Students views of integrating web-based learning technology into the nursing curriculum – A descriptive survey

Nurse Education in Practice (2006) 6, 12–21

Nurse

www.elsevierhealth.com/journals/nepr

Educationin Practice

Students views of integrating web-basedlearning technology into the nursingcurriculum – 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

Summary This paper describes students’ experiences of a Web-based innovationat one university. This paper reports on the first phase of this development wheretwo Web-based modules were developed. Using a survey approach (n = 44) students’access to and use of computer technology were explored. Findings revealed thatstudents’ prior use of computers and Internet technologies was higher than previ-ously reported, although use of databases was low. Skills in this area increased dur-ing the programme, with a significant rise in database, email, search engine andword processing use. Many specific computer skills were learned during the pro-gramme, with high numbers reporting ability to deal adequately with files and fold-ers. Overall, the experience was a positive one for students. While a sense ofstudent isolation was not reported, as many students kept in touch by phone andclass attendance continued, some individual students did appear to isolate them-selves. This teaching methodology has much to offer in the provision of convenienteasy to access programmes that can be easily adapted to the individual lifestyle.However, student support mechanisms need careful consideration for studentswho are at risk of becoming isolated. Staff also need to supported in the provisionof this methodology and face-to-face contact with teachers for some part of theprogramme is preferable.

�c 2005 Elsevier Ltd. All rights reserved.

KEYWORDSNursing students;Web-based;Internet;Information technology

1d
471-5953/$ - see front matter �c 2005 Elsevier Ltd. All rights reseroi:10.1016/j.nepr.2005.05.005
* Corresponding author. Tel: +353 1 6083699.E-mail address: [email protected].

Introduction

There has been much attention in the past decadeto the use of technology in nursing education withmany recent descriptions of web-based learning

ved.

mailto:[email protected]

Students views of integrating web-based learning technology into the nursing curriculum 13

experiences (Calderone, 1994; Mills, 2000; Thieleet al., 1999; Sapnas et al., 2002; Atack and Rankin,2002a,b; Buckley, 2003; Wilkinson et al., 2004).This innovation in educational delivery methodsovercomes traditional barriers to education, andmakes education more accessible for registerednurses (Atack and Rankin, 2002a). However, littleempirical evidence exists that supports the use ofWeb-based rather than traditional methods for stu-dent learning (Billings, 2000; Buckley, 2003). Theimpact of programmes on either nursing practiceor personal computer skills is little explored (Bill-ings, 2000). As computer skills are increasinglyimportance in today’s technological age, theenhancement of these skills through Web-basedlearning media have a potentially valuable contri-bution to practice (Diekelmann and Schulte,2000; Atack, 2003). This paper aims to report thefindings of a descriptive survey that exploresundergraduate nursing students’ learning experi-ence in this area. The supporting literature high-lights that computer skills are important fortoday’s practicing nurse and encouraging thesethrough Web-based learning programmes is impor-tant. However, support systems for participantsneed careful consideration, particularly with re-gard to improving entry IT skills and preventing iso-lation during the programme.

Nurses’ IT skills

McNeil et al. (2003) suggested that health caredelivery increasingly relies on IT for effective deci-sion-making and care delivery. Computer use, inparticular Internet and database use, is of greatimportance in today’s technological environment(Atack, 2003). Familiarity with computer use isnecessary for many practical nursing applications.Reporting on a USA national survey (n = 2000)McCannon and O’Neal (2003) found that e-mailusage, operating basic Windows applications, andsearching databases were found to be the most cru-cial aspects of IT skills required by nurses. Theseskills are also useful for evidence-based practice(Thompson et al., 2001a).

However, despite the professed need for theseskills, some studies revealed minimal use of Inter-net and databases by nurses and poor access tocomputers in the workplace (Thompson et al.,2001a; Estabrooks et al., 2003). In a recent study,Thompson et al. (2001a) demonstrated low use ofonline databases among nurses, despite their rela-tive accessibility. Thompson et al. (2001) observedthat nurses relied mostly on written informationsources, such as journal articles, local policies,files, newsletters and books. They also placed a

higher value on information direct from other indi-viduals. This apparent lack of IT skill is of concern.

