Online learning: enhancing nurse education?

A multi-method study to determine the effectiveness of, and student attitudes to, online instructional videos for teaching clinical nursing skills

E-learning is regularly promoted in higher education settings as a way of fostering more flexible approaches to learning. It has been argued however that the 'potential benefits of new information and communication technology instruments in education' have not been subjected to critical scrutiny (Debande, O., 2004. ICTs and the development of e-learning in Europe: the role of the public and private sectors. European Journal of Education 39 (2), 191-208, p. 192). This paper outlines a multi-method evaluation of an e-learning innovation designed to teach clinical skills to student nurses. Responding to the challenges of teaching clinical skills to large class sizes, we developed a set of instructional videos for one undergraduate skills-based module, which are now integral to the module and available online to students on a continuous basis. Evaluation suggests that students' performance outcomes are unchanged. The students view the flexible and self-management aspects of this method of learning positively, with some attitudinal differences between male and female, and mature and non-mature students. However, it is best used to complement rather than replace lecturer demonstration, lending support to a 'blended' model (Collis, B., van der Wende, M., 2002. Models of Technology and Change in Higher Education: An International Comparative Survey on The Current and Future Use of ICT in Higher Education, University of Twente, Center for Higher Education Policy Studies, The Netherlands).

Improving information technology competencies: implications for psychiatric mental health nursing

While substantial evidence links information technology (IT) with improved patient safety, care quality, access, and efficiency, nurses must demonstrate competencies in computers, informatics, and information literacy in order to use IT for practice, education, and research. The nursing profession has established IT competencies for all nurses at beginning and experienced levels. Newly revised standards also articulate role-specific expectations for advanced practice nurses. Unfortunately, there is a concern that many nurses may not possess these capabilities and that nurse educators are not prepared to teach them. IT competency evaluations, which have focused predominately on nursing education, indicate novice skill levels for most faculty and students. In numerous studies, again conducted largely in nursing education, significant improvement in IT competencies has been achieved only with intensive interventions. Deficits in IT competencies are a significant concern, because the federal government has mandated full implementation of Electronic Health Records (EHR) by 2014. EHR will require all nurses to use IT to deliver, document, and obtain reimbursement for patient care. In response to these concerns, two recent initiatives, the "Health Information Technology Scholars (HITS)" and "Technology Informatics Guiding Education Reform (TIGER)" projects, have been launched. By enhancing IT competencies, these projects will enable nurses to use evidence-based practice and other innovations to transform clinical care, education, and research. This report updates psychiatric-mental health nurses on the IT competencies literature, recent enhancement initiatives and innovations, and their implications for the specialty.

An exploratory study of web-enhanced learning in undergraduate nurse education

AIM

The aim of the study was to explore undergraduate nursing students' views of web-enhanced learning and to examine issues relating to their pattern of access to a rehabilitation nursing module website.

BACKGROUND

As information technology is an integral component of western health care, all nurses are expected to have the necessary knowledge, skills and attitudes to be competent in its use.

METHODS

In phase 1, a focus group interview was conducted with students (n = 6) who had not logged onto a similar module website. In phase 2, a questionnaire was administered to students undertaking the web-enhanced module. In phase 3, each student's (n = 231) pattern of access to the module was identified and compared with the student's performance as evidenced by their module assignment mark.

RESULTS

Students held favourable attitudes towards web-enhanced learning but some students experienced difficulties. There was a significant positive association between the students' assignment mark and the number of times logged onto the module website. Significant negative correlations were found between mark and week of first log on, and week of first log on and number of hits onto the module site. This suggests that students who logged onto the module in the first few weeks were more likely to achieve higher marks.

CONCLUSIONS

This study's findings suggest that students who accessed the module website early and often were more likely to produce more comprehensive nursing assessments and consequently achieve higher assignment marks than their colleagues.

RELEVANCE TO CLINICAL PRACTICE

The findings have relevance to all nurses as lifelong learning is a mandatory requirement for maintaining clinical competence and electronic learning can provide students (regardless of registration status) with the flexibility to gain access to course content at a time and place convenient to them. The role of electronic learning in promoting a more holistic nursing assessment is also discussed.

