Blockchain-Enabled E-Portfolios for Competency Tracking in Undergraduate Nursing Education: A Randomized Controlled Trial (BCEP-RCT)

Blockchain-Enabled E-Portfolios for Competency Tracking and Lifelong Learning in Nursing Education: An Explanatory Sequential Mixed-Methods Randomized Controlled Trial

This study evaluates whether a blockchain-enabled electronic portfolio can improve competency tracking and lifelong learning in undergraduate nursing education. Conventional electronic portfolios are often fragmented across courses and clinical rotations, difficult to verify across institutions, and limited in supporting learner ownership of records. To address these challenges, this study compares a blockchain-enabled e-portfolio system with a conventional Moodle-based e-portfolio during a medical-surgical clinical rotation.

Third-year undergraduate nursing students at Jouf University, Saudi Arabia, were randomly assigned to use either the blockchain-enabled e-portfolio intervention or the conventional e-portfolio control. The intervention was designed to support cryptographically verifiable competency records, structured reflective evidence, and personalized competency feedback through dashboard analytics.

The main outcomes include clinical competence assessed by an Objective Structured Clinical Examination (OSCE), lifelong learning orientation, portfolio quality, and trust in the credibility and portability of competency records. After the quantitative phase, focus group interviews were conducted with students in the intervention group to explore their experiences with the system and the mechanisms through which it may influence learning.

The study aims to determine whether blockchain-enabled e-portfolios offer educational advantages over conventional portfolio systems in competency-based nursing education and to identify implementation factors that may support or hinder adoption.

Study Overview

• Status: Completed
• Conditions: Nursing Education; Clinical Competence; Competency-Based Education; Electronic Portfolios; Lifelong Learning
• Intervention / Treatment: Behavioral: Blockchain-Enabled E-Portfolio Platform; Behavioral: Conventional Moodle-Based E-Portfolio

Detailed Description

Competency-based nursing education requires students to demonstrate progressive attainment of clinical and professional competencies across time and settings. Conventional electronic portfolios are commonly used to document reflections, skills, assessments, and learning evidence, but these systems often have limitations, including fragmented documentation across rotations, weak portability of records, restricted external verifiability, and limited learner ownership of competency evidence.

This study evaluates a blockchain-enabled electronic portfolio (BC-EP) model developed to support competency tracking and lifelong learning in undergraduate nursing education. The intervention was designed to provide a tamper-evident and portable framework for documenting competency attainment while also supporting reflective learning and personalized feedback. The BC-EP model was implemented using a permissioned blockchain architecture and included three core components: (1) a verifiable competency ledger in which competency-related artifacts were linked to cryptographically signed attestations; (2) a reflective evidence layer that connected clinical events, competency tags, reflective narratives, and preceptor attestations; and (3) a data-driven dashboard designed to identify competency gaps and guide individualized development.

The study used an explanatory sequential mixed-methods design. In the quantitative phase, a two-arm parallel randomized controlled trial was conducted among third-year undergraduate nursing students enrolled in a medical-surgical clinical rotation at the College of Nursing, Jouf University, Saudi Arabia. Participants were randomized in a 1:1 ratio to either the BC-EP intervention group or a control group using the institution's conventional Moodle-based electronic portfolio. Both groups received the same clinical rotation, but the intervention group used the blockchain-enabled platform for competency documentation, reflective evidence submission, and personalized progress monitoring.

The primary educational outcome was clinical competence, assessed using a six-station Objective Structured Clinical Examination (OSCE). Secondary outcomes included lifelong learning orientation, portfolio quality, and trust in the credibility and portability of educational records. Baseline demographic and educational data were also collected. Following completion of the quantitative phase, qualitative focus group interviews were conducted with a purposive sample of intervention-group participants to explore user experiences, perceived benefits, challenges, and possible mechanisms of effect.