Estabrooks et al. (2003) revealed similar results.These authors surveyed over 7000 nurses in Canadaat two separate time intervals (1996) and (1998),to ascertain their use and access to electronicand other resources. The findings revealed thathalf of the nurses surveyed in 1998 had access tocomputers at home, representing an average in-crease of almost 10% from the 1996 study. Thosewith reported access to computers at home rosefrom 58.5% to 66.1%; however, access to comput-ers at work was surprisingly low at 57.8%.Twenty-two percent of the group used email andthis figure increased to 28% in 1998, however;again, the work use remained low.

In the 1998 survey, they also asked whethernurses used the Internet to look up nursing infor-mation and 16% reported that they did so at home,with only 5% doing this at work. This was 9% in 1996and 13% in 1998. Estabrooks et al. (2003) also com-pared nurses’ use of computers to householdersand physicians in Canada, using national surveydata. This comparison revealed that nurses wereless likely to use computerised resources, with78% of physicians reporting using a home computerand half of them using email. Forty-seven percentof physicians reported using the Internet to accessbibliography databases whereas only less than 17%of nurses reported this time of usage. Nurses com-pared favourably to the public of Canada, in that27% used the Internet at home compared to only22% 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 thatnurses were less comfortable with accessing theInternet at work, possibly due to the hands on nat-ure of their work, with the potential to respond topatient needs urgently while on duty. They sug-gested that nurses ‘‘. . .lag behind others in theworkplace use of the internet’’ (sic), citing lackof resources as one possible reason for this.

The literature reveals that nurses have ambiva-lent feelings toward computerised technologies.While databases were useful to staff in Thompsonet al.’s (2001) study, the use of this facility waslow in clinical practice, unless nurses were in-volved personally in courses of study. For the mostpart nursing practice relied on local policies, guide-lines, specialist knowledge, and the informationavailable via the Internet placed at a low priority.Estabrooks et al. (2003) commented on this lowuse of the Internet by practicing nurses; purportingit to be due to the hands on nature of the work,where sitting at the computer, is not crucial to

14 A. Adams, F. Timmins

care delivery. Conversely, these authors reportedhigh Internet use among practicing GP’s whose pri-mary concern is also with patient care. However,over reliance on self-reporting of skills via ques-tionnaire may have contributed to an inaccuratepicture. Medical students in Seago et al.’s (2002)study appeared to exaggerate their knowledge ofdatabase use, which became apparent only on sub-sequent testing of skills.

While it appear that IT skills are a prerequisite oftoday’s practicing nurse and physician, there ap-pears to be some reticence on the part of nursesto fully adapt to technological innovations. Thismay be due in part to the nature of nursing work(Estabrooks et al., 2003) or limited access to onlineresources. Although in Thompson et al.’s (2001a)study these were available but not used. Similarly,Timmons (2003) (UK) noted a resistance by nursesto the implementation and use of computersystems.

Estabrooks et al. (2003) suggested that nursesmight be trailing behind in this crucial area. How-ever, increasingly, Web-based learning is formingpart of many nurse education programmes and thismay lead to improvements in nurses’ IT knowledgeand usage. The reasons for development are multi-farious, however increasing continuing educationaccessibility (Cragg et al., 2003), and allowing flex-ible study options (Wilkinson et al., 2004) particu-larly for those with work and home commitmentsappear to be popular rationale. IT skills upon entryto these courses are not as high as Seago et al.’s(2002) undergraduate medical students, with re-cent studies of qualified nurses undertaking studyreporting previous Internet usage from 60% to 67%(Atack and Rankin, 2002). Participants often com-menced programmes without sufficient skills andspent considerable time during the programmeacquiring these (Atack, 2003). This factor, togetherwith nurses’ professed lack of skill in the area or lackof recognition of the importance of these skills doesraise an issue about the support required by nursesprior to entering Web-based programmes. Whileprogrammes did appear to positively influence skillsin this area, prior assessment of skills with adequatesupport during the course of study may increase thevalue of these programmes for nurses.

Nurses’ experience of web-based learning

While students may have been unprepared from anIT skill perspective, studies revealed positive atti-tudes by nurses to Web-based learning withimprovements in IT skills emerging (Atack and Ran-kin, 2002a,b; Atack, 2003). Studies revealed that

computer access was mainly performed from thehome place, which was convenient, but createdan additional financial burden for respondents(Atack and Rankin, 2002a). In addition, many par-ticipants found the experience isolating (Atackand Rankin, 2002a).

