# data[].attributes.attachment_link.title
32 Strategies for Building a Positive Learning Environment

# data[].attributes.attachment_link.description
These tips were contributed by the educators and parents of Edutopia's community in response to our Start the Year Strong Sweepstakes. There were many amazing ...

# data[].attributes.body
Student perceptions of a great clinical instructor.

# data[].attributes.attachment_link.readable_text
Abstract

Purpose

To identify characteristics and teaching techniques of effective clinical instructors that can be utilized or implemented to improve the student nurse clinical experience.

Background

The clinical instructor is an integral part of a quality clinical experience. They help students transfer didactic information to the practice setting. The clinical nursing experience is a vital component in the developmental process of the nursing student. Research has been done on this subject, but gaps remain. The need for a more in-depth understanding of students' perceptions of the characteristics and teaching techniques that best aid their comprehension and learning will help instructors to maximize student learning experiences in the practice setting.

Method

This qualitative research study utilized the phenomenological research method. Three open-ended questions were posed to 14 nursing students to identify the characteristics and teaching techniques they believed comprised an effective clinical instructor. Individual interviews were conducted and transcribed interviews were reviewed to identify common themes. Three faculty members provided member checking to prevent bias by reviewing the transcribed interviews for common themes.

Findings

Participants identified four main themes which include a trusting relationship, experience or knowledge, coach, and role model. The students found that they gained more knowledge, developed more critical thinking, and felt more confident with instructors who utilized characteristics and techniques from these four areas.

Conclusion

Clinical instructors play an important role in preparing the student nurse in becoming a competent nurse in the practice setting. This information can be used to provide a foundation in creating an educational opportunity to inform nurse educators in the ways to become a more effective clinical instructor.

Introduction

Clinical nursing experience is a vital piece in the developmental process of the nursing student. The clinical instructor (CI) is an important part of the quality clinical experience for the student. They are charged with the task of aiding the student in transferring the knowledge learned in the classroom to the practice setting. Multiple studies have delved into the importance of the CIs influence on the student nurse's clinical experience and development, but gaps remain based on type of program and student demographic. The gap to be addressed in this current study is a focus on a different student demographics and program type. Participants in this study were both basic and accelerated students with a varied age range. The purpose of this study was to see if additional or different traits and techniques of an effective CI emerge. This current study identified multiple factors that impact the student experience with their CIs in the practice setting.

Literature Review

CIs are tasked with utilizing their combined clinical and teaching skills to help nursing students transfer knowledge acquired during lectures, lab, and simulations by applying this knowledge to the complex clinical situations found while performing the hands-on patient care in the practice setting ( Norris, 1986). The CI is instrumental in helping the student in combining the use of cognitive, psychomotor, and affective skills needed to treat the client as the student moves from dependency on the teacher to that of an independent practitioner ( Windsor, 1987). The CI plays a central role in student development by helping to create a conducive learning environment. Their teaching strategies are a critical piece in developing this environment and promoting learning in the practice setting ( Gignac-Caille & Oermann, 2001). Tang, Choy, and Chaing (2005) identified personality characteristics, interpersonal relationship skills, professional competence, and teaching ability as strong indicators of effective CIs in their ability to perform the role to develop nursing students. Their results suggested that instructor attitude toward students was a crucial difference between effective and ineffective CIs.

A trusting relationship, defined as a developmental relationship in which the CI provides guidance and facilitates the student's learning as the student grows into a successful and productive nurse, has been found to be needed to facilitate an optimal emotional environment for student learning. This type of environment fosters a positive relationship between CIs and students. CIs then become coach, guide, helper, and advocate for students. To effectively serve in all of these roles, CIs must be able to combine proficient clinical skills and effective teaching abilities ( Hou, Zhu, & Zheng, 2010).

A meta-analysis done by Parsh (2010) uncovered traits and techniques of an effective CI which play an essential role in maximizing a student's clinical educational experience. The author identified characteristics and five themes or attributes of a CI that aids the student in acquiring knowledge, hands-on skills, and decision-making skills in the practice setting. These are personality, teaching ability, evaluation, nursing competence, and interpersonal relationships. The purpose of this current study is to uncover additional or different traits and techniques of the effective CI based on a different student demographic and program type.

CIs play an important role in the overall clinical experience of nursing students and in assisting them to develop the knowledge and skills of novice professional nurses. To search for the qualities of a CI that either aid or hinder this preparation, nursing students provided their perceptions of their clinical experiences.

Methods

Design

A phenomenological approach using three open-ended questions was used for this study. The phenomenological approach allowed students to use their lived experience in identifying characteristics of an effective CI. Evaluation of data involved a systematic review of data. The data were constantly compared at increasing levels of abstraction, searching for main themes. The goal was to identify the main themes of participants and how they perceived their experiences.

Research Questions

1. What do you identify as characteristics of an effective clinical instructor?

2. What are the differences you identify between an effective versus an ineffective clinical instructor?

3. What differences did you notice between the clinical instructor you felt was effective as compared to the clinical instructor you felt was less effective?

Institutional Review Board Statement

This study was approved by the university institutional review board.

Sampling and Procedures

This study used purposive sampling in which students were asked to volunteer to be participants. Inclusion criteria for participants were junior or senior level and completion of at minimum three clinical rotations in the nursing program. All 14 participants were Bachelor of Science (BSN) students at the same urban university with an age range of 21 to 40 years. Of these volunteer participants, 3 were male and 11 female. The delineation as to program type is as follows, two participants were in the accelerated option in which they finished their BSN in 16 months, while the other 12 participants were in the basic traditional 3-year nursing track (see Table 1). Informed consent was reviewed with each student individually and signed before starting the interview. Participants were informed that the study was voluntary and they could stop at any time without penalty or consequence. Each of the participants was interviewed and audiotaped separately by one of the nurse researchers on the university campus in a private office with each interview lasting between 30 to 45 min. The audiotapes were transcribed verbatim and then tapes were deleted. The transcripts (with all identifying information removed) were kept in the principle investigator's locked office in a locked drawer where these will be kept for 3 years then destroyed.

Demographic Information of Participants.

Data Analysis

Data collection and analysis were done concurrently until saturation was reached with repeat themes. All interview transcripts were transcribed verbatim and each interview was reviewed by three nurse researchers individually first and then by all three researchers together. All three nurse researchers have a medical surgical background and serve as CIs, two also teach didactic nursing courses. None of the participants were current students with any of the three nurse researchers during the study. Data were reviewed looking for common themes among the interviewees. An original list of 30 themes was found. Initially, the categories were broad. The themes became more specific as the data were further reviewed and analyzed using first, second, and third level coding. Level of abstraction was raised to reveal four major themes and four to five subthemes identified under each major theme.

Rigor

With this study, the initial research questions were clear and the design of the study was appropriate for the research goals. Each successive interview allowed for confirmation of previous findings and sometimes new themes were identified. With the list of themes, several participants were poled to see if the themes identified accurately reflected what they felt at the data collection time of the study. Participants agreed that their experiences were captured in the themes identified by the research team.

Results

The four major themes identified from the data were as follows: (a) trusting relationship, (b) experience or knowledge, (c) coach, and (d) role model. Participants identified these as important aspects of their clinical experience. Data collected provided information about how students perceive their clinical experience and the role their CI has in that experience.

Trusting Relationship

Participants identified trusting relationship as one of the most important aspects of their clinical experience. Subthemes were as follows: approachability, availability, clear expectations, and wanting to teach.

Participants felt that an approachable instructor greatly enhanced the clinical learning experience and trust relationship. One participant stated, "A student needs to feel able to trust that your instructor is there to help you succeed and not to just shut you down every day." Another participant stated, "It is important to be able to trust them to be helpful and supportive so you have a good experience."

