Over the past two decades, the development of the nursing profession in Saudi Arabia has accelerated over several transformational stages [1]. The nursing profession is still in rapid development due to the efforts and measures of the Saudi Ministry of Education (MOE). Moreover, recommendations by the Saudi Ministry of Health (MOH) have helped prepare and improve nurses’ educational and training competencies to improve the quality of nursing care in all health sectors [2]. The latest published statistics by MOH showed that nursing staff represents 41% (83,596) of the MOH workforce. Particularly, Saudi citizens represent approximately 63% of the total healthcare workers [2, 3]. The current plan of the nursing colleges in Saudi Arabia is to graduate approximately 26,200 new nurses by 2027 [2, 3]. Alongside this plan, important educational factors such as students' preferred learning styles should not be ignored.

Internationally, nurses are responsible for providing a range of healthcare services, which are supposed to be based on vital nurses’ knowledge and skills [4, 5]. Nurses should be prepared to respond to emergencies and provide comprehensive patient-centered care [6]. Also, they must be prepared to provide safe patient care and be involved in enhancing the mental and psychosocial health status of individuals and the community [7]. Therefore, it is the responsibility of nursing education to have a plan to prepare future nurses with the knowledge, information, and skills needed to provide safe, holistic patient care [8].

Accordingly, to achieve the Saudi national plan of graduating approximately 26,200 new nurses by the year 2027 [2, 3], nursing education in Saudi Arabia must be associated with the globally updated nursing education strategies and methods that aim to improve students' knowledge, information, and skills [9, 11]. Therefore, the Saudi strategic plan should be developed based on international nursing education strategies and methods that could potentially guide educators in choosing appropriate teaching strategies that fit students learning styles.

One of the most important elements in nursing education is students' preferred learning style [11-13]. Several learning styles are used in education to provide learners with better information to achieve their academic goals [13]. Some individuals prefer to receive information by oral presentation (i.e., verbal learners), whereas others prefer to receive information through pictures (i.e., visual learners). Learners may also prefer to be active participants in small groups or work independently to gain information. The literature suggests that using different learning styles—especially a student’s preferred learning style-is significantly associated with improving their academic achievements [13, 14]. For example, several studies were conducted to assess the impact of using different learning styles on the academic achievements of undergraduate students [13-17]. Most of the studies found a positive correlation between students preferred learning styles and their academic performance.

Due to rapidly increasing advancements in nursing education curricula in Saudi Arabia, nurse educators are responsible for keeping themselves updated to assist and meet students’ learning needs. Of these needs, understanding nursing students' learning styles can be crucial. Indeed, different learning styles and preferences are essential for strategic attainment throughout a demanding nursing degree. A literature review is necessary to gain detailed information regarding Saudi nursing learning styles and preferred learning styles to generate a comprehensive educational tool for nursing educators. Therefore, this literature review aims to offer detailed information about the preferred learning style of Saudi nursing students studying in Saudi Arabia. Specifically, the objectives of this review were to 1) provide a brief overview of Kolb’s model, the Felder-Silverman learning style model (FSLSM), and the Visual, Aural, Read/Write, and Kinesthetic (VARK) Learning Styles Inventory, and 2) discuss and compare the most common learning style models that have been used in Saudi nursing education programs in Saudi Arabia. The results of this study will positively contribute to improving nursing education in Saudi Arabia and other Arab countries. Moreover, it will help Saudi nursing educators to choose the most appropriate teaching methods that fit nursing students' needs.

An integrative literature review was conducted to identify the learning styles of Saudi nursing students based on the premises of three learning style models: VARK Learning Styles, Kolb's model, and FSLSM learning style. The research strategy for this study was based on online international databases, such as PubMed, Medline, CINAHL, EBSCO, Google Scholar, and Saudi health databases and journals. The database search was conducted using the following keywords: “nursing education,” “learning style,” “learning preference,” “academic learning style,” “Undergraduate Nursing Students,” and “Nursing students in Saudi Arabia”. The inclusion criteria were 1) published literature in the English language, 2) peer-reviewed articles, and 3) literature with a focus on using learning styles in nursing education in Saudi Arabia. Discussion articles, letters to the editors, and articles with weak documented references were excluded from this literature review. Moreover, studies that have been conducted in different settings outside of Saudi Arabia were also excluded.