SONIC: workbook evaluations from students using web-based resources

Problem-based learning (PBL) or enquiry-based learning (EBL) methods are frequently used within UK nursing curricula in order to support students in their learning. At the same time students are increasingly using electronic resources for information to support their learning. Following a successful Fund for the Development of Teaching (FDTL-phase 4) award, the Students Online in Nursing Integrated Curricula (SONIC) project ran from 2002 to 2005. This project developed and evaluated web-based resource-enriched scenarios to support students using PBL or EBL. This collaborative project across four institutions also included another six institutions in the evaluations. To facilitate evaluation a workbook was devised enabling data to be obtained from a total of 241 students from across different branches. Evaluations showed that they welcomed the open access and particular resources such as the animations, the hyperlinks, and the self-assessment quizzes. Whilst the evaluations did not ascertain the impact on students' learning, they nevertheless demonstrate that the students themselves regarded the resources as supplemental to, rather than substituting other approaches to learning. The development of these resources took place in nursing departments and interest has been demonstrated by a number of other professions nationally and internationally.

Evaluating a Web-enhanced bachelor of nursing curriculum: perspectives of third-year students

Little is known about nursing students' information literacy skills and perceptions of Web-enhanced educational approaches. This study examined graduating Bachelor of Nursing (BN) students' perceptions of a Web-enhanced learning environment, their computer literacy skills, and use of technology, and how these influenced their satisfaction. This Australian survey produced a 64% (n = 170) response rate. The 3-year BN program provides Web-enhanced learning opportunities by incorporating online activities and content such as quizzes, videos, and virtual laboratories that augment on-campus and off-campus learning approaches. Upon graduation, 61.4% of the students reported having competent information literacy skills. The quality and usefulness of the Web-enhanced material was rated fair to above average. The students' perception of technical and faculty support for Web-enhanced learning was low. Overall satisfaction with the Web-enhanced program was associated with level of information technology (IT) skills and perceived quality and usefulness of the Internet material. A regression analysis of factors contributing to students' overall satisfaction of a Web-enhanced learning environment (IT literacy skills, access, and perceived quality, usefulness, and support) accounted for 18.5% of variance. As more nursing programs use Web-based resources, greater attention should be given to the initial assessment and development of students' information literacy skills. Students with good IT skills are more likely to perceive Web-enhanced material as useful.

Feasibility of combining e-health for patients with e-learning for students using synchronous technologies

AIM

This paper is a report of a project to introduce and evaluate methods for using information and communication technologies to involve academic staff, students, and patients in a common synchronous e-learning environment.

BACKGROUND

Although there is no strong evidence for this, there may be benefits in 'efficiency' and for patients and students from shared e-learning. Asynchronous e-learning methods in nursing education are well-established, but synchronous methods have received less attention. However, if feasible, because they are more akin to face-to-face contact, they may be more suitable for patients and may provide a quicker development path for e-learning.

METHOD

We evaluated three synchronous technologies: (1) non-commercial satellite interactive television (TV); (2) Internet videoconferencing; and (3) webcasting, through feasibility studies of 'TV-style' panel discussions on health topics and seminars with interaction with viewers by e-mail, inter-site research meetings with face-to-face interaction, user surveys and literature reviews.

RESULTS

Interactive satellite TV required the booking of rooms with specialized receiving equipment. This limited accessibility contributed to the high cost per participant. Videoconferencing proved acceptable for cross-site research meetings and is proposed for joint meetings for doctoral students with overseas centres but has the same access issues as interactive satellite TV. Webcasting is accessible to most users with Internet access and provides a feasible means of delivery of synchronous interactive material. Reported live webcasts have had audiences of thousands. Presentation formats: panel discussions with mixed patient-professional membership and mixed patient-professional audiences were acceptable to participants but engaging academic staff and students was problematic. This may be overcome with webcasting but there may still be barriers such as timetabling and students' concerns about learning in the same 'live' environment as patients.

CONCLUSIONS

Limitations in accessibility have been demonstrated for both satellite broadcasts and videoconferencing. Webcasting proved the most acceptable way of supporting a common synchronous environment. Having identified a feasible synchronous method we can now investigate hypothesized benefits for staff, students, and patients of combined e-health e-learning.

