Michael Cardiel, MSN

Jerome Espanola

Julibeth Chris Rombaoa

Roison Andro Narvaez, MSN, RN, CMCS, LGBH, PhD St

St. Paul University, Philippines

Citation: Cardiel, M., Espanola, J., Rombaoa, J. C. & Narvaez, R. (2022). Adaptive Learning in Nursing Education: A Concept Analysis. Canadian Journal of Nursing Informatics, 17(2).  https://cjni.net/journal/?p=10092

Abstract

Aims: This concept analysis aims to present the concepts and understanding behind adaptive learning in nursing education, including its defining attributes based on how the term is used in scholarly articles and studies.

Background: The 2019 Coronavirus Disease (COVID-19) has affected the way students are educated at schools. From the face-to-face teaching mode, classes have shifted to different learning methods where students can pursue their studies through modular or virtual formats. The classes held during the pandemic are referred to as the ‘new normal of education.’

Design: This concept analysis uses the Walker and Avant (2019) approach of concept analysis with the help of its eight stages including the choice of concept, determining the purpose, and more. As mentioned above, it aims to study the concept of adaptive learning in nursing education along with its defining attributes. Understanding and definitions of the concept were analyzed through case studies (i.e., model case, related cases, contrary case, and borderline case) while noting the concept’s antecedents, consequences, and empirical referents.

Results: It was found that adaptive learning is already used in many countries worldwide. Technological formats are often used to promote a student-focused learning model. It is defined as a process that personalizes learning based on students’ prior knowledge, preferences, and differences. Meanwhile, its defining attributes include the following: (1) It is driven by technology; (2) Differences of learners; and (3) Student-focused learning.

Conclusion: In just a short period, the physical means of education have shifted to a more technological-driven method. Despite the challenges that adaptive learning has faced during the pandemic, nursing schools still adapted to new methods of teaching and learning.

Introduction

The 2019 Coronavirus Disease (COVID-19) has affected how students are educated in schools. From the face-to-face teaching mode, classes have shifted to different learning methods where students can pursue their studies through modular or virtual formats. The classes held during the pandemic have become the ‘new normal of education’ in many schools. Pacheco (2021) pointed out that the pandemic has affected the social spheres that surround everyone, as well as personal and economic spheres in society. With the help of technology, we have survived these impacts, and bridged connections from person to person despite distancing. The education sector is one of the industries that have been heavily affected by the pandemic. The pandemic has opened debates on how to adapt unique learning methods that benefit students, without sacrificing the extensive training that healthcare students must undergo before they put their skills and knowledge into practice.

The Asian Development Bank (2021) described how the global pandemic disrupted the ordinary lives of students. During pre-pandemic times, students were required to attend all face-to-face classes as their school institutions were equipped with laboratories and facilities that catered to their chosen field. However, due to strict implementation and health protocols in response to the COVID virus, everyone was asked to stay in the safety and comfort of their own homes and continue their studies there. The World Bank (2021) reinforced the importance of educational technology (i.e., radio, television, e-learning, texting, etc.) during the pandemic. It was used to aid students in accessing their lessons while they were far from their educational institutions.

A study conducted in Spain found inevitable disparities in training students face-to-face and online. It highlighted the limitations of e-learning for nursing students living in rural areas, with limited access to electronic devices, and work and family responsibilities (Ramos-Morcillo et al., 2020). One specific online training that quickly became common during the pandemic is the online Simulation Learning Environment (SLE), where students are given specific activities to test out certain procedures in nursing. Simulation has been used for years to help students learn skills before treating actual patients and simulating events like an actual operation, but usually in a face to face laboratory setting.

Based on a study by Chakraborty et al. (2020), almost all countries have adjusted to this new normal and embraced distance education in some way.  Specifically, most countries have used online classes to provide lessons to the students and continue the academic year, reinforcing that despite the pandemic, education must not be interrupted (United Nations, 2020). The Commission on Higher Education (2020) in the Philippines recommended the use of flexible learning during the pandemic. Flexible learning has three key modes: offline, online, and blended learning. These can all be examples of adaptive learning, if they address the needs of students based on their preferences, capabilities, and access to technology without compromising their learning.

