This study aimed to explore the practicalities of implementing a mobile spaced learning model to deliver symptom management education to undergraduate nursing students.
The objectives of this study were to:
(1) Explore the usability and acceptability of a mobile spaced learning platform in providing symptom management education to first year undergraduate nursing students.
(2) Determine if mobile spaced learning can be successfully implemented to deliver symptom management education to first year undergraduate nursing students.
(3) Explore participants’ perceptions of the impact of the spaced learning digital intervention on the development of knowledge in relation to symptom management.
This pilot study adopted a mixed methods approach to explore the practicalities of implementing the proposed digital learning model. The qualitative element was based on broad interpretivism. The philosophy of interpretivist research is that the researcher will interpret the world they investigate . The aim of an interpretivist approach is to understand the world from the point of view of the participants in it rather than the world’s explanation , it was therefore, consistent with the aims of the study.
Ethical approval was granted from the School of Nursing and Midwifery Research Ethics Committee (Ref: 5. CMcVeigh 04.18.M5.V1). Prior to the commencement of the study all participants were made aware they could withdraw from the study at any point with no negative consequences. Participants were made aware prior to data collection that every endeavor would be taken to protect their privacy and identity throughout the duration and after the study is complete. In the reporting of results, pseudonyms are used to protect the identity of participants when verbatim quotations are used.
The online spaced learning material related to symptom management was embedded in a current module being delivered in the first year of the undergraduate BSc (Hons) Nursing programme at one University in the United Kingdom. Case based scenarios and multiple choice questions (MCQs) were developed by members of the research team, who teach the module involved and also have expertise in symptom management. Scenarios and questions developed were based on the learning outcomes of the module and the content that it delivers . Figure 1 outlines the intervention and how this was delivered. On completion of the face-to-face learning on symptom management, three case based symptom management scenarios were delivered directly to consenting participants’ e-mails in a spaced, repeated, and tested format over 2 weeks. This could then be accessed on a desktop or mobile device. Each case scenario was tested using four sets of MCQs. Participants engaged with each case and completed the related questions in a location and time of their choice. The correct answer to each MCQ question was provided as soon as a response was submitted, providing participants with the answer, a key take home message and links to evidence based resources. If participants correctly answered all the MCQs for the case scenario on the first attempt, then this scenario was forwarded to them again in 72 hours. After they correctly answered all the MCQs for a scenario twice, they did not receive this scenario again. If a participant was unsuccessful on their first, second, or both attempts in correctly answering all MCQs for a scenario, they had a third opportunity to repeat this, 72 hours after their last attempt. Participants only received each scenario a maximum of three times. Responses to the MCQs were only used for the purposes of this research and not towards any summative assessment. Lecturers in the School of Nursing and Midwifery outside the research team did not have access to participant’s individual responses.
Sample and Participants
Convenience sampling was used to recruit relevant participants into the study. This involved selecting participants who were able to be accessed conveniently and efficiently. By using convenience sampling the researcher was able to accept any student who met the criteria and agreed to take part in the study as a participant . Participants of the study were eligible if they were a first year undergraduate student on the BSc (Hons) Nursing programme, who were completing the Professional Nursing Values Module. There were 135 nursing students from one cohort of students who were invited to participate in the study. It was proposed that six to twelve participants would be recruited to participate in the focus group.
Recruitment commenced in September 2018. An information session was delivered to all students in week one of phase three. Information packs were also provided at the end of the information session containing an invitation letter, information sheet, and consent forms for both the study and questionnaire, and the focus group. Before the focus group commenced, verbal and written informed consent was obtained from each participant.
First year undergraduate nursing students (n=135) were invited to take part and given information packs. As figure 2 highlights, 20% (n=27) of students consented to take part in the study, however 10 did not participate leaving a total of 17 participants from the cohort of students (13%) who took part in the spaced learning. Seventy-one percent of these participants (n=12) completed the online survey after the spaced learning was complete. For the focus group, 13 students consented and 8 of these took part (47% of participants). In relation to the spaced learning, 12% (n=2) completed all required elements, and 88% (n=15) only partially completed the spaced learning activities.
At the end of the two-week period of spaced learning (weeks two and three on Figure one), a report was generated via the digital platform to show participants performance. To evaluate the acceptability and usability of the spaced learning approach using mobile technology, participants were then invited to participate in an online survey (Supplement 1) via survey monkey related to the usability and acceptability of spaced digital learning as a learning method within the university setting. Following this, a focus group (Table 1) was conducted with 8 participants to further explore their views on the acceptability and usability of the mobile spaced learning education approach. Focus groups were digitally recorded and transcribed verbatim.
Data from students’ engagement in the MCQs using spaced learning was collated by the research team and the survey data was analysed using descriptive statistics. Qualitative data from the focus group was analyzed using a thematic content analysis approach as described by King and Horrocks . To assist the management and the sorting of the data a computer software package, NVivo was used. Validation was secured from the research team after the data was analysed in order to verify the researcher’s interpretation of the data.
To enhance the trustworthiness of the qualitative component of this study, it is essential that rigour is demonstrated throughout the study . One method used to demonstrate credibility was the use of reflective questioning. The researcher was reflexive when interpreting the participants’ responses, throughout the focus group, in an attempt to capture the meaning the participants were hoping to convey. Transferability of the results generated in the study was achieved through ‘thick description’ . This entailed the researcher providing explicit accounts of the experiences of the participants’ and not just detailing the surface phenomena of their interpretations but also uncovering the meaning behind their feelings and action . An audit trail was maintained to promote dependability and confirmability .