Atack and Rankin (2002a) described nurses’experiences (n = 57) of a Web-based post-diplomacourse in Canada. Sixty-seven percent of the groupaccessed the course from home only with only 8%accessing from work only. Sixty-four percent ofthe nurses rated their computer skills as beginnerlevel at the start and 67% stated that they werebeginner Internet users. There was a significant re-ported improvement in skills throughout the pro-gramme. The Web-based course appeared tooffer the group a convenient method of study.Items concerning being able to work on the courseat a convenient time and being able to access thecourse from home both received high mean scores.The respondents also liked ‘‘learning through anonline course at home’’. However, items such astime and ‘‘tying up the phone line for modem ac-cess’’ emerged as rather less satisfactory (Atackand Rankin, 2002: p. 461). Nurses also reported dis-satisfaction with the sense of isolation from peersand teachers, although some of the group reportedfeeling connected through online discussions.

In 2003, Atack further articulated the results ofthe latter focus group interviews and revealed fouremerging themes. The first: Knowledge, skills andcomfort level with technology revealed initial frus-tration by nurses as they struggled to come toterms with computer technology. Some candidatesfelt technologically ill prepared for the programmehaving had little prior knowledge of Internet oremail use. Many reported that they spent much oftheir time learning these skills, to the detrimentof the course material. Difficulty with technologyor accessing a computer also resulted in a highdropout rate from the course (15%). Communica-tion and connection with teacher and peersemerged as another theme. The nurses remarkedon the amount and quality of support received fromtheir teachers and peers online. Online and face-to-face dialogue with peers was identified as criti-cal in keeping nurses from withdrawing from thecourse and fostering learning. However, not allnurses experienced this sense of connection. Twonurses reported they felt isolated as learners atmidterm and these feelings persisted through tothe end of the course. In another theme, experi-ences with the learning environment nurses identi-fied several computer access issues that causedseveral of them not opting to use computers atwork as initially planned. Problems identified with


this included: computer and Internet availabilityand location, time constraints and the nature ofnursing work. The final theme, home learners’experiences described the benefits of being ableto access their study from home, which reducedthe need for additional time off, childmindingand long car journeys.

Some studies compared student-learning out-comes between Web-based learning programmesand traditional ones. Little overall differencesemerged (Frith and Kee, 2003; Buckley, 2003;Bata-Jones and Avery, 2004). Many students re-ported the experience as a positive one, althoughnegative aspects also emerged. Frith and Kee(2003) (USA) compared the effectiveness of differ-ent instructional communication methods in aweb-based course on students’ cognitive learning,satisfaction, and motivation to complete thecourse using an experimental approach (n = 174).The majority (73%) of students used home comput-ers. Nearly 75% of the sample reported their abilityto use e-mail as excellent, and 60% reported theirability to use the Internet as excellent. No differ-ences were noted between the motivation and cog-nitive learning between the groups. However,there was a significant difference reported for stu-dent satisfaction with the course. A need for tech-nical support also was identified. Frith and Kee(2003) also caution that web-based learning maynot be suitable for all students, and support shouldbe given to students to assist them to give carefulconsideration to their choice.

In the USA, Bata-Jones and Avery (2004) using anexperimental approach, evaluated student learningoutcomes on an online graduate pharmacologycourse to. Eighteen students chose to participatein the web-based programme, 52 opted for theusual didactic class. The same instructor taughtboth courses. Again, there were no significant dif-ferences between the students’ scores. However,in congruence with Frith and Kee’s (2003) findingsstudents undertaking the web-based aspect of theprogramme were very positive about their experi-ence. Similarly, Buckley (2003) (USA) comparedthe effectiveness of the traditional classroom toweb-based delivery of a nutrition course for 58undergraduate nursing students. Again no differ-ences were found in student examinationoutcomes.

In 2004, Babenko-Mould et al. (USA) used a quasi-experimental research design, to examine theinfluence of computer conferencing on fourth-yearbaccalaureate nursing students’ (control group:n = 27; online intervention: n = 15) self-efficacyfor computer mediated learning (CML). There wereno significant differences noted in self-efficacy at

the outset and computer conferencing enhancedlearning, and students’ self-efficacy for CML in-creased. Strengths of CML included connection,support, learning and sharing. Challenges involvedtime 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 ateaching strategy for bioethics. The potential forless vocal students to participate was highlighted.However, difficulties noted included fears of tech-nology and dislike of ‘‘feeling based’’ discussion(pp. 709). The researchers highlighted the benefitof discussion boards for clinical nursing topics suchas this that require critical thinking developmentthrough active discussion and debate.

