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The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL.
This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations.
A validated online survey was administered to students while on placement in a range of health care settings in two Australian states.
There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (
Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken,
The rapid evolution of digital technology in health care environments has created new challenges for learning and teaching (L&T). While increasing access to mobile or portable devices has enabled opportunities for promoting learning at the workplace in real-time [
The reported use, effectiveness, and impact of eHealth and mobile devices internationally is similar to the Australian situation. Systematic reviews demonstrate that evidence is required to guide clinicians and develop frameworks for use in clinical environments [
Gray and colleagues [
The second global survey on eHealth [
Previous studies have focused on the technology available rather than the learning afforded by its use [
Perceived risks associated with using mobile devices in the workplace have been investigated. Potential distraction from patient care while using a mobile device
This cross-sectional study captured self-report of undergraduate nurses’ access to Internet or device-based resources, using a mobile or portable device at, and away, from the workplace. The study involved administration of a survey to undergraduate nurses, while they were in clinical practice during January 2014, at a range of health care settings in two Australian states.
Minimum risk ethics for this research was approved by the University of Tasmania Human Research Ethics Committee, approval number H0013729. Consent was implied by completion of the survey.
Eligible participants were identified through consultation with lecturers from the University. All participants were undertaking WIL and were recruited via email. Two reminder request emails were sent at two week intervals following the initial request.
Of the 22 survey items relating to utilization of mobile devices to access information, 15 were from a validated tool developed by McBride, LeVasseur and Li [
The survey data were imported into IBM SPSS (Version 21) for analysis and frequencies were investigated. Chi-square tests were utilized to explore differences between those who had access to a mobile device and those who did not. Differences in responses to scales for ‘Away from PEP’ and ‘During PEP’ were explored using Wilcoxon signed ranks tests. All tests were two-sided and differences were accepted at
A total of 476 students undertaking WIL were offered the opportunity to participate in the online survey and 84 responded (18% response rate). There were 37 respondents (44%) who participated in WIL in New South Wales, and 38 (45%) in Tasmania. Of those respondents, 45 (54%) were in their first year of nursing study. Furthermore, 44 respondents (52%) undertook WIL at tertiary health care facilities and the remainders were dispersed at district hospitals or community-based facilities.
A filter question requiring access to a mobile or portable device (Do you have current access to a mobile technology device?) rendered 37 respondents ineligible to complete the second section of the questionnaire.
Demographic information of respondent access to a mobile or portable device.
Demographic descriptor | All respondents |
Access to a portable or mobile device |
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Male | 19 (23%) | 14 (30%) |
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Female | 56 (67%) | 33 (70%) |
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Missing; non respondents | 9 (11%) | 0 (0%) |
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<21 | 10 (12%) | 4 (9%) |
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21-30 | 22 (26%) | 13 (28%) |
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31-40 | 20 (24%) | 15(32%) |
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41-50 | 13 (15%) | 8 (17%) |
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>51 | 10 (12%) | 7 (15%) |
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Missing | 9 (11%) | 0 (0%) |
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Yes | 24 (29%) | 14 (30%) |
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No | 51 (61%) | 33 (70%) |
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Missing | 9 (11%) | 0 (0%) |
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Secondary | 20 (24%) | 9 (19%) |
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Vocational certificate | 21 (25%) | 15 (32%) |
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Undergraduate degree | 26 (31%) | 18 (38%) |
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Post graduate | 8 (10%) | 5 (11%) |
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Missing | 9 (11%) | 0 (0%) |
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NSW | 37 (44%) | 23 (49%) |
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TAS | 38 (45%) | 24 (51%) |
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Missing | 9 (11%) | 0 (0%) |
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First year | 45 (54%) | 27 (57%) |
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Final year | 30 (36%) | 20 (43%) |
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Missing | 9 (11%) | 0 (0%) |
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Major hospital | 44 (52%) | 31 (66%) |
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District hospital | 11 (13%) | 5 (11%) |
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Primary care | 5 (6%) | 2 (4%) |
