Strengths and Limitations of This Study

• This study systematically conducted a scoping review following a predeveloped protocol, and the search process can be highly trusted due to the keyword selection and literature search conducted by search experts.
• This study focuses on Internet of Things (IoT) platforms used in undergraduate nursing education. However, considering the global trend toward digitalized education, the future directions for the IoT platforms suggested in this study through the facilitating factors and barriers can attract international interest.
• Because the scope of this study was limited to classes within schools, excluding IoT platforms as an alternative to clinical practice, it is difficult to draw a generalized conclusion.  

Introduction

Internet of Things (IoT) are everyday objects and devices connected through wireless networks [1] thus, these objects allow the uninterrupted exchange of information with a wireless internet connection, regardless of time and location. The term “platform” means “flat raised area or structure” and means various things, including a subway platform for people to get on and off, a podium for public speaking, and a specific type of computer technology that cannot be shared with other programs [2]. In education, an IoT-based platform refers to a collection of connected technologies and infrastructures that enable communication through the Internet and a set of relationships and networks that promote participation and collaboration.

In future education, IoT-based platforms serve as a collection of values and principles that determine the purpose and direction of education, influencing the content, curriculum, evaluation, and teaching methods [3]. In particular, in times of pandemics, natural disasters, and wars, IoT-based platforms provide educational access for learners who cannot physically be present in classrooms due to safety, health, or mobility issues [4]. Given that each learner has different learning styles, preferences, or requirements, IoT-based platforms not only provide various learning resources and activities to supplement and enhance face-to-face education when hybrid learning is needed but also allow learners to progress at their own pace and choose their learning paths and goals when individual learning is required, such as when learners have different prior knowledge, skills, or interest levels [5].

IoT-based platforms can be optimized for personalized learning in various situations. Therefore, understanding how IoT technology is being used in education is essential to prepare for future education. Undergraduate nursing education has faced issues and limitations with traditional in-classroom teaching strategies, such as lack of student participation, insufficient feedback, and difficulty applying evidence-based learning in real clinical situations [6]. To overcome these problems and limitations, research is being conducted on hybrid learning, which uses online platforms or resources like IoT-based education to provide part or all of the course content [7]. However, most research has focused on literature that virtualizes simulations as alternatives to clinical education [8-11]. If students have solid and accurate theoretical knowledge for the right time before clinical practice, it will be a strong foundation for building knowledge for clinical practice. Meaningfully structured knowledge will allow them to effectively and efficiently search and apply it during clinical practice [12]. In other words, the robust knowledge structure of IoT-based platforms can be the basis for improving the quality of future undergraduate nursing education.

A scoping review is an evidence synthesis that aims to provide a comprehensive overview of the available literature on a broad topic. Its goal is to identify and map evidence organized and transparently about important concepts, sources, gaps, and issues related to the topic [13]. A scoping review increases the overall understanding of the research topic and helps gain new ideas by identifying the trends and future directions of the topic [14-16]. Therefore, conducting a scoping review on the use of IoT platforms in undergraduate nursing education can enhance the current understanding of how IoT platforms are used in nursing education, identify the direction and future trends of research and serve as a foundation for generating ideas for a new undergraduate nursing education based on IoT platforms.

Scoping reviews in nursing education have been conducted, such as a scoping review on guidelines for nursing and midwifery students [17], and a scoping review on team-based learning in nursing education [18]. There have also been studies on IoT-based platforms in undergraduate nursing education, such as researching platforms for learning nursing processes for home visits [19] and developing platforms for learning nursing processes for various cases [20]. However, a scoping review of IoT-based platforms used in undergraduate nursing education is difficult to find.

As a result, this research conducts a scoping review to propose the direction of IoT-based platforms for future undergraduate nursing education.

The following research questions were formulated:

1. What are the characteristics of the IoT platform educators and nursing students use in undergraduate nursing education?
2. What are the scientific and technological characteristics and scope of the IoT platforms used in nursing undergraduate education?
3. What are the barriers and facilitating factors of IoT platforms used in undergraduate nursing education to prepare for the future nursing education environment?

