Content area
Aim
To identify and examine factors affecting postgraduate nursing students’ engagement with online learning in higher education.
Background
Online learning offers registered nurses flexible opportunities for postgraduate study. However, maintaining engagement can be challenging and specific influences on this group require further investigation
Design
Mixed methods literature review following systematic review principles.
Methods
A systematic search was conducted in November 2022 and updated in February 2025 across six databases: CINAHL Ultimate, MEDLINE, ERIC, APA PsycInfo, Academic Search Ultimate and Education Research Ultimate. The review adhered to PRISMA guidelines. A convergent integrated approach was employed to synthesise qualitative, quantitative and mixed methods findings using thematic analysis. While undertaken by a single reviewer and not registered with PROSPERO, established systematic review methods and a formal quality appraisal tool were applied.
Results
Fifteen studies met the inclusion criteria. Seven themes were identified: (1) convenience of online learning; (2) curriculum design; (3) educator presence; (4) social interaction with classmates; (5) technology issues; (6) independent learning; and (7) working with peers. These themes could act as enablers, barriers, or both for engagement with online learning
Conclusions
Engagement in postgraduate online learning is shaped by a complex interplay of personal, social and structural factors. Key enablers include educator presence, supportive learning communities and well-structured curricula; persistent barriers include isolation and time pressures. Tailored, inclusive teaching strategies, alongside further research into a broad range of influences on engagement, including cultural and technological factors, are essential to optimise learning experiences and support postgraduate nurses in evolving digital environments.
1 Introduction
The number of registered nurses working in the National Health Service (NHS) in England has reached an all-time high; however, this has not kept pace with growing service demands, resulting in a record number of nursing vacancies ( NHSEngland, 2024). Workforce shortages have limited opportunities and access to traditional in-person continuing education and training. In the United Kingdom (UK), where continuing professional development (CPD) is mandatory to ensure nurses maintain competence in their practice and deliver safe, up-to-date care, online learning has become a vital mode of delivering structured education. It supports registered nurses in pursuing formal postgraduate qualifications and other accredited learning opportunities alongside their clinical responsibilities.
Postgraduate nursing education has grown globally to meet increasing care complexity and workforce development needs, particularly for advanced practice roles, ( Dunn et al., 2024; Janson et al., 2024; Ingram et al., 2025). As more nurses undertake postgraduate study alongside clinical responsibilities, demand has increased for flexible, accessible learning formats. In response, online learning has become an essential mode of delivery for delivering postgraduate nursing programmes and enabling nurses to remain up to date with their continued professional education.
Online learning, broadly defined as the use of internet-based platforms to deliver educational content and facilitate interaction between educators and students ( Moore et al., 2011), offers flexibility, accessibility and autonomy. For registered nurses undertaking postgraduate study, online learning enables participation in learning without the need to take leave from work, accommodating shift patterns and personal responsibilities to learn at their own pace ( Jones et al., 2015; Health and Social Care Committee, 2021). This aligns with adult learning theory ( Knowles et al., 2020), which highlights the importance of personal motivation, self-direction and learner relevance. Moreover, online learning can support a constructivist approach to learning, where learners construct knowledge through active engagement with a broader range of learning materials and resources and interaction with their peers ( Joint Information Systems Committee, 2009;Mello.,2016; Afzal and Crawford, 2022).
The COVID-19 pandemic accelerated the shift to online learning which highlights its potential ( Regmi and Jones, 2020). However, this also exposed the limitations of online learning and even before the pandemic, barriers to online learning had been identified. These include unreliable internet access, technical difficulties and limited institutional support ( Clark and Mayer, 2016; Croft et al., 2010; Gordon, 2014; Kenny, 2000). Additionally, the absence of face-to-face interaction in asynchronous courses may reduce opportunities for dialogue, peer learning and collaborative engagement ( Button et al., 2014; Smyth et al., 2012). These issues can significantly impact student engagement, which is a central concern in online education. Student engagement encompasses behavioural, cognitive and emotional involvement in learning and can be defined as the degree of attention, interest, motivation and active participation that a student exhibits in the learning process ( Krause and Coates, 2008; Sharif Nia et al., 2023). However, in postgraduate nursing education, the concept of engagement extends from passively absorbing content to include reflective dialogue, peer interaction and collaboration and critical thinking, skills which are essential components of advanced clinical practice ( Dianati et al., 2022). Yet, engagement in online learning environments can be difficult to sustain. Factors such as educator presence, class size, feedback quality and platform usability play a significant role in shaping students’ experiences ( Boling et al., 2012; McKeown and Anderson, 2016).
Despite the increasing reliance on online learning in postgraduate nursing programmes, much of the existing literature has centred on undergraduate students. Postgraduate nurses, many of whom are registered practitioners, balance academic and personal responsibilities alongside professional employment, bringing distinct expectations, responsibilities and learning goals. Unlike undergraduates, who are often new to healthcare, postgraduate learners are expected to engage at a deeper level, applying theory to complex clinical scenarios and contributing to leadership and service development ( Ho and Kember, 2018; Scott and Turrise, 2021). However, online learning is often oriented toward more didactic rather than pedagogic approaches ( Papageorgiou et al., 2024), which may not sufficiently support the depth of engagement required for postgraduate nurses. Recent reviews have examined engagement in online nursing education, including postgraduate nurses ( Dunn et al., 2024), reflecting the growing attention to this population. Our review complements the existing evidence by providing a more detailed thematic analysis, distinguishing seven factors that may act as enablers, barriers, or both. Whereas some reviews conflate informal continuing professional development (CPD) with academic study, creating ambiguity about the population of interest, our review focuses on registered nurses undertaking formal, structured online education such as accredited courses and postgraduate programmes. By refining the scope and providing a more granular synthesis, this review adds clarity to the evidence base and offers targeted insights into the factors that support or hinder postgraduate nurses’ engagement with online learning.
To maintain clarity and consistency, this review uses the term ‘online learning’ as an overarching descriptor for education delivered entirely through digital platforms requiring internet access to enable learners to engage remotely with materials, educators and peers. The term includes web-based learning, e-learning, digital learning, virtual learning, mobile learning, distance learning and remote learning, which are often used interchangeably in the literature ( Joint Information Systems Committee, 2009; The Quality Assurance Agency for Higher Education, 2020). In contrast, blended or hybrid learning, where face-to-face and online components are combined, were considered conceptually distinct and therefore excluded from this review. Similarly, various terms are used in higher education to describe teaching personnel. In this review, the term ‘educator’ is used as an inclusive term covering tutor, instructor, teacher, lecturer and academic, to reflect the range of roles encountered in the literature.
Given the growing importance of flexible, high-quality education for the nursing workforce, understanding how to foster engagement in postgraduate online learning is essential. Few contemporary studies have examined this area, revealing a gap in the literature on both general engagement factors and the potential role of emerging technologies. Although innovations such as artificial intelligence (AI) are beginning to influence nurse education ( Ma et al., 2025), most research on postgraduate nursing students’ engagement predates these development. This is also true for the studies in this review, which do not address such technologies directly. To address the wider gap, this review synthesises current evidence on factors influencing engagement in postgraduate online learning and identifies priorities for future research, including the potential impact of new technologies. Identifying these factors can inform the design of effective, evidence-based educational strategies that meet the learning needs of postgraduate nursing students, promote retention and support their progression into advanced roles.
