Comparison the Effect of Paper-based versus Electronic Nursing Process on Clinical Decision-Making of Nursing Students


1 Ph.D. Student in Nursing, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Assistant Professor, Medical Surgical Department, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.

3 Medical Surgical Department, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Associate Professor, Management Department, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.



Background: Clinical decision-making skill development, have paramount importance for systematic reasoning performance, so it is essential to implement thinking oriented scientific methods such as nursing process in the nursing education programs. This study aimed to compare the effect of implementing nursing process based on paper-based vs. electronic methods on clinical decision making of undergraduate nursing students.

Method: This semi-experimental study was conducted with the participation of 64 nursing students of Mashhad University of Medical Sciences, Iran, who were randomly assigned to two groups (each group of 32 students) to implement the nursing process using paper-based vs. electronic methods. The intervention consisted of holding a one-day workshop on the nursing process for selected students (two groups), and then implementing the nursing process in two methods during the two weeks of internship for the patients under their care. Before and after the intervention, the clinical decision-making of two groups were measured with Lauri's clinical decision-making questionnaire (version 2001). Data were analysed using SPSS software version 16.0

Results: 64 undergraduate nursing students participated in this study, 60.9% (39 students) of them were women. Results showed that before the intervention, the clinical decision score of the students of the paper-based group was 65.5±3.2 and the electronic group was 63.3±3.4 (range: 24-120). After the intervention, it was 72.0±9.2 and 78.8±11.0, respectively, which increased by 9.9% and 24.2% compared to before the intervention (p<0.001).

Conclusion: Based on the results, after intervention, the clinical decision-making ability of students in the electronic group was higher. Therefore, by using electronic tools and facilitating the implementation of the nursing process, the clinical decision-making skills of students were improved, and it is recommended to pay more attention to this educational method in the planning of nursing education.