Being able to feel comfortable asking questions is important to students. One participant stated, "With my approachable instructor, I was comfortable asking her questions. This gave me a better understanding of everything and I was able to have a better learning experience." Another participant identified their best clinical experience as follows: "When the instructor made it clear they were there to help. They were there for you if you had any questions and that we are learning together."

One participant identified a negative experience that affected her in the clinical area. "I have had instructors who would make us feel stupid when we had interactions. Now, I am not learning because I am more afraid to ask them questions." Another participant stated,

There was an instructor who berated us in front of others, including patients, who talked down to us and made us feel like she was the boss and we were subservient. This was not conducive to learning, causing me to shut everything off and not learn at all.

Being able to feel like the CI is there to help them learn enhanced the clinical experience.

Participants also identified availability to help them on the unit as part of the trusting relationship. Five of the participants identified availability as an effective characteristic. They wanted both physical and emotional availability which was summed up by one participant when she states, "I need to be able to see you, be able to talk to you and be able to find you if I need you." Another participant shared the following experience: "When I had my first patient with a chest tube, my instructor was available to come in with me and do a brief overview with me so I felt I was giving safe care."

All 14 participants mentioned clear expectations as a way to improve learning and help build trust between instructors and students. One participant stated, "An effective instructor lays out clear expectations at the beginning of the semester. That way you know what you are supposed to be working towards and gives you an idea as to where you are performance wise." Clear expectations can help relieve some anxiety related to the clinical experience.

A majority of participants identified a desire to teach as an essential characteristic. This was reflected in several statements that were made. One participant stated, "My effective instructor was someone who obviously cared about teaching and wanted to be there." Another participant stated, "The most important characteristic I feel is someone who is passionate about their work and is passionate about teaching the next generation of nurses." Students need to see that their CI is interested in teaching them and wanting to help them do their best in the practice setting.

Coach

Participants identified the need for CIs to use coach techniques to assist with learning. The subthemes for this theme were as follows: calm or patient, student advocate, critical thinking or quizzing, and constructive criticism.

Participants stated that they want to learn as much as possible in the practice setting. They want someone who is calm and can help the students stay calm. One participant states, "Somebody who's kind of calm and collected ... but just somebody who can kind of keep it together and doesn't lose it easily." They also wanted a CI who was a student advocate and was looking out for them on the nursing unit. One participant stated, " ... being an advocate for students ... someone who can relate to the student experience."

Findings revealed that most participants stated that they like to be challenged in the clinical area and they like being quizzed as part of the clinical day. A participant stated, " ... making us think, making me use my critical thinking skills to come up with the answer, and pulling the information out of me. You make us think, critical thinking, asking the right questions to help us think." This was an important part of the clinical experience. Participants wanted to be able to pull things together and figure out how labs, diagnostic tests, medications, and pathophysiology of the disease all fit together.

The last area under this major theme was constructive criticism. Participates did not mind being corrected. As a matter of fact, they want to be told if they were doing something wrong so they can correct themselves. How that feedback is given makes a difference in the student experience. One participate observed, "Be able to see where the students might be struggling and be able to offer some constructive criticism and teach them how to go about whatever it is that they are doing."

Another participant shared a negative experience with a medication pass. The participant reported:

It was my very first time to draw up and pass insulin, my patient was diabetic. I couldn't remember cloudy/clear, you know, that whole process, and I was nervous. Um, her personality was such that it kind of made everyone on edge ... She brought me to tears cause I thought I don't know this, I'm never going to-she really made me feel like this was the end all, like I didn't belong there if I didn't know this ... So, as you can imagine, unfortunately that was fairly early on in the semester, so that was a- it created a complete block between us.

CIs need students to be safe, but if they criticize students harshly, it can cause the student to be afraid to approach them for other issues that may be more life threatening.

Experience or Knowledge

Participants felt that the CI had to have experience and knowledge in the area they were teaching clinical in order to be an effective instructor. The subthemes were specialty experience, competent, debriefing, and validation of assessment.

One item brought up by participants was CIs teaching in areas that were not their specialty. One participant shared her experience with her CI in OB stating, "During the C-section, because she is very knowledgeable ... she explained to me everything that was going on and that was really good." CIs who shared their experiences with their students provided a memorable learning opportunity.

Participants stated that the CI needs to be competent in the skills performed on the unit. A participant reported, "being competent themselves in their own skills ... I didn't know if she was not confident in her skills but she never showed us how to do anything." If students do not feel confident in their CI, it is hard for them to feel comfortable in the clinical area. If the instructor does not "appear" to know what to do, it is uncomfortable for the student.

Debriefing is another aspect identified by participants as a helpful technique used by effective CIs. This can be on the clinical unit after a procedure or during post conference when students can express their feelings about what happened on the nursing unit. One participant provided the following related to post conference:

I do like that we go around the table and say how was your day. It gives the students an opportunity to say, you know, my med pass today was a disaster, you know and to talk about that. Why was it a disaster, let's review the process, what did you feel went wrong here, this is what I saw that went wrong, what can we do in the future, you know, just reviewing the students product.

According to this participant, the debriefing allowed them to look at the process and review the nursing skill related to a med pass. Debriefing allows for student reflection and helps with application, critical thinking, and understanding the nursing process.

The last subtheme in this area is that of validation of assessment. One example given by a participant was described as follows: "Mini prep before I do anything, let me go through step by step of what I'm going to do, a quick rundown, like the teach back method." Another participant gave the following different example regarding this subtheme,

They would explain a situation to me or the class and then we would actually go out and do it with coaching at the same time, you know, this is how we do it and then we would go in there and do it and have a positive coaching experience.

Students wanted to have someone validate that what they were doing was correct.

Role Model

All participants felt that the CI should be a role model for students and demonstrate the same qualities that the students were being asked to emulate. The subthemes for this theme were the following: organized, professional, socialized to the unit, and ability to multitask.

Participants wanted someone who was organized. One participant stated,

Clinical instructors who were effective, I feel like, kind of had to do with experience; like they were comfortable in their roles, that they were able to take care of 16 patients at a time and knew everything that was going on.

Students feel that if they are asked to be organized in their work, then their instructor needs to be demonstrating the same work ethic.

The next subtheme is that of being professional. Students want a CI who demonstrates nursing professionalism. A participant stated the following: " ... really like (instructors) to have ... a professional manner." Another participant stated,

[Instructors] ... do what they say they are going to do, going to be where they tell us. They hold us to very high expectations, as does the School of Nursing (SON), so I feel that when the instructor [is] leading by example.

Participants also want the CI to be socialized to the unit. The students felt that the CI should know how the unit runs, where to find information, and where students should look for information. A participant stated, "The instructors that would be able to navigate socially on the floors made us more welcome and made the nurses more welcome to us where other instructors who didn't have that were not as welcoming on the floor environment."

The final subtheme is the ability to multitask. The students felt that the CI needed to know what was going on with the patients and to be able to multitask and identify when something was urgent. One participant stated,

being available when I need something- and I know that isn't always possible but you can tell some clinical instructors know how to prioritize. If there is something that needs to be addressed right now, they will drop what they are doing and come and help you with something especially something that has to do with patient safety. That's awesome.

Discussion

This current study explored the perceptions of nursing students on what characteristics make up an effective CI based on a different student demographic and program type. Participants in this study were both basic and accelerated students with a varied age range. The goal was to identify several major themes that can be generalized as effective characteristics for any CI to incorporate. Some of the characteristics and themes identified in this study are consistent with previous research done on this topic. New characteristics identified as an effective CI by this research group include: the role of the coach, the debriefing process, being organized, and exhibiting professional behavior.

