Effectiveness of e-learning on Acute Care Nurses' Knowledge, Skills, Satisfaction, and Self-efficacy - A Systematic Review and Meta-analysis

Objective: It is difficult for novice nurses to utilize the learning contents from their basic education in their hospital or clinic practice. This discrepancy is particularly noticeable in care of patients' acute phase, in which patients' conditions are serious and their status changes greatly. Clearly, acute care nurses need in-depth knowledge and skills to deal with the increasingly complex status of patients. E-learning has many advantages; it can be used anytime and anywhere and is as effective as conventional face-to-face classes. E-learning is often used in continuing education for nurses. However, systematic reviews describing the impact of this method specifically targeting only acute care nurses have not been published to date. Therefore this systematic review assessed the effect of e-learning on the knowledge, skill performance, satisfaction and self-efficacy of acute care nurses and compared the efficacy of e-learning and traditional learning according to previous studies. Method: A systematic review and a meta-analysis of randomized controlled trials were performed. A systematic search of MEDLINE, EMBASE, PubMed, CINAHL, PsycINFO, ERIC, and CENTRAL identified relevant peer-reviewed articles. English literature published by November 2019 was targeted. Quality and risk of bias were assessed for every study included using the Cochrane Collaboration Handbook for Syatematic Review of Interventions. A random-effect meta-analysis was performed to generate a pooled mean difference in the e-learning outcome. We assessed the quality of the evidence using the GRADE approach. Results: We identified four randomized controlled trials (N = 273 nurses). We observed no statistical difference between groups for acute care nurses' knowledge, satisfaction, and self-efficacy. The e-learning group had a significantly higher score of skill performance than the traditional learning group. However, studies were largely heterogeneous and generated very low-certainty evidence. This might be due to small sample size, high risk of bias, and lack of blinding in the studies included. Conclusions: Further investigation with larger sample sizes and more studies following the CONSORT statements are needed to evaluate the effects of e-learning. It can be difficult to improve both knowledge and skills with e-learning alone. Accordingly, we think that combining e-learning and face-to-face lessons may be more effective.