As healthcare becomes more knowledge intensive, nurses are challenged to effectively manage clinical information and keep abreast of professional knowledge (Procter 2001; Snyder - Halpern et al 2001; Pare & Elam 1998). Rapid

proliferation of new knowledge, expanding professional practice expectations and changing practice environments require that nurses become lifelong learners capable of constantly reflecting on and modifying their practice. Nurse education needs to embrace and make use of information

technology learning media to help nurses meet these demands. This paper considers how post registration nursing students responded to a technology based learning package directed at enhancing mental health skills and care management. At the completion of the course the participants completed a module evaluation. Representative participants comments are presented throughout this paper to highlight issues raised within the literature on technology based learning

Hurley, J.

Linsley, P.

English

University of Lincoln Institutional Repository

ITIN                                           Volume 15  Issue 4  December 2003                                       16BACKGROUNDAs healthcare becomes more knowledge intensive,nurses are challenged to effectively manageclinical information and keep abreast ofprofessional knowledge (Procter 2001; Snyder –Halpern et al 2001; Pare & Elam 1998). Rapidproliferation of new knowledge, expandingprofessional practice expectations and changingpractice environments require that nurses becomelifelong learners capable of constantly reflecting onand modifying their practice. Nurse educationneeds to embrace and make use of informationtechnology learning media to help nurses meetthese demands. This paper considers how postregistration nursing students responded to atechnology based learning package directed atenhancing mental health skills and caremanagement. At the completion of the course theparticipants completed a module evaluation.Representative participants comments arepresented throughout this paper to highlight issuesraised within the literature on technology basedlearning.AIMThrough highlighting the nurse educationalchallenge of teaching humanistic skills from a‘cold’ technology source, this paper seeks topromote the vital importance of developing learningtechnology so that adult learning principles arereflected. This paper also seeks to demonstratethat the educational strategy of using technologybased learning in a nursing programme can reflectthe principles underpinning the nurse clientrelationship. Through drawing on a range ofliterature this paper also seeks to highlight theadvantages and disadvantages of adoptingtechnology based learning packages and the impactthis has upon the role of the nurse tutor.Education strategies need to focus on the long-term development of an information culture, andnot as in the past, on short-term training designedsimply to get people using computer andinformation systems (Ballard 2001). In turn, thesetraining strategies should be fully integrated andco-ordinated with organisational and mainstreameducational programmes of learning. TheUniversity of Nottingham School of Nursing runs apost registration module in acute mental healthcare designed to enhance the skills and practicesof healthcare professionals working in the acute in-patient care setting. This is achieved by developingknowledge and awareness of best practice withinthe field of acute adult mental health. The moduleis run at degree level over a twelve-week periodcombining Technology Based Teaching andLearning (TBTL) methods that include reviewingon-line material, group discussion (via a chat room)and six directed web/CD ROM study days.This mode of delivery challenges to achieve theflexibility to meet the needs of a variety of studentsat different stages of their personal andprofessional development while equally, promotinghumanistic nursing skills and attributes from atechnology base. At present, learning applicationstend to be sealed micro-worlds with littleintegration into the real world (DOH 2001). Thesetend to follow a similar pattern of design for atutorial/narrative with questions of comprehensionplaced either during or at the end of each session.These learning applications can have inbuiltnotebooks, reference materials, calculations andfinal tests. The primary learning activity tends to bethe consumption of the content for the purpose ofregurgitation during the final test. The module hastried to steer clear of this type of approach and hassought a greater interaction with the studentthrough the available technological applications.While rote learning and memorisation may have aplace within the learning process, overwhelminglylearning is not something that is external to thelearner nor is it solely a practice of graftingknowledge and understanding onto a learner(Robotham 1999). Rather learning is ideally afunction of understanding, thinking actively aboutmaterials, their structure and relationships(Entwistle 