The searching and reviewing process was guided by this research’s aim of assessing the background of nursing education in Saudi Arabia and identifying the dominant learning styles among Saudi nursing students. The search of the literature took place in June and July 2021. Each selected article was carefully screened for relevance by reading the title, abstract, purpose, samples, study design, and measurement. The literature search revealed seven full-text peer-reviewed articles Fig. (1). shows the flowchart for the selection of studies retrieved from databases.

Fig (1). PRISMA flowchart for selection of studies retrieved from databases.

Published studies in Saudi Arabia were included in this literature review based on study aims, year of publication, and language. Limited published original research articles were found, and those related papers were examined thoroughly. Most selected articles were published in the English language between 2010 and 2020 and assessed Saudi nursing students' learning styles. Based on the inclusion criteria, 7 out of a total of 44 studies were considered in this study (Table 1).

The contents of the literature were analyzed following Mayring's (2004) methodology [30]. The seven studies were selected for their appropriateness for this literature review, as they aimed to examine Saudi nursing students’ learning styles. Based on Mayring’s (2004) guidelines [30], the literature review process encompasses and involves broadly four stages: (a) collecting materials/resources, (b) descriptive analysis, (c) selecting categories, and (d) evaluating the findings of selected studies field [30]. Following the previously described standards, the authors chose to review the selected literature to explore Saudi nursing students' learning styles to identify the literature gaps regarding this topic in Saudi Arabia. After identifying the original research articles, only seven articles were included in this literature review paper. Secondary sources, unrelated articles, and gray literature papers were also withdrawn from this article.

Searching the literature revealed limited sources and a scarcity of published articles regarding the specific objectives of this study. Overall, three learning style models were noted in the searched literature. Therefore, the authors of this study classified the results into three subheadings to present the reviewed literature regarding the three learning style models used in nursing education in the KSA.

The most crucial element in all areas of education is the learning process [32, 34, 35]. The process of learning is one in which the student actively participates in acquiring information and building knowledge. One of the key elements in enhancing student learning and boosting their abilities, aptitudes, and competencies in nursing education is their learning style preferences [32, 34, 35]. The current literature review aimed to identify the learning styles of Saudi nursing students based on the premises of three learning style models: VARK Learning Styles, Kolb's model, and FSLSM learning style. To date, a few studies have highlighted advances in the patterns and trends developed in the modern nursing education system while considering the ground report on learning style preferences among nursing students studying in nursing institutes in Saudi Arabia. Available literature addresses several concerns, particularly the most preferred learning styles in Saudi Arabia. Currently, the VARK, Kolb's model, and FSLSM of learning style preferences exhibit how individuals differ in their learning preferences. The reviewed learning theories depict the significance of learning style preferences among undergraduate nursing students in Saudi Arabia.

The literature review revealed that the kinesthetic learning style is the most preferred learning style for Saudi nursing students according to the VARK model [2]. According to Stirling and Alquraini (2017), many students prefer kinesthetic learning styles compared to visual learning styles, verbal learning styles, and sequential techniques [28]. The present results were consistent with the conclusions of a survey conducted by Alkooheji and Al-Hattami (2018) in Bahrain [36]. The study in Bahrain demonstrated that the learners preferred multi-modular learning styles, such as visual and kinesthetic learning styles. According to Elgzar et al. (2019), in students who prefer the kinesthetic learning style, learning takes place when students are physically active as opposed to listening to lectures or watching demonstrations [34]. Therefore, nursing students with kinesthetic learning styles prefer to have hands-on practice while they are learning. This is suitable for nursing students in training and simulation labs or clinical settings [34].

