Teaching a Bachelor of Nursing unit on-line: some experiences and results.
AEJNE Volume 3 - No.2 March,1998.
Dr P J Martyr.
The Tasmanian School of Nursing is the sole provider of nurse education in Tasmania. As such, the TSON is faced with the difficult task of effective education delivery to remote areas, from three campuses which are roughly 200km apart. The TSON's main campus is at Launceston, in the north of the state. There is also a campus in the Clinical School of the southern campus of the University of Tasmania, in Hobart, and a third campus in the north-west of the state at Burnie.
The School undertook on-line teaching at the end of 1996 as an initiative towards the better delivery of nurse education in Tasmania, particularly given the remote-area access potential. But rather than focus on the clinical units, where face-to-face teaching was felt to be more important, the School instead selected some of its supporting studies units, to see if they would effectively convert to electronic format.
Two units have been trialled in this way. This article will focus on the second of these, Child and Adolescent Health, a second year unit in the Bachelor of Nursing course.
This article has four major parts:
Part 1: The course team and original planning
The course team consisted of Dr Judy Sankey, Ms Sheryl Brennan, myself and Ms Judy Austen. Sankey and Brennan were the original course designers, sharing between them expertise in areas such as breast-feeding, child health, feminism and mothering, the history of nursing and nursing practice, maternal health, and post-natal depression. I am an historian of health care and lecturer in research methods and health sociology, and was brought into the team as the WWW designer of the course.
While Sankey, Brennan and I were all based in Launceston, Austen was teaching in Hobart. As such, her Internet access was limited. The Clinical School has endured continuous problems with obtaining internet access due to a lack of appropriate computer networking.
The course was originally planned, during the mid-semester break of June-July, to be run as an electronic unit only. Immediate problems faced were:
1. Would the numbers of students enrolling in the unit be able to be distributed evenly among the tutoring staff?
The course had had an unexpectedly high enrolment of over 250 students, from across the state. By enlisting Judy Austen's help, even distribution was achieved satisfactorily by arranging tutorials so that numbers were evenly distributed.
2. How would the staff teaching the unit cope with the new technology?
This was a matter of grave concern for some team members. While I was comfortable with electronic teaching and learning, other team members did not feel entirely comfortable with delivering an entire unit on-line. This problem was partially overcome by staff seeking advice and help on improving their computer skills.
3. Did the students have sufficient computer literacy to cope with electronic learning?
This question had a corollary - did students have sufficient access to computers and to the Internet to make this a workable proposition? Informal monitoring of student use of the nursing computer laboratory provided at the main campus of the TSON indicated that access was not so much a problem of provision as a question of timing - demand could fluctuate considerably over the semester. Students who undertake the Bachelor of Nursing course complete, in their first year of studies, a semester-long course in Applied Computing. While for the most part this gave students some confidence with computers, many of the students undertaking the course were mature-age students. Studies of computers and nurse education have shown that there are major problems with confidence in their computing skills among nursing students (Wilson, 1991), and particularly among mature age students (Schwirian, P. et al. 1989; Van Dover and Boblin, 1991; Burkes, 1991).
4. How would the Internet access problem in Hobart be overcome?
This was possibly the most frustrating of this set of problems. Without an injection of funding - which was unlikely, given the current climate of higher education - the University would not be in a position to upgrade Internet facilities in the Clinical School. While there was a student laboratory with good Internet access, obtaining similar access for staff was proving problematic. The TSON offices in the Clinical School were small, old and cramped, which made the provision of Internet access a questionable proposition.
As events will show, staff access became a moot point,
and the focus shifted to student access as a priority.
