The use of technology to improve clinical practice in nursing education

ISRCTN	ISRCTN86628074
DOI	https://doi.org/10.1186/ISRCTN86628074
Secondary identifying numbers	AKTIV-2018/10101

Submission date: 23/02/2021
Registration date: 25/02/2021
Last edited: 24/02/2021

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Other

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Record updated in last year

Plain English summary of protocol

Background and study aims
Nursing students must demonstrate a strong ability in critical thinking to meet the demands of the nursing profession. This ability must be learned and practiced, and nursing students can best do that in clinical practice. In Norway, nursing students spend a great part of their education in clinical practice, in which registered nurses, called nurse preceptors, guide the students and provide a foundation for the development of critical thinking. Clinical practice can be challenging for students, because, nurse preceptors may lack experience in guidance and nurse educators are not involved in the daily guidance of students. Hence, communication between nursing students, nurse preceptors and nurse educators may be limited. Technological tools have the potential to improve the guidance of nursing students and thus stimulate the development of critical thinking in new ways, but it is currently unclear which technological tools should be used and how they should be used to support nursing students in developing their critical thinking ability.
This study aims to compare the effectiveness of guiding nursing students with technological support (i.e., a mobile application and virtual meetings in the intervention group) against guidance as usual (i.e., a control group without technology). The outcomes to be measured include self-efficacy, the clinical learning environment, the effects on critical thinking and the acceptance of new technology.

Who can participate?
First-year undergraduate nursing students in clinical practice at Lovisenberg Diaconal University College (LDUC), Oslo, Norway.

What does the study involve?
First-year undergraduate nursing students in clinical practice will be randomly assigned to either a control group or the intervention group. Both groups will receive daily guidance from a nurse preceptor during their clinical practice, and the participants in the intervention group will additionally use an application called Technology Optimised Practice Process in Nursing (TOPP-N) as a guidance tool along with virtual meetings with the nurse educator.
The students in the intervention group will use the mobile application daily for 6 weeks, and their levels of critical thinking, self-efficacy, perception of the clinical environment and acceptance of technology will be measured by self-reported tests and questionnaires. Measurements will be taken before their clinical practice, upon completion and then 3 and 9 months after the last day of clinical practice.

What are the possible benefits and risks of participating?
The benefits for participants include structured, systematic guidance in clinical practice, stimulation of the development of critical thinking, reflection on their own learning and improved communication with nurse preceptors and nurse educators. There are no risks associated with participation.

Where is the study run from?
Lovisenberg Diaconal University College (LDUC) (Norway)

When is the study starting and how long is it expected to run for?
September 2019 to April 2023

Who is funding the study?
1. Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education (DIKU) (Norway)
2. Lovisenberg Diaconal University College (LDUC) (Norway)

Who is the main contact?
Mr Jaroslav Zlamal
Jaroslav.Zlamal@ldh.no
Mrs Andrea Aparecida Goncalves Nes
Andrea.Nes@ldh.no