Methods and Analysis

Protocol and Registration

The protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) and revised by the research team and contributing members [21]. The finalized protocol was registered prospectively with the Open Science Framework (OSF) on September 7, 2021 (https://doi.org/10.17605/OSF.IO/DHZFR).

Eligibility Criteria

All studies focused on nursing students included in undergraduate nursing programs were incorporated in the scoping review. All literature that discusses the use of scientific technologies of IoT platforms in undergraduate nursing education was also included. This research limited the context to undergraduate nursing education programs, excluding graduate nursing aide, maternity nurse courses, and nurse training institutions. Eligible research is not limited to geographical limitations. The study design was not limited, but those without discernible content related to IoT platforms were excluded. All reports that utilized the IoT platform technology were included. Still, given the large volume of literature about VR platforms in undergraduate nursing education, the eligibility was limited to theoretical undergraduate nursing courses, excluding studies on scenario development for simulations or performance checklists. While there were no constraints on the form of literature, editorial formats and personal opinions for which the content could not be determined were excluded. As the advent of IoT was mentioned in the 2015 Davos Forum [22], research before 2015 was not considered. This study did not give particular attention to the research design, and language was restricted to English or works providing English translations. The specific eligibility criteria are outlined in Table 1. 

Table 1: Inclusion criteria for the scoping review

Information Sources

To search for relevant documents, databases such as PubMed (NCBI), Embase (Elsevier), Cochrane Library and Cumulative Index to Nursing & Allied Health (CINAHL) were searched during the period from January 1, 2015, to August 12, 2022.

Search

The final search strategy in Pubmed can be found in Table S1.

Table S1: Search strategy for the current study

Selection of Source of Evidence

References retrieved through an information search expert [23] were imported into Endnote ver. 20.0.0 (Clarivate Analytics, Pennsylvania, USA), and duplicates were removed. Final data retrieved via the information searcher based on the title and abstract were screened following the established inclusion criteria. Subsequently, full texts of relevant studies were researched and selected. In cases where there was a discrepancy in opinion, it was rediscussed. Finally, the selected pieces of full-text literature were reviewed to determine if they met the inclusion criteria. In contrast, full-text articles were examined to determine if they followed the “narrow and well-defined” inclusion criteria. In this process, ambiguous cases were discussed multiple times.

Data Charting Process

In the data charting process pilot phase, the data that were difficult to extract because detailed content was not described, such as perception equipment, access unit, access network, middleware, application, and judge server, were integrated as technology utilization. System-related aspects of learners and teachers were integrated as functions using the system. To further specify the characteristics of the study, “Content” and “Teaching method” were added to the analytical framework. Data were extracted using Excel based on the developed protocol.

Data Items

The general characteristics of the extracted studies were categorized into authors, affiliation, Publication year, country of origin, purpose, study design, and population / sample size. On the other hand, the characteristics of IoT platforms were categorized into platform type, perception equipment, access unit, access network, middleware, and technology used, considering the application. Moreover, the scientific and technological characteristics and scope of the IoT platform were categorized into scientific and technical aspects utilized by the learner and teacher sides, content and teaching method, and barriers and facilitating factors of the IoT platforms were also used for the table.

The results were synthesized to propose the direction of the IoT platform used in future nursing undergraduate education. The analysis results for each research question were grouped, and a wide range of results for the general literature characteristics for each question was summarized, including the characteristics of the IoT platform, scientific and technological utilization, facilitating factors, and barriers to future directions.

Result

Selection of Sources of Evidence

Out of 6,880 pieces of literature, 3,571 citations were identified from searches of electronic databases. Based on the title and the abstract, 3,331 were excluded as they did not meet the eligibility criteria, leaving 240 full-text articles retrieved and assessed for inclusion. Sixteen full-text studies were selected for inclusion in this scoping review. A PRISMA flow diagram depicts the study selection process in Figure 1.

Figure 1: A PRISMA flow diagram.