Similarly, McAlpine et al. (2002) described anevaluation of a web-based ethics course in Canadafrom both a student and teacher perspective.These authors revealed that the students felt thatit was easier for normally quiet students to voicetheir opinions. They reported that they were‘‘hooked’’ into ‘‘. . .serious contemplation of pre-sented ethical practice issues’’ (pp. 16). Negativeissues arose concerning isolation and problems withtechnology. From the teachers perspective, it wasreported that upon reading student evaluationsthey identified a ‘‘..poignant need for face-to-facecontact on the part of a few students. . ..nothingwill ever replace a preference for human contact’’(pp. 17).

In these studies that examined student experi-ence there was an overwhelming positive responseto the use of Web-based methodologies. While con-fidence with technologies appeared to increase(Babenko-Mould et al., 2004) there was little over-all influence in assessment scores, motivation orlearning (Frith and Kee, 2003; Buckley, 2003;Bata-Jones and Avery, 2004). While this approachwas noted to be convenient, it was also time con-suming and had resource implications. In addition,many students lacked the required basic IT skills atthe outset or were deemed unsuited to this type ofinstruction (Frith and Kee, 2003). One requirementof Web-based courses may be a pre-screening forlearning styles and IT skills. Furthermore, manystudents reported technical difficulties and techni-cal support for these programmes was suggested inone study. Isolation was a recurring theme and Die-kelmann and Schulte (2000) suggested that this isan inherent challenge that needs to be addressedin innovative ways:

The absence of physical presence (in this case theteacher’s) in distance learning challenges students,teachers and clinicians to create neoteric possibil-


ities for nursing education. Distance education maybe the place to push the edges of what constitutesschooling, learning, and teaching and to createnew pedagogies for the changing instructionallandscape as nursing education enters the newmillennium.

However, many participants in McAlpine et al.’s(2002) valued the continued interaction with theteacher on the programme. In Thompson et al.’s(2001) it was noted that nurses’ preferred informa-tion route in the clinical setting was that of per-sonal contact, even in the presence oftechnology. This aspect of Web-based coursesought to be retained and strengthened to providesupport to students.

The study

The aim of this paper is to describe students’ expe-rience of a Web-based innovation at one universityprogramme. This programme originated to facili-tate admission onto a 1-year part-time Bachelorsdegree in Nursing (BNS) programme at the Univer-sity. Those who did not hold a diploma in nursingor equivalent were provided with this additional1-year part-time programme (Access to DegreeProgramme) as a pathway to BNS entry.

Development of the core content of this pro-gramme reflected contemporary trends in nursingpractice in addition to theoretical gaps in tradi-tional nurse training programmes. The programmecomprised five core modules, the scientific basisof nursing practice, ethics and law, research appre-ciation, health promotion and professional devel-opment in nursing. As there are many potentialrurally based candidates in Ireland, it was envis-aged that the development of a Web-based Accessto degree programme would reduce travelling andattendance demands, which was a source of stressfor these students (Nichol and Timmins, 2005). Inaddition, the advent of all graduate nurse educa-tion for Ireland since 2002, meant that the provi-sion of this course was likely to be a short termventure that required delivery to an ever decreas-ing class size as demand tailored off, therebynecessitating the need to explore responsive, costeffective teaching programmes.

The majority of the students were mature learn-ers, in full-time employment, many of which, spentsignificant amounts of time travelling to campusfor study days. The School aimed to offer thesepeople more flexibility and convenience whenstudying at College. Online content and e-commu-nications supplemented fewer campus-based clas-

ses and allowed students to study at times thatare more compatible with their individual homeand work commitments.

One lecturer within the department, with appro-priate knowledge and skills oversaw this project.This role involved leadership of a team of lecturersto develop individual modules and partnership withalready established web-based initiatives withinthe university. This paper reports on the first phaseof this development where two modules of the pro-gramme were developed and run for one year (online study skills and ethics). The paper describesstudent experience of the online aspects of theprogramme, and their level of computer skills.The aims of the study were:

1. To assess students access to and use of com-puter technology prior to and after programmecommencement.

2. To ascertain whether relationships existbetween computer knowledge and other vari-ables such as age, gender and computer use.

