Nurse Education in Practice (2006) 6, 12–21
Nurse Education in Practice www.elsevierhealth.com/journals/nepr
Students views of integrating web-based learning technology into the nursing curriculum – A descriptive survey Audrey Adams, Fiona Timmins
*
School of Nursing and Midwifery, Trinity College Dublin, 24 Dolier Street, Dublin 2, Ireland Accepted 13 May 2005
KEYWORDS
Summary This paper describes students’ experiences of a Web-based innovation at one university. This paper reports on the first phase of this development where two Web-based modules were developed. Using a survey approach (n = 44) students’ access to and use of computer technology were explored. Findings revealed that students’ prior use of computers and Internet technologies was higher than previously reported, although use of databases was low. Skills in this area increased during the programme, with a significant rise in database, email, search engine and word processing use. Many specific computer skills were learned during the programme, with high numbers reporting ability to deal adequately with files and folders. Overall, the experience was a positive one for students. While a sense of student isolation was not reported, as many students kept in touch by phone and class attendance continued, some individual students did appear to isolate themselves. This teaching methodology has much to offer in the provision of convenient easy to access programmes that can be easily adapted to the individual lifestyle. However, student support mechanisms need careful consideration for students who are at risk of becoming isolated. Staff also need to supported in the provision of this methodology and face-to-face contact with teachers for some part of the programme is preferable. c 2005 Elsevier Ltd. All rights reserved.
Nursing students; Web-based; Internet; Information technology
Introduction * Corresponding author. Tel: +353 1 6083699. E-mail address:
[email protected].
There has been much attention in the past decade to the use of technology in nursing education with many recent descriptions of web-based learning
1471-5953/$ - see front matter c 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2005.05.005
Students views of integrating web-based learning technology into the nursing curriculum experiences (Calderone, 1994; Mills, 2000; Thiele et al., 1999; Sapnas et al., 2002; Atack and Rankin, 2002a,b; Buckley, 2003; Wilkinson et al., 2004). This innovation in educational delivery methods overcomes traditional barriers to education, and makes education more accessible for registered nurses (Atack and Rankin, 2002a). However, little empirical evidence exists that supports the use of Web-based rather than traditional methods for student learning (Billings, 2000; Buckley, 2003). The impact of programmes on either nursing practice or personal computer skills is little explored (Billings, 2000). As computer skills are increasingly importance in today’s technological age, the enhancement of these skills through Web-based learning media have a potentially valuable contribution to practice (Diekelmann and Schulte, 2000; Atack, 2003). This paper aims to report the findings of a descriptive survey that explores undergraduate nursing students’ learning experience in this area. The supporting literature highlights that computer skills are important for today’s practicing nurse and encouraging these through Web-based learning programmes is important. However, support systems for participants need careful consideration, particularly with regard to improving entry IT skills and preventing isolation during the programme.
Nurses’ IT skills McNeil et al. (2003) suggested that health care delivery increasingly relies on IT for effective decision-making and care delivery. Computer use, in particular Internet and database use, is of great importance in today’s technological environment (Atack, 2003). Familiarity with computer use is necessary for many practical nursing applications. Reporting on a USA national survey (n = 2000) McCannon and O’Neal (2003) found that e-mail usage, operating basic Windows applications, and searching databases were found to be the most crucial aspects of IT skills required by nurses. These skills are also useful for evidence-based practice (Thompson et al., 2001a). However, despite the professed need for these skills, some studies revealed minimal use of Internet and databases by nurses and poor access to computers in the workplace (Thompson et al., 2001a; Estabrooks et al., 2003). In a recent study, Thompson et al. (2001a) demonstrated low use of online databases among nurses, despite their relative accessibility. Thompson et al. (2001) observed that nurses relied mostly on written information sources, such as journal articles, local policies, files, newsletters and books. They also placed a