1998). Students undertaking the postregistration module were encouraged to developtheir own interpretation of information throughinteractivity and hence construct their ownWeb learning in post registrationnurse education: application andtheory. A practical experience ofcombining humanistic, educationaland technological considerations.Peer reviewed research paperLinsley, P & Hurley, J., Health LecturersUniversity of NottinghamITIN                                           Volume 15  Issue 4  December 2003                                       17meaning. These learning principles reflect theneeds of most adult learners who are self-directive, relatively independent and need to focustheir learning on individual life issues (Goodsir1978). Consequently, adult nurse learning becomesan experiential approach to individualisedchallenges that subsequently allow the learner toautonomously pursue relevant learning. Personalautonomy subsequently becomes both part of thenurse-directed learning process and a desired goalof the process (Kreber 1998). This capacity forpersonal autonomy also represents a significantclient centred goal within the therapeuticrelationship, a goal made more attainable by thenurse having their own capacity for autonomy(Clarkson 1989). Technology based learning can beshown here as supporting humanistic aspects ofnurse education through the process of allowingnursing students the freedom to access, processand reflect upon information when and how theychoose, dependent upon their adult needs at thattime.Participant 1 ‘The work is up to you to do, you learn morewhen you have to find the information yourselfrather than being spoon-fed’.It is not enough to think that the ‘navigation’ itselfwill give the learner control and that this willautomatically translate into intrinsic motivation andempowerment (Salmon 2003). Learnersundertaking the post registration course wereencouraged to engage in learning activities with theintention of understanding or seeking meaning, andnot memorisation as the focus or objective of theirlearning. Nursing requires both instrumental andcommunicative learning to encompass the taskorientated and critically reflective components ofeffective clinical nursing (Chase 1997).Communicative learning utilises speech, art andwriting to promote an understanding of themeaning of ideals and values of others (Mezirow1996). Incorporating web-based communication tofacilitate rational discourse, central tocommunicative learning, not only offers anothercommunication modality but also a modality thatexports discourse from local geographical confinesinto vast pools of informed, rational and reflectiveprofessional others.Participant 2‘Guided study format was supportive of active yetcomprehensive learning’.Research has shown that the learning approachreflects learning outcomes (Entwistle andRamsden, 1983; Watkins, 1983).  Memorisation,learning information that can be reproduced, isassociated with poor learning outcomes whereasstudents that are engaged with the intention ofunderstanding or seeking meaning are associatedwith higher quality learning outcomes.The simple transfer of text or other learningmaterial into hypertext/hypermedia has no use asthe primacy of the learning experience, as it onlyallows the user to follow predefined pathways anddoes not take full advantage of the technologicalplatform; it is merely repackaging (Diller, 1995).Students need to do more than access or look forinformation as the primacy of their learningexperience, but should be enabled to examine,perceive, interpret and experience information(Brookfield 1987). Interactive media only provideopportunities for users to learn to visualise andunderstand complex relationships in ways that arenot possible in other media. One possible solutionto this might be to change the primacy of thelearning experience to heuristic activities thattrigger and encourage the student to seek meaningby accessing various disparate media andinformational resources (Koppi & Chaloupka,1997).Participant 3‘Encouraged me to access relevant information viathe internet, an area I hadn’t really explored’.The ability to adapt a computer system to meet theneeds of all its users whilst delivering the essentialinformation to support the nurse in practice mustbe one of the fundamental aspects of healthinformation technology (Anderson et al., 1995).Ideally, nurses should be able to engage withcomputers as a component of their work anddevelop their own interpretations of the informationprovided by computers in order to construct theirown meaning of that information for use in clinicalpractice (Drazen et al., 1995). To this endcomputers should be seen as an integral part of,and not something separate from, clinical practiceif they are to make a worthwhile contribution to thework of those that use them (Button, 1993; Lorenziand Riley, 1995).Participant 4‘Very relevant to practice, encouraged practicetheory link’.ITIN                                           Volume 15  Issue 4  December 