Methods: The protocol of this review of SRs has been published elsewhere (Rouleau et al., 2017). The general methods for Cochrane reviews (Higgins & Green, 2011) and other relevant works (Becker & Oxman, 2011; Lunny, Brennan, McDonald, & McKenzie, 2016; Smith, Devane, Begley, & Clarke, 2011) were used as guidance to conduct and report this review of SRs. The search strategy was developed by the research team and validated by a health information specialist. We searched for relevant publications in PubMed, CINAHL, Embase and Joanna Briggs Institute electronic databases. The eligibility criteria were formulated using the PICOS model (Centre for Reviews and Dissemination, 2009; O’Connor, Green, & Higgins, 2011). Participants: RNs using e-learning. Interventions: e-learning interventions. Comparisons: face-to-face and (non)electronic learning. Outcomes: We used the Nursing Care Performance Framework (NCPF) to organize the outcomes of interest (Dubois, D’Amour, Pomey, Girard, & Brault, 2013). Studies: Systematic quantitative, qualitative and mixed studies reviews (MSRs) published in English, French or Spanish from January 1, 2006 were considered. Three reviewers independently screened the title and abstract first, and then the full texts of potentially relevant papers in order to assess eligibility. Using a predefined form, three reviewers extracted the characteristics and findings from the selected reviews. Two reviewers independently performed critical appraisal with two tools: AMSTAR 2 (Shea et al., 2017) and ROBIS (Whiting et al., 2016). In order to integrate the results from various types of SRs, we performed a qualitative thematic synthesis using a databased convergent synthesis design (Creswell, 2014; Pluye & Hong, 2014). We qualified quantitative data, meaning that we used a textual and narrative approach to name and qualify the effect.
Results: 12428 titles/abstracts were screened; full-text papers of 183 articles were retrieved and 17 publications met the eligibility criteria. Nine were MSRs and eight were quantitative reviews. RN were at different stages of their career, had different title job and worked in different settings (e.g. intensive care units, emergency, coronary care units, medical-surgical, pediatrics, mental health, palliative care, geriatric hospital). Examples of technologies used for supporting e-learning were: computer-assisted instructions, CD-ROM, videoconference, situated e-learning, virtual journal club, social networking and web-based program computer-assisted instructions. These e-learning interventions were compared to electronic interventions, face-to-face interventions, no intervention or blended learning. Only three reviews of SRs mentioned the use of theoretical approaches (e.g. adult learning theory, Kirkpatrick model) to guide the development and/or the evaluation of e-learning interventions. The most frequently reported outcomes were: learning; nurses’ competencies and skills; nurses’ satisfaction with using e-learning; and assessment, care planning and evaluation.
Conclusion: The reviewed SRs present heterogeneity in terms of population, interventions, workplace settings and designs. This heterogeneity can complexify the understanding of the components of the e-learning intervention that cause a specific effect; but it can also broaden the overall portrait of the effects of e-learning interventions on a range of indicators underlying nursing care. To the best of our knowledge, this is the first review of systematic reviews that uses the NCPF to draw a broad, multidimensional and systems-based perspective on the dimensions and indicators of nursing care that can be impacted by e-learning interventions.