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higher value on information direct from other individuals. This apparent lack of IT skill is of concern. Estabrooks et al. (2003) revealed similar results. These authors surveyed over 7000 nurses in Canada at two separate time intervals (1996) and (1998), to ascertain their use and access to electronic and other resources. The findings revealed that half of the nurses surveyed in 1998 had access to computers at home, representing an average increase of almost 10% from the 1996 study. Those with reported access to computers at home rose from 58.5% to 66.1%; however, access to computers at work was surprisingly low at 57.8%. Twenty-two percent of the group used email and this figure increased to 28% in 1998, however; again, the work use remained low. In the 1998 survey, they also asked whether nurses used the Internet to look up nursing information and 16% reported that they did so at home, with only 5% doing this at work. This was 9% in 1996 and 13% in 1998. Estabrooks et al. (2003) also compared nurses’ use of computers to householders and physicians in Canada, using national survey data. This comparison revealed that nurses were less likely to use computerised resources, with 78% of physicians reporting using a home computer and half of them using email. Forty-seven percent of physicians reported using the Internet to access bibliography databases whereas only less than 17% of nurses reported this time of usage. Nurses compared favourably to the public of Canada, in that 27% used the Internet at home compared to only 22% usage by the public. However, interestingly, the public had greater access to email at work (23%) compared to the nurses (5%). Estabrooks et al. (2003, p. 80) concluded that nurses were less comfortable with accessing the Internet at work, possibly due to the hands on nature of their work, with the potential to respond to patient needs urgently while on duty. They suggested that nurses ‘‘. . .lag behind others in the workplace use of the internet’’ (sic), citing lack of resources as one possible reason for this. The literature reveals that nurses have ambivalent feelings toward computerised technologies. While databases were useful to staff in Thompson et al.’s (2001) study, the use of this facility was low in clinical practice, unless nurses were involved personally in courses of study. For the most part nursing practice relied on local policies, guidelines, specialist knowledge, and the information available via the Internet placed at a low priority. Estabrooks et al. (2003) commented on this low use of the Internet by practicing nurses; purporting it to be due to the hands on nature of the work, where sitting at the computer, is not crucial to
14 care delivery. Conversely, these authors reported high Internet use among practicing GP’s whose primary concern is also with patient care. However, over reliance on self-reporting of skills via questionnaire may have contributed to an inaccurate picture. Medical students in Seago et al.’s (2002) study appeared to exaggerate their knowledge of database use, which became apparent only on subsequent testing of skills. While it appear that IT skills are a prerequisite of today’s practicing nurse and physician, there appears to be some reticence on the part of nurses to fully adapt to technological innovations. This may be due in part to the nature of nursing work (Estabrooks et al., 2003) or limited access to online resources. Although in Thompson et al.’s (2001a) study these were available but not used. Similarly, Timmons (2003) (UK) noted a resistance by nurses to the implementation and use of computer systems. Estabrooks et al. (2003) suggested that nurses might be trailing behind in this crucial area. However, increasingly, Web-based learning is forming part of many nurse education programmes and this may lead to improvements in nurses’ IT knowledge and usage. The reasons for development are multifarious, however increasing continuing education accessibility (Cragg et al., 2003), and allowing flexible study options (Wilkinson et al., 2004) particularly for those with work and home commitments appear to be popular rationale. IT skills upon entry to these courses are not as high as Seago et al.’s (2002) undergraduate medical students, with recent studies of qualified nurses undertaking study reporting previous Internet usage from 60% to 67% (Atack and Rankin, 2002). Participants often commenced programmes without sufficient skills and spent considerable time during the programme acquiring these (Atack, 2003). This factor, together with nurses’ professed lack of skill in the area or lack of recognition of the importance of these skills does raise an issue about the support required by nurses prior to entering Web-based programmes. While programmes did appear to positively influence skills in this area, prior assessment of skills with adequate support during the course of study may increase the value of these programmes for nurses.
