The Effectiveness of E-Learning Application Developed for Chest Tube Care in Nursing Students

Developed in 1995 by Lewis at IBM, the Computer System Usability Questionnaire (CSUQ) is one of the widely used questionnaires in the field of usability. The scale, which was adapted into Turkish by Erdinç in 2013, consists of 13 items in total. It has 4 sub-dimensions: system usefulness (items 1-6), information quality (items 7-9), interface quality (items 10-12) and general satisfaction (item 13). Each item is scored as 1 (Strongly agree) - 7 (Strongly disagree). The Cronbach α of the scale is \> .70 and the Cronbach α value for each sub-dimension varies between .73 and .92. A minimum score of 13 and a maximum score of 91 can be obtained from the scale. A low score is defined as good usability, and the higher the score, the lower the usability quality of the system (Erdinç \& Lewis, 2013).

In the form developed by the researchers in line with the literature, a total of 12 questions were included to determine the socio-demographic characteristics of the students (such as age, gender, academic average, whether they provide care to patients with chest tubes, whether they receive training on chest tube care). All participants in the experimental and control groups were applied once as a pre-test.

It is a comprehensive assessment tool developed by Huang Huiman (2018) to determine the clinical reasoning readiness levels of nursing students in Taiwan (Ho et al., 2021; H.-M. Huang et al., 2018). 'Clinical Reasoning Readiness Scale for Nursing Students' consists of 4 sub-dimensions. These sub-dimensions are 'awareness of clinical clues' (4 items), 'verification of clinical problems' (4 items), 'action determination and implementation' (4 items) and 'evaluation and reflection' (4 items). Each sub-dimension contains four items to assess students' clinical reasoning readiness levels. The lowest score that can be obtained from the scale is 16 and the highest score is 80. Responses to the scale are evaluated on a 5-point Likert scale (5=strongly agree, 4=agree, 3=decided, 2=disagree, 1=strongly disagree). Cronbach's α ranged from 0.894 for the total and 0.78 to 0.89 for each sub-dimension. The corrected item-total correlation is between 0.627-0.728. Higher scores indicate higher levels

The original Self-Managed Learning Scale was used as a self-report scale by Lounsbury et. al. (2009). The Turkish adaptation and validity and reliability study of the scale, which shows the extent to which individuals learn autonomously with a one-dimensional structure, was conducted by Demircioğlu, Öge, Fuçular, Çevik, Nazlıgül, and Özçelik in 2018. The scale is 5-point Likert-type and consists of 10 items. For each item, participants are expected to respond according to 1 (Strongly disagree), 2 (Disagree), 3 (No opinion), 4 (Agree) and 5 (Strongly agree). Cronbach's alpha coefficient of the scale is 0.85. In line with the scores obtained from the scale, above average self-directed learning skill means high and below average self-directed learning skill means low (Demircioğlu et al., 2018). Both groups were applied as pre-test and post-test.

It was created by the researchers in line with the evidence in the literature (Abuejheisheh et al., 2021; Basler, 2020; Bertrandt et al., 2019; Charnock \& Evans, 2001; El-Senousy, Mahrous, Abd-Al Salam, \& Zedan, 2020; Ho et al., 2021; Tarhan et al., 2016; Zisis et al., 2015). The 'Chest Tube Care Management Knowledge Test' was initially prepared as a total of 43 multiple-choice questions, including the headings and subheadings in each session (Abuejheisheh et al., 2021; Malone, 2015). Expert opinions were obtained from 5 faculty members with clinical experience and studies on chest tube care. The experts gave suitability scores to the knowledge test questions one by one on a 4-point Likert-type scale (1: The item is not suitable, 2: The item should be seriously revised, 3: Suitable should be slightly revised, 4: Suitable). In line with the suggestions from the experts, the questions were reorganised and 9 questions were removed. For the remaining 34 multiple-choice questions in the kno