What do Nursing Students’ Stories Reveal about the Development of their Technological Skills and Digital Identity? A Narrative Inquiry

Background

Rapid developments in information technology and social media have revolutionized the nursing profession. E-learning, which is the use of technology in education delivery, is arguably the most significant change in nursing education since the move from training in hospitals to post-secondary institutions (Button, Harrington & Belan, 2014).  Due to the time-sensitive delivery of effective and precise decisions, nurses entering the profession are required to demonstrate high adaptability and proficiency in the latest technologies. Today’s nursing students will graduate into a workforce that will require them to not only skillfully navigate information systems and social media, but also be able to consolidate their research findings into a superior point-of-care practice (McKenzie & Murray, 2010). Exploring nursing students’ technological skills and digital identities during their education is a vital aspect of determining their preparedness in becoming competent and capable nurses upon graduation. 

Current research in education suggests that student nurses taught using online methods are better equipped to develop their personal identity and nursing skills in a way that face-to-face teaching cannot (McKenzie & Murray, 2010). This is simply because online learning provides students greater flexibility in practical applications, social media development, and adapting their identities as part of professional nursing. Hansen (2006) examined the attitudes of nursing students in the United States towards the use of technology in nursing practice. It was found that while students viewed technology positively overall, most did not feel adequately prepared to use available tools as they transitioned into the health-care system. Wilkinson, Roberts, and While (2013) followed first-year nursing students in the United Kingdom and found that 67% were not confident with using information systems, and 60% were not prepared for technology enhanced learning. To adequately prepare students to enter the field, Button et al., (2014) argued that skill development in information technology and research should be incorporated into undergraduate nursing curricula with ongoing support surrounding nursing informatics. Nursing administrators interviewed in this study identified key technological skills that nurses would be required to use upon entry into practice: accessing research databases for medical information, efficient and effective use of nursing software such as bedside charting and computer-activated medication dispensers, familiarity with basic window operations, and skillful navigation of online information (McCannon & O’Neill, 2003).

Most research studies that have tracked nursing students’ use of technology have been conducted outside of Canada, and there is limited research which explores technology use as describedby students themselves. This narrative qualitative study aims to explore nursing students’ development of their technological skills and digital identities by assembling an unbiased collection of narrative stories. Specifically, this study will use a narrative framework to ask what nursing students’ stories reveal about their technological skills and thedevelopment of professionaldigital identities. In general, digital identity refers to theonline persona of an individual, organization, or electronic device, whichencompasses all information about that subject. It is the unique representation of a subject online, including actions of personal information, transaction, and online engagement (Grassi, Garcia & Fenton, 2017). In the context of this study, professional digital identity which includes one’s online reputation is explored since this can have ramifications on how individual nurses and nursing as a whole are perceived. 

An aim of this study is to explore how well students are in touch with their own digital identity and how nursing education can support them to develop a professional digital identity worthy of a nurse professional. “With the proliferation of digital tools, and use of social media across generations, educators in colleges, universities, and adult-learning settings are in a position to help students develop a professionally acceptable digital identity and make contributions as citizens in digitally connected democratic societies. Educators can achieve this by developing students’ capacities to meet employers’ needs, leveraging currently used social media platforms, learning management systems, e-portfolios, and other tools, and by promoting or modeling appropriate engagement through development of digital identity” (Salman, 2015, p. 36).

The use of narrative inquiry focuses nursing students’ stories about their technological development and digital identities into an organized collection of insights using real-life stories, documents, and themes. Narrative inquiry is essential to reconcile conflicting stories and highlight current tensions or challenges – thus demonstrating what opportunities are available for educational innovation to support students in their development.

Study Design

Qualitative research is exploratory research that uses non-numerical data to explain the experiences of human beings (LoBiondo-Wood, Haber, Cameron, & Singh, 2018). Qualitative research methods have become more valued in the scientific community as researchers have recognized that the human phenomenon cannot be fully understood by quantitative research methods alone (Streubert & Carpenter, 2011). Educators are interested in the everyday experiences of students and narrative inquiry – a form of qualitative research that can contribute needed student-centered information to improve education.