2 Methods
2.1 Design
This mixed methods literature review followed a systematic process and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines ( Page et al., 2021) including the abstracts checklist. The review was primarily conducted by a single reviewer; however, the quality appraisal and overall findings were independently reviewed by the lead author’s academic supervisor as part of a Master’s dissertation. The Joanna Briggs Institute (JBI) convergent integrated approach ( Lizarondo et al., 2020) guided the synthesis and integration of findings across different study types. The convergent integrated approach involves transforming and integrating qualitative and quantitative data into a single synthesis, enabling the development of integrated themes across diverse study designs. In parallel, the guidance of Bettany-Saltikov and McSherry (2016) was followed for the systematic searching, critical appraisal and management of mixed methods literature. This approach ensured the systematic integration of different evidence types and supported the development of evidence-based recommendations based on the full breadth of available research.
2.2 Search strategy
The literature search was conducted by the lead author (AC). An initial search was carried out in November 2022 using the EBSCOhost research platform across six databases: CINAHL Ultimate, MEDLINE, ERIC, APA PsycInfo, Academic Search Ultimate and Education Research Ultimate. This selection provided broad coverage of peer-reviewed literature relevant to nursing and education. The search was updated in February 2025, applying the same search strategy but limited to publications from 2022 onwards to capture the most recent studies.
The search strategy was developed in collaboration with an academic and library specialist from the University of Hull to ensure inclusion of all relevant terms and synonyms. Guided by a PEO(T) (Population, Exposure, Outcome, Study Type) framework and preliminary literature scanning, synonyms and related terms were identified and combined using Boolean operators (AND, OR) and truncation (*). Searches targeted titles, abstracts and subject headings, incorporating MeSH (Medical Subject Headings) terms. To improve relevance, a title-field restriction was applied after an initial broader search produced over 4600 records, many of which were not directly relevant to the review’s focus. Full search terms and combinations are summarised in
2.3 Inclusion and exclusion criteria
Inclusion and exclusion criteria were also developed using the PEO(T) framework. Studies were limited to the English language due to a lack of resources and time for translation. However, no geographic restrictions were applied, as an initial scoping search identified the prevalence of online learning globally and international perspectives were considered relevant and applicable to the review. No date limiters were used, as online learning in higher education has been established since the 1990s and a broad range of studies was sought to capture historical and current practices. Only primary research studies were included. Literature that was not research-based, not focused on nursing education, or that involved undergraduate nurses was excluded, as it was outside the scope of the review. A detailed summary of the inclusion and exclusion criteria is provided in
2.4 Study selection
The lead author independently managed the study selection process, applying the inclusion and exclusion criteria throughout. After removing duplicates, the titles and abstracts of the remaining articles were screened by the lead author to exclude irrelevant studies. At this stage, 23 articles were identified as potentially eligible and underwent full-text assessment against the predefined inclusion and exclusion criteria. Following full-text screening, 14 primary research articles met the eligibility criteria and were included in the initial review synthesis. The updated database search added a further paper published since the original search, which is included in the data synthesis. The selection process, including reasons for exclusion at each stage, is detailed in the PRISMA 2020 flow diagram (
Page et al., 2021) (
2.5 Quality appraisal
The methodological quality of the selected studies was conducted by the lead author using the Mixed Methods Appraisal Tool (MMAT) for quantitative, qualitative and mixed methods research designs ( Hong et al., 2018). The MMAT algorithm was used to select the appropriate study category to assess each paper, ensuring that each study was evaluated against the relevant criteria. To enhance the rigour and credibility of the appraisal process, the completed assessments were independently reviewed by the academic supervisor (CW). Any discrepancies or differences in judgement were discussed collaboratively until consensus was reached.
Consistent with MMAT guidance, the papers were not numerically scored. Instead, both authors collaboratively developed the quality categories (low, medium, high) used to summarise the appraisal findings. These categories were based on recurring patterns in the methodological strengths and limitations of the included studies:
• Low quality: Papers that had fundamental methodological concerns such as inappropriate sampling, unclear analysis, or a 'No' response to at least one MMAT screening question.
• Medium quality: Studies that demonstrated some methodological robustness but also reported identifiable limitations or partial adherence to MMAT criteria.
• High quality: Papers that met all MMAT criteria, with clearly described design, data collection and analytical procedures and no major limitations.
Out of the reviewed papers, eight papers were assessed as low quality ( Mash et al., 2006; Horiuchi et al., 2009; Liang et al., 2011; Vandall-Walker et al., 2012; McIntyre et al., 2013; Seven et al., 2014; Claywell et al., 2016; de de de Luzuriaga-Balaria et al., 2024) and six papers were assessed as medium quality ( Bergeron and Melrose, 2006; Penz et al., 2007; Valaitis et al., 2007; Andrew et al., 2015; Hjorth-Johansen et al., 2019; Tiedt et al., 2021). One study met all MMAT criteria and was categorised as high quality ( Burruss et al., 2009). None of the papers were excluded because of the MMAT critical appraisal process. Complete details of the quality appraisals of all the selected papers are available in Supplementary Material 2.
2.6 Data extraction
The lead author conducted data extraction using a standardised template developed in accordance with the guidance from the
Centre for Reviews and Dissemination (2009). The template was created in Microsoft Word (2019) to facilitate systematic extraction and ensure consistency across all included studies. The following information was manually extracted from each included study: bibliographic information, aim, study design, sample, intervention where applicable, data collection methods and key findings. For studies with mixed populations (undergraduate and postgraduate nurses), only data specifically pertaining to postgraduate nursing students were extracted and analysed to ensure alignment with the review’s focus on postgraduate nurses. A reflexive record was maintained digitally to document decisions, uncertainties and the rationale for inclusion or exclusion. Any ambiguities or questions about data interpretation were discussed with the academic supervisor to enhance trustworthiness and reduce potential bias. All extracted data were compiled in a summary of extracted data (
2.7 Data analysis and synthesis
Data analysis was conducted by the lead author. Data were synthesised using the Joanna Briggs Institute (JBI) convergent integrated approach to integrate qualitative and quantitative findings ( Lizarondo et al., 2020). In line with this methodology, quantitative findings were qualitized, where data is transformed into textual descriptions, to facilitate thematic integration with the qualitative data. While this approach enabled a comprehensive thematic synthesis, it also required subjective interpretation of numerical findings, which introduces potential for interpretive bias. To minimise this risk, this process was informed by the guidance of Sandelowski et al. (2006), to avoid misinterpretation that can result from attributing numerical values to narrative data.
Following the data transformation, an inductive process using Thomas and Harden’s (2008) three-stage thematic synthesis approach was then applied to analyse the data in the synthesised studies’ findings. In the first stage, initial codes were generated from all the studies’ findings through line-by-line coding of the text. This process was recorded and organised manually using Microsoft Word (2019). In the second stage, codes were grouped into descriptive categories based on patterns and similarities within and across studies. The third stage involved interpreting these categories to generate analytical themes that captured commonalities and divergences across the reviewed studies. Codes and themes were revisited iteratively to ensure consistency, coherence and alignment with the review question. While the coding and theme development were led by a single reviewer, the process was supported through regular discussions with the academic supervisor, who provided critical feedback and peer debrief to enhance rigour. The academic supervisor reviewed preliminary themes and their supporting data to ensure coherence, clarity and alignment with the review aim. A reflexive approach was maintained throughout, with analytical decisions documented in a research log to support transparency and consistency.
