An Interdisciplinary Partnership Approach
to Improving the Digital Literacy Skills of
Nursing Students to Become Digitally
Fluent, Work-Ready Graduates
Zeruba LOKMIC-TOMKINSa,b,1, Lindy COCHRANE c,
Tania CELESTE c and Morag BURNIEd
a
Department of Nursing, The University of Melbourne, Australia
b
Centre for Digital Transformation of Health, The University of Melbourne, Australia
c
Library Services, The University of Melbourne, Australia
d
Academic Skills Unit, The University of Melbourne, Australia
Abstract. Digital transformation and the development of a digitally fluent nursing
workforce are necessary for engagement with digital technologies in healthcare
settings. For this purpose, educators aim to develop workforce-ready graduates
equipped with disciplinary knowledge, expertise, and digital capabilities supportive
of further professional development. Having identified a subset of nursing students
with low levels of digital literacy, the nursing faculty engaged with library services
and the academic skills unit to develop and embed a sustainable Nursing Digital
Literacy Module in the graduate entry to practice nursing program. This paper
reports on the model created and early evaluation of the student uptake of the module.
Keywords. Digital literacy, digital health, nursing students, education, workforce,
library
1. Introduction
The implementation of digital health technologies into healthcare environments depends
on the agility of the healthcare workforce to adapt, use, and effectively contribute to the
development of these innovations. Unfortunately, literature suggests that some nursing
students have low levels of digital literacy [1], which was incidentally observed at this
university. Following identification of a small cohort of first year graduate entry to
practice Master’s nursing students, possessing low digital literacy skills to manage their
studies and assessments related to the course and work-integrated learning environments
(WIL), nursing academics recognized that a significant intervention was required to
address digital literacy in this population. Without this intervention, this student
population was unlikely to successfully meet their course requirements. Addressing
deficits in digital literacy is important as students were likely to carry low levels of digital
literacy into their nursing practice thus potentially having a negative impact on patient
1 Corresponding Author, Zerina Lokmic-Tomkins, Department of Nursing, The University of Melbourne,
Grattan Str, Melbourne, Australia; E-mail: [email protected].
Nurses and Midwives in the Digital Age
M. Honey et al. (Eds.)
© 2021 International Medical Informatics Association (IMIA) and IOS Press.
This article is published online with Open Access by IOS Press and distributed under the terms
of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0).
doi:10.3233/SHTI210679
103
outcomes [1]. To address the issue, the academic nursing team reached out to the
discipline-specific librarian to identify a diagnostic tool that could help identify gaps in
basic digital literacy skills to be addressed through purposeful intervention. The team
aimed to build a long-term, sustainable partnership and create a digital literacy module
embedded in a learning management system (LMS) for easy access to students. This
paper describes the results of this partnership.
2. Methods
2.1. Development of the Module Brief
Initial planning for the brief comprised the nursing program director, two staff members
from the academic skills unit, the digital capabilities project coordinator, discipline
librarian and two liaison librarians. The initial discussions focused on the needs of
students to meet course requirements and WIL. The planning evolved towards the need
to prepare nursing students with digital skills required to meet the demands of digitally-
driven healthcare environments. The assumption was made that the module content must
meet the needs of the students whose digital literacy was lowest whilst containing
elements engaging to students whose level of digital literacy was higher. The module
had to be scaffolded so that the complexity of digital literacy could be expanded as the
complexity of the course and WIL environments grew. Students could access the module
as needed. Through reiterative discussion, the team decided that the module should
contain seven themes: Theme 1: Digital skills required to use LMS, including WIL
systems; Theme 2: Basic Computer Skills; Theme 3: Internet Basics; Theme 4: Using
Email; Theme 5: Microsoft Word. Theme 6: Microsoft PowerPoint.; Theme 7: Using
Library to improve information literacy skills. These themes provided the anchor where
there was a danger of being overwhelmed on what to include in each module.
