning; readiness goes beyond equipment readiness as it traditional teaching overnight amidst COVID-19 lockdown
also includes psychological and technological readiness. regulations came as a huge challenge for many educational
institutions to adapt to such sudden change. Network-related
Theme 4: Advantages of technology use in issues which include audio virtual disparities, interruption of
nursing education sessions because of unexpected logging out from network
There are several studies that have reported the advantages and continuous buffering are amongst the challenges
of technology usage in nursing education (Barisone et al. experienced when using technology for teaching and learning
2019:59; Mackay et al. 2017:3; Toothaker 2018:82). This theme (Sigh et al. 2021:2). Moreover, poor connectivity and
explores the advantages of technology use in nursing technological illiteracy are also the challenges related to the
education concurrently with its benefits. use of technology for teaching and learning in nursing
education (Suliman et al. 2021:3; Uprichard 2020:273). In
Advantages of technology use in classroom nursing addition, participants reported lack of time management
education between family responsibilities and online learning amongst
According to Coopasami et al. (2017:305), the use of married couples, which was seen as a disadvantage of
technology in nursing education is one of the facilitators of technology use in classroom nursing education (Suliman
self-directed and life-long learning, which are amongst the et al. 2021:4).

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Disadvantages and challenges of technology use in clinical is a notable upward trend in technology use for teaching and
nursing education learning. Of the same importance is that this current review
As much as the use of technology in nursing education should summarised evidence of the uses of technology in teaching
not lose the unique potentiality of nurse–person relationship, and learning and its advantages.
it seems to be lacking human interaction (Uprichard 2020:273).
This is seen as a disadvantage when using technology for The findings of this study further highlight that technology
clinical nursing education, in a sense that, in the nursing use in nursing education is not limited to classroom
profession, nurse–patient interaction and relation is vital as it boundaries, but goes as far as clinical nursing education as
plays a role in facilitating the tridomains of competence, well. Although their uses are different in those two
components of nursing education, their aim is to corroborate
namely, psychomotor, affect and cognitive. As a result, some
or to complement each other. However, the acceptance of its
clinical staff perceive the use of technology devices negatively;
use especially by nurses at the clinical facilities for WIL seems
it is seen more as a social than an educational tool (Mackay
to be an issue till date. According to Willemse et al. (2019:72),
et al. 2017:3).
technology use at clinical facilities is perceived to be
unprofessional. Zarandona et al. (2019:69) stated that some
Theme 6: Technology use in nursing education students have been reported to be using technology devices
amidst COVID-19 for personal issues at least once when at practicals. However,
It is almost impossible to divorce technology use in nursing there is no evidence supporting the connection between the
education with COVID-19 pandemic, especially in this era. negative perception of technology use by nurses and the
This pandemic has indeed changed the teaching–learning seldom incorrect use of technology by student nurses.
landscape by navigating it to an abrupt online modality of
teaching and learning, thus making technology use in Like any other approach in teaching and learning, there are
nursing education unpopular and unfamiliar to nursing disadvantages of technology use in teaching and learning.
In this review, the disadvantages are discussed together
students because of a lack of preparation for its introduction
with the challenges. Poor connectivity and interrupted
(Oducado & Soriano 2021:8). Although the main purpose for
sessions are amongst the challenges of technology use
the shift to fully use technology for teaching and learning
highlighted by a number of researchers (Maboe 2017:226;
amidst the COVID-19 pandemic was mainly to safe the
Suliman et al. 2021:3; Uprichard 2020:273). Similarly,
academic year, several researchers reported mainly on the connectivity which leads to interrupted sessions seems to
challenges that were brought about the implementation of be an issue in the geographical context of the authors of this
this modality of teaching and learning (Mawere et al. 2021:53; current review. In addition, the findings of this integrative
Oducado & Soriano 2021:8; Singh et al. 2021:6). Such review highlighted that some institutions have no capacity
challenges included (1) the lack of training for both students to offer technology-based nursing education because of lack
and educators on technology-supported teaching and of resources, which led to course extension for students.
learning, (2) the lack of infrastructure that enables technology- However, the common factor in the articles included in this
supported teaching and learning and (3) the lack of devices review is that they were all conducted in urban areas with
that are necessary for technology-supported teaching and university students and educators as the study population.
learning. The challenges were mainly owing to its abrupt
introduction and the disparities that exist between the ‘haves’ Limitations of the study
and the ‘have-nots’. As Singh et al. (2021:6) and Mawere et al.
The researchers used ‘technology use’ and ‘nursing
(2021:53) put it, infrastructure for technology use for teaching
education’ as search terms in this study, and there are other
and learning, including lack of capacity to use technology surrogate terms to these two terms used to search for
devices, is a huge challenge facing rural education institutions literature. As a result, there is a likelihood that if a similar
and disadvantaged students. Nevertheless, the upward trend study can be conducted using surrogate terms like ‘health
of technology use remains in the shores of nursing education. science education for nursing education’ and ‘e-learning for
technology use’, it might yield different results. Secondly, the
Discussion time frame in this study was set to the recent years
(2016–2021), which can be a limitation also, given the fact that
This integrative review offered a contemporarily updated
technology use in general has long been a burning issue
evidence on technology usage for teaching and learning in
given the fast approaching of Fourth Industrial Revolution.
nursing education. The findings of this integrative review
Lastly, the researchers focused on a discipline of nursing
indicated that there is a general adoption of technology usage education in which if the context could be changed, it might
for teaching and learning in higher learning institutions, yield different results.
although some challenges with regard to full adoption are
still noted. This is evidenced by the recent upward trend in
technology use for teaching and learning, especially given Conclusion
the current COVID-19 social distancing regulations. A study The results of this integrative review showed that despite the
conducted by O’Connor and Andrews (2018:174) concurs few challenges and disadvantages reported with regard to
with the results of this review wherein they found that there technology use, its use continues to grow in an exponential

