Nursing and healthcare students' experiences and use of e-learning in higher education

Development of complex pedagogical competencies and reflexivity in clinical teachers via distance learning: a mixed methods study

Clinical reasoning is the cornerstone to healthcare practice and teaching it appropriately is of utmost importance. Yet there is little formal training for clinical supervisors in supervising this reasoning process. Distance education provides interesting opportunities for continuous professional development of healthcare professionals. This mixed methods study aimed at gaining in-depth understanding about whether and how clinical teachers can develop complex pedagogical competencies through participation in a Massive Open Online Course on the supervision of clinical reasoning (MOOC SCR). Participants self-assed their clinical supervision skills before and after partaking in the MOOC SCR through the Maastricht Clinical Teachers Questionnaire. Item scores and the distribution of response proportions before and after participation were compared using paired t-tests and McNemar's tests respectively. In parallel, the evolution of a subset of MOOC participants' pedagogical practice and posture was explored via semi-structured interviews throughout and beyond their MOOC participation using simulated and personal situational recalls. The verbatim were analysed with standard thematic analysis. Quantitative and qualitative findings converged and their integration demonstrated that partaking in the MOOC SCR promoted the development of complex pedagogical competencies and reflexivity with the participants. This was quantitatively evidenced by significantly higher self-assessed supervision skills and corresponding attitudes after completing the MOOC. The qualitative data provided rich descriptions of how this progression in pedagogical practice and posture occurred in the field and how it was shaped by participants' interaction with the MOOC's content and their motivations to progress. Our findings provide evidence for the development of pedagogical skills and corresponding attitudes for the supervision of clinical reasoning through participation in the MOOC SCR and contribute to the literature body on the opportunities that distance learning provides for the development of pedagogical competencies. The extent to which the pedagogical underpinnings of the MOOC contributed to these developments remains to be determined.

Nursing students' experiences of using flipcharts as a learning tool during the COVID-19 pandemic

BACKGROUND

Building mastery of clinical skills is essential for nursing students to ensure readiness for clinical placements. During the coronavirus disease (COVID-19) pandemic, limited face-to-face teaching and student access to campus facilities, along with the rapid adoption of online methods, increased the need to develop innovative teaching tools to support students.

OBJECTIVE

This study aimed to explore nursing student perceptions and experiences of using Flipcharts for learning clinical nursing skills during the COVID-19 pandemic.

DESIGN

This study used a qualitative descriptive design.

METHODS

Second-year nursing students were invited to participate at the end of the semester to share their experiences of using Flipcharts in their clinical simulation laboratory. A total of 12 nursing students participated in individual semi-structured interviews conducted between December 2020 and February 2021. Data were analysed using Braun and Clarke's six-step method of thematic analysis.

RESULTS

The findings of the study demonstrated that students considered Flipcharts to be beneficial in developing their clinical skills and were additionally valuable in supporting students with English as a second language. Three major themes were identified: the perceived value of Flipcharts during limited face-to-face teaching, the role of Flipcharts in supporting skills acquisition across learning domains, and the practicality and accessibility of this learning resource across different mediums.

CONCLUSION

Students perceived the use of Flipcharts to be valuable in achieving mastery of clinical skills during COVID-19. The students' experience of using Flipcharts was positive overall and found the learning tool practical and accessible in supplementing learning.

Use of Digital Technology as a Collaborative Tool among Nursing Students-Survey Study and Validation

BACKGROUND

This research aimed to develop a questionnaire to analyze perceived aspects of using digital technology among nursing students as a collaborative tool. We further sought to evaluate the psychometric reliability of the instrument.

METHODS

A cross-sectional observational study was performed using a questionnaire developed from scratch. Psychometric studies and univariate and bivariate analyses were performed.

RESULTS

132 nursing students participated. The exploratory and confirmatory analyses of the questionnaire excluded 4 of the initial 18 items and established four domains, and internal consistency was found. The mean global score of the answers to the questionnaire was 4.67 on a scale of 1-5 points, and all the domains obtained high scores. Men scored higher on the usefulness and the global score, while no differences were found regarding age.

CONCLUSIONS

Nursing students positively assess the use of digital technology as a collaborative tool, regardless of age. Digital technology as a collaborative tool is perceived as beneficial, improves their involvement, and allows nursing students to obtain a better knowledge of their partners. These findings can help develop group projects and tools based on technology to train future nursing professionals. The questionnaire developed is a valid tool to assess this.

Student performance and perceptions of anatomy and physiology across face-to-face, hybrid, and online teaching lab styles

Health science represents the fastest-growing industry in the United States, a trend not predicted to slow for the next decade. The high demand for health professionals has led to increased demand for anatomy and physiology (A&P) courses and a transition to hybrid-style labs to meet the necessary increased enrollment without increasing the need for lab space and compromising educational quality. The transition to hybrid-style labs has only accelerated and become more important with the COVID-19 pandemic. It has been relatively unclear, however, how the hybrid style has impacted student learning, satisfaction, and performance. Furthermore, there is a general lack of research investigating the advantages and disadvantages across hybrid, online, and face-to-face styles. This lack of research is particularly obvious within biological sciences, including A&P. Attendance, practical grades, and overall grades were compared between face-to-face, hybrid, and online A&P lab styles. A survey was administered to compare student perceptions and experiences between hybrid and online lab styles. The hybrid style had many of the same advantages as online and face-to-face styles yet very few disadvantages. Hybrid lab students reported better experiences and greater satisfaction, attended more labs, and outperformed online lab students. Face-to-face lab students, however, outperformed hybrid lab students. These findings can ultimately inform how to best implement, organize, and improve hybrid-style labs to maximize student learning, achievement, and enjoyment.NEW & NOTEWORTHY Demand for health professionals increased the demand for A&P courses and led to a transition to hybrid-style labs. There is a general lack of research investigating advantages/disadvantages across hybrid, online, and face-to-face styles. I found that the hybrid style had many of the advantages of online and face-to-face styles yet very few disadvantages. Hybrid lab students reported better experiences and greater satisfaction and outperformed online lab students. Face-to-face lab students, however, outperformed hybrid lab students.