3 Results
3.1 Characteristics of the included studies
Three studies used qualitative methods (
Bergeron and Melrose, 2006; Vandall-Walker et al., 2012; McIntyre et al., 2013). Seven studies used quantitative methods; two were randomised controlled trials (RCTs) (
Horiuchi et al., 2009; Hjorth-Johansen et al., 2019), one non-randomised trial (
Tiedt et al., 2021) and four were descriptive studies (
Burruss et al., 2009; Liang et al., 2011; Seven et al., 2014; Claywell et al., 2016). Five studies used mixed methods (
Mash et al., 2006; Penz et al., 2007; Valaitis et al., 2007; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). The selected studies were conducted in Canada (
n = 5), United States of America (USA) (
n = 3), Australia (
n = 1), Japan (
n = 1), Norway (
n = 1), Philippines (
n = 1), South Africa (
n = 1), Taiwan (
n = 1), Turkey (
n = 1). Using the PEO framework, the main characteristics of each paper are summarised in
3.2 Integrated findings
Thematic analysis identified seven key themes that influence postgraduate nursing students’ engagement with online learning in higher education: 1) convenience of online learning; 2) curriculum design; 3) educator presence; 4) social interaction with classmates; 5) technology issues; 6) independent learning; and 7) working with peers. These themes acted as enablers, barriers, or both, depending on how students experienced them. Each theme includes one or more subthemes that highlight specific aspects of the experience. A summary of the themes, their classification and associated subthemes is presented in the thematic map (
3.2.1 Theme 1: convenience of online learning (Both Enabler and Barrier)
Convenience of online learning was identified in eight of the 15 studies ( Mash et al., 2006; Valaitis et al., 2007; Burruss et al., 2009; Horiuchi et al., 2009; McIntyre et al., 2013; Andrew et al., 2015; Hjorth-Johansen et al., 2019; de de de Luzuriaga-Balaria et al., 2024). The flexibility of online learning supported engagement by allowing students to manage their study time around personal and professional responsibilities. Students appreciated the ability to learn at their own pace and on their own schedule, which supported autonomy and reduced time-related pressure ( Mash et al., 2006; Burruss et al., 2009; Horiuchi et al., 2009; Andrew et al., 2015; Hjorth-Johansen et al., 2019). Accessing course materials from home or off-site, especially through asynchronous formats, was considered highly convenient and practical for working nurses ( Valaitis et al., 2007; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). However, two studies also reported that engagement with online learning can be affected by competing demands and responsibilities ( McIntyre et al., 2013; Andrew et al., 2015).
3.2.2 Theme 2: curriculum design (Both Enabler and Barrier)
Curriculum design was identified in six of the 15 studies ( Mash et al., 2006; Burruss et al., 2009; Vandall-Walker et al., 2012; Andrew et al., 2015; Tiedt et al., 2021; de de de Luzuriaga-Balaria et al., 2024) and was found to both support and hinder student engagement depending on its structure and delivery. The use of diverse learning activities, including videos, polls, visual and audio materials, cartoons and online debates, was found to promote engagement among postgraduate students ( Vandall-Walker et al., 2012; Andrew et al., 2015). While some students benefited from smaller class sizes and extended course lengths ( Mash et al., 2006; Burruss et al., 2009; Tiedt et al., 2021), others reported challenges due to a lack of structure in online courses. McIntyre et al. (2013) found that the absence of pacing commonly provided in face-to-face learning was problematic and hindered meaningful engagement. Similarly, de de de Luzuriaga-Balaria et al. (2024) reported that the non-traditional nature of online formats negatively affected engagement for some students. The structure of online courses was also identified as having a positive impact on student engagement and that postgraduate students prefer smaller classes and longer courses ( Mash et al., 2006; Burruss et al., 2009; Tiedt et al. (2021).
3.2.3 Theme 3: educator presence (Enabler)
Educator presence, in both synchronous and asynchronous online teaching methods, was consistently identified as a positive factor for student engagement in eight of the studies ( Bergeron and Melrose, 2006; Mash et al., 2006; Horiuchi et al., 2009; Vandall-Walker et al., 2012; Seven et al., 2014; Andrew et al., 2015; Claywell et al., 2016; Tiedt et al., 2021). Students valued instructors who were visible in the learning environment, responded promptly, participated in discussions which were regarded as building a sense of community ( Bergeron and Melrose, 2006; Mash et al., 2006; Vandall-Walker et al., 2012; Claywell et al., 2016; Tiedt et al.; 2021). Timely feedback and guidance helped students stay motivated and feel that their progress was being supported ( Andrew et al., 2015; Tiedt et al., 2021).
3.2.4 Theme 4: social interaction with classmates (Both Enabler and Barrier)
Five of the 15 studies identified social interaction with classmates as a key influence for engagement in online learning ( Mash et al., 2006; Vandall-Walker et al., 2012; McIntyre et al., 2013; Andrew et al., 2015; Tiedt et al., 2021). Its impact varied depending on how well peer communication and collaboration were facilitated. As an enabler, online peer interaction helped reduce feelings of isolation, fostered a sense of belonging and supported motivation through shared ideas and emotional encouragement ( Mash et al., 2006; Andrew et al., 2015). Asynchronous and synchronous discussion forums contributed to a sense of classroom community ( Vandall-Walker et al., 2012; Tiedt et al., 2021). In contrast, McIntyre et al. (2013) reported that while platforms allowed for peer connection, asynchronous formats often failed to replicate the immediacy and spontaneity of face-to-face interaction.
3.2.5 Theme 5: technology issues (Barrier)
Technology issues were identified as a consistent barrier in eight of the 15 studies ( Mash et al., 2006; Penz et al., 2007; Valaitis et al., 2007; Liang et al., 2011; Vandall-Walker et al., 2012; McIntyre et al., 2013; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). Access and infrastructure problems, which included limited internet access, security blocks and institutional firewalls were identified as issues that affect engagement with online learning ( Mash et al., 2006; Penz et al., 2007; Valaitis et al., 2007; McIntyre et al., 2013; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). Lack of experience with online platforms, technophobia and anxiety around using technology negatively affected engagement ( Mash et al., 2006; Liang et al., 2011; Vandall-Walker et al., 2012; McIntyre et al., 2013). The limitations of online platforms were seen as less effective for collaborative tasks, particularly group work and real-time interaction across time zones ( Mash et al., 2006; McIntyre et al., 2013).
