Digital Transformation in Nursing Education: A Systematic Review on Computer-Aided Nursing Education Pedagogies, Recent Advancements and Outlook on the Post-COVID-19 Era

The COVID-19 pandemic has transformed nursing education worldwide. Due to the globally applied restrictions of interpersonal interactions, many educational institutions transitioned from traditional to computer-aided nursing education pedagogies. However, an obligatory change, this digital transformation in nursing education, has been deemed promising by students and academics, yet raising concerns about the effectiveness of innovative nursing pedagogies. Hence, this systematic literature review aims to investigate the state of the art of computer-aided nursing pedagogies in the post-COVID-19 era and provide recommendations for further research investigation. Specifically, it utilises a mixed methods approach to examine (1) the evolution of computer-aided nursing pedagogies before and after COVID-19; (2) their effectiveness against traditional methods in terms of knowledge, skills acquisition and self-efficiency; and (3) nursing students' experiences and opinions when exposed to computer-aided nursing education pedagogies. For this purpose, several databases (PubMed, MEDLINE, CINAHL Complete, Academic Search Elite, IEEE, ACM, Scopus, ERIC and Cochrane Library (Controlled trial requests) were searched, initially retrieving 802 articles published between 2013-2023. After removing duplicates, exclusion criteria and assessment for eligibility, the number of articles assessed for eligibility was reduced to 78 conducted in 20 different countries. The articles comprised quantitative research (n=37), including Randomised Control Trials (n=14) and Quasi-experimental studies (n=23), and qualitative research (n=41) including observational studies (n=14), mixed-methods methodological design (n=15), pilot studies (n=7) and conference papers (n=5). Moreover, this SLR utilised the Joanna Briggs Institute (JBI) methodological approach for conducting a mixed-methods systematic review (MMSR) and provided a narrative synthesis of all studies. The results of this mixed-methods SLR suggested that the post-COVID-19 era has enabled the implementation of a variety of computerised systems in nursing education, including desktop-based systems, mobile applications, Virtual Reality, Augmented Reality, Mixed Reality and holograms, haptics, Artificial Intelligence-enabled chatbots and systems, smart glasses and multimodal systems. The authors found that these computer-aided nursing education pedagogies were superior to traditional nursing pedagogies regarding acquiring knowledge, skills, and self-efficiency. However, the generalisability of the above findings should be interpreted with caution due to variations in sample size and effect size established via Hedges' g calculations among the 35 quantitative articles. Nevertheless, nursing students' experiences and opinions were encouragingly positive. Further research is needed to incorporate more realistic and memorable scenarios and examine the effects of computer-aided nursing educational pedagogies on long-term knowledge gains and the effective learning domain.