Investigation of the factors affecting the e-learning process in occupational therapy education during the pandemic with principal component analysis

Introduction

The aim of this study is to examine the factors affecting the e-learning process in occupational therapy education in the COVID-19 period.

Method

In the study, a form containing personal information and questions about the e-learning process, the International Physical Activity Questionnaire, the Academic Self-Efficacy Scale, the Perceived Stress Scale, and the Rosenberg Self-Esteem Scale were applied to 253 occupational therapy students via the Google form. Principal component analysis was used to evaluate the data.

Results

A large number of questionnaires were applied in the study, and principal component analysis, an advanced statistical method that enables the interpretation of this type of big data more effectively, was used. 13 components were determined, and a variance of 88% was explained. The main components were listed as students' self-perception about the education system, learning methods, home and university environment, information technologies, physical activity level, and academic performance/participation.

Conclusion

We hope that the results of our study will provide a perspective on what innovations can be made for quality improvement in occupational therapy education. It would be beneficial to increase student feedback by applying similar studies in other education programs.

Comparison of Academic Motivation between Business and Healthcare Students in Online Learning: A Concurrent Nested Mixed-Method Study

While the demand for online education and the diversity of online students have been increasing worldwide, how online students motivate themselves to continuously engage in learning remains to be appraised. Research in the face-to-face contexts reports that academic motivation is central to student success and wellbeing, and the type of motivation can differ by subject. In particular, the motivation of business students and healthcare students can differ considerably. This study aimed to understand the motivation of online students, and compare them between business and healthcare students using a concurrent nested mixed-method design with correlation and thematic analyses. A survey regarding motivation, learning enjoyment, and study willingness was responded to by 120 online students (61 business and 59 healthcare). Business students were associated with extrinsic motivation, whereas healthcare students were associated with intrinsic motivation. While students in both groups enjoyed the pursuit of knowledge, healthcare students valued the process and accomplishment, whereas business students regarded education as steppingstones in their careers. Findings can help educators develop effective motivational support for these student groups.

Postgraduate students’ experiences with learning management systems at a selected nursing education institution in KwaZulu-Natal Province

Background. Learning management systems (LMS) are indispensable teaching and learning tools in nursing education, and in recent years, LMS have become a cornerstone to support online learning, particularly during the COVID-19 pandemic. The South African (SA) e-education policy requires every teacher and learner in the education and training sector to be information and communication technology (ICT)-capable, and able to use ICTs confidently and creatively to help develop the skills and knowledge they need as lifelong learners to achieve their personal goals and be full participants in their global communities. Objective. To investigate postgraduate students’ experiences with learning management systems at a selected nursing education institution in KwaZulu-Natal Province, SA. Method. An exploratory, descriptive research design was used, and the whole population of 16 postgraduate nursing education students who were exposed to Moodle as a learning management system participated in the study. Qualitative data were collected through semi-structured interviews, followed by focus group discussions, with thematic analysis used to analyse data. Results. This was the first time that most participants had been exposed to an online learning course, and the experience made them feel empowered as it provided enabled reflection and deep learning. Participants indicated that the range of interactions and level of engagement determined the eventual level of knowledge constructed. The online facilitator played a central role in guiding and supporting students, and ensuring that they achieved the learning outcomes. The online learning benefits included increased socialisation, convenience and flexibility, asynchronicity and accessibility of learning material. The challenges were the lack of real-time response, financial cost and technical issues. Conclusion. An intense ICT orientation for students is recommended to ensure that they are informed of the requirements before starting the online course. The online facilitators must be more visible in the online space, participate more often in discussions and stimulate constructive dialogue.

Interdisciplinary interprofessional education using an online learning environment called values exchange: A qualitative investigation

Introduction

Interprofessional education (IPE) is implemented throughout the curricula of student healthcare professions as it is understood to provide positive impact on patient outcomes in the clinical environment. There are different methods to provide IPE such as through online learning or traditional face‐to‐face methods. However, there is a lack of research surrounding the use of Online Learning Environments (OLEs) to teach IPE.

Methods

In a pilot study, seventy‐one undergraduate radiography students and twenty Master of Pharmacy students engaged in an ethical scenario using the OLE, Values Exchange (Vx). Following the activity, students were invited to complete an open‐ended response question. Fourteen students responded and these data were used for qualitative analysis.

Results

A thematic analysis of the students' open‐ended responses found the emergence of three major themes, namely; understanding the roles of other healthcare professionals, developing self‐reflection skills and, preparing for the clinical environment. Students suggested that additional time allocated for undertaking the study would benefit their engagement in the activity. Students would benefit from added engagement in the Vx task in both the short and long term for IPE.

Conclusion

Students are receptive in utilising contemporary approaches such as OLEs in furthering their IPE. Positive interpretations and suggestions by both radiography and pharmacy students in this study demonstrate how Vx as an OLE teaching tool can be used effectively. OLEs can overcome barriers that exist in face‐to‐face education experiences. OLEs should be considered for greater use within academic curricula of healthcare professions, but only if they have been evaluated for effectiveness.

