Vol.7, No.2 July 2001
Editorial | Contents
Computer Mediated Communication In Distance Education For Nurses
Refereed Article
(Submitted August 1997)
Stephen Elsom
Lecturer
School of Nursing, Monash University
Phone +61 3 9904 4206; Fax +61 3 9904 4655
Email: Stephen.Elsom@nursing.monash.edu.au
and
Greg Logan
Lecturer
School of Nursing, Monash University
Phone +61 3 9904 4206; Fax +61 3 9904 4655
Abstract
The aim of this paper is to describe the implementation of computer mediated communication (CMC) in the Graduate Diploma of Nursing (Psychiatric Nursing) offered by the School of Nursing at Monash University. The reasons for the introduction of CMC are explained and the costs and benefits of the approach are discussed.
Introduction
The Graduate Diploma of Nursing (Psychiatric Nursing) was originally developed as a Graduate Certificate in Psychiatric Nursing following requests from senior nurse educators and administrators of the Office of Psychiatric Services (Health Department of Victoria) for an education program designed to equip nurses with the skills and knowledge necessary to meet the challenges of professional practice in psychiatric nursing into the next century. External members of the course advisory committee were also concerned that many psychiatric nurses live and work in areas that are geographically isolated, making access to most university courses impracticable. For this reason several options for designing a course which could be accessed by nurses in all areas of Victoria and Australia were investigated.
In 1992, the authors presented a report on the development of a pilot distance education program for psychiatric nurses at the 18th annual convention of the Australian and New Zealand College of Mental Health Nurses (Elsom & Logan, 1992). The overwhelmingly positive response to this presentation provided the impetus for the development of the Graduate Diploma of Nursing (Psychiatric Nursing) for distance education. This project was facilitated by a grant from the Monash Development Fund of approximately $98,000 which enabled the development of four clinical specialist units in psychiatric nursing and the establishment of a computer mediated communication system as an integral component of the course.
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The Challenge of Distance Education
The decision to offer a postgraduate course in psychiatric nursing raised several important questions, the most critical being: How do we facilitate the development of students skills in a profession that is primarily concerned with human interaction, through the mail? In addition, we wanted to ensure that students who were geographically and professionally isolated were able to communicate with each other, with the teaching staff, and with professional psychiatric nurses who would, in a traditional program based in a psychiatric hospital setting, provide neophyte psychiatric nurses with both formal and informal guidance and mentoring during the course of their learning.
In order to address these important issues, several options were considered. The traditional approach in distance education courses which require a practical hands on component has been the incorporation of residential schools. This solution carries with it the obvious benefit of providing opportunities for students to meet with staff and to engage in face-to-face dialogue with other students as well as opportunities for assessment of clinical skills. The negative aspect of this approach, however, is that it is extremely expensive for students to travel to the university (we currently have students in Victoria, New South Wales, Queensland, and Western Australia), to pay for accommodation during the period of the residential school, and to take leave from work commitments. A further shortcoming of this solution is that, apart from the relatively brief period of the residential school, students remain isolated from each other and from teaching staff and other professionals for the majority of their courses. For these reasons this approach was rejected.
Another option that has been widely used in distance education is teleconferencing. This provides the benefit of real time interaction between students and teaching staff but can become very costly in STD telephone calls. It has also been our experience that establishing reliable telephone links and conducting effective teleconferencing sessions with any more than a handful of participants is very problematic. Also the need to schedule teleconferences at times which suit participants from several time zones across the country as well as allowing for other commitments of students and staff (shift work, family, etc) led us to eliminate teleconferencing as a workable solution to our needs.
The final option we considered and eventually adopted was the use of computer mediated communication. In order for CMC to fulfil our requirements we needed a system which was inexpensive, easy to use, and which allowed communication between the students, teaching staff, and clinical specialists on a reliable and effective basis. In seeking such a system we appraised several products. Our decision to adopt a commercially available product was made on the basis of its ease of use and its graphical user interface. We needed a system that was user-friendly enough to allow us to send the software to students (who in many cases had no prior experience of any sort with the use of computers - some had no idea of what a modem was) via the mail. The students then were required to use the system proficiently during the first semester of the Graduate Diploma of Nursing (Psychiatric Nursing) with little, if any, tuition. It is pleasing to report that the system adopted has more than fulfilled these requirements.
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CMC in the Graduate Diploma of Nursing (Psychiatric Nursing)
It is important to note that CMC is not utilised in the Graduate Diploma of Nursing (Psychiatric Nursing) as a substitute for face-to-face interaction between students and experienced clinicians. In order to complete the course, students require access to a qualified and experienced counsellor who acts as a mentor and supervisor during their study of the Counselling subject, and similarly they work with a qualified and experienced psychiatric nurse during the Clinical Practicum subject. In both subjects, the students’ successful completion depends upon a satisfactory assessment of clinical skills by their mentor.
CMC is used in the course to allow the students to communicate with each other, with teaching staff, and with clinical specialists in the field of psychiatric nursing who are able to answer students’ questions and to comment upon their conference contributions. In addition, students submit all written assignments via email and have them returned with corrections via the same means.
