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. 2023 Sep 16;10(11):7144–7153. doi: 10.1002/nop2.1998

Educational strategies and nursing theory to prepare leaners for NCLEX‐RN

Khalid Bandar Almasloukh 1,✉, Melissa Miner 1, Kathleen Phillips 1, Michael Evans 1
PMCID: PMC10563409  PMID: 37715615

Abstract

Aim

To identify teaching stategies, theories, and methods to enhance students' quality of life (QOL) that are used in preparing students for the NCLEX‐RN exam.

Design

A scoping review was conducted.

Methods

Arksey and O'Malley's methodological framework and PRISMA‐ScR guidelines were utilized. Data were derived from four databases including CINAHL, ERIC, PsychINFO and Web of Science using specific keywords. Inclusion criteria were English language and articles published in the last 7 years.

Results

Studies (N = 25) revealed that multiple educational strategies are used to prepare students for the NCLEX‐RN exam; however, there was not a consensus on a best practice. Eight theories were utilized in more than one article. QOL concerns of psychological, social, spiritual, financial and occupational dimensions may relate to the NCLEX‐RN results.

Public Contribution

Patterns in educational strategies and theories were noted among articles, but there was no focus on enhancing students' QOL.

Keywords: clinical judgement, education, nursing theory, quality of life

1. INTRODUCTION

Although there are numerous preparation resources for the National Council Licensure Examination for the Registered Nurse (NCLEX‐RN), the focus on the quality of life (QOL) for nursing students during preparation for the licence exam is limited. In April 2023, The Next Generation NCLEX‐RN (NGN) was launched with new question types (National Council of State Boards of Nursing [NCSBN], 2019, 2023), that have limited available resources compared to the accumulated resources for the former, traditional NCLEX‐RN. Students, professors and school officials may be focusing solely on preparing students for the NGN exam, which may increase the stress level of the students.

Almasloukh and Fahs (2021) conducted a QOL concept analysis based on Roy adaptation model (RAM). According to Roy (2009), one of the main nursing goals is to maintain and enhance QOL. According to Almasloukh and Fahs (2021), QOL is defined as “continuous process based on the degree of balance, self‐esteem, and satisfaction, among different life dimensions that are influenced by the perception of life events and are shown in positive or negative actions” (p. 72). This means nursing students' QOL may depend on many life dimensions that students should stay balanced in and maintain self‐esteem and satisfaction while preparing for NCLEX‐RN. Educators should use educational strategies to ensure academic and NCLEX‐RN success, while focusing on students' positive QOL.

Social relationships and social welfare may affect the QOL of students who are preparing for their NCLEX‐RN. For example, when students are identified at risk of failure or in need of remediation, or they receive low scores that threaten their success, they may isolate, withdraw and disengage from many educational activities because of feelings of hopelessness or shame (Maas, 2017). Faculty are urged to recognize those complex social, emotional and psychological effects on students when they may happen during the preparation of the NCLEX‐RN. Similarly, social welfare, relationships and external expectations should be assessed for adult learners to ensure well‐motivated learners (Maas, 2017). Students' social welfare may affect their chance to pass NCLEX‐RN, and schools should aim to keep their nursing students positively socially engaged and motivated. Williams (2018), who utilized Wenger's social learning systems and the community of practice, explained learning as competencies based on social processes and experiences based on the individual level. Furthermore, Wangerin (2015) conducted a qualitative analysis of 20 programme improvement plans and considered nursing education as an integral part of the educational system and the healthcare system, both of which have social structures that are continuously evolving and changing.

2. METHODS

This scoping review is guided by Arksey and O'Malley's (2005) methodological framework and follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐Extension for Scoping Review (PRISMA‐ScR) guidelines as explained in the Joanna Briggs Institute (JBI) methodology (Peters et al., 2020). Arksey and O'Malley's (2005) methodological framework consists of five required stages starting with stating the research question.