The reviewed literature showed a clear impact of SDL, concrete experience, and abstract conceptualization on students' learning styles. Studies on Kolb's learning styles [32, 33] depict a similarity in accommodating and converging learning preferences by a majority of Saudi nursing students. As expounded in Kolb's matrix, the two styles are categorized under active experimentations. El-Gilany and Fel (2013) showed a significant trend in students' preference for converter learning styles, for example, abstract conceptualization and abstract thinking [32]. In particular, most of the learners preferred accommodating and converging styles to diverging learning and preferred SDL when dealing with feeling, thinking, and doing tasks rather than watching simultaneously [32]. Due to the nature of the nursing profession, which requires nurses to be active in clinical settings, accommodating and converging learning preferences are suitable for most nursing students [32]. Students preferring a converging learning style prefer using technology while studying [21, 22]. Therefore, it is recommended to incorporate teaching technology into students learning experiences. This could include increasing the utilization of nursing simulations and virtual learning in nursing curricula. On the other hand, studies in Saudi Arabia revealed otherwise. AbuAssi and Alkorashy (2016) showed that the diverging style was the most frequently used throughout the sampled population, followed by the accommodating and converging styles [31]. Students who prefer diverging styles usually prefer to observe and watch while they are studying instead of actively practicing [32]. Students with diverging styles prefer to think and brainstorm information prior to generating ideas or information [21, 22]. Nursing students can exhibit this learning style during the early education levels, where students need to learn while watching clinical instructors perform certain nursing tasks. Nursing students prefer visual learning styles followed by active learning styles, as identified by Alharbi et al. (2017) [33]. To help nursing students learn better, nursing educators should stress the importance of building curricula that focus on visual and active learning styles to improve students' learning process [33].

Notably, the studies reviewed have significant asymmetries among them. In particular, the findings on VARK-based research conducted by Stirling and Alquraini (2017) [28] and Aljohani and Fadila (2018) [2] offer contradictory remarks. All reviewed studies concluded that kinesthetic learning was found to be the most dominant learning style among sampled populations. Kinesthetic learners learn best through physical activities instead of listening or watching. Besides, visual learners were characterized by excellently evaluating, authenticating, and synthesizing information with the help of meaningful signs in graphical presentations. Even though optical efficiencies in learning describe them, the category may not have effectiveness in comprehending videotapes. Most nursing students preferred learning styles examined using VARK preferred kinesthetic learning style, which focuses on students being physically active during the learning process. Similarly, most nursing students preferred learning styles examined using Kolb's model and reported they prefer accommodating and converging learning styles that require them to have hands-on practice while learning. Finally, most nursing students using FSLSM prefer visual and active learning styles that require them to be physically active and have hands-on practice while learning [33].

Thus, it can be argued that the findings of this literature review study are significantly provocative to elevate the standard of education systems in nursing learning institutions in Saudi Arabia. The visual mode of learning was accepted unanimously as the most preferred style among all sampled students. However, the kinesthetic style engages the student who prefers hands-on experience or participatory knowledge; these students learn better by taking physical roles in the learning process.

The nursing education system in Saudi Arabia is steadily evolving, necessitating flexibility while maintaining maximum quality standards in the learning approaches. Understanding the students’ preferred learning styles can be envisioned as the key to enhancing nursing comprehension in Saudi Arabia. The reviewed literature offers significant insights worth emulating to maximize learners' strengths. Given that students prefer various learning styles, nurse educators must address and accommodate this variety to improve and adjust suitable learning methods for motivating and enhancing students’ academic performances and outcomes. The findings depict a higher percentage of learners preferring kinesthetic, accommodating, converging, visual, and active learning styles. These learning styles emphasize the importance of practical experience and students' hands-on practice as the best style that improves nursing students learning experience. The education policies should include a parallel nursing quality assurance program to optimize the interface between teaching and learning patterns in nursing and healthcare institutions across the country.