Exploring undergraduate nursing students' experiences towards home-based learning as pedagogy during the COVID-19 pandemic: a descriptive qualitative exploration

Background

The global COVID-19 pandemic has led to the need for educators to explore online platforms in delivering lessons to students. Home-based learning is one of the most commonly-used teaching methods that allow learning to take place despite a physical separation between the students and the educators.

Methods

A descriptive qualitative approach was used to explore the experiences of nursing undergraduates when using home-based learning as a pedagogy during the COVID-19 pandemic. Data were collected from twenty-three nursing students (n = 14 in year one; n = 9 in year two) of their full-time pre-registration nursing program in a public-funded university in Singapore. Semi-structured interviews using an interview guide was conducted through Zoom-based video-conferencing from November 2020 to January 2021. The interview lasted between 45 and 65 min (median = 45 min). Data collection took place concurrently with thematic analysis through Braun and Clarke’s six-step approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research.

Results

Three main themes identified during the data analysis were: (1) challenges of home-based learning, where students detailed their experiences and difficulties encountered during the process; (2) the effectiveness of home-based learning, which explored the pedagogy’s impact on the students’ learning experience; and (3) students’ motivation to learn, where the effects on student morale and motivation in partaking in learning tasks were discussed.

Conclusions

Results from this study suggested that universities should incorporate more home-based learning opportunities as home-based learning to continue playing a crucial role in the foreseeable future. Universities should continue to incorporate more home-based learning opportunities into the existing nursing curriculaa in order to test their capacities and address technical challenges in online learning. Future studies should also consider incorporating other pedagogical strategies when conducting lessons online.

Leveraging e-Learning technology to enhance pre-service training for healthcare trainees in Ghana: evidence from a pilot project and pointers to policy reforms

BACKGROUND

E-Learning solutions are increasingly being advocated to augment existing traditional teaching and learning efforts in health training institutions. Unfortunately, these emerging technologies rarely focus on health sciences education within the context of public universities, hence the need for this study. This project evaluated experiences of healthcare trainees with a pilot e-Learning project (SMART e-Learning project) initiated in one of Ghana's public universities in 2017. The study used a mixed methods cross-sectional approach among 363 healthcare trainees. Data collection was between 17th October, 2019 to 3rd December, 2019. Data was analysed descriptively and test for variable differences done using Pearson Chi-square and Fisher's Exact for categorical variables. Wilcoxon Mann-Whitney test was used to test for differences in the Likert scale items. Additionally, rotated varimax factor analysis was performed for the health trainees' rated satisfaction factors.

RESULTS

Out of 446 respondents who consented to participate in the study, 363 responses were complete and valid, representing a response rate of 81 %. Most frequently used e-learning facilities by healthcare trainees were: writing interim assessments (IAs) (82 %) while the least used function was live chating with faculty (5 %). Challenges associated with the e-learning pilot project were: limited workspace in the pilot computer laboratory (33 %), slow internet/intranet speed (29 %) and limited capacity of teaching and ICT staff to support users (28 %).

CONCLUSIONS

There is the need to engage relevant stakeholders at the University, ministries of health and education through policy dialogues to develop statutory e-Learning guidelines for health educational institutions of higher learning to complement existing traditional teaching and learning approaches.

Preregistration adult nursing students' experiences of online learning: a qualitative study

BACKGROUND

Online learning (OL) is widely used in UK preregistration nursing programmes and the latest Nursing and Midwifery Council professional education standards state digital technology must be embedded in the curriculum. An exploration of preregistration adult nursing students' experiences of OL considers how technology supports learning theory and practice, and assists in designing and delivering effective OL in future programmes.

AIM

This study aimed to explore preregistration adult nursing students' OL experiences.

METHOD

Two focus groups with students were held and thematic analysis carried out.

FINDINGS

Three main themes emerged regarding OL: advantages, disadvantages and preferences. The main advantages included time, accessibility and convenience, being able to revisit learning and the variety of approaches. Disadvantages included inadequate communication, support and interaction. Students preferred an adequate balance of OL with traditional teaching, more communication, synchronous OL, preparation and support.

CONCLUSION

OL is valuable to adult nursing students, providing convenience and flexibility. While it has advantages, the disadvantages and preferences require addressing to ensure future programmes are effective and meet nursing students' requirements.

The varied role, scope of practice, and education of cardiovascular nurses in ESC-affiliated countries: an ACNAP survey

AIMS

Cardiovascular disease burden is increasing globally, pressuring nursing staff to deliver high-quality care across a diverse range of treatment areas. As such, an evaluation of the educational preparation of nurses is needed. To determine the current role, scope of practice, education level, and needs of cardiovascular nurses working across the European Society of Cardiology (ESC)-affiliated countries.

METHODS AND RESULTS

A short survey was distributed in paper (EuroHeartCare 2018) or electronic format to nurses delivering cardiovascular care. A total of 876 cardiovascular nurses from 26 ESC-affiliated countries completed the survey. Most respondents (79%), were educated to at least bachelor level, with 46% having a masters or doctorate, and were highly motivated to continue their educational development. Despite this, a large number (44.3%) of respondents believed they were not fully prepared for their job. The main areas where further education was requested included acute care in cardiovascular disease (CVD) and CVD risk factor management. Face-to-face courses/training were the most requested delivery mode, followed by E-learning-which appears to be underutilized in this population. Awareness of the existing curricula for cardiovascular nurse education was minimal, and therefore these resources require further promotion and implementation.

