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Brains and Bytes: Enhancing Cranial Nerve Assessment Through Teacher-Guided vs. Computer-Assisted Instruction in Nursing Education
* Corresponding author: Dr. Giriypura Rudrappa Gireesh, Department of Nursing Foundation, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India. gireeshsachin@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Valappil AM, Gireesh GR. Brains and Bytes: Enhancing Cranial Nerve Assessment Through Teacher-Guided vs. Computer-Assisted Instruction in Nursing Education. J Health Allied Sci NU. doi: 10.25259/JHASNU_106_2025
Abstract
Objectives
To compare the effectiveness of teacher-guided instruction (TGI) and computer-assisted instruction (CAI) on knowledge and psychomotor skills related to cranial nerve assessment among undergraduate nursing students, and to determine the relationship between post-test knowledge and skill scores.
Material and Methods
A quasi-experimental pre-test post-test control group design was adopted among 75 second-year B.Sc. Nursing students were selected using purposive sampling and randomly allocated into three groups: TGI (n=25), CAI (n=25), and Control (n=25). Data were collected using a validated structured knowledge questionnaire (CVI = 0.92) and an observational skills checklist (CVI = 0.89). Interventions included a 45-minute teacher-guided session for Group I and a 15-minute animated CAI module for Group II, while the control group received routine curriculum-based teaching. Statistical analysis was performed using paired t-tests, independent t-tests, Chi-square, and Pearson correlation.
Results
Both TGI and CAI significantly improved students’ knowledge and skills compared to the control group. TGI demonstrated superior effectiveness, with excellent post-test performance of 72% in both knowledge and skills, compared to 40% in the CAI group. The mean post-test knowledge score was significantly higher in the TGI group (12.04 ± 2.42) than in the CAI group (9.96 ± 2.40), with a mean difference of 2.08 (p = 0.004). Similarly, skill scores were higher for TGI (11.8 ± 2.56) compared to CAI (9.72 ± 2.17), with a mean difference of 2.08 (p = 0.003). A strong positive correlation (r = 0.688; p < 0.001) was observed between post-test knowledge and skill scores.
Conclusion
Teacher-guided instruction was more effective than Computer-Assisted Instruction in enhancing both cognitive and psychomotor competencies in cranial nerve assessment among nursing students. The findings support the integration of structured, hands-on teaching methods along with blended learning approaches to optimise clinical skill acquisition.
Keywords
Computer-assisted learning
Cranial nerve evaluation
Nursing education
Psychomotor competencies
Teacher-led instruction
INTRODUCTION
The integration of innovative pedagogical approaches has represented a significant paradigm shift in the advancement of nursing education. In the field of neuro-assessment, particularly cranial nerve evaluation, nursing students must possess a comprehensive understanding and clinical skill set.[1] Cranial nerve assessment is a critical component of a neurological examination, as it enables the early identification and treatment of a variety of neuro-pathological issues. The evaluation of cranial nerves is a critical aspect of neurological examination, as it is essential for the identification of early indicators of neurological impairment. Mastery of this assessment is essential for nursing professionals to provide timely and accurate patient care, particularly in emergency and critical care settings. In order to execute this technique effectively, undergraduate nursing students must acquire the requisite academic knowledge and practical skills.[2]
Educational institutions worldwide are increasingly recognising the necessity of integrating traditional methods with technology-enhanced learning (TEL) to enhance knowledge retention, psychomotor abilities, and clinical reasoning.[3] The World Health Organization emphasises the importance of fostering the development of skilled health professionals who possess both cognitive and technical skills in order to meet the demands of global healthcare. The quality of healthcare services and patient outcomes worldwide must be improved through educational reform and technology-driven pedagogies, as emphasised in the Institute of Medicine (IOM) report.[4]
Global research suggests that computer-assisted instruction (CAI) enhances autonomous learning and active participation in the field of health sciences. The clinical performance and confidence of nursing students were significantly improved by simulation-based and digital training, according to a study conducted in Canada.[5] Institutions in the United Kingdom are incorporating blended learning methodologies, which involve the integration of e-learning modules into traditional instruction. This approach has led to improved academic performance and the development of nursing trainees’ skills.[6]
The Indian Nursing Council (INC) has recognised the significance of educational innovations in the transformation of nursing education in India. A burgeoning body of Indian literature underscores the obstacles that nursing students encounter when attempting to acquire intricate clinical skills through theoretical instruction alone.[7] In Delhi, a study demonstrated that students who were instructed using teacher-guided instruction (TGI), which incorporates feedback and demonstration, demonstrated a higher level of clinical competence than those who were solely provided with lectures. Furthermore, a separate investigation conducted in Bangalore discovered substantial enhancements in students’ knowledge levels who participated in computer-based modules that concentrated on neurological subjects.[8]
CAI and team-based learning (TBL) are student-centered and interactive approaches that have the potential to significantly enhance learning outcomes when compared to traditional lectures, according to global data. The nursing curricula of countries such as the United States, Canada, and Australia are increasingly incorporating competency-based teaching. Nevertheless, there is a dearth of data on the comparative efficacy of these interventions, particularly in low- and middle-income countries like India, where infrastructure and accessibility vary significantly.[9]
While the application of innovative approaches such as CAI remains inconsistent, the emphasis remains primarily on theoretical training in the Indian setting, despite the gradual curriculum modifications instituted by the INC. There is a lack of standardised research that evaluates the impact of these strategies on information acquisition and psychomotor abilities, which are critical in the field of neurology.
