Standards for evaluating the quality of undergraduate nursing

Abstract

Background: E-learning is redefining the learning and teaching landscape in low- and middle-income countries (LMICs). Nurses with competing interests like family, work and distance can now upgrade from diploma to degree level through e-learning. Evaluating the quality of such undergraduate e-learning nursing programmes remains fundamental to ensure that nurse graduates can meet dynamic healthcare systems' demands. The paucity of standards for evaluating the quality of undergraduate nursing e-learning programmes with consideration of contextual challenges in low- and middle-income countries offers critical underpinning for the development of this study. The critical solutions addressed by these standards provide local solutions to local problems. This study, therefore, aimed to develop standards for evaluating the quality of undergraduate nursing e-learning programmes in Kenya. Methods: A multiple methods, multi-phase approach underpinned by the standard development framework by the Health Standards Organisation (HSO) was used. In the first phase, an integrative review was conducted to synthesise available evidence related to standards for evaluating undergraduate nursing e-learning programmes in LMICs. The second phase of this study incorporated a modified Delphi technique, including experts drawn from low and middle-income countries (LMICs) to validate the criteria from the first phase. A feasibility study of standards developed in the preceding phase was carried out in a leading university in Kenya to ascertain the standards’ feasibility, usability, and practicality in Kenya. Results: The findings of the integrative review revealed six standards with 109 criteria for evaluating the quality of undergraduate nursing e-learning programmes. The standards were presented to 14 experts drawn from Africa and Asia for a modified Delphi through three rounds leading to a consensus to remove 4 criteria across the various standards. The experts further agreed on the standards being feasible, usable, and practical for use in low- and middle-income countries, a total of six standards and 105 criteria were agreed upon. The study’s third phase intended to test the standards feasibility, usability, and practicality in a local university in Kenya. The findings suggested that the standards were feasible, usable, and practical in LMICs. These findings were VI further presented to experts with experience in the Kenyan higher education landscape and quality assuarance in e-learning and the findings were unanimous on the feasibility, usability, and practicality in LMICs. Conclusion: Standards developed in this study provide a holistic overview of the quintessential requirements in evaluating the quality of undergraduate nursing e-learning programmes in low- and middle-income settings. The quality of nurses produced is dependent on the quality of teaching offered, and e-learning is one of the teaching modalities to be availed in most institutions of higher learning and middle-level colleges. The intricacies of nursing education programmes having theoretical and clinical components invoke deeper thought on how to evaluate these programmes. The rigorous process that culminated in the development, validation and testing of these standards invokes action in institutions of higher learning seeking to develop e-learning programmes and provide quality e-learning. The contextual concerns of low-resource settings have been meticulously considered to ensure strong scientific evidence to provide local solutions to local problems. The quality of an e-learning programme is evaluated using standards that are feasible, usable, and practical. The holistic multidimensional approach adopted by the standards ensures that all key tenets of e-learning are addressed, and the interplay of each standard is identified. The study recommends adoption and testing of these standards for evaluating e-learning undergraduate nursing programmes in different LMICs to further improve the quality of e-learning.