SCOPING REVIEW

Teaching and learning with a multisensory approach in undergraduate Nursing education: scoping review protocol

Gabriela Feitosa Esplendori1, Kelli Borges dos Santo2, Vilanice Alves de Araújo Püschel1

1University of São Paulo, São Paulo, SP, Brazil

2University of Juiz de Fora, Juiz de Fora, MG, Brazil

ABSTRACT

Objective: To describe instructional strategies and resources used with a multisensory approach for face-to-face teaching of undergraduate nursing students and to summarize the authors’ discussions/conclusions regarding the impact of teaching with this approach on the student’s learning process. Methods: The Joanna Briggs Institute (JBI) methodology was used to develop this protocol and will be used to conduct and report the scoping review. There will be no restrictions on language, date, or type of publication. Sources of information will include PubMed, Cumulative Index in Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Excerpta Medica Database (EMBASE), Web of Science, Educational Resources Information Center (ERIC), Virtual Health Library (VHL) portal, Scientific Electronic Library Online (SciELO), ProQuest, and five sources of grey literature. Rayyan and JBI SUMARI software are used for study selection. Title and abstract screening, full-text reading, and data extraction will be performed by two independent reviewers using a tool developed and tested by the authors. If necessary, a third reviewer will be involved. The results will be presented in a narrative format, graphs, or tables.

Descriptors: Nursing Education; Teaching Materials; Perception.

INTRODUCTION

Teaching with a multisensory approach involves utilizing visual, auditory, kinesthetic, and tactile resources to enhance memory and facilitate learning(1). In the educational process, instructors employ the multisensory approach by connecting academic objectives to educational activities that require students to engage multiple senses, thereby creating mental representations of objects, concepts, or phenomena(2).

Teaching focused on sensory integration plays a crucial role in improving working memory(3), which is understood as a form of short-term memory where information is simultaneously stored, processed, or manipulated to perform complex cognitive tasks and is related to long-term memory(4).

Indeed, there are unisensory and multisensory neurons in the central nervous system, and when information from different sensory modalities is congruent, it is integrated to produce enhanced neural and behavioral outcomes(5).

In this regard, stimulating different modalities (visual, auditory, and kinesthetic) is used in the education of children with learning difficulties(6) and in inclusive education to facilitate learning for individuals with visual or auditory deficits(2). In undergraduate health education, there are reports of using the multisensory approach in teaching students with dyslexia and dyscalculia(7).

In nursing education, authors of studies involving newly graduated nurses and undergraduate nursing students have implemented various activities (such as reading poems aloud, using strings and cartoons, among others) targeting the cognitive, affective, and psychomotor domains of learning. They concluded that multisensory training could enhance learning and support the development of a creative and sustainable professional career, providing nursing educators with opportunities to enrich their teaching toolkits and foster individual and collective learning beyond traditional didactic formats(8).

In undergraduate nursing education, careful examination reveals publications that describe the use of diverse resources to stimulate the different sensory modalities of students (such as multicolored buttons, dishes, nose plugs(9), canvas, balloons, and colored adhesive tapes(10)). However, they do not explicitly state the intentional use of the multisensory approach. In this context, mapping studies that have applied the multisensory approach in undergraduate nursing education will help understand the teaching strategies employed and the outcomes achieved in student learning.

A preliminary search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), The International Prospective Register of Systematic Reviews (PROSPERO), Cochrane Database of Systematic Reviews and JBI Evidence Synthesis databases using the keywords “Multisensory”, “Multisensory approach”, “Multisensory learning”, “Multisensory teaching”, and “Multisensory instruction” on December 9, 2022. However, no systematic or scoping reviews (completed or ongoing) were found on teaching and learning with a multisensory approach in the context of nursing education.

Therefore, there is a justified need to conduct a scoping review with the objectives of mapping instructional strategies and resources used with a multisensory approach in undergraduate nursing education and summarizing authors’ discussions/conclusions regarding the impact of teaching with this approach on students’ learning process. These impacts will be assessed considering cognitive responses (knowledge/skills acquired), affective responses (changes in interest, attitudes, emotions, or values), and psychomotor responses (development of motor skills)(11).

The results of this review will likely contribute to mapping the available evidence on the use of the multisensory approach in the learning of undergraduate nursing students, considering cognitive, affective, and/or psychomotor aspects.

Review questions

Two review questions were formulated based on the PCC (population, concept, and context) framework:

1. What educational strategies and instructional resources have been used to teach undergraduate nursing students using a multisensory approach in any educational context or setting?

2. What are the findings and conclusions of studies on the learning outcomes of nursing students when using the multisensory approach?

Inclusion criteria

Participants

Studies with undergraduate nursing students will be included as individuals enrolled in a school or program of higher education at the undergraduate nursing level(12), at in any stage of the program, in any teaching setting, or any public or private educational institution. Studies must meet all three of the following criteria:

1. Studies that describe educational strategies or instructional resources used in a class, course, training, clinical activity, or laboratory activity to teach a topic or subject.