There are many reasons to incorporate adaptive learning in learning institutions. According to Kurt (2021), adaptive learning usually occurs through a web-based platform, and it requires software that contains the information that the students need to learn. This means that adaptive learning addresses the needs of students based on what they already know, what they still need to learn, and what will prepare them to succeed in their field. Kurt (2021) also said that students could work at their own pace based on their learning speed, students get more motivated, teachers support their students through practice problems, students learn more using this mode, students experience less stress as they can track their learning progress, and due to dedication to content, students achieve better learning success.

This concept analysis aims to provide a better understanding of adaptive learning in nursing education through the review of selected research studies and scholarly articles. It is known that the education sector has been greatly challenged during the pandemic. Still, adaptive learning has helped the sector continue to educate students through flexible learning from their homes. With the help of the Walker and Avant (2019) method of concept analysis, it is possible to dive into the concept of adaptive learning systematically.

Definitions and Use of Concepts

The concept of adaptive learning became more well-known during the emergence of the 2019 Coronavirus Disease (COVID-19) pandemic. However, the concept of adaptive learning has long been used in many disciplines, especially in professional development medical and nursing courses, to continue their training and receive continuous education about procedures.

Adaptive Learning

According to the Merriam-Webster Dictionary (n.d.) the term “adaptive” means “providing, contributing to, or marked by adaptation: arising as a result of adaptation”. It was noted that the term has been in existence since 1760, bearing the root word “adapt” and the suffix “ve” to turn it into an adjective. As adaptive is associated with “learning” in this concept analysis, the term serves as a descriptive word that talks about the learning in nursing education: learning that adapts to the needs of students.

Teasley (2015) noted that the concept of “adaptive learning” came from the education icon, B. F. Skinner. This concept emerged in the 1950s when Skinner was interested in building a teaching machine to reinforce memorization in students effectively. The machine allowed students to learn new concepts and answer a wide variety of questions, and if the students correctly answered the questions, then, they would receive positive feedback and reinforcement. Adaptive learning has since evolved and is often used in educational fields such as science, the military, and many more.

Adaptive Learning and Technology

Electronic learning has been used for many years now, and has lately evolved to include a personalized approach, based on adaptive learning. According to Fontaine et al. (2019), adaptive learning is defined as a learning environment that takes each learner’s interactions and performance level into account and uses these to anticipate which types of content and resources they need to see. This approach has led to the development of adaptive e-learning environments (AEEs).

Simon-Campbell & Phelan (2016) described how adaptive quizzing systems are a common form of adaptive learning that most educational institutions employ today as an institutional-wide strategy to improve the retention and learning of students. These authors reinforced that adaptive learning in nursing education supports the students’ performance and persistence measured by mathematical formulas. As stated, the researchers used the concept of adaptive learning to help nurse graduates achieve success in the lessons and procedures they learned while they were nursing students.

Content posted on the Osmosis by Elsevier website explained that adaptive learning is a concept where students receive, change, and adapt their learning materials based on their individual preferences and is driven by technology. Osmosis is an example of an advanced tool used by many school institutions that is commonly used online. Firstly, it supports distance learning, which is very timely. Secondly, online learning resources are integrated across the website. Lastly, it transforms live in-class courses into online courses. All of these qualities fit the goals of adaptive learning and ensures that the adaptiveness of learning is done in real-time (Marshall & Xiao, 2021).

Adaptive Learning Linked to Nursing Education

Since the concept of adaptive learning has been linked with “nursing education”, it is relevant to include its definition. The Encyclopedia.com (2018) website discusses “nursing education” as a term that refers to the formal learning and training in the science of nursing. This includes the functions and duties in the physical care of patients and the diverse disciplines that support the recovery of patients from illness. The need for information and content by nursing students must be ideally provided by learning that is both adaptive and contributive.

