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Vol.7, No.1 April 2001
Editorial | Contents

What Makes an On-Line Nursing Unit (un)Successful?

Author

Dr P J Martyr
Lecturer
Tasmanian School of Nursing
University of Tasmania
Launceston 7250
P.Martyr@utas.edu.au

The Tasmanian School of Nursing 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 of this form of delivery. 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. The School will be returning the unit to face to face format from 2000, and will be offering for the first time a Year 3 level unit called Professional Issues in Nursing in fully web-enabled format.

With some notable exceptions (Gregor & Cuskelly 1992, Naidu et al 1994) current evaluative studies of electronic course delivery are few. This article examines qualitative data from the group of students who undertook the unit Child and Adolescent Health (CAH) on-line at the end of 1998. The results seem to indicate several concrete conclusions about what types of students benefit the most from on-line learning, and what these nursing students think about the process itself.

The overall course site for Child and Adolescent Health included pages on computer support, a tutorial room where each week's topics were displayed, and a reading room with print and web resources useful for the students. I also produced a Help Book, which was distributed to all students enrolled in the unit, explaining how to use the course web site successfully. The web site was password controlled, and all students were issued with the username and password required.

The electronic process of learning for all three versions of the unit was organised in this way: students would access the on-line lectures or attend the face-to-face versions, complete the reading from the print and web resources, and then each week would participate in a closed-list majordomo e-mail discussion group. The list was unmoderated, in that messages could be sent directly to it without being screened first by the tutor.

The CAH 1998 sample group consisted of the entire final enrolment of the group, which came to 147 students. All these students took the course electronically. The return rate of surveys was 46%, or 68 surveys.

The group was surveyed after completion of the course. The unit was evaluated by students who undertook the course electronically, through a staff-developed survey which was posted to their home address with a return-addressed envelope. The group were also asked to provide qualitative data on their experiences of on-line learning. Each survey collected demographic data in the first four questions on age, sex, campus and type of enrolment, which was used to measure whether the survey group were representative of the cohort. Participants were also invited to provide qualitative data on their experiences of on-line learning, and it is this data which forms the basis of this study.

Forty eight of the sixty eight survey respondents (70%) made written comments in the section provided for this, immediately following the question asking for suggestions and improvements. The bulk of these comments reflected on the tutorial experience.

Comments have been arranged into a series of themes which emerged from the data. These themes are: 1) the unique nature of face to face teaching; 2) specific problems experienced in the electronic tutorial; 3) positive overall experiences of electronic teaching; and 4) solutions to some of these perceived problems.

These revolved largely around issues of body language, authenticity and spontaneity. Students clearly valued these in the face to face context, and missed them in the electronic context. The respondents made clear comparisons between their experiences as face to face students and their experiences as electronic students. Some found that electronic learning made them inarticulate; that they could not fully explain themselves, and that they felt powerless and prone to their words being taken out of context.

This finding is borne out by the quantitative data, which indicates that the most popular suggestions for improving the course was to include study days and to have face to face tutorials.

"I felt you couldn't fully explain yourself via e-mail. Some comments made were easily taken out of context, and we had no way of verbally explaining ourselves by a way of body language and tone of voice."

"No chance to read people's body language to see if they actually believe in what they are saying."

"Comments were taken the wrong way."

"In a face to face tutorial, people can't repeat themselves, discussions are productive and people can't be taken out of context, etc."

"People tend to spark off each other in face to face tutorials, and more discussion about a topic is produced."

"I believe face to face contact provides the best and most genuine responses."

"There is no way of replacing the productiveness of face to face lectures and specially tutorials."

"I felt that there was no interaction between the group - no spontaneity as you would get in face to face discussion."

"I missed the spontaneity of a joke or a shared insight or story."

"I found it hard not having the face to face conversation with the other group members as well as the tutor."

"I felt it wasn't personal enough."

Students were clear and consistent in their identification of problems with electronic learning, particularly in the tutorial environment.

Repetition

Repetition was an ongoing problem in the e-mail tutorials, as the students' comments bear out:

"The e-mail system was all right, but a lot of the same comments were being written again and again (I was also to blame for this). I don't know if a bulletin board would stop the repeated comments."

"I found conversing with other students on e-mail boring and uninteresting."

"80% of my tutorial group, myself included, regurgitated what the first two or three people sent to the tutorial group."

"I found it [contributions] very repetitive and shallow."

"With the on-line system, answers to a question get quite repetitive due to lack of reading other people's answers."

"There is less discussion by e-mail - people tend to write one response for each week."

"I don't think tutorials should be done electronically, because everyone just repeats what someone has just said."

