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Electronic Networking in Community Nursing Education
AEJNE Volume 5 - No.1 August, 1999.
Brown, A., Burgess, K., Ginich, R., Hadid, A.,
Kennelly, M., Menadue, D., Smart, A. & Treasure,
This paper describes and evaluates a community nursing assignment that was set for senior nursing students. The aims of the project were to increase students' awareness of health issues in other countries, network with nurses in those countries and gain experience in the use of information technologies. Each of eight students explored a community health issue in another country. Examples of the health issues included child immunisation, care of the elderly, health beliefs and practices in another culture, sex education in high schools, and acquired immunodeficiency syndrome prevention. The students communicated with nurses in Japan, Brazil, Peru, the United States of America and Scotland via electronic mail and most utilised additional information from the Internet. The students evaluated the assignment positively; they were enthusiastic about their improved computer and Internet skills, the knowledge they gained about different cultures and health care practices, and their networking with nurses in other countries.
The authors are very grateful for the time, dedication to our project and enthusiastic collaboration of the following nurses: Isabel Penarrieta, Ana Cristina de Sa, Sayonara Barbosa, Kiyoko Makimoto, Rie Naganuma, Mayumi Kato, Anne Robertson and many members of the GLOBALRN list.
This paper has been adapted from one entitled: Speaking in Many Tongues: Sharing of
Student Nurses' Experiences via the Internet presented by S. Trick, D. Menadue, K. Burgess, A. Hadid and M. Kennelly at the Third Nursing Academic International Congress: Collaboration in Nursing, in Canberra, February 1998.
Many nursing students are proficient users of computer technologies and the Internet. Nurse academics also need to be proficient in the use of these information technologies. As McMillan pointed out, today's curricula demand radical changes in the way we think and our students must have a 'new level of information literacy'. She highlighted the need for more flexible approaches to teaching and learning (McMillan, 1999, 5). The possibilities for curricula innovation are endless and provide many challenges for faculty and students. An 'international' assignment was set for nursing students which could be easily managed and exciting for the students.
This paper describes and evaluates an assignment set for senior students undertaking a year-long community nursing subject that was offered as an optional assignment and called an International Field Study. It was made available to a limited number of students interested in exploring community health issues from a global perspective. Student numbers were limited because the assignment was a new initiative requiring additional computer based support in terms of training and equipment resources. It was optional because of potential difficulties in student access to university computers already in huge demand, and resultant issues of equity of access.
The aims of the assignment were to increase students' awareness of global health issues by networking with nurses in other countries and to improve students' experience in the use of information technologies. Eight students took up the option and it is chiefly their experiences that are described and evaluated in this paper.
It is clear from the literature that there is a growing awareness of the need for nurses to become computer literate (Bryson, 1991; Dauvin, 1996; Hardy et al, 1996; Lewis, Watson & Newfield, 1997; Roberts et al, 1998; Saranto & Leino-Kilpi, 1997; Saranto, Leino-Kilpi & Isoaho, 1997; Scarpa, Smeltzer & Jasion, 1992; Sparks, 1993; Ward, 1997). Some strategies for developing computer literacy include exposing student nurses to the technology by setting assignments that require the use of the Internet for information retrieval and communicating about health issues with nurses worldwide. Because e-mail is now more readily available in the university sector, it can be utilised by students to facilitate a broad awareness of global health matters. E-mail is a form of communication (Anthony, 1996; Edwards, 1997) and through computer networks, such as the Internet and the world wide web, nurses around the world can consult with each other. E-mail is a flexible, cheap, reliable and quick way to communicate and it opens the way for the expansion of communication networks such as newsgroups, bulletin boards and mail lists (Anthony, 1996; Edwards, 1997).
The attitudes of nurse academics, nurses and student nurses to computer technologies have been evaluated in a number of recent studies (Bryson, 1991; Jayasuriya, Milbourne & Tooth, 1994; Lewis & Watson, 1997; Saranto, Leino-Kilpi & Isoaho, 1997; Saranto & Tallberg, 1998; Scarpa, Smeltzer & Jasion, 1992). Results indicate that motivation to utilise the emerging technologies available for teaching and learning is enhanced when attitudes to the technologies are positive and opportunities are made available for individuals to be exposed to and given adequate support for their learning about them.
For the assignment each student was expected to explore a community health issue in another country. They were asked to conduct a minimum of five e-mail exchanges with their contact nurse in that country. The contacts included a public health nurse from Peru, Isabel Penarrieta; a PhD student and lecturer in Nursing, Ana Cristina de Sa and an intensive care nurse, Sayonara Barbosa, both from Sao Paulo, Brazil; a public health nurse, Rie Naganuma and a graduate student, Mayumi Kato, both from Kanazawa, Japan; and a lecturer in Nursing from Edinburgh, Scotland, Anne Robertson. One student networked with a number of nurses in the United States of America (USA) and another student drew her information from the Internet alone.
