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研究生： 安達娜
Adif, Shannastaniar Aisya
論文名稱： 轉化式電子學習方案對護理學生數位能力與批判性思考之成效：一項混合方法研究
Effect of Transformative E-Learning Program on the Digital Competence and Critical Thinking Disposition of Nursing Students: A Mixed-Methods Study
指導教授： 顏妙芬
Yen, Miaofen
學位類別： 博士
Doctor
系所名稱： 醫學院 - 護理學系
Department of Nursing
論文出版年： 2026
畢業學年度： 114
語文別： 英文
論文頁數： 256
外文關鍵詞： digital competence, critical thinking disposition, nursing students, e-learning, mixed-methods study
相關次數： 點閱：69  下載：1 
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    • Background:
    Digital competence is increasingly essential in nursing education, yet structured training remains limited. Because digital competence involves information evaluation, ethical judgment, digital safety, and decision-making, it may also support critical thinking disposition.

    Objective:
    This study evaluated the effect of the DigiNurse transformative e-learning program on undergraduate nursing students’ digital competence and critical thinking disposition, and explored students’ learning experiences.

    Methods:
    A mixed-methods intervention study was conducted using pre-test, post-test, and one-month follow-up assessments, followed by qualitative inquiry. Digital competence was assessed across four domains, and qualitative participants were purposively selected using four outcome-pattern quadrants.

    Results:
    Digital competence improved after the program and was broadly sustained at follow-up, although the Safety domain showed weaker sustainability. Critical thinking disposition increased after the program and continued to improve at follow-up. Qualitative findings suggested that case-based questions, repeated attempts, mastery requirements, and reflective scenarios supported deeper engagement and helped students connect digital competence with ethical reasoning and professional judgment.

    Conclusion:
    DigiNurse showed promise as a structured e-learning program for improving self-reported digital competence and supporting critical thinking disposition. Further studies should examine objective performance, longer-term sustainability, and educator preparation for digital competence education.