Part 2: Designing the course
Child and Adolescent Health is a semester-long unit, which is designed to introduce students to key concepts in promoting and maintaining the health of babies, young children, and young adults. The course material was written by Sankey and Brennan, and consisted of on-line text lectures which the students could download, and a series of tutorial questions for discussion. I converted this material to HTML format, and created an overall course site which included pages on computer support, frequently asked questions (FAQ) and the tutorial room, where each week's topics were displayed. I also produced a Help Book, which was posted to all students enrolled in the unit, explaining the change in format, and how to undertake the course successfully. I provided telephone support over the semester to any students having any sort of problem with the unit while studying it electronically.
Student concerns made themselves felt in the form of a petition from second year students, asking that the course be available under both face-to-face and electronic formats. This was actioned a fortnight before semester was due to begin. Staff were, however, able to meet this need, and the course was then presented under both formats - face-to-face tutorials and electronic tutorials, based on a self-selection process for students. The final proportions of the total enrolement were 80% selecting face-to-face, and 20% selecting electronic teaching - approximately 200 to 60.
The electronic process of learning was organised in this way: students would access the on-line lectures at their own pace, complete the reading from the hard-copy reader compiled by staff and available for purchase, and then each week would participate in a closed-list majordomo email discussion group. The address of the group was firstname.lastname@example.org, and subscriptions were handled by me, as I was teaching the electronic group. The list was unmoderated, in that messages could be sent directly to it without being screened first by the tutor.
Part 3: Going Live - the Results
This paper will focus on the experience of electronic teaching and learning undergone by the 20% of the enrolement that selected this option. I will examine patterns of student learning and participation during the ten weeks of the course, the impact of the format on rates of participation in tutorials, and the possible impact of this on final grades in the course.
I began with a group of 62 students, of whom eventually thirteen dropped out of the electronic format, either through choice to move to face-to-face classes, or withdrawl from the unit. This left a total of 49 students enrolled in the electronic version of the unit.
(a) The group
The following figures help to form a profile of the group:
So the most common profile is that of a female enrolled nurse participating in the course through the Launceston campus.
(b) Student activity in the tutorial group
The following chart shows the proportion of messages sent to email@example.com which were sent by the tutor and by the students, with a total figure.
Chart 1. Messages sent to firstname.lastname@example.org over ten weeks
Overall, the number of messages were high at first, but tapered off as the semester continued. It can be seen that the tutor's role in the group was highly involved at first, then diminished as the group became largely self-moderating, requiring less and less tutor intervention. The second chart shows the relationship between the number of students responding to messages, and the number of student messages sent to the list. A high level of multiple postings were experienced in the early weeks of the course, which again tapered off until the norm was one posting per student per tutorial topic.
Chart 2. Chart of relationship between no. of student responses and no. of student respondents
Chart 3. Relationship between total email group numbers and number of students contributing to discussion.
Chart 3 shows the level of participation against the total numbers subscribed to the email list. On both charts 2 and 3, week 5 shows a sharp drop, as that was the week in which the first assignment was due. I also recorded the number of weeks in which a student actually contributed to the list, out of the ten weeks of the course. These figures are shown in chart 4. Only three students scored a perfect 10, the majority participating in anywhere from five weeks to eight weeks.
Chart 4. Student participation rate by number of weeks
Chart 5. Correlation between grades received for first assignment and tutorial participation.
Chart 5 shows the grades scored by students after their final assessment, matched to the number of weeks they attended. The grades have been averaged, but the full range is reproduced in the table below for comparison. Note the range of marks in each group, which may have skewed the average grade for each group.
The overall trend is one of higher participation leading to higher marks. The conclusion may well arise from this that the more studentsparticipate in the discussion, the higher their mark. This is not necessarily the case. What may be more likely is that those students who are already organised and committed to work find both the time to participate regularly in the tutorial and to organise their workloads so that they produce a higher standard of written work. Anecdotal evidence from students suggests that they have experienced a correlation between their own personal discipline and study habits and their participation in the tutorial.
Correspondingly, it must also be noted that students who had lower rates of attendance - such as three weeks - scored quite well. It may be that these students did not feel the need to participate as much in tutorial discussion, but to focus instead on their written work.