A study from Hinkle et al. (2020) described the effectiveness of using an adaptive learning platform in nursing education, specifically for to teach pathophysiology. The results showed that 86% of the respondents agreed that they had learned a lot with the help of adaptive learning. This study defined adaptive learning as a process of personalizing the content that students want and need to see. The platform adjusted the content based on the students’ prior knowledge, preferences, and differences in language acquisition. The study emphasized that the adaptive learning has the potential of supporting students’ learning well.

Byers (2020) highlighted that the education sector survived the challenges brought on by the global COVID-19 pandemic because of adaptive learning. Nursing schools were among the school institutions that were hard to manage amidst the emergence of the virus because students usually learn different procedures in face-to-face settings. The author emphasized that it was a helpful to include adaptive learning in nursing education, and that students regarded this adaptive learning as “cool and interactive” (p. 2), it introduced a variety of technologies into programs, and allowed students to still connect and engage in hands-on learning.

Wolters Kluwer’s Expert Insights (2017) report concluded that 92% of nursing students who have used adaptive learning enjoyed this newly created learning method. The authors defined adaptive learning as an educational method that uses computers as an interactive learning and teaching device to provide lessons to students based on what they need. Specifically, nursing students and instructors used mobile-friendly applications for quizzes, remediation, and to review their lessons. Taylor et al., (2021) also defined adaptive learning as a personalized learning method used to increase students’ learning levels and success using technology as its primary basis to personalize learning and continuously evaluate student performance in real-time.

Methods

This concept analysis has been guided by the systematic format provided by Walker & Avant (2019) which has been widely used in nursing as the basis for analyzing different concepts. This method of concept analysis includes distinct steps to guide researchers in selecting relevant case studies and models to properly present the concept that is being analyzed and show an understanding of its defining attributes.

Specifically, this method includes eight systematic steps: (1) Selecting a concept, (2) Determining the aims or purpose of analysis, (3) Identifying all uses of the concept that researchers can discover, (4) Determining the defining attributes of the concept, (5) Identifying a model case, (6) Identifying borderline, related, contrary, invented, and illegitimate cases, and lastly (7) Identifying the antecedents and consequences of the concept including its empirical referents (Walker & Avant, 2019). All these steps have been followed in this work to showcase the individual stages of analyzing the concept of adaptive learning in nursing education, hence the goal is to employ different research articles and studies to define the concept and identify its defining attributes.

Data Collection

Data collection consists of identifying different relevant parts of the concept analysis. It is composed of determining the defining attributes of the concept and the collection of case studies cited as a case model, related case, contrary case, and borderline case along with their respective analyses. It is also enclosed in the antecedents, consequences, and empirical referents to highlight adaptive learning in nursing education and distinguish it from other related concepts.

Due to limited access to physical libraries, the researchers employed technology to search for appropriate and related literature and studies online. This process made the process of data collection more accessible and faster. The researchers ensured that all cited studies were from published journals and other verifiable websites. The researchers then examined all gathered research articles and studies to assess whether to approve them as part of this concept analysis. Overall, the total related articles are not less than ten, which is deemed sufficient to understand the concept being presented.

Defining Attributes

Adaptive education in nursing education was initially defined with the help of different scholarly articles and studies available. However, this concept could be more fully and clearly defined. To support this, the concept of adaptive education can be categorized by looking at its defining attributes which can help to distinguish this concept uniquely compared to similar concepts.

Specifically, there are three identified defining attributes evident in the concept of adaptive learning in nursing education. These concepts are considered critical as they are all required to exist to meet its true definition. These defining attributes include the following: (1) It is driven by technology; (2) Learner differences; and (3) Student-focused learning. These attributes are based on the definitions and concepts presented by the cited studies discussed in the preliminary definitions and uses of the concept part of this concept analysis.

For the first defining attribute, adaptive education is driven by technology. Based on the articles previously discussed, technology serves as the primary medium for the concept. Looking at the recent emergence of the global COVID-19 pandemic, the concept of distance education became central, reinforcing the importance of the use of technology in education to help learners and instructors connect despite the distance between them.