2.1. Stage 1: Identifying the research question

The research study is driven from the aims of this review. This scoping review research questions are as follows:

  1. What education strategies have been utilized when preparing students for the NCLEX‐RN? 2. What theories have been utilized as frameworks when preparing students for the NCLEX‐RN? 3. What is known about learners' QOL when preparing for the NCLEX‐RN?

2.2. Stage 2: Identifying relevant studies

Authors identified the following keywords, including all synonyms and corresponding controlled vocabulary: (1) teaching strategies or teaching methods or teaching approaches or classroom techniques or strategies or clinical reasoning or clinical judgement or critical thinking or wellness or quality of life, (2) AND theory or model or framework or concept, (3) AND NCLEX or nursing licens* exam*. The search includes results from the last 7 years, 2015–2022. On April 4, 2022, an updated search was conducted and initially resulted in 168 articles from four databases, CINAHL (81), ERIC (5), PsychINFO (29) and Web of Science (53). The exact keywords and controlled vocabulary were developed in collaboration with a coauthor, who is a librarian.

2.3. Stage 3: Study selection

After deleting duplicates, items decreased from 168 to 143. After manually removing additional duplicates, the number decreased from 143 to 137 items. The title and abstract screening removed an additional 93 items, resulting in 44 items for full‐text review. Each item was screened by two investigators independently, and when any item received different decisions, the final decision was made by a third investigator. Editorials and articles that did not include educational strategies to prepare nursing students for NCLEX‐RN were excluded. After a full article review, items decreased from 44 to 25 (Figure 1).

FIGURE 1.

FIGURE 1

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PRISMA‐ScR flow diagram modified for scoping review process.

2.4. Stage 4: Charting the data

Data from each article were charted in a shared Google Doc among authors. Data included authors, publication date, population of the study, sample size, study method and design, educational strategies, theories, relation to QOL and location of each study.

2.5. Stage 5: Collating and summarizing and reporting the results

Tables 1, 2, 3 were extracted from the main shared charted data to highlight level of evidence, educational strategies and the commonly used theories, respectively. To ensure the breadth and depth of reporting results, the PRISMA‐ScR guidelines were used.

TABLE 1.

Level of evidence.

Level Design Reference
III Quasi‐experimental Blakeslee (2019)
V Correlational Garwood (2015), Hackney (2017), Harrison (2018), Maas (2017), Moniyung, (2015) and Pence and Wood (2018)
Cohort Duncan and Schulz (2015), Harris (2018), Kinyon et al. (2021), Myles (2018), Romanowski et al. (2021) and Schlairet and Rubenstein (2019)
VI Descriptive Brackney et al. (2017), Davis and Morrow (2021), Eisenmann (2021), Hensel and Billings (2019), Sanderson et al. (2022) and Zehler and Musallam (2021)
Qualitative Gonzalez et al. (2021), Johnson (2015), Joseph (2017), Ryan (2019), Wangerin (2015) and Williams (2018)
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TABLE 2.

Result of individual sources.

