Under surveillance: Mapping remote proctoring practices in the assessment of nursing students — a scoping review

Synthesis: Harerimana, Mtshali and Mchunu searched six databases for empirical evidence on Remote Proctoring in nursing student assessment from 2015 to 2025. Of 795 records, six studies met the inclusion criteria, covering an aggregate of 1,567 nursing students (individual samples from 17 to 970) in the USA, the UK, Southern Africa and Egypt. The review maps a heterogeneous set of modalities: live human invigilation, AI-based browser-extension proctoring, recorded webcam monitoring, lockdown browsers, a mobile invigilation app and fixed test-center cameras. Proctoring was consistently perceived as deterring misconduct and sustaining assessment continuity, while the evidence on performance, anxiety, infrastructure and Privacy is thinner, contradictory, or imported from sources outside the six included studies. The authors conclude that implementation must balance exam security against student Well-Being, fairness and equitable access, and that no single modality is universally effective.

Key Findings

1. A six-study evidence base drawn from 795 records, none published before 2021. Searches in CINAHL, MEDLINE, Emcare, PsycInfo, Scopus and Web of Science produced 775 records (CINAHL 89, Emcare 7, MEDLINE 32, PsycInfo 27, Scopus 193, Web of Science 427), plus 20 from Google Scholar and reference-list screening. After 85 duplicates were removed, 710 records were screened, 660 were excluded at title and abstract, and 50 full texts were assessed; 44 were excluded, 35 for the wrong population, four for an unspecified proctoring mode, three as instructional or learning-focused, and two as reviews. The six included studies were one qualitative study, two quantitative studies, two mixed-methods studies and one implementation study. Although the search window ran from 2015, every included study was published between 2021 and 2024, which the authors read as a direct consequence of the pandemic shift to online assessment.
2. The proctoring mapped is a spectrum, not a single practice. Honorlock, an AI-driven browser extension integrated into the LMS with webcam, microphone and behavior flagging, was used in the UK. ProctorU's synchronous live human invigilation (identity checks, room scans, continuous monitoring) was used in two US studies. Respondus Monitor with LockDown Browser, and a webcam-plus-lockdown-browser configuration, covered other US programs. An institutionally deployed mobile invigilation app was used in Southern Africa, and Egypt used fixed test-center desktops monitored by central surveillance cameras. The authors argue this diversity reflects disparities in infrastructure and institutional capacity rather than a shared standard, and that it "challenges the assumption that remote proctoring represents a monolithic practice."
3. Deterrence is documented as perception, not as reduced misconduct. In a graduate nurse practitioner program, 98–100% of students agreed that webcam proctoring and lockdown browsers deterred cheating (Aplin-Snider et al. 2021), and high-risk AI alerts were rare at no more than 5% (Castaño et al. 2021). The same study found that frequent minor alerts produced false positives and required time-intensive faculty review, and South African lecturers reported continued dishonesty despite active monitoring, described by Khalil et al. (2022) as "subterranean Ethics." The review's reading is that proctoring fosters compliance through fear of detection rather than intrinsic academic values, and that many students believe determined peers can bypass the systems.
4. The one comparative performance study points against remote proctoring. McClure (2024) compared two BSN cohorts (n = 181, with 88 in 2019 and 93 in 2020) and found that the in-person proctored cohort achieved significantly higher HESI Exit Exam scores and greater NCLEX readiness than the ProctorU cohort. The review notes that remote modalities may alter testing conditions and influence results, and cites Oeding et al. (2024) on remote proctoring significantly changing grade distributions in graduate nursing courses. Against that, Castaño et al. (2021) reported that all ADN students (100%) completed remotely proctored examinations and progressed without graduation delays during campus closures, so continuity was preserved even where technical problems were frequent.
5. Anxiety runs in both directions, and concentration suffers. Ford et al. (2023) found mixed experiences among UK pre-registration students: some were less anxious because they stayed at home and avoided travel, while others were anxious about connectivity and about being wrongly accused of cheating. Maboe and Tomas (2023) reported that the mobile invigilator app was anxiety-inducing for first-time users and that students found it hard to concentrate while being watched. Omran et al. (2022) found that fewer than half of Egyptian students were satisfied with their concentration during electronic exams. Preferences split rather than converge: roughly half of the UK students preferred retaking exams online, about two-fifths preferred face-to-face exams, and a minority were indifferent.
6. Infrastructure determines who can be assessed at all. Four of the six studies reported internet connectivity problems, and one reported load shedding (Maboe and Tomas 2023), alongside limited data bundles and high broadband costs. Technical failure was routine: device incompatibility, browser extension faults, environmental scan failures especially on desktops and iPads, device freezing, incomplete recordings and video processing delays. In the UK, about one fifth of students hit browser-extension or connectivity problems despite preparatory resources. The review concludes that infrastructural inequity can severely disrupt proctored assessments and exacerbate educational disadvantages, which is an equity finding rather than a technical one.