3. To ascertain whether relationships existbetween Internet usage and other variables suchas age, gender and computer use.

4. To access the level of contact that has devel-oped between students.

Methods

A thirty-two-item questionnaire containing fiveopen-ended items administered to all students(n = 44) who attended class on day of data collec-tion. This represented 73% of the total class. Theresponse rate was 72.7% (n = 32). Data were ana-lysed using SPSS version 10. The questionnaire, spe-cifically devised for this purpose, drew uponliterature on the topic and contained contextualitems related to programme development. Theinternal consistency of items contained in thequestionnaire was measured using Cronbachs co-efficient Alpha. An acceptable level of consistencybetween responses is indicated by a result greaterthan 0.5. The Alpha Coefficient for the question-naire was .86, which is an acceptable level(Mathers and Huang, 1998). Staff explained ques-tionnaires to students, and participation equalledconsent to participate. Participation was entirelyvoluntary. Researchers emphasised that studentscould choose not to take part, and that this wouldnot affect their progress on the course. They pro-vided twenty minutes to complete the question-naire. All questionnaires were anonymous and


confidential. Staff destroyed questionnaires wereupon completion of the study, and permission toconduct the study was obtained from the coursecoordinator. A pilot test of the survey was notconducted.

Results

Most of the group were female (76.9%, n = 30) twowere male. The age group of the cohort varied,with the most of the respondents (66.7%) underthe age of thirty-five (Table 1). All of the candi-dates were aged above 26 years. The most fre-quently cited age category was 26–30 years, andthe median age group was 31–35.

Students were also asked the length of time ta-ken to travel to class. The majority of students(87.5%) travelled for less than 3 h, with 59.4% trav-elling less than hour (Fig. 1). Four students trav-elled for 3–4 h (12.5%).

Seventy-two percent of students reported own-ing or using a computer prior to commencing theprogramme. Just over half of the group (56.3%)used this facility for word processing (Table 2).

Table 1 Age distribution of respondents

Number of respondents Percent

20–25 0 12.826–30 13 33.331–35 8 20.536–40 6 15.441–45 2 5.1>45 5 12.8Total number 30 100.0Missing values 2

How long does it ta

2-30-1 hours

Per

cent

70

60

50

40

30

20

10

0

Figure 1 Length of time t

This usage increased to 90.3% after commence-ment of the programme and this was statisticallysignificant (Table 2). Usage was mainly reportedto be in the home (87.5%) with 37.5% using theseservices in the workplace. None of the group re-ported usage in an Internet cafe.

Only 10.3% of students had experience of com-puterised database use. This figure rose to 29% aftercommencing the programme, which was significant(p = 0.005) (Table 2). Computerised spreadsheetuse remained unchanged. Both Internet and Emailusage were high among the group prior to com-mencing the programme (Table 2), however a sta-tistically significant rise was noted in the use ofemail since commencement. 68.8% of respondentshad used a search engine prior to commencing andusage increased significantly to 93.8%. Internetusage remained unchanged with 96.9% of the groupusing Internet Explorer as a browser.

Students were asked about the facilities avail-able to them for Internet access. There was a highproportion of missing data and ‘don’t know’ in thiscategory, indicating perhaps lack of knowledge inthis area. Students were asked whether they use amodem, ASDL or ISDN line to connect to the Internet(Table 3) 25% of students didn’t know and 6.3% hadno response. Similarly, almost most of the group(65.6%) either did not know or did not respond whenasked the speed of their modem (Table 4). Knowl-edge of Internet connection was correlated to com-puter access (P = 0.004) and Internet use (P = 0.002)prior to commencing the programme. It bore norelationship to either age or gender.

Specific student skills were also analysed. Stu-dents were asked whether specific areas of com-puter skills had improved since commencing theprogramme (Table 5). Most students were profi-cient at creating and saving a file prior to pro-

ke you to travel to class?

3-4 hours hours

aken to travel to class.