Reference Population Educational strategies
Blakeslee (2019) 69 Junior BSN students High‐fidelity simulation and written case studies
Brackney et al. (2017) 41 Senior‐level BSN students Capstone simulation
Davis and Morrow (2021) 10 BSN faculty from 6 BSN programs NCLEX‐style questions integrated throughout programme and NCLEX review course
Duncan and Schulz (2015) 240 BSN students None: Concept‐based curriculum
Eisenmann (2021) 90 pre‐licensure students New approach to concept mapping
Garwood (2015) 40 BSN students Short video clips, small group activities in flipped classroom, and concept maps
Gonzalez et al. (2021) Associate‐degree nursing (ADN) students Clinical coaching via collaboration among faculty, students, and healthcare members
Hackney (2017) 127 Senior‐level BSN students Meaningful faculty‐student interactions via academic advising and student choice of assignments
Harris (2018) 55 BSN students None: Neuman's and Rotter's theories with perceived competencies
Harrison (2018) 239 Associate of Science in Nursing (ASN) students None: Concept‐based curriculum associated with increased critical thinking exit scores and predicting first‐time NCLEX pass rates
Hensel and Billings (2019) N/A Clinical scenarios via case studies and simulation
Johnson (2015) 15 Registered Nurses previous associate degree graduates Problem‐solving and critical thinking exercises in small groups, test‐taking strategies, and mini‐case scenarios
Joseph (2017) Nine ADN graduates NCLEX‐style question exposure throughout programme and development of NCLEX study plan
Kinyon et al. (2021) Nursing faculty teaching Nursing Care of Children with data from 6 semesters Cased‐based learning–unfolding case‐based learning activities, modified flipped classroom, and reflection, test‐taking strategies, and knowledge content on five quizzes
Maas (2017) 729 ASN at‐risk graduates Remediation programme and nursing faculty support
Moniyung (2015) 838 ADN Students None: Academic & non‐Academic variables and NCLEX‐RN success
Myles (2018) Pre‐licensure nursing students Remediation plans, 2‐day mandatory relearning seminar, and 8‐week asynchronous online NCLEX‐RN review
Pence and Wood (2018) 195 BSN students Computer adaptive quizzing with PassPoint
Romanowski et al. (2021) 90 Registered nurse students Active learning strategies such as assessment tools and gaming
Ryan (2019) 4 Diploma nursing programs‐46 nursing faculty Early exposure to test‐taking strategies and NCLEX‐style questions
Sanderson et al. (2022) 1500 pre‐licensure BSN graduates Faculty mentoring and coaching in student‐gathering spaces and faculty offices
Schlairet and Rubenstein (2019) 120 students and 24 faculty coaches in BSN Programs NCLEX Coaching Model conducted in senior‐level leadership course with nursing faculty member and NCLEX review course
Wangerin (2015) 20 Programs: 10‐BSN and 10‐ASN Active learning/teaching with concept maps, case study discussions, computer‐assisted learning and NCLEX review course
Williams (2018) 12 ADN & 5 Licensed Practical Nursing students Exposure to NCLEX‐style questions with rationales throughout curriculum, case studies and reviewed student study habits
Zehler and Musallam (2021) 26 Junior‐level BSN students Game‐based learning activity
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TABLE 3.

Theories and models that were found in more than one reviewed article.

Theory or model Citation from this review Theorists
Clinical judgement model Brackney et al. (2017), Eisenmann (2021) and Gonzalez et al. (2021) Tanner
The NCSBN Clinical Judgement Measurement Model (NCJMM) Gonzalez et al. (2021) and Hensel and Billings (2019) NCSBN
The adult learning theory (andragogy) Garwood (2015), Johnson (2015) and Maas (2017) Knowles
The three learning domains (cognitive, psychomotor, and affective) Brackney et al. (2017), Joseph (2017) and Maas (2017) Bloom
Theory of interpersonal relations Davis and Morrow (2021) and Schlairet and Rubenstein (2019) Peplau
Bandura's theory of self‐efficacy Maas (2017) and Ryan (2019) Bandura
Self‐determination theory of motivation Hackney (2017) and Ryan (2019) Deci & Ryan
Input‐environment‐outcome model Brackney et al. (2017) and Moniyung (2015) Astin
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3. RESULTS

3.1. Selection and characteristics of source

The reviewed studies (N = 25) included dissertations (n = 9) and peer‐reviewed articles (n = 16). Among dissertations and all reviewed studies, similarities in methodologies were noted, including qualitative and quantitative methods of descriptive, cohort designs and pretest‐posttest studies. Qualitative designs were used in five out of the nine dissertations (Johnson, 2015; Joseph, 2017; Ryan, 2019; Wangerin, 2015; Williams, 2018). A case study was the design of three out of the five qualitative dissertations (Johnson, 2015; Joseph, 2017; Williams, 2018). Similarly, descriptive designs were found in eight studies (Brackney et al., 2017; Eisenmann, 2021; Garwood, 2015; Harrison, 2018; Hensel & Billings, 2019; Myles, 2018; Pence & Wood, 2018; Sanderson et al., 2022). Cohort studies were the design for six studies (Duncan & Schulz, 2015; Harris, 2018; Kinyon et al., 2021; Myles, 2018; Romanowski et al., 2021; Schlairet & Rubenstein, 2019). Finally, a pretest‐post‐test method was used in three studies (Blakeslee, 2019; Kinyon et al., 2021; Zehler & Musallam, 2021), including a pilot pretest‐posttest study (Zehler & Musallam, 2021).