2.2. Screening Tools
The team explored existing generic diagnostic tools and resources such as a) the Digital
Competence Wheel’ [2], b) E-health Literacy Assessment Toolkit [3], and c) ’All
Aboard’ [4] as means to allow students to self-identify deficits in digital literacy. When
discussing the tools, the guiding principle was that the tool would be adaptive to the
needs of the discipline and help identify students who needed more significant support
and referral to further resources.
2.3. Module Composition
The module was developed to assist students to build digital literacy skills essential for
full engagement with their nursing studies and WIL. As the students are time-poor, the
module was designed to be worked through as a series of steps, to work at their own pace.
Using existing resources that were freely accessible to the university and internally
available resources, the librarians curated these resources utilizing the brief to create a
module that incorporated the diagnostic tools and the learning resources needed to
address self-identified deficits. The need for the resources to be freely available, of good
quality and reliable, was imperative due to the need to facilitate the long-term
Z. Lokmic-Tomkins et al. / An Interdisciplinary Partnership Approach104
sustainability of the module utilization without causing undue constraints on the
operating budget to any of the partners involved. In addition, it was reasoned that with
free resources, this model could be transferred to any setting where there was a need to
improve future workforce digital literacy skills.
For each of the seven themes (see section 2.1), the student had an option to self-
assess their skill level on a chosen topic before commencing the module, record their
results using a poll for each skill, and undertake online training to learn new digital
literacy skills by clicking on the links suggested. After that, the student could undertake
the same assessment to determine if there was an improvement in their skill. In Theme
1, students could watch a series of videos that provided an overview of the LMS, navigate
to different areas of the course, navigate the assessment tab, view lists of assignments,
and submit the assessment, view feedback and allocated grades. For Themes 2 to 6, the
students were directed to an external site (Northstar Digital Literacy) [5]. The student
could take a public version of a short assessment and receive a report on their skill level
for basic computer skills. The generated report provided the student with information on
skills to improve. Students could self-select relevant links to resources for further
learning in areas that were identified as deficient.
The librarians developed a ‘private link’ to the module. The nursing academic team
then embedded the private link in four first-year core subjects. As the link was private,
the discipline librarian could monitor the overall student engagement and student
participation in the modules.
2.4. Analysis of Engagement
A number of total views for each theme and the number of views across the academic
year were collected to analyse student engagement. For this program, the student
orientation week runs mid-February, whilst the academic year spans from March to the
end of November. Therefore, data presented in this study spans the period from January
2020 to April 12, 2021, noting that during January 2021, the nursing academic team
accessed the resource to review the modules.
3. Results
The module was completed on the 22nd of January 2020. In 2020, the course enrolled
160 first-year students. In 2021, the course enrolled 164 first-year students.
3.1. Screening Tool
Although several tools were considered as means of identifying students at risk of low
digital skill literacy, it was concluded that the implementation of the tool into curriculum
structure would be complex as none of the diagnostic tools were adaptive enough to
facilitate specific referral of the student to a set of resources needed to address the
student’s individual needs. There was also the issue of non-completion, how students
responded to questions and what impact this would have on students in terms of time
needed to complete the self-assessment. There was also the issue of where the diagnostic
tool would be implemented so to avoid duplication. Furthermore, as the tool needed to
be completed before starting the program, there was also an issue regarding whether a
student with poor digital literacy skills would have the necessary skills to access and
Z. Lokmic-Tomkins et al. / An Interdisciplinary Partnership Approach 105
complete an online test without help. For this last reason, it was decided that the
screening tool will not be implemented. Instead, each academic will promote the module
to students through voluntary, self-directed engagement driven by adult learning
principles [6]. The academic team would promote modules before any
activity/assessment that required specific digital skills for successful completion. In
addition, the liaison librarian would promote the module during student orientation week,
which occurs one week before students commenced studies
3.2. Engagement with the Module
As the module was embedded in the LMS and the library organized private link access
for nursing students, it was possible to track student engagement. Table 1 presents the
total number of views for each module. Figure 1 shows the number of views since the
module’s implementation to the 12th of April 2021.