Novelty of the study
The study endeavours to address the gap in nursing education by contrasting two distinct instructional methods, TGI and CAI, with a control group that receives routine instruction. The effectiveness of both strategies on cognitive and psychomotor outcomes among nursing students in a single-institution setting can be assessed using this quasi-experimental design. The novelty is in the examination of both knowledge and skills, thereby addressing the underexplored dimension of instructional methodology in cranial nerve assessment training. The INC guidelines mandate that cranial nerve assessment be introduced in the second year of the “Medical Surgical Nursing-I” curriculum, which is why the second-year B.Sc. Nursing students were chosen. This guarantees that participants possess fundamental knowledge and are developmentally appropriate for advanced skill training. The inclusion of additional years would introduce a degree of variability in baseline knowledge and exposure.
MATERIAL AND METHODS
A quasi-experimental pre-test post-test control group design was used to evaluate the effectiveness of teacher-guided instruction and CAI on knowledge and skills related to cranial nerve assessment among undergraduate nursing students. The study was conducted at Yenepoya Nursing College, Mangaluru, Karnataka, over a period of seven days, from February 11, 2022, to February 17, 2022. Ethical clearance for the study was obtained from the Institutional Ethics Committee (Approval Number: YEC2/865, dated 07/10/2021).
Although purposive sampling was initially mentioned, the participants (n = 75) were randomly assigned to three groups using a stratified random allocation method to ensure balanced distribution. To minimise researcher bias, intervention delivery was standardised the same researcher delivered TGI using a structured script, and pre-recorded modules were used for CAI. Contamination bias was controlled by conducting sessions separately for each group, scheduling them at different times, and restricting inter-group interaction during the study period. The assessor for skill evaluation was blinded to group allocation.
Ethical considerations
All participants provided written informed consent after being briefed about the study’s objectives, procedures, potential risks, and benefits. The anonymity of participants was ensured, and all data collected was kept confidential and used solely for research purposes.
Population and sampling
The target population for the study comprised second-year B.Sc. Nursing students from Yenepoya Nursing College who were developmentally appropriate for cranial nerve assessment training according to the INC curriculum. A purposive sampling method was adopted to recruit eligible students who provided informed consent, and the participants were randomly allocated into groups to minimise bias. The required sample size was calculated using G*Power software with an effect size of 0.5, an alpha level of 0.01, and a statistical power of 95%, which indicated a minimum of 75 students. Accordingly, 75 participants were enrolled and equally distributed into three groups: Teacher-Guided Instruction (n = 25), CAI (n = 25), and Control (n = 25). Inclusion criteria were second-year B.Sc. Nursing students who were willing to participate and had not previously received structured training on cranial nerve assessment, while exclusion criteria included students from the first, third, and fourth years, as well as Post Basic B.Sc. Nursing students, since their level of exposure and curriculum content differed.