Characteristics of Sources of Evidence

Of the first authors, nine were in nursing (^#S1¬–S6, S8, S10, S12). Of coauthors, including corresponding authors, six were in nursing (^#S3-S6, S13, S15). In terms of population, 11 targeted only nursing undergraduates (^#S1,S3, S5,S6,S8-S13,S16). Sample size ranged from a minimum of 25 (^#S2) to a maximum of 455 (^#S13), and there was a case (^#S7) where it was developed for nursing students but not applied. The selected literature was conducted in various countries, including five in the United States (^#S3,S5,S6,S12,S15); three in Brazil (^#S2,S7,S11); two in Taiwan (^#S4,S16) and Canada (^#S10,S13); and one each in South Africa, the United Kingdom, Portugal, Jordan, Sweden, and Egypt. The specific details of Characteristics of Sources of Evidence are presented in Table 2. 

Table 2: General characteristics of the selected articles.

Characteristics of the IoT Platform

The characteristics of the IoT platform were analyzed based on platform type, access, and application. Depending on the platform type, 15 cases were based on online applications, and 1 (^#S6) used a separate device. As for the application, two studies focused on Facebook (^#S4, S8), while another two studies focused on Moodle (^#S2,S11). WhatsApp platform (^#S1), Zoom (^#S3), 3D Game Lab (^#S5), Plataforma Pensinar (^#S7), a web-based platform for drug calculation (#S9), a multiplatform–based (class response system) on Top Hat software (^#S10), VoiceThread (^#S12), e-textbook (^#S13), Blackboard Collaborate platform (^#S14), Microsoft Teams and Stream (^#S15), and National Taiwan University’s web-based anatomy atlas (NTU-WAA) (^#S16), indicating a wide variety, were highlighted in one study each. One study (^#S6) could be accessed only through a separate device like an iPad. Regarding access, in 14 cases, all devices connected to the internet could be used to access the platform (^#S3-S5, S7-S16); however, there was 1 case where access was possible only through a personal mobile device (^#S1); 1 case where access was possible through a notebook, smartphone, and microcomputer (^#S2); and 1 case where access was possible only through an iPad (^#S6). In terms of the application of platforms used in undergraduate nursing education, 6 cases provided a discussion environment (^#S1-S3, S10-S12); 14 cases provided an online learning environment (^#S2-S13,15,16); 3 cases provided a social network environment (^#S2, S4, S11); 3 cases that provided online examinations (^#S6, S7, S10, S13); 6 cases that provided homework (^#S2,S7,S10,S11,S13, S14); and 5 cases that provided team activities (^#S2,S3,S7,S14,S15).

Scientific and technological characteristics and scope of the IoT platform

The scientific and technological scope used in nursing education included question and answer, discussion, real-time lectures, surveys, video sharing, tests, feedback, connection to other sites, provision of learning materials, wall posts, team activities, and assignment activities. For instance, ^#S1 used an application that provided a discussion environment but operated the question-and-answer section separately. In the case of ^#S2, although it utilized online learning, scientific and technological features were used in question and answer through quizzes, discussion, real-time lectures, video sharing, tests, feedback using comments, connection to resources, and provision of learning materials through presentations and memo summaries.

Facilitation factors and barriers of the IoT platform

The barriers for the IoT platforms include technological issues, such as battery problems (^#S1); issues with the integrated platform and game system (^#S5); connection issues (^#S6,S8-S10); complexity (^#S15); and lack of communication (^#S16). From the learners’ perspective, barriers included self-management (^#S2, S3, S8); adaptation difficulties (^#S5, S11-S13,15); privacy issues (^#S8); the importance of individual literacy skills (^#S9); and class disruption (^#S10). From the teachers’ perspective, barriers included the need for tutors (^#S2), the need for postmanagement (^#S4), difficulties in meeting diverse multidisciplinary requirements (^#S4), the need for development due to inappropriate content (^#S5), lack of resources and participants (^#S7), absence of evaluation and unclear standards for competence enhancement (^#S9), increased time spent outside of class (^#S15), lack of platform guidelines (^#S15), difficulties in evaluating increases in confidence, etc., (^#S16), and the need for additional education for theoretical knowledge (^#S9,S16).