Narrative inquiry makes use of the written or spoken word of individuals in the form of a personal story (Lo-Biondo-Wood et al., 2018). The meaning of a person’s experience is studied through the “gathering, analyzing and presenting (of) storied texts or personal accounts” (Casey, Proudfoot, & Corbally, 2015, p 1204). Story-telling is widely used cross-culturally as a method of communicating experience and therefore provides a universal approach to data collection. Narrative inquiry is a useful form of qualitative research as it recognizes the unique story of individuals (Hall & Powell, 2011). Personal characteristics and feelings can be portrayed, allowing the complexities of people to be better conveyed and understood. Through the use of personal stories, data reflects life context, giving the research findings more social and cultural meaning. Stories can take into account the various environmental and sociocultural influences of an individual’s life, allowing for a more holistic interpretation of the person (Alicea-Planas, 2015). In our research, we aimed to address the key question “what do nursing students’ stories reveal about their technological skills and digital identity?” The use of narrative inquiry as a method to study this question was appropriate since it involves the gathering of individual stories. Personal stories written by nursing students allow for a deeper understanding of the experiences of each individual student within the context of the inquiry: in this case, related to their technological skills and digital identity development.

In order to carry out this research, the following steps were performed (Figure 1): Initial review of the literature for background, identification of the phenomenon of interest (technological skills and digital identity), posing a research question, study design (narrative inquiry), sample selection (storytellers), data collection (collect stories), data analysis (narrative analysis), literature review and describing the findings.

Figure 1: Steps involved in carrying out this research study

This study used an anonymous online questionnaire platform within a Moodle Learning management system (LMS) using open-ended questions to gather narrative stories from theparticipants. The participants were semester one, four and seven nursing students in the nursing program. The use of an online tool facilitated the narrative method well, since it was easy to overcome space, location and time constraints because each student had ready access to the Moodle interface (Wright, 2005). A key control in this research method was that every participant was asked the same questions in the same way. The researchers were able to readilycollect and analyze textdata from participants, sincethis method of collection ensured all participant stories could be interpreted and clustered into similar narrative themes (Seale, 2018). Another benefit to this research approachis that the data collection was carried out anonymously. It not only respected the participants’ confidentiality, but also eliminated potential researcher bias.

Data gathered in this study was interpreted using narrative analysis. According to the Medical Dictionary (n.d), narrative analysis is defined as a “method of qualitative research in which the researcher listens to the stories of the research subjects and attempts to understand the relationships between the experiences of the individuals and their social framework” (“Narrative analysis”, n.d). The stories of individuals were interpreted in order to discernthemes between the stories (Casey et al., 2015). The data collected was reviewed and grouped into similar clusters labelled as “themes” that recurred across experiences, derived from the nursing students’ stories and what those revealedabout their technological skills and digital identity. This method of analysis allowed the development of general storythemes while also understanding the unique experiences of each participating nursing students.

Sample

The participants eligible for the study included nursingstudents in semesters one, four, and seven of the fall 2018 term. There were 39 participants from semester one, 37 from semester four and 38 from semester seven, with an overall total of 114 potential participants eligible for this study.  All participants in the study were enrolled in a hybrid BSN second-degree program, meaning courses were held both in-person and online. Participants were selected using purposive sample methods to access nursing students and invite them to share their stories about how they developed their technological skills and digital identity; this was done by inquiring about certain characteristics and their experiences (Lund Research, 2012). 

Certain inclusion criteria allowed participants to be eligible for the study, such as their status as a nursing student, as well as their access to and previous experience with technology (Lund Research, 2012).  Maximum variation (heterogeneous) sampling, a type of purposive sampling, was used to gather information on the development of technological skills and digital identity from a variety of perspectives, such as socioeconomic, environmental and physical factors (Palinkas et al, 2015).

Participants were contacted through an online anonymous survey tool that included five open-ended qualitative questions as well as six demographic questions. Access was provided using an online Moodle survey tool, easily accessed by all potential participants. An online tool was chosen for its easy accessibility, and its quick and cost-effective nature.

Various demographic data was collected from participants, including age, education background, geographic location, household income, and previous technological experience. The purpose of identifying these particular variables was to determine if they had an effect on the function and interpretation of technology in the nursing student narratives, particularly involving their development of technological skills and digital identity (Casey, et al., 2015). Technology advances, age, education level, and previous technological experience may play a role in how comfortable individuals are with technology and how it is ultimately used. Geographic location and household income of the individual affect the availability of and access to certain technologies. However, previous experience with technology is the most influential factor, as it has the potential to change the perception and narrative of the students in regard to their technological skills and overall digital identity.

Ethical and Legal Considerations

Four student researchers prepared an institutional Research Ethics Board (REB) application within the course-based, Minimal Risk Research category. As outlined in the REB guidelines: Minimal Risk is defined in the Tri-Council Policy Statement version 2 (TCPS 2) as: “if potential subjects can reasonably be expected to regard the probability and magnitude of possible harms implied by participation in the research to be no greater than those encountered by the subject in those aspects of his or her everyday life that relate to the research then the research can be regarded as within the range of minimal risk” (Government of Canada, 2014, Chapter 2, part B).