3.2. Critical appraisal: Level of evidence and significance

The level of research evidence was based on the criteria recognized by Grove and Gray (2019), consisting of seven levels from the highest to the lowest. Among the reviewed articles, there were no Level I (systemic review and meta‐analysis) or Level II (randomized control trial or experimental) studies. Similarly, there were no Level IV studies such as a mixed‐methods systematic review or qualitative meta‐synthesis. The highest article was Level III (Table 1). Editorials, Level VII, were excluded from this review.

Statistical significance among the reviewed articles was limited to five articles (Harris, 2018; Harrison, 2018; Pence & Wood, 2018; Schlairet & Rubenstein, 2019; Zehler & Musallam, 2021). The duration of those studies and sample sizes and designs played an important role in finding significance in quantitative studies. For example, Harrison (2018) conducted a descriptive retrospective correlational study on nursing students (n = 258) and found a statistically significant positive correlation between concept‐based curriculum and critical thinking (p < 0.001). A concept‐based curriculum examines concepts that link to the delivery of patient care. It challenges students to think more critically about topics and situations they encounter by applying prior knowledge (Duncan & Schulz, 2015; Harrison, 2018). Harrison also found that critical thinking (p = 0.009) can predict the probability of passing the NCLEX‐RN the first time.

The importance of the duration of the preparation was highlighted in a pilot cohort study. Schlairet and Rubenstein (2019) conducted a 6‐week study during the last semester to test the effect of NCLEX Coaching Model on the first‐time NCLEX‐RN passing rate. There was a mild improvement in the first‐time passing rate, from 89% (n = 101) to 90% (n = 107). According to the authors, if the study had been longer in time, the results might have detected statistically significant improvement. Although the authors did not find significant data on the first‐time passing rate, the authors found statistically significant (p < 0.001, n = 114) improvements in confidence/readiness scores after the completion of the intervention when compared to before starting the intervention. The authors suggested a possible maturation effect on the sample as this study was conducted in the last semester (Schlairet & Rubenstein, 2019).

3.3. Educational strategies

Educational strategies (Table 2) varied within the current literature review. Active learning strategies were the most frequent (n = 11) educational strategy cited in this scoping review, followed by faculty coaching/support (n = 6), NCLEX‐RN‐style question exposure (n = 5), NCLEX‐RN review course and products (n = 4), remediation/tutoring for at‐risk students (n = 3), and simulation (n = 2).

3.4. Theories

The utilization of theories or models was noted in (n = 19) studies. Eight theories/models appeared in more than one article (Table 3); many theories were used once in one of the reviewed articles. Tanners clinical judgement model was frequently found in this review (Brackney et al., 2017; Eisenmann, 2021; Gonzalez et al., 2021). Similarly, Gonzalez et al. (2021) and Hensel and Billings (2019) discussed the NCSBN Clinical Judgement Measurement Model (NCJMM) and referred to the originality of Tanner's clinical judgement model.

Similarities between Tanner's clinical judgement model (Tanner, 2006) and the NCJMM are abundant. The first step in Tanner's clinical judgement model is noticing, which is explained as noticing important aspects of the situation. Similarly, the NCJMM starts with recognizing cues and then analysing cues. Likewise, interpreting is the second step in Tanners' clinical judgement model, which involves analysing reasoning patterns. In the interpreting and responding steps, Tanner (2006) discusses rolling out hypotheses; similarly, the third step in the NCJMM is prioritizing hypotheses. Finally, reflection is the last step in Tanner's clinical judgement model. Tanner's model depicts reflection‐in‐action and then reflection‐on‐action, whereas the second layer in the NCJMM includes refining hypotheses and then evaluation. According to Eisenmann (2021) and Tanner (2006), nursing students should still learn the nursing process in addition to other clinical judgement strategies. It was suggested that the NCJMM has higher advantages and available resources to prepare nursing students among other clinical judgement models (Hensel & Billings, 2019).