CONCLUSIONS

This international sample of cardiovascular nurses was generally educated to degree level and motivated to improve their cardiovascular knowledge. Many believed they were underprepared for their role, highlighting the need for increased investment in education. This should be focused on specific needs and delivered using a face-to-face, E-learning, or blended-learning format. Furthermore, increased signposting of existing resources is required.

Designing and evaluation of E-health educational intervention on students' physical activity: an application of Pender's health promotion model

BACKGROUND

The present study was conducted to design and evaluate the software and web-based curriculum based on Pender Model in order to promote students' physical activity.

METHODS

This is a quasi-experimental study conducted on 225 eligible students who were randomly divided into two groups of web and software-based intervention and control. The sample size of the study was selected using stratified sampling method. The evaluation was done with pre-test and post-test and follow-up, which were performed immediately two and six months following the intervention. The data were analyzed employing statistical software SPSS using descriptive statistics, chi-square, one way ANOVA, and repeated measures ANOVA.

RESULTS

The obtained results revealed that the level of physical activity after the intervention in the web and software groups significantly increased compared to the control group (p < 0.001). Moreover, the mean score of Pender model constructs, immediately two and six months after the intervention, was significantly different in the web and software groups (p < 0.001).

CONCLUSION

Our results indicated that, providing tailored message based on health promotion model's constructs has a positive effect on promoting physical activity of students.

TRIAL REGISTRATION

Name: Iranian Registry of Clinical Trials. Registration number: IRCT20181009041298N1 . Registration date: 2018-12-02 [retrospectively registered].

Online Synchronous Clinical Communication Training During the Covid-19 Pandemic

PURPOSE

As the COVID-19 pandemic outbreak occurred, most structured clinical communication training were transformed from in-person to remote seminars. The aim of our study was to evaluate the usefulness and feasibility of online synchronous clinical communication training from both students' and tutors' perspectives.

PATIENTS AND METHODS

We conducted a cross-sectional study. Geneva Faculty of Medicine' 3rd year medical students and tutors involved in clinical communication were asked to respond to an online survey.

RESULTS

Eighty-five of 149 students and 15/16 tutors responded. Students highly valued both online seminars and reported little technical difficulty. They felt that tutors were well prepared and actively involved them in experiential learning. Tutors globally reported little technical difficulty and felt rather well prepared to do so online. Although both students and tutors preferred the in-person format, half of them could still consider using an online format in the future outside the pandemic but mentioned it required specific rules.

CONCLUSION

Our results suggest that clinical communication can be taught and practiced online and that tutors can quickly adapt to such changes.

Validation of the online theoretical module of a minimally invasive surgery blended learning course for nurses: A quantitative research study

BACKGROUND

The progressive development of Minimally Invasive Surgery (MIS) implies the need to train health professionals in such field, for which e-learning and blended learning methods are increasingly been used. Most nurses lack experience and training in MIS, so a laparoscopic blended learning course for nursing has been created.

OBJECTIVES

To perform the validation of the online theoretical module of such course to evaluate student perception and satisfaction, sociability and usability metrics, and also the interest of nurses in blended learning.

DESIGN

A quantitative design has been used.

PARTICIPANTS

24 nurses participated in the validation tests performing the online module of the course.

METHODS

Subjective (questionnaires) and objective (performance statistics) metrics were analysed.

RESULTS

The e-learning environment has ease of access, good layout, consistency and intuitive navigation. Chat and forums have not been used and nurses miss a moderator. Participants consider that videos provide added value to the course, and contents are easily understandable and of high quality. However, questionnaires are not well balanced in difficulty and few interactive 3D designs have been viewed. Participants consider blended learning as the most effective training method for its flexibility in time and place.

CONCLUSIONS

This study suggests that a simple, easy-to-use and attractive e-learning environment has been developed to train nurses in MIS. However, installation of additional software should be avoided. A moderator/tutor should manage forums to encourage user participation, using conversational agents. But nevertheless, chats have no interest. Questionnaires for content evaluation should be designed with efficiency and equity. Videos designed according to micro-learning, with audio and interactivity, should be included. These courses should be designed to meet factors to promote the engagement of students. Blended learning is considered by nurses as ideal method for training, but further research to assess whether it improves learning outcomes is needed.

A systematic review of the factors - enablers and barriers - affecting e-learning in health sciences education

BACKGROUND

Recently, much attention has been given to e-learning in higher education as it provides better access to learning resources online, utilising technology - regardless of learners' geographical locations and timescale - to enhance learning. It has now become part of the mainstream in education in the health sciences, including medical, dental, public health, nursing, and other allied health professionals. Despite growing evidence claiming that e-learning is as effective as traditional means of learning, there is very limited evidence available about what works, and when and how e-learning enhances teaching and learning. This systematic review aimed to identify and synthesise the factors - enablers and barriers - affecting e-learning in health sciences education (el-HSE) that have been reported in the medical literature.

METHODS

A systemic review of articles published on e-learning in health sciences education (el-HSE) was performed in MEDLINE, EMBASE, Allied & Complementary Medicine, DH-DATA, PsycINFO, CINAHL, and Global Health, from 1980 through 2019, using 'Textword' and 'Thesaurus' search terms. All original articles fulfilling the following criteria were included: (1) e-learning was implemented in health sciences education, and (2) the investigation of the factors - enablers and barriers - about el-HSE related to learning performance or outcomes. Following the PRISMA guidelines, both relevant published and unpublished papers were searched. Data were extracted and quality appraised using QualSyst tools, and synthesised performing thematic analysis.