For the second defining attribute, adaptive learning focuses on learner differences. This concept gave birth to the creation of adaptive e-learning environments (AEEs), which is basically about building a profile of learners based on their differences. Each student is said to have unique navigation behaviours, preferences, and knowledge, which are essentially key basic considerations of adaptive learning. Each learner has unique differences in their schema or prior knowledge, tastes, and learning styles, and adaptive learning can build on these to provide adaptive strategies for students to learn effectively.

The last defining attribute of the concept is that adaptive learning is student-focused learning. It is personalized and adapts to the needs of individual students. This adaptive ability considers every special need of the learners which allows them to enjoy learning as if the lessons were made primarily for them. The main goals of adaptive learning are to increase student learning and success, which also reinforces its’ central focus on students and their needs.

Case Studies

The case studies included in this paper are categorized into different formats. As mentioned, the defining attributes of the concept include the following: (1) It is driven by technology; (2) learner differences; and (3) Student-focused learning. These defining attributes serve as the basis of all these case studies to distinguish if the case is a model case, just a related case, a contrary case, or a borderline case. Each case is presented with an analysis to explain how the concept of adaptive learning in nursing education fits within it.

Table 1 outlines the cases included in this paper. All the persons involved are working as faculty members in a Nursing undergraduate program. All of them were teaching their students through adaptive learning during the surge of the 2019 Coronavirus Disease (COVID-19) pandemic, when physical or face-to-face education was not allowed.

Table 1: Case Studies

Case	Person Involved	Description
Model Case	Prof. S.	49 years old, University Professor, Nursing Department
Related Case	Dr. F.	55 years old, University Professor, Nursing Department
Contrary Case	Dr. A.	63 years old, University Professor, Nursing Department
Borderline Case	Ms. C.	24 years old, Instructor, Nursing Department

Model Case and Analysis

Model Case and Analysis is a prominent part of the Walker & Avant (2019) method of concept analysis. The model case consists of all the defining attributes of the concept, which in this case, must be all about adaptive learning in nursing education. The model case below includes the following defining attributes: (1) It is driven by technology; (2) Learner Differences; and (3) Student-focused learning.

Prof. S. is a 49-year old University Professor from a well-known institution in the Philippines. She teaches in the school’s Bachelor of Science in Nursing program and is currently assigned to five nursing classes per semester. She was excited when she was assigned to this program in 2019 when the education sector was still following face-to-face education. But when the global COVID-19 pandemic came, the education scene in the country changed.

Prof. S.’s university provided their students with laptops, which they used for their daily online classes. This was done to ensure that all of the students had ready access to technology, as it is considered the foundation of the “new normal of education” in the country.

When Prof. S. was teaching one of her classes, she realized that the lessons being shown on the course website were only those she could not teach yet. She felt that the website was guiding her to teach the course through a clear and concise list of objectives, followed by easy-to-learn discussion tips and activities.

She also realized that despite teaching her lessons remotely, she could teach all required procedures through interactive and student-centered activities. She was guided not just by the course website but also by the administration to do so. The College Dean would always remind the professors to continue education as effectively as possible despite the challenges of online and adaptive learning.

However, Prof. S. still saw how different her students’ learning styles and needs were. There were students in her classes who quickly learned the topic with the help of technology, while some would still message her asking to focus on the same topic that she already discussed, or to recommend a book that was helpful to the subject, and to use more interactive materials in the future. Prof. S. realized that despite her students being members of Generation Z, her students still had unique learning styles and needs.

Analysis

This case model consists of all defining attributes of the concept. It does not just talk about the struggles that students face in the middle of a challenging situation such as what was mentioned in the case, the 2019 Coronavirus Disease (COVID-19) pandemic. Prof. S., as a Nursing Professor, realized the positive effects of adaptive learning in nursing education by teaching her lessons with the help of technology, knowing the differences of her students, and receiving lessons based on the student-centered learning. She also realized that she must be open to various teaching styles as her students also do have unique learning styles. Some learn through reading or writing, some are auditory learners, some are visual learners, and others are kinesthetic learners, and so on.

