Replacing Hard Copies of Textbooks With e-Books in Bahrain: Effects on Nursing Student Learning

Friday, 28 July 2017: 1:50 PM

Seamus Cowman, PhD, MSc
School of Nursing & Midwifery, Royal College of Surgeons Ireland Bahrain, Adliya, Bahrain
Eman Ebrahim Fateel, MSc
School of Nursing & Midwifery, RCSI Bahrain, Manama,, Bahrain


Within one month of launching iPads, Apple announced that 1.5 million eBooks were downloaded and with the accelerating educational technology, sophistication has given rise to specific tools for education and student learning(1).

Since the foundation of the School of Nursing & Midwifery at RCSI Bahrain in 2006, undergraduate nursing students’ have been provided with hard copies of textbooks and a laptop at the commencement of the programme. Educationally, the provision of a MacBook Air and hard copies of text books, was somewhat contradictory. Given the high level of smart phone ownership, social media usage, and the provision of a MacBook Air to all students, it was believed that a move away from hard copies of text books, to eBooks, could enhance nursing student learning approaches. A strategic and policy decision was taken to provide all students entering nursing from 2014 with eBooks, as an alternative to hard copies of textbooks. The provision of eBooks was consistent with the schools educational emphasis on blended learning, the use of a VLE and the encouragement of independent and flexible learning approaches. To evaluate the impact of eBooks, a research study was developed to evaluate and understand student nurse learning approaches.


A longitudinal, descriptive, mixed methods research approach was agreed with data collection through surveys, focus-group interviews and documentary data on student use. The eBook vendor held extensive records of student eBook engagement through the technology platform, which served as an important data source. The study was approved through the research ethics committee of the university. The study participants included: yr 1 students provided with eBook only; yr 2 students provided with a combination of eBooks and hard copies of text books and yr 4 students who in former years had been provided with hard copies of text books only. Structured training on the use of eBooks was provided to students with eBooks and staff, separately, by the vendor. An established questionnaire, Approaches and Student Skills Inventory for Students (ASSIST instrument, which was previously validated for use with nursing students(2)was selcted to examine student nurses learning approaches. The instrument consists of three sections; (a) describing learning; (b) approaches to studying; (c) preference for different types of teaching.


The findings reflected no differences in examination results between study participants with eBooks and examination results for the previous corresponding year cohort, without eBooks. Overall students with eBooks, only, stated a greater preference for eBooks when compared to students with eBooks and hard copies of books. Students reported that eBooks facilitated the accessibility of wide ranging learning materials through the different platforms at any time and any place in formal and informal locations; stimulated peer-to-peer interactions and supportive learning. In particular the potential to access text books on a phone introduced flexibility to student learning. Some difficulties reported related to the artifact of the digital technology and system unfamiliarity which highlighted the need for continuous technology support and guidance for students whilst using eBooks. The majority of students reported that they had not used an eBook prior to entering nursing school. The results show that the most common method of accessing the eBook was the PC however 16% of students reported using a smart phone most often. The most common place to use the eBook was the home, followed by the classroom, and out socially. Some the more negative reporting included: a minority of respondents suggested that eBooks caused problems such as headache, eye strain and backache due to continually using a machine to read the eBooks. User interface improved the usability of eBooks especially when the layout is organized and included supportive learning features such as: creating highlights; adding notes; sharing highlights and notes; definitions, translation; ability to copy and paste information, and cite and reference material for assignments. Participants also stated that the ability to perform split view allowed them to multitask and leads to better time utilization. Other important patterns of approaches to learning will be reported in the presentation.


Educational technologies have been slow to impact on medical and nursing education. Internationally there is a paucity of published work on the use of eBooks in nursing and there are no reported studies Bahrain. This study provides important educational insights into nursing students’ learning behaviours and studying approaches with the use of assisted technology. Training in the use of eBooks and technology support is essential in not only providing the necessary confidence to users, but also ensures that students embrace the full potential of eBooks in their learning. The outcomes of this study indicates that the use of eBooks adds a new dimension to nursing education.


1 Kirkwood, Adrian and Price, Linda (2014). Technology-enhanced learning and teaching in higher education: what is ‘enhanced’ and how do we know? A critical literature review. Learning, Media and Technology, 39(1) pp. 6–36.

2 Cowman S. (1995) The Learning/Teaching Preferences of Student Nurses in the Republic of Ireland. International Journal of Nursing Studies 32(2), 126-136.