Informed Consent

A letter of informed consent was developed to provide information about the study to the hybrid program students in semester one, four, and seven in the fall 2018 term. This consent document outlined how an online anonymous survey tool was being used to gather information from students regarding their technological skills and digital identity. They were informed that the survey consisted of six demographic and five qualitative questions installed in select program courses in the Moodle LMS. They were assured that online survey participants could withdraw at any time prior to the completion of the online survey by simply abandoning the survey, and that research participants who clicked the “submit” button at the end of the survey would have their responses included in the data analysis and final report.

Minimal Risk

The informed consent document also outlined that there were no known risks if students took part in the study, but they were free to refuse to answer questions or stop the study at any time they experienced any discomfort. They were assured that their responses to the survey questions would not have any impact on their education, and that their identity would be protected at all times.

Confidentiality

The potential participants were also assured that their privacy and confidentiality would be protected throughout the study. They were told that electronic data (survey results) would be stored on a password protected memory stick. All information and data collected, including any hard copy items, would be stored in a locked filing cabinet in the principal investigator’s office. Information from the online survey would be coded to preserve participant anonymity and confidentiality, and summarized in anonymous format, in the body of the final report. Finally, they were assured that the identity of each participant would be received in an anonymous manner within the Moodle LMS, so that even the researchers would not know participant identities. At no time would any specific comments be attributed to any individual since identity is unknown. When participants clicked on the Answer the Questions link beneath the online version of the informed consent (in Moodle), they accepted the Letter of Consent, with full awareness that their data was being entered anonymously and their identity was unknown to the researchers.

Ethics Preparation

All 29 students who worked on this project as part of their Qualitative Research course assignments showed proof of completion of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans Course on Research Ethics (TCPS 2: CORE) tutorial and certification (Government of Canada, 2017).

Data Collection

A narrative approach in qualitative research is defined as the analysis of “story data, collected from participants who share a common experience” (Kaminski, 2018, para. 1). A narrative approach aims to understand, explore meaning, and “gain a general overview of subjective experiences” (Bingley, Thomas, Brown, Reeve, & Payne, 2008, p. 3). With the main goal of exploring the development of technological skills and digital identity of nursing students, the student researchers have defined the following key terms: technological skills and digital identity. Technological skills are the abilities and knowledge required by an individual to perform tasks through the use of technology which include: “mobile phones…the Internet, e-mail, work-based programmes, and online education” (Doyle, 2018; Hills et. al., 2016). Digital identity has been defined as the all-encompassing body of information available online about an individual or organization (Gill, Zampini & Mehta, 2015).

The data collection tool createdfor this study was an online anonymous survey with demographic and open-ended questions. This method of data collection allowed us to gain rich textual data from nursing student participants in a way that was both easily accessible and time efficient. The setting for our data collection was through the online campusMoodle site and the 114 potential participants were from the targetBSN program in semesters one, four and seven. A narrative approach was suitable for our data collection since we were interested in collecting and examining stories of nursing students and what this revealed about their technological skills and digital identities.

The four nursing research students responsible for the data collection section created a Google Document to brainstorm ideas and collaboratively develop six demographic and five open-ended qualitative research questions to form the anonymous online survey. These questions were written in a way that would allow the gathering of relevant information about technological skills and digital identity, but broad enough to not constrain participants’ experiences and the potential exploration of unanticipated influences and relationships between phenomena of interest. Research questions were framed to collect narrative stories about past and current technological skill level, attitudes, and experiences; construction of personal and professional digital identities; and related future implications within the field of nursing and beyond.

In order to keep the identity of the participants anonymous, their names and identifying features such as gender were not included in the anonymous online survey. All participants were asked the same questions, so we could analyze and categorize their responses based on “commonalities and differences” in order to group subjective responses into “overarching categories of meaning” (LoBiondo-Wood et al, 2018, p. 153). The final data collection tool is summarized in Table 1.