Trusting Relationship

Study participants identified trusting relationship as a characteristic needed to be an effective CI. They felt that CIs needed to be approachable and available to the students in the clinical setting. They stated that when they were comfortable with their CI, they felt they could ask them questions and get direction in their learning.

The subthemes of approachability and availability were consistent with findings in the literature. Kristofferzon, Martensson, Mamhidir, and Lofmak (2013) surveyed 107 Swedish nursing students and discovered supportive behaviors by the CI were rated high among these students. Tang, Chou, and Chaing (2005) found that effective instructors were identified as treating students sincerely, objectively, and as "people with thought and wisdom" (p. 190). Gillespie (2002) and Hovland (2011) both identified students who wanted support by their CIs in the clinical area and had positive outcomes for students' learning experiences.

The current literature supports the student comments about approachability and availability as being important and allowing the students to feel comfortable in their learning. This study revealed two additional subthemes of clear expectations and wanting to teach. The students stated that CIs who used these two subthemes in the practice setting augmented their ability to learn.

Coach

Participants felt CIs should assist students in the learning process. Part of this learning was helping students develop critical thinking skills. Students expressed that the purpose of clinical time was to help them "put the pieces" together by asking them questions about the patients for whom they were caring.

Hsu (2006) found that an important teaching strategy was to question students to help guide their learning. Allison-Jones and Hirt (2004) discovered that students wanted instructors who helped them learn how to problem-solve and develop decision-making skills. Phillips and Duke (2001) looked at the questioning skills of clinical teachers and how they impacted the development of critical thinking skills in students. They found that although CIs asked a great number of questions overall and at high cognitive levels, they needed to increase the number of these questions to better aid the students' critical thinking skill development. Students in this study felt that they needed to be challenged in the clinical area and were grateful to CIs who could do this effectively.

Constructive criticism was identified as an essential characteristic. Students want to do better, but want criticism that is constructive and helps them develop as a nurse. Sharif and Masoumi (2005) found that CIs play a vital role in helping the student develop self-confidence and clinical competence. These researchers stated that the CI needs to have an evaluative role as well as that of teaching. Parsh (2010) discovered CIs who were able to identify areas that need improvement and provide suggestions to help the student progress in a way that put negative things (issues, skills and knowledge that the student needs to improve) in a positive manner was valued by the students, as opposed to the CI who put down or demeaned the student. This current study finding is consistent with literature in regard to critical thinking or quizzing and constructive criticism. However, the findings support the need for calm or patient interactions that the CI be a student advocate within the practice setting.

Experience or Knowledge

Participants felt it was important for CIs to have knowledge and experience in the clinical area they are teaching. They also wanted instructors who were familiar with the patient population and disease processes that they were seeing in the practice setting so the CI could share their experience and skills. Another aspect of CI experience was using debriefing and post conference time to review the day. This was time to allow students to discuss their day, both challenges and successes, with their fellow students. It was a time for discussing what could have been done better on the unit or with the care of a patient.

Megel, Nelson, Black, Vogel and Uphoff (2013) stated that the role of the CI is to help students to understand and find meaning in their clinical experiences. Morgan and Knox (1987) found that faculty and students perceived "best" clinical teachers as "skilled clinicians who took responsibility for their own actions" (p. 333). Hsu (2006) found that CIs clinical knowledge is important to students' success. Parsh (2010) identified CI's who had experience in the type of nursing being taught and who could tell of past experiences or scenarios that helped to teach the desired concept. In addition, they were able to explain how and why the instructor did what they did and what the students' could do to improve their performance.

This current study was consistent with current literature in regard to specialty experience and competence. New findings of this study included the importance of using post conference as a debriefing opportunity. Validation of assessments was identified by students' as an important part of their learning process.

Role Model

Participants identified being a role model as another essential characteristic. Instructors who are organized in their work and understand what is going on with each patient assigned to students was viewed as effective in the practice setting. Students felt another characteristic of an effective CI was someone who was socialized to the unit and was a link between class, lab, simulation, and the clinical experience.

Research has shown that students want instructors who demonstrate positive values and characteristics of nurses ( Sharif & Masouni, 2005; Tang, Chow, & Chiang, 2005). Dunn and Hansford (1997) found that there was also a link between the students and staff. Students felt instructors who could negotiate the environment and were familiar with the staff made it easier for students to be involved on the unit ( Dunn & Hansford, 1997).

This current study was consistent with literature in regard to professional behavior, socialized to the practice setting, and organized in managing of students. An additional subtheme identified in this current study was the ability to multitask which participants felt was a characteristic of an effective CI.

Limitations

When interpreting the results of this study, several limitations should be considered. First, these are experiences of students from one university. Although the experiences of the participants were with many different instructors, influences from the university nursing program may play a part in the experiences of the participants. Second, the majority of students were from the basic nursing track. It may be helpful to compare experiences between the accelerated nursing students with those of the basic nursing students to see if their expectations are different. Third, students volunteered for this single study. It would be helpful to expand this study to other program tracks of the baccalaureate nursing program and in different practice settings.

Implications for Nursing Practice

The findings in this study suggest that students have specific expectations of CIs in facilitating their learning experience between classroom and the practice area. Participants in this study identified specific characteristics they believe to be important for a CI to display. These are trusting relationship, coach, experience or knowledge, and role model. One challenge with nursing faculty is that a number of instructors come to academia with knowledge and skills related to nursing but not much background in adult learning or effective teaching techniques.

Understanding the findings from this research can help nursing programs educate clinical faculty to be effective CIs. This can be done in several ways. The first is by educating CIs in effective teaching methods for the practice area. This can be done by working one-on-one in the practice area, or by pairing a more seasoned instructor with a newer CI. The seasoned instructor can demonstrate effective teaching methods to the new CI. The seasoned instructor can also observe the new faculty during a clinical day to provide clarification and constructive feedback on the teaching methods implemented by the new CI. Second, there can be a mentor assigned to all new CIs. This person would be available to answer questions and provide clarification, feedback, and direction for the new CI throughout the school year. A third option might be to develop a one-day workshop on what characteristics comprise an effective CI. This could be done each semester prior to the start of each rotation. This would provide support to new and part-time faculty and help them develop a teaching skill set for the practice setting.

Summary

The relationship between a CI and nursing student can have a major impact on the student learning experience. It is postulated among experts in nursing education that the CI is pivotal to this process. This research project arose from a strong interest to assist CIs to improve their effectiveness and thereby improve the learning outcomes of nursing students. This was done using a phenomenological qualitative method to explore the lived experience of nursing students regarding their various experiences in the clinical setting with their CIs. The findings of this study add to the current knowledge of CIs, theories about adult education, students' experiences in the practice area, and student expectations of CIs. Assisting and supporting CIs in their role by identifying the characteristics and teaching strategies that are effective for nursing students' learning in the practice area produces a better, more prepared student and can help provide a smoother transition into the nursing profession.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Allison-Jones, L. L., Hirt, J. B. (2004) Comparing the teaching effectiveness of part-time and full-time clinical nurse faculty. Nursing Education Perspectives 25(5): 238-243. |
Google Scholar Medline

Gignac-Caille, A., Oermann, M. (2001) Student and faculty perceptions of effective clinical instructors in ADN Programs. Journal of Nursing Education 40(8): 347-353. |
Google Scholar Medline | ISI

Hovland, O. J. (2011) Together in supervision: Nurse students' experiences. A pilot study. International Journal for Human Caring 15(4): 33-39.
Google Scholar

Norris, J. (1986) Teaching communication skills: Effects of two methods of instruction and selected learner characteristics. Journal of Nursing Education 25(3): 102-106. |
Google Scholar Medline

Sharif, F., Masoumi, S. (2005) A qualitative study of nursing student experiences of clinical practice. BMC Nursing 4: 6. |
Google Scholar Crossref | Medline

Tang, F., Chow, S., Chiang, H. (2005) Student's perceptions of effective and ineffective clinical instructors. Journal of Nursing Education 44(4): 187-192. |
Google Scholar Medline | ISI

Windsor, A. (1987) Nursing student's perceptions of clinical experience. Journal of Nursing Education 26(4): 150-154. |
Google Scholar Medline

# data[].attributes.attachment_link.title
Nursing Students' Perceptions on Characteristics of an Effective Clinical Instructor

# data[].attributes.attachment_link.description
Abstract Purpose To identify characteristics and teaching techniques of effective clinical instructors that can be utilized or implemented to improve the student nurse clinical experience. Background The clinical instructor is an integral part of a quality clinical experience. They help students transfer didactic information to the practice setting.

