How the TPACK Framework Can Support Nurse Educators Adopting Digital Learning Solutions

According to the Future of Nursing Report, changing demographics and technological advancements will transform nurses’ professional roles in the United States through this decade (2020-2030). These shifts will impact how nurses will interact with patients and adopt patterns of health care delivery and communication to ensure improved outcomes for all. As a result of this forecast, evolutions in nursing school curricula will be at the forefront. Additional changes will be driven by the implementation of Next Generation NCLEX® (NGN) in 2023.

Elsevier recognizes the complexities of the nursing profession and the transformations that are on the horizon. We strive to empower nursing programs with curricular solutions that are beneficial for cultivating the requisite knowledge, skills, and attitudes for students. Through Elsevier’s total curriculum solution, we are committed to supporting faculty in incorporating a variety of pedagogical approaches and digital technologies to meet their teaching, learning, and assessment needs. Our educational solutions focus on three primary areas to support students’ knowing, doing, and becoming competent nursing professionals:

  • Building Knowledge: We ensure students master nursing knowledge and develop confidence in their understanding. Our solutions like eBooks, Sherpath courseware offerings, and Elsevier Adaptive Quizzing (EAQ) emphasize careful curation of foundational content and students’ active engagement in the learning process throughout the nursing curricula.
  • Applying Clinical Judgment: We situate students’ ability to “think like a nurse” in authentic learning situations where knowledge acquisition and application are tightly integrated. Our offerings like Shadow Health and Simulation Learning System (SLS) for high-fidelity simulation-based learning and immersive virtual reality (VR) scenarios are crucial for supporting students’ cognitive, social and psychomotor skills. Additionally, technologies like course-based SimChart® offer practice with electronic health records (EHR) and case studies that further students’ clinical readiness required to succeed as a nurse.
  • Assessing and Reviewing: We enable assessment of students’ progress throughout the program and offer solutions to improve their learning in target areas. HESI Specialty Exams, HESI Exit Exams, and HESI Compass facilitate knowledge retention and application as students prepare for the NCLEX-RN.

Technologies within Elsevier’s total curriculum solution have been developed and refined as a result of our ability to carefully listen to macro and micro needs within nursing education. However, we take it as our responsibility to also support faculty in developing awareness of the educational solutions so that they can make well-informed decisions about which technologies to integrate into the nursing curricula, for whom, and how. We believe that the Technological Pedagogical Content Knowledge (TPACK) framework is relevant to this discussion.

The TPACK framework was developed by Mishra and Koehler (2006) to conceptualize the interdependent knowledge educators need to enhance their instruction with technology. To provide a brief historical context on the development of TPACK, Shulman (1986) argued for educators to cultivate pedagogical content knowledge to effectively teach in a specific content area. Mishra and Koehler (2006) expanded this concept to include knowledge of technology for educators when teaching with digital tools. This expanded knowledge base is captured in the TPACK framework. TPACK explains the interaction between these three dynamic areas of knowledge and how teachers can use it flexibly in their respective areas of expertise to create an effective learning environment. The framework also allows us to support educators’ decisions to use a specific technology, which should be made in conjunction with considerations about content (what to teach) and pedagogy (how to teach).

Recently, Mishra (2019) argued for the addition of contextual knowledge (XK) within the framework. This encompasses educators’ awareness of social and organizational factors within their context while making decisions about technology integration in their curricula. Furthermore, Mishra and Warr (2021) urged educators to be cognizant of the broader systems and culture within which classrooms operate to integrate technologies meaningfully for all learners.

TPACK has been adopted in nursing curricula to design and deliver courses. For instance, Tai, Pan and Lee (2015) applied the framework to design an online collaborative writing training course for nursing students needing to learn English writing skills in a nursing university in southern Taiwan. Similarly, Levitt and colleagues (2016) described the application of TPACK for an online program designed to support graduate nursing education students’ technology-based pedagogical skills. TPACK can also be co-opted as an analytical lens to understand the context-attuned characteristics of educational technologies (Foster, Mishra & Koehler, 2011; Jayatilleke & Shah, 2020; Shah & Foster, 2015; Shah, 2019).