Validity and reliability
The data collection tools included a structured knowledge questionnaire and an observational skills checklist. Content validity was confirmed through expert review, with CVI scores of 0.92 for the questionnaire and 0.89 for the checklist. Reliability testing indicated high internal consistency (Cronbach’s alpha = 0.85) and strong inter-rater agreement for skills (Cohen’s kappa = 0.81). Reliability and pilot testing were conducted on a different group of students who were not included in the main study sample to avoid pre-exposure bias. The pilot study involved a smaller number of students randomly assigned to three groups to assess the feasibility, clarity of tools, time required, and logistics of the intervention. Necessary modifications were incorporated before proceeding with the main study.
Data collection procedure
The target population consisted of second-year B.Sc. Nursing students from Yenepoya Nursing College, selected using purposive sampling based on inclusion and exclusion criteria. Students willing to participate and without prior structured training on cranial nerve assessment were included, while those from other academic years or Post Basic B.Sc. Nursing were excluded. A sample size of 75 was calculated using G*Power (effect size 0.5, α=0.01, power 95%) and distributed equally into three groups: Experimental Group I (TGI, n=25), Experimental Group II (CAI, n=25), and Control Group (n=25).
On February 12, students in Experimental Group I (TGI) attended a 45-minute teacher-guided session comprising a lecture-cum-demonstration on all 12 cranial nerves, their functions, clinical signs, and bedside examination. Experimental Group II (CAI) received a 15-minute session using CAI that included animations, interactive video demonstrations, mnemonics, and audio narration. The control group continued with standard curriculum-based instruction and received no additional training during the study period. The control group received routine curriculum-based instruction in neurological assessment as prescribed by the INC, without any additional training during the study period.
Statistical analysis
The collected data were entered into Microsoft Excel and analysed using IBM SPSS Statistics software (Version 25.0). The choice of statistical tests was based on the type of data, distribution, and study objectives. Paired t-tests were used to compare pre- and post-test scores within each group. Independent t-tests were applied to compare mean post-test scores between groups. Chi-square tests assessed associations between demographic variables and outcomes. Pearson correlation was used to examine relationships between knowledge and skill scores. All tests were selected based on the normal distribution of data and interval-level measurement.
RESULTS
Demographic characteristics of participants
A total of 75 second-year B.Sc. Nursing students participated in the study, with 25 students in each group (Experimental Group I, Experimental Group II, and Control Group). In Experimental Group I, the majority of students (76%) were 19 years old, all were female (100%), and most identified as Christian (84%). Similarly, in Experimental Group II, the majority (56%) were 20 years old, 72% were female, and 84% were Christian. In the Control Group, 52% were 19 years old, 96% were female, and 80% identified as Christian. Most students reported receiving prior information about cranial nerve assessment from health professionals: 72% in Group I, 56% in Group II, and 64% in the Control Group.
The data in Table 1 shows the comparison of pre-test and post-test knowledge levels.
| Description | Experimental group I | Experimental group II | Control group | |||
|---|---|---|---|---|---|---|
| Pre-test | Post-test | Pre-test | Post-test | Pre-test | Post-test | |
| f (%) | f (%) | f (%) | f (%) | f (%) | f (%) | |
| Excellent | --- | 18 (72%) | ----- | 10 (40%) | ----- | ---- |
| Average | 08 (32%) | 07 (28%) | 09 (36%) | 15 (60%) | 10 (40%) | 07 (28%) |
| Poor | 17 (68%) | _ | 16 (64%) | _ | 15 (60%) | 18 (72%) |
f represents frequency.
The data indicate a marked improvement in knowledge levels among students receiving instructional interventions. In Experimental Group I (TGI), 72% achieved excellent scores post-test, up from 68% poor pre-test performance. Experimental Group II (CAI) also showed improvement, with 40% reaching excellent post-test scores. In contrast, the Control Group showed minimal change, with poor performance increasing from 60% to 72% post-test, suggesting that TGI was most effective, followed by CAI. [Table 1].
As illustrated in Table 2, the pre-test and post-test skill levels were compared.
| Description | Experimental group I | Experimental group II | Control group | |||
|---|---|---|---|---|---|---|
| Pre-test | Post-test | Pre-test | Post-test | Pre-test | Post-test | |
| f (%) | f (%) | f (%) | f (%) | f (%) | f (%) | |
| Excellent | ---- | 18 (72%) | ------ | 10 (40%) | ---- | ---- |
| Average | 01 (04%) | 07 (28%) | 05 (20%) | 15 (60%) | 04 (16%) | 02 (08%) |
| Poor | 24 (96%) | _ | 20 (80%) | _ | 21 (84%) | 23 (92%) |
f represents frequency.