RESULTS

Out of 985 records identified, a total of 162 citations were screened, of which 57 were found to be of relevance to this study. The primary evidence base comprises 24 papers, with two broad categories identified, enablers and barriers, under eight separate themes: facilitate learning; learning in practice; systematic approach to learning; integration of e-learning into curricula; poor motivation and expectation; resource-intensive; not suitable for all disciplines or contents, and lack of IT skills.

CONCLUSIONS

This study has identified the factors which impact on e-learning: interaction and collaboration between learners and facilitators; considering learners' motivation and expectations; utilising user-friendly technology; and putting learners at the centre of pedagogy. There is significant scope for better understanding of the issues related to enablers and facilitators associated with e-learning, and developing appropriate policies and initiatives to establish when, how and where they fit best, creating a broader framework for making e-learning effective.

Blended learning via distance in pre-registration nursing education: A scoping review

Prior to the Covid-19 global pandemic, we reviewed literature and identified comprehensive evidence of the efficacy of blended learning for pre-registration nursing students who learn across distances and/or via satellite campuses. Following a methodological framework, a scoping literature review was undertaken. We searched six databases (EBSCOHOST (CINHAL plus; Education research Complete; Australia/New Zealand Reference Centre); Google Scholar; EMBASE (Ovid) [ERIC (Ovid); Medline (Ovid)]; PubMed: ProQuest Education Journals & ProQuest Nursing & Allied Health Source) for the period 2005-December 2015. Critical appraisal for critiquing qualitative and quantitative studies was undertaken, as was a thematic analysis. Twenty-eight articles were included for review, which reported nursing research (n = 23) and student experiences of blended learning in higher education (n = 5). Four key themes were identified in the literature: active learning, technological barriers, support, and communication. The results suggest that when delivered purposefully, blended learning can positively influence and impact on the achievements of students, especially when utilised to manage and support distance education. Further research is needed about satellite campuses with student nurses, to assist with the development of future educational practice.

A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review

Background

Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia.

Objective

This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program—an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice—and (2) determine how these features correlate with the DCC&TN.

Methods

Six electronic databases—Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar—were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick’s model for the evaluation of training were used to ensure quality and rigor of the analysis.

Results

A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick’s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick’s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN.

Conclusions

A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick’s salient elements of the model—reaction, learning, behavior, and results—in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick’s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training.

Development and Evaluation of a Hybrid Course in Clinical Virology at a Faculty of Pharmacy in Lille, France

BACKGROUND

During their studies, pharmacy students must acquire the specific skills in clinical virology required for their subsequent professional practice. Recent experiments on teaching and learning in higher education have shown that hybrid courses strengthen the students' commitment to learning and enable high-quality knowledge acquisition.

OBJECTIVE

This study concerned the design and deployment of a hybrid course that combines face-to-face and Web-based instruction in clinical virology for fourth-year pharmacy students. The study's objectives were to (1) measure the students' level of involvement in the course, (2) gauge their interest in this type of learning, and (3) highlight any associated difficulties.

METHODS

The study included 194 fourth-year pharmacy students from the Lille Faculty of Pharmacy (University of Lille, Lille, France) between January and June 2017. The students followed a hybrid course comprising an online learning module and 5 tutorial sessions in which professional situations were simulated. The learning module and 3 online evaluation sessions were delivered via the Moodle learning management system. Each tutorial session ended with an evaluation. The number of Moodle log-ins, the number of views of learning resources, and the evaluation marks were recorded. The coefficient for the correlation between the marks in the online evaluation and those in the tutorials was calculated. The students' opinions and level of satisfaction were evaluated via a course questionnaire.

RESULTS

The course's learning resources and Web pages were viewed 21,446 and 3413 times, respectively. Of the 194 students, 188 (96.9%) passed the course (ie, marks of at least 10 out of 20). There was a satisfactory correlation between the marks obtained in the online evaluations and those obtained after the tutorials. The course met the students' expectations in 53.2% of cases, and 57.4% of the students stated that they were able to work at their own pace. Finally, 26.6% of the students stated that they had difficulty organizing their work around this hybrid course.

CONCLUSIONS

Our results showed that pharmacy students were strongly in favor of a hybrid course. The levels of attendance and participation were high. However, teachers must be aware that some students will encounter organizational difficulties.

The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study

BACKGROUND

Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments.

OBJECTIVE

We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described.

METHODS

The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course.

RESULTS

Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages.

CONCLUSIONS

Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed.

The effectiveness of web-based learning in supporting the development of nursing students' practical skills during clinical placements: A qualitative study

Web-based learning, on its own or in combination with traditional teaching methods, has become a consolidated practice in many countries, and has been described as a valid and effective method that supports practical learning in undergraduate nursing students. The aim of this study was to explore the perception and effectiveness of web-based learning in facilitating the development of clinical skills in undergraduate nursing students. A qualitative descriptive study was conducted including online videos in three nursing schools of a university in Northern Italy. The participants were 26 undergraduate nursing students. A dedicated website was built including four videos and the respective checklists of four nursing techniques: insertion of a urinary catheter; insertion of a nasogastric tube; taking a blood sample; and the insertion of a peripheral intravenous line. Three Focus Groups were conducted, one for each nursing school. Thanks to its ease of use and unlimited access, web-based learning effectively supported students' clinical learning process by offering additional virtual visual support. Web-based learning could be effectively used to reduce the gap between theory and practice, and even as an upgrade for already qualified nurses.