# data[].attributes.attachment_link.description
A flipped class (view image) is one that inverts the typical cycle of content acquisition and application so that: students gain necessary knowledge before class, and instructors guide students to actively and interactively clarify and apply that knowledge during class.

# data[].attributes.attachment_link.readable_text
millions use Screencastify to create amazing videos

/* Sets tab pane to display block instead of default display:none */ /* Allows CSS opacity transitions */ .w-tab-pane, .w--current { display: block; } /* Any .w-tab-pane that does not have webflow .w--curent sets opacity 0 */ .w-tab-pane:not(.w--curent) { opacity: 0; } /* Any element with .w-tab-pane that has .w--tab-active sets the opacity 100% */ .w-tab-pane.w--tab-active { opacity: 1; } /* Set the opacity transition to 1 second ease-in */ .w-tab-pane { transition: opacity 1s ease-in; }

Educator, student, marketer, engineer, gamer. Whatever part you play, you'll have simple, yet powerful screen recording and editing tools.
Learn more

Easily share your creations in multiple channels. Let more viewers watch, pause and rewind on their schedule while maximizing time by eliminating unnecessary meetings.
Learn more

Collect video assignments to ensure any team or student is heard. Track viewing activity and add interactive questions and more to ensure your message is understood.
Learn more

Educator, student, marketer, engineer, gamer. Whatever part you play, you'll have simple, yet powerful screen recording and editing tools.
Learn more

Easily share your creations in multiple channels. Let more viewers watch, pause and rewind on their schedule while maximizing time by eliminating unnecessary meetings.
Learn more

Collect video assignments to ensure any team or student is heard. Track viewing activity and add interactive questions and more to ensure your message is understood.
Learn more

loved by everyday video creators

# data[].attributes.attachment_link.title
Screencastify | Screen Recording and Video Editing

# data[].attributes.attachment_link.description
Screencastify is the leading screen recorder for Chrome. Install the extension to record, edit, and share videos in seconds. Create video class assignments, training and tutorials, and make business communication faster.

# data[].attributes.headline
Mobile technology in undergraduate nursing education

# data[].attributes.subject
Mobile technology in undergraduate nursing education

# data[].attributes.attachment_link.readable_text
I. Introduction

In the 21st century, technology is evolving more rapidly than ever. The younger generations, including undergraduate nursing students, live daily lives equipped with highly advanced mobile technology, challenging nursing educators to incorporate mobile technology in education to improve the learning outcomes of students [ 1, 2]. Though no clear definition of mobile technology is confirmed in nursing education, the purpose of mobile technology is often described in nursing education as "handheld platforms that incorporate hardware, software, and communication [ 2]."

The personal digital assistants (PDAs) introduced in the early 1990s were initially used to store and manage personal information; however, they have further evolved into smart devices such as smartphones and tablet PCs, the latest version of mobile technology. These devices have multiuse features including audio and video recording and web portal support systems [ 3].

Due to their ubiquity, mobile devices have been proposed to enhance the outcomes of student clinical learning during clinical rotation and improve student-faculty interactions [ 4, 5]. Nursing students practice in various clinical environments, including acute hospital settings and community health centers, where close individual supervision by the clinical instructors is not always available [ 5]. Additionally, nursing students tend to use knowledge and skills learned in the classroom when providing bedside care to patients. Current healthcare emphasizes evidence-based practice to ensure quality care, and mobile devices including PDAs and smartphones can be considered suitable for immediate access to up-to-date medical information [ 6, 7]. The use of PDA resources supported clinical reasoning among undergraduate students by facilitating problem solving with reliable information [ 7]. Mobile-based applications further enable more active learning by actively constructing knowledge using a wide range of webbased clinical applications. Thus far, various mobile devices with applications have increasingly been used in classroom activities and clinical practicum including e-portfolio in many countries [ 2, 5]. Although numerous studies found positive attitudes toward and satisfaction with the use of mobile devices among nursing students [ 6, 7, 8] and barriers to using mobile devices including protecting the confidential information of patients, infection control issues, technical difficulties, short battery life, the cost of mobile devices, and negative perceptions of hospital staff and patients [ 2, 3].

The advantages of mobile technology in nursing education have been examined in research using a survey study design and qualitative research methods [ 4, 8, 9]. Recently published review studies only summarized the studies without critical study appraisals or described the benefits and barriers to use the mobile technology in nursing education [ 2, 3]. This makes it difficult to determine the effectiveness of mobile device use and confirm their educational effects on nursing education. Thus, a systematic review is needed to review and critically appraise the literature on the implementation of mobile technology in undergraduate nursing education. The findings of this review will contribute to the advancement of nursing education by improving our understanding of the impact of mobile technology and providing an insight into developing strategies in mobile technology application in nursing education.

II. Methods

1. Aim

This systematic review aimed to identify and appraise studies on the use of mobile technology in undergraduate nursing education. The major learning outcomes of students were evaluated in this review to determine the educational effectiveness of mobile technology in nursing education.

2. Search Strategy

On February 14, 2018, search strategies and subsequent literature searches were performed by an experienced systematic review researcher in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 10]. Literature searches of the Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and CINAHL databases were conducted to identify articles evaluating the efficacy of mobile education in nursing undergraduate students. The following search terms were used: "{(nursing or nurse) AND (student OR students)} AND (mobile OR handheld OR PDA OR smartphone OR tablet PC OR tablet computer OR wireless)." For example, we searched Ovid-MEDLINE using the following strategy: {("nursing" [TW] OR "nurse$1" [TW]) AND "student$1" [TW]} AND ("computers, handheld" [Mesh] OR "mobile" [TW] OR "handheld* " [TW] OR "PDA" [TW] OR "smartphone" [TW] OR "tablet PC" [TW] OR "tablet computer$1" [TW] OR "wireless" [TW]).

The inclusion criteria for this review were: (1) primary empirical studies, (2) studies involving undergraduate nursing students, and (3) studies reporting findings on mobile technology implemented in nursing education. The exclusion criteria were: (1) proceedings, discussions, dissertations, editorial articles, and reviews, and (2) studies involved postgraduate or other allied health professionals. Only experimental design studies such as randomized controlled trials (RCTs) and quasi-experimental studies were considered. Studies were limited to those published in either Korean or English between 2000 and 2018.

3. Search Outcomes

We retrieved 956 citations from four databases. After deleting duplicate citations, the abstracts of 439 studies were independently screened by two reviewers using the inclusion and exclusion criteria. All reasons for exclusion were recorded. The full texts of 88 studies were reviewed and finally 14 studies were identified for data extraction and synthesis ().

4. Data Extraction and Synthesis

The data were extracted using predetermined themes of methods/research design, study purpose(s), sample population, mobile device and intervention, outcome measures, and key findings. The synthesis of the studies was conducted by addressing key learning outcomes of knowledge, clinical skills (performance), self-efficacy, and student satisfaction.