Table 1. The number of total views of individual module themes since module implementation.
Theme Number of views
Digital Literacy Module 724
Theme 1: Using a learning management system 143
Theme 2: Basic computer skills 103
Theme 3: Internet basics 69
Theme 4: Using email 50
Theme 5: Microsoft Word 60
Theme 6: Microsoft PowerPoint 45
Theme 7: Using the library 85
Feedback 0
Figure 1. The distribution of the number of times students viewed the Digital Literacy modules since
implementation. A) During 2020; B) Since January 2021.
4. Discussion
The initial project brief aimed to identify students with low digital literacy skills so that
such deficit can be corrected and not transferred into their registered nurse practice,
negatively impacting patient outcomes [1]. The idea to screen all students was abandoned
as this could not be achieved in terms of sustainability and student tracking. Instead, the
model had to rely on active promotion by the nursing academic team and discipline
Z. Lokmic-Tomkins et al. / An Interdisciplinary Partnership Approach106
librarians. Another challenge that the team encountered was that during the ‘storming’
of ideas, there were substantial differences between what the nursing academics thought
was required and what the academic skills unit and library representatives thought was
needed. It took some time to recognize that building more sophisticated digital literacy
skills rested on addressing the coalface issues rather than implementing the module with
a higher degree of complexity that made assumptions on the existing level of digital
literacy. The team considered this to be the next step in scaffolding digital literacy skills
in the nursing program. As ideas evolved, the team experienced attrition from the group
whereby members with specific interests pulled out as they felt that their expertise was
not required.
Data obtained so far suggests that students have engaged most with the module with
Theme 1, which is focused on digital literacy needed to navigate the LMS used in the
course and WIL. This reflects the need of students to use this platform daily to manage
their nursing studies and WIL. This was followed by basic computer skills (Theme 2)
and using the library (Theme 6). The data does not tell us which students have accessed
the resources, whether each view was attributable to a different student, or if the same
subpopulation of the student cohort continuously engaged with the source to improve
their digital literacy. It is noted that students left no feedback on the module. This may
reflect being time-poor, not understanding the importance of providing feedback, or how
this module is scaffolded into formal assessment taking place within the course, whereby
course assessment completion depends on the digital literacy skills. The next step in this
module is to increase student engagement on adult learning principles [6] and build the
complexity of digital literacy skills to reflect the increasing needs of healthcare
environments, including informatics. More work is planned on engaging with the student
cohort to obtain feedback on the modules and how this can be improved to meet their
needs as they transition to nursing practice.
5. Conclusion
Addressing nursing students’ deficits in digital literacy skills during university study is
an intervention that may facilitate nursing student timely progression through their
studies and better transition to nursing practice in digitally-driven healthcare
environments. The model reported here is relatively inexpensive, transferable to any
settings where a library exists and permits the healthcare student/staff to engage in their
own time and privacy.
References
[1] Brown J, Morgan A, Mason J, Pope N, Bosco A. Student nurses’ digital literacy levels: Lessons for
curricula. CIN: Computers, Informatics, Nursing, 38 (2020), 451-458.
[2] Skov A. The digital competence wheel. last accessed on 2021-05-06
[3] Karnoe A, Furstrand D, Christensen KB, Norgaard O, Kayser L. Assessing competencies needed to
engage with digital health services: Development of the eHealth literacy assessment toolkit. J Med
Internet Res 2018;20(5):e178 doi: 10.2196/jmir.8347
[4] All Aboard. Digital skills in higher education. last accessed on 2021-05-06
[5] Northstar Digital Literacy. last accessed 2021-05-04
[6] Merriam SB, Bierema LL. (2013). Adult learning: Linking theory and practice. Jossey-Bass. 2013.
Z. Lokmic-Tomkins et al. / An Interdisciplinary Partnership Approach 107
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