Related Case

Walker & Avant (2019) said that related cases in concept analysis consist of the defining attributes of the concept being studied, but not all of them. Thus, at least one of the three defining attributes cited under the concept of adaptive learning in nursing education, would be missing. An example of a related case can be found below.

Dr. F., 55-years-old, has been a Nursing Professor at a University located in the Philippines since 1980, but when the pandemic started, he decided to stop teaching for a while. After eight months of hiatus, he was asked to teach Nursing students again. At first, he declined because he knew he was not very knowledgeable in using course websites and he had a low technological level of expertise compared to his colleagues. However, administration convinced him to return because of his exemplary contribution to the nursing field in the Philippines and the fact that he knows that many students love the way he teaches.

When Dr. F. started his classes online, he ensured that all students had access to all learning materials based on what they already knew and what they should continue to learn. In this way, Dr. F. taught the value of continuous online education to his nursing students. It is also important that Dr. F.’s technological skills improved after taking a two-week course about online classes provided by the Human Resource Department of his University.

The problem with Dr. F.’s class was that some students became bored after one hour of online discussion because Dr. F. was only following a lesson plan that he also used for his PT students. The students started to ask Dr. F. to realign his lesson plan and make it more nursing content and student focused.

Analysis

This is an example of a related case. Despite not having all attributes of adaptive learning in nursing education, it is still understandable that this case is about the concept of adaptive learning in nursing education. Dr. F. who was teaching a nursing course to his students, knew the importance of technology in adaptive learning. However, his instruction lacked student-focused learning. Aside from this, Dr. F. seemed to forget the differences of his learners, confusing his lessons for his PT students with his Nursing students. He thinks that the lesson plan that works for PT students can also be applied to Nursing students since both are in the healthcare field.

Contrary Case

A contrary case is defined as “not the concept” by Walker & Avant (2019). This concept analysis is mainly focused on the concept of adaptive learning in nursing education. This means that the contrary case should not be about it so that it could be about physical learning methods or face to face learning. An example of a contrary case can be found below.

Dr. A. is a 63-year old Nursing professor in the university. He is a registered nurse and has completed a doctorate degree in Nursing from a prestigious university in the country.

Although Dr. A. knows about the shift in educational strategies and methods due to technological innovations and developments, he is a firm believer in face-to-face or physical learning. He thinks that authentic learning only happens when done in-person, and never happens online. His past students were always afraid to be late for his class because he would ask them to go somewhere else if they were even one minute late. All his lessons are based on books, as he believes that reading is an essential skill that a nursing student should possess

Analysis

This is a contrary case because it talks about face-to-face learning unlike the concept of adaptive learning being discussed in this paper. Physical learning is the opposite of adaptive learning because it follows a specific pattern of learning and teaching. Students learn from their instructors and are usually done in a classroom-based setup. This case also does not address any of the three attributes of adaptive learning in nursing education.

Borderline Case and Analysis

Walker & Avant (2019) explained that borderline cases are examples of instances when the defining attributes of adaptive learning in nursing education are present, but not all of them. It may be almost the same as the related case cited in this paper, but in the borderline case, most attributes can be found. An example of a borderline case can be found below.

Ms. C. is a 24-year old Nursing Instructor in a Bachelor of Science in Nursing program in a local university. She was excited and nervous about earning her Nursing degree just last year when she was tapped to teach because she knows that she spent most of her previous years learning through online classes. Despite being confident that she embodies the knowledge and skills that a nurse should have, Ms. C. is still concerned about whether she would be a good nursing instructor.

With the help of technology, Ms. C. learned different essential nursing procedures before she graduated the previous year. Her university introduced a simulation-based learning environment to their students to practice techniques that can only be learned through a mannequin or a cadaver. She thought that technology really became a foundation of online learning during the global pandemic with strict implementation of health protocols and lockdowns. At that point, she knew she had the knowledge and skills to teach her students online.