Additionally, Eisenmann (2021) referred to the Caputi‐think‐like‐a‐nurse theoretical framework and explained how it might assist in educating nursing students to make clinical decisions. Moreover, Eisenmann (2021) discussed Benner's novice‐to‐expert theory and suggested this theory may assist in combining educational knowledge with clinical experience to approach appropriate clinical reasoning. Furthermore, many authors referred to different theories, and some authors used more than one theory in a study. For example, Harris (2018) utilized Neuman system model and referenced RAM as another system theory.

3.5. Quality of life

Although addressing QOL of students who are preparing to take the NCLEX‐RN test was one of the goals of this review, no clearly focused discussion about QOL in any of the reviewed articles was found, except elements that may relate to the QOL, such as social welfare and mindfulness. To illustrate, Sanderson et al. (2022) developed a model that focuses on non‐academic factors. They found that only 36% of NCLEX‐RN success is attributed to academic factors. Sanderson et al. (2022) designed a model for student success and tested it on 1500 students over four campuses in a multi‐campus university. Authors identified risk factors outside the classrooms and even before starting the nursing programme and reacted based on identified weaknesses (Sanderson et al., 2022). Similarly, Brackney et al. (2017) and Moniyung (2015) utilized Astin's input‐environment‐outcome model. The input includes student characteristics upon admission (Moniyung, 2015).

Sanderson et al. (2022) examined psychosocial and socioenvironmental factors and test‐taking strategies on admission. The interventions included mindfulness resilience programs and NCLEX‐RN preparation materials. With these multidimensional interventions, the passing rate for the NCLEX‐RN continued to trend upward for four consecutive years. Training in mindfulness and coping strategies was provided based on student needs, and students and the faculty selected activities together (Sanderson et al., 2022). Similarly, in another study, it was recommended measuring test anxiety and the effect of mindfulness activities before taking tests. This is because mindfulness has the potential to increase calmness, allows students to envision success, and consequently may increase students' probability of passing a test (Ryan, 2019).

4. DISCUSSION

Although various theories and educational strategies were found, limited discussion about students' QOL was noted. This may relate to the fact that some theories focused mainly on education rather than on enhancing the learner's experience and QOL during the educational process. Active learning strategies were the most found strategy among other valuable educational strategies.

4.1. Educational strategies to prepare nursing students for NCLEX‐RN

Active learning or integrative learning strategies support student engagement and application of new and previous knowledge. Unfolding case studies were frequently used as an active learning/educational strategy. Case‐based learning was found to stimulate rich student‐led discussion, foster critical thinking and enhance student content mastery on standardized exams (Johnson, 2015; Kinyon et al., 2021; Romanowski et al., 2021; Wangerin, 2015; Williams, 2018). Hensel and Billings (2019) claimed that all types of case studies (i.e. clinical scenarios, integrative, unfolding) could be used to teach clinical judgement because case studies “provide students the opportunity to link classroom learning with clinical practice” (p. 129). Game‐based learning was found to be a positive active educational strategy because it created a collegial culture in the classroom, fostered critical thinking and clinical judgement and prepared students for the NGN (Romanowski et al., 2021; Zehler & Musallam, 2021).

Concept mapping was also frequently cited as an active learning/educational strategy. Concept mapping helps students to visualize and remember concepts, increases their ability to prioritize nursing care and improves critical thinking and clinical judgement (Eisenmann, 2021; Garwood, 2015; Wangerin, 2015). Based on this review and in particular the work of Eisenmann (2021), a concept map was designed (Figure 2). This concept map utilizes RAM framework (Roy, 2009) centrally to visualize some possible relationships among different aspects such as physiological adaptation and psychological integrity. Furthermore, the concept map incorporates the NCJMM (National Council of State Boards of Nursing [NCSBN], 2019) and parts of the NGN test plan (National Council of State Boards of Nursing [NCSBN], 2023). The figure depicts client‐centred care, as Blakeslee (2019) suggested that although students are encouraged to think critically, care should be patient‐centred.