Nurses’ experience of web-based learning While students may have been unprepared from an IT skill perspective, studies revealed positive attitudes by nurses to Web-based learning with improvements in IT skills emerging (Atack and Rankin, 2002a,b; Atack, 2003). Studies revealed that
A. Adams, F. Timmins computer access was mainly performed from the home place, which was convenient, but created an additional financial burden for respondents (Atack and Rankin, 2002a). In addition, many participants found the experience isolating (Atack and Rankin, 2002a). Atack and Rankin (2002a) described nurses’ experiences (n = 57) of a Web-based post-diploma course in Canada. Sixty-seven percent of the group accessed the course from home only with only 8% accessing from work only. Sixty-four percent of the nurses rated their computer skills as beginner level at the start and 67% stated that they were beginner Internet users. There was a significant reported improvement in skills throughout the programme. The Web-based course appeared to offer the group a convenient method of study. Items concerning being able to work on the course at a convenient time and being able to access the course from home both received high mean scores. The respondents also liked ‘‘learning through an online course at home’’. However, items such as time and ‘‘tying up the phone line for modem access’’ emerged as rather less satisfactory (Atack and Rankin, 2002: p. 461). Nurses also reported dissatisfaction with the sense of isolation from peers and teachers, although some of the group reported feeling connected through online discussions. In 2003, Atack further articulated the results of the latter focus group interviews and revealed four emerging themes. The first: Knowledge, skills and comfort level with technology revealed initial frustration by nurses as they struggled to come to terms with computer technology. Some candidates felt technologically ill prepared for the programme having had little prior knowledge of Internet or email use. Many reported that they spent much of their time learning these skills, to the detriment of the course material. Difficulty with technology or accessing a computer also resulted in a high dropout rate from the course (15%). Communication and connection with teacher and peers emerged as another theme. The nurses remarked on the amount and quality of support received from their teachers and peers online. Online and faceto-face dialogue with peers was identified as critical in keeping nurses from withdrawing from the course and fostering learning. However, not all nurses experienced this sense of connection. Two nurses reported they felt isolated as learners at midterm and these feelings persisted through to the end of the course. In another theme, experiences with the learning environment nurses identified several computer access issues that caused several of them not opting to use computers at work as initially planned. Problems identified with
Students views of integrating web-based learning technology into the nursing curriculum this included: computer and Internet availability and location, time constraints and the nature of nursing work. The final theme, home learners’ experiences described the benefits of being able to access their study from home, which reduced the need for additional time off, childminding and long car journeys. Some studies compared student-learning outcomes between Web-based learning programmes and traditional ones. Little overall differences emerged (Frith and Kee, 2003; Buckley, 2003; Bata-Jones and Avery, 2004). Many students reported the experience as a positive one, although negative aspects also emerged. Frith and Kee (2003) (USA) compared the effectiveness of different instructional communication methods in a web-based course on students’ cognitive learning, satisfaction, and motivation to complete the course using an experimental approach (n = 174). The majority (73%) of students used home computers. Nearly 75% of the sample reported their ability to use e-mail as excellent, and 60% reported their ability to use the Internet as excellent. No differences were noted between the motivation and cognitive learning between the groups. However, there was a significant difference reported for student satisfaction with the course. A need for technical support also was identified. Frith and Kee (2003) also caution that web-based learning may not be suitable for all students, and support should be given to students to assist them to give careful consideration to their choice. In the USA, Bata-Jones and Avery (2004) using an experimental approach, evaluated student learning outcomes on an online graduate pharmacology course to. Eighteen students chose to participate in the web-based programme, 52 opted for the usual didactic class. The same instructor taught both courses. Again, there were no significant differences between the students’ scores. However, in congruence with Frith and Kee’s (2003) findings students undertaking the web-based aspect of the programme were very positive about their experience. Similarly, Buckley (2003) (USA) compared the effectiveness of the traditional classroom to web-based delivery of a nutrition course for 58 undergraduate nursing students. Again no differences were found in student examination outcomes. In 2004, Babenko-Mould et al. (USA) used a quasiexperimental research design, to examine the influence of computer conferencing on fourth-year baccalaureate nursing students’ (control group: n = 27; online intervention: n = 15) self-efficacy for computer mediated learning (CML). There were no significant differences noted in self-efficacy at