5. Quality Appraisal

All 14 studies were appraised for methodological quality by two independent reviewers using a critical appraisal tool adapted from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBIMAStARI) [ 11]. The critical appraisal tools included 13 items for the RCT and 9 for quasi-experimental study with four possible responses: yes (the criteria are clearly identifiable through the report description and assigned 1 point), unclear (the criteria are not clearly identified in the report), and no (the criteria failed to be applied appropriately). The 13 items for the RCT assess the following domains: randomization, allocation, similarity between groups, blindness, treating identically, dropout, intention-to-treat analysis, outcomes measured, and statistical analysis [ 11]. The 9 items for quasi-experimental study assess the following domains: cause and effect, similarity between groups, control group, multiple measurements, dropout, outcomes measured, and statistical analysis [ 11]. After independent review, the results were collected and discrepancies were discussed with a third reviewer experienced in systematic reviews. Each study was displayed with its total points and classified into one of the following categories: low risk of bias as all criteria were met, moderate risk of bias as one or more criteria were unclear, high risk of bias as one or more criteria were unmet ().

Table 1

III. Results

Of 14 studies, seven were RCTs. The publication years ranged from 2006 to 2018. Studies were conducted in five countries, and 9 (64.3%) studies were conducted in Korea.

1. Method/Research Design

The quality of the studies varied from high to low risk of bias. The quality of all RCT studies was weak due to high risk of bias, whereas most quasi-experimental studies were rated as having a low risk of bias. Among RCT studies, many studies did not appropriately discuss the aspects of the blindness of the treatment group, participants, and researchers to treatment. One quasi-experimental study had a high risk of bias from the lack of homogeneity of the two groups and another showed a moderate risk of bias due to unreliable outcome measures.

2. Sample Population

The sample sizes for the studies ranged from n = 11 to 45 in each group. Most studies recruited over 30 students in each group, and 6 described the sample power in the report. The students recruited for the studies ranged from the second to fourth year of nursing college.

3. Types of Mobile Device and Intervention

The studies published in the early 2000s used PDAs such as Hewlett Packard iPAQs (the most popular brand) and MP3, whereas later studies frequently used smartphones. The most commonly downloaded application or database for PDAs was drug or clinical reference information. The video and audio features of smartphones were extensively used in inculcating the fundamental clinical skills of Foley catheterization. Infant airway management and academic electronic medical records were also tested in two studies. The duration of intervention varied from 1 to 10 weeks. The wide variation in devices and interventions in the studies reviewed made the data synthesis difficult.

4. Key Findings

The synthesis of results on effectiveness of mobile devices in nursing education focused on the following main outcomes: knowledge, clinical skills performance, self-efficacy, and satisfaction ().

Table 2

1) Knowledge

No study reported an improvement in pharmacological knowledge in nursing students [ 12, 13], but one found improved knowledge related to lung assessment [ 14]. Most students' knowledge was evaluated by quizzes developed for the studies.

2) Clinical skills performance

Fundamental nursing skills including Foley catheterization were investigated to determine whether students improved their skills by reviewing the procedures on their own smartphones multiple times [ 15, 16, 17]. None of the three studies reported improved performance in the experimental groups as measured with a skill checklist. Infant management skills improved in nursing students [ 18].

3) Self-efficacy

Self-efficacy in drug knowledge and dosage calculation improved in two studies [ 19, 20], but efficacy in Foley catheterization skills did not improve in students who used their smartphones for practice [ 15]. Communication competency using smartphone video clips [ 21] and academic motivation using smartphone applications (Kakao Talk) [ 22] significantly increased in the experimental group of students during the classroom activities.

4) Student satisfaction

In majority of studies, nursing students expressed satisfaction with the mobile technology applied in education and found it useful for clinical learning sources during clinical practicums [ 23, 24]. However, neither the study comparing smartphone applications for cardiopulmonary assessment skills with a high-fidelity human simulator [ 14] nor that using an application for infant airway management reported higher satisfaction in the experimental group students [ 18]. Using the mobile-device-based academic electronic medical record did not affect students' clinical practicum satisfaction [ 25].

IV. Discussion

With the recent explosion in the use of wireless device, nursing faculties have become more interested in incorporating mobile technologies into their teaching and learning strategies. This timely study systematically reviewed the experimental studies investigating the effects of mobile technology on learning outcomes in undergraduate nursing students. The overall findings of this review did not provide consistent results on the improvement of knowledge and clinical skills of nursing students, but noted students' satisfaction and preference for these methods over the traditional teaching methods.

Studies published early in the 2000s focused on the use of PDAs and downloaded databases in nursing education. Since 2010, smartphones have been quickly replacing PDAs, as they have more advanced functionality with a wealth of applications. The advanced features of smartphones, including text, audio, and images, have changed the way they may be employed in clinical and classroom teaching. The recorded video clips of the students' performance of the Foley catheterization procedure allowed them to remodel their skills immediately upon viewing their performance [ 15, 16, 17]. Similarly, communication training using smartphones' audio-video recording capabilities could improve students' communication competencies [ 21]. These multimedia capabilities of mobile devices can be further incorporated in more complex ways in nursing education to stimulate students' learning motivation.

Pharmacology was the most popular subject in the studies reviewed. This may be attributed to concerns over medication errors in clinical practice. Using a pharmacology database through the mobile device did not increase the students' pharmacology knowledge and thus, did not seem to improve the contextual knowledge retention of students [ 12, 13]. However, the improved efficacy of drug dosage calculations might be considered a facilitating factor for better clinical practice in the future [ 20].

No improvements in skill competency or knowledge of Foley catheterization were found in students with mobile devices [ 15, 16, 17] as evaluated using a checklist, which is a more objective skill measure. Unlimited viewing of the self-performance of student procedures was assumed to be beneficial due to possible self-directed practice. Strategies to maintain students' interest in correcting their nursing skills still need to be developed because student interest decreases over time after repeated views of the clips. The video clips of communication among students helped increase competence in the mobile device groups [ 21]. Attitudes and communication skills seem to be rather better modified through self-reflection on the video recordings using mobile devices.

The overall quality of the 6 RCTs was evaluated as showing a high risk of bias due to a failure to appropriately describe the blind aspects in the treatment and subjects. This is readily understood because the educational treatments given to the participating students are not easily concealed from the other group of students in confined classroom or clinical settings. Interestingly, over half the identified studies were conducted in Korea. The higher computer literacy and possession of smart devices among Korean students might stimulate nursing researchers to investigate the application of mobile devices to education. Three studies investigated the use of smartphones to enhance the fundamental nursing skills practice of students. This appears to reflect the current emphasis on clinical skills in nursing education in Korea [ 26]. The mobile-based applications developed for these studies, such as infant airway management and cardiopulmonary assessment, were evaluated as effective in student learning outcomes. These studies can be considered as yielding worthwhile results in terms of creative ways to develop the educational contents. As many mobile applications currently lack an evidentiary base [ 2], the quality and suitability of educational contents need to be validated.

The weaknesses in the methodologies of the studies reviewed allow only a limited overall generalizability from their results. Objective measures including standardized knowledge test and skill performance checklist assessed by a third party can be better used to evaluate the outcomes of learning and benefit from the implementation of mobile technology, which are needed for future studies.

The younger generations that have grown up in our environment of rapid developments in mobile devices may become more motivated to learn when these technologies are incorporated in education. However, apparently, we are currently in the early stages of the implementation of mobile devices in the nursing education curricula. This systematic review found no support for consistent positive effects of mobile device use on undergraduate nursing students' knowledge and clinical skills outcomes. The use in clinical environments of mobile devices loaded with appropriate databases may help close the gap between theory and practice and enhance the evidence-based practice of undergraduate students. Mobile technology can support innovative teaching strategies for nursing education once rigorous studies provide consistent results on the pedagogical effectiveness of mobile device.