"Tracking through the mountains of e-mail in tutorial became quite trying at times and even harder to comprehend."

"I found quite a few times that the stuff that was said by other people was exactly what I wanted to say."

"I do believe that there wasn't much debate in the on-line, because people said their bit and that's all."

What is gratifying here is the students' candour in admitting that they themselves were part of the problem, rather than part of the solution. Students did, however, find the repetitive nature of the contributions an impediment to their enjoyment of the course and their learning.

Poor quality debate and discussion

This was a very interesting reflection on the students' perception of what is important in the tutorial learning environment. Like the issues of spontaneity and body language, students saw electronic learning as denying them a level of interaction and debate which they experienced in face to face tutorials. In these comments, however, unlike those on repetition, there is no perception that students themselves might be responsible for making a tutorial an active debating area, regardless of the format.

"Face to face tutorial facilitate a better understanding of different views and beliefs and allows for problems to be attend[ed] to that time."

"I think there is much more interaction and debate in a face to face tutorial."

"I didn't know most of the people in my tut group, therefore using the computer became a chat group."

"I didn't find the tutorials beneficial because there were not really any discussions."

"There was no continuity in the tutorial sessions."

"The on-line tuts did not really raise informative discussion."

"I felt I didn't learn anything from this unit as there was no opportunity for discussion as it is not easy to have an open discussion via e-mail."

"The electronic tutorials are not successful as there is no discussion - only people's thoughts."

"I don't mind the lectures on line however face to face tutorials are much more constructive. They allow for actual discussion rather than individuals making statements."

Academic referencing of tutorial contributions

This was a contentious issue. The course team decided early on in the unit that it would be advisable to take advantage of the written format of the tutorial to ask students to reference some of their contributions. There were two forms of response to this in the survey: one view argued that there should have been more referencing, and the other argued that it should not have been required of students.

"I thought the topics were too general and were based on a understanding of society in general - rather than actually having to research tutorial answers in depth which would have made it more involving and enjoyable."

"It ended up that everyone just gave their personal opinions on things and the facts were never learnt."

"[The readings for the unit] were hardly ever talked about - it was more about personal experience (the tuts, that is)."

"The tutorials were ridiculous. I didn't learn much from them at all. There was no interaction and we couldn't back up our comments and explain what we meant properly."

Against:

"Another pressure was writing skills, and the nuisance of requiring references. In face to face tutorials this is not as essential."

"Shouldn't expect us to reference in tuts, as you don't have to reference what you say in face to face tuts!"

Students' perceived lack of self-directed learning skills

It should come as no surprise, given the above data, that students reflected a lack of self-directed learning skills. Some of them perceived this and commented on it:

"I read maybe six or seven pages of the on-line lectures and I can't remember much of what I read; compared to a face to face lecture which is much easier."

"I found that I did not contribute at all in the tuts."

"I think most of the students would agree that once they had written their tutorial for the week, that was it, and any other tutorial answers would get trashed."

"I felt that doing this subject all electronically it felt like I was teaching myself - even though I did find it interesting."

"Only a few members of the group participated."

"Self directed study is convenient, but I always feel like I might be missing some important point."

"However this course is a good learning experience for discipline and self-directed learning."

"It can be difficult to know whether your responses are on the right track by e-mail. I find myself less inclined to ask questions by e-mail."

These problems feed into and in turn reflect the problems described earlier - the sense of missing out on something; the repetitive nature of many tutorial contributions, and the lack of real debate and discussion as students took the minimal option of one contribution a week. Many of these can be directly traced to students with little or no motivational or self-directed learning skills, who are used to working in a university environment where they are supported almost constantly by regular face to face contact with teaching staff. If on-line learning is to be successful, students must either be helped to acquire independent learning skills, or courses offered electronically should be targeted towards those students who are most likely to have those skills, such as mature age and distance education students.

Tutor contact - concerns about assignments

The issue of tutor contact flows on from the issue of self-directed learning. Students clearly missed the regular face to face contact with their tutor, seeing the electronic contact as inferior and staff as unavailable, despite their being contactable via e-mail at any time.

"I missed teacher contact and this made doing assignments difficult sometimes."

"Weekly tutorials again definitely needed as often it is hard to gain face to face contact with tutors, re difficulty understanding an essay topic or the subject in general."

"Weekly [face to face] tutorials definitely needed, allowing students to discuss uncertainties with lecturer about subject."

"It is difficult to know what the lecturer wants of you - in terms of assignments as there is no real feedback."

"Having the staff available at all times not just via e-mail would be helpful."