Contact information

Mr Jaroslav Zlamal
Scientific

Lovisenberggata 15 B
Oslo
0456
Norway

ORCID ID	0000-0002-7083-3433
Phone	+47 (0)95963522
Email	Jaroslav.Zlamal@ldh.no

Dr Andrea Aparecida Goncalves Nes
Scientific

Lovisenberggata 15 B
Oslo
0456
Norway

ORCID ID	0000-0003-0684-1401
Phone	+47 (0)90703168
Email	Andrea.Nes@ldh.no

Study information

Study design	Single-center interventional two-armed individually randomized controlled trial
Primary study design	Interventional
Secondary study design	Randomised controlled trial
Study setting(s)	Other
Study type	Other
Participant information sheet	No participant information sheet available
Scientific title	Technology-supported guidance to increase flexibility, quality and efficiency in the clinical practicum of nursing education
Study acronym	TSGM
Study objectives	Hypothesis (primary outcome): H1. Participants in the intervention group will demonstrate a higher overall level of critical thinking than participants in the control group at post-test and at 3- and 9-month follow-up. Hypotheses (secondary outcomes): H2. Participants in the intervention group will have higher overall levels of self-reported self-efficacy than participants in the control group at post-test and at 3- and 9-month follow-up. H3. Participants in the intervention group will have a more favourable impression of their clinical environment than participants in the control group at post-test. H4: Participants in the intervention group will express a greater acceptance of new technology at post-test than at pre-test. H5: Participants in the intervention group will demonstrate a stronger use of self-regulatory and metacognitive processes than the control group at post-test and at 3- and 9-month follow-up.
Ethics approval(s)	Approved 21/12/2020, Norwegian Centre for Research Data (NSD, Harald Hårfagres gate 29, N-5007 Bergen, Norway; +47 (0)55 58 21 17; personverntjenester@nsd.no), ref: 338576
Health condition(s) or problem(s) studied	Ensuring the quality of clinical practice in nursing education
Intervention	This is a single-center interventional two-armed (intervention and control group) individually randomized controlled trial. Intervention group: The intervention is delivered as an application, technology-optimized practice process in nursing (TOPP-N), that is accessible from mobiles phones, tablets and internet browsers. Participants fill out reports daily before starting their shift in clinical practice and consequently before completing their daily shift. In these reports, they plan, reflect upon and evaluate their need for learning and guidance and plan their learning activities accordingly. Nurse preceptors give daily feedback to students through the application according to their planned and completed learning activities. The participants’ understanding of their need for guidance as well as the nurse preceptors’ understanding of the participants need for guidance is registered daily in the application. If the application detects a difference between a participant’s and a nurse preceptor’s understanding of the need for guidance, it alerts the participant and nurse preceptor about the difference. The alert allows participants and nurse preceptors to review and discuss the reason for the discrepancy in their understanding. If a difference is detected for more than four days, the nurse educator is also prompted and can intervene if necessary. Additionally, TOPP-N provides a digital summative assessment of student performance via an Assessment of Clinical Education (AssCe) that is part of the application. Students, nurse preceptors and nurse educators evaluate student performance using AssCe during a virtual meeting. The duration of the intervention is 6 weeks. Control group: In the control group, the clinical practicum period is performed as usual. Randomization: Participants are randomized to the intervention or control group by an independent administrative worker at Lovisenberg Diaconal University College (LDUC). Informed consent, questionnaires and tests will be collected through Questback (person-based feedback platform) and custom testing system (Insight Assessment) at various time points: at pre-test, at post-test (after 6 weeks of clinical practice) and 3 and 9 months after a participant’s last day of clinical practice. The participants will not receive their individual results of questionnaires and tests.
Intervention type	Other
Primary outcome measure	Critical thinking measured by the Health Sciences Reasoning Test (HSRT) at pre-test, post-test and 3- and 9-month follow-up
Secondary outcome measures	1. Self-efficacy measured by the Self-Efficacy in Clinical Performance Scale (SECP) at pre-test, post-test (after 6 weeks of clinical practice) and 3- and 9-month follow-up 2. Perception of clinical environment and supervision measured by the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T) at post-test (after 6 weeks of clinical practice) 3. Acceptance of technology measured by the Technology Acceptance Model (TAM) at pre-test and post-test (after 6 weeks of clinical practice) 4. The Self-Regulation and Metacognition in Clinical Practice (SMCP) test at 1 week after the start of the intervention and at post-test (after 6 weeks of clinical practice)
Overall study start date	26/09/2019
Completion date	01/04/2023

Eligibility

Participant type(s)	Other
Age group	Adult
Sex	Both
Target number of participants	100
Key inclusion criteria	1. First-year undergraduate nursing students at Lovisenberg Diaconal University College (LDUC) 2. Nursing students who are to enter their first clinical practice period 3. Willing to electronically fill in Norwegian questionnaires 4. Willing to give signed informed consent 5. Willing to attend the preparatory course on the use of Technology Optimised Practice Process in Nursing (TOPP-N) application
Key exclusion criteria	1. Second- and third-year undergraduate nursing students at Lovisenberg Diaconal University (LDUC) 2. Undergraduate nursing students at other educational institutions than LDUC 3. Postgraduate nursing students at LDUC
Date of first enrolment	26/01/2021
Date of final enrolment	19/04/2021

Locations

Countries of recruitment

Norway

Study participating centre

Lovisenberg Diaconal University College (LDUC)

Lovisenberggata 15 B
Oslo
0456
Norway

Sponsor information

Lovisenberg Diakonale Høgskole
University/education

Lovisenberggata 15 B
Oslo
0456
Norway

Phone	+47 (0)22358200
Email	admin@ldh.no
Website	https://ldh.no/en
"ROR"	https://ror.org/015rzvz05

Funders

Funder type

Government

Direktoratet for internasjonalisering og kvalitetsutvikling i høgare utdanning
Government organisation / National government

Alternative name(s): Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education, Direktoratet for høyere utdanning og kompetanse | HK-dir, The Directorate for Higher Education and Skills, Direktoratet for høyere utdanning og kompetanse, DIKU
Location: Norway

Lovisenberg Diakonale Høgskole
Private sector organisation / Universities (academic only)

Alternative name(s): Lovisenberg Diaconal University College, Lovisenberg Diaconal College, LDH
Location: Norway

Results and Publications

Intention to publish date	02/04/2022
Individual participant data (IPD) Intention to share	No
IPD sharing plan summary	Data sharing statement to be made available at a later date
Publication and dissemination plan	Planned publication in a high-impact peer-reviewed journal.
IPD sharing plan	The data-sharing plans for the current study are unknown and will be made available at a later date.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Protocol article	protocol	23/06/2020	23/02/2021	Yes	No

Editorial Notes

24/02/2021: Trial's existence confirmed by the Norwegian Centre for Research Data (NSD).