The effect of a mobile clinical decision support application on clinical decision-making skills and satisfaction in undergraduate nursing students

Clinical decision-making is an essential nursing skill that undergraduate nursing students struggle to develop. This dissertation comprises two manuscripts focusing on mobile clinical decision support (mCDS) resources in undergraduate student nurses: a systematic literature review and an empirical intervention study. The literature review manuscript identified which mCDS resources student nurses utilized and assessed how they affected students’ knowledge, skills, and perceptions. Information related to medication administration and medical calculators was most commonly sought. There were mixed results on the effects of mCDS apps on students’ knowledge and skills. None of the studies evaluated the impact of an mCDS app on students’ clinical reasoning or decision-making. The second manuscript presents a randomized controlled trial with pre-test and post-test design. The Technology Acceptance Model guided the study. The experimental group (EG) (n = 26) used an mCDS app (Medscape) while completing sepsis and cardiac tamponade scenarios, while the control group (CG) (n = 28) used traditional tools. Outcomes included the students’ perceptions of the usefulness, ease of use, attitude toward use, satisfaction with, and behavioral intent to use the app, as well as self-efficacy in clinical reasoning and decision-making skills.
Students in the EG positively perceived the usefulness, ease of use, attitude toward use, satisfaction with, and intent to use the mCDS app. Perceived usefulness and attitude toward use were significant predictors of intent to use the app. After completing the scenarios, the change in clinical reasoning scores over time differed for the two groups; scores increased in the EG but declined in the CG. Also, the EG had significantly higher clinical reasoning scores than the CG. In exploring the cardiac scenario, the EG had higher clinical decision-making scores than the CG. However, the groups did not differ significantly regarding sepsis or combined total scenario scores. This study showed that mCDS apps promote clinical reasoning and decision-making. However, future research should utilize diverse clinical scenarios with varying complexity and include a more diverse population from multiple universities and other settings, such as simulation exercises, to ensure the generalizability of the findings and support students’ use of mCDS apps during clinical practice.