• Geneviève Rouleau, Marie-Pierre Gagnon, José Côté, Julie Payne-Gagnon, Emilie Hudson, Carl-Ardy Dubois, and Julien Bouix-Picasso.
• Faculty of Nursing, Université Laval, Quebec, QC, Canada.
• J. Med. Internet Res. 2019 Oct 2; 21 (10): e15118.

BackgroundE-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses' continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context.ObjectiveWe aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context.MethodsWe conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results).ResultsWe identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick's levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration.ConclusionsThe effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714.©Geneviève Rouleau, Marie-Pierre Gagnon, José Côté, Julie Payne-Gagnon, Emilie Hudson, Carl-Ardy Dubois, Julien Bouix-Picasso. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.10.2019.

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