Collaborative Approaches in Online Nurse Education: A Systematic Literature Review

According to the socio-constructivist theories of learning, collaborative learning allows negotiation of shared meanings and co-construction of new knowledge among peers. This approach fits particularly well with healthcare professional education needs, as these professionals often face challenging issues that require the ability to fully understand the complexity of the patients' health conditions through working with others. However, while collaborative learning approaches are widely used in face-to-face nurse education contexts, their online equivalent still seem to be understudied, in spite of their great potential for the field. This systematic literature review investigates: (1) to what extent are online collaborative learning activities being adopted and investigated in formal nurse education, (2) What kind of online collaborative learning activities/techniques are proposed and what team structures are employed, (3) what technologies are used to run these learning activities, and (4) what methods are used to evaluate the impact of these activities. Studies were included if they presented online collaborative learning activities proposed by Universities or VET (Vocational Education and Training) providers. Articles published in 2015 or later were collected in November 2022 from Scopus, Web of Science and Medline. A total of 1059 records were retrieved, selected and analysed by four coders, resulting in a final dataset of 75 papers that were coded for type of collaborative approach, study characteristics, research methodology used, strength of evidence, and relevance to the research questions. Most of them described the use of activities like Discussions, Case Studies and Peer Reviews, sometimes in association with Role Play. In terms of technologies, Learning Managements Systems, forums and social media were already common pre-pandemic, but during the lockdown synchronous communication tools -- often used to support simulations -- took over. Data collection was carried out quantitatively, qualitatively or using mixed methods, but in many cases data reporting is weak or absent at all. The majority of the retrieved papers illustrate activities where collaboration was not structured in any way and there was no joint assignment or common objective/artefact that learners needed to reach/produce. In case of blended interventions, often collaboration is limited to the face-to-face sessions, while the digital setting is used for individual work. In terms of social structure, most of the time small groups or plenaries are used. In summary, the review reveals that studies on online collaborative learning for nurses are limited, especially in Europe, and the design of online collaborative activities often clashes with the principles put forward by the Computer Supported Collaborative Learning (CSCL) research community. Based on the results of the review we put forth some key recommendations, such as ensuring that online collaboration involves the creation of a shared artefact and striving to make virtual simulations actually collaborative, rather than limited to envisage student interactions in the debriefing phase. The paper also proposes a number of research areas seldom investigated and that would deserve further attention in the future.