Notetaking among nursing students

Problem

There has not been a literature review of nursing studies exploring notetaking for nursing students. The purpose of this review is (1) to determine the current literature for notetaking among nursing students, and (2) to identify implications for nursing education and research. Nursing students uniquely use notetaking as a learning strategy and continue to utilize this skill in their nursing profession as a means for ongoing success in communication and documentation. Identification of strategies that promote nursing student outcomes, such as notetaking, may assist in positive outcomes for future nursing careers.

Literature search and terms

A literature review was performed using CINAHL, Gale, ERIC, Medline, Journals@OVID, and Complementary Index for the search period of 2018–2023. The decision was made to search literature from the Google Scholar database from the same time period. Searches were performed and replicated by both researchers. The keywords were chosen as terms related to the topic of interest as well as terms that were appropriate for indexing [11]. The keywords were “notetaking OR note-taking OR note taking” AND “students,” AND “nursing.” The initial search yielded 65 results. A summary table was created to track searches. Initial searches used the keywords as general search terms and then “notetaking” and “students” were restricted to abstract terms. Restricting “notetaking OR note-taking OR note taking” did not change any results. Adding “education” or “educat*” to “nursing” did not generate any new results.

Literature selection criteria

The searches were limited to peer-reviewed items that were in the English language during 2018 and 2023. The date was chosen to represent the current literature. The aim was to identify notetaking for nursing students. Items not related to nursing students or to notetaking were removed. Such items included similar related concepts such as notemaking. The results from each database were reviewed independently by each author and synthesized from the summary table into a matrix by author, year, article type, aim, sample, and relevant findings for comparison. Duplicate results, abstracts, posters, and book reviews were omitted. One book, two brief “teaching tip” articles, one descriptive article, 29 miscategorized or inappropriate findings, and 25 duplicates were removed from the final analysis. After removal of items that did not meet criteria for review parameters, a total of seven studies remained for discussion (see Figure 1).

Figure 1:

Flow chart of literature search and selection criteria.

Critical assessment and synthesis of literature

An iterative process of comparison and discussion was used to confirm that the articles were appropriate for the aims of the narrative literature review. The articles were appraised using critical appraisal tools from the literature [13], [14], [15]. The articles were evaluated for the results, interpretations, and contributions to the topic [11]. With the scarce number of studies returned, and all studies meeting the topic of discussion, all seven studies were retained for the discussion (see Table 1).

Learning style

Two articles discussed notetaking as applicable to student learning style [4, 8]. Learning styles include multimodal approaches incorporating auditory, visual, kinesthetic, and written techniques to support learning [8]. Many students will prefer more than one style [8]. Nursing students may shift approaches as they move from different content areas or gain new experiences, particularly as they transition from didactic to clinical experiences; sedentary preferences may be different than hands-on (kinesthetic) activities in the laboratory or clinical areas [8].

Findings by Cowen et al. [8] support previous research that notetaking is one of the most favorable student learning methods [9]. Notetaking involves a combination of tactics including the facilitation of acquisition, retention, and recall of material, and using auditory, visual, and written techniques [9]. Students are able to listen to (auditory), look at (visual), and write out content. After writing their notes, they can review their notes (reflect) for recall and further apply the knowledge. In their descriptive survey, Cowen et al. [8] asked 96 junior level students to rate how they learned best. Visual aids (34 %) and notetaking (25 %) were identified as the top learning methods, and the “best ways to learn new content” [8], consistent with the previous findings outlined for learners [9].

A study by Amhout et al. contributed to notetaking being a preferred learning style. The researchers examined the results of the Cornell method on intervention and control groups in 128 nursing students over three nursing courses. They administered pre-tests before implementing this note-taking method and compared results to post-test scores after using this style that has been reported in the literature [18]. They found that there was a significant result on student performance in the intervention groups (p<0.05) and determined that notetaking was a valuable learning style.

Notetaking skill

Six studies discussed the importance of notetaking skills [4, 10, 20, 21, 23, 24]. In addition to supporting the critical importance of notetaking for learning clinical skills, Tavener-Smith [24] found that the skill varied. They conducted a phenomenological study to describe faculty perspectives of student notetaking experiences. Students struggled with vocabulary and medical terms, having the inability to relay experiences, and not having the time to adequately describe thoughts or ideas in few words. Additionally, Tavener-Smith [24] determined that notetaking was not only an important skill for the nursing student, but an integral skill for the professional nurse. In this qualitative study, nursing students were observed during their clinical placements for accuracy and clarity, articulation, and vocabulary in nursing notetaking. Observers noted that students struggled with notetaking and lacked an understanding for the importance of notetaking and the perspective for the significance of notes in contributing to learning nursing concepts [24]. These findings are significant for nursing students as they enter the nursing profession and take on roles such as transcribing and documenting. Consistency and accuracy are essential skills for nurses to have prior to entering the profession.

Similarly, another study found that while notetaking is an essential skill for learning fundamental skills, there is a need for students to change their notetaking approach (43 %) [20]. They assessed student study strategies, including notetaking, and found that the 77.24 % of 200 students used notetaking to study. The study identified a need for students to revise the way that they were performing this notetaking skill for future success in their nursing program. Su et al. [23] designed a notetaking course and found support for previous findings. They examined 49 students during their note writing and notetaking course activities and found that student classroom outcomes improved after the course completion. The addition of a course for notetaking helped students with their notetaking skills. Results by Amhout et al. support these findings; they found that using a notetaking course or method, such as the Cornell method as in their study, could strengthen the quality of note production and learning by supporting and improving nursing student notetaking skills including recall.