Table 1. Data Collection Survey Questions

Demographic Questions (six in total):

1. What is your age? • Under 22 (generation Z) • 22-37 (generation Y) • 38-53 (generation X) • 54+ (baby boomers) 2. What semester of the BSN-AE Program are you in? 3. What prior bachelor’s degree did you complete prior to the BSN-AE program? 4. What is your household income? • Less than $20,000 • $20,000-$39,999 • $40,000-$59,999 • $60,000-$79,999 • $80,000+ 5. Where do you live? • Urban Lower Mainland • Rural Lower Mainland • Other Urban BC Region • Other Rural BC Region • Other Urban Province Region • Other Rural Province Region • Other Urban Country Region • Other Rural Country Region 6. Please describe your previous technological experience with any of the following: software, apps, online programs

Qualitative Questions

7. Please share how your previous degree program and other prior experience prepared you for the technology-related aspects of the BSN program. 8. Please share how your technological skills and associated confidence have transformed since beginning the BSN program. 9. How do you feel the use of various technologies learned during the BSN program will assist you in helping clients throughout your career as a Registered Nurse? 10. How has the use of social media and other online platforms/technologies aided in the construction of your current digital identity – both personally and professionally? 11. How do you envision your digital identity will transform once you become a Registered Nurse?

Data Analysis

The data collected from the responses provided by the participants was categorized into groups for analysis. A categorical approach to narrative analysis was used since it can “compare all references to the selected phenomenon within one interview or across several interviews” (Gilbert & Stoneman, 2015, p. 475).

The first five questions of the questionnaire gathered information about demographics such as age, prior degree, household income, and place of residence. This information was separated according to responses provided by participants from semester one, four, and seven, and then put into a table for further review (Table 2).

Table 2: Demographics of respondents

The subsequent questions were open-ended, which required narrative analysis. Each question was broken down into further sub-categories to facilitate grouping of the responses.  The sub-categories were created and refined as all members of the team read through the responses. We modified the categories until we came to unanimous agreement that encompassed the storyessence of the responses provided. Once the sub-categories were discerned, ATLAS ti software program was used to find the responses that fit each category. The goal was to organize the data in a way that would make it easy to see how students view their technological development and their digital identity. 

For instance, question six requested that participants “please describe your previous technological experience with any of the following: software, apps, online programs”. As a group, we read through the responses provided in all three semesters and looked for patterns that could be used to categorize the data and reveal the students’ stories of their experience. After reviewing the responses, the general pattern that emerged was that students used technology for either professional reasons such as school or work, or for personal use.  All of the responses were then put into their appropriate categories for further analysis (Table 3). 

Table 3: Examples of Previous Experience responses

Question seven stated “Please share how your previous degree program and other prior experience prepared you for the technology-related aspects of the BSN program”. The sub-categories that were created based on responses for this question were previous experience did prepare (through course apps or online course), or it didnot prepare students. The responses were then placed into their respective categories (Table 3). 

Question eight asked students “please share how your technological skills and associated confidence have transformed since beginning the BSN program”. The responses showed a pattern of confidence either increasing or staying the same. All responses were placed into a category based on how the question was answered (Table 4). 

Table 4: Examples of Confidence responses

Question nine asked “how do you feel the use of various technologies learned during the BSN program will assist you in helping clients throughout your career as a Registered Nurse.” All members of the team read through the responses and found four patterns. The responses stated one of four things: learn new skills, teach clients, be comfortable with change/adaption, and prepared for the future. The responses were put into their appropriate categories (Table 5).

Table 5: Examples of Client Care responses

The second main focus of this study was to gather stories related to professional digital identity development in the students. Question ten stated, “Digital identity can be defined as the body of information about an individual, organization or electronic device that exists online. How has the use of social media and other online platforms/technologies aided in the construction of your current digital identity-both personally and professionally?” The responses provided showed a pattern of three possibilities. Participants either mentioned that digital identity affected their life personally, professionally, or was very limited (Table 6).

Table 6: Examples of Digital Identity responses

Lastly, question eleven asked “how do you envision your digital identity will transform once you become a Registered Nurse?”. The sub-categories identified for the provided responses were no change, more professional, or more private. After the responses were put into the appropriate sub-categories each group member read through them and identified which common themes were present, and selected responses to support the themes. The members then came together and presented their identified storythemes and worked through a process of elimination and modification until they came to a unanimous decision about the themes (Table 7).

Table 7: Examples of Digital IdentityTransformation responses

Literature Review

Over the last few decades, technology has become ubiquitous, effectively integrating itself into most aspects of our daily lives. While technology is necessary and can certainly be beneficial, it does have the capacity to elicit mental health disorders in extreme cases (Rosen, Whaling, Rab, Carrier & Cheever, 2013). Despite Rosen et al.’s (2013) terrifying evidence of technology affecting its users with games and social media platforms having the potential to negatively impact one’s mental health, there is no denying it also has its advantages in academic and clinical environments and situations.  It is also easy to see how big an effect technology can have on shaping a person and how they interact with the world around them.  As such, technology has the potential to have a negative impact on a nursing student’s, or newly graduated nursing professional’s digital identity and the manner by which they present themselves and interact online.  