2. Studies that used strategies or resources to promote object manipulation or tactile sensation, sensations derived from any part of the body’s skin (touch), stimulation of taste perception (taste), promotion of verbal expression (language), use of pictures, shapes, colors, and spatial vision stimulation (vision), verbal sounds, tones, melodies, or music (hearing), stimulation of smell or odor perception (smell), or intentional stimulation of physical movement.

Educational strategies refer to the processes used for communication between teachers and students(13). These include but are not limited to technology-based, simulation-based, and collaborative strategies(14). Instructional resources refer to tools or vehicles used to facilitate communication between teachers and students, using tangible materials or real objects to engage students’ senses, help teachers make sense of abstractions, and simplify complex messages(13). This review includes but is not limited to, buttons, nose plugs, utensils(9), balloons and colored ribbons(10), flipcharts, and puppets(13).

1. Studies in which the authors describe results and conclusions regarding the learning outcomes of undergraduate nursing students when using the multisensory approach.

Concept

The concept of this review is multisensory learning, which refers to the learning process that uses combinations of two or more senses, and may include visual, auditory, tactile, kinesthetic, olfactory, and gustatory sensations(3).

Context

The context of this review will encompass environments where teaching and learning activities occur, including classrooms, laboratories, hospitals, communities, or any other setting/context where face-to-face instruction, training, or practical activities occur, regardless of country.

Types of sources of evidence

Studies will be considered without restriction as to type or design, year of publication, or language, as long as they meet the inclusion criteria. However, methodological studies on the development of instructional resources that primarily aim to assess the functionality of the resource without the explicit intention of teaching a specific topic in an instructional context will be excluded.

METHODS

This review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews(15). The entire protocol is registered on the Open Science Framework (OSF) and can be accessed via the following link: https://osf.io/v3j5x. In addition, the protocol update can be found at this link: https://osf.io/6g7xk/?view_only.

Search strategy and sources of information

Both published and unpublished studies (grey literature) will be considered. An initial search was conducted in MEDLINE (PubMed) and Cumulative Index in Nursing and Allied Health Literature (CINAHL/EBSCO) through the Capes Periodicals Portal to identify relevant studies. The words contained in the titles, abstracts, terms, and keywords of the relevant studies were used to develop a comprehensive and tailored search strategy for MEDLINE (PubMed) and CINAHL (EBSCO), as described in Figure 1.

Source: Developed by the authors, 2023.

Figure 1 - Search strategy in the MEDLINE database via PubMed and CINAHL via EBSCO. São Paulo, SP, Brazil, 2023

Similarly, the initial search guided the development of appropriate strategies for each other information source. Double (or single) quotation marks, operators (AND, OR) and other search strategies were used in the databases and grey literature, as described in Figure 2.

Source: Developed by the authors, 2023.

Figure 2 - Advanced search strategy according to the other sources of information. São Paulo, SP, Brazil, 2023

Since only one database has a descriptor closely related to the concept of the study (multisensory learning in ERIC) and another has "candidate terms" (Embase), broad search strategies were adopted for all databases. After removing duplicates, a total of 2,121 unique items were retrieved.

The search strategies were defined by the reviewers with the assistance of a librarian. Additionally, the reference lists of all selected studies will be checked to identify additional studies.

Study selection

The study selection process will be presented in a flowchart based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) guidelines(16), following the established inclusion criteria. All retrieved studies will be imported into the Mendeley reference manager, where duplicates will be removed. Subsequently, the studies will be imported into the Rayyan software, where titles and abstracts will be read and assessed (in a blinded manner) by two independent reviewers. Potentially relevant studies will be obtained in full text and imported into the JBI Sumari software(17), where two independent reviewers will assess them. If necessary, the authors of the included studies will be contacted. The reasons for excluding studies assessed in the full text will be recorded and reported. Any disagreements that arise between the reviewers at each stage of study selection will be resolved through discussion or with the involvement of a third reviewer.

Data extraction

The data from the included studies will be extracted using an instrument specifically developed for this purpose (Figure 3), which has been tested through the full reading of two studies.

Source: Developed by the authors, 2023.

Figure 3 - Data extraction instrument. São Paulo, SP, Brazil, 2023

Any disagreements that arise between the reviewers during the data extraction process will be resolved by discussion between the reviewers or, if necessary, with the intervention of a third reviewer. If missing or additional data are required, the study authors will be contacted to request this information.

Data presentation

The extracted data will be presented in graphs or tables consistent with the objectives of this scoping review. In addition, a narrative summary will be provided to accompany the tabular or graphical results, describing how the results relate to the objectives and research questions of the review.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

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Submission: 01/10/2023

Approved: 07/10/2023