2003                                       18Web based learning also impacts upon the role ofthe nurse tutor (Taylor 1995). The demands ofhaving technological expertise and utilisation skillsdiverts teacher roles away from the imparting ofknowledge toward managing knowledge andpromoting conceptual discourse, a shift alreadyinfluenced by increasing nursing student numbers(Johnson 1992). Educators are required to produceresources, printed course material and computergenerated materials suitable for a wide variety oflearners whilst also providing opportunities forlearners and courses that require socialinteractivity to promote learning (Taylor 1995).Tutor‘ It was false to think that E learning would reducemy workload. A great deal of thought had to begiven not only to the materials that I used but moreimportantly how these materials would bepresented. I had to learn the additional skills ofhow to produce a web site and how to encouragestudent interactivity while ensuring that individuallearning needs were not lost. The wholeexperience required me to undergo a change in myown approach to teaching’. While professional peer support can be readilyavailable for most problems arising from traditionalclassroom teaching, this resource pool diminisheswhen technological expertise is a requirement.Support is also required from the administration inthe form of assistance from technicians, budgetallocations and workload redistribution (Link &Scholtz 2000). Potential advantages to this rolechange exist in the change of relationship betweenstudent and tutor. Adult learning requires areduction of the power differential between tutorand student (Mezirow 1996). Removing the tutorfrom the front of the classroom and into a sharedcommunication modality is a demonstrativestrategy to address the power differential. This re-balancing of a power differential also reflects thenursing curriculum and nursing practice whereissues of equal partnership between nurse andservice users are central. In this respect the use ofinformation technology to diminish the teacherlearner differential also reflects what is beingsought in the nurse –client relationship. While students reported positive aspects onlearning through a technology base a balancedappraisal of this modality is required. Advantagesof students being able to the turn the tutor on oroff, avoiding travel and parking cost or increasingaccess and life quality to students with disabilitiesare secondary to ensuring learners are internalisingthe structure and relationship of the presentedmaterials (Burgstahler 1997). Students who arestruggling or unmotivated are not easily detectedand the technology medium can be experienced ascold or unemotive  (Christianson, Tiene & Luft2002). These educational concerns are offset byhow technology based learning can enhance thejoining of practice and theory with an entire intakegroup being able to communicate with tutors whilston placement rather than waiting for a campusbased practice based learning day. The non-–threatening environment to discuss ideas andengage in discourse also makes this learningmedium a powerful consideration in promotinggroup reflective practice. (Platzer, Blake &Ashford 2000). Organisational considerations suchas the presumed savings associated with computerbased learning and the reduced need for valuableclassroom space are balanced with initial highcosts in equipment and training tutors who are stillrequired to provide guidance to students (Malloy &DeNatale 2001).CONCLUSIONThe matrix of educational, organisational andprofessional considerations makes the use oftechnology in nurse education both exciting andpotentially non-beneficial.  Pivotal is the applicationof adult deep learning principles to the technologyrather than the technology dictating what is taughtand how it is taught. With this overarching educa-tional approach in place tutors are then challengedto use the technology so that the themes of thecurriculum and the nursing profession are seen asbeing congruent. Health and education organisa-tions must then act in partnership to ensure thetechnological and human resourcing of the technol-ogy learning project is in place. With these essentialcriteria met the educational and professionaladvantages of embracing technology-based learn-ing can be captured and utilised by nurses withintheir daily practice.Reference listAnderson, J.G., Aydin, C. & Jay, S.J. (1995),‘Evaluating Health Care Information  Systems’,Sage, London.Ballard, E. (2001) ‘Taking control of information’,Nursing Management.  