Nurses were contacted in various ways and the process of seeking contacts was an example of good collaboration. The lecturer had met Kiyoko Makimoto during a sabbatical at the University of Washington, USA. Kiyoko, now a lecturer in Nursing at Kanazawa University in Japan, recruited Rie and Mayumi for the project. Ana was contacted by the lecturer through the GLOBALRN list and she was instrumental in encouraging Isabel in Peru and Sayonara in Brazil to participate. Anne from Scotland was also contacted through the GLOBALRN list. One student found a number of nurse contacts through her own GLOBALRN searches.
All students sought information from books, journals, the GLOBALRN list and other health and nursing related Internet lists, and from the home pages of organisations such as the World Health Organisation and the United Nations. Students chose community health issues which included sex education in USA high schools, alcoholism and mental illness in the USA, child immunisation protocols in Peru and Brazil, the use of therapeutic touch in patient care, health beliefs and practices in Japanese culture, care of the elderly in Japan, and AIDS prevention programs in Europe.
Meetings with the lecturer were conducted throughout the year. At the first meeting students were given details about the assignment, contact addresses of overseas nurses and information about the University's PINE e-mail system. Given the experimental nature of the assignment everyone was expected to be flexible. All became aware that the assignment allowed for a lot of scope and that self-directed learning might be stressful for some students not used to such 'freedom'. Assessment was a written report, including a presentation of the subject matter and a description of the 'process' of the assignment. This meant that each student kept a diary of her experiences. The due date for the report was negotiable as there was an expectation of initial problems making contacts with the nurses. All students completed a questionnaire at the completion of the assignment and most chose to incorporate this in their reports.
Initially, considerable time was spent discussing the procedures needed to access the university computer system, for example, acquiring student numbers and passwords; assessing the availability of computers and learning about the e-mail system. Although the feeling was one of optimism at the first meeting, there was some anxiety about undertaking such a challenging assignment. The students assisted each other in accessing university computers, and discussing health related topics and ideas about making contact with nurses from other countries. In later meetings many of these issues were discussed and resolved in an atmosphere of support, flexibility and good humour, and where students with excellent computer skills were able to assist those who were wary and lacking confidence. There were also discussions about the type of questions they should ask and which would elicit the most pertinent amount of information about their chosen topics.
Topic choices and considerations of cultural issues were discussed in detail. As the cultures of Japan, Brazil and Peru are completely different to their own, students sought further information about the countries; the geography, health beliefs and customs. Once communications were underway other issues arose such as, an awareness of the need to keep English expression simple so that the nurses from Peru, Brazil and Japan could understand more easily; and a sensitive consideration of the busy workloads of all the nurse contacts. Language usage for non-English speaking nurses was discussed frequently. Students had to avoid use of jargon and Australian colloquialisms and detailed questions which, in their enthusiasm to find out 'everything', they asked at times. As one student had difficulty contacting nurses she used the Internet to research her particular topic. Other problems were related to different semester times, individuals taking vacations and computer glitches.
All eight students involved in the assignment were women. Most had some experience in word processing and half had experience using the Internet and e-mail. One student had computer access at home and one chose to use a computer at another university; the remaining students used our university facilities. All students reported that the assignment heightened their awareness of the benefits and challenges of using the Internet in their studies and of some international health care issues.
Whether students gained information from their communications with nurses or from the Internet, all found out much about their areas of interest. All noted the difficulties in prioritising large amounts of data, and as with any self-directed enterprise, they had to organise the information according to their purposes. Validation of information from the nurses was an issue of concern for most students. Ways of referencing this information and that from the Internet were also of concern, despite some draft guidelines for citing being provided. Validation of Internet information is obviously a problem as there is so much information that is not as rigorously assessed as that contained in printed materials (Ward, 1997; Dauvin, 1996). Students and the lecturer were mindful of this. As Ward noted, one of the teacher's roles is to provide students with the skills to evaluate and analyse the quality of information gleaned from the Internet (Ward, 1997).
The students corresponded more frequently than the minimum of five exchanges recommended in the assignment. Most students stated that computer access and availability were difficult at times, an issue discussed in Dauvin's thesis. In his conclusions he suggested that the physical means of connecting to the Internet is a fundamental requirement if this technology is to be used in Nursing curricula (Dauvin, 1996). Although Internet access is becoming more available at our university, it is still difficult for Nursing students en masse to undertake assignments such as the International Field Study because of the heavy demand of students from other disciplines on computer facilities.
Comments were also related to the need for each student to define the scope of their topic of interest. Making contacts who 'matched' in terms of the interests of both parties was considered desirable. This did not always occur and students learnt much about 'flexibility' and were tolerant of a certain amount of ambiguity. Issues relating to whether students should choose a topic before or after contact with the nurse were discussed. The ideal scenario would be to match the interests of student and overseas nurse when making initial contact. Flexibility and patience on the part of lecturer and students were key factors in surviving this experimental assignment. It was clear that the best responses came from the lecturer's personal contacts in Peru, Brazil and Japan. Her emphasis on the process of the assignment rather than the content relieved some of the pressure on the students, so that in planning their reports students were encouraged to stress the process if they found the content wanting.