# data[].attributes.attachment_link.title
Mobile Technology in Undergraduate Nursing Education: A Systematic Review

# data[].attributes.attachment_link.description
In the 21st century, technology is evolving more rapidly than ever. The younger generations, including undergraduate nursing students, live daily lives equipped with highly advanced mobile technology, challenging nursing educators to incorporate mobile technology in education to improve the learning outcomes of students [ 1, 2].

# data[].attributes.attachment_link.readable_text
Starting out as a nurse educator can be a daunting and 'thrown in at the deep end' experience. Teaching to students, colleagues and other nurses in the workplace or higher education setting presents an array of challenges. But now you're in the role, your expected to be able to deliver many types of education and understand adult education theory. We will provide some tips on starting out and helpful resources in these first critical elements of the role.

Lesson Plan: Create a lesson plan to deliver focused education sessions. Make the most out of the valuable teaching time by being organised (lesson plan template).

Education Philosophy: First resource to consider is reading Malcolm Knowles' The Adult Learner (link here). In nursing, the constructivist pathway for nursing proficiency is standard, so using Patricia Benner's (1984) Novice to Expert framework is a good starting resource (link here).

Taxonomy: Anderson & Krathwohl (2001) revision and understanding of Bloom's cognitive taxonomy provides consideration and assessment of different levels of knowledge, in particular for setting learning outcomes to guide the nurse educator (link here).

Social Learning Theory: Group work and collaboration are encouraged for adult learners, we are social learners. Can you replace the lecture with a case study or simulation for more hands on and real life learning scenarios? Make it team based or collaborative approach. Help facilitate communities of practice (CoP's).

Facilitation Style: remove the traditional teacher approach and you quickly move your style to that of facilitator, encouraging adult learning and increasing engagement from the students. Adults engage in authentic learning tasks so link content to their professional environment. (#Heutagogy)

Presentation Skills: Avoid death by powerpoint, go along the visualisation pathway (Slide-ology). Add quizzes into your talk to engage and test your audience. Break down session times to meet attention spans of your students, rather than fit into a set timetable. Be flexible, if the group look tired or need a break, give it to them and start again after a coffee fix. Here is one for the bored audience Presentation Bingo.

Timing: This is important to ensure the aims of the session are covered, trying to fit in too much content is common at the start. A mixture of preparation, practice and experience seems to help with timing. When you become comfortable with the content and environment, it all seems to fall into place. Sometimes it can all go wrong with room bookings, guest presenters are late and equipment malfunctions, this is when you get creative and 'wing it'. Try to have a back up plan, imagine you have no electricity or devices, how could you deliver the session in the best alternative method.

Handouts: You can find education research arguing for and against handouts. Some state that providing handouts makes students switch off as you have provided them with the content so they don't bother engaging, so instead hand them out at the end. When you don't provide handouts, you will find students complain, as they like to make notes. You will find students have a mix of handwritten and electronic note taking methods. Consider providing some brief outlines, key readings and space for students to take notes (provide either a paper or an electronic format).

Peer Observation: Observe other educators and use some of their approaches that you see students respond to or you believe in. Remember what seems effortless may well have taken them many attempts (a few fails along the way as well), so resist comparing yourself to them, they have developed their expertise over time.

Feedback: Ask for constructive feedback from your educator colleagues (#developrhinoskin).
References
Anderson, L. W. and Krathwohl, D. R. (2001) A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives. Allyn & Bacon. Boston, MA (Pearson Education Group).

Benner, P. (1984). From novice to expert. Menlo Park.

Clynes, M. P., & Raftery, S. E. (2008). Feedback: an essential element of student learning in clinical practice. Nurse Education in Practice, 8(6), 405-411.

Duffy, K. (2013). Providing constructive feedback to students during mentoring. Nursing Standard, 27(31), 50.

Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2014). The adult learner: The definitive classic in adult education and human resource development. Routledge.

McNamara, P. (2016) A Nurse's Guide To Twitter.

Race, P., Higgs, B., & Potter, J. (2008). In at the deep end: starting to teach in higher education. NAIRTL.

Sayers, J., DiGiacomo, M., & Davidson, P. (2011). The nurse educator role in the acute care setting in Australia: important but poorly described. Australian Journal of Advanced Nursing, 28(4), 44-52.

Nursing Education Network (2016) Adult Learning (Androgogy).

Nursing Education Network (2016) Learning to Learn, Understanding Understanding.

# data[].attributes.attachment_link.title
Nurse Educator Role: A Guide For The New Nurse Educator

# data[].attributes.attachment_link.description
Starting out as a nurse educator can be a daunting and 'thrown in at the deep end' experience. Teaching to students, colleagues and other nurses in the workplace or higher education setting presents an array of challenges. But now you're in the role, your expected to be able to deliver many types of education and...

# data[].attributes.attachment_link.readable_text
When most people think about accessibility in technology, their first thought may be about accessibility for blind or D/deaf people: captioning, visual descriptions or Braille conversion. Blind and D/deaf people aren't the only ones who benefit from inclusive technology, though. Autistic people, people with learning disabilities, people with ADHD and other neurodivergent people also have access needs that site designers and developers can meet. Here are five ways you can make your websites and apps more accessible for neurodivergent people.
Use subtitles/captions.
Subtitles and captions for online videos aren't just for D/deaf people or people with hearing loss. Many autistic people and other people with disabilities can have auditory processing difficulties that make it hard to understand spoken, recorded language. Using subtitles helps people follow what they're listening to. Subtitles can also help people retain what they've heard long after they've finished watching the video.
Avoid flashing images and clashing palettes.
Quickly flashing animated GIFs or other animations are an access issue for several people. If people have difficulty processing what they're reading, and they're interrupted by a flashing GIF, they may be thrown off entirely. They could end up leaving your website because they can't concentrate on what you're trying to show them. There's also the danger that quickly flashing animations will trigger medically threatening seizures in people with epilepsy or other seizure disorders.

The same applies to clashing palettes and site schemes. Like flashing GIFs, they make your content harder to interact with. Lime green text on a magenta background is probably not a good idea! You can also include different style sheets for your site with different levels of text/background contrast so that your visitors can choose the options that work for them.
Avoid autoplaying videos and music.
Autoplaying content can distract people from the article they're trying to read. News sites are especially notorious for embedding autoplaying videos. This can be especially troubling if readers struggle with maintaining their attention span - they may visit your site to read an article, but they can't absorb what they've read because a loud video that may or not be relevant is blasting at them. This applies both to native content from sites and apps and third-party advertising. If you embed autoplaying video ads in your site, you may end up losing potential customers because you've prevented them from enjoying the site you're trying to advertise on.
Make your writing accessible.
The heart and soul of online content is writing. Your words matter, and the way they come across to readers matter. When writing online content, it's important to be mindful that people with different reading skills may be reading your content. People with intellectual disabilities, cognitive disabilities or dyslexia may struggle with long-winded paragraphs or jargon-packed sentences. If you want to get a rough idea of how readable your article is, you can use an online readability checker, like the one at readable.io. These checkers examine written content for sentence length, syllable counts and other attributes that can affect how easy it is to read something.

The same applies to the text in online or mobile apps. Keep it simple. Understanding is the goal. You'll find that making instructions and user interfaces understandable will help everyone who uses your products.
Use readable typography.
The font you use on your websites and apps matters. Some fonts are more readable than others. Sans-serif fonts are easier to read for many people than serif fonts are. This is because it's easier to tell letters apart with sans-serif fonts. Serif fonts have little 'feet' on the letters. Examples of serif fonts are Times New Roman, Georgia, Palatino and Garamond. Examples of sans-serif fonts include Helvetica, Arial, Avenir and Verdana. Make sure to set the text you use at a readable size (at least 11 or 12 points, 1 em or roughly 14 pixels), too.