3.2.6 Theme 6: independent learning (Both Enabler and Barrier)
Seven of the 15 studies explored the impact of independent learning on engagement ( Bergeron and Melrose, 2006; Mash et al., 2006; Burruss et al., 2009; Horiuchi et al., 2009; McIntyre et al., 2013; Seven et al., 2014; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). It was viewed as an enabler when it fostered confidence and autonomy, allowing students to control their pace and schedule ( Seven et al., 2014). However, limited interaction with faculty and peers, especially in large cohorts, led to isolation, reducing motivation and engagement ( Bergeron and Melrose, 2006; Mash et al., 2006; Burruss et al., 2009; Horiuchi et al., 2009; McIntyre et al., 2013; Andrew et al., 2015). Horiuchi et al. (2009) found that students in web-based groups felt anxious due to reduced faculty presence, unlike those in face-to-face settings who valued direct contact. McIntyre et al. (2013) similarly reported that peer discussion was hindered when students worked at their own pace.
Four studies highlighted time as a factor affecting independent learning ( Mash et al., 2006; McIntyre et al., 2013; Andrew et al., 2015; de de de Luzuriaga-Balaria et al., 2024). Balancing academic, professional and personal responsibilities posed a barrier to engagement. However, effective time management helped students better integrate online learning. de de Luzuriaga-Balaria et al. (2024) noted that improved organisational skills enabled students to manage study more effectively.
3.2.7 Theme 7: working with peers (Barrier)
Two of the 15 studies identified difficulties with peer collaboration in online settings ( Bergeron and Melrose, 2006; McIntyre et al., 2013). Online group work can cause conflict and affect dynamics between peers working together, with students reporting feelings of anxiety, intimidation, or vulnerability. Group tasks could be hindered by a lack of ground rules, different expectations, poor communication or conflicting beliefs and values.
4 Discussion
This mixed methods literature review synthesised findings from 15 studies on postgraduate nursing students’ engagement with online learning in higher education. Seven themes were identified: educator presence (primarily an enabler), technology issues and working with peers (primarily barriers) and convenience, curriculum design, social interaction with classmates and independent learning, which could act as either, depending on individual and contextual factors.
A prominent finding is that postgraduate nursing students value the convenience and accessibility of online learning, which allows flexible study from home and accommodates those with travel limitations or caregiving responsibilities. These benefits align with other studies showing that the convenience of online learning supports nurses' ongoing professional development and access to education ( McVeigh, 2009; Smyth et al., 2012; Aitken, 2020; Beckett, 2020). However, although the convenience of online learning is consistently valued, a recurring tension in the literature is between the flexibility of online learning and the challenges it creates for postgraduate nursing students. Many postgraduate nurses report feeling overwhelmed by competing commitments, describing time demands as a major obstacle to sustained engagement. Other studies also highlight that postgraduate nurses struggle to balance work and family commitments against the demands of online learning and that the convenience of online learning can become a source of pressure when the boundaries between work, study and personal life are blurred ( McVeigh, 2009; Smyth et al., 2012; Burrow et al., 2016; Dickson, 2016; Beckett, 2020; Dunn et al., 2024). These factors can pose a significant challenge to their engagement, leading to potential disengagement with learning.
This tension is closely connected to independent learning which was also identified as both an enabler and a barrier. When it fostered confidence and autonomy, students could take ownership of their learning and maintain engagement. However, limited interaction with educators and peers, especially in large online classes, could lead to isolation and reduce motivation. Across studies, educator presence emerged as a decisive factor in shaping engagement. While postgraduate nursing students are generally capable of self-directed learning, they also rely on guidance, instruction and educator presence to sustain engagement, a finding which is supported in other studies of postgraduate nursing students ( Shirazi et al., 2017; Steindal et al., 2021). This review found that educator visibility, responsiveness and active involvement in discussions and feedback promote engagement, aligning with wider literature that highlights educator presence as essential for fostering community, reducing isolation and sustaining motivation ( Smyth et al., 2012; Fitzgerald et al., 2013; Phillips et al., 2013; Osborne et al., 2018; Murphy et al., 2021).
Across both convenience and independent learning, time emerged as a cross-cutting theme, influencing engagement positively and negatively. The challenge of managing competing academic, professional and personal responsibilities, often left students struggling to prioritise and maintain consistent engagement. Dunn et al. (2024) similarly noted that although online learning can provide time to prepare for asynchronous activities, study time is often limited and fragmented by personal responsibilities. However, time also acted as an enabler when students developed or improved time management and organisational strategies to integrate online study into their daily lives.
These findings reinforce that autonomy and support are not opposing needs but interdependent. While adult learners are often assumed to be self-directed, sustained engagement in postgraduate online nurse education depends on a balance of independence and educator involvement. Curriculum design plays a central role here: well-structured, interactive online courses with clear expectations support students’ confidence, whereas vague instructions, inconsistent pacing and unclear expectations create confusion and disengagement. Class size and course length also influence this balance. Smaller groups and shorter online sessions foster a sense of community and promote engagement, a finding reported in other studies ( Smyth et al., 2012; Ferrell et al., 2018; Aitken, 2020; Watson et al., 2020). These findings highlight the importance of clear guidance and well-defined expectations when designing online learning for postgraduate nurses. Additionally, some of the included studies reported that postgraduate nursing students prefer longer courses, as these allow more time to adjust to the demands of online learning. This suggests that initial challenges ease as students become more familiar with the online environment and its expectations. However, further research is needed to explore a possible preference for longer courses over shorter ones.
A further dynamic influencing engagement was the tension between connection and isolation. Social interaction with classmates emerged as a key factor for postgraduate nursing students, where establishing social connectedness and a sense of community among peers is integral to fostering deep learning experiences ( Phillips et al., 2013; Brenton, 2015). When effectively facilitated, peer interaction reduced isolation and enhanced collaborative learning. This aligns with other studies of postgraduate nurses, highlighting the importance of fostering community in alleviating students’ feelings of isolation ( Smyth et al., 2012; Fitzgerald et al., 2013; Mackavey and Cron, 2019; Watson et al., 2020; Ahern and Biedermann, 2022). Educator supported discussions and reflections can further strengthen peer connections ( Brown and Wilson, 2016; Aitken, 2020), reinforcing the earlier finding that educator presence is essential for fostering interaction and building a learning community among postgraduate nursing students. However, not all forms of online learning were experienced positively. For example, asynchronous activities lacked the immediacy and spontaneity of real-time exchanges and structured group work could also create challenges.
Although social interaction with classmates could act as both an enabler and a barrier, working with peers was reported in some studies as a barrier to engagement. Online group work sometimes generated conflict, typically due to non-contributing members, unclear expectations, or the compulsory nature of tasks, leaving some students feeling anxious, overwhelmed, or unfairly assessed. Additional barriers included feelings of vulnerability when sharing ideas in online discussions and the absence of clear ground rules, which created different levels of expectations and commitment. These findings suggest that challenges may stem less from group work itself than from its design and facilitation, reinforcing the need for structured collaboration and clear protocols. Notably, this contrasts with much of the wider literature, where peer collaboration in postgraduate nursing is reported as an enabler of engagement ( Carroll et al., 2009; Moule et al., 2010; Osborne et al., 2018; Kolstad et al., 2024). Overall, evidence that peer collaboration functions as a barrier for postgraduate nurses is limited, but it reinforces this review’s broader conclusion that factors influencing engagement are not clear-cut and may function as either enablers or barriers depending on context.