The data reveal a substantial improvement in skill levels following the interventions. In Experimental Group I (TGI), excellent performance increased from 0% to 72%, with a reduction in poor scores from 96% to 0%. Experimental Group II (CAI) also improved, with excellent scores rising to 40% and poor scores eliminated. However, the Control Group showed minimal progress, with poor performance increasing from 84% to 92%, indicating that TGI was most effective, followed by CAI, while the control group lagged significantly. [Table 2].
Table 3 presents the effectiveness of teacher-guided instruction compared to CAI.
| Variables | Group | Mean ± SD | Mean difference | ‘t’ value | df | p value |
|---|---|---|---|---|---|---|
|
Post-test knowledge |
Experimental group I | 12.04 ± 2.42 | 2.080 | 3.045 | 24 | 0.004*** |
| Experimental group II | 9.96 ± 2.40 | |||||
|
Post-test skill |
Experimental group I | 11.8 ± 2.56 | 2.080 | 3.095 | 24 | 0.003*** |
| Experimental group II | 9.72 ± 2.17 |
p < 0.005 considered significant, SD: Standard deviation, df: Degree of freedom.
The post-test results indicate that Experimental Group I (TGI) performed significantly better than Experimental Group II (CAI) in both knowledge and skill scores. The mean difference for knowledge was 2.08 (t = 3.045, p = 0.004***), and for skill, also 2.08 (t = 3.095, p = 0.003***). These p-values (< 0.01) confirm that the differences are statistically significant, highlighting the superior effectiveness of TGI in enhancing both cognitive and psychomotor competencies. [Table 3].
The results show a strong positive correlation between post-test knowledge and skill scores with an r value of 0.688 and a highly significant p value of 0.0001*. This indicates that as students’ knowledge increased, their skill performance also improved, demonstrating a close relationship between cognitive understanding and psychomotor ability in clinical learning.
DISCUSSION
This study demonstrated that both teacher-guided and computer-assisted instructional strategies effectively enhanced nursing students’ knowledge and skill in cranial nerve assessment.[10] Teacher-guided instruction, however, was significantly more effective. These findings are consistent with previous research suggesting that structured, face-to-face clinical teaching strengthens psychomotor development and critical thinking in nursing students.[11,12]
CAI also produced favorable results in improving cognitive learning outcomes, confirming the utility of digital learning tools, particularly for theoretical concepts.[13]
However, its relative underperformance in skill enhancement compared to TGI supports existing literature that emphasises the irreplaceable value of hands-on practice for mastering clinical competencies.[14]
The observed correlation between knowledge and skill scores aligns with Benner’s Novice to Expert Model and indicates that theoretical understanding contributes meaningfully to clinical skill development.[15] However, theoretical input alone is not sufficient; structured and supervised clinical exposure remains essential.[16]
Although most demographic variables did not show a statistically significant effect on learning outcomes, a difference based on gender was observed in Group II (CAI).[17] However, this finding should be interpreted with caution, as the overall sample was predominantly female, potentially limiting the representativeness and introducing analytical bias.[18]
Limitations
The single-institution nature and short intervention period limit the generalisability of findings. However, the structured approach and detailed methodology provide insights that may benefit similar nursing institutions with comparable educational settings. Future studies should include diverse and larger samples from multiple institutions, assess long-term outcomes, and gather qualitative data on learner experiences to better inform instructional design in nursing education.
Funding: This research did not receive any financial support or funding from any government, private, or non-profit organization. It was conducted as part of academic requirements.
CONCLUSION
Teacher-guided instruction was more effective than computer-assisted learning in improving both theoretical knowledge and psychomotor skills in cranial nerve assessment. These findings reinforce the need for structured, hands-on instruction within nursing curricula and support the incorporation of blended methods to optimise learning outcomes.
Nursing educators should integrate guided clinical instruction alongside digital learning tools to ensure comprehensive skill development. Faculty training and institutional support should focus on promoting blended learning tailored to students’ clinical competency needs.
Acknowledgement
The authors would like to thank the participating students, faculty members, and the management of the institution for their support and cooperation during the study.
Ethical approval
The research/study was approved by the Yenepoya University Ethics Committee-2 at Yenepoya (Deemed to be University), number YEC2/865, dated 7th October 2021.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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