It's also helpful to use sans-serif fonts that distinguish between capital I and lowercase l so that people can tell them apart easily. Some common fonts available on most computers that do this are Verdana, Trebuchet MS and Tahoma. You can also download the Source Sans Pro font or use it as a web font in your site or app.

Be careful about using gaudy display fonts or swirly script typefaces in your headings and logos. These are more difficult to read than more standard-looking fonts. You don't have to be boring and consign yourself to Times New Roman and Verdana; there are readable fonts that are visually interesting. You just want to make sure that people to be able to read your attention-grabbing headlines.

# data[].attributes.attachment_link.title
5 Ways to Make Your Web Content More Neurodiversity Inclusive

# data[].attributes.attachment_link.description
When most people think about accessibility in technology, their first thought may be about accessibility for blind or D/deaf people: captioning, visual descriptions or Braille conversion. Blind and D/deaf people aren't the only ones who benefit from inclusive technology, though.

# data[].attributes.attachment_link.readable_text
This is my consideration to reviewing accessibility of this blog and to aid future creation of resources. After reading this post by Finn Gardiner on neurodiversity inclusiveness it really makes you consider how you create education items. At times I have created short video recordings and added them into YouTube for students to access, normally talking over a few powerpoint slides explaining focus of upcoming course content or discussing an article for journal club but had never thought to add captioning or subtitles. The below resources explain the reasons for inclusivity and then a how to guide to add captions 'Charlie Chaplin' style. At the bottom right of this blog, is a translate option that hopefully allows more accessibility.

I try to add a mix of text, image and video resource to provide a variety of sources of information and to keep it light and interesting (#microlearning). What I am not sure about is the accessibility or loading speed for those accessing around the world. The open access approach means quick access, no passwords, payments but access to published articles is dependent on publisher rights so sometimes only a link to a abstract can be provided.
Make The Internet Accessible by Annie Elainey. Creating Subtitles and Closed Captions on Your Youtube Videos by Derral Eves Resources
Finn Gardiner (2017) 5 ways to make your web content more neurodiversity inclusive. Nosmag.org

National Association of The Deaf (2017) Captioning on the internet.

# data[].attributes.attachment_link.title
Making The Internet and Resources Accessible

# data[].attributes.attachment_link.description
This is my consideration to reviewing accessibility of this blog and to aid future creation of resources. After reading this post by Finn Gardiner on neurodiversity inclusiveness it really makes you consider how you create education items. At times I have created short video recordings and added them into YouTube for students to access, normally...

# data[].attributes.attachment_link.title
Kahoot! | Learning games | Make learning awesome!

# data[].attributes.attachment_link.description
Kahoot! is a game-based learning platform that brings engagement and fun to 1+ billion players every year at school, at work, and at home.

# data[].attributes.attachment_link.title
Welcome to Quick Rubric – Free, Fast, and Easy to Use! :)

# data[].attributes.attachment_link.description
Quick Rubric – FREE, fast and simple rubric creator

# data[].attributes.attachment_link.readable_text
EasyTestMaker is an online test generator to help you create and manage your tests!

Create, print and publish your tests online! EasyTestMaker makes it easy for you to perfectly format multiple question types, print alternate versions, and publish to the web for online tests. Online tests are automatically graded!

Sign Up - It's Free

Features Why you should use EasyTestMaker!

Perfectly formatted tests

Create multiple choice, fill-in-the-blank, matching, short answer and true or false questions. Add instructions and divide your test into multiple sections. Learn more...

Online tests graded automatically

Published online tests are graded automatically. View and print student's results and override grading when necessary. The same test you print, is the same test you publish online! Learn more...

Question Pools

Create a test with your entire question bank. Publish your test and choose to present as few or as many questions as you require. Each test taker will have a random set of questions.

Question analysis reporting

Quick and easy reports to see how many test takers answered which questions right and wrong.

Alternate versions to reduce cheating

Alternate versions and answer sheets provided with no extra work. Questions and answer choices are automatically resorted in a different order. Learn more...

Build exams with ease

Create an exam from your existing tests with just a few clicks. At any time you can copy a question from one test to another one! Learn more...

Export to Word or PDF

Any test, any version, including answer sheets can be download as a Micrsoft Word or PDF document to be saved and printed later. Learn more...

Make the most of your time, sign up now for EasyTestMaker!

EasyTestMaker eliminates wasted time spent on formatting. Add new questions and sections, move them around as needed and let EasyTestMaker do the hard work for you. All your tests are saved for easy retrieval. You can make changes or print out additional copies of any test you create.

Features I'm confused. I thought this was free?

Free, Plus and Premium plans are available. All are without ads. See below which plans include specific features. If you are not completely satisifed, we'll refund your full payment within the first 30 days of purchasing or upgrading, no questions asked.

Free $0/year
Core features to create tests

An easy to use test interface

All question types available

Answer sheets

Multiple sections

Automatic question renumbering when questions are moved

25 test limit

Publish online tests with up to 25 results stored at one time.

Sign up now!

Plus $59.95/year
Everything from Free plus:

Automatically generated alternate versions

Exam builder

Export to PDF and Word

Spell Check

Bold, Highlight, Italicize & more...

Unlimited tests

Publish online tests with up to 250 results stored at one time.

Sign up now!

Premium $79.95/year
Everything from Free & Plus plus:

Upload images, charts or graphs

Results automatically graded

Set time limits for online tests

Print individual test results with grading marks

Export results in Excel/CSV file

Publish tests to be taken online with up to 2,500 results stored at one time.

Detailed test result analysis reports. See which answers were selected and by who for each question. All in one summary view.

Advanced online test options, timed tests, download options and more...

Sign up now!

# data[].attributes.attachment_link.description
EasyTestMaker is an online test generator to help you create and manage your tests! Create, print and publish your tests online! EasyTestMaker makes it easy for you to perfectly format multiple question types, print alternate versions, and publish to the web for online tests. Online tests are automatically graded!

# data[].attributes.attachment_link.readable_text
Within this shared enterprise, instructors have another, rather heavy responsibility: making certain students can function in an atmosphere free of academic dishonesty. Section 4.2 of the UNL Student Code of Conduct is specific about the importance of maintaining academic honesty and integrity in our classrooms. While integrity is expected of all members of the university community, teaching assistants are uniquely positioned to teach, model, and assure integrity in students' academic assignments.

Persons with academic integrity work honestly, ethically and accurately, taking full credit for their own work, and giving full credit to others who have helped, or whose work has been incorporated into their own. Your primary responsibility as a teaching assistant is not merely to react to incidents of academic dishonesty, but to prevent them from happening at all, and to instill in your students a healthy sense of integrity and pride in themselves, their work and their profession.

Before the semester begins, think about how you will approach issues of academic honesty in your teaching.

When you meet with your supervising professor to make plans for the semester, discuss strategies you can use to let students know the value of academic integrity. Also clarify the procedures your department uses in responding to academic dishonesty (the UNL Student Code of Conduct describes several possible responses). Some faculty may delegate full responsibility for such matters to TAs, while others would prefer that you consult with them to determine how to proceed. Be sure your syllabus fully explains your policy on academic integrity and identifies the sanctions you will impose on any student who violates it.

During the first class meeting, emphasize the importance of academic honesty.

Include a discussion of the ethical standards for the course - and the consequences of non-compliance.

As you present each assignment during the semester, reinforce how important it is for students to approach their academic tasks honestly.

Make sure students know the criteria you'll use for evaluating their performance. Describe acceptable and unacceptable behavior and give examples of plagiarism or improper collaboration.