It should be no surprise that technology is quickly replacing many traditional practices regarding nursing education and clinical practice, inevitably influencing students’ digital identity.  Cochrane & Antonczak (2015) emphasizedthe importanceof professional digital identityin the transition from students’ online interactions with their peers to online networks of international experts in a professional manner.  Professional digital identity within the field of nursing practice is criticaldue to the degree of sensitive and personal patient information which nurses have access to.  

Cochrane & Antonczak (2015) explored the development of students’ professional digital identity through a short, six-week elective course, also using narrative analysis that looked at student feedback to support the success of their study. The study having been conducted in such a short time-frame begs the question of the program’s long-term effects, with novelty and the incentive of class grades being potential confounds.  It is possible that after the program had concluded, students may have reverted back to their more casual digital identities so it is important to explore this topic over a longer duration.  

Experts, such as Prensky (2001), credited the modern thought and information processing of today’s students to their birth into and co-development with the digital world. While that may be true, it may also be only one factor alongside education level and previous technological experience influencing ease of adaptability. It is easy to accept that traditions are lost in this process of teaching, as Prensky (2001) has lamented, eliciting concern on how technology may negatively impact a student nurses’ competency level. In a quasi-experimental study, e-learning programs are found to be a qualified substitute for traditional instructor-led method (Abbaszadeh, Sabeghi, Borhani & Heydari, 2011).

For example, experts such as McKenzie and Murray (2010) stated that e-learning benefits nurse education and helps shape students’ professional identity. In their work, they explored how technological advances can facilitate a change in the identity of a nursing student throughout their education, concluding that online and traditional learning delivery methods were equal in eliciting such changes. Further, they proposed that e-learning may be more beneficial for introverts and students who suffer from anxiety and communication difficulties. While these findings are encouraging, they do not offer these students many opportunities to practice interacting with others. Critically, these students lack experience dealing directly with patients which can potentially lead to difficulty integrating into their clinical settings down the line. McKenzie & Murray (2010) briefly noted the existence of a virtual identity but failed to elaborate on how e-learning influences the development of it. With such easy access to technology, professional digital identity could be positively or negatively impacted. Such issues cannot be addressed in an e-learning environment, whereas a traditional setting would allow for immediate input or correction from a teacher.

While digital-centric and traditional learning each offer their respective benefits and drawbacks, hybrid learning outcomes for nursing students enrolled in online nursing programs offer an attempt to utilize the best of both. Technological advances in healthcare and post secondary education continue to evolve and become prevalent parts of the skill sets required for practicing nurses as well as nursing students. As such, it is imperative to determine competency skills of students enrolled in hybrid programs.

Since technology is the future of healthcare, web-based learning in nursing provides a means to enhance the traditional face-to-face lessons which can be considered as a representation of a collaborative learning environment (Dos Santos Nogueira de Goes, Monti Fonseca, de Camargo, de Oliveira & Felipe, 2015). In doing so, faculty can better guide the development of professional digital identity among student nurses prior to clinical integration as they build their technological skill set.

Previous research available regarding the use of technology and digital identity was mainly conducted outside Canada and focused on accessing databases for medical information, nursing specific software for online charting, and the operation of Microsoft Windows (McCannon & O’Neill, 2003). Though the authors addressed the need for development of technological skills required for seamless integration into clinical practice, professional digital identity was not explored. A more recent study examined how the future of nursing will involve increased technology trends in terms of nursing education and patient care, since “the education of nurses, both students and practitioners, has always required a balance between teaching for present needs while anticipating future demands” (Risling, 2015, p. 89). The study further identified four areas in healthcare technology trends which included; the expansion of the healthcare record, increased influence in wearable technology devices for patients and practitioners, data analytics, and patient engagement in directing and managing care.

Nursing students enrolled in hybrid nursing programs have likely used technology in their personal lives through the use of smart phones, laptop computers, tablets, or wearable devices such as Fitbit’s and computerized watches as well as tracking data with apps and computer programs. Technological use of multimedia such as podcasts or blogs, sharing professional documents and an understanding of social media and professional platforms such as LinkedIn, have been identified as vital for future nursing professionals (Risling, 2015). Healthcare professionals are using apps in their practice and encouraging patients to do the same for tracking health for things like diet, weight management, sleep and blood sugar monitoring.

Despite these benefits, the accessibility of such technology also presents opportunity for misuse, accidental and inappropriate dissemination of private information or promotion of beliefs, as well as thoughts and actions that may misalign with some health care policies and practices. Consequences of unethical, unprofessional digital identity could negatively impact the livelihood and reputation of the organization, the offending student or nurse, and the mental and emotional well-being of the affected client(s) and their families.