Distance education in nursing: an integrated review of online nursing students' experiences with technology-delivered instruction

One proposed solution to educating more nurses to decrease and eventually eliminate the nursing shortage is distance education. But what are nursing students' experiences with distance education? Answering this question can assist in the development of effective teaching and learning strategies to provide for the development of quality distance education programs. This article provides an integrative review of the nursing literature to ascertain the student perspective of distance education. A review of nursing literature was completed using a number of databases and specific criteria to locate research studies specific to this topic. The studies were analyzed for validity and reliability, and limitations were mentioned. Student perceptions garnered from the research studies analyzed are summarized with the acronym DISTANCE ED. Implications, recommendations, and needs for future research are discussed. A supplementary review of the literature is used to augment the findings.

Computer-assisted instruction for novice nurses in critical care

The current worldwide nursing shortage is having the greatest effect on the critical care areas as novice nurses enter these specialty areas in unprecedented numbers. Massive healthcare restructuring, a rapidly aging nursing work force, and high nursing turnover and absenteeism rates have all contributed to a healthcare environment that is struggling to care for critically ill patients. Computer-assisted instruction in the form of interactive computer programs may be used as an adjunct educational resource for these novice practitioners. These programs have the potential to bridge the gap between theory and practice, which may assist the novice nurse in achieving safe, competent clinical practice.

Achieving change through mutual development: supported online learning and the evolving roles of health and information professionals

INTRODUCTION

Major changes in health care, within an information- and technology-rich age, are impacting significantly on health professionals and upon their education and training. Health information professionals-in both the National Health Service (NHS) and higher education (HE) contexts-are consequently developing their roles, skills and partnerships to meet the needs of flexible education and training. This article explores one facet of this-supported online learning and its impact on role development.

METHODOLOGY

A case study approach was taken, aiming to explore how academics, health information professionals and learning technologists are developing supported online learning to explicitly address the e-literacy and information needs of health students within the context of NHS frameworks for education. This was contextualized by a literature review.

RESULTS

The case study explores and discusses three dynamics--(i) The use of supported online learning tools by future health-care professionals throughout their professional training to ensure they have the appropriate e-literacy skills; (ii) the use of supported online learning by current health professionals to enable them to adapt to the changing environment; (iii) the development of the health information professional, and particularly their role within multi-disciplinary teams working with learning technologists and health professionals, to enable them to design and deliver supported online learning.

CONCLUSIONS

The authors argue that, in this specific case study, health information professionals are key to the development of supported online learning. They are working successfully in collaboration and their roles are evolving to encompass learning and teaching activities in a wider context. There are consequently several lessons to be drawn in relation to professional education and role development.

A comparison of on-campus first year undergraduate nursing students' experiences with face-to-face and on-line discussions

Only limited pedagogical use has been made of information and communications technology (ICT) in nursing education in Norway. In this study the use of ICT was linked to assignments in the first year undergraduate nursing program and included four on-line discussions. There is evidence to suggest that on-line discussions can enhance the learning environment. The students' experiences of the on-line discussions are compared to those of the students participating in traditional group discussions. The results show little difference between the two groups' opinions of the discussions' fruitfulness and the ease in which they expressed their feelings, thoughts and ideas. However, there is a marked difference between the two groups regarding their experience of how the discussions affected the amount of contact between group members outside the discussions. Possible reasons for these findings are discussed.

The development and evaluation of the use of a virtual learning environment (Blackboard 5) to support the learning of pre-qualifying nursing students undertaking a human anatomy and physiology module

Students commence nurse education with varying levels of understanding of human anatomy and physiology due to a wide range of previous exposure to the topic. All students, however, are required to attain a broad knowledge of this topic prior to qualification. This paper describes the use of a Virtual Learning Environment (VLE), Blackboard 5, and the associated development of appropriate resources aimed at supporting nursing students undertaking a human anatomy and physiology module at Higher Education Level 1. The VLE was used as part of a blended learning approach. The results suggested that the majority of students utilised the VLE throughout the academic year. Opportunities for independent and self-directed learning were available in that students chose when and where to learn. Students generally commented favourably on ease of use and type of resources available. Frequency of use of the VLE, however, did not correlate strongly with the final examination mark achieved. Overall the VLE and the associated available resources appeared useful in supporting student learning and has been adopted for use in subsequent years.

Examination of the impact of information-skills training on the academic work of health-studies students: a single case study

AIM

To examine the impact of information-skills training on the academic studies of student midwives. Objectives include ascertaining whether student confidence increases, learning experiences are enhanced and academic standards are improved.

METHODS

A student midwives' discussion group at a higher education institution, plus an in-depth interview with the students' course leader.