The study seeks to determine whether a blockchain-enabled e-portfolio can improve educational outcomes in nursing students compared with a conventional e-portfolio system and to generate implementation-relevant insights for future digital credentialing models in nursing education.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Jeddah, Saudi Arabia
    • faculty of nursing Gouf university

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Third-year undergraduate nursing students
• Enrolled in the medical-surgical clinical rotation at the College of Nursing, Jouf University
• Admitted through the standard national admission route
• Willing to participate and able to provide informed consent

Exclusion Criteria:

• Prior formal training in blockchain or distributed-ledger applications
• Expected absence for more than two weeks during the clinical rotation
• Self-reported lack of proficiency in basic digital learning tools
• Enrollment in a non-standard curriculum track, such as bridging or transfer programs

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Blockchain-Enabled E-Portfolio; Participants assigned to this arm used a blockchain-enabled e-portfolio platform during a 14-week medical-surgical clinical rotation. The platform supported cryptographically verifiable competency attestations, structured reflective evidence linked to competency tags, learner-held record ownership, and dashboard-guided personalized feedback.	Behavioral: Blockchain-Enabled E-Portfolio Platform; A blockchain-enabled educational portfolio system used to support competency tracking and lifelong learning in undergraduate nursing education. The intervention included a verifiable competency ledger, structured reflective evidence linked to competency tags and preceptor attestations, learner-held credential ownership, and dashboard-based personalized competency feedback during a 14-week clinical rotation.
Active Comparator: Conventional E-Portfolio; Participants assigned to this arm used the institution's conventional Moodle-based e-portfolio during a 14-week medical-surgical clinical rotation. The platform supported routine artifact uploads, reflection templates, self-assessments, and asynchronous discussion without blockchain-based verification or personalized competency analytics.	Behavioral: Conventional Moodle-Based E-Portfolio; A conventional institutional electronic portfolio system used for routine documentation during a 14-week clinical rotation. The control platform included portfolio templates, artifact uploads, self-assessment activities, and discussion forums, but did not include blockchain verification, cryptographic attestation, portable credentials, or personalized competency dashboards.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lifelong Learning Orientation Assessed by Jefferson Scale of Physician Lifelong Learning-Nursing Adaptation	Lifelong learning orientation was assessed using the Jefferson Scale of Physician Lifelong Learning-Nursing adaptation (JSPLL-N), a 14-item measure assessing learning beliefs and motivation, scanning for learning opportunities, and attention to learning opportunities. Higher scores indicate stronger lifelong learning orientation.	One week after completion of the 14-week clinical rotation
Clinical Competence Assessed by Objective Structured Clinical Examination Total Score	Clinical competence was assessed using a six-station Objective Structured Clinical Examination (OSCE) aligned with medical-surgical nursing competencies. The six stations assessed comprehensive health assessment, medication administration and safety, aseptic technique and infection control, patient education and discharge counselling, clinical reasoning and prioritization, and professionalism/interprofessional communication/ethics. Total scores ranged from 0 to 100, with higher scores indicating better clinical competence.	At the end of the 14-week clinical rotation (approximately 14 weeks after allocation)

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Mostafa Shaban, Cairo University

Publications and helpful links

General Publications

• Wei FC, Kao LJ, Chang CT, Chung JY. Enhancing nursing education through e-portfolios: evaluating the impact on learning effectiveness, self-efficacy, and job satisfaction of NPGY trainees. BMC Medical Education. 2025;25:1132. doi:10.1186/s12909-025-07497-w
• Casino F, Dasaklis TK, Patsakis C. A systematic literature review of blockchain-based applications: Current status, classification and open issues. Telematics and Informatics. 2019;36:55-81. doi:10.1016/j.tele.2018.11.006

Study record dates

Study Major Dates

• Study Start (Actual): February 20, 2025
• Primary Completion (Actual): June 18, 2025
• Study Completion (Actual): June 27, 2025

Study Registration Dates

• First Submitted: April 9, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 15, 2026

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Blockchain; Undergraduate Nursing Students; Blockchain-Enabled E-Portfolio; Competency Tracking; Medical-Surgical Clinical Rotation
• Other Study ID Numbers: BC-EP-NEP-2025-JU; JU-CON-2025-BC-EP (Registry Identifier: Institutional Review Board (IRB) Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared due to ethical and institutional restrictions related to student educational records and privacy considerations. The dataset contains potentially identifiable academic and performance information from undergraduate nursing students, and consent for open data sharing was not obtained at the time of study enrollment. De-identified aggregated data supporting the findings of this study may be made available from the corresponding author upon reasonable request, subject to institutional approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No