For this study, the research design targeted nursing students’ personal narrative stories to reveal their current technological skill set and how they are using hybrid methods and technology to develop their professional digital identities within the program. An open-ended questionnaire allowed participants to freely express themselves with in-depth, accurate information on internal factors such as students’ confidence with technology and their digital identity. They gave insight about their ability and challenges when using technology and creating a digital identity, providing an accurate account of the experiences of current nursing students over three semesters of the two-year advanced entry nursing program. The major themes that were reflected in the study were current skill level, adapting new skills and challenges, and the preparedness of students for their future practice in the nursing field. Some challenges to hybrid learning along with skill levels are access to technology and devices and related costs. The demographic of students acquired for the study included respondents at the beginning of semester one, at the midpoint in semester four and the end with semester seven. This allowed for stories that reflected any progression of skills a student developed as they moved forward in the hybrid program. The same questions were given to 114 hybrid nursing students to gain their experience at the start of the program, at the midpoint and at the end in the last semester.

Data was collected via online questionnaire for ease of access and to ensure anonymity. One American study looked at the divide between college students and their access to technology as differences in socioeconomic status. Gender, race, socioeconomic status, primary language, geographical location, (dis)ability, educational level and generational characteristics were found to be associated with disparities in access to and use of technology (Goode, 2010). Socioeconomic status and geographic location were irrelevant to our study since most participants were between the ages of 22-37 accompanied with the majority of household income being less than $20k, suggesting participants are likely living with their parents or families. As the study examined the use of technology and digital identity, using purposeful sampling eliminated the possibility of technologic accessibility being an issue since participants had specifically chosen a hybrid learning based program. The narrative themes represented past and current technological skill levels, attitudes and experiences, construction of digital identities, and future implications within the nursing field.

Responses for previous experiences were separated into professional and personal domains. Of the narrative stories shared, respondents had experience and confidence in their professional abilities. On a personal level, poor technology skills were identified by some students and preparedness for the hybrid program was explored. Nursing students’ responses were a mixture between feeling prepared and not feeling prepared. These feelings were associated with an individual’s previous degrees obtained and the required use of technology while obtaining those degrees. Confidence level, as students move throughout the program, was a mix between confidence staying at the same level and confidence increasing. For the sub category of participants being able to teach or help clients with apps and technology in healthcare, most of the narratives shared had participant responses as positive for being able to incorporate the use of technology and apps with clients. The subcategory of digital identity at present had all narratives shared in the study as having a presence on social media personally, professionally, and some who limited their social media use for professional reasons. In terms of transformation of digital identity throughout the program, there was equal representation of no change, more professional and more private.

Findings

114 students were invited to participate in this study from which 29 individuals responded. Participants were either considered to be generation Y, ages 22-27, which formed the majority (86%) or generation X (14%), ages 28-53. Responses collected ranged from students in semester 1 (69%), semester 4 (24%), and semester 7 (7%) and were kept anonymous to ensure confidentiality and provide a safe and private platform. Based off the study results three story themes became evident related to the development of technological skills and professional digital identity. The most significant contributor being “exposure”, followed by “confidence levels”, and “innovation and application.”

The majority of students reported that exposure from previous experiences was an immense aspect of how they had developed their current technological skills. The exposure came from multiple different sources as well, such as personal, work, or educational experiences in addition to growing up in the digital age which provided avenues that gave students the opportunity and time to build a foundation regarding the use of technology. Moreover, that exposure to technology had helped them to be able to learn new technological skills easily. With accessibility to smartphones and tablets, various apps can be downloaded for leisure and enjoyment. As such, some individuals reported using apps daily for reasons such as fitness, streaming, getting directions and for communication. With new apps continuously emerging this provides further opportunity for exposure to new applications and skills. Many students cited, as expressed below, the development of their skills occurred through the use of apps in their personal life which were used for recreational and social purposes:

“[I] use apps all the time on my phone -Facebook, YouTube, Google Docs, Instagram…grew up in the internet and the online world became an important tool to navigate social life, school, and work.” (Semester 1)

“I am pretty comfortable with most software, apps, and online programs. I was able to learn how to use a new one fairly quickly.” (Semester 4)

“I utilized computer-based technology throughout my undergraduate degrees in many capacities (word processing, photo editing, e-learning platforms, etc.) and so for me it was a smooth transition into the BSN online learning platform.” (Semester 7)

Through past employment, several students disclosed having operated many different computer applications and software programs such as Microsoft Word and Excel. Again, familiarization with these programs taught them how to orient and govern various technologies through exposure. For example, two semester one participants stated:

“My previous job however, gave me many skills in navigating programs and apps, as well as troubleshooting.”