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the outset and computer conferencing enhanced learning, and students’ self-efficacy for CML increased. Strengths of CML included connection, support, learning and sharing. Challenges involved time and Internet access. Students in Ellenchild Pinch and Graves (2000) study (USA) enjoyed the Web-based discussion (Web-board) and debate that formed part of a teaching strategy for bioethics. The potential for less vocal students to participate was highlighted. However, difficulties noted included fears of technology and dislike of ‘‘feeling based’’ discussion (pp. 709). The researchers highlighted the benefit of discussion boards for clinical nursing topics such as this that require critical thinking development through active discussion and debate. Similarly, McAlpine et al. (2002) described an evaluation of a web-based ethics course in Canada from both a student and teacher perspective. These authors revealed that the students felt that it was easier for normally quiet students to voice their opinions. They reported that they were ‘‘hooked’’ into ‘‘. . .serious contemplation of presented ethical practice issues’’ (pp. 16). Negative issues arose concerning isolation and problems with technology. From the teachers perspective, it was reported that upon reading student evaluations they identified a ‘‘..poignant need for face-to-face contact on the part of a few students. . ..nothing will ever replace a preference for human contact’’ (pp. 17). In these studies that examined student experience there was an overwhelming positive response to the use of Web-based methodologies. While confidence with technologies appeared to increase (Babenko-Mould et al., 2004) there was little overall influence in assessment scores, motivation or learning (Frith and Kee, 2003; Buckley, 2003; Bata-Jones and Avery, 2004). While this approach was noted to be convenient, it was also time consuming and had resource implications. In addition, many students lacked the required basic IT skills at the outset or were deemed unsuited to this type of instruction (Frith and Kee, 2003). One requirement of Web-based courses may be a pre-screening for learning styles and IT skills. Furthermore, many students reported technical difficulties and technical support for these programmes was suggested in one study. Isolation was a recurring theme and Diekelmann and Schulte (2000) suggested that this is an inherent challenge that needs to be addressed in innovative ways: The absence of physical presence (in this case the teacher’s) in distance learning challenges students, teachers and clinicians to create neoteric possibil-
16 ities for nursing education. Distance education may be the place to push the edges of what constitutes schooling, learning, and teaching and to create new pedagogies for the changing instructional landscape as nursing education enters the new millennium. However, many participants in McAlpine et al.’s (2002) valued the continued interaction with the teacher on the programme. In Thompson et al.’s (2001) it was noted that nurses’ preferred information route in the clinical setting was that of personal contact, even in the presence of technology. This aspect of Web-based courses ought to be retained and strengthened to provide support to students.
The study The aim of this paper is to describe students’ experience of a Web-based innovation at one university programme. This programme originated to facilitate admission onto a 1-year part-time Bachelors degree in Nursing (BNS) programme at the University. Those who did not hold a diploma in nursing or equivalent were provided with this additional 1-year part-time programme (Access to Degree Programme) as a pathway to BNS entry. Development of the core content of this programme reflected contemporary trends in nursing practice in addition to theoretical gaps in traditional nurse training programmes. The programme comprised five core modules, the scientific basis of nursing practice, ethics and law, research appreciation, health promotion and professional development in nursing. As there are many potential rurally based candidates in Ireland, it was envisaged that the development of a Web-based Access to degree programme would reduce travelling and attendance demands, which was a source of stress for these students (Nichol and Timmins, 2005). In addition, the advent of all graduate nurse education for Ireland since 2002, meant that the provision of this course was likely to be a short term venture that required delivery to an ever decreasing class size as demand tailored off, thereby necessitating the need to explore responsive, cost effective teaching programmes. The majority of the students were mature learners, in full-time employment, many of which, spent significant amounts of time travelling to campus for study days. The School aimed to offer these people more flexibility and convenience when studying at College. Online content and e-communications supplemented fewer campus-based clas-
A. Adams, F. Timmins ses and allowed students to study at times that are more compatible with their individual home and work commitments. One lecturer within the department, with appropriate knowledge and skills oversaw this project. This role involved leadership of a team of lecturers to develop individual modules and partnership with already established web-based initiatives within the university. This paper reports on the first phase of this development where two modules of the programme were developed and run for one year (on line study skills and ethics). The paper describes student experience of the online aspects of the programme, and their level of computer skills. The aims of the study were: 1. To assess students access to and use of computer technology prior to and after programme commencement. 2. To ascertain whether relationships exist between computer knowledge and other variables such as age, gender and computer use. 3. To ascertain whether relationships exist between Internet usage and other variables such as age, gender and computer use. 4. To access the level of contact that has developed between students.