FIGURE 2.

FIGURE 2

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Concept map and Roy adaptation model.

Faculty coaching and support were cited in this review of literature as a resource to assist students to successfully prepare for the NCLEX‐RN. Regular academic advising as a meaningful faculty‐student interaction fosters academic motivation in students and assists in the identification of potential and actual student barriers to successful learning throughout the nursing programme (Davis & Morrow, 2021; Hackney, 2017; Maas, 2017; Ryan, 2019). Schlairet and Rubenstein (2019) found that NCLEX‐RN coaching improved students' confidence (personal and professional) and readiness and promoted NCLEX‐RN success. Davis and Morrow (2021) emphasized the importance of creating a unified faculty attitude where “it was everyone's job to ensure students pass NCLEX‐RN” (p. 363). Furthermore, the cooperation among faculty, students and healthcare clinical members was valued by the students (Gonzalez et al., 2021).

According to Davis and Morrow (2021), faculty members were committed to working unitedly and invested their time above and beyond the expected towards students' success in the NCLEX‐RN examination. This commitment allowed students to view faculty members as counsellors for their NCLEX‐RN success. When students have a higher quality of educational support, they are more likely to pass NCLEX‐RN (Sanderson et al., 2022). However, dismissal decisions were made since those who fail two nursing courses are twice as likely to fail their first NCLEX‐RN compared to those who fail one nursing course or never fail a nursing course (Sanderson et al., 2022). Thus, although supporting strategies and resources should be implemented, it may be reasonable to have a dismissal policy based on failing two nursing courses.

NCLEX‐RN‐style questions exposure was identified in the literature review as an important educational strategy to prepare nursing students for the NCLEX‐RN. Continually practising NCLEX‐RN‐style questions and rationales is a beneficial learning approach and should be implemented throughout the programme (Davis & Morrow, 2021). Early exposure to test‐taking strategies coupled with NCLEX‐RN‐style questions and rationales boosted students' confidence and readiness for standardized assessments and NCLEX‐RN readiness measures (Johnson, 2015; Joseph, 2017; Ryan, 2019). Williams (2018) claimed that continual exposure to NCLEX‐RN‐style questions and rationales assisted students to “think like a nurse” in classroom and clinical settings. A NCLEX‐RN review course was highly recognized as an important strategy to prepare students to have first‐attempt success on the NCLEX‐RN. Delivery formats differed from asynchronous online to live and in‐person and varied in length from 3 days to 8 weeks (Myles, 2018; Schlairet & Rubenstein, 2019; Wangerin, 2015).

Remediation plans and tutoring opportunities in nursing programs are effective educational strategies that are also recognized in this scoping review. Including academic support programs such as remediation and tutoring within a nursing programme can positively support students, especially those identified as at risk (Myles, 2018; Wangerin, 2015). Maas (2017) emphasized the importance of providing at‐risk students support and additional resources to participate positively in a remediation programme to support their success within the programme and the NCLEX‐RN. Sanderson et al. (2022) described the importance of providing students access to open skills and simulation labs for practice and remediation and peer support for supplemental instruction.

Simulation was also described as an effective educational strategy. Simulation has been used to increase students' critical thinking, clinical judgement, confidence in the clinical setting, and readiness for the RN role (Blakeslee, 2019; Brackney et al., 2017). In this scoping review, simulation could have been included as a format for a case study. Multiple educational strategies to prepare nursing students for the NCLEX‐RN have been described in the literature. Blakeslee (2019) stated, “instead of focusing on a single teaching strategy, nursing education programs are encouraged to develop multiple comprehensive teaching strategies to help nursing students improve their critical thinking skills” (p. 6).