How the review was conducted

The review follows the five-stage scoping framework of Levac et al. (2010) and is reported against PRISMA-ScR (Tricco et al. 2018), so it is a scoping review with an audit trail rather than a formal synthesis of a mature literature. Three questions framed the mapping: which remote proctoring modalities are used in nursing student assessment, what outcomes are associated with them, and what challenges are identified. The search strategy was developed with an academic librarian, combined controlled vocabulary and free-text terms for online proctoring, invigilation, assessment and nursing students, and was restricted to English-language studies published between 2015 and 2025. Inclusion required empirical findings on proctoring within nursing education; reviews, opinion pieces, non-nursing contexts, unproctored assessments and studies without available full text were excluded.

Screening ran in two phases: titles and abstracts were assessed independently by three reviewers with disagreements settled by consensus, after which full texts of the 50 remaining articles were retrieved and assessed for eligibility. Methodological quality was appraised with the Mixed Methods Appraisal Tool (Hong et al. 2018) using design-specific criteria, extraction used a standard form piloted on a subset of studies, and charting produced four tables covering study characteristics, proctoring modalities, outcomes and challenges. Analysis followed Braun and Clarke's (2006) thematic analysis, with quantitative and qualitative findings integrated into a narrative synthesis. One methodological consequence follows from the design: with one qualitative study, two quantitative studies, two mixed-methods studies and one implementation study, the review can describe variation but cannot pool it.

What proctoring actually monitors

The review catalogs the surveillance data these systems collect, and the inventory is broader than most institutional policies acknowledge. The platforms captured images of students' faces, identity documents such as student IDs, driver's licenses and passports, and their physical environments, with some systems using 360-degree room scans or CCTV feeds from test centers. Audio monitoring captured microphone input to detect speech and ambient sound that might indicate collaboration or external assistance. Biometric identity checks, principally facial recognition, ran in ProctorU, Respondus Monitor and Honorlock.

At the device level, the systems logged screen recordings, browser activity, lockdown events such as disabled copy-paste functions, and in some cases keystroke and mouse tracking. Mobile invigilation monitored movement and verified venue access through selfies and GPS data to confirm that students were in authorized environments. The output was detailed time-stamped event logs and metadata: frame exits, low face detection, multiple logins, vocalisations, suspicious movements, network instability, and exam start and end markers. These logs become the evidence faculty review. Castaño et al. (2021) note that reviewing three-hour flagged videos without clear guidelines increases workload and anxiety, which locates the cost of surveillance data inside the assessment platform and its review workflow as much as in the exam room.

Deterrence, privacy and the evidence gap

The review's strongest claims about academic integrity rest on a narrow evidentiary base. The headline deterrence figure, 98–100% agreement that webcam monitoring and lockdown browsers maintained integrity, is a self-report finding from one graduate nurse practitioner program, and the review itself observes that acceptance there was conditional on the existing integrity culture. Broader concerns among nursing students are documented in the introduction from studies outside the review: Adama et al. (2023) found that 31.7% of respondents perceived a high risk of misconduct among students aged 18 to 24, that collusion was a prevalent concern at 24.5%, and that in a sample of 380 students cheating was reported as more likely in assessments lasting one to two weeks (46%). Aplin-Snider et al. (2021) found that graduate nursing students generally valued integrity and were willing to report cheating, but that those nearing graduation saw deterrence measures as less effective, a pattern the review labels integrity fatigue.