“[My] job was working in IT – large amount of experience with a variety of software, apps and online programs.”

Students also reported the greatest development of their technological skills came from previous educational experiences. Within their first degree, technology was utilized for course delivery, content, communication, resources, and university websites. All students in the BSN program have a previous degree, and in this sample 59% had a Bachelor of Science (BSc) and 41% had a Bachelor of Arts (BA) so all participants have been exposed to this factor. Responses from semester 4 and 7 participants were fairly aligned with each other as demonstrated:

“My previous degree and experience prepared me for the technology related aspects in several ways such as, troubleshooting technological glitches, communicating with other classmates over social media platforms and virtual media software.” (Semester 4)

“I utilized computer-based technology throughout my undergraduate degrees in many capacities (word processing, photo editing, e-learning platforms, etc.) and so for me it was a smooth transition into the BSN online learning platform.” (Semester 7)

Thus, exposure to various technological platforms helped students feel prepared to navigate unknown technology as they felt they would be able to troubleshoot for solutions. Due to previous exposure some students reported having a limited learning curve for new technology. One student who felt comfortable utilizing a broad range of software, apps, and programs indicated seeking out online courses specifically:

“I opted for online courses during my undergrad whenever I could. I was familiar with both Apple and Windows products, using Apple at home and Windows at work. I feel comfortable utilizing a broad range of software, apps, and online programs.” (Semester 7)

In contrast, there were students with limited exposure to technology in their previous degrees who shared that they did not feel prepared for unfamiliar technology or comfortable in their digital identity as seen below:

“My previous degree was in a classroom environment, so it did not prepare me very well for an online program.” (Semester 7)

“I have a Macbook Air and the only use I made of it during my previous degree was to open Google Chrome and Microsoft Word. So, it’s safe to say that I wasn’t prepared at all for the technology-related aspects of the BSN-AE program.” (Semester 1)

Although some students did not feel as though their technological skills were advanced by school, most students were influenced by some aspect of exposure in their personal life which has helped in their skill development. Considering the dominant generation in this study, Generation Y, aka Millennials, were exposed to technology from a young age, the impact of social media and a resultant digital identity always existed. Generation Y have the ability to obtain instantaneous results and with the advancements of mobile phones and apps, this has become an essential tool as disclosed:

“I grew up with social media such as Facebook in high school and Instagram in university. Social media plays a huge part in meeting new people/dating.” (Semester 1)

Exposure to personal, educational, or work experiences were not the only aspects that influenced participant technological skills or digital identity. The BSN program itself has supported the development of digital identities based off new app and software usage, and in turn this has demonstrated an impact on individual confidence levels. Their growing confidence, as stated, has also led to increased monitoring as students prepare to pursue professional endeavours:

“I feel I have way more knowledge with using various software and apps that I would never had had exposure to prior. I am more confident in using them and actually knowing what I am doing.” (Semester 4)

“I have already become more aware of what is online about myself, so I think I’ll continue to maintain professionalism, and probably increasingly so. I have changed many of my accounts to private accounts and am more cognizant of what I post and whether it is accessible to people I don’t want it to be accessible to.” (Semester 1)

The development of students’ professional digital identity and the confidence that followed through this program has enabled students to feel as though they are able to better relate to their clients, and that technology can be used as an instrumental teaching tool. Many students reported that they felt as though integrating technology into their client’s lives could have the potential to improve client care, planning, teaching, and therapeutic regimen adherence:

“Getting to know some of the apps will allow me to be able to introduce them to clients and give them a rundown of how they work. It is much easier to demonstrate and suggest an app if you know it well.” (Semester 1)

“Help them lead healthier lifestyles with apps such as MyFitnessPal- can provide guidance and direction. They can also help clients stay accountable, motivated, implement goals into their daily lives. Apps are very accessible and affordable.” (Semester 1)

Additionally, students felt technology literacy would allow them to become more comfortable and adaptable to changes in healthcare technology and better prepare them for future interactions with clients. Technology is constantly changing and advancing to make aspects of healthcare simpler and more precise, so it is imperative to stay up to date with technological advances which was also acknowledged by students:

“I think technology will increase in every facet of nursing and being able to adapt and learn new technologies will be critical to giving the best care. I think it’s important this program forces the students to learn different ways of accessing information or sharing it.” (Semester 1)

“The future is very technology oriented, no matter what program you go into, especially nursing. There are new machines, software, etc. being developed and used and it is extremely important to be familiar with technology as an RN.” (Semester 1)

“I think various technologies will help me in the future as a RN if I decide to practice as a rural nurse (utilizing e health technology), if I pursue teaching opportunities I will be able to use the various technologies I was introduced to in this program to create teaching documents and planning, working in a team where meetings are held virtually, teaching clients about various apps that promote wellbeing and health etc.” (Semester 4)

The findings represent story themes of exposure, confidence, and innovation and their application demonstrates how students’ technological skills have developed and continue to develop which in turn advances their professional digital identity.