Table 2 Reported frequencies of computer skills prior to and after commencing the Access to Degree Programme

Computer skill Percentage frequency of reported usage of respondents

Prior toprogramme

After commencingprogramme

Significance level(Pearson’s correlationcoefficient)

Word processing 56.3% 85% P = 0.019Spreadsheet use 12.9% 12.9% NoneDatabase use 10.3% 29% P = 0.005Internet use 84% 84% NoneSearch engine 71.9% 93.8% P = 0.002Email use 68.8% 90.6% P = 0.004

Table 3 Reported Internet connection use


If you connect to the Internet/WWW do you use. . .Modem 18 56.3ASDL line 3 9.4ISDN line 1 3.1Don’t know 8 25.0Missing values 2 6.3

Total 32 100

Table 4 Reported modem speed


If you use a modem, what speed is it?28 kbp 0 036 kbp 0 056 kbp 11 34.4Don’t know 8 25.0Missing values 13 40.6

Total 32 100


gramme entry, and knowledge increased overallchanges reported in these areas were not statisti-cally significant. Before starting the programmehalf the class or less, reported being able to move,rename or delete a folder and knowledge of folderuse in general was poor. All of these areas reportedhigh increases in numbers of students able to com-plete the task, which were significant.

Students were also asked about their level ofstudent contact. 68.8% of the cohort reported con-tact with fellow students by telephone betweenclasses; less than half (43.8%) contacted by emailcontact was reported. Less than half (40%) re-ported face-to-face contact, and 3.1% of studentsnever made contact. More than half the class(59%) formed study groups independently. Therewere no significant correlations between level of

contact and gender or age. However, it was notedthat those who never contacted classmates at allwere also less likely to contact my email or phoneand this was significant at the 0.05 levels.

Discussion

Consistent with Atack and Rankin’s (2002) findingsthere was a significant reported improvement instudent skills. Reported database use before com-mencing the programme was low and this concurswith previous findings on the topic (Thompson etal., 2001a). Although there was a much higher workusage of the Internet than reported by Atack andRankin (2002), this was much less than reportedby Estabrooks et al. (2003). Skills in word process-ing, database, search engine and email use rosesignificantly. Although it could be argued that thevery nature of the programme and its delivery ap-proach as well as the programme outcomes wouldhave produced these findings. There were alsomany reported significant improvements in specificcomputer skills. Internet use was high at the outsetand remained unchanged. The adoption of theseskills satisfies the criteria of todays practicingnurse as described by McCannon and O’Neal(2003). Nurses clearly embraced the IT skills re-quired to complete the course, and didn’t demon-strate any resistance as described by Thompsonet al. (2001b) and Timmons (2003). However, it isnot uncommon for those attending programmesof study to become more enthusiastic aboutaccessing electronic resources (Thompson et al.,2001b).

In complete contradiction to Estabrooks et al.’s(2003) and Atack and Rankin’s (2002) study, initialcomputer and Internet use was quite high amongthis group. However, at the outset of the pro-gramme specific knowledge related to computercapability, Internet use and access eluded many

Table 5 Frequency of reported knowledge of specific computer skills since commencing the programme

Specific computer skills Percentage frequency of reported knowledge of respondents

Prior toprogramme

After commencingprogramme

Significance level(Pearson’s correlationcoefficient)

File usageCreate a file 65.6 90.6 NoneSave a file 68.8 90.6 NoneMove a file 28.1 59.4 P = 0.002Rename a file 43.8 75.0 P = 0.004Delete a file 53.1 78.1 P = 0.003

Folder useCreate a folder 50.0 75.0 P = 0.001Save a folder 50.0 71.9 P < 0.001Move a folder 21.9 50.0 P = 0.005Delete a folder 37.5 62.5 P < 0.001Rename a folder 37.5 59.4 P < 0.001


of the students. Thus technical support may havebenefited these students.

In contrast to Atack and Rankin (2002) and McAl-pine et al.’s (2002) studies, a sense of isolationfrom peers did not appear to be problematic asmost of the students kept in contact with theirpeers on the programme. This was mostly byphone, although email was also used. This suggeststhat although this group were becoming proficientat IT skills and had access to email, their prefer-ence remained as in Thompson et al.’s (2001)study, for direct communication with individuals.However, some individuals appeared to isolatethemselves from all contact, the impact of whichmay need further consideration when the depart-ment fully integrates the Interactive e-learning re-sources programme. Although Ellenchild Pinch andGraves (2000) and McAlpine et al. (2002) suggestedthat web based programmes offer the opportunityfor less vocal students to take part in discussions,there is also the possibility that some students willtotally disconnect themselves. Isolation fromteachers, as reported in Atack and Rankin’s(2002), may have been an issue for some studentsin this study. However, this was not addressed inthe present study. Psychological readiness andlearning styles of students may also have affectedtheir willingness to engage with web-based (Frithand Kee, 2003) and this factor also needs consider-ation for selection of future participants to attend.The factor is taken into account when advertisingthe programme in national newspapers when thenature of the programme (Web-based) is clearlyoutlined.