Below, the co-opted TPACK framework is used to generate a list of questions nursing faculty can reflect upon in an ongoing manner as they integrate a variety of digital learning solutions in their curricula (Shah, 2015). The questions can be applied to each solution or part of a solution in relation to specific program needs. For instance, adopting SLS with VR simulations may offer students adaptive and immersive opportunities for patient-centered care (e.g., patient interaction, patient education). The questions can also be applied to multiple solutions to understand how each technology complements another for meeting specific curricular goals. For example, EAQ may offer a useful instructional approach for helping students practice recalling the medications for a variety of diagnoses, while simulations may be useful for practicing medication administrations on virtual patients and obtaining real-time feedback on the respective procedures.

TPACK Framework Questions for Digital Implementation
What is the primary and secondary objective(s) of this educational solution?
What is the predominant instructional style of this educational solution? Or, how would you describe its teaching approach?
What academic content and skills can be learned from this educational solution?
What do students do to meet the objectives embedded within this educational solution?
How does the educational solution support a demonstration of students’ accomplishment of objectives (e.g., scores, performance summary)?
Which nursing standards/competencies are addressed in this educational solution?
How will students learn of the topic/academic content in the educational solution?
How does the educational solution scaffold students’ learning about the topic/academic content?
What is the nature of feedback and instruction provided in this educational solution?
What kinds of faculty instructions and guidance will students need to participate in this educational solution?
What kind(s) of prior knowledge and skills are essential for students’ successful use of the educational solution?
For which groups of nursing students is the education solution beneficial and how?
In what ways does the educational solution augment faculty expertise and curricular goals?
What kind of training will faculty need for the successful integration of the educational solution to meet the curricular goals?
Which current pedagogical practices and policies would need to be adjusted as a result of adopting the education solution?
What infrastructure adjustments should be considered to successfully integrate the educational solution?
What scheduling adjustments should be considered to successfully integrate the educational solution?
What opportunities will the educational solution catalyze at the individual, cohort, program level?
What insights and feedback can be gathered to reflect on the effectiveness of the educational solution and its implementation in the program?

The co-opted TPACK framework is beneficial for helping nursing programs implement a variety of technologies while developing a deep understanding of how each digital learning solution supports nursing educators’ curricular goals and students’ learning needs. Please explore the following resources for further reading on TPACK:

  • Foster, A., Mishra, P., & Koehler, M. (2011). Digital game analysis: Using the technological pedagogical content knowledge framework to determine the affordances of a game for learning. In M. S. Khine (Ed.), Learning to play: exploring the future of education with video games (pp. 189-212). New York: Peter Lang.
  • Jayatilleke, A. & Shah, M. (2020). Examining the technological pedagogical content characteristics of games for medical education. Medical Science Educator, 30, 529-536.
  • Kraglund-Gauthier, W., & Moseley, J. (2019). Building teaching-learning capacities of online nurse educators: Using TPACK to frame pedagogical processes and identify required supports. Canadian Journal of Learning and Technology, 45(1).
  • Levitt, C. G., Digger, K., & Lewis, M. P. (2016). Using the TPACK model to increase digital skills and pedagogy in graduate nursing education students. Paper presented at Sigma International Nursing Research Congress. Retrieved from
  • Mishra, P. (2019). Considering contextual Knowledge: The TPACK diagram gets an upgrade. Journal of Digital Learning in Teacher Education. 35(2), 76-78.
  • Mishra, P., & Koehler, M. J. (2006). Technological pedagogical content knowledge: A framework for teacher knowledge. Teachers College Record, 108(6), 1017–1054.
  • Mishra, P., & Warr, M. (2021). Contextualizing TPACK within systems and culture. Computers in Human Behavior, 117, 106673.
  • National Academies of Sciences, Engineering, and Medicine (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press.       
  • Shah, M. (2019). Supporting teachers’ examination of games for teaching, learning, and assessment. In Ifenthaler D., & Kim Y. (Eds.), Game-Based Assessment Revisited (pp.185-210). Springer, Cham.
  • Shah, M. (2015). Pre-service teacher education in game-based learning: Cultivating knowledge and skills for integrating digital games in K-12 classrooms (Doctoral Dissertation, Drexel University).
  • Shah, M. & Foster, A. (2015). Developing and assessing teachers’ knowledge of game-based learning. Journal of Technology and Teacher Education, 23(2), 241-267. Waynesville, NC USA: Society for Information Technology & Teacher Education. 
  • Shulman, L. E. (1986). Those who understand: Knowledge growth in teaching. Educational Research, 15(2), 4–14.
  • Tai, H. C., Pan, M. Y., & Lee, B. O. (2015). Applying technological pedagogical and content knowledge (TPACK) model to develop an online English writing course for nursing students. Nurse Education Today35(6), 782-788.