Validating information provided by the nurses; identifying what was relevant or not in their contributions and whether they were accurate or not, were difficult for students. This was a direct result of not having very specific objectives for the assignment and most students commented on this aspect. This was also a relevant point in the 1998 study by Roberts et al in which Nursing students communicated with others from another Australian university. The researchers also noted the importance of anticipating technical and communication problems when using this new technology (Roberts et al, 1998). Because of the experimental nature of the International Field Study, it was felt that specific objectives may have been too limiting and it was agreed that for the purposes of the assignment the students need only describe the factors they thought were relevant about their topics of interest. Unless the overseas nurse was an expert in the area of interest, only general concerns could reasonably be discussed. It was noted that in the communication process much can be gleaned about the attitudes of the nurses to the chosen topics.
All students were apprehensive about the assignment at first. Arwa wrote that she was 'relieved and comforted by her (Ana's) apparent enthusiasm and her willingness to help, my apprehension was reduced to delight and interest'. As the communication progressed Arwa wrote: 'The beauty of this assignment was that I could ask (questions) and get my answer the next day'. Angela wrote: 'I ... found the informality of the assignment scared me somewhat. I am used to structure ... I am very glad, that at the end, I was able to have the experience and I believe that it has proven successful'.
Other students found the communication process difficult as computers did not work, servers were 'down' at both ends, contact nurses were unavailable for various reasons, responses were delayed or messages returned. Debra used her new home computer for the assignment and found that having twenty four hour access to e-mail facilities a definite advantage. Regina was reminded of the need to phrase her questions carefully when communicating with Mayumi in Japan as English was not her first language. As an example of differences in the way people are addressed in Japan, Regina wrote: ' ... in an early letter, Mayumi called me by my surname. I thought this very odd until I was reminded that, in Japan, names are written with the surname or family name first ... such a simple thing ...'
All students provided constructive feedback about the assignment and the following quotes demonstrate this:
'...any problems with the study were far outweighed by the benefits. My knowledge of computers, e-mail and the use of the Internet has increased greatly. I am aware now of how complex the issue of immunisation is in Australia. I particularly appreciated the opportunity to discuss health issues with an overseas colleague ... I found this to be the most interesting assignment I have undertaken during my tertiary studies.' Debra Menadue
'The insight that this field study gave into health issues in other countries was priceless. It enabled the facilitation of the learning of concepts, ideas and issues in relation to health in other countries as well as in Australia. The research was more beneficial due to the fact that the information was gathered from a fellow health professional in an exciting way rather than from text books or journals. I found that the insight into the use of e-mail and Internet services was also advantageous and will be extremely useful in the future...' Elizabeth Treasure
'Many of the skills used in this assignment have been newly acquired ... An insight was gained into another culture and this was eye opening. Another success of the assignment was the ability to work closely with the lecturer and others involved in the assignment. Working closely ... allowed us to teach and learn as the assignment progressed. This was rewarding.' Kylie Burgess
'This was a great assignment, despite the fact that I was unable to conduct any correspondence. I learned a great deal about the value of computers in the process of conducting research, and gained many computer skills which I have already used in other subjects.' Anita Smart
'The group interaction was a vital aspect. We were able to discuss computer and resource problems and together were able to overcome most difficulties. This sharing of information made the assignment much more viable and less daunting. The assignment was very worthwhile and has intensified my interest in other cultures. The input from Mayumi was vital.' Regina Gnich
'Not only will nurses be able to interact with colleagues in their own country, but also converse with nurses in different parts of the world ... The world is no longer a mass of separate continents, but a global community. The world and its people are not alone and this assignment highlighted this point quite successfully.' Arwa Hadid
'While the assignment was not entirely a success for me I was able to have brief contact with someone and gain a limited amount of information about my chosen topic. I seemed to encounter a few difficulties along the way, such as not being able to converse with my contact due to computer problems. I seemed to find myself becoming more frustrated as time went on ...' Angela Brown
'I believe there was a high degree of collegiality, that is, mutual respect and recognition between fellow students and of course, Sandra. This was rewarding in itself. For me, this was also evident in my relationship with Rie and Kyioko. Their response could only be commended, being both immediate and informative. The exchange led to an awareness of a different culture, to a shared global community health issue and to the similarities and differences of the issue.' Moya Kennelly
In this assignment students communicated with nurses from different countries by using e-mail. Although the knowledge that these nurses shared was, in most cases, necessarily subjective this very subjectivity enabled the students to explore various perspectives of culture, mores, attitudes, health beliefs and practices; and some of the ways nursing and health systems are constructed in other countries. Although the assignment posed many process problems, all students found the assignment challenging, exciting and for the most part, fun.
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