Technology issues emerged as a significant and consistent barrier to postgraduate nursing students’ engagement with online learning. This echoes the findings of other studies of postgraduate nursing students’ online educational experiences ( McVeigh, 2009; Smyth et al., 2012; Fitzgerald et al., 2013; Ousey and Roberts, 2013; Havenga and Sengane, 2018). Digital access in postgraduate nursing higher education has been identified as a challenge ( Ahern and Biedermann, 2022) and although no included studies explored internet access in direct relation to geographical location, this remains a critical area for investigation. For example, in the UK, despite improvements in broadband coverage, digital connectivity remains inconsistent especially in rural and remote areas (Office of Communications [ Ofcom], 2022). This technical barrier is an important issue for postgraduate nursing students given the need to be able to access online learning remotely,
The mode of delivery also plays a key role. A blend of asynchronous and synchronous methods was found to be most effective in supporting student engagement. This is supported by the broader literature, which emphasises that both modes are essential for fostering social interaction and building a sense of community and promoting engagement ( Wang and Newlin, 2001; McInnerney and Roberts, 2004; Campbell et al., 2006). Asynchronous methods, such as discussion boards, allow students to reflect, explore ideas at their own pace and engage in dialogue with peers and educators ( Campbell et al., 2006; Dickson, 2016; Osborne et al., 2018; Scott and Turrise, 2021). This correlates with constructivist principles and is particularly suited to postgraduate nursing students who bring prior professional experience and benefit from engaging in collaborative and practice-based learning contexts ( Kala et al., 2010). Asynchronous methods also offer personal control over learning and can reduce social pressure and as such, can be particularly beneficial for neurodivergent students and those with learning disabilities ( Dahlstrom-Hakki et al., 2020). Complementing these, synchronous methods, such as interactive classrooms and online debates, offer opportunities for immediate feedback, co-construction of knowledge and social interaction ( Brown and Wilson, 2016; Aitken, 2020).
The findings of this review point to several key strategies for improving online teaching and learning in postgraduate nursing education. First, educators should establish clear expectations and boundaries for participation in online activities, including well-defined protocols to support effective group work, case-based discussions and debates. Second, fostering a sense of connection within the online learning environment is critical; this can be achieved by using accessible technologies and, where feasible, delivering shorter sessions to small groups to enhance engagement. Third, adequate time and resources must be allocated to ensure educator presence in the online space, with a focus on using diverse but affordable teaching strategies that blend synchronous and asynchronous approaches to support motivation and learner connectedness. Finally, proactive efforts are needed to address technological barriers and promote inclusivity, including ensuring that students are aware of available support services such as technology assistance, financial aid and student welfare.
5 Limitations
This review has several limitations. A recurring challenge throughout has been the lack of targeted evidence specific to postgraduate nursing students’ engagement with online learning in higher education. The exclusive focus on nursing education may also limit the applicability of findings to other healthcare disciplines. Although the search strategy was broad, it was not exhaustive. The exclusion of non-English language studies and non-academic sources potentially omitted relevant perspectives. Future reviews may benefit from drawing on a wider range of data sources.
While supervision was provided, the review was conducted by a single researcher, which may increase the risk of bias and error. This may have affected the reliability and validity of the findings, particularly during the qualitization of quantitative data. Although this method supported the integration of diverse study types and facilitated theme development, it relies on researcher interpretation, which may influence the consistency of interpretation across reviews. To address this, a reflexive approach was adopted, including use of a reflective diary to document emerging insights and minimise bias.
There are also conceptual gaps that warrant further exploration. Despite the international nature of the included studies, cultural and socio-economic contexts were not explicitly examined, potentially overlooking how such factors shape engagement. Similarly, age, gender and intersectional factors were not addressed, despite their likely impact on engagement. Future research should incorporate these dimensions to inform inclusive online teaching practices.
Comparative studies between synchronous online learning and traditional face-to-face instruction are also needed to better understand how delivery mode affects engagement in postgraduate nursing education. Additionally, this review highlights a gap in the literature regarding emerging educational technologies. Many included studies predate innovations such as augmented reality, virtual simulation, game-based learning and AI-driven learning. These approaches may offer new opportunities for promoting engagement but have yet to be thoroughly explored in the current literature.
6 Conclusion
This review highlights the complex factors influencing postgraduate nursing students’ engagement with online learning in higher education. While the convenience and accessibility of online education are clearly valued, they do not uniformly enhance engagement. Instead, individual experiences are shaped by a dynamic interplay of enablers and barriers. Educator presence, well-structured curricula and supportive learning communities are critical to counter challenges such as technology issues, time pressures and isolation. Factors like independent learning, time and peer interaction can act as both enablers and barriers, affirming the need for tailored pedagogical approaches that blend synchronous and asynchronous methods and reflect postgraduate nursing students’ diverse personal, professional and contextual circumstances. To enhance engagement, educators and higher education institutions should foster inclusivity, social presence and responsive support through clear communication, peer collaboration and investment in technology. Greater attention is also needed to underexplored dimensions such as cultural and socio-economic influences, as well as the potential of emerging digital tools to create flexible, innovative learning opportunities that accommodate postgraduate nurses’ needs as working professionals and adult learners.
Authors' contribution
Anthony Chambers was the main author of the work. Clare Whitfield was Anthony’s supervisor for the dissertation, and Clare’s contributions included reviewing and overseeing the research process and providing advice and suggestions to the writing of the report, and proof-reading and editing the submitted manuscript.
CRediT authorship contribution statement
Clare Whitfield: Writing – review & editing, Supervision. Chambers Anthony: Writing – original draft, Methodology, Formal analysis, Data curation.
Ethics
This research presents an accurate account of the work performed, all data presented are accurate and methodologies detailed enough to permit others to replicate the work.
This manuscript represents entirely original works and or if work and/or words of others have been used, that this has been appropriately cited or quoted and permission has been obtained where necessary.
This material has not been published in whole or in part elsewhere.
The manuscript is not currently being considered for publication in another journal.
That generative AI and AI-assisted technologies have not been utilized in the writing process or if used, disclosed in the manuscript the use of AI and AI-assisted technologies and a statement will appear in the published work.
That generative AI and AI-assisted technologies have not been used to create or alter images unless specifically used as part of the research design where such use must be described in a reproducible manner in the methods section.
All authors have been personally and actively involved in substantive work leading to the manuscript and will hold themselves jointly and individually responsible for its content.
Funding
This research did not receive any funding or grants from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
We declare that the submitted manuscript under our authorship has not been published or is being considered for publication elsewhere.
We have agreed to allow the corresponding author to serve as the primary correspondent with the editorial office.
We declare that we have no competing interests.
Ethics committee approval was not required for this article.