Methods A thirty-two-item questionnaire containing five open-ended items administered to all students (n = 44) who attended class on day of data collection. This represented 73% of the total class. The response rate was 72.7% (n = 32). Data were analysed using SPSS version 10. The questionnaire, specifically devised for this purpose, drew upon literature on the topic and contained contextual items related to programme development. The internal consistency of items contained in the questionnaire was measured using Cronbachs coefficient Alpha. An acceptable level of consistency between responses is indicated by a result greater than 0.5. The Alpha Coefficient for the questionnaire was .86, which is an acceptable level (Mathers and Huang, 1998). Staff explained questionnaires to students, and participation equalled consent to participate. Participation was entirely voluntary. Researchers emphasised that students could choose not to take part, and that this would not affect their progress on the course. They provided twenty minutes to complete the questionnaire. All questionnaires were anonymous and
Students views of integrating web-based learning technology into the nursing curriculum confidential. Staff destroyed questionnaires were upon completion of the study, and permission to conduct the study was obtained from the course coordinator. A pilot test of the survey was not conducted.
Results Most of the group were female (76.9%, n = 30) two were male. The age group of the cohort varied, with the most of the respondents (66.7%) under the age of thirty-five (Table 1). All of the candidates were aged above 26 years. The most frequently cited age category was 26–30 years, and the median age group was 31–35. Students were also asked the length of time taken to travel to class. The majority of students (87.5%) travelled for less than 3 h, with 59.4% travelling less than hour (Fig. 1). Four students travelled for 3–4 h (12.5%). Seventy-two percent of students reported owning or using a computer prior to commencing the programme. Just over half of the group (56.3%) used this facility for word processing (Table 2).
Age distribution of respondents
20–25 26–30 31–35 36–40 41–45 >45 Total number Missing values
Number of respondents
Percent
0 13 8 6 2 5 30 2
12.8 33.3 20.5 15.4 5.1 12.8 100.0
This usage increased to 90.3% after commencement of the programme and this was statistically significant (Table 2). Usage was mainly reported to be in the home (87.5%) with 37.5% using these services in the workplace. None of the group reported usage in an Internet cafe ´. Only 10.3% of students had experience of computerised database use. This figure rose to 29% after commencing the programme, which was significant (p = 0.005) (Table 2). Computerised spreadsheet use remained unchanged. Both Internet and Email usage were high among the group prior to commencing the programme (Table 2), however a statistically significant rise was noted in the use of email since commencement. 68.8% of respondents had used a search engine prior to commencing and usage increased significantly to 93.8%. Internet usage remained unchanged with 96.9% of the group using Internet Explorer as a browser. Students were asked about the facilities available to them for Internet access. There was a high proportion of missing data and ‘don’t know’ in this category, indicating perhaps lack of knowledge in this area. Students were asked whether they use a modem, ASDL or ISDN line to connect to the Internet (Table 3) 25% of students didn’t know and 6.3% had no response. Similarly, almost most of the group (65.6%) either did not know or did not respond when asked the speed of their modem (Table 4). Knowledge of Internet connection was correlated to computer access (P = 0.004) and Internet use (P = 0.002) prior to commencing the programme. It bore no relationship to either age or gender. Specific student skills were also analysed. Students were asked whether specific areas of computer skills had improved since commencing the programme (Table 5). Most students were proficient at creating and saving a file prior to pro-
70 60 50
Percent
Table 1
40 30 20 10 0 0-1 hours
2-3 hours
3-4 hours
How long does it take you to travel to class?
Figure 1
17
Length of time taken to travel to class.
18 Table 2
A. Adams, F. Timmins Reported frequencies of computer skills prior to and after commencing the Access to Degree Programme
Computer skill
Percentage frequency of reported usage of respondents
Word processing Spreadsheet use Database use Internet use Search engine Email use
Table 3
Prior to programme
After commencing programme
Significance level (Pearson’s correlation coefficient)
56.3% 12.9% 10.3% 84% 71.9% 68.8%
85% 12.9% 29% 84% 93.8% 90.6%
P = 0.019 None P = 0.005 None P = 0.002 P = 0.004
Reported Internet connection use Number of respondents
Percent
If you connect to the Internet/WWW do you use. . . Modem 18 56.3 ASDL line 3 9.4 ISDN line 1 3.1 Don’t know 8 25.0 Missing values 2 6.3 Total
Table 4
32
Reported modem speed Number of respondents
If you use a modem, what speed is it? 28 kbp 0 36 kbp 0 56 kbp 11 Don’t know 8 Missing values 13 Total
100
32
Percent 0 0 34.4 25.0 40.6 100
gramme entry, and knowledge increased overall changes reported in these areas were not statistically significant. Before starting the programme half the class or less, reported being able to move, rename or delete a folder and knowledge of folder use in general was poor. All of these areas reported high increases in numbers of students able to complete the task, which were significant. Students were also asked about their level of student contact. 68.8% of the cohort reported contact with fellow students by telephone between classes; less than half (43.8%) contacted by email contact was reported. Less than half (40%) reported face-to-face contact, and 3.1% of students never made contact. More than half the class (59%) formed study groups independently. There were no significant correlations between level of
contact and gender or age. However, it was noted that those who never contacted classmates at all were also less likely to contact my email or phone and this was significant at the 0.05 levels.