In addition to serving as a source for learning acquisition and recall, notetaking provides students with a frame of reference for material [21]. Few students master the ability to organize notes and use minimal words, so that while they are recording information during notetaking, they can benefit from the complexity of listening and learning the information [21]. In a study of third year nursing students, Seid and Teklay [21] found that 36.4 % were poor notetakers, while only 54.5 % were moderate notetakers; very few students had mastered the skill. Their questionnaire found that discrepancies in notetaking skills were related to students not having the motivation to clarify any questions during the lecture; they found that 54.1 % were less motivated to ask questions and this was related to not having to take notes (r=0.663, p=0.001). Slides that were prepared by faculty in advance offered the notion that all questions would be addressed in the slide content. In addition to having slides in advance, many students preferred to have slides to take notes electronically alongside the advance content. Emory et al. [10] found that 69.3 % of students preferred to have the slides available to take their electronic notes during class, supporting the previous college student literature [22]. Having advance access to handouts or slides with much of the content emphasized often replaces notetaking during class time [22].

Notetaking and technology

Two articles discussed notetaking in relation to technology [10, 23]. Su et al. [23] examined an electronic platform that was implemented to facilitate notetaking skills in nursing students. This module allowed the time and space for reflective notes and learning with instructor feedback. Student writing competencies for notetaking improved after this semester long notetaking course (p<0.001). Students indicated the pace was appropriate for learning and to allow for feedback from instructors [23]. Students in this notetaking course also preferred taking notes online with technology as compared to traditional handwritten methods. This was comparable to previous findings that supported that students have a connectedness to technology and online environments [7, 16, 22].

Additional research was performed regarding the use of technology to take notes. Emory et al. [10] found that most nursing students utilized laptops to take notes during class. Students often chose to use a laptop for notetaking when the speed of the information delivery outpaced their ability to keep up with handwriting notes. These students also acknowledged their tendency to become distracted when using technology for notetaking. However, they felt that this risk was worth the benefit of gathering information at a quicker pace [10]. There were no significant differences identified between the preferred methods of notetaking, and there were no significant differences found between method of notetaking and GPA.

Implications for nursing

The purpose of this literature review was to determine the state of literature for notetaking among nursing students and identify implications for nursing education and research. While current literature is limited, nursing faculty must be aware of these findings in order to promote optimum learning among their students. Assessing student learning styles and notetaking ability are components of nursing education that faculty should incorporate into their practice. Identifying the learning styles of nursing students is a key factor in achieving learning outcomes [8, 17]. Faculty can assist students in self-identification of learning strategies and tactics, which often includes notetaking, as well as revise both pre-class assignments and classroom learning activities to include notetaking [8, 9]. Classroom assignments might include assigning notetaking activities, reflective activities for notes taken, or peer activities to collaboratively review or revise notes. In addition to acknowledging the varied learning methods students use, faculty need to assess nursing students’ notetaking ability. Current literature suggests that nursing students struggle with notetaking in the classroom as well as in the clinical setting [10, 20, 21, 23, 24]. This has implications not only for classroom content organization and mastery, but for the care and outcomes of their future patients. Some curricular strategies for success may include incorporating a separate notetaking course or considering instances that allow students to view lecture slides ahead of class for better notetaking during class time [4, 10, 20, 22, 23]. Notetaking is a critical part of nursing practice as medical terminology and patient information must be accurately represented and documented. Faculty must find ways to assist students with taking notes for future success.

Using technology to take notes has recently become a common practice among nursing students. Current students are more connected and adjusted to online learning environments [17]. Nursing students most often prefer the use of electronic platforms or laptops for notetaking compared to the traditional method of handwriting notes [10, 23]. Faculty should be simultaneously aware of distractions when students have access to other online websites or platforms while in class while also acknowledging the preference for use [10]. Faculty often have concerns regarding electronic notetaking and learning outcomes, however, previous research among nursing students has not demonstrated a significant difference between notetaking methods and student GPAs when comparing those who take notes by hand with those who use laptops [10]. This finding is in agreement with previous literature among college students [5].

There was a paucity of research in the area of notetaking for nursing students. Future studies could examine longitudinal success throughout nursing curricula in didactic and clinical settings to identify the best strategies for success. Both nursing student and nursing faculty perspectives on notetaking practices would increase the knowledge in this area of research.

Strengths and limitations

A strength in this review was that multiple databases were searched for current literature. A narrative literature review was performed, and steps were taken to strengthen the review. A method from the literature was used to frame the review strategy. Two reviewers screened the literature with an iterative approach to review using methodology from the literature. Critical appraisal tools from the literature were used to evaluate the literature [13], [14], [15]. Results were reported in a flow diagram outlining the data search, selection, evaluation, and synthesis process [19]. Few studies involving nursing students were identified in this literature search, indicating a gap in the literature. None of the identified studies utilized educational frameworks to guide the analyses, indicating a theoretical gap. Most studies that were found were located outside of the United States, suggesting a need for national-level research. All but one of the articles found used some statistical analyses in study methods, and many were designed as cross sectional surveys. Future research approaches may consider longitudinal designs across nursing student curricula to capture rich data. This review was limited to articles published in English and may have excluded relevant literature on the topic.