As facilitating factors for the IoT platform, positive learning–related facilitators such as increased support with learning (^#S2,S4,S6,S8-S11,S13,S15,S16); level-specific learning (^#S3,S8,S9,S16); improved interest (^#S12); potential for curriculum integration (^#S10); a paradigm shift in learning (^#S7); and deep thinking (^#S12) were identified. Environmental facilitators such as comfort (^#S4, S8, S9, S12); reliability (^#S7); enhanced participation (^#S10, S13); the importance of teaching strategies (^#S11); the possibility of virtual team activities (^#S14); and diverse problem-solving methods (^#S15) were suggested. Interactively facilitators such as anonymity (^#S1); interaction (^#S2,S7,S8,S14); quick feedback (^#S6); the potential for diverse content development (^#S11); and improvement of communication difficulties (^#S16) were also identified (Table 3).

Table 3: Facilitating factors and barriers of selected articles.

Synthesis of Results

In this study, and authors of the selected literature were mostly in nursing, medicine, and healthcare. There was only one case, PEnsinar^®, that involved the development of an IoT platform as well as content. Regarding scientific and technological utilization, there were only cases where traditional teaching methods were transformed online, and it was difficult to find evidence of advanced teaching methods. Based on this study, the identified barriers in undergraduate nursing education were technological difficulties, self-management’s importance, adaptation difficulties, and privacy issues. The facilitating factors were increased support with learning and level-specific learning, comfort, anonymity, and interaction, which were positive, environmental, and interactive.

Discussion

In this scoping review, 16 studies on the use of IoT platforms in undergraduate nursing education were analyzed. Of these 16, the first authors of 14 studies were in the fields of nursing, medicine, and health, and the coauthors, including the corresponding authors, of 15 studies were also from the fields of nursing, medicine, and health, with only one from exact science. Many studies have already been conducted on the need for convergence between nursing and other fields. For instance, research calls for converging nursing and other disciplines for improved caring [24], emphasizing professional socialization in nursing [25]. However, finding convergence with fields such as engineering, sociology, and business studies was challenging in researching IoT platforms in nursing education. Active integration with other fields is needed to prepare for future nursing education.

Three studies developed IoT platforms solely for nursing education, and five developed both the platform and content. The three studies that only developed a platform focused on nursing processes, student response systems, and response systems at the level of social media and the platform dedicated to undergraduate nursing education can only be found in PEnsinar^{® #}S7. The five studies that developed both a platform and content concerned using a game application and Facebook for adult health nursing and advanced health nursing subjects and developing drug calculations, digital textbooks, and anatomy textbooks developed in two languages, usually auxiliary means in undergraduate education. The only case where the developed platform is dedicated to the purpose of undergraduate nursing education was the case of S8 using Facebook. Some examples include interactive screens, voice-to-text technology, webcams in classrooms, electronic bracelets, head sensors, and smart classrooms. There is a wide range of IoT applications in the educational sector, such as video projectors, sensors, and facial recognition algorithms [26]. However, the use of IoT in undergraduate nursing education, as identified in this study, has not yet been integrated with the scientific technologies used in these research results. Therefore, future researchers would have to try to understand the level of the latest scientific technologies and actively incorporate these technologies into undergraduate nursing education.

The platform type was application-based in 15 cases, and one involved the use of separate devices, with 14 cases being able to connect with any electronic device connected to the internet. In addition, the teaching methods used with these platforms were not so much appropriate for the IoT platform but rather applied existing teaching methods. However, an existing scoping review on the impact of artificial intelligence on nursing education [27] has already called for curriculum reform and new teaching methods in nursing education for the AI era, integrating knowledge and technology. This observation indicates that the actual trend in undergraduate nursing education is not keeping pace with the trend demanded by society. Therefore, it is imperative to develop innovative AI-based educational curriculums in undergraduate nursing education and a platform to integrate such curriculums in Korean and global nursing education.