[Reflections on Nursing Education of Technological Developments]

Geçmişte sınıflarda var olan yazı tahtası, tepegöz ve film şeritleri vb. teknolojiler günümüzde yerini bilgisayar, internet, simülasyon, öğretim videoları, mobil araçlar, sosyal medya vb. teknolojilere bırakmış, e-öğrenme ve mobil öğrenme gibi uzaktan eğitim yöntemleri giderek yaygınlaşmıştır. Bu teknolojilerin kullanılmadığı eğitim eğitim ortamları, artık günümüzün bireysel ve toplumsal beklentilerine, gereksinimlerine yanıt veremez hale gelmiştir. Bu nedenlerle günümüz dünyasında her ülke eğitimini, teknolojik gelişme ve değişmelerden yararlanılacak şekilde yeniden yapılandırmaya başlamıştır. Bu derlemede, hızlı değişim ve gelişim değişim gösteren teknolojilerin hemşirelik eğitimine yansımalarını ortaya koymak amaçlanmıştır.

Challenges in Implementing an E-Learning Education Program for Syringe Pump Use

To prevent the incidence of risks imputable to human error during the process of preparing the infusion pump, clarity in teaching and learning are required. Because traditional classroom training is difficult and time-consuming, the aim of the present study was to challenge the implementation of an e-learning education program for syringe pump use. The impact of the e-learning program was evaluated with 100 nurses between March and June 2016. The e-learning program significantly increased general baseline knowledge in syringe pump use; however, aspects of the program confused participants. The feedback from 98 % of nurses on the e-learning program was that it was effective in helping them with this skill. However, only 54 % opted for the e-learning program versus traditional training. The present study showed nurses preferred a blended learning format. Based on our hospital incident and error reports, this study shows local training requires a specific approach strategy for syringe pump education.

Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices

BACKGROUND

When performed erroneously, the venous blood specimen collection (VBSC) practice steps patient identification, test request management and test tube labeling are at high risk to jeopardize patient safety. VBSC educational programs with the intention to minimize risk of harm to patients are therefore needed. In this study, we evaluate the efficiency of a large-scale online e-learning program on personnel's adherence to VBSC practices and their experience of the e-learning program.

METHODS

An interprofessional team transformed an implemented traditional VBSC education program to an online e-learning program developed to stimulate reflection with focus on the high-risk practice steps. We used questionnaires to evaluate the effect of the e-learning program on personnel's self-reported adherence to VBSC practices compared to questionnaire surveys before and after introduction of the traditional education program. We used content analysis to evaluate the participants free text experience of the VBSC e-learning program.

RESULTS

Adherence to the VBSC guideline high-risk practice steps generally increased following the implementation of a traditional educational program followed by an e-learning program. We however found a negative trend over years regarding participation rates and the practice to always send/sign the request form following the introduction of an electronic request system. The participants were in general content with the VBSC e-learning program.

CONCLUSIONS

Properly designed e-learning programs on VBSC practices supersedes traditional educational programs in usefulness and functionality. Inclusion of questionnaires in the e-learning program is necessary for follow-up of VBSC participant's practices and educational program efficiency.

Nurses' Attitudes toward, and Needs for Online Learning: Differences between Rural and Urban Hospitals in Shanghai, East China

Health professionals need continuing education to maintain their qualifications and competency. Online learning increases the accessibility and flexibility of continuing education. Assessment of nurses' attitudes toward, and needs for, online learning can provide suggestions regarding learning program design and delivery. This study aimed to evaluate Chinese nurses' attitudes toward, and needs for, online learning, and to explore the differences in attitudes and needs between nurses working in rural and urban hospitals. This work is a secondary analysis of a multicenter cross-sectional study conducted in Shanghai in 2015 (n = 550). Multiple regression techniques were used to determine the factors associated with nurses' attitudes toward, and needs for, online learning. Results showed that nurses in rural hospitals had more positive attitudes toward online learning (102.7 ± 14.2) than those in urban hospitals (98.3 ± 12.9) (p < 0.001). For rural hospitals, nurses who could use computers and access the internet in their workplace reported more positive attitudes than those who could not. For urban hospitals, nurse educators showed significantly more positive attitudes than others. Communication skills (86.5%) and patient education (86.3%) were the most commonly-reported learning needs for nurses regardless of their working settings. Chinese nurses were willing to adopt online learning as a continuing education method. Nurses working in rural hospitals displayed more positive attitudes toward, and needs for, online learning than those working in urban hospitals. Nursing educators and managers should develop online learning programs and provide appropriate support to fulfill nurses' learning needs, especially for those working in rural healthcare settings.

Using video podcasting to enhance the learning of clinical skills: A qualitative study of physiotherapy students' experiences

BACKGROUND

Video podcasts, or vodcasts are increasingly used by a range of healthcare professions in the mastery of new skills. Little is known about the experiences of using vodcasts in physiotherapy education. Traditional pedagogic strategies have been employed in order to master those skills required for physiotherapy practice. There have been advances in the use of technology in medical education in the nursing, dentistry and medical fields. Vodcasts offer great versatility and potential when used as a pedagogical tool, embedded within a physiotherapy curriculum.

AIM

To explore students' experiences of using technology enhanced learning, namely vodcasts, in the Physiotherapy curriculum to develop the learning of clinical skills.

METHOD

A series of focus groups were carried out with undergraduate and pre-registration physiotherapy students (n=31).

FINDINGS

Students valued the versatility and audio-visual nature of vodcasts; helpful in revising for practical examinations and practising their skills prior to, during and after taught skills classes. Watching and practising simultaneously allowed students to practice repeatedly and formulate a process for each skill. When learning a new skill, a combination of teaching and learning approaches was favoured, marrying traditional approaches with those that utilise technology.

CONCLUSIONS

This study's findings add to the existing body of evidence in skills based teaching and support a multi-media, blended approach in those disciplines involved in the learning and teaching of clinical skills.

Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study

BACKGROUND

Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers.

OBJECTIVE

The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses' perceived brief MI skills and self-reported clinical use of brief MI.

METHODS

We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients' motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session.

RESULTS

We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%-91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0-7), perceived ease of use (mean 6.16, SD 0.78; scale 0-7), and system quality (mean 6.15, SD 0.58; scale 0-7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10-50). Other results were nonsignificant.

CONCLUSIONS

Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx).

Content and discontent: a qualitative exploration of obstacles to elearning engagement in medical students

BACKGROUND

Elearning is ubiquitous in healthcare professions education. Its equivalence to 'traditional' educational delivery methods is well established. There is a research imperative to clarify when and how to use elearning most effectively to mitigate the potential of it becoming merely a 'disruptive technology.' Research has begun to broadly identify challenges encountered by elearning users. In this study, we explore in depth the perceived obstacles to elearning engagement amongst medical students. Sensitising concepts of achievement emotions and the cognitive demands of multi-tasking highlight why students' deeply emotional responses to elearning may be so important in their learning.

METHODS

This study used focus groups as a data collection tool. A purposeful sample of 31 participated. Iterative data gathering and analysis phases employed a constant comparative approach to generate themes firmly grounded in participant experience.

RESULTS

Key themes that emerged from the data included a sense of injustice, passivity and a feeling of being 'lost at sea'. The actual content of the elearning resource provided important context.

CONCLUSIONS

The identified themes have strong emotional foundations. These responses, interpreted through the lens of achievement emotions, have not previously been described. Appreciation of their importance is of benefit to educators involved in curriculum development or delivery.

Access to, interest in and attitude toward e-learning for continuous education among Malaysian nurses

BACKGROUND

Continuous nursing education (CNE) courses delivered through e-learning is believed to be an effective mode of learning for nurses. Implementation of e-learning modules requires pre-assessment of infrastructure and learners' characteristics. Understanding the learners' needs and their perspectives would facilitate effective e-learning delivery by addressing the underlying issues and providing necessary support to learners.

OBJECTIVE

The aim of this study was to examine access to computer and Internet facilities, interest in and preferences regarding e-learning, and attitudes toward e-learning among nurses in Peninsular Malaysia.

DESIGN

The study utilized a cross-sectional descriptive survey.

SETTING

Government hospitals and community clinics in four main regions of Peninsular Malaysia.

PARTICIPANTS

A total of 300 registered nurses.

METHOD

Data were collected using questionnaires, which consisted of demographic and background items and questions on access to computer and Internet facilities, interest and preferences in e-learning, and attitudes toward e-learning. Descriptive analysis and a chi-squared test were used to identify associations between variables.

RESULTS

Most Malaysian nurses had access to a personal or home computer (85.3%, n=256) and computer access at work (85.3%, n=256). The majority had Internet access at home (84%, n=252) and at work (71.8%, n=215); however, average hours of weekly computer use were low. Most nurses (83%, n=249) did not have an e-learning experience but were interested in e-learning activities. Most nurses displayed positive attitudes toward e-learning. Average weekly computer use and interest in e-learning were positively associated with attitudes toward e-learning.

CONCLUSION

Study findings suggest that organizational support is needed to promote accessibility of information and communications technology (ICT) facilities for Malaysian nurses to motivate their involvement in e-learning.

Odnos študentov zdravstvene nege do e-izobraževanja

Uvod: E-izobraževanje je v terciarnem izobraževanju vse bolj pomembno, kljub temu pa tovrsten način učenja ni povsod uspešno implementiran. Na uspešnost uvajanja e-izobraževanja v študij pomembno vpliva pripravljenost na tovrstno obliko izobraževanja in odnos študentov do njega. Namen raziskave je bil proučiti naklonjenost študentov zdravstvene nege do e-izobraževanja. Metode: Kvantitativno raziskavo s spletnim anketiranjem smo izvedli v marcu 2014, na priložnostnem vzorcu (n = 92) študentov Fakultete za zdravstvo Jesenice. Koeficient Cronbach alfa je bil 0,966. Podatke smo obdelali s SPSS 20.0. Uporabili smo frekvenčno analizo, t-test za neodvisne vzorce, enosmerno analizo variance, korelacijsko, faktorsko in regresijsko analizo. Rezultati: Prednosti e-izobraževanja so najvišje ocenjene s strani študentov, ki so v e-učilnici sodelovali pri treh predmetih (p = 0,000). Odnos do e-izobraževanja je povezan z računalniško pismenostjo študentov (p < 0,05). Na odnos študentov do e-izobraževanja statistično značilno pozitivno vplivajo njegove prednosti (0,211< β

Building a Community of Scholars: One Cohort's Experience in an Online and Distance Education Doctor of Philosophy Program

BACKGROUND

Online and distance education is becoming increasingly common in higher education. As students explore graduate programs, they are often overwhelmed with the variety of program delivery options available. For graduate students pursuing a Doctor of Philosophy (PhD), a particular concern relates to building a community of scholars and how to do so through an online and distance learning program.

METHOD

Through a review of literature and personal stories, this article will highlight innovative strategies utilized by a cohort of PhD students related to online and distance learning and developing a community of scholars.

RESULTS

PhD students developed a community of scholars using innovative strategies to communicate and collaborate.

CONCLUSION

Building a community of scholars is possible through online and distance education using simple forms of technology to connect and collaborate.

Virtual patients: development in cancer nursing education

BACKGROUND

The number of men diagnosed with prostate cancer is increasing and internationally there are high incidence rates. It is important that nurses and healthcare professionals are enabled to provide appropriate care to those men affected by prostate cancer and their families. Despite this need, there is recognition that many professionals feel ill prepared and lack knowledge in a number of areas. This paper presents the development of a Virtual Patient (VP) online resource to support practitioner learning.

