Iran Journal of Nursing

Introduction
Clinical education is an important part of medical education. Clinical competency in nursing, which refers to a nurse’s ability to effectively apply knowledge and skills in patient care, is important. Due to the limitations of available educational fields for nursing students to learn clinical skills, there is an increasing need to create a situation for more collaboration between students and professors to improve practical learning. Collaborative learning seems to be more effective than other methods. On the other hand, virtual education in medical sciences has found a special place in recent years and has shown effective results. There is great potential for using web-based collaborative learning methods in medical education. This study aimed to investigate the effect of collaborative learning using WhatsApp on the clinical competence of Iranian nursing students.

Materials and Methods
This is a quasi-experimental study with a pretest/posttest design conducted in 2021. The research setting was the intensive care unit (ICU) of a teaching hospital affiliated with Rafsanjan University of Medical Sciences. The study population consisted of all intern students in the 7th semester of the nursing course at Rafsanjan University of Medical Sciences. To prevent data contamination, the study was conducted on students of one class, and participants and data analysts were blinded. The sample size was estimated to be 13.44 per group. By considering a 25% sample dropout, the sample size increased to 21 per group. A total of 42 students were randomly divided into two groups of training and control. A virtual group was created on the WhatsApp platform for the training group. For three weeks, they received educational materials, including the necessary clinical skills in the ICUs and disease reports in the form of scenarios. Information exchange between the students and professors was carried out on WhatsApp, and the students discussed and exchanged opinions regarding the scenarios of real patients hospitalized in ICUs based on the content, and shared the best diagnosis, treatment, and care according to their learning. The control group received the routine internship program in the ICU. 
The study instrument in this study was the clinical competency scale designed and validated by Ebadi et al in 2015. It has 44 items rated on a five-point Likert scale from 1 (never) to 5 (always). This tool measures five domains, including: care management (17 items), practical competence (8 items), individual management (11 items), patient-centered care (4 items), and knowledge seeking (4 items). The total score ranges from 44 to 220. A score of 44-73 reports low clinical competence, a score of 73-147 indicates moderate clinical competence, and a score>147 indicates high clinical competence. The data analysis was done in SPSS software, version 23 using descriptive statistics, independent t-test, paired t-test, chi-square test, and Fisher’s test. The level of significance was set at 0.05.

Results
In the control group, two participants were excluded. The mean age of respondents was 22±5.35 in the intervention group and 22.36±0.76 in the control group. There were 50% males in both groups, and 55.6% females in the intervention group, and 44.4% in the control group. There was no statistically significant difference between the groups in terms of age, gender, marital status, and place of residence (P>0.05). The results of the paired t-test showed a statistically significant difference in the mean score of clinical competence before and after the intervention in the training group (P=0.034); the collaborative learning through WhatsApp improved the clinical competence of nursing students. There was a significant difference between the intervention and control groups in the mean score of clinical competence.

Conclusion
Collaborative learning through WhatsApp can improve the clinical competence of nursing students. Therefore, managers of medical universities, hospitals, and educational centers in Iran should provide a favorable environment for the implementation of web-based collaborative learning methods to improve the learning and capabilities of nursing students.

Ethical Considerations

Compliance with ethical guidelines
The curent study obtained the ethical approval from   Rafsanjan University of Medical Sciences (Code: IR.RUMS.REC.1400.255). The participants were assured that their information would be kept confidential, and they had the right to leave the study at any time.

Funding
This article was extracted from the master’s thesis of Asma Kianfar, funded by Rafsanjan University of Medical Sciences.

Authors' contributions
Conceptualization and design: All authors; Data collection: Asma Kianfar and Tayebeh Jalali; Data analysis and interpretation: Asma Kianfar, Ahmad Reza Sayadi, Ali Khodadaizadeh, and Tayebeh Jalali; Writing: Asma Kianfar and Sakineh Sharifian; Critical revision: Ali Khodadadizadeh and Sakineh Sharifian; final approval: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellor of Research and Technology of Rafsanjan University of Medical Sciences for the financial support and all participants for their cooperation in this study.



 