When she was looking at the website she would use to teach the students and hold class discussions, she noticed that all the lessons acknowledged the differences of students. In the learning management system website at the university, there was also a consistent reminder that if the students had any problems with the modules or learning materials, that they were expected to contact their instructor.

When Ms. C. was looking at her emails, she found an email from one of her outstanding students saying that the material did not fit their learning style. She did not know what to answer, so she just ignored the message.

Analysis

This is an example of a borderline case because the case started with Ms. C’s acknowledgement of the importance of technology and knowing the differences of students in adaptive learning. However, adaptive learning was not complete since when a student asked for assistance to make the material more appropriate to their needs and preferences, they were ignored.

Antecedents

Walker & Avant (2019) said that antecedents serve as a basis of an event or incident based on what must occur first before the emergence of the concept. It must be noted that this concept analysis focuses on the concept of adaptive learning in nursing education which is only a small part of the larger concept of learning. This means that the concept being discussed is more specific.

The antecedents of adaptive learning in nursing education are easy to determine. Since it is a mode of learning that relies on the advancement of technology, then it implies that the antecedents must also rely on this. According to Johnson & Sloan (2020), the Colorado Technical University implemented adaptive learning several years ago. This concept has taught them so much, which has led them to create or gather lessons to help prepare educational institutions who also want to implement the concept. Firstly, they learned that adult learners tend to enjoy technology. This means that to implement adaptive learning in nursing education, learners, as well as teachers, must know how to use technology. Secondly, students need to have engagement and the lessons that the students engage with must be adaptive. Thirdly, there is a need for course designs that are inclusive and universal. Lastly, there is a need for mobile access for students to increase their use of the technology. It was reported that almost 57% of students use mobile applications to access adaptive technology. All of these points apply to adaptive learning that is focused on nursing education.

Consequences

Walker & Avant (2019) highlighted that consequences are “events or incidents that occur as a result of the occurrence of the concepts, or in other words, the outcomes of the concept” (p. 175). It is evident that the consequences of the concept being discussed can be easily determined as it has already been applied in many educational institutions, especially since the pandemic.

Taking the example discussed in the antecedent section, the Colorado Technical University (CTU) had already implemented adaptive learning before the pandemic emerged. The concept of adaptive learning left them with many useful lessons, which also reflected the outcomes of the concept in their institution. From the past years, the school was able to discuss the consequences of 218 online courses with students where many participants were involved. Many of the faculty members of CTU have joined the program while this was occurring. The consequences of the concept included the following: the majority of learners enjoyed the mode of learning as it was more conducive and adaptive, students showed greater interest in topics that increased their enjoyment, revisions in course design to improve the digital tools used to support adaptive learning, increases in instructor engagement for a more positive course experience, and increase in overall learning success (Johnson & Sloan, 2020).

Despite all the positive feedback that adaptive learning potentially improves education, it cannot hide the possibility of causing negative responses in some learners. A study about nursing student reactions to the application of adaptive technology was done in selected schools such as Kathmandu University, Chitwan Medical College-Tribhuwan University, Pokhara University, and Shree Medical and Technical College- Purbanchal University of Nepal, which showed the disadvantages of adaptive learning that some students experience. The negative consequences of the concept included the university’s lack of technology and inability to provide technical support to the students, unstable internet connections which increased student stress, and lack of interactions with patients (Thapa et al., 2021).

Empirical Referents

Walker & Avant (2019) emphasized that empirical referents are “classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself” (p. 176).