Discussion Consistent with Atack and Rankin’s (2002) findings there was a significant reported improvement in student skills. Reported database use before commencing the programme was low and this concurs with previous findings on the topic (Thompson et al., 2001a). Although there was a much higher work usage of the Internet than reported by Atack and Rankin (2002), this was much less than reported by Estabrooks et al. (2003). Skills in word processing, database, search engine and email use rose significantly. Although it could be argued that the very nature of the programme and its delivery approach as well as the programme outcomes would have produced these findings. There were also many reported significant improvements in specific computer skills. Internet use was high at the outset and remained unchanged. The adoption of these skills satisfies the criteria of todays practicing nurse as described by McCannon and O’Neal (2003). Nurses clearly embraced the IT skills required to complete the course, and didn’t demonstrate any resistance as described by Thompson et al. (2001b) and Timmons (2003). However, it is not uncommon for those attending programmes of study to become more enthusiastic about accessing electronic resources (Thompson et al., 2001b). In complete contradiction to Estabrooks et al.’s (2003) and Atack and Rankin’s (2002) study, initial computer and Internet use was quite high among this group. However, at the outset of the programme specific knowledge related to computer capability, Internet use and access eluded many
Students views of integrating web-based learning technology into the nursing curriculum Table 5
19
Frequency of reported knowledge of specific computer skills since commencing the programme
Specific computer skills
Percentage frequency of reported knowledge of respondents Prior to programme
After commencing programme
Significance level (Pearson’s correlation coefficient)
File usage Create a file Save a file Move a file Rename a file Delete a file
65.6 68.8 28.1 43.8 53.1
90.6 90.6 59.4 75.0 78.1
None None P = 0.002 P = 0.004 P = 0.003
Folder use Create a folder Save a folder Move a folder Delete a folder Rename a folder
50.0 50.0 21.9 37.5 37.5
75.0 71.9 50.0 62.5 59.4
P = 0.001 P < 0.001 P = 0.005 P < 0.001 P < 0.001
of the students. Thus technical support may have benefited these students. In contrast to Atack and Rankin (2002) and McAlpine et al.’s (2002) studies, a sense of isolation from peers did not appear to be problematic as most of the students kept in contact with their peers on the programme. This was mostly by phone, although email was also used. This suggests that although this group were becoming proficient at IT skills and had access to email, their preference remained as in Thompson et al.’s (2001) study, for direct communication with individuals. However, some individuals appeared to isolate themselves from all contact, the impact of which may need further consideration when the department fully integrates the Interactive e-learning resources programme. Although Ellenchild Pinch and Graves (2000) and McAlpine et al. (2002) suggested that web based programmes offer the opportunity for less vocal students to take part in discussions, there is also the possibility that some students will totally disconnect themselves. Isolation from teachers, as reported in Atack and Rankin’s (2002), may have been an issue for some students in this study. However, this was not addressed in the present study. Psychological readiness and learning styles of students may also have affected their willingness to engage with web-based (Frith and Kee, 2003) and this factor also needs consideration for selection of future participants to attend. The factor is taken into account when advertising the programme in national newspapers when the nature of the programme (Web-based) is clearly outlined. Many students reported spending several hours travelling and finding supported the need to con-
tinue to develop distance education facilities within the School. Many of the studies reported benefits to students through the facilitation of home study. However, negative aspects also arose, such as potential for isolation and blocking the home phone line to access the modem. Students’ experiences and benefits from distance Web-based study programmes warrant further investigation. As self-report was the primary source of evidence collected in this study, this limits the authenticity of the findings. Students may have inappropriately estimated their skills in any area as reported by Seago et al. (2002). Furthermore, data were collected at the end of the programme, thus reliant on memory of skills at the outset. As the survey yielded only quantitative data it is likely that views of frustration, expressed by respondents in studies, may have existed but were not captured. In addition, the instrument, although deemed reliable was not subjected to a pilot study prior to use. Participants access to computers in the workplace was not ascertained, and this may be of use when conducting further studies of this nature. Despite these limitations, the findings contribute to the evolving body of knowledge in this area.