AIM

To develop five online VP simulation scenarios to meet the learning needs of nurses and health-care professionals caring for men with prostate cancer.

METHOD

Topic areas for the VPs were taken from previous work exploring the needs of health care professionals working with men with prostate cancer. An initial scoping exercise involving nursing practitioners, students and a prostate cancer charity confirmed the focus of the case study scenarios. Service users and specialist practitioners reviewed an outline of each case study to ensure fidelity of the simulations scenarios. Cases were entered into UChoose, a web based interactive VP player and authoring tool. The final case studies were reviewed by a sample of both registered and non-registered nurses and nursing students.

RESULTS

The majority of respondents reported an increase in knowledge and suggested that they would recommend the resource to others. A number of positive aspects of the resource were highlighted. Respondents also commented about areas of weakness, a number of which have been addressed subsequently.

CONCLUSIONS

The VP case studies provided an opportunity to develop knowledge and confidence in caring for men with prostate cancer. The mode of delivery and the content was acceptable for less experienced and knowledgeable staff.

Using principal components analysis to explore competence and confidence in student nurses as users of information and communication technologies

Aim

To report on the relationship between competence and confidence in nursing students as users of information and communication technologies, using principal components analysis.

Design

In nurse education, learning about and learning using information and communication technologies is well established. Nursing students are one of the undergraduate populations in higher education required to use these resources for academic work and practice learning. Previous studies showing mixed experiences influenced the choice of an exploratory study to find out about information and communication technologies competence and confidence. A 48‐item survey questionnaire was administered to a volunteer sample of first‐ and second‐year nursing students between July 2008–April 2009. The cohort (N = 375) represented 18·75% of first‐ and second‐year undergraduates. A comparison between this work and subsequent studies reveal some similar ongoing issues and ways to address them.

Methods

A principal components analysis (PCA) was carried out to determine the strength of the correlation between information and communication technologies competence and confidence. The aim was to show the presence of any underlying dimensions in the transformed data that would explain any variations in information and communication technologies competence and confidence. Cronbach's alpha values showed fair to good internal consistency.

Results

The five component structure gave medium to high results and explained 44·7% of the variance in the original data. Confidence had a high representation. The findings emphasized the shift towards social learning approaches for information and communication technologies. Informal social collaboration found favour with nursing students. Learning through talking, watching and listening all play a crucial role in the development of computing skills.

Mental Health Education and Virtual Learning Environments (VLEs) in Pre-registration Nursing Degrees: Follow the Leaders?

Virtual learning environments (VLEs) are now commonly used, worldwide, as teaching and learning platforms for pre-registration nursing education. However, there is only limited evidence in the research literature to suggest that VLEs are employed to support the education of student nurses about mental health and illness. This article describes the work of mental health nurse educators who have taken the lead by providing case-based simulations on VLEs, thereby enabling students to acquire knowledge and develop the clinical skills required for practice in mental health settings. Benefits of VLEs include their flexibility and accessibility, and also the opportunity they provide for students to engage with Web 2.0 technologies. Leadership in education must include the utilization of the most current pedagogical tools and strategies, as well as staying abreast of contemporary evidence-based practices in clinical settings, to support the knowledge acquisition and practice-based learning of the registered nurses (RNs) of the future.

Effects of mobile phone-based app learning compared to computer-based web learning on nursing students: pilot randomized controlled trial

Objectives

This study aimed to determine the effect of mobile-based discussion versus computer-based discussion on self-directed learning readiness, academic motivation, learner-interface interaction, and flow state.

Methods

This randomized controlled trial was conducted at one university. Eighty-six nursing students who were able to use a computer, had home Internet access, and used a mobile phone were recruited. Participants were randomly assigned to either the mobile phone app-based discussion group (n = 45) or a computer web-based discussion group (n = 41). The effect was measured at before and after an online discussion via self-reported surveys that addressed academic motivation, self-directed learning readiness, time distortion, learner-learner interaction, learner-interface interaction, and flow state.

Results

The change in extrinsic motivation on identified regulation in the academic motivation (p = 0.011) as well as independence and ability to use basic study (p = 0.047) and positive orientation to the future in self-directed learning readiness (p = 0.021) from pre-intervention to post-intervention was significantly more positive in the mobile phone app-based group compared to the computer web-based discussion group. Interaction between learner and interface (p = 0.002), having clear goals (p = 0.012), and giving and receiving unambiguous feedback (p = 0.049) in flow state was significantly higher in the mobile phone app-based discussion group than it was in the computer web-based discussion group at post-test.

Conclusions

The mobile phone might offer more valuable learning opportunities for discussion teaching and learning methods in terms of self-directed learning readiness, academic motivation, learner-interface interaction, and the flow state of the learning process compared to the computer.

Home Nurses’ Opinions Toward e-Learning in Continuing Education

There is an increased focus on the introduction of e-learning in the continuing education of home nurses. The aim of this study was to explore the opinions of home nurses toward continuing education via e-learning. The majority of the participants (87.9%) were willing to be educated via e-learning. The five main criteria in the success of an e-learning module were the user friendliness (79.7%), a thorough explanation about the use of the platform (63.7%), a thorough development of the subject (34.7%), the possibility to exchange ideas with colleagues or teachers (30.9%), and the availability of online illustrations (30.8%). The home nurses are willing to be educated via e-learning, but they were not conclusive on their preference toward classical education or education via e-learning.