VOL. 15, No. 1, 1-20
This article describes women's experiences using print-based and multimedia CD-ROM technology to deliver a nursing course to registered nurses from communities across Nova Scotia enrolled in a distance education BScN program. Five focus group interviews (3 CD-ROM groups and 2 print-based groups) were conducted to identify the learning needs, concerns, and experiences of women as working nurses related to these approaches. Participants' descriptions of their experiences as adult distant learners using print-based and CD-ROM technology to learn nursing provide rich data that can help shape course delivery and development policies. Six major themes emerge as descriptive of the women's experiences. The study outlines six principles to guide the selection and use of media in distance education and recommends the integration of CD-ROM and print-based technologies together as an effective delivery strategy rather than exclusively one or the other.
Cet article décrit les expériences de femmes qui utilisent une technologie combinant l'imprimé et le CD-ROM multimédia, dans un cours destiné à des infirmières professionnelles. Ces femmes, provenant de communautés de la Nouvelle-Écosse, sont inscrites à un programme de baccalauréat à distance en sciences infirmières. Cinq entrevues menées lors de groupes de discussion (CD-ROM : 3 groupes; imprimé : 2 groupes) ont permis d'identifier les besoins, les intérêts et les expériences de ces infirmières en exercice, relativement à ces approches. Les descriptions fournies par les participantes à propos de leurs expériences d'adultes étudiant à distance et utilisant l'imprimé et le CD-ROM pour étudier en sciences infirmières comportent une richesse d'informations susceptibles d'orienter les politiques de diffusion et de développement de cours. La description des expériences de ces femmes fait émerger six thèmes d'intérêt. L'étude souligne six principes pour guider la sélection et l'utilisation des médias en formation à distance et recommande d'intégrer à la fois les technologies s'appuyant sur le CD-ROM et sur l'imprimé comme stratégie efficace de diffusion, plutôt que d'utiliser l'un ou l'autre exclusivement.
One of the most important objectives in adult education is to engage professionals in the development of lifelong learning skills. The continual advances in nursing science and health-care knowledge require that we develop students and health professionals who take responsibility for their learning and are not dependent on an expert to decide what they should learn (Eisen, 1998; Mastrian & McGonigle, 1997). The keys to promoting lifelong learning are to get the students actively engaged in the learning process, get them excited about their learning, and give them ownership of the content and problems in a supportive environment. This project deals with a new electronic technology that has potential to accomplish this task and compares it with traditional print-based technology. Interactive, multimedia CD-ROM has many commercial applications, but has not been widely used in distance education generally or in nursing distance education in particular. Hence this project fills an important gap in the distance education literature. It describes from the perspective of women who are returning to university the learning needs and experiences related to using print-based and CD-ROM technology to study nursing at a distance from university centers. The project was jointly funded by a research grant from the Office of Learning Technologies, Human Resources Canada and St. Francis Xavier University.
The number of adult learners in nursing education programs in North America is increasing steadily (Raudonis, 1987). The traditional nursing student—the 18-year-old female high school graduate—no longer comprises the majority of the student body in nursing schools. Given the changing demographics, nurse educators must be responsive to the needs of adult learners and apply the principles of adult learning (i.e., encouraging student participation in learning and acceptance of responsibility for learning; teaching at the pace the student chooses; and employing a variety of instructional methods) in a way that ensures the quality of nursing education. CD-ROM technology, through its potential to achieve a one-on-one relationship with the learner and enable the learner to be an active participant in the process, holds promise for responding to the needs of adult learners who increasingly are forming the majority of nursing class enrollments.
Research studies relevant to CD-ROM technology in distance education are scant and inconclusive. Those that are reported in the literature are often methodologically flawed, with weak research designs (Cohen & Decaney, 1994; Fritz, 1994; Kulik, Kulik, & Cohen, 1980), limited sample sizes inappropriate to support conclusions, and the level of statistical significance is often not reported. The literature contains no empirical evidence of the impact of CD-ROM technology to deliver nursing education courses to distance learners nor any assessment of the learning needs of adult nurses associated with this technology. This information is needed to guide the relevant application of CD-ROM technology to current and future education programs. Therefore, two broad research questions guided the study: (a) what are the learning needs and concerns of post-RN distance education students related to the use of print-based and CD-ROM technologies in the delivery of a BScN curriculum? and (b) from the perspective of adult learners, how does the use of these technologies to deliver a distance education course influence the teaching-learning process?