The concept of adaptive learning in nursing education has already been established in many institutions, which implies that there are many scholarly articles and studies that show a evidence of how adaptive learning in nursing education can be measured to be analyzed further. In a study by Mirata et al. (2020), the authors state that adaptive learning provides challenges and contexts during implementation in higher education. This means that to successfully identify if a phenomenon demonstrates adaptive learning in nursing education, it will be analyzed through the identifying measurable impacts of technology-based learning (TBL), identifying measurable effects of adaptive learning (AL), identifying technology-based learning (TBL) challenges, identifying adaptive learning (AL) challenges, narrowing down TBL and AL challenges, and ranking of these challenges. The result of these measurements can be used to improve adaptive learning in higher institutions as part of its promise to be “adaptive.”  For the measurable impacts of TBL and AL, it is necessary to identify these to understand the root problems and the positive and negative aspects of adaptive and technology-based learning. Meanwhile, identifying its challenges can result in a list of things that must be altered or developed to improve this type of learning. Narrowing down TBL and AL challenges can further result in a list of tasks and actions that can be prioritized. Lastly, a ranking of these challenges can highlight the actions that should be prioritized to ensure high-quality adaptive learning.

Discussion

The concept of adaptive learning in nursing education is described as a personalized learning method used to increase students’ learning levels and success (Taylor et al., 2021). The concept of adaptive learning came from an education field icon, B. F. Skinner. This concept arrived in the 1950s when Skinner was interested in building a teaching machine to reinforce memorization in students effectively. It is essential to study the concept of adaptive learning in general. Still, its applications in nursing education have been deprived because of the 2019 Coronavirus Disease (COVID-19) pandemic when students were required to continue their studies at home.

There are three identified defining attributes found in the concept of adaptive learning in nursing education. These concepts are considered critical as they are all required to exist to give it a true definition. These defining attributes include the fact that the idea is/has: (1) Driven by technology; (2) Learner differences; and (3) Student-focused learning. These attributes are based on the definitions and concepts presented by the cited scholarly articles and case studies in this concept analysis.

Four case studies were presented, including a model case, related case, contrary case, and borderline case. All these cases were about faculty members who may have enjoyed or struggled due to the concept of adaptive learning. Taking the case of Prof. S as an example under the model case, it was mentioned that she was working as a Nursing Professor in a well-known university in the country. She realized the positive effects of adaptive learning in nursing education by teaching her lessons with the help of technology, the appropriateness of the lessons for her students that addressed their differences and delivering lessons based on the student-centered learning model. These represent the three attributes of the concept as mentioned above.

The antecedents of the concept of adaptive learning in nursing education are technological knowledge/skill, engagement of students, a course design that is inclusive and adaptive, and mobile access for students. These antecedents must be applied first before the actual implementation of adaptive learning in nursing education. Meanwhile, the consequences of the concept include the majority of learners enjoyed the mode of learning as it is more conducive and adaptive, students preferred greater interest in topics that increased their enjoyment, revisions in course design to improve the digital tools used to support adaptive learning, growth in instructor engagement for a more positive course experience, and an increase in overall learning success. Most of these consequences are positive and describe how “adaptive” adaptive learning should be. However, despite the positive feedback that adaptive learning brought to our current situation, learners can still encounter negative consequences in applying it. These include a lack of technology and/or technical support for students, unstable Internet connections, and a lack of patient interaction. Lastly, the empirical referents of the concept included: identifying measurable impacts of technology-based learning (TBL), identifying measurable effects of adaptive learning (AL), identifying technology-based learning (TBL) challenges, identifying adaptive learning (AL) challenges, narrowing down TBL and AL challenges, and ranking of the challenges. This is analyzed through software that transforms participants’ open-ended responses into a measurable set of data.

Limitations

Adaptive learning is a concept that has existed for several years yet is still foreign for some educational institutions. It was discussed above how the concept was used in universities and colleges, but despite these examples, there are still limitations with implementing the concept. These limitations often prevent institutions from comprehensive implementation of adaptive learning.

Since it is new for many institutions, both students and faculty members might face problems that will limit their ability to follow the concept. These may include the lack of knowledge/skills of both students and teachers in technology, differences in teaching and learning styles of teachers and students, and organizational issues. These limitations stop faculty members and students from enjoying the benefits of adaptive learning, making the concept less adaptable or attainable. Other limitations in this paper include the issues that the researchers faced upon crafting this concept analysis. These are the lack of materials found in physical libraries, the lack of ability to compose the analysis with the presence of expert panels, and the lack of materials about the application of adaptive learning in nursing education.