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RACF | 3 (4%) | 2 (4%) |
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Multipurpose | 2 (2%) | 1 (2%) |
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GP | 3 (4%) | 3 (6%) |
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Mental health | 4 (5%) | 2 (4%) |
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Other | 3 (4%) | 1 (2%) |
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Missing | 9 (11%) | 0 (0%) |
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Yes | 47 (56%) |
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No | 12 (14%) |
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Missing | 25 (30%) |
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aMay not equal 100% due to rounding
Differences in participant reports of behavior in accessing information away from and during WIL were found for several variables (
Differences in access to information using a mobile or portable device away from or at the workplace, were reported for 6 out of the 7 items grouped in non-work related activities. Non-work related uses of portable devices were more frequent when students were away from the workplace. These included messaging (median 4 vs median 2,
Study-related activities that were conducted more regularly away from the workplace included browsing on the Internet (median 4 vs median 3,
There were no differences found away from or during WIL for accessing work-related activities such as accessing drug, nursing, and medical information or professional education and development resources. Students reported infrequently accessing study-related text or email messages from academic supervisors, or submitting assessment tasks using a mobile or portable device. Respondents also used a mobile or portable device as a clock or a stopwatch (median 4 vs median 2,
Participants reported that during WIL they did not shop on the Internet; check or post on social networking sites; play online or games loaded on the device; conduct personal business online; or check/send personal text messages or emails to co-workers. Access to work-related protocols and mobile apps that assist with patient or client care were more likely (once per day) to be accessed during WIL.
Respondents reported they did not access sites for patient handouts and teaching, communicating with other members of the health care team to coordinate patient or client care, or to play games.
Utilization of portable or mobile devices during work integrated learning.
Use of portable or mobile devices to access information | Away from PEP Median, (Range) | During PEP Median, (Range) |
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I access work-related drug references | 3 (1-5) | 3 (1-5) | .94 |
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I use it to communicate with other members of the health care team to coordinate patient or client care | 1 (1-5) | 1 (1-5) | .94 |
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I access work-related protocols | 1 (1-5) | 2 (1-5) | .90 |
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I access work-related apps that assist patient or client care | 1 (1-5) | 2 (1-5) | .75 |
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I access sites for patient handouts and teaching | 1 (1-5) | 1 (1-5) | .53 |
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I use the device as a calculator for nursing/medical formulas | 2 (1-5) | 2 (1-5) | .52 |
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I access sites for professional education and development | 3 (1-5) | 3 (1-5) | .23 |
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I access work-related nursing/medical information | 3 (1-5) | 3 (1-5) | .21 |
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I check/send personal text messages or emails to family or friends | 4 (1-5) | 2 (1-5) | <.001 |
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I check/post on social networking sites (Facebook, Twitter, Snapchat etc) | 4 (1-5) | 1 (1-5) | .01 |
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I shop on the Internet | 2, (1-5) | 1 (1-5) | .01 |
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I conduct personal business online (eg paying bills, banking) | 2 (1-5) | 1 (1-5) | .01 |
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I play games loaded on the devicea | 1 (1-5) | 1 (1-5) | .05 |
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I check/send personal text messages or emails to co-workers | 2 (1-5) | 1 (1-5) | .04 |
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I play online games | 1 (1-5) | 1 (1-5) | .84 |
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I browse (eg use a search engine Google, Safari etc) for information to assist with progression of my studiesa | 4 (1-5) | 3 (1-5) | < .001 |
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I check/send study related text messages or emails to friends or co-workers | 3 (1-5) | 2 (1-5) | .01 |
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I access University related sites (eg MyLO) to assist with progression of my studiesa | 4, (1-5) | 3, (1-5) | .01 |
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I check/send study related text messages or emails to my academic supervisorsa | 2, (1-5) | 2, (1-5) | .26 |
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I access study related sites (eg library, journal articles) to assist with progression of my studiesa | 3, (1-5) | 2, (1-5) | .03 |
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I submit assessment tasksa | 2, (1-5) | 2, (1-5) | .44 |
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I use the device as a clock or stopwatcha | 4, (1-5) | 2, (1-5) | .01 |
aNon-validated question.