Appendix A Supporting information
Supplementary data associated with this article can be found in the online version at
Appendix A Supplementary material
Supplementary material
Supplementary material
Table 1
| Concept | Search terms (with Boolean operators and truncation) |
| Population
(Postgraduate nurses) |
postgrad* OR "post-grad*" OR "post grad*" OR graduate* OR "advance* practice" |
| AND | |
| Profession
(Nursing only) |
nurs* |
| AND | |
| Exposure
(Educational mode) |
T1 (title) (online OR e-learn* OR web OR web-based OR digital OR distance OR mobile OR electronic OR remote OR virtual) (learn* OR teach* OR educat* OR lecture* OR class*) |
| AND | |
| Outcome
(Engagement) |
(engag* OR motivat* OR involv* OR participat* OR inclus* OR attitude* OR attention) |
| Databases | CINAHL Ultimate, MEDLINE, ERIC, APA PsycInfo, Academic Search Ultimate, Education Research Ultimate |
| Date Searched | 11th November 2022 and 14th February 2025 |
Table 2
| PEO(T) domain | Inclusion criteria | Exclusion criteria | Rationale |
| Population | Nurses (including registered/licensed nurses) undertaking postgraduate (post-registration) higher education programmes. | Undergraduate nursing education and non-nursing populations (e.g., physicians, allied health practitioners). | To focus on post-registration higher education programmes. |
| Exposure | Studies examining fully online, web-based, distance, digital, mobile, remote, or virtual learning modes as the primary mode of delivery. | Studies where the primary mode of delivery was blended or hybrid learning, in-person formats, or where online delivery was not clearly defined. | To isolate the impact of fully digital learning environments. |
| Outcome | Outcomes related to learner engagement, motivation, involvement, participation, and inclusion. | Studies that do not report on any engagement, or participation outcomes. | To align with the review aim to explore nurses’ engagement in online postgraduate education. |
| Type of study | Primary research studies (qualitative, quantitative, or mixed methods) published in peer-reviewed academic journals, in English, from any country. | Non-English language papers; grey literature (e.g., dissertations, theses, conference abstracts); non-research items (e.g., opinion pieces, reviews, editorials, books, or magazines). | To ensure quality, relevance, and peer-reviewed reliability. |
Table 3
| Bibliographic details of study: (Author(s), year & country) | Study aim(s) | Sample | Study design & intervention where applicable | Data collection methods | Key findings |
| Andrew et al. (2015), Australia | To enhance online learning in two nurse theory units through a pilot to design, implement and evaluate the introduction of interactive classroom technology. | 144 nursing students: UG ( n = 130), PGT ( n = 14). | Mixed methods study.
Classroom options (evening interactive online classroom) introduced into 2 nurse theory units. |
Cross-sectional survey of multiple-choice, open-ended and free text response options. | Real-time participation was considered to be good for the first time interactive classroom option offered (53 % = UG & 79 % = PGT).In student interaction with tutors, the learning activities and materials was highly valued.Teaching/learning methods that enhance academic engagement provide increased student satisfaction.Recorded sessions are appreciated by students as useful (ensures learning can take place at a convenient time, place and pace), but cannot provide active participation opportunities. |
| Bergeron and Melrose (2006), Canada | What issues do online graduate learners face when working in groups; and what instructional behaviours are helpful in addressing these issues? | Health care practitioners including graduate nurses. | Qualitative study. | In person and focus group interviews. | Professional learners value the importance of groups being created intentionally (i.e. the educator takes time to find out about each student and assigns them to a group based on that information. |
| Burruss et al. (2009), USA | To identify how class size was related students’ perceptions of the use of technology and to selected educational practices and outcomes in web-based courses in undergraduate and graduate nursing programs. | 1128 UG ( n = 265) and PGT ( n = 863) nursing students. | Quantitative descriptive study. | Online survey sent to all students enrolled in fully web-based nursing courses from 7 schools of nursing. | Significant differences by class size in students’ perceptions of active participation in learning. Larger class sizes perceived as having less participation. |
| Claywell et al. (2016), USA | To determine if there is a correlation between participation of faculty in online discussions and student-perceived learning and satisfaction. | 3 research sites. 280 online course sections included: 140 from 2 BSN programs and 140 from 2 MSN programs. | Quantitative descriptive study. | Analysis of 3 evaluation questions from each site’s end-of-course student evaluations. | RN-BSN students prefer a medium level of faculty participation, but MSN student satisfaction and perceived learning increased with higher levels of faculty participation. |
| de de de Luzuriaga-Balaria et al. (2024), Philippines | To describe the relationships among demographic and work profile, work-life balance, and online student engagement. | 173 registered nurses enrolled on a fully online Master of Arts in Nursing program. | Mixed methods study. | Quantitative and qualitative data collected using a single online survey. | Students with better work-life balance had higher online student engagement. |
| Hjorth-Johansen et al. (2019), Norway | To create, implement and evaluate an e-learning course on nursing infants with CHD and to measure its efficacy compared with classroom learning. | PGT students ( n = 15) and newly employed nurses ( n = 13) randomly assigned to e-learning or classroom group. | Comparative intervention study (RCT).
e-learning group working on their course at their pace in a computer laboratory. The classroom group received traditional lectures from an experienced nurse specialist in a classroom. |
Data collected before and after the course using a 36-question multiple choice test. The scores were computed as the difference between the pre- and post-knowledge scores. | Improvement in knowledge between pre- and post-knowledge test did not differ significantly by the learning method. |
| Horiuchi et al. (2009), Japan | To assess the learner outcomes of web-based learning as compared to face-to-face (F2F) lecture group and to explore methods that maximise the use of web-based learning for continuing nursing education. | 93 (or 90 as discrepancy in stated recruited numbers) nurses and midwives randomly assigned to web-based learning group or a F2F lecture group. Following allocation to a group further attrition leaving 70 participants: web-based learning group ( n = 37) and F2F ( n = 33) | RCT.
Educational program for both groups. Web-based learning group required 4 classes in 1 month; each session allocated 30 mins. F2F group attended 1 evening lecture per week for 4 weeks; each session allocated 90 mins. |
Pre- and post- test knowledge score (written questionnaire). | No difference in the post-test scores between either group. |
| Liang et al. (2011), Taiwan | To explore nurses’ attitudes towards web-based continuing learning. | 267 nurses | Quantitative descriptive study. | 2 questionnaires (Internet self-efficacy survey (ISS) and the Attitudes toward Web-based Continuing Learning Survey (AWCL) completed by the participants. | Nurses’ basic and advanced internet self-efficacy were significant predictors of the perceived usefulness and the perceived ease of use of web-based continuing learning;both basic and advanced internet self-efficacy are critical factors in encouraging nurses to participate in web-based continuing learning. |
| Mash et al. (2006), South Africa | To explore the perceptions of students and lecturers within the current instructional designs employed in distance learning programmes using virtual learning environment (VLE) and Interactive Television (ITV). | 5 focus group interviews with lecturers ( n = 6), Family Medicine and Human Nutrition students ( n = 22), and Nursing students ( n = 4). Additional questionnaire sent to all students enrolled in both teaching departments ( n = 218). | Mixed methods study. | Focus groups and questionnaire. | VLE supported more cognitive presence than ITV. Student-lecturer interactions in ITV were perceived as more likely to solve problems and enhance learning; interactions were more instructional with the lecturer delivering a large amount of content and answering questions directly. In VLE the lecturer was more facilitative and guiding the dialogue within the discussion boards; learning evolved as much from the student-student discussion as lecturer input.VLE emerged as an environment that enabled student-student and student-lecturer dialogue. |
| McIntyre et al. (2013), Canada | How do peer dynamics influence student learning in an online environment? | Graduate nurses ( n = 30). | Qualitative study. | Hermeneutic data analysis of interviews, focus groups and journal notes. | Expectations of both students and educators developed in a F2F (onsite) learning environment do not easily transfer to an online e-learning format |
| Penz et al. (2007), Canada | To examine the types of perceived barriers to participation in continuing education (CE) activities among rural and remote registered nurses. | Registered nurses ( n = 2838). | Mixed methods study. | Analysis of results of a multi-method national survey: cross-sectional mail survey of rural and remote registered nurses based on a modified version of Dillman’s (1999) Tailored Design Method. | Rural and remote registered nurses who perceive barriers (isolation, distance concerns, lack of access to/availability of educational opportunities, time constraints, financial limitations) most likely are 30–59 years old. Newly educated registered nurses in the younger age group and registered nurses closer to retirement may perceive less of a need for CE and therefore do not perceive any barriers.Nurses who perceived barriers shared certain characteristics (likely to be without a partner, have dependent children, work fulltime), and these characteristics were congruent with the actual barriers perceived such as lack of adequate registered nurse staffing, family and work-related time constraints. |
| Seven et al. (2014), Turkey | To evaluate the opinion of nurses on distance post-graduate education. | 238 nurses. | Quantitative descriptive study. | Data collection form of 18 questions in 2 sections: (1) socio-demographic characteristics; (2) opinions of the nurses regarding the newly applied PGT distance education. | Distance education will provide nurses more accessibility and an easier way for PGT education.Some concerns about the quality of distance-learning education. |
| Tiedt et al. (2021), USA | To examine the effect of online course length on nurse educator students’ perceptions of the learning experience and to examine the development of a community of inquiry (COI) in an 8-week vs 16-week online graduate nursing course. | Convenience sample of graduate nursing students ( n = 50). Assignment to either group was based on when which semester they were enrolled on. | Non-randomized trial.