The scientific and technological characteristics used in undergraduate nursing education were diverse. However, these were not necessarily related to IoT-based education but were mostly seen in traditional face-to-face lectures, video sharing, tests, and feedback. In a systematic literature review on digital technology and nursing care, studies on ICT, robots, sensors, and e-learning have already been carried out [28]. However, most of these studies targeted nurses or patients, and no studies were specifically for undergraduate nursing education. As mentioned in the discussion of the authors’ affiliations in the general characteristics of the research, the field of nursing education has yet to significantly step further for a convergence with the scientific and technological fields. Therefore, a proactive challenge is required to move beyond traditional face-to-face teaching methods and develop new teaching methods by actively integrating with experts in the field of science, applying and converging with advanced scientific technologies.

This scoping review identified technological difficulties, the importance of self-management, difficulties in adaptation, and privacy concerns as personal barriers to the future development of IoT platforms in undergraduate nursing education. In addition, the teachers’ perspective confirmed the need for tutors, continuous post-management, and the lack of content to meet interdisciplinary requirements. These results are consistent with the studies suggesting the need for technical support in digital education, the potential for student distraction [29], and the need for human rights protection and continuous assistance for development [30]. The facilitating factors of IoT development showed that the IoT platform can serve as a learning aid and induce interest-based learning, which are educational advantages. In addition, it offers environmental advantages like comfort, reliability, and enhanced participation. Moreover, there are interactional advantages such as anonymity, interaction, quick feedback, improvement of communication difficulties, and the possibility of developing various contents. These results align with the studies suggesting the advantages of digital learning as a learning plarform [31]. Thus, keeping these barriers and facilitators in mind while developing an IoT platform for future nursing undergraduate education creates a more quality-based system for undergraduate nursing education.

Limitations

This study excluded research on virtual simulation, which is used as an alternative to clinical practice. Therefore, it did not consider the IoT platforms that could have been utilized for theoretical knowledge in clinical practice learning, making it difficult to generalize this study’s results. In addition, this study aimed to present the future direction by understanding the overall situation of the research on IoT platforms in undergraduate nursing education. As it is not a study that evaluates the level of evidence through a critical review, individual studies could have been either under- or overestimated. Finally, this study analyzed only 16 of the total searched literature, which is a small number. It is unlikely that the duplicated or excluded literature significantly impacts the research results, but it is still important to recognize the significance of the excluded literature.

Conclusion

The IoT platforms used in undergraduate nursing education are diverse, but there is a lack of convergence with other disciplines or integrated IoT platforms for nursing education. Therefore, IoT platforms for future nursing education should take the following directions

• The development of IoT platforms for future undergraduate nursing education should move in an integrated direction through active convergence research with other fields.
• IoT platforms for future undergraduate nursing education should attempt to develop new teaching methods that move away from traditional teaching methods and incorporate cutting-edge scientific technologies, such as artificial intelligence.
• IoT platforms for future undergraduate nursing education should consider the barriers and facilitators identified in this study and require multidisciplinary efforts to create a higher-quality undergraduate nursing education system.

Based on these findings, the following suggestions are made for future research

• Nursing educators and researchers should continue to find intersections between nursing and other fields, such as engineering, sociology, and business management.
• Research should actively be conducted to develop digital literacy skills for nursing educators and students.
• In preparation for a future where nursing education will mostly be on IoT platforms, there needs to be much discussion about what should be taught by nursing educators.

Registration

The data presented in this study are openly available on Open Science Framework (OSF) on September 7, 2021 (https://doi.org/10.17605/OSF.IO/DHZFR).

Contribution

C.E.S: AJ acquired financial support for this study, collected and analyzed the data, and wrote the manuscript. CES also performed data analysis and wrote the manuscript.

Source of Funding

This study was supported by the National Research Foundation of Korea (2021R1I1A3046198)]. However, they had and will not have a role in study design, data collection, analysis, the decision to publish, or manuscript preparation.

Conflicts of Interest

The authors of this study declare no competing interest of any form.

Ethics and dissemination

The Institutional Review Board of Nambu University, South Korea, approved the exemption of this study for IRB review (1041475-2021-HR-030). Study results will be disseminated through peer-reviewed journals.

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