Time delay

Time delay is related to tutor contact. Students describe their perceived need for immediate contact with a tutor, and an immediate solution or answer to a problem. They see electronic learning as delaying this, which is for them a negative outcome. It may be important in future to help students to readjust to this concept of asynchronous learning; that answers may not come immediately, but that this does not necessarily diminish the learning experience.

"When a message is sent to the lecturers it is not answered for a while when immediate answers are necessary."

"The tutorials did not allow you to learn anything as the conversation didn't follow and input from the tutor was minimal and usually late."

"If you have a question [in face to face tuts] it can be answered straight away (instead of one week later). The lecturers are more readily available as they are there in front of you."

"Also this way [face to face] one would be able to get one-one feedback at the same time as the contribution is made, not 4 days later when you have forgotten your original comment."

"The only problem I had with online was that I was unsure whether what I [had] done was correct or not."

Philosophical problems

Although these criticisms were in the minority, that they appeared at all was of interest. Students who made comments of this type felt that information technology, as a means of delivering nursing education, was inappropriate and dehumanising.

"I believe that one gains a lot from interacting face to face with others. If you are a people person (and most people who want to be/are nurses are people oriented) then it is very difficult to get excited about on-line tutorials. I feel some personal interaction is needed in the course."

"I have found the whole unit impersonal. I have felt isolated, lost and up in the air with the whole unit. Has been an added expense I could have done without. I felt I have done two units: (1) Learning the Internet and (2) CAH. If nursing is heading towards electronics, I'm sorry I have chosen Nursing as a career. Nursing is about caring Ö not electronics. It has been time-consuming with little result."

"As we were taught in Discipline Studies in Nursing last year eye contact is one of the most important and effective means of communication."

These fell into four main categories - the issue of access, that of continuity with other subjects, the advantage of electronic learning for people who felt ill at ease in face to face groups, and time management. Some of these outcomes were recognised by students who also commented on the uniqueness of face to face learning; this is also a positive outcome, as students have learnt to recognise that the learning needs of others are not always the same as their own.

"I think I found it easier as I was able to access from home."

"I found the subject fun and it linked with [Perspectives on] Ageing quite well."

"I noticed some of my colleagues who are very quite and never participate in face to face actually said a lot on the electronic tuts"

"A benefit with this system is that there is more input to tutorials by the 'quiet people'!"

"However quiet people (like me!) have the opportunity to have their say when on-line."

"It's good having the subject on line because it gives us more time without having to attend class."

"On-line tutorials were excellent - best part of course as you could still contribute but in your own time."

"Near the end I began to appreciate the fact that I could do the lectures and tutorials whenever I had spare time."

(4) Solutions

Many students took their comments beyond simple critique into a constructive and reflective presentation of possible solutions to perceived problems. That students feel confident in presenting reflective comments in this way is itself a positive learning outcome in a degree course which encourages reflective practice.

Comments fell into three broad categories:

• using electronic learning for distance education

• providing students with a choice of learning mode

• better support.

Using electronic learning for distance education

Some of these were negative, but show an understanding that this form of educational delivery can be beneficial to those who cannot attend university personally.

"Would be very successful for students doing long distance education."

"I don't understand why I have to travel 2 hours to sit in front of a computer and email people who are sitting right next to me."

Would use it again "Only if I was doing it by distance education, e.g. overseas, interstate."

Would not use it again "unless it was the last resort in a circumstance such as long distance education."

"I feel cheated that I drove up to Launceston every week just to sit behind a screen and didn't have the opportunity to interact with the lecturer in a meaningful way."

Providing students with a choice of learning mode

The majority of the responses in the survey's quantitative section on changes and improvements to the course asked for an integration of electronic and face to face methods in the course. This finding is borne out in the qualitative data:

"I think there should be the option for students of whether they wish to do the course electronically or not."

"Maybe it would be OK to have face to face tuts but also make available 1 electronic tut for people who do not normally participate in face to face."

"You should be able to choose to do the course electronically or face to face, like Perspectives on Ageing last semester."

"The way Perspectives on Ageing is run is a lot more beneficial as this way you are forced to learn and achieve more in face to face tutorials."

Better support

This is a difficult area. Most of the Year 2 students (those who study Child and Adolescent Health) have already undergone the Year 1 semester course on computing practice for nursing. Some, however, have not, so it is not possible to rely on blanket preparation for the electronic delivery of the course. One comment below, for example, indicates that the respondent lacked the knowledge of how to increase a font in a browser to make the type easier to read.

Putting the readings on line is an issue which has been considered by the course team, but issues such as copyright tend to stand in the way of effective transition of readings to the WWW. This is an issue which any on-line course must consider - the costs advantages of providing on-line readings for students may have negative counterbalances, in that (as noted above under self-directed learning skills) students may still not read the material.

