Related Experiment Video
Updated: Jan 17, 2026

Using Learning Outcome Measures to assess Doctoral Nursing Education
Published on: June 21, 2010
Unwrapping success: A scoping review of exam wrappers and metacognitive skill development in undergraduate nursing
Elissa Dabkowski1, Chelsea Webb1, Elianna Johnson1
1Institute of Health and Wellbeing, Federation University Australia, Churchill, Victoria, Australia.
Aim:
This scoping review explored what is known about the impact of exam wrappers on the development of metacognitive skills among undergraduate nursing students. Specifically, it examined implementation approaches, educational outcomes and faculty involvement across published studies.
Background:
Metacognition is essential for clinical reasoning, judgement and self-regulated learning in nursing education. Exam wrappers are structured reflection tools completed after assessments and offer a practical strategy to enhance metacognitive awareness. Despite their success in other disciplines, their integration in undergraduate nursing programs remains limited and inconsistent.
Design:
Scoping review.
Methods:
Using Arksey and O'Malley's (2005) five-stage scoping review framework, a systematic search was conducted across nine databases in August 2024 and updated in May 2025. Studies were included if they focused on undergraduate nursing students and the use of exam wrappers. Data were analysed using narrative synthesis and thematically organised.
Results:
Nine U.S.-based studies met the inclusion criteria. Three key themes emerged: (1) variations in delivery approaches, (2) enhanced learning and metacognitive outcomes and (3) fostering academic support. Exam wrappers were delivered in various formats, including written grids and one-on-one debriefs and were shown to improve student reflection, academic performance and study behaviours. Faculty time and institutional support influenced implementation success.
Conclusion:
Exam wrappers are promising tools for developing metacognitive skills in nursing students. Embedding them early in curricula, using digital platforms and supporting feedback literacy may improve uptake and sustainability. Future studies should examine the long-term impact of exam wrappers on academic and clinical performance in diverse nursing education settings.
More Related Videos
12:55Multimodal Protocol for Assessing Metacognition and Self-Regulation in Adults with Learning Difficulties
Published on: September 27, 2020
07:32Use of Galvanic Skin Responses, Salivary Biomarkers, and Self-reports to Assess Undergraduate Student Performance During a Laboratory Exam Activity
Published on: February 10, 2016
Related Concept Videos
Metacognition
Critical Thinking I
Patient-centered Care
Critical Thinking II
Nursing Process for Patient and Caregiver Teaching III: Evaluation and Documentation
Nurses can use several methods to evaluate patient outcomes. For example, oral questions can assess cognitive learning,...
Nursing Process for Patient and Caregiver Teaching I: Assessment and Diagnosis
It is critical to determine the patient's learning needs during the assessment. Determination of learning needs compounds data...