    ABSTRACT iii TABLE OF CONTENT iv LIST OF FIGURES x LIST OF TABLES xi Chapter 1 Introduction 1 1.1. Background 1 1.2. Significance of the Study 5 1.3. Research Objectives 6 Chapter 2 Literature Review 7 2.1. Digital Competence 7 2.1.1. Definition and Framework of Digital Competence 7 2.1.2. Measurement Tool of Digital Competence: Digital Competence Assessment Checklist (DCAC) 13 2.2. Critical Thinking Disposition 15 2.2.1. Definition of Critical Thinking Disposition 15 2.2.2. Measurement Tool of Critical Thinking Disposition: Short Form Critical Thinking Disposition Inventory Chinese Version 19 2.3. Relationship Between Digital Competence and Critical Thinking Disposition 21 2.4. Relationships Among Demographic Characteristics, Digital Competence, and Critical Thinking Disposition 23 2.4.1. Age 23 2.4.2. Gender 25 2.4.3. Years of Education 25 2.4.4. Academic Performance 26 2.5. Development and Validation of the Transformative E-Learning Program: DigiNurse 27 2.5.1. Instructional Design and Pedagogical Justification of the DigiNurse E-Learning Program 30 2.6. Sequential Explanatory Mixed-Methods Design in Educational Intervention Evaluation 34 2.7. Research Framework 37 2.8. Operational Definitions 39 2.8.1. Digital Competence 39 2.8.2. Critical Thinking Disposition 41 2.8.3. Demographic Characteristics 41 Chapter 3 Methods 43 3.1. Design 43 3.2. Setting 43 3.3. Participants 44 3.4. Measurements 46 3.4.1. Demographic Characteristics Survey 47 3.4.2. Digital Competence Assessment Checklist Bahasa Indonesia Version 47 3.4.3. Short Form Critical Thinking Disposition Inventory Bahasa Indonesia Version 48 3.5. Cross-Cultural Adaptation Process of the Instruments 49 3.6. Ethical Consideration 54 3.7. Data Collection Procedures 56 3.7.1. Participant Recruitment 56 3.7.2. Digital Informed Consent 57 3.7.3. Participant Registration and Eligibility Screening 57 3.7.4. Baseline Data Collection 58 3.7.5. Intervention Access and Monitoring 58 3.7.6. Immediate Post-Intervention Data Collection 59 3.7.7. One-Month Follow-Up Data Collection 59 3.7.8. Qualitative Follow-Up 60 3.7.9. Data Management and Confidentiality 60 3.7.10. Token of Appreciation 60 3.8. Implementation Mechanism 61 3.8.1. Development of the DigiNurse Learning Management System 61 3.8.2. Mode of Delivery 62 3.8.3. Program Duration and Timeline 63 3.8.4. Learning Sequence and Access Control 64 3.8.5. Content Overview of the DigiNurse Program 64 3.8.6. Module Post-Tests 65 3.8.7. Participant Engagement and Implementation Fidelity 66 3.8.8. Follow-Up Evaluation 66 3.9. Data Analysis 67 3.10. Data Integration and Meta-Inference 71 Chapter 4 Results 73 4.1. Psychometric Evaluation of the SF-CTDI English Version 73 4.1.1. Translation and Cross-Cultural Adaptation 73 4.1.2. Participant Characteristics and Critical Thinking Disposition Scores 75 4.1.3. Item Analysis 77 4.1.4. Sampling Adequacy and Factorability 79 4.1.5. Confirmatory Factor Analysis 80 4.1.6. Convergent and Discriminant Validity 86 4.1.7. Known-Groups Validity (give the score for this known group validity) 87 4.1.8. Reliability 87 4.2. Psychometric Evaluation of the SF-CTDI Bahasa Indonesia Version 88 4.2.1. Translation and Cross-Cultural Adaptation 88 4.2.2. Participant Characteristics and Critical Thinking Disposition Scores 94 4.2.3. Item Analysis 96 4.2.4. Sampling Adequacy and Factorability 98 4.2.5. Confirmatory Factor Analysis 98 4.2.6. Standardized Factor Loadings and Communalities 100 4.2.7. Convergent and Discriminant Validity 102 4.2.8. Reliability 103 4.3. Psychometric Evaluation of the DCAC Bahasa Indonesia Version (DCAC-BI) 104 4.3.1. Translation and Cross-Cultural Adaptation 104 4.3.2. Participant Characteristics 109 4.3.3. Descriptive Statistics of DCAC-BI Scores 110 4.3.4. Item Analysis 112 4.3.5. Sampling Adequacy and Factorability 114 4.3.6. Confirmatory Factor Analysis and Structural Validity 115 4.3.7. Convergent Validity 116 4.3.8. Known-Groups Validity 117 4.3.9. Internal Consistency (Reliability Testing) 118 4.4. Effects of the DigiNurse Program on Critical Thinking Disposition and Digital Competence: Quantitative Analysis 119 4.4.1. Attrition and Complete-Case Analysis 119 4.4.2. Participant Characteristics 119 4.4.3. Descriptive Statistics for Digital Competence Across Time 121 4.4.4. Descriptive Statistics for Critical Thinking Disposition Across Time 123 4.4.5. Baseline Comparability Across Demographic Characteristics 125 4.4.6. Baseline Correlation Between Critical Thinking Disposition and Digital Competence 126 4.4.7. Repeated-Measures ANOVA of Digital Competence Across Time 128 4.4.8. Repeated-Measures ANOVA of Critical Thinking Disposition Across Time 133 4.4.9. Association Between Changes in Digital Competence and Changes in Critical Thinking Disposition 138 4.4.10. Regression Analysis Predicting Changes in Critical Thinking Disposition 140 4.4.11. Summary of Quantitative Findings 142 4.5. Effects of the DigiNurse Program on Critical Thinking Disposition and Digital Competence: Qualitative Analysis 143 4.5.1. Characteristics of the Participants 143 4.5.2. Overview of Thematic Analysis 144 4.5.3. Self-Reported Behavioral Applications 157 4.5.4. Deviant Case Analysis: P59 159 4.5.5. Curricular Implications from the Qualitative Findings 160 4.5.6. Integrative Summary 161 4.6. Summary of Strand-Specific Findings Used for Integration 162 4.7. Data-Inference Point 1: Why Overall Digital Competence Improved and Why Safety Showed Weaker Sustainability 165 4.7.1. Quantitative Pattern 165 4.7.2. Qualitative Explanation 166 4.7.3. Integrated Inference 167 4.8. Data-Inference Point 2: Why Critical Thinking Continued to Grow After the Program Ended 168 4.8.1. Quantitative Pattern 168 4.8.2. Qualitative Explanation 168 4.8.3. Integrated Inference 169 4.9. Data-Inference Point 3: The DC-CTD Relationship as a Two-Pathway Model 170 4.9.1. Quantitative Pattern 170 4.9.2. 4.9.2. Qualitative Explanation 170 4.9.3. Integrated Inference 171 4.10. Data-Inference Point 4: Assessment Design as the Primary Pedagogical Mechanism 172 4.10.1. Quantitative Pattern 172 4.10.2. Qualitative Explanation 172 4.10.3. Integrated Inference 173 4.11. Data-Inference Point 5: Participant Heterogeneity and Access to Learning Pathways 173 4.11.1. Quantitative Pattern 173 4.11.2. Qualitative Explanation 174 4.11.3. Integrated Inference 175 4.12. Joint Display of Integrated Data Inferences 175 4.13. Conceptual Integration Model 177 4.14. Convergence, Complementarity, Expansion, and Complexity 180 4.15. Chapter Summary 181 Chapter 5 Discussions 183 5.1. The Psychometric Evaluation of the SF-CTDI English Version 183 5.2. Psychometric Evaluation of the SF-CTDI Bahasa Indonesia Version 188 5.3. Psychometric Evaluation of the DCAC Bahasa Indonesia Version 193 5.4. Effect of the DigiNurse E-Learning Program on Digital Competence and Critical Thinking Disposition: Quantitative Findings 199 5.5. Effect of the DigiNurse E-Learning Program on Digital Competence and Critical Thinking Disposition: Qualitative Findings 204 5.6. Discussion of the Integrated Data Inferences 210 5.6.1. Data Inference 1: Overall Digital Competence Improved, but Safety Showed Weaker Sustainability 210 5.6.2. Data Inference 2: Critical Thinking Disposition Continued to Grow After Program Completion 212 5.6.3. Data Inference 3: Digital Competence and Critical Thinking Disposition Developed Through Two Pathways 213 5.6.4. Data Inference 4: Assessment Design Was the Primary Pedagogical Mechanism 214 5.6.5. Data Inference 5: Participant Heterogeneity Reflected Unequal Access to Learning Pathways 215 5.6.6. Overall Interpretation of the Integrated Data Inferences 216 5.7. Strengths and Limitations 218 5.7.1. Strengths 218 5.7.2. Limitations 220 5.8. Implications 222 5.8.1. Implications for Nursing Education 222 5.8.2. Implications for E-Learning Instructional Design 224 5.8.3. Implications for Clinical Learning and Professional Practice 225 5.8.4. Implications for Policy and Institutional Support 226 5.8.5. Implications for Future Research 227 Chapter 6 Conclusion 230 REFERENCES 233

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