RESULTS

Students reported increased confidence in using library and information resources. Appropriate and timely information-skills training embedded into health-studies curricula can lead to students becoming independent and lifelong learners, as well as improving the standard of their academic work.

CONCLUSION

Information skills for health-studies curricula in higher education can be developed and delivered collaboratively by both library and academic staff. This can have very positive effects on both student perceptions and experiences and standards of teaching and learning.

The Importance of Informatics Competencies in Nursing

Over the past two decades, dramatic changes have occurred in the nature and extent of communication and information technology use in nursing worldwide. The need for student nurses to be well prepared for the use and application of information technology in nursing is arguably now paramount. This article details areas where information and communication technology is used in nursing in Australia and discusses why nurses must be diligent in maintaining skills in this area to facilitate the delivery of safe, quality care in any healthcare setting. It will then discuss the importance of information and communication technology (ICT) skills, knowledge and understanding as an integral aspect of nursing programs in tertiary institutions. The challenge for training providers to prepare nurses for ever-changing ICT technology and technological applications in their workplace is highlighted.

Interaction in cyberspace: an online focus group

AIM

This paper reports a study that explored whether active engagement and group interaction could be captured in an online environment.

BACKGROUND

Focus groups have become a common means of capitalizing on group interaction to collect rich responses to questions posed. Whilst their use is well established in the repertoire of qualitative researchers, with changing technology there is the opportunity to use a computer program that facilitates online engagement and interaction to bring together a group of people to explore issues, attitudes and perceptions.

METHOD

Using a qualitative descriptive method and purposive sampling, 38 Australian Enrolled Nurses participated in an online focus group. WebCT, a program that facilitates online engagement and interaction, was used to enable participants to interact from any computer, from any location, at any time.

FINDINGS

The experience of conducting an online focus group was a positive one. Advantages such as cost savings and convenience for both researcher and participants were identified. This study demonstrated that participants could be actively engaged over a 2-month period and that group interaction could be achieved to collect richly detailed research data.

CONCLUSION

Whilst online focus groups may not be suitable in every situation, the potential exists to capitalize on technology to bring together a group of people separated by distance in an online environment that encourages interactive discussion.

Experiences of online learning: students' perspective

This paper explores students' views of an online learning initiative within a post-registration degree in nursing in Hong Kong. A self-administered questionnaire was used for data collection. One hundred and ninety eight students completed the study. Online learning was seen to be convenient allowing students to study at their own pace and time. Students reported that online learning enabled them to hold a higher level of accountability for their own learning and to learn independently. Not all experiences were positive. A major hindrance to online learning was the inadequate opportunity for human interaction which was deemed necessary for establishing peer support and developing in-depth group discussion on subject matter. These findings provide a guide for further development and improvement in online teaching and learning methodologies.

Examining the role of technology in learning: An evaluation of online clinical conferencing

The rapidly expanding use of instructional technology requires faculty openness to new teaching and learning situations. This study compared two instructional methods of conducting clinical conferences for baccalaureate nursing students: online versus face-to-face. Quantitative and qualitative data were collected from 77 students in 10 clinical sections of a senior capstone nursing course. Mean scores for all 11 items on the clinical evaluation tool were higher for students who had conferences online than those in face-to-face conferences. Four of the 11 items were statistically significant, reflecting greater participation and convenience for online participants. Online students also reported greater opportunities to reflect on ethical issues. There were no significant differences in quiz scores between the groups when students were tested on content covered in their clinical conferences. Students identified advantages including opportunities for flexibility and equal participation. Barriers included unfamiliarity with technology and lack of face-to-face-contact. The findings suggest that students can successfully achieve the intended purpose of clinical conferences through an online instructional technique. Ongoing research in the use of technology is necessary to meet student needs, enhance student learning, and support evidence-based practice in nursing education.

An exploration of four web-based open and flexible learning modules in post-registration nurse education

This paper presents an exploratory evaluation of four newly developed web-based modules for post-registration nurses. The topics for the modules were: dermatology; diabetes; mentorship; and prescribing.

STUDY OBJECTIVE

To explore the students' perceptions of the web-based modules before and after completing the modules.

DESIGN

A pre-post test design using questionnaires and group interviews.

