Walker and Avant described concept analysis as the process of examining the elements that form a concept’s basis, identifying what is important when explaining its nature, and gaining insights by analyzing the similarities and differences in all its possible uses [9] . In Japan, artifacts are discussed in fields such as education and psychology; however, they are not widely recognized in nursing. Therefore, a concept analysis of the “utilization of artifacts” was conducted based on Walker and Avant’s procedures to examine its applicability in nursing practice instruction.

The usage of “artifacts” was explored using general and English dictionaries. The search covered the period from the 1980s, when Vygotsky’s ideas began to be re-evaluated [10] , to 2022. Journal of Health Care and Society constituted this study’s utilized database. Keywords included “artifact” or “jinkoubutsu,” and the search included original articles and reviews/special issues. Consequently, 3,164 articles were extracted from the database. After excluding articles that did not use the term “artifact” in the sense of “tool” or “artifact” and those that did not meet the research objectives, three articles were selected. In addition, two articles obtained through manual searching that met the research purpose were included. Five articles in total were selected for concept analysis ( Figure 1 ).

As this study used existing literature, all references were publicly available. Appropriate citations are provided to avoid copyright infringement.

According to the “Britannica International Encyclopedia,” artifacts refer to artificial products or objects that did not originally exist, including substances or structures that arose secondarily because of inappropriate handling during biological fixation or death. Artifacts also refer to noise or extraneous signals that become mixed with the target signal during measurement. Artifacts can cause errors in the results, making it necessary to eliminate them during testing or measurements [11] . The “Medical Dictionary” translates artifacts as artificial structures or results, referring to things that do not originally exist in the body. Various voltage changes of biological or non-biological origin may become mixed with electroencephalogram (EEG), electromyography, or magnetic resonance imaging recordings. For example, muscle or heart signals from the subject are common artifacts in EEG recordings. Artifacts arising from indoor wiring are also common [12] . The “Random House English-Japanese Dictionary” defines artifacts as 1) artificial products, tools, weapons, ornaments, and so on; 2) archaeological artifacts; 3) mass-produced items of modern society; 4) artificial structures; and 5) fabrications or artificial results [13] . In the field of education, artifacts include tools such as books, writing instruments, and experimental equipment used for learning, as well as learning contents and systems on the Internet, language systems, and visual expressions, all of which are historically accumulated human-made artifacts [10] . In cognitive psychology, cognitive artifacts are designed as artificial tools that hold, display, and manipulate information to fulfill expressive functions [14] . However, these artifacts are rarely used in nursing. It is, therefore, necessary to examine the application of the meaning used in education to nursing.

A thorough literature review revealed no similar concepts. However, the term “artifact” is primarily used in medicine and education, with different meanings in each field.

Thus, it became clear that the meanings of artifacts varied depending on the academic field in which they were used.

Two attributes of artifact utilization in nursing practice instruction were extracted: “connecting people to people” and “connecting people to objects” ( Table 1 ).

“Connecting people to people” refers to the use of artifacts to connect practice instructors and students, students and students, and students and patients. Specific examples include spaces available for students, understanding the use of items by observing nurses, using self-made items to assist patients, practice-specific notebooks, creating instruction time tailored to students, and proactively communicating. “Connecting people to objects” refers to the use of artifacts to help people understand things better. Specific examples include new ways of using items, incorporating knowledge learned in training into practice instruction, using notes for nursing assistance and practice records, differentiating towel colors in surgical and medical wards, explaining ward characteristics and structure, explaining while observing the patient’s environment, and explaining while showing actual items used in the hospital.

Presenting model examples with clearly defined attributes helps illustrate the concept and shows its defining characteristics through supplementary examples [9] . Some relevant model examples are provided below.

Practice instructor A, who had just completed a practice instructor training course, prepared for basic nursing practice starting the following week. To improve the ward’s physical environment, a small room and supplies were prepared exclusively for students’ use. On the first day of practice, A conducted a ward orientation, explaining the environmental and safety aspects of the patient rooms assigned to students. Before students returned to school, A provided time for individual reflection with each student. As a different nurse was to be the practice instructor the next day, A wrote down the day’s activities and instructions in a handover notebook for the next instructor.

Practice instructor B, who was appointed by the head nurse, had no interest in student instruction and conducted the practice instruction haphazardly. When encountering difficulties, B consulted an educational head nurse but did not use knowledge or materials from the practice instructor training course. To secure a place for students, B allocated a corner of the nurse station. Though reflection on the day’s activities was also conducted, the noisy environment made it difficult for students to concentrate. As B was also to be the practice instructor the next day, no notes were written in the handover notebook, and the next day’s instructions proceeded without any issues. However, the following day, practice instructor C, who wanted to review the past instructions in the handover notebook, found it blank and had to call B to confirm the instructions.

Two antecedents were extracted: “recognition of artifacts” and “selection of artifacts” ( Table 2 ). “Recognition of artifacts” involves starting with recognizing artifacts and then utilizing them. “Selection of artifacts” involves selecting the best artifacts for utilization.

The consequences of artifact utilization in nursing practice instruction were divided into two categories: “designing a fulfilling learning environment” and “improving the quality of education” ( Table 3 ). “Designing a fulfilling learning environment” involves using artifacts to enhance the design of the learning environment, including constituting the learning environment; providing a good learning environment; mediating learners’ recognition of space, activities, and community; and creating a physical and social environment by organizational members. “Improving the quality of education” involves using artifacts to enhance the quality of education, including the effect of advice on task performance, the impact of words on continuing practice, awareness of effective time use, and significant impact on learning outcomes.

Thus, the effectiveness of utilizing artifacts was clarified.

Figure 2 illustrates the concept model derived from the concept analysis. Artifact utilization in nursing practice instruction is defined as “promoting the utilization of artifacts by recognizing and selecting them, connecting people to people and people to objects, designing a fulfilling learning environment, and improving the quality of education.”

Mima and Yamauchi view the process of participating in social practices as learning and emphasize the importance of designing a learning environment [17] . Organizing activities for the people involved, preparing space, and building a community are crucial for the development and success of a society or an organization [17] . Learning environments must be designed comprehensively by integrating spaces, activities, communities, and artifacts [3] . Using artifacts to interact with the object reorganizes and changes the object’s meaning, in turn, changing the way the subject confronts the object [15] . Therefore, promoting the utilization of artifacts is essential for connecting spaces, activities, and communities and designing the learning environment.

This study’s relevant concepts were extracted from the literature. The search was conducted using the Journal of Health Care and Society database and a manual search; however, only five relevant articles were found. Therefore, future research should consider using other databases, such as CINAHL and PubMed, to conduct a broader concept analysis. Additionally, such a broad concept analysis makes the applicability of its results to other fields challenging. Therefore, utmost care is required when applying the results of this study.