Implication for Nursing Practice

Education and training are essential aspects of nursing education. According to Wolters Kluwer (2017), adaptive learning is a concept being applied in nursing education, and it appears that participants are enjoying its benefits. 92% of students who joined the Lippincott CoursePoint and Lippincott PassPoint in 2019 agreed that they preferred the features of these educational tools. Adaptive learning also improved the mastery of course content of nursing students, improved outcomes in NCLEX-RN passing rates (98.3% for members of the Lippincott PassPoint, 83.6% as national average), and a better patient-centered learning experience. Indeed, these data imply that nursing practice has improved because of adaptive learning since 2009 when the first adaptive learning in nursing education was introduced. Because of these data, it is recommended that higher institutions should also test the effectiveness of adaptive learning. They must commit to adaptive learning and make it a part of their strategy to increase the passing rates to become a registered nurse, help in providing resources for students, and build the required infrastructure to implement the concept. In general, the organization must be willing to participate in improving the nursing practice in the country.

Conclusion

The concept of adaptive learning has proven that the nursing education that students receive today can still be improved. The concept was analyzed using its definitions from reliable websites, journals, articles, defining attributes, and cases describing how the concept changes when one concept is added or missing.

Firstly, the concept of adaptive learning came from an education field icon, B. F. Skinner. This concept arrived in the 1950s when Skinner was interested in building a teaching machine to reinforce memorization to students effectively (Teasley, 2015).  Secondly, the defining attributes of adaptive learning in nursing education include being driven by technology, differences of learners, and student-focused learning model. Thirdly, the antecedents of the concept of adaptive learning in nursing education are technological knowledge/skill, students’ engagement, a course design that is inclusive and adaptive, and mobile access for students. Fourthly, the positive consequences of the concept include the majority of learners enjoying the mode of learning as it is more conducive and adaptive, students prefer greater interest in topics to increase their enjoyment, revision of course design to improve the digital tools used to support adaptive learning, increase in instructor engagement for a more positive course experience, and increase in overall learning success while the negative consequences contain lack of technology and technical support for students, unstable Internet connection and, lack of patient interaction. Fifthly, the empirical referents of the concept include identifying measurable impacts of technology-based learning (TBL), identifying measurable effects of adaptive learning (AL), identifying technology-based learning (TBL) challenges, identifying adaptive learning (AL) challenges, narrowing down TBL and AL challenges, and ranking of the challenges. As well, limitations in the concept are a lack of knowledge/skills of both students and teachers in technology, differences in teaching and learning styles of teachers and students, and issues in organizations. Lastly, it was shown how adaptive learning increases the overall learning success of nursing students, making the concept beneficial to nursing education and practice.

References

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Author Bio(s)

Michael Cardiel, MSN

St. Paul University, Philippines

https://orcid.org/0000-0001-7545-7396

The authors acknowledge the support of the Graduate School of St. Paul University Philippines.

Jerome Espanola

St. Paul University, Philippines

https://orcid.org/0000-0002-4112-921X

Julibeth Chris Rombaoa

St. Paul University, Philippines

https://orcid.org/0000-0001-7224-6032

Roison Andro R. Narvaez, MSN, RN, CMCS, LGBH, PhD St

Rois is currently practicing telehealth as a Clinical Case Manager at Ace Home Health and Hospice, a part-time Professor and PhD student in Nursing Science at St. Paul University of the Philippines (MSN), a part-time Faculty of Pamantasan ng Lungsod  (BSN) and University of Makati Center of Nursing (BSN).

Correspondence concerning this article should be addressed to Roison Andro Narvaez, St. Paul University Philippines, Mabini Street, Tuguegarao, Cagayan, 3500 Philippines, rnarvaez@spup.edu.ph

https://orcid.org/0000-0001-7555-5420