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 Page 9 of 9 Original Research

way. Furthermore, the results showed that technology in Coopasami, M., Knight, S. & Pete, M., 2017, ‘E-Learning readiness amongst nursing
students at the Durban University of Technology’, Health SA Gesondheid 22(1),
nursing education is used in both clinical and classroom 300–306. https://doi.org/10.1016/j.hsag.2017.04.003
teaching to complement learning. However, there is still a Dhir, S.K., Verma, D., Batta, M. & Mishra, D., 2017, ‘E-learning in medical education in
India’, Indian Pediatrics 54(10), 871–877. https://doi.org/10.1007/s13312-017-1152-9
gap in its acceptance despite its upward trend. To meet the DiMattio, M.J.K. & Hudacek, S.S., 2020, ‘Educating generation Z: Psychosocial dimensions
demands of the Fourth Industrial Revolution and the upward of the clinical learning environment that predict student satisfaction’, Nurse
Education in Practice 49, 102901. https://doi.org/10.1016/j.nepr.2020.​102901
trend of technology use amidst COVID-19 pandemic and Forehand, J.W., Miller, B. & Carter, H., 2017, ‘Integrating mobile devices into the
possibly beyond, the authors of this study recommend that nursing classroom’, Teaching and Learning in Nursing 12(1), 50–52. https://doi.
org/10.1016/j.teln.2016.09.008
further studies should explore the acceptance of technology Foronda, C.L., Swoboda, S.M., Hudson, K.W., Jones, E., Sullivan, N., Ockimey, J. et al.,
use by educators and students in nursing education. Also, 2016, ‘Evaluation of vSIM for Nursing™: A trial of innovation’, Clinical Simulation in
Nursing 12(4), 128–131. https://doi.org/10.1016/j.ecns.2015.12.006
further research is recommended on students’ and educators’ Harerimana, A. & Mtshali, N.G., 2019, ‘Nursing students’ perceptions and expectations
attitude towards technology use for teaching and learning in regarding the use of technology in nursing education’, Africa Journal of Nursing
and Midwifery 21(2), 1–20. https://doi.org/10.25159/2520-5293/5103
nursing education. Hashim, H., 2018, ‘Application of technology in the digital era education’, International
Journal of Research in Counseling and Education 2(1), 1–5. https://doi.
org/10.24036/002za0002
Acknowledgements Kangasniemi, M., Pakkanen, P. & Korhonen, A., 2015, ‘Professional ethics in nursing:
An integrative review’, Journal of Advanced Nursing 71(8), 1744–1757. https://
The authors acknowledge all authors of the data sources that doi.org/10.1111/jan.12619
Maboe, K.A., 2017, ‘Use of online interactive tools in an open distance learning
were used in compiling this integrative review. The authors context: Health studies students’ perspective’, Health SA Gesondheid 22, 221–227.
of data sources used in this article are acknowledged both https://doi.org/10.1016/j.hsag.2017.02.001