This study demonstrated differences in accessing the Internet or device-based resources using a mobile or portable device at, and away, from the workplace by undergraduate nurses. Undergraduate nurses reported there was a range of non-work related Internet-based activities they avoided during WIL. Predominantly these activities related to social networking with family or friends, shopping, or conducting personal business online. McBride, Le Vasseur, and Li [
The research indicates that through lack of access to mobile devices or resources there were lost opportunities to engage with patients or clients at point of care. Undergraduate nurses reported they never accessed patient handouts for teaching or communicating with other members of the health care team to coordinate patient care. At registration there is an expectation that students are work-ready [
There was no demonstrated difference in behavior for accessing work-related drug references, nursing or medical information, and professional education and development. Undergraduate students continue to study when they are not at the workplace. The convenience of enabling access to mobile or portable devices
Differences were found in browsing for information, accessing study or University related sites, which predominantly occurred away from WIL. The convenience and ease of using a mobile device supported student-centered learning [
While away from the workplace students tend to use mobile or portable devices to monitor time. This behavior was less likely during WIL, suggesting that undergraduate students did not access their mobile device to conduct patient observations such as pulse or respiration assessments. Institution or organization policy that dissuades the use of mobile or portable devices during WIL may be a factor for regulating use [
Respondents indicated that communicating with family, friends, co-workers, and study were more likely to be accessed than playing online games loaded on the device while away from or during WIL. Communication or maintenance of meaningful relationships may contribute to lack of interest in playing games using a mobile device. The predominance of females in the cohort may also have negatively skewed the result as females are less likely than males to game [
This study had several limitations. The first included the low response rate. This may have occurred because although the survey was anonymous, it may have contributed to students feeling that if they did not respond appropriately there was a chance of disadvantage with their studies. Additionally, survey fatigue of students may also have contributed to a lower level of engagement with completion of the survey. Respondents were recruited from one university and may attend WIL at partner health care organizations that have guidelines impacting the conduct by students during WIL, which could reduce the generalizability of the findings. Of the questions asked, 7 relating to access to study options were not validated. In these cases the sentence construction was similar to the validated questions, however their actual reliability is unknown at this time. Finally, as this survey has been administered by staff at the teaching university there is the possibility of social desirability bias, the tendency to respond to questions in a known socially acceptable manner.
Further examination of preferred mobile or portable devices used for L&T by undergraduate nurses is warranted. Review of higher education institutional and health care organization policy relating to mobile devices could reveal there is a need to change to allow students to prepare for their future profession in accessing learning objects or resources while they are undertaking WIL. Concurrently, there is a need to ensure ICT architecture and infrastructure at organizations supports L&T at the workplace. Curriculum design to incorporate appropriate and safe use of mobile devices is necessary to promote diffusion of this informal method of L&T into the workplace. Over time, responsible use of mobile devices to minimize risk could create a cultural shift that will enable safe use for L&T
Exploration of access to information using a mobile or portable device by undergraduate nurses away from and during WIL contributes to the discourse about the challenges of using these devices at systems, organizational, and individual levels. This study found that undergraduate nurses limited their access to non-work or non-patient-centered care while undertaking WIL. Furthermore, the risk of distraction was unlikely due to student nurses’ accessing non-work related sites (4,6). The use of mobile devices for study purposes occurred during WIL, but was more frequent away from the workplace. This suggests students were focused on developing competency in patient care while in the workplace. Acceptance of access to mobile devices as a legitimate L&T tool during WIL is imperative. To support this aim there is a need to promote professional identity and facilitate L&T by including guidance for appropriate mobile learning behavior in the curriculum. The development of best practice guidelines or policy to minimize risk and enable improvement of health outcomes of patients at point of care is necessary. Undergraduate students are the next generation of nurses. This study showed they can discern appropriate mobile device use. Over time, nurses will expect easy access to mobile learning resources to enable them to deliver safe and effective health care to patients.
information communication technology
learning and teaching
mobile learning
work-integrated learning
Author 1 was involved with all aspects of development of the study design, ethics application, data collection, analysis, preparation, and review of the manuscript. Author 2 was involved with study design, ethics, review, and edit of the manuscript. Author 3 was involved with analysis, review, and edit of the manuscript. Nil funding.
None declared.