1. Sportsman S. Competency education and validation in the United States: What should nurses know? Nursing Forum. 2010; 45(3):140. [Link] 
2. Sadeghi T, Ravari A, Shahabinejad M, Hallakoei M, Shafiee M, Khodadadi H. Performing of OSCE method in nursing students of Rafsanjan University of medical science before entering to clinical field inyear 2010: A process for quality improvement. Commun Health J. 2012; 6(1):1-8. [Link]
3. Liou SR, Chang CH, Tsai HM, Cheng CY. The effects of a deliberate practice program on nursing students' perception of clinical competence. Nurse Educ Today. 2013; 33(4):358-63. [DOI:10.1016/j.nedt.2012.07.007] [PMID] 
4. Mirlashari J, Qommi R, Nariman S, Bahrani N, Begjani J. Clinical competence and its related factors of nurses in neonatal intensive care units. J Caring Sci. 2016; 5(4):317-24. [DOI:10.15171/jcs.2016.033] [PMID] [PMCID] 
5. Pitt V, Powis D, Levett-Jones T, Hunter S. Factors influencing nursing students' academic and clinical performance and attrition: An integrative literature review. Nurse Educ Today. 2012; 32(8):903-13. [DOI:10.1016/j.nedt.2012.04.011] [PMID] 
6. Cant R, McKenna L, Cooper S. Assessing preregistration nursing students' clinical competence: A systematic review of objective measures. Int J Nurs Pract. 2013; 19(2):163-76. [DOI:10.1111/ijn.12053] [PMID] 
7. Slavin RE. Cooperative Learning and Academic Achievement: Why Does Groupwork Work?. Ann Psychol. 2014; 30(3):785-91. [DOI:10.6018/analesps.30.3.201201] 
8. Medina MS, Conway SE, Davis-Maxwell TS, Webb R. The impact of problem-solving feedback on team-based learning case responses. Am J Pharm Educ. 2013; 77(9):189. [DOI:10.5688/ajpe779189] [PMID] [PMCID] 
9. Ofstad W, Brunner LJ. Team-based learning in pharmacy education. Am J Pharm Educ. 2013; 77(4):70. [DOI:10.5688/ajpe77470] [PMID] [PMCID] 
10. MacGregor J, Cooper JL, Smith KA, Robinson P. Strategies for energizing large classes: From small groups to learning communities. San Francisco: Jossey-Bass Inc; 2000. [Link]
11. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven L. Definition of Health 2.0 and Medicine 2.0: A systematic review. J Med Internet Res. 2010; 12(2):e18. [DOI:10.2196/jmir.1350] [PMID] [PMCID] 
12. Payne KB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): A regional survey. BMC Med Inform Decis Mak. 2012; 12:121. [DOI:10.1186/1472-6947-12-121] [PMID] [PMCID] 
13. Sclafani J, Tirrell TF, Franko OI. Mobile tablet use among academic physicians and trainees. J Med Syst. 2013; 37(1):9903. [DOI:10.1007/s10916-012-9903-6] [PMID] [PMCID] 
14. Kitching F, Winbolt M, MacPhail A, Ibrahim JE. Web-based social media for professional medical education: Perspectives of senior stakeholders in the nursing home sector. Nurse Educ Today. 2015; 35(12):1192-8. [DOI:10.1016/j.nedt.2015.05.013] [PMID] 
15. Magro MJ. A review of social media use in e-government. Adm Sci. 2012; 2(2):148-61. [DOI:10.3390/admsci2020148] 
16. Karimiankakolaki Z, Eslami A, Gerayllo S, Heidari F, Hajataghaie SS, Goudari SB. Effect of education using the virtual social networks on promoting women's self-efficacy in preventing osteoporosis. J Educ Commun Health. 2018; 5(3):57-62. [DOI:10.21859/jech.5.3.57] 
17. Schriver JA, Talmadge R, Chuong R, Hedges JR. Emergency nursing: Historical, current, and future roles. Acad Emerg Med. 2003; 10(7):798-804. [DOI:10.1197/aemj.10.7.798] [PMID] 
18. Tabari Khomeiran R, Deans C. Nursing education in Iran: Past, present, and future. Nurse Educ Today. 2007; 27(7):708-14. [DOI:10.1016/j.nedt.2006.10.003] [PMID] 
19. Rassouli M, Zagheri Tafreshi M, Esmaeil M. Challenges in clinical nursing education in Iran and strategies. J Clin Excell. 2014 Mar 10; 2(1):11-22. [Link]
20. Ebadi A, Tabanejad Z, Pazokian M, Saeid Y. [Clinical competence among MSc students of critical care nursing (Persian)]. Iran J Med Educ. 2015; 14(12):1030-9. [Link]
21. Yang L, Jiang D, Nie H, Tang S. Research on the effect of cooperative learning model on nursing skills of practice nurses and standardized training of newly-recruited nurses. Biomed Res. 2018; 29(9):1788-91. [DOI:10.4066/biomedicalresearch.29-17-3992] 
22. Hemmatipour A, Jahangirimehr A, Safari DZ, Hatami A, Arizavi Z. [The effect of education using social networks on knowledge and performance of nursing students in regard to safe injections (Persian)]. J Mil Med. 2020; 22(3):306-13. [Link]
23. Tran VD. Does cooperative learning increase students' motivation in learning? Int J High Educ. 2019; 8(5):12-20. [DOI:10.5430/ijhe.v8n5p12] 
24. Rashidi Fakari F, Kordi M, Mazloom SR, Khadivzadeh T, Tara M, Akhlaghi F. [Comparing the effect of traditional, web based and simulation training on midwifery students' clinical competence in postpartum hemorrhage management (Persian)]. J Mazandaran Univ Med Sci. 2015; 25(123):65-77. [Link]
25. Behrangi M, Agha Yari HT. [Developing the traditional instruction based on Jig-Saw cooperative model of teaching (Persian)]. J Educ Innov. 2005; 3(10):35-53. [Link]
26. Bogam RR, Khan AS. Jig saw technique: An interactive approach to sensitize medical students in Saudi Arabia about Type 2 diabetes mellitus. J Educ Technol Health Sci. 2016; 3(3):107-10. [Link]
27. Lu DF, Lin ZC, Li YJ. Effects of a Web-based course on nursing skills and knowledge learning. J Nurs Educ. 2009; 48(2):70-7. [DOI:10.3928/01484834-20090201-10] [PMID] 
28. Brettle A, Raynor M. Developing information literacy skills in pre-registration nurses: An experimental study of teaching methods. Nurse Educ Today. 2013; 33(2):103-9. [DOI:10.1016/j.nedt.2011.12.003] [PMID]