in-text and in the reference list. Mackay, B.J., Anderson, J. & Harding, T., 2017, ‘Mobile technology in clinical teaching’,
Nurse Education in Practice 22, 1–6. https://doi.org/10.1016/j.nepr.2016.11.001
Márquez-Hernández, V.V., Gutiérrez-Puertas, L., Granados-Gámez, G., Gutiérrez-
Puertas, V. & Aguilera-Manrique, G., 2020, ‘Problematic mobile phone use,
Competing interests nomophobia and decision-making in nursing students mobile and decision-
making in nursing students’, Nurse Education in Practice 49, 102910. https://doi.
The authors have declared that no competing interests exist. org/10.1016/j.nepr.2020.102910
Mawere, J., Mukonza, R.M. & Kugara, S.L., 2021, ‘Re-envisioning the education system
for 4IR: Exploring the experiences faced by first entering students from rural-
based institutions on the use of digital learning during the coronavirus pandemic
Authors’ contributions in Limpopo province, South Africa’, Journal of African Education 2(2), 43–66.
https://doi.org/10.31920/2633-2930/2021/v2n2a2
All authors contributed equally to this article, from the Moagi, M.M., Der Wath, A.E.V., Jiyane, P.M. & Rikhotso, R.S., 2021, ‘Mental health
challenges of lesbian, gay, bisexual and transgender people: An integrated
conceptualisation until the completion of the final manuscript. literature review’, Health SA Gesondheid 26, 1487. https://doi.org/10.4102/hsag.
v26i0.1487
O’Connor, S. & Andrews, T., 2018, ‘Smartphones and mobile applications (apps) in
Funding information clinical nursing education: A student perspective’, Nurse Education Today 69,
172–178. https://doi.org/10.1016/j.nedt.2018.07.013
This study was funded by the North-West University O’Connor, S. & LaRue, E., 2021, ‘Integrating informatics into undergraduate nursing
education: A case study using a spiral learning approach’, Nurse Education in
postgraduate bursary. Practice 50, 102934. https://doi.org/10.1016/j.nepr.2020.102934
Oducado, R.M.F. & Soriano, G.P., 2021, ‘Shifting the education paradigm amid the
COVID 19 pandemic: Nursing students’ attitude to E learning’, Africa Journal of
Data availability Nursing and Midwifery 23(1), 1–14. https://doi.org/10.25159/2520-5293/8090
Singh, H.K., Joshi, A., Malepati, R.N., Najeeb, S., Balakrishna, P., Pannerselvam, N.K.
Data sharing is not applicable to this article because the study et al., 2021, ‘A survey of e-learning methods in nursing and medical education
during COVID-19 pandemic in India’, Nurse Education Today 99, 104796. https://
used data that are already in the public domain. doi.org/10.1016/j.nedt.2021.104796
Stovold, E., Beecher, D., Foxlee, R. & Noel-Storr, A., 2014, ‘Study flow diagrams in
Cochrane systematic review updates: An adapted PRISMA flow diagram’,
Disclaimer Systematic Reviews 3(1), 1–5. https://doi.org/10.1186/2046-4053-3-54
Subedi, S., Nayaju, S., Subedi, S., Shah, S.K. & Shah, J.M., 2020, ‘Impact of E-learning
The views and opinions expressed in this article are those of during COVID-19 pandemic among nursing students and teachers of Nepal’,
International Journal of Science and Healthcare Research 5(3), 68–76.
the authors and do not necessarily reflect the official policy or Suliman, W.A., Abu-Moghli, F.A., Khalaf, I., Zumot, A.F. & Nabolsi, M., 2021, ‘Experiences
position of any affiliated agency of the authors. of nursing students under the unprecedented abrupt online learning format forced
by the national curfew due to COVID-19: A qualitative research study’, Nurse
Education Today 100, 104829. https://doi.org/10.1016/j.nedt.​2021.104829