CMC is an integral component of the course and, as such, it is not possible for students to complete the psychiatric nursing subjects without using the system. Although the course uses high quality written materials and selected readings as with traditional distance education programs, the students are also required to participate in organised computer conferences which may be likened to classroom tutorials except that these tutorials may include clinical practitioners and other experts from around the world as well as other students and lecturers. Communication is asynchronous. That is, discussion of particular topics occurs in an incremental fashion over a period of hours, days or weeks. Synchronous or real time interaction is possible using the Chat facility. With any more than three students chatting simultaneously, however, this becomes rather clumsy unless strict meeting procedures are established. In practice, the use of real time chatting has been limited to chats between two students who find each other on-line at the same time and between teaching staff and individual students on a one-to-one basis. This has been very useful for sorting out problems and talking through particular procedures such as uploading assignments. For the most part, however, the students use of the CMC system has been for conferencing activities as described above.
In the case of the Foundations of Psychiatric Nursing subject, there are two or three such conference activities in each of the ten sessions which comprise the subject. It can be seen, therefore, that the use of CMC in this course is regarded as an essential component of the teaching/learning process and as such, the course materials had to be written and developed with this in mind. Although CMC could be utilised as an adjunct to existing teaching materials, the resources required to effectively use the system mitigate against such an approach. Wells (1990), in a review of the available literature concerning CMC, found that tacking CMC onto existing course materials negatively impacts on rates of usage and that the success of CMC depends, to a large extent, upon making it so integral to course delivery that students are unable to succeed without using the system.
A further important use of the CMC system has been the submission and return of written assignments. Students send their assignments, which are written using any word-processing program, as file attachments to a specially created conference folder. This conference allows students to send their assignments to it and to see that other students have submitted their assignments. They cannot, however, open or read any of the items in this conference folder. Only the teaching staff have access privileges to read and download the students’ assignments. It is also possible to create special conferences that only certain groups of users can see. For example, a conference for anonymous comments and suggestions has been created that only students and teaching staff can see. Other users, eg. consultants, do not even know that this conference exists. It simply does not appear on their desktops.
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Resource Implications
The CMC system used in the course is a client-server software application. This requires that all students (and other participants) have access to a computer upon which to run the Client application and a modem to connect either directly to the server or to an Internet service provider. The Client software is Public Domain and is provided free of charge to all students. The hardware requirements are minimal. The client software will run on virtually any Apple Macintosh computer from the MacPlus onwards or on any IBM compatible PC with Microsoft Windows installed (386 upwards). A survey commissioned by Monash University’s Distance Education Centre in January 1996 found that 86% of current distance education students had access to a computer for study purposes.
The system requires a dedicated computer to act as the server. This may be either an Apple Macintosh (MacPlus upwards) or an IBM compatible PC running Microsoft Windows NT Server. For the Graduate Diploma of Nursing (Psychiatric Nursing) a Macintosh computer located in the course coordinator’s office is used. Other than the initial costs of setting up the system, the server has been virtually maintenance free. All administration of the system (eg. creating and maintaining user accounts, organising subscriptions to specific computer conferences, determining user privileges and access rights, etc.) has been undertaken by the course teaching staff.
An important consideration for nurse teachers considering the use of CMC systems in their teaching is the resource intensiveness of this type of teaching and whether or not this is justified. The temptation to use new technologies simply because they are available must be tempered by a considered appraisal of their cost effectiveness. The teaching of the Graduate Diploma of Nursing (Psychiatric Nursing) by distance education currently involves approximately 6 to 8 hours per week of academic staff time per subject (with an enrolment of approximately 30 students per subject). During the first two months of the course, the time commitment of academic staff was approximately 12 to 16 hours per week per subject. This was primarily due to the need for considerable tutoring and encouragement for students who were not only being introduced to a completely new specialisation in nursing practice but also to technology with which they had had no prior experience. In the majority of cases these students had also had no prior experience of distance education and this was also the first experience of distance education teaching for the academic staff. It could be predicted that the time commitment of academic staff to the Graduate Diploma of Nursing (Psychiatric Nursing) will decrease in future years as the staff become more familiar with this method of teaching and, as computer technologies become more commonplace, the entry level of students also increases. Notwithstanding these factors, however, the use of CMC requires a considerable degree of academic staff input in comparison to traditional methods of distance teaching and the decision to do so should be a carefully considered one.
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Conclusion
The decision to use CMC in the Graduate Diploma of Nursing (Psychiatric Nursing) was taken after careful consideration of several options for overcoming the difficulty of delivering such a course by distance education. In view of the resource implications of using CMC, it is recommended that any nurse academics contemplating this approach give due regard to all other options including traditional methods of distance teaching.
This paper has provided only a brief overview of the implementation of a computer mediated communication system in distance education for nurses. In future articles, the authors will address in more detail, several important issues including the pedagogical value of CMC, student learner outcomes, system administration, and current technological advances and their potential for further development in nurse education.
List of References
Elsom, S.J. & Logan, G. (1992) "Distance Education for Psychiatric Nurses: a Pilot Program", Proceedings of the 18th annual convention of the Australian College of Mental Health Nurses, Ballarat.Wells, R. A. (1990), Computer-Mediated Communications for Distance Education and Training: Literature Review and International Resources. Paper commissioned by the Army Research Institute, Boise State University, Idaho.
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