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Acta Paulista de Enfermagem

Print version ISSN 0103-2100

Acta paul. enferm. vol.24 no.5 São Paulo  2011 



Virtual learning objects: contributions to the learning process in health and nursing*


Objetos virtuales de aprendizaje: contribuciones para el proceso de aprendizaje en salud y enfermería



Ana Graziela AlvarezI; Grace Teresinha Marcon Dal SassoII

IGraduate student (PhD) Program Graduate Nursing, Federal University of Santa Catarina - UFSC, Florianópolis (SC), Brazil
IIPhD in Nursing. Professor, Graduate Program in Nursing, Federal University of Santa Catarina - UFSC, Florianópolis (SC), Brazil

Corresponding Author




OBJECTIVE: To highlight the contributions of the application of Virtual Learning Objects (OVAs) for the learning process in health and nursing.
METHODS: A systematic review was conducted using the databases of PubMed / MEDLINE, Scopus, CINAHL and ISI Web of Knowledge. We analyzed 13 studies, published in the English language, for the period of 2004 to 2008.
RESULTS: The predominate research about OVAs was developed with a focus on patients (50%), students (38.4%) and healthcare professionals (7.1%). With regard to the levels of evidence, 30.8% of the studies were classified as level II and level III-1, respectively, and 30.4% were level IV.
The OVAs have contributed significantly to the increase in knowledge and learning in patients, students and caregivers, providing a promising perspective for education in health and nursing.

Keywords: Nursing; Learning; Nursing informatics; Educational technology; Computer simulation


OBJETIVO: Evidenciar las contribuciones de la aplicación de Objetos Virtuales de Aprendizaje (OVAs) para el proceso de aprendizaje en salud y enfermería.
MÉTODOS: Estudio de revisión sistemática realizada en las bases de datos PUBMED/MEDLINE, SCOPUS, CINAHL e ISI Web of Knowledge. Fueron analizados 13 estudios, publicados en el idioma inglés en el período de 2004 a 2008.
RESULTADOS: Predominaron las investigaciones sobre OVAs desarrolladas con enfoque en pacientes (50%), estudiantes (38,4%) y profesionales de salud (7,1%). En cuanto a los niveles de evidencia el 30,8% de los estudios fueron clasificados como nivel II y nivel III-1, respectivamente y el 30,4% como nivel IV.
CONCLUSIÓN: Los OVAs contribuyeron significativamente en el aumento del conocimiento y aprendizaje en pacientes, alumnos y cuidadores, constituyendo una prometedora perspectiva para la educación en salud y en enfermería.

Descriptroes: Enfermería; Aprendizaje; Informática aplicada a la enfermería; Tecnología educacional; Simulación por computador




The growing use of web-based technology in health education shows new opportunities for online learning in a flexible and easy way(1-3).

In this scenario, the Digital Learning Objects (DLOs) offer a new opportunity for the teaching and learning process in health and nursing. This technology can be defined as a digital resource that can be used to support teaching using a pedagogical perspective and planning, integrated with the teaching and learning process(4-5).

Some of the following factors favor the use of technology in health education: flexibility, simple construction, possibility to reuse, facility to update, interoperability, and support to online or face-to-face teaching(4-7).

Considering that the DLOs can help building the cognitive path of students and that there are very few studies in this area, we asked the following question: What are the contributions of DLOs to the teaching and learning process in health and nursing?

The objective of the revision was to show the contributions of the use of DLOs to nursing and health learning.



Systematic review(8) without meta-analysis developed in the following stages(9): Definition of the research question; Specification of the inclusion and exclusion criteria; Identification of the relevant studies and method test; Search in online data base PUBMED/MEDLINE, SCOPUS, CINAHL and ISI Web of Knowledge (ago/ 2009); Inclusion of articles; Review of the abstracts carried out by two reviewers and application of the inclusion/exclusion criteria; Discussion to reach consensus among reviewers; Analysis of the complete texts by reviewers, application of the inclusion and exclusion criteria and encoding of the studies (A1 to A13); Inclusion of the outcomes in an electronic spreadsheet; and Presentation of the results and discussion.

The inclusion criteria were studies on DLOs related to health and/or nursing from Jan /2004 to Dec/2008, English and full text available; original articles with a clear method description, and result presentation. The exclusion criteria included: lack of compliance to the study theme, not being able to classify the level of evidence and full text not available.

The terms used to search for the articles in the database are available in the Mesh (Medical Subject Headings) vocabulary, except for the term "object learning", because it is a recent theme. The search was organized as shown in Chart 1.

For the present article, we have considered as DLOs all type of media used in the online teaching and learning process (videos, audios, discussion forums, simulated environments, among others).

In the first step, 85 articles have been found and were imported to the software EndNoteWeb®2.7. Forty articles have been excluded because of repetition.

The analysis of the 45 articles with full texts was carried out by two reviewers and, after application of the exclusion criteria, there were 13 articles left, which were the reference for the analysis. The strength of evidence of the studies was classified using the Joanna Briggs Institute scale(10) (Chart 2).



The articles selected were inserted in an electronic spreadsheet (Excel 2007®) and classified according to: article code, complete reference, level of evidence, method, objectives and contributions to the learning (Chart 3).

Based on the analysis, we could identify the predominance of studies on DLOs developed with a focus on the patients (50%), students (38.4%), and health professionals (7.1%).

As for the strength of evidence of the studies, 30.8% were classified as level II (A12, A7, A4, A13), 30.8% as level III-1 (A5, A11, A3, A8) and 38.4% as level IV (A10, A1, A2, A6, A9), and there were no studies level I.


Tab. 03



The DLOs increased students' knowledge, leading to impacts on students' learning averages in online courses(13). The educational technology has also brought significant contributions to the learning experiences of students in clinical simulation settings(11-12) and an impact in their sense of belonging(20).

Assessments on the quality of the DLOs resulted in students' satisfaction regarding to: content usefulness, quality, presentation and adequacy(12,16,19).

As for professionals, the access to DLOs improved the use of auxiliary equipment in the treatment, patients' guidance and preparation of the care plan(15).

On patients' perspective, the DLOs led to enhancement in care education for their own health(15,17,21), improved the knowledge on certain themes(23), improved memory(18) and have also contributed to the reduction of complications regarding the presence of chronic disease(22).

Based on the analysis of the DLOs contribution for health and nursing learning, the aspects regarding the improvement of knowledge and learning used both by students, health professionals and patients stand out.



From the diversity of studies currently published in indexed journals on the database searched, we noticed a lack of studies on the use of DLOs in the health and nursing teaching and learning process. Most times, the publications only reported the development of technologies geared to learning, but they did not include the assessment of the outcomes of its application.

The main contribution of the study was to identify research with evidence levels strong enough to demonstrate the contribution of DLOs in the health and nursing teaching and learning process, cooperating for evidence-based practice.

We highlight that the DLOs can significantly contribute to the learning process of patients, health professionals and students and, for that reason, we believe that new studies should be carried out to further study the theme and identify the impact of its application in health and nursing learning in the several care areas.



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Corresponding author:
Ana Graziela Alvarez
R. Joinville, 1008 - apto. 201 - Vila Nova
Blumenau - SC - Brazil
CEP. 89035-200

Received article 04/04/2010 and accepted 08/08/2011



* Study carried out at Universidade Federal de Santa Catarina - UFSC, Florianópolis (SC), Brazil.

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