Make sure students feel they can succeed in your class without having to resort to dishonesty.

Encourage students to come talk with you if they are having difficulties. Ensure equal access to study materials (assignments, exams, old homework assignments).

Use various strategies for promoting honesty in written assignments.

Teach students how to successfully research and write a paper or prepare a lab report.

Teach students proper methods of attribution. Describe and give examples of plagiarism, paraphrasing and direct citation.

Assign specific topics or give students a limited choice of topics. Become familiar with the literature in those areas, both in print and online. Require students to discuss paper topics with you before getting started.

Be reluctant to allow students to change topics or hand in something that is off the assignment.

Have students submit an essay outline or first draft for feedback.

Discuss areas of difficulty in assignments. Meet with students to monitor their progress and offer feedback and support.

Provide specific guidelines for the format of written assignments and adhere to them when evaluating student work.

Prepare new assignments each semester.

To lessen the possibility of papers or assignments being lost or stolen, require students to submit assignments in class or directly to you.

Use various strategies for promoting honesty on exams.

Prepare new exam questions each time you teach the course. If a pool of multiple-choice questions is available, rotate their use.

When proctoring, circulate throughout the room, especially at the back.

Prepare a seating plan or have students sit in every other seat.

Ask students to leave their bags and backpacks at the end of an aisle or at the front of the room before sitting down to write an exam or test.

Collect examination papers individually.

To discourage any additions after exams or tests are returned to students, place a mark or dash at the end of each answer and/or a line through any unused sections of their examination papers or booklets.

If you suspect students of cheating or plagiarizing material, confront them directly.

Deal with the problem immediately. Talk with the student about your suspicions and listen carefully to the student's response. If you still are convinced the student behaved unethically or dishonestly, pursue the matter according to your established policy.

See also Academic Integrity at UNL: Understanding Plagiarism http://www.unl.edu/gradstudies/current/integrity#plagiarism

Resources: Office of Student Judicial Affairs.

For a more comprehensive discussion of this topic, go to the University of California-Berkeley's Tools for Teaching web page and read a chapter from the book Tools for Teaching by Barbara Gross Davis; Jossey-Bass Publishers: San Francisco, 1993.

# data[].attributes.attachment_link.description
Within this shared enterprise, instructors have another, rather heavy responsibility: making certain students can function in an atmosphere free of academic dishonesty. Section 4.2 of the UNL Student Code of Conduct is specific about the importance of maintaining academic honesty and integrity in our classrooms. While integrity is expected of all members of the university community, teaching assistants are uniquely positioned to teach, model, and assure integrity in students' academic assignments.

# data[].attributes.attachment_link.readable_text
Here are 156 free nursing games with some 6,000 questions designed to make your nurse learning / education more interesting, engaging and fun! In this section we have developed, and are experimenting with, different kinds of educational nursing games. Online games are very popular, so why not apply them to your nursing education?

The Super Nurse and Word Guess games have been developed in HTML5. Therefore, the latest browser versions of Internet Explorer (IE10/11), Firefox, Chrome or Safari need to be used. These games can also be played on most mobile devices.

We have enhanced the games software to produce a Report that you can print out and keep for your records, or to hand in for assignments. For statistical and research purposes, the game results are now being tracked and recorded.

Click on a Title below to open up a specific nursing educational game in a new window. If you find the audio annoying or distracting, click the Mute button on your computer. Enjoy!

1. Nursing Games - Super Nurse Series

1.27 Drug Dosage Calculations I - This game tests your knowledge of the metric system and how to accurately make conversions between the various units. ( 15 items selected from 50 questions).

1.28 Drug Dosage Calculations II - Test and refresh you knowledge and skills about how to calculate the correct tablet medication dosages. ( 15 items selected from 50 questions).

1.29 Drug Dosage Calculations III- This game is designed to assess and review your knowledge and skills in calculating the correct fluid medication dosages. ( 15 items selected from 50 questions).

1.30 Drug Dosage Calculations IV - Test and refresh your knowledge and skills in calculating the correct dosages for medication administration by injection. ( 15 items selected from 50 questions).

1.31 Drug Dosage Calculations V - This game assesses your knowledge and skills in calculating the correct intravenous (IV) dosages, flow rates and administration times. ( 15 items selected from 50 questions).

2. Nursing Games - Word Guess Series

2.45 Pediatric Disorders I - Test your knowledge of the names of disorders related to child development, vision, hearing, blood, respiratory system and nervous system in pediatric patients. (1 5 items drawn from a pool of 45 questions).

These Drag and Drop games were developed using Articulate's StoryLine 3 software. For best viewing of these SL3 games on Apple's iPhone and iPad, download and install the FREE Articulate from the iTunes Store. If you are using an Android tablet or phone, download and install the FREE Articulate Android Player App from Google Play.

3.2 Blood Tests I - See how well you know the indications / applications of 60 blood tests used to diagnose and monitor various body disorders and diseases. ( 15 questions selected from 60).

3.3 Blood Tests II - Test and refresh your knowledge of the indications / applications of another 60 blood tests used to diagnose and monitor various body disorders and diseases. ( 15 questions selected from 60).

3.4 Cancer Symptoms - Try this funky nursing game to see how well you know the signs and symptoms of 12 different types of common cancers. ( 24 questions).

3.5 Diagnostic Tests I - Try this game to see how well you know the indications / applications of 45 electrodiagnostic, endoscopic and nuclear diagnostic technologies, tools and procedures used to identify, monitor and evaluate body disorders and diseases. ( 15 questions from 45).

3.6 Diagnostic Tests II - Another game to see how well you know the indications / applications of 45 manometric, ultrasound and x-ray diagnostic technologies, tools and procedures used to identify, monitor and evaluate body disorders and diseases. ( 15 questions from 45).

3.10 Infectious Diseases - See how well you know the causes (bacteria, virus, fungi, parasites or protozoa) of these infectious diseases. ( 48 questions).

3.18 Oral Dosages - Another game about calculating the correct dosages for medications administered orally using solutions, suspensions, mixtures and syrups. ( 15 questions randomly selected from 35 items).

3.21 Pressure Ulcer Terms II - Another game to review the terminology used in the assessment, prevention and treatment of pressure ulcers / bedsores. ( 20 questions chosen from 70 items).

# data[].attributes.attachment_link.description
Here are 156 free nursing games with some 6,000 questions designed to make your nurse learning / education more interesting, engaging and fun! In this section we have developed, and are experimenting with, different kinds of educational nursing games. Online games are very popular, so why not apply them to your nursing education?

# data[].attributes.attachment_link.description
The Learning Nurse is an independent, free and safe learning resource for nurses at all levels to assess, develop and enhance their nursing professional competence.

# data[].attributes.attachment_link.readable_text
Are you interested in AGACNP-BC, AGPCNP-BC, Family NP, Med-Surg, or other nursing certifications?

Certification validates that you have the skills needed to succeed in this ever-changing profession and ANCC has many certification options. Earn credentials as an expert in your specialty, and become the nurse you want to be.
Find out more

# data[].attributes.attachment_link.title
ANA Enterprise | American Nurses Association

# data[].attributes.attachment_link.description
Discover the ways that ANA Enterprise advances nursing to improve health care for all.

# data[].attributes.attachment_link.title
How Does Health Care Simulation Affect Patient Care? | AHRQ Patient Safety Network

# data[].attributes.attachment_link.description
This piece explores health care simulation including the four main methods used and the evidence base for its impact on learning and patient care.

# data[].attributes.attachment_link.title
Nursing Care Plans: What You Need to Know

# data[].attributes.attachment_link.description
If you aspire to become a nurse, you'll want to familiarize yourself with what Nursing Care Plans (NCPs) are all about.