The effect of Personal Digital Assistants in supporting the development of clinical reasoning in undergraduate nursing students: a systematic review.
BACKGROUND
The objective of this review was to determine whether the use of Personal Digital Assistants (PDAs) would provide greater support in developing undergraduate nursing students' clinical reasoning, in comparison to more traditional resources such as textbooks.


METHODS
The search strategy sought to identify published data from five electronic databases: CINAHL, Medline, Cochrane Library, Meditext and Scopus. Unpublished literature was also sought in digital dissertations, conference proceedings, relevant scholarly websites and reference lists.


METHODS
All undergraduate nursing students were considered eligible for inclusion. Types of interventions considered for this review were inclusive of all forms of PDAs and traditional resources. The research setting of this systematic review reflects the diversity of nursing practice, and includes the classroom, clinical or simulated environment. The process of clinical reasoning was defined by four outcome measures; alterations in theoretical nursing knowledge, clinical skills, problem solving and reflection.
Studies of potential significance to the review were assessed for methodological quality independently by two reviewers using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Authorship of the studies was not concealed from the two reviewers. From the nine studies assessed for quality, only data from four studies were included in the review.


RESULTS
Four published studies were included in the systematic review of literature. The designs of the studies included a nonrandomised quasi-experimental design, case control study, comparative descriptive design and a pre test post test mixed method study. Four outcomes were identified by the four included studies. These outcomes addressed possible effects of PDA usage on undergraduate nursing students' practice of medication administration, self-efficacy, anticipation to exercise professional nursing judgment and clinical reasoning.This systematic review provides evidence that the use of PDAs is able to improve nursing students' self-efficacy and accuracy in clinical situations that require direct and context-free answers, such as medication administration, but is not as supportive as textbooks in assisting students to apply this knowledge critically in decision making and problem solving.


CONCLUSIONS
The use of PDAs by undergraduate nursing students can improve students' confidence in the often stressful clinical environment. This bears significance in contemporary nursing education where undergraduates are failing to maximise the clinical experience because of insufficient support or guidance from busy clinicians or supervisory staff. From these findings, PDAs are also beneficial in improving the accuracy and efficiency of medication administration in nursing students. However, the application of the knowledge provided by PDAs is not supported to be used critically in its application to decision making and problem solving. Nursing students need to be educated in methods to develop critical analysis in order to use these resources effectively.


CONCLUSIONS
This systematic review highlights the poor quantity of literature currently available in nursing and the subsequent need for primary quantitative studies examining the effect of PDAs in developing undergraduate nursing students' clinical reasoning skills.
1. Family and Community Health Research Group (FaCH), Research Associate NSW CEBHC. A collaborating centre of the Joanna Briggs Institute, Australia 2. Assistant professor at the University of Canberra, Australia.
Karen
K
Jeffrey
Sharon
S
Bourgeois