Garwood (2015) suggested that an effective educator must not only ascertain how students learn best but also motivate them to learn. Similarly, the self‐determination theory of motivation was suggested to positively correlate with the probability of passing the NCLEX‐RN. Self‐determination theory differentiates between intrinsic motivation such as personal interest and values and extrinsic motivation such as grades (Hackney, 2017; Ryan, 2019). Thus, nursing instructors may use different strategies to motivate students based on their gratification and deprivation, as learners are expected to experience gratification and deprivation during their educational journey. Therefore, faculty can play a vital role in motivating students to foster self‐determination, and students with higher levels of determination are more likely to pass NCLEX‐RN and continue a lifelong learning journey after graduation (Hackney, 2017).

4.2. Theories

In this review, Knowles' adult learning theory was one of the most found among the reviewed articles. Knowles' adult learning theory of andragogy views adult learners as self‐directed and internally motivated who value activities focused on their goals, such as licence or certification (Garwood, 2015; Johnson, 2015; Maas, 2017). Furthermore, Moniyung (2015) noted the adult generational differences, including the millennial generation – those born from 1980 to 2000.

Although there are some common characteristics in adult learners, such as thriving in a respectful environment (Garwood, 2015) and the ability to cooperate with others (Garwood, 2015; Moniyung, 2015), millennials are more comfortable with using technology (Moniyung, 2015). Garwood (2015) suggested that nursing faculty should adapt to engage and motivate the millennial generation. Indeed, millennial students may corroborate successfully using technology to prepare for their NCLEX‐RN exam, and faculty may need to adapt to engage and motivate millennial students. Pence and Wood (2018) conducted a retrospective, descriptive correlational study on Bachelor of Science in Nursing (BSN) critical care course students (n = 195) and found a positive, statistically significant relationship (p < 0.001) between using software, including PassPoint and PrepU from publisher Wolters Kluwer, and NCLEX‐RN success. Davis and Morrow (2021) found that commercial NCLEX‐RN products are a necessary strategy to improve NCLEX‐RN first‐time pass rates as they supplement the program's curriculum and support faculty and students with a variety of NCLEX‐RN readiness resources. Pence and Wood (2018) noted that preparation started from the first semester in the nursing programme and should be continued to the NCLEX‐RN exam day.

4.3. Quality of life

When Peplau's theory was utilized to develop the NCLEX Coaching Model, the authors illustrated that advantages might extend socially even after passing NCLEX‐RN. The social confidence that students gain may allow students to confidently find an appropriate job (Schlairet & Rubenstein, 2019). Faculty commitment fostered the students' accountability. Davis and Morrow (2021) further discussed self‐accountability based on Peplau's theory and referred to the article that was found in this search (Schlairet & Rubenstein, 2019). Self‐accountability allowed students to have a higher level of responsibility, confidence, and consideration of further educational advancement in the nursing profession. Peplau's theory of interpersonal relations was useful and fit logically in implementing a Student NCLEX Coaching Model (Schlairet & Rubenstein, 2019). Thus, both social factors and self‐accountability may affect students' success.

In addition, spiritual factors may relate to the student's QOL during preparation for the NCLEX‐RN. To illustrate, Harris (2018) utilized Neuman's nursing system theory and Rotter's social learning theory. Harris found a significant relationship between spirituality and perceived NCLEX‐RN competency. Additionally, internal or external locus of control, which is part of Rotter's theory, has been found to relate positively to the NCLEX‐RN Test Plan. Finally, failing the NCLEX‐RN may lead to negative QOL, including financial difficulties, low self‐esteem and loss of employment (Pence & Wood, 2018). Thus, psychological, social, spiritual, financial and occupational dimensions may relate to the NCLEX‐RN results, either positively or negatively.