8(2), 10-15.ITIN                                           Volume 15  Issue 4  December 2003                                       19Brookfield, S.D., (1987). ‘Developing criticalthinkers: Challenging adults to explorealternative ways of thinking and acting’.Jossey-Bass, San FranciscoBurgstahler, S. (1997),’Teaching on the Net:What’s the difference?, Technological  Horizonsin Education Journal, April, pp.61-64.Button, G., (Ed), (1993), ‘ Technology in workingorder. Studies of work, interaction, andtechnology’, Routledge, London.Chase, S.K. (1997), ‘Charting critical thinking:Nursing judgements and patient outcomes’.Dimensions of Critical Care Nursing, 16(2), 102-111.Christianson, L, Tiene, D, &  Luft, P, (2002), ‘Web-based Teaching in Undergraduate NursingPrograms’ Nurse Educator, Volume 27(6), pp 276-282.Clarkson, P (1989), Gestalt Counselling inAction, Sage publications, London.Department of Health (2001), ‘Building theinformation Core- Implementing the NHS Plan’,Department of Health Publishing, London.Diller, B. (1995) , ‘Don’t repackage –redefine’.[Available] www.Hotwired.com.Drazen, E.L., Metzger, J.B., Ritter, J. L. &Schneider, M.K. (1995), ‘Patient careinformation systems; Successful Design andImplementation’, Springer, New York.Entwistle, N. J. (1998), ‘Improving teachingthrough research on student learning’. In JJFForest (Ed) University teaching: InternationalPerspectives. (p 73-112), Garland, New York.Entwistle, N & Ramsden, P. (1983),‘Understanding Student Learning’. Croom HelmLondon.Goodsir, W.W. (1978), ‘Knowles term“Andragogy” and its implications for adulteducation’. Australian Journal of AdultEducation, vol. 18, pp. 10-18.Koppi, A. & Chaloupka, M. (1997). ‘Heuristiccontextual action works best’,ASCILITE, 1997.Kreber, C. (1998), ‘ The relationship between self-directed learning, critical thinking, andpsychological type, and some implications forteaching in higher education’, Studies In HigherEducation, vol. 23 pp. 71-87.Link, DG & Scholtz, S, (2000), ‘EducationalTechnology and the Faculty Role: What You Don’tKnow Can Hurt You ‘ Nurse Educator, Vol. 26(6), pp. 274-276Lorenzi, N.M.& Riley, R.T. (1995),‘Organizational Aspects of Health careInformatics; managing Technological Change’,5th ed. Macmillian, New York.Johnson, R. (1992), ‘Open learning: Unseenissues’, Australian Training Review, Aug/Sept/Oct, pp. 5-7.Malloy, SE. & DeNatale, ML, (2001), ‘OnlineCritical Thinking: A Case  Study Analysis’, NurseEducator, Vol. 26(4), pp. 191-197Mezirow, J. (1996), ‘Contemporary paradigms oflearning’, Adult Education Quarterly, vol. 46, no.3, pp. 158-72.Pare, G & Elam, J. J. (1998), ‘Introducinginformation technology in the clinicalsetting’.International Journal of TechnologyAssessment in Health Care, 14(2) 331-343.Platzer, H., Blake, D. & Ashford, D. (2000),‘Barriers to learning from reflection: a  study ofthe use of groupwork with post-registrationnurses’, Journal of Advanced Nursing, vol. 31,pp. 1001-1008.Procter, P. M (2001), ‘Information andcommunications technology: Nursing’s future role’.Japanese Journal of Nursing Research, 34(3)73-80.Robotham, D. (1999), ‘The Application oflearning style theory in higher educationteaching’, University of Wolverhampton.Salmon, G. (2003), ‘Bang on the door…’, Newtechnologies and E-Learning, NottinghamUniversity School of Nursing Conference, July 1st2003.Snyder-Halpern, R., Corcoran-Perry., & Narayan,S. (2001), ‘Developing Clinical  PracticeEnvironments: Supporting the Knowledge Work ofNurses’. Computers in Nursing. 19(1), 45-52.Taylor, J.C. (1995),’ Distance educationtechnologies: The fourth generation’,  AustralianJournal of Educational Technology, vol. 11, no.2, pp. 1-7.Watkins, D.A., (1983), ‘Depth of processing andthe quality of learning outcomes’, InstructionalScience, 12, 49-58.

Web learning in post registration nurse education: application and theory. A practical experience of combining humanistic, educational and technological considerations

As healthcare becomes more knowledge intensive, nurses are challenged to effectively manage clinical information and keep abreast of professional knowledge (Procter 2001; Snyder – Halpern et al 2001; Pare & Elam 1998). Rapid proliferation of new knowledge, expanding professional practice expectations and changing practice environments require that nurses become lifelong learners capable of constantly reflecting on and modifying their practice. Nurse education needs to embrace and make use of information technology learning media to help nurses meet these demands. This paper considers how post registration nursing students responded to a technology based learning package directed at enhancing mental health skills and care management. At the completion of the course the participants completed a module evaluation. Representative participants comments are presented throughout this paper to highlight issues raised within the literature on technology based learning

Linsley, Paul

Hurley, John

ePublications@SCU

University of East Anglia digital repository

Web learning in post registration nurse education: application and theory:A practical experience of combining humanistic, educational and technological considerations

Web learning in post registration nurse education: application and theory. A practical experience of combining humanistic, educational and technological considerations

Abstract

Similar works

Full text

Available Versions

University of Lincoln Institutional Repository

ePublications@SCU

University of East Anglia digital repository