References Toothaker, R., 2018, ‘Millennial’s perspective of clicker technology in a nursing

classroom: A mixed methods research study’, Nurse Education Today 62, 80–84.
https://doi.org/10.1016/j.nedt.2017.12.027
Al-Hariri, M.T. & Al-Hattami, A.A., 2017, ‘Impact of students’ use of technology on Uprichard, K., 2020, ‘E-learning in a new era: Enablers and barriers to its
their learning achievements in physiology courses at the University of Dammam’, implementation in nursing’, British Journal of Community Nursing 25(6), 272–275.
Journal of Taibah University Medical Sciences 12(1), 82–85. https://doi. https://doi.org/10.12968/bjcn.2020.25.6.272
org/10.1016/j.jtumed.2016.07.004 Van Vuuren, V.J., Goon, D.T. & Seekoe, E., 2018, ‘The perceptions of nurse educators
Alsayed, S., Bano, N. & Alnajjar, H., 2020, ‘Evaluating practice of smartphone use among regarding the use of high fidelity simulation in nursing education’, Africa Journal of
university students in undergraduate nursing education’, Health Professions Nursing and Midwifery 20(1), 1–20. https://doi.org/10.25159/2520-5293/1685
Education 6(2), 238–246. https://doi.org/10.1016/j.hpe.​2019.06.004 Verkuyl, M. & Mastrilli, P., 2017, ‘Virtual simulations in nursing education: A scoping
review’, Journal of Nursing and Health Sciences 3(2), 39–47.
Barisone, M., Bagnasco, A., Aleo, G., Catania, G., Bona, M., Scaglia, S.G. et al., 2019,
‘The effectiveness of web-based learning in supporting the development Whittemore, R. & Knafl, K., 2005, ‘The integrative review: Updated methodology’,
of nursing students’ practical skills during clinical placements: A qualitative Journal of Advanced Nursing 52(5), 546–553. https://doi.org/10.1111/​j.1365-
study’, Nurse Education in Practice 37, 56–61. https://doi.org/10.1016/j. 2648.2005.03621.x
nepr.2019.02.009 Willemse, J.J., Jooste, K. & Bozalek, V., 2019, ‘Experiences of undergraduate nursing
Chalmers, I., Bracken, M.B., Djulbegovic, B., Garattini, S., Grant, J., Gülmezoglu, A.M. et al., students on an authentic mobile learning enactment at a higher
education institution in South Africa’, Nurse Education Today 74, 69–75. https://
2014, ‘How to increase value and reduce waste when research priorities are set’, The doi.org/10.1016/j.nedt.2018.11.021
Lancet 383(9912), 156–165. https://doi.org/10.1016/S0140-6736(13)62229-1
Zarandona, J., Cariñanos-Ayala, S., Cristóbal-Domínguez, E., Martín-Bezos, J., Yoldi-Mitxelena,
Chang, Y.M. & Lai, C.L., 2021, ‘Exploring the experiences of nursing students in using A. & Cillero, I.H., 2019, ‘With a smartphone in one’s pocket: A descriptive cross-sectional
immersive virtual reality to learn nursing skills’, Nurse Education Today 97, study on smartphone use, distraction and restriction policies in nursing students’, Nurse
104670. https://doi.org/10.1016/j.nedt.2020.104670 Education Today 82, 67–73. https://doi.org/10.1016/j.nedt.2019.08.001

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