A Help Book is provided to all students, but support infrastructure is limited to what the University's Information Technology Services staff can provide. Students deserve better support in electronic learning, and this should be considered by any school or faculty planning to undertake any form of electronic course delivery.

"On-line lectures are hopeless as is - font is far too small and it is hard to learn from a written lecture - you need to break up the text with pictures, some audio stimulus etc. I think this is crucial - if not they will need to be taught face to face."

"Readings should definitely be on-line."

"Some education prior to the commencement of the course on e-mail etc. I found that the first two weeks were upon me before I had got my technological get together."

"There was a lack of info all round on on-line course."

The qualitative data presented here produce several solid conclusions. The first is that if electronic learning is to be offered, students need to be given a choice. In 1997, students in Child and Adolescent Health were presented with a choice as to whether they would complete the course on-line or face to face. Those who chose to complete the course electronically experienced far more positive outcomes that the subsequent enrolment, who did not have a choice (Martyr, 1998).

It is understandable that CAH 1998 students found it incongruous that they should attend a tutorial in a computer lab when, the year previously, they could have gone upstairs and attended a face to face tutorial, which they clearly perceived as a better quality learning experience. These comments are borne out in the qualitative data on distance education reported above. The lack of enthusiasm at being 'conscripts' to electronic learning may also explain the largely negative quantitative outcome for 1998 students' perception of their participation in the electronic tutorials. This produced noticeably more negative perceptions for the CAH 1998 cohort.

In the absence of being able to give students a choice, the second most compelling conclusion is that students need, value and appreciate some form of face to face contact in the course of undertaking a unit electronically. This may take the form of two or three study days per semester, which students who are travelling long distances can plan ahead for, and conversely students who find electronic learning more to their taste need not attend the study days unless they wish to. Alternatively, face to face tutorials may prove a solution.

This presupposes that an electronic course would be being offered to students who would conventionally undertake such a course in the traditional face to face mode. For distance education students, however, electronic course delivery is still an excellent option, and one which may open many doors for students otherwise unable to access the university campus. It is perhaps to this end that electronic learning should be directed, rather than as a substitute for conventional undergraduate studies. If it is to be offered to the latter, then a choice should be made available to the students as to whether they will undertake the course in this way or not. The while the short-term outcomes may mean inconvenience for teaching staff, the long-term outcomes may include a student population more willing to use electronic learning once they are in the workplace, and are seeking to improve their qualifications from remote areas.

While the results indicate that younger students are willing to use this form of delivery, there are concerns in that the group who represent the greatest potential market for flexible delivery - mature age, off-campus, or remote area students - are not accessing that delivery. Instead, students who are not perceived as the 'needy' of the electronic teaching world - those who have full access to face-to-face classes and tuition, and are centrally based - are taking up the option. Future profitable studies might include an exploration of the barriers to accessing on-line flexible delivery among mature age and remote or off-campus students.

The move to electronic teaching has had some positive outcomes for the TSON. We now have a reworked computer course for year 1 nursing students, quite a lot of data on student computer knowledge and activity, a better computer lab for nursing students, and better computers for staff. As to whether we have better-educated students overall has not yet emerged from the data. I have carried out some correlations between electronic tutorial activity and grade scored, with the result that those who participated more received higher marks.

What has yet to be done is a practical comparison between those students who receive face to face instruction and those who do a course electronically. This would be difficult to set up, as the groups would have to have the same marker for their work, and a marker who was competent in both face to face and electronic delivery of course material.

Gregor S D; Cuskelly E F. 1992. An investigation of situated learning in distance education through computer mediated communication. In: B Chia, R Pennell, R Sims (eds). 1992. ASCILITE '92: a future promised: proceedings of the 1992 Conference of the Australian Society for Computers in Learning in Tertiary Education, Sydney, Australia. Broadway NSW: Australian Society for Computers in Learning in Tertiary Education (ASCILITE): 290-298.

Martyr, P. 1998. Teaching a Bachelor of Nursing unit on-line: some experiences and results, Australian Electronic Journal of Nursing Education, 3(3). http://www.scu.edu.au/schools/nhcp/aejne/vol3-2/pjmartyrvol3_2.htm

Naidu S; Olsen P; Barrett J. 1994. Design, implementation and evaluation of an electronic teaching-learning environment: results of a pilot study. Open Learning '94: proceedings of the 1st International Conference on Open Learning, 9th-11th November 1994, Brisbane Qld Australia. Brisbane: Queensland Open Learning Network and University of Queensland. Continuing Education.

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