PARTICIPANTS

39 students enrolled on the modules, pre-module data were collected on 74% (n = 29) and post-module data on 71% (n = 28). None of students had previous web-based education experience. 79% (n = 31) completed and 66% (n = 26) passed the modules. Students level of IT skills prior to commencing the modules were important in explaining module completion and outcome. The modules were rated highly in terms of achieving learning outcomes with moderate ratings for level of support and utility of learning materials. The content analysis of the interviews highlighted the importance of preparing students ensuring they have the IT and independent learning skills necessary to participate in web-based learning programmes, together with a number of issues relating to the accessibility of the learning materials. The perceived benefits of this mode of learning were that they offered flexible and resource rich learning. The downside was that the learning can be isolating.

CONCLUSIONS

This form of learning may not be suited to all groups of nurses or all educational topics. Further research is required to establish the educational benefits of different approaches to e-learning.

The development and evaluation of Student Training, Education and Practice for Dietetics CD-ROM: a computer-assisted instruction programme for dietetic students

The Student Training, Education and Practice for Dietetics (STEP-DIET) CD-ROM was developed at the University of Surrey to prepare dietetic students for the practical dietetic training component of their Nutrition/Dietetics degree. This study aimed to evaluate student response to the programme and its effectiveness as a teaching tool, based on the evaluation framework of D.L. Kirkpatrick (Evaluating a Course, 2nd edn. London, Kogan Page). Quantitative and qualitative methodologies were employed, with 41 dietetic students, separated by year group, completing questionnaires and taking part in six focus groups, at the University of Surrey. Student attitudes towards the instruction method and the STEP-DIET programme itself were investigated, in conjunction with their perceived learning achievements. Students rated the programme highly in terms of design and content, however, there was a reluctance to accept computer-assisted instruction (CAI) as a sole teaching method. A number of learning achievements relevant to dietetic practice were reported including a perceived increase in ability to conduct a dietetic interview and an increased understanding of the management of Type 2 diabetes. In general students reacted positively to the STEP-DIET programme and it was perceived by students to be effective in preparing them for the practical component of their dietetic training.

Evaluation of a computer assisted instruction resource in nursing education

The STEP-DIET program, a computer assisted instruction (CAI) tool, was developed to prepare dietetic students for their hospital based practical training in the academic setting. This study aimed to evaluate the potential for using the programme within nursing education. The evaluation framework of Kirkpatrick [I. Forsyth, A. Jolliffe, D. Stevens (Eds.), Evaluating a Course, second ed. Kogan Page, London, p. 5] was employed to assess student response to STEP-DIET and its effectiveness as a teaching tool, with regards to perceived learning achievements. Knowledge and attitudes towards nutrition education were also investigated. Quantitative and qualitative methodologies were employed, with nine second and six final year BSc (Adult) nursing students completing questionnaires and taking part in two focus groups, separated by year group. Students rated STEP-DIET highly in terms of design and content and reported a number of perceived learning achievements including increase in nutritional knowledge, understanding of Type 2 diabetes management and the dietitian's role, however there was a reluctance to accept CAI as a teaching method. Students reported a poor knowledge of nutrition, but recognised its importance. This study demonstrates that multidisciplinary learning by the sharing of resources has benefits to students. However, the integration of CAI into taught programmes needs to be managed to take into account student's reluctance to rely on this method of instruction.

Defining Interaction and Strategies to Enhance Interactions in Web-Based Courses

Designing interaction components in Web-based courses is important to ensure an effective learning environment. The author provides a definition of interaction and describes four types of interactions: learner-content, learner-learner, learner-instructor, and learner-interface. Finally, strategies to enhance the four types of interaction when developing and delivering Web-based course are discussed.

Student Satisfaction With Technology-enhanced Learning

The purpose of this descriptive study was to determine student satisfaction with technology-enhanced learning through a survey of nursing and health science students. Satisfaction generally was high, and there were few differences between nursing and health science students, or between undergraduate and graduate students. Faculty expertise in the creation, selection, and use of the technology is a major factor influencing student satisfaction.

Student nurse theatre placements. The new curriculum

Following the implementation of the Fitness for Practice (FFP) nurse education curriculum, opportunities are available for student nurses to return to the operating theatre environment during their surgical module. This follows a ten-year absence in most parts of Wales. This article investigates what realistic placement objectives are available for student nurses in Wales and how close mentor supervision can enhance the learning process and promote the clinical experience of theatre nursing.