2 online MSN nurse educator programs. Group A completed an 8-week course (experimental course duration) and Group B completed a 16-week course (traditional course length). Both courses identical except for course duration. |
Data collected through a background information form (to collect mainly demographic information to establish equivalence between the 2 groups). At the end of the course participants completed the COI Questionnaire (34-item questionnaire with responses ranked on a Likert scale), and a course evaluation form (16 questions with a Likert scale). | Mixed support for the 16-week course over the 8-week format:both courses supported a positive online learning experience,students were actively engaged in the learning process as a community of learners, higher levels of rapport and interpersonal connectedness in the 16-week course.Social presence and connectedness are essential for optimal online learning. |
| Valaitis et al. (2007), Canada | To explore faculty, staff, and student perceptions of web conferencing as a support for teaching and learning in health sciences. | Non-random convenience sample of 36 participants: medical residents ( n = 14), nursing graduate students ( n = 11), health sciences faculty ( n = 9), health sciences staff ( n = 2). | Mixed methods study (Q-methodology). | Q-sort 42 statement questionnaire developed by the researchers. | All participants felt positively about the use of web conferencing to support education. Web conferencing was an enabler especially where F2F meetings were not possible. Audio features more valued than video features. Adequate technical support and training must be provided for successful implementation of web conferencing. |
| Vandall-Walker et al. (2012), Canada | Report on their qualitative descriptive study to examine the learning outcomes of MN student debating when undertaken online using a modified formal debate structure. | 24 PGT nursing students. | Qualitative study. | The participants’ debates, discussions and reflections about their experiences with debating were analysed using constant comparison techniques. | Online debating is an invaluable teaching strategy: All participants reported benefits to debating. The level of student (MN) and the format (online, individual debates) explains some of the results. |
Table 4
| Full bibliographic reference | Country | Population | Exposure | Outcome | Results |
| Andrew, L., Maslin-Prothero, S. & Ewens, B. (2015) Enhancing the online learning experience using virtual interactive classrooms. Australian Journal of Advanced Nursing, 32(4), 22–31. | Australia | 144 undergraduate (UG) ( n = 130) and postgraduate (PGT) ( n = 14) nursing students. | Virtual interactive classrooms options were introduced into two nurse theory units. | Student demographics, ease of classroom navigation, percentage of those actively participating in the classroom option. Student experiences captured through qualitative data. | Online classrooms were an added value to traditional methods of online learning.
Supports the need to use a range of learning materials and methods to promote student engagement. |
| Bergeron, K. & Melrose, S. (2006) Online graduate study health care learners’ perceptions of group work and helpful instructional behaviours. i-Managers Journal of Educational Technology, 3(1), 71–77. | Canada | Graduates of masters nursing programs in one Canadian University. | How graduate students experience online group work and what instructional behaviours are perceived as helpful during the group process. | How online healthcare professionals in two graduate studies programs valued knowing their facilitator was consistently present and available. | Three strategies emerged as themes: Create groups intentionally (i.e., the educator takes time to find out about each student and assigns them to a group based on that information) Intervene with non-contributing members Measure individual contributions. |
| Burruss, N.M., Billings, D.M., Brownrigg, V., Skiba, D.J. & Connors, H.R. (2009) Class size as related to the use of technology, educational practices, and outcomes in web-based nursing courses. Journal of Professional Nursing, 25(1), 33–41. | USA | 1128 UG ( n = 265) and PGT ( n = 863) nursing students. | How does class size relate to students’ perceptions of the use of technology and to selected educational practices and outcomes in web-based courses in UG and PGT nursing programs? | To assess practices and outcomes in web-based nursing courses. Are there differences in students' perceptions of the use of technology and of the presence of selected educational practices and outcomes related to class size, And is class size related to whether the students are in undergraduate- or graduate-level courses? | Class size is related to the presence of certain educational practices and outcomes.
There were no differences by class size in perceptions of use of technology and convenience. There were differences when separating the data by educational level with PGT students reporting less satisfaction in larger classes. Two primary factors identified that motivate students to take online classes:Students who have undertaken web-based courses previously are comfortable with managing their time using the technologyHaving access to and being convenient. |
| Claywell, L., Wallace, C., Price, J., Reneau, M. & Carlson, K. (2016) Influence of nursing faculty discussion presence on student learning and satisfaction in online courses. Nurse Educator, 41(4), 175–179. | USA | Registered nurses enrolled in continuing education (CE) courses in three research sites.
280 online course sections included from the three sites. |
To determine the relationships between faculty participation in online discussions with student satisfaction and perceived learning in online RN-BSN (Registered Nurse-Bachelor of Science in Nursing) and MSN (Master of Science in Nursing) courses. | To determine if there is a correlation between participation of faculty in online discussions and student-perceived learning and satisfaction. | RN-BSN students prefer a medium level of faculty participation, but MSN student satisfaction and perceived learning increased with higher levels of faculty participation. |
| de Luzuriaga-Balaria, C.J.R., Cleofas, J.V., & Nob, R.M. (2024) Work-life balance and online student engagement among registered nurses enrolled in online graduate nursing education: a mixed methods study. Contemporary Nurse, 60(5), 465–478. | Philippines | 173 registered nurses enrolled on a fully online Master of Arts in Nursing program in one university. | To examine the relationship among demographic and work characteristics, work-life balance (WLB), and online student engagement (OSE) of registered nurses studying an online post graduate program. | Association between WLB and OSE.What factors influence WLB and OSE. | The ability to balance work, life, and study can be influenced by personal factors, such as motivation and time management, and external ones, such as nature of and overlapping of work, social, and student life.