Recommendations

Although this study showed some common story themes in the data, further research is needed in order for the results to be generalizable. Future research into the development of the technological skills and professional digital identities of nursing students should strive to reach a broader section of the nursing student population. This study was confined to a single program at one Canadian school, so future research is needed to compare the different nursing programs available in order to achieve an overall understanding of the life of nursing students and how their digital identity is created and viewed. For future research, a study using a larger sample size might allow researchers to look more closely at the role technology plays in the nursing world and how much impact it has on student learning.

Furthermore, the majority of respondents were first semester students who had just entered the program, which could impact the data to favour how their transition has been since coming into the program versus students who have been in the program for a longer period of time. Valuable insight could be gained from students who have been studying nursing for a longer period of time as this could allow for more generalizability to the target population. Finding out ways to allow for a richer and more diverse data collection process could benefit future studies. An additional avenue for potential future research would be a longitudinal study design, where the same group of students are contacted at a later date in their schooling to discuss how their development of technological skills and digital identity in the nursing world is proceeding. Due to the limited research on exploring technology use in nursing programs, it would be beneficial to conduct more research regarding this topic to understand the importance of technology and what effects it has on a nurse’s education and development of professional digital identity.

Limitations

Although this study was able to produce desirable results, a major limitation of this study was the format. Open-ended questions were time consuming for the participants, which may explain why there was a low turnout. Since the target study group are students who, presumably, do not have a lot of spare time, making the questionnaire as easy to complete as possible may have improved recruitment in the study. Incorporating open and closed ended questions may have allowed for a higher participation turnout rate, but since this was a narrative study, open-ended questions fit the design the best. This study used purposive sampling to select participants but due to the low turnover rate, the study ultimately had to resort to convenience sampling where they had to analyze data from any of the participants who responded to the questionnaire. Students from the first semester may have felt more obligated to participate due to their involvement in the study, thus jeopardizing the internal validity of this study. A narrative design was used to address this concern since it facilitates researcher space for both subjective and objective story data, yet it definitely adds to the study limitations overall. The generalizability of this study is minimal because of the low participation, as well as the fact that all participants were from the same school program. The majority of the participants were from the same semester (semester 1) of the same program while there were only two responses from students in their final semester (semester 7).

Another limitation of the study is the fact that it was purely qualitative in nature; qualitative studies are difficult to analyze without participant feedback, and this was not incorporated into this particular study, especially since narrative design advocates for collaboration through the process of research and prefers participants to be actively involved in the inquiry. This could lead to potential gaps between the narrative told and the narrative reported which can reduce the accuracy of the data obtained and lead to misinterpretation of data. Finally, the majority of the participants were generation Y (age: 22-37) which could have an effect on the data that is collected as nursing programs that are offered see a wide range of students coming in and the data in the study may not accurately reflect that. In the future, formatting the questionnaire to make it more convenient and working with a more representative group of participants could allow for better generalizability in the study.

Conclusion

Having a solid understanding of technology is crucial for success in programs like this hybrid BSN, as well as for success in a career in nursing. While some students struggle with learning via an online platform, many prefer it because it is easy to work around pre-existing demands. In our study of the development of technological skills and professional digital identities of students in the BSN program we found that most students had become accustomed to the use of technology in their daily lives, whether through previous schooling or education. The majority of students also recognized the need for fluency in technology in order to work in the field of nursing, since technological advances in nursing are ever proceeding. Results of this study show that students of this BSN program show confidence and innovation in their use of technology, and that the increased exposure to health-care related technology further increases their confidence as well as their practical skill set for a career in nursing.

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ABOUT THE AUTHORS

This study and paper was collaboratively done by 39 Critical Inquiry: Qualitative Research students in the Fall of 2018 during their course work in the BSN-AE Nursing Program with faculty, June Kaminski at Kwantlen Polytechnic University in British Columbia, Canada. For more information about the process established for previous cohorts, read the Editorial: Collaborative Qualitative Research as a Learning Tool in Nursing Education