Conclusion Recent decades heralded an acceleration and explosion of technology use in health care settings. Practitioners need to have the requisite skills to make the best use of facilities (McNeil et al., 2003; Atack, 2003). Research-based practice is an integral component of nursing practice, and
20 technology forms a crucial component of this, as resources are commonly on the Internet. The integration of interactive e-learning resources into undergraduate programmes creates the context for situational learning of computer skills. Nurse educators perceive anecdotally that students, engaged in meaningful tasks online will, practice and improve their skills. This study supports this notion of increase of skills, with most areas demonstrating significant improvement. In addition, there is a belief that nurses are more reliant upon written and verbal sources rather than technology, and this improvement may encourage these nurses to explore alternative information options in their practice area. This study revealed that nurses have a quite a high usage of computer technology and useful skills have developed throughout the programme. It is envisaged that these students will further use these skills in the practice environment and represent an emergence of nurses that fully embrace all that technology has to offer. Overall, the experience was a positive one for students. There was not a sense of student isolation reported, as many students kept in touch by phone and class attendance continued. Some students did appear, however to isolate themselves and supportive measures for students need further exploration. Although this study yielded positive results, experimental research indicated little overall benefit of Web-based compared with traditional forms of education (Frith and Kee, 2003; Buckley, 2003; Bata-Jones and Avery, 2004). Students did report positive attitudes to this method and increased satisfaction (Frith and Kee, 2003; Buckley, 2003; Bata-Jones and Avery, 2004). This indicates that although academic performance did not improve students seemed to like it. However, there were those that found this methodology less favorable, particularly with regard to the requirement for increased IT skills, the sense of isolation and the personal cost (money and time) (McAlpine et al., 2002). This indicates that further research is required in this area, especially in the UK context to ascertain the benefits and pitfalls of Web-based learning so that lessons may be learned for the future. This teaching methodology has much to offer in the provision of convenient easy to access programmes that can be easily adapted to the individual lifestyle (Atack, 2003). Further evaluation of these methods is essential to ascertain the quality of programmes and highlight any difficulties that emerge. Student support mechanisms need consideration for students who are at risk of becoming isolated, particularly from teachers. Systems need
A. Adams, F. Timmins to be easy to use and technical support needs to be available. In order to ensure that quality programmes are developed that adequately meet student needs it is important that standards are developed that conform to Quality Assurance Guidelines. Appropriate student guidelines are also essential to ensure that students can adequately navigate the system and use system components. Staff development also needs to be considered to prepare academic and administrative staff for supporting students. Individual staff members involved in Web-based learning may need to carry out selfappraisal to identify personal learning needs, as these may vary. In additional, specific generic skills such as managing the Web-based system, developing materials and supporting student discussion board may need to be provided through in service study days.