Many students reported spending several hourstravelling and finding supported the need to con-

tinue to develop distance education facilities with-in the School. Many of the studies reported benefitsto students through the facilitation of home study.However, negative aspects also arose, such as po-tential for isolation and blocking the home phoneline to access the modem. Students’ experiencesand benefits from distance Web-based study pro-grammes warrant further investigation.

As self-report was the primary source of evi-dence collected in this study, this limits theauthenticity of the findings. Students may haveinappropriately estimated their skills in any areaas 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. Asthe survey yielded only quantitative data it is likelythat views of frustration, expressed by respondentsin studies, may have existed but were not cap-tured. In addition, the instrument, althoughdeemed reliable was not subjected to a pilot studyprior to use. Participants access to computers inthe workplace was not ascertained, and this maybe of use when conducting further studies of thisnature. Despite these limitations, the findings con-tribute to the evolving body of knowledge in thisarea.

Conclusion

Recent decades heralded an acceleration andexplosion of technology use in health care settings.Practitioners need to have the requisite skills tomake the best use of facilities (McNeil et al.,2003; Atack, 2003). Research-based practice isan integral component of nursing practice, and


technology forms a crucial component of this, asresources are commonly on the Internet. The inte-gration of interactive e-learning resources intoundergraduate programmes creates the contextfor situational learning of computer skills. Nurseeducators perceive anecdotally that students, en-gaged in meaningful tasks online will, practiceand improve their skills. This study supports thisnotion of increase of skills, with most areas demon-strating significant improvement. In addition, thereis a belief that nurses are more reliant upon writtenand verbal sources rather than technology, and thisimprovement may encourage these nurses to ex-plore alternative information options in their prac-tice area.

This study revealed that nurses have a quite ahigh usage of computer technology and useful skillshave developed throughout the programme. It isenvisaged that these students will further use theseskills in the practice environment and represent anemergence of nurses that fully embrace all thattechnology has to offer. Overall, the experiencewas a positive one for students. There was not asense of student isolation reported, as many stu-dents kept in touch by phone and class attendancecontinued. Some students did appear, however toisolate themselves and supportive measures forstudents need further exploration.

Although this study yielded positive results,experimental research indicated little overall ben-efit of Web-based compared with traditional formsof education (Frith and Kee, 2003; Buckley, 2003;Bata-Jones and Avery, 2004). Students did reportpositive attitudes to this method and increasedsatisfaction (Frith and Kee, 2003; Buckley, 2003;Bata-Jones and Avery, 2004). This indicates thatalthough academic performance did not improvestudents seemed to like it. However, there werethose that found this methodology less favorable,particularly with regard to the requirement for in-creased IT skills, the sense of isolation and thepersonal cost (money and time) (McAlpine et al.,2002). This indicates that further research is re-quired in this area, especially in the UK contextto ascertain the benefits and pitfalls of Web-basedlearning so that lessons may be learned for thefuture.

This teaching methodology has much to offer inthe provision of convenient easy to access pro-grammes that can be easily adapted to the individ-ual lifestyle (Atack, 2003). Further evaluation ofthese methods is essential to ascertain the qualityof programmes and highlight any difficulties thatemerge. Student support mechanisms need consid-eration for students who are at risk of becomingisolated, particularly from teachers. Systems need

to be easy to use and technical support needs to beavailable. In order to ensure that quality pro-grammes are developed that adequately meet stu-dent needs it is important that standards aredeveloped that conform to Quality AssuranceGuidelines. Appropriate student guidelines are alsoessential to ensure that students can adequatelynavigate the system and use system components.Staff development also needs to be considered toprepare academic and administrative staff for sup-porting students. Individual staff members involvedin Web-based learning may need to carry out self-appraisal to identify personal learning needs, asthese may vary. In additional, specific generic skillssuch as managing the Web-based system, develop-ing materials and supporting student discussionboard may need to be provided through in servicestudy days.

References

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Documents

Students views of integrating web-based learning technology into the nursing curriculum – A descriptive survey