Part 4 - Follow up Survey and Results
I also surveyed the students upon the conclusion of the course, by posting out a survey and letter and a reply envelope. Of the 61 sent out - to all students who had initially self-selected into the electronic component - I received 31 replies. Only two of these were from students who had not continued with the electronic component, so 29 replies came from the group of 49 students, an almost 60% response rate.
The answers to Section A are represented below:
Age of respondents:
Sex of respondents:
Type of enrolment:
This provides a basic profile of the majority of respondents - female enrolled nurses studying at Launceston, and aged between 27 and 40 years.
Section B asked students about their experiences of electronic learning. The majority of responses were positive:
Question 7 - Reasons for selecting the electronic component:
*More than one answer permitted
These options are presented here in the order of popularity. It is valuable to note that the majority of respondents found the electronic formatattractive because it allowed them to arrange their time more conveniently. The appeal of trying a new mode of delivery was also attractive,which indicates a higher level of confidence with electronic learning than I expected to find.
Question 8 - Location of computer resources used by students:
*6 students gave more than one answer
This was of interest, because it showed that one option listed - the Hobart Clinical School's computer facility - was not used at all by respondents. Instead, the most popular options were home computers, followed by the Newnham campus nursing computer laboratory in Room M101. This indicates a higher level of home internet access than expected.
Question 9 - Students' perception of their contribution to electronic discussions:
The respondents perceived their level of participation fairly accurately. Most students participated quite well in electronic discussions.
Question 10 - Perceptions of overall increased knowledge/understanding of information technology:
The results here were gratifying, and showed that the time spent on computer education by the TSON has not been wasted. The majority of respondents showed an improvement on their basic skills gained through participating in the electronic version of the course. A significant proportion of respondents felt that they had learned a great deal about computing and its uses from participating in this way.
Question 11 - Student rating of enjoyment/new learning experienced in the electronic component:
This was also gratifying. Many respondents enjoyed the format and delivery, and although they found it difficult at times, they found they improved their skills over the ten weeks of the course.
Question 12 - Student opinions on where they might appreciate electronic-based units in future study:
*More than one answer permitted
This shows that electronic delivery of course material is appreciated by respondents, who see a role for it in their future formal education as
nurses - a significant finding for the course arrangement and delivery of material at the TSON.
Questions 5 and 6 were for students who did not continue with the electronic format of the unit. I received two responses to this section:
Question 5 - What made you decide to drop out of this option and resume face-to-face teaching? Tick as many answers as are applicable
Question 6 - Would you ever consider trying electronic learning again? Select one.
Although these results are limited, they are revealing in that the reasons given for not participating were not based on lack of access to computer facilities, lack of support, or a lack of interest. The students who responded also felt that they would try electronic learning again at some point in the future.
The introduction of electronic delivery of learning materials at the TSON has been fraught with difficulties. This unit has proved a forum for overcoming many of these difficulties, and making electronic teaching and learning a more profitable and fulfilling experience for those participating in it. Future course material will also be monitored in this way, with an eye to improving overall the content and delivery of material. The flexibility offered by on-line delivery has proved attractive to the type of student who selects this option - mature-age female students, who may find it allows them time to work, study and have time with their families. Future research needs to be conducted to find out what factors are influencing students' choices of electronic delivery of materials.
Burkes, M. 1991. Identifying and relating nurses' attitudes toward computer use. Computers in Nursing, 9 (5): 190-195.
Schwirian, P. et al. 1989. Computers in nursing practice: a comparison of the attitudes of nurses and nursing students. Computers in Nursing 7 (4): 168-176.
Van Dover, L, and Boblin, S. 1991. Student nurse computer experience and preferences for learning. Computers in Nursing, 9 (2): 75-79.
Wilson, B. 1991. Computer anxiety in nursing students. Journal of Nursing Education, 30 (2): 52-56.
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