References Atack, l., 2003. Issues and innovations in nursing education becoming a web-based learner: registered nurses’ experiences. Journal of Advanced Nursing 44 (3), 289–297. Atack, L., Rankin, J., 2002a. A descriptive study of registered nurses’ experiences with web-based learning. Journal of Advanced Nursing 40 (4), 457–465. Atack, L., Rankin, J., 2002b. Nurses’ experiences with Webbased learning. Canadian Nurse 98 (7), 18–22. Babenko-Mould, Y., Andrusyszyn, M.-A., Goldenberg, D., 2004. Effects of Computer-Based Clinical Conferencing on Nursing Students’ Self-Efficacy. Journal of Nursing Education 43 (4), 149–155. Bata-Jones, B., Avery, M.D., 2004. Teaching Pharmacology to Graduate Nursing Students: Evaluation and Comparison of Web-Based and Face-to-Face Methods. Journal of Nursing Education 43 (4), 185–189. Billings, D.M., 2000. A framework for assessing outcomes and practices in Web-based courses in nursing. Journal of Nursing Education 39 (2), 60–67. Buckley, K.M., 2003. Evaluation of classroom-based, Webenhanced, and Web-based distance learning nutrition courses for undergraduate nursing. Journal of Nursing Education 42 (8), 367–370. Calderone, A.B., 1994. Computer assisted instruction: learning, attitude, and modes of instruction. Computers in Nursing 12 (3), 164–170. Cragg, C.E., Edwards, N., Yue, Z., Xin, S.L., Hui, Z.D., 2003. Integrating Web-based technology into distance education for nurses in China: computer and Internet access and attitudes. CIN: Computers, Informatics, Nursing 21 (5), 265– 274. Diekelmann, N., Schulte, H.D., 2000. Technology-based distance education and the absence of physical presence. Journal of Nursing Education 39, 51–52. Ellenchild Pinch, W.J., Graves, J.K., 2000. Using web-based discussion as a teaching strategy: bioethics as an exemplar. Journal of Advanced Nursing 32 (3), 704–712. Estabrooks, C.A., O’Leary, K.A., Ricker, K.L., Humphrey, C.K., 2003. The internet and access to evidence: how are nurses positioned? Journal of Advanced Nursing 42 (1), 73–81.
Students views of integrating web-based learning technology into the nursing curriculum Frith, K.H., Kee, C.C., 2003. The effect of communication on nursing student outcomes in a web-based course. Journal of Nursing Education 42 (8), 350. Mathers, N., Huang, Y.C., 1998. Evaluating methods for collecting data in published research. In: Crookes, P.A., Davies, S. (Eds.), Research into Practice. Balliere Tindall, London. McAlpine, H., Lockerbie, L., Ramsay, D., Beaman, S., 2002. Evaluating a web-based graduate level nursing ethics course: thumbs up or thumbs down? The Journal of Continuing Education in Nursing 33 (1), 12–18. Mills, A.C., 2000. Creating Web-based, multimedia, and interactive courses for distance learning. Compuers in Nursing 18 (3), 125–131. McNeil, B.J., Elfrink, V.L., Bickford, C.J., Pierce, S.T., Beyea, S.C., Averill, C., Klappenbach, C., 2003. Nursing Information Technology Knowledge, Skills, and Preparation of Student Nurses, Nursing Faculty, and Clinicians: A U.S. Survey. Journal of Nursing Education 42 (8), 341–349. McCannon, M., O’Neal, P.V., 2003. Results of a National Survey Indicating Information Technology Skills Needed by Nurses at Time of Entry Into the Work Force. Journal of Nursing Education 42 (8), 337–340. Nichol, H., Timmins, F., 2005. Programme-related stressors among part-time undergraduate nursing students. Journal of Advanced Nursing 50 (1), 93–100.
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Sapnas, K.G., Walsh, S.M., Vilberg, W., Livingstone, P., Asher, M.E., Dlugasch, L., Villanueva, N.E. 2002. Using Web technology in graduate and undergraduate nursing education Computers in Nursing Plus 1,2,1, 3–7. Seago, B.L., Schlesinger, J.B., Hampton, C.L., 2002. Using a decade of data on medical student computer literacy for strategic planning. Journal of the Medical Library Association 90 (2), 202–209. Thompson, C., McCaughan, D., Cullum, N., Sheldon, T., Mulhall, A., Thompson, D.R., 2001a. The accessibility of researchbased knowledge for nurses in United Kingdom acute care settings? Journal of Advanced Nursing 36 (1), 11–22. Thompson, C., McCaughan, D., Cullum, N., Sheldon, T., Mulhall, A., Thompson, D.R., 2001b. Research information in nurses’ clinical decision-making: what is useful? Journal of Advanced Nursing 36 (3), 376–388. Timmons, S., 2003. Nurses resisting information technology. Nursing Inquiry 10 (4), 257–269. Thiele, J.E., Allen, C., Stucky, M., 1999. Effects of Web-based instruction on learning behaviors of undergraduate and graduate students. Nursing Health Care Perspective 20 (4), 199–203. Wilkinson, A., Forbes, A., Bloomfield, J., Fincham Gee, C., 2004. An exploration of four web-based open and flexible learning modules in post-registration nurse education. International Journal of Nursing Studies 41 (4), 411–424.