Similarly, Roy (2009) depicted that adaptation and coping occurs through four modes, including self‐concept, physiologic, role‐function, and interdependence modes. Most of the reviewed articles may be included under the role‐function mode and a few under the self‐concept mode. To clarify, none of the reviewed articles focused on the physiologic mode. Based on RAM (Roy, 2009), this review illustrates how different identified educational strategies may fit under the different modes, which may affect the students' QOL (Figure 3). The figure illustrates that education should be student‐centred because students should be active and responsible for their education (Joseph, 2017).

FIGURE 3.

FIGURE 3

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Roy's adaptation model and NCLEX preparation.

4.4. Summary of evidence

Multiple educational strategies to prepare students for the NCLEX‐RN were mentioned in the literature versus a single best practice. Suggested approaches included active learning strategies, faculty coaching and support, continuous exposure to NCLEX‐RN style questions, NCLEX‐RN review courses and products, remediation or tutoring and simulation. Different theories were used, and limited discussion about students' QOL was noted. No clearly defined theory that focuses on students' QOL while students are preparing for the NCLEX‐RN was discussed.

4.5. Limitations

One of the main limitations of this review is that it did not target specific educational strategies. Secondly, the used keywords were designed to gather articles that include theories and theoretical frameworks or “concepts” as part of the conceptual theory. However, five articles were picked by the research engine because they included educational strategies, such as concept‐based methods or curricula or concept maps (Duncan & Schulz, 2015; Gonzalez et al., 2021; Harrison, 2018; Myles, 2018; Romanowski et al., 2021). This may lead this scoping review to focus on the “concepts” as educational strategies more than other vital educational strategies. The review did not find focused papers on NGN, which may be related to the fact that the NGN had not been launched at the time of this review.

4.6. Recommendation

It is recommended to focus on multidisciplinary research with various majors, including education and nursing. Eight of the nine reviewed dissertations were conducted in departments of education and did not necessarily include a committee member from the nursing profession. In this review, authors who are nurses published many research articles mainly in educational peer‐reviewed journals. A cooperation between nursing and education professions is recommended to advance dissertations that bridge these fields. Also, researchers in this field should pursue conducting studies with higher levels of evidence. Conducting a grounded theory study is recommended because none of the theories in the review addresses student QOL. For example, conducting a study that is theoretically guided with RAM may fill this gap. Additionally, faculty should use a variety of teaching strategies, while also focusing on student QOL to enhance student outcomes. The authors also recommend testing the effect of the theoretically designed models. To illustrate, Figure 2 may be tested to study the effect of applying this concept map to student's clinical judgement. Similarly, a researcher may utilize Figure 3 to incorporate various teaching strategies and test their relationships to learners' QOL. Some researchers used more than one educational strategy, and the utilization of RAM may allow researchers to be more comprehensive. Finally, it is recommended to focus research on NGN instead of the traditional NCLEX‐RN.

5. CONCLUSION

This scoping review did not reveal a favoured theory or framework that should be used to guide preparation of students for the NCLEX‐RN. Different educational strategies were discussed, and active learning strategies were the most founded. Further interventional, theoretically guided research should be conducted with larger sample sizes and stronger research designs using various active learning strategies, while also focusing on student's QOL variables.

AUTHOR CONTRIBUTIONS

Khalid Bandar Almasloukh: conceptualization, writing original draft, and project administration. Melissa Miner: writing original draft, review, and editing. Kathleen Phillips: methodology and resources. Michael Evans: conceptualization, validation, supervision, writing‐review and editing.

CONFLICT OF INTEREST STATEMENT

Authors report no conflict of interest.

Supporting information

Data S1.

Click here for additional data file. (12.8KB, docx)

ACKNOWLEDGEMENTS

This research received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

Almasloukh, K. B. , Miner, M. , Phillips, K. , & Evans, M. (2023). Educational strategies and nursing theory to prepare leaners for NCLEX‐RN . Nursing Open, 10, 7144–7153. 10.1002/nop2.1998

DATA AVAILABILITY STATEMENT

The data that supports the findings of this study are available in the supplementary material of this article.

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Associated Data

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Supplementary Materials

Data S1.

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Data Availability Statement

The data that supports the findings of this study are available in the supplementary material of this article.

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