Privacy and algorithmic accountability are, by contrast, largely absent from the six included studies and are supplied from adjacent literature. Khalil et al. (2022) argue that integrity was assumed without adequately addressing Privacy, equity or trade-offs in outcomes, and that institutions rarely consider the implications of capturing audio-visual and behavioral data from private spaces. Labayen et al. (2021) report that 83% of respondents expressed surveillance fears, 58% reported discomfort and 72% raised data-privacy concerns, yet 78% still supported future use of proctoring, and that students were generally more accepting of biometrics than teachers. Khalil et al. (2022) and Nigam et al. (2021) note that these algorithms are seldom transparent about their training methods or demographic error rates despite shaping academic decisions. On AI Governance, the review finds that instruments such as the General Data Protection regulation and South Africa's Protection of Personal Information Act offer limited control while cross-border vendor contracts create compliance problems.

The adoption history in the review explains the gap between claim and evidence. Online proctoring platforms emerged around 2008, with ProctorU, Proctorio, Examity and ExamSoft operating well before the pandemic (Lee and Fanguy 2022), but Balash et al. (2023) reported a 720% increase in proctoring use at the onset of COVID-19, an increase the review characterizes as largely reactive rather than strategic. Reputational and regulatory pressure to meet the standards of patient-safety-critical programs drove procurement, while the trade-offs in performance, equity and student experience went largely unevaluated. What the six studies establish is that surveillance produces deterrence perceptions and a heavy review burden; what they do not establish is that it produces more honest learning, and the review treats that as an open question rather than a settled benefit.

What this means for practice

• Assessment designers. Diversify assessment alongside proctoring, using integrity-by-design approaches that prioritize authentic learning, student Well-Being and equity, and treat remote proctoring as one instrument among several rather than the default safeguard.
• Administrators. Adopt context-sensitive, ethically grounded proctoring policies rather than importing a single commercial model, since success proved highly context-dependent: the recommendations follow from the implementation problems rather than from the deterrence claims.
• Administrators. Where high-stakes proctoring is necessary, govern it with robust data protection standards, clear communication with students, and dedicated invigilation structures that relieve individual faculty of forensic responsibility for flagging decisions.
• Administrators. Invest in the conditions that make proctoring work at all: reliable connectivity, suitable devices, cross-platform testing, user-friendly platforms and technical support, since device, browser and environmental scan failures were recurrent.
• Educators. Extend the evidence base with longitudinal, multi-site, theory-informed studies that measure sustained academic, psychological and equity effects, including more countries and specifically more low- and middle-income settings.

Limitations

• Six empirical studies met the inclusion criteria — one qualitative, two quantitative, two mixed-methods and one implementation study — and their variation in design, modality and outcome measure prevents pooling and rules out causal inference.
• Most included studies measured self-reported perceptions rather than objective or longitudinal learning and professional outcomes, and the headline deterrence figure (98–100% agreement that webcam monitoring and lockdown browsers maintained integrity) comes from a single graduate nurse practitioner program and was conditional on that program's existing integrity culture.
• Evidence is concentrated in the USA, the UK, Southern Africa and Egypt, and the English-language 2015–2025 search window leaves low- and middle-income settings largely unrepresented.
• Privacy and algorithmic accountability are largely absent from the six included studies and are supplied from adjacent literature, and the review's claims about cost — from anxiety and technostress to performance penalties and normalized intrusion — are reasoned more confidently than those six studies can support. What the six studies do support is more modest: a family of practices with real operational costs, a demonstrated effect on the assessment conditions students sit under, and a deterrence case that rests on how students say they feel, not on what they do.

Citation

Harerimana, A., Mtshali, N., & Mchunu, G. (2026). Under surveillance: Mapping remote proctoring practices in the assessment of nursing students—a scoping review. International Journal for Educational Integrity, 22(19).