Nursing education for the 21st century
: An analysis of blended learning to teach clinical skills to 2nd year adult nursing students

Student thesis: Doctoral ThesisDoctor of Education


There are competency requirements identified by the regulatory body that nurses must meet when they complete a preregistration programme. Subsequently, nurse educators must ensure that student nurses acquire and retain the relevant theory and practice of core clinical skills, to prepare them for registration. The teaching of clinical skills in particular remains a contentious area in nurse education as many nursing students report feeling unprepared and lacking in confidence upon registration. A challenge therefore exists for nurse educators to identify and implement the most appropriate teaching and learning strategies to enhance clinical competence in our future practitioners. Blended learning is gaining attraction as a method that enhances student learning but there is limited literature regarding using blended learning to teach clinical skills.

This mixed method study aimed to explore how blended learning might be used to support the learning of clinical skills in 2nd yr undergraduate adult nursing students. A computer-based learning package was designed by the researcher to learn the clinical skill of neurological observations. This was incorporated into the blended learning teaching strategy, which was theoretically underpinned by Laurillard Conversational Framework.

The first element of the mixed methods study undertook a quantitative experimental study to examine if by using either instructional face-to-face or blended learning teaching strategy was there a difference in 2nd year adult nursing students’ knowledge and skill acquisition and retention of the clinical skill. This study randomly assigned the cohort (n=270) to an instructional face-to-face (control) group or to a blended learning (intervention) group to learn the clinical skill. A pre-test (N =99) post-test N =102) was used to assess acquisition of knowledge test with a 12 weeks post-test assessing retention of knowledge (N = 94) was obtained. The student’s clinical skill acquisition and retention was assessed by two skills tests using an Objective Structured Clinical Examination (OSCE). All results were analysed using the statistical package for social sciences software (SPSS).
Element 2 of the study was a qualitative case study with a subsequent cohort of 2nd year adult nursing students (n =150) using the same blended learning approach to learn the same neurological clinical skill. Students voluntarily participated in three focus groups (n= 24) to discuss their opinions and perceptions of this blended learning approach. The data was analysed using Braun and Clarkes thematic framework (Braun and Clark, 2006).

The findings from the experimental study suggested that neither blended learning nor instructional face-to-face teaching surpassed the other when testing nursing students’ overall acquisition or retention of a clinical skill. Further to this, both strategies increased students’ knowledge and clinical skills acquisition and retention. When asked for their opinions about blended learning in the case study element, students perceived an increase in confidence when attending the face-to-face-class after they had practiced the skill using the CBLP. Students also described how the interactive nature and instant feedback of the online component supported their learning. Students also recognised the value of authentic learning when practicing the skill either in the online component or face-to-face. Overall, the students valued the blended learning approach as it enabled them to develop the skill prior to coming to class flexibly and without pressure feeling better prepared for the face-to-face clinical skills class.

Overall, this thesis concludes that the blended learning approach incorporating the CBLP is a valuable method to support students in learning clinical skills.
Date of AwardJul 2021
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorChristine Brown Wilson (Supervisor) & Cathal McManus (Supervisor)


  • Blended Learning
  • clinical skills
  • nursing students
  • computer based learning package
  • qualitative case study
  • quantitative random assignment
  • Braun and Clark
  • SPSS

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