A work-life balance facilitates better online student engagement among graduate nursing students. |
| Hjorth-Johansen, E., Hofoss, D. & Kyno, N.M. (2019) E-learning or lectures to increase knowledge about congenital heart disease in infants: A comparative interventional study. Nursing Open, 6, 1143–1149. | Norway | PGT nursing students ( n = 15) and newly employed nurses ( n = 13). | To create, implement and evaluate an e-learning course on nursing infants with congenital heart disease (CHD) and measure its efficacy compared with classroom learning.
The outcome measure was the increase in the knowledge score on a multiple-choice test. |
To create, implement and evaluate an e-learning course on haemodynamic understanding and nursing infants with CHDTo measure its efficacy compared with traditional face-to-face learning. | Both groups produced better knowledge scores between pre- and post-testing, but the improvement did not differ significantly by the learning method.
Participants reported experiencing traditional classroom teaching as more positive, but e-learning was more time effective. |
| Horiuchi, S., Yaju, Y., Koyo, M., Sakyo, Y. & Nakayama, K. (2009) Evaluation of a web-based graduate continuing nursing education program in Japan: A randomized controlled trial. Nurse Education Today, 29, 140–149. | Japan | Registered nurses and midwives ( n = 90) randomly recruited into two groups. | Assess learner outcomes of web-based learning compared to face-to-face lecture group. | Multiple-choice Knowledge pre- and post-knowledge test. Participants completed a six-item course evaluation survey on the course content.Analysis of subjects’ degree of satisfaction regarding web-based learning and face-to-face lecture. | Findings support hypothesis that there is no difference in learner outcomes when comparing a web-based learning program and face-to-face lecture.
Students in both groups attained similar post-test scores, but three distinct advantages for the web-based group: Lower dropout rateFlexibility and suitability of web-based learning Web-based learning is adaptable across wide-age range |
| Liang, J-C., Wu, S-H. & Tsai, C-C. (2011) Nurses’ internet self-efficacy and attitudes toward web-based continuing learning. Nurse Education Today, 31, 768–773. | Taiwan | 267 in-service nurses. | To use two questionnaires to respectively survey a group of nurses’ internet self-efficacy (IS) and attitudes toward web-based continuing learning (AWCL). | To explore nurses’ IS and AWCL. | Nurses’ basic and advanced IS were significant predictors of the perceived usefulness and the perceived ease of use of web-based continuing learning.
Increasing nurses’ IS may be critical in encouraging nurses to participate in web-based continuing learning. |
| Mash, B., Marais, D., Van Der Walt, S., Van Deventer, I., Steyn, M. & Labadarios, D. (2006) Assessment of the quality of interaction in distance learning programmes utilizing the internet or interactive television: perceptions of students and lecturers. Medical Teacher, 28(1), 1–9. | South Africa | Students and lecturers from one health and one nursing programme ( n = 32 for the focus groups; all students: n = 218). | To explore students’ and lecturers’ perceptions of the quality of interaction in distance learning programmes using web-based virtual learning environment (VLE) and interactive television (ITV). | How effective current approaches to instructional design and interaction have been in utilizing these two technologies to support interaction, and what lessons can be learnt. | The VLE and ITV groups did not differ across a number of likely barriers to interaction.
Both groups reported the need for more flexible and better paced instructional designs. |
| McIntyre, M., McDonald, C. & Racine, L. (2013) A critical analysis of online nursing education: balancing optimistic and cautionary perspectives. Canadian Journal of Nursing Research, 45(1), 36–53. | Canada | PGT nurses ( n = 30) from two online nursing programs. | Nursing students’ experiences of the influence of peer dynamics on online learning. | To understand how peer dynamics influence student learning in an online environment. | Four themes emerged: Time Demands of online participation Conflict Developing skills in an online environment. Expectations of both students and educators developed in a face-to-face (onsite) learning environment do not easily transfer to an online e-learning format.
Significant challenges related to frequency and timing of participation and group work. |
| Penz, K., D’Arcy, C., Stewart, N., Kosteniuk, J., Morgan, D. & Smith, B. (2007) Barriers to participation in continuing education activities among rural and remote nurses. The Journal of Continuing Education in Nursing, 38(2), 58–66. | Canada | Registered nurses ( n = 2838) living in rural areas. | To examines the types of perceived barriers to participation in CE activities among rural and remote registered nurses in Canada. | To examine the barriers to participation in CE that are perceived by rural and remote registered nurses in Canada. | The main barriers identified were:Rural accessibility Time constraints Financial constraints |
| Seven, M., Çinar, I., Fidanci, B.E. & Akyuz, A. (2014) Nurses’ perspective of distance post-graduate education: A Turkish study. International Journal of Caring Sciences, 7(2), 652–661. | Turkey | 238 nurses in a university hospital and a nursing school of the university. | Why do nurses opt or not opt for distance PGT education, and what are the opinions of nurses on distance PGT education and the affecting factors? | To evaluate the opinions of nurses on distance PGT education. | Distance education can provide nurses with easier and more accessible ways to undertake PGT education.
Prominent barrier (62.6 % of the nurses) for PGT education was nurses did not have the required English language proficiency. |
| Tiedt, J.A., M. Owens, J.M. & Boysen, S. (2021). The effects of online course duration on graduate nurse educator student engagement in the community of inquiry. Nurse Education in Practice, 55, 1–8. | USA | PGT nursing students ( n = 50) | To examine the effect of course duration (8-week versus traditional 16-week timeframes) on student engagement, student perceptions of the learning experience, and self-reported learning behaviours. | The effect of course length on the student learning experience in a graduate online nurse educator course. | Mixed support for the 16-week online course over the 8-week format.
In both formats, students were actively engaged in the learning process as a community of learners; but students in the 16-week course established higher levels of rapport and interpersonal connections than the students in the 8-week course. |
| Valaitis, R., Akhtar-Danesh, N., Eva, K., Levinson, A.& Wainman, B. (2007). Pragmatists, positive communicators, and shy enthusiasts: Three viewpoints on web conferencing in health sciences education. Journal of Medical Internet Research, 9(5), 1–12. | Canada | 36 participants including PGT nursing students ( n = 11). | To identify common viewpoints of students, faculty, and administrative staff who had exposure to web conferencing. | To explore faculty, staff, and student perceptions of web conferencing as a support for teaching and learning in health sciences. | Overall, all participants viewed web conferencing as an enabler especially when face-to-face meetings were not possible.
Adequate technical support and training need to be provided for it to be successfully implemented. |
| Vandall-Walker, V., Park, C.L. & Munich, K. (2012) Outcomes of modified formal online debating in graduate nursing education. International Journal of Nursing Education Scholarship, 9(1), 1–14. | Canada | PGT nursing students ( n = 24). | To examine debating as a strategy to enhance learning and participation in nursing class discussions. | To examine the learning outcomes of students when undertaking online learning using a modified formal debating structure. | Online debating is an invaluable teaching strategy. Five categories emerged: Risk taking Defense of a positionCoverage of all aspects Skill and knowledgeCritical thinking |
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