Phase 1 of a two-phase project began with the pilot testing of CD-ROM technology to deliver an introductory nursing course to post-RN students who were studying at a distance from a university center. It included developing the ability to remotely service the distance learning sites for use of CD-ROM technology, as well as providing an orientation to the use of CD-ROM technology in the delivery of university-level nursing courses for students, faculty, and local educational consultants who support students in their home study program. Phase 1 combined both quantitative and qualitative approaches in its research design. A pretest-posttest experimental design was used for the quantitative part of the study. Eighty students registered in the distance version of the introductory nursing course consented to participate. All students in the course were adult learners who had completed a two- or three-year diploma nursing program and had a minimum of one year of nursing practice experience. The quantitative component of the study is reported elsewhere (Gillis et al., 1998).
Because students in the distance program come from a large number of geographically dispersed regions that are isolated from university centers, they traditionally have been assigned an educational consultant with whom they meet on a regular basis. The meetings occur at regional resource centers within a 50-kilometer radius of their home community. In this project we wished to test the efficacy of the CD-ROM in comparison with the traditional print-based mode of delivering the course. However, because there were regional groupings of students, it was inappropriate simply to assign students randomly to either the CD-ROM or PRINT treatment groups. The problem would be that some students in the group would have the course delivered in one way, others in another way. To avoid this contamination, we decided to assign students to groups using the following procedure: (a) a measure of the experience with computers for each person in each of the resource center groups was determined, (b) the mean level of computer experience in each group was determined and used to rank-order the groups from highest level of experience to lowest level, (c) each of the eight groups was assigned to receive either the CD-ROM or PRINT treatments; the highest two groups in computer experience were randomly assigned to a treatment, followed by the next two groups; this procedure was followed until all groups were assigned to a treatment; all members in the group received the same treatment. The control group received the traditional PRINT-based version of the course whereas the experimental group received the CD-ROM version of the course. The learning needs, concerns, and experiences of the post-RN students related to learning method (print-based and CD-ROM) were explored for both groups.
A descriptive participatory research approach was used to address the research questions. To assess the learning needs of post-RN students related to the use of print-based and CD-ROM technologies in the delivery of university level nursing courses, planned focus group interviews were conducted with students at regional sites where the program was offered. The focus groups were conducted by a skilled facilitator with expertise in participatory research approaches and the principles of adult education.
Focus group interviews provide in-depth information without requiring full-scale ethnographic investigations and offer the opportunity to observe a large amount of interaction on a given topic in a limited time. They are especially useful for generating ideas provide a dynamic where participants learn from one another and develop ideas together (Creswell, 1998; Jackson, 1999; Spradley, 1979; Streubert & Carpenter, 1999). The researcher is able to detect if there is wide agreement on a point or whether a view being expressed is limited to one or two individuals. Like answers to open-ended questions in a questionnaire, the responses may well lead into important issues unanticipated initially by the researcher. The strength of the focus group method is the fact that the group determines the direction of the discussion (Jackson, 1999).
Five student focus groups (one in each health region) were conducted. The focus groups involved a purposive sampling approach intended to achieve inclusive perspectives on the needs and experiences of adult learners related to the use of print-based and multimedia CD-ROM technology to learn nursing at a distance from a university center. Three focus groups were conducted with participants who used the CD-ROM technology, and for purposes of comparison two focus groups were conducted with participants using the print-based technology. The aim of the focus groups was to elicit the students’ perceptions of their experiences with the technology without imposing any of the researchers’ views on them. Each focus group consisted of 6 to 12 members and lasted approximately one and a half hours. Because focus group data represent group data it was important to resist attempts to count individuals participating in the focus group research rather than the number of groups. Although the responses from members of the group were not independent of one another, it was important to remember that the group was considered the fundamental unit of analysis in this study.
Probes were developed to facilitate the identification of adult learning needs and concerns. The focus groups highlighted the students’ experiences with multimedia or print-based technology, their learning needs and concerns related to the use of the technology, their descriptive assessment of the effectiveness of this technology as a teaching-learning tool, and their perceptions of the determinants and factors that both enhanced and/or impeded the learning experience. The focus groups were audiotaped to preserve the richness and completeness of the data and the tapes were transcribed verbatim. The transcripts were analyzed using content and thematic analysis. Thematic units, or categories, were identified based on the topics used in the focus group protocol (Figure 1). The focus group transcripts were coded into 21 categories (Figure 2) and underlying themes then identified.
The thematic analysis resulted in six central themes: (a) life as a distance learner, (b) motivation for enhanced quality of life, (c) skill seeking, (d) factors supporting learning, (e) deterrents to learning, and (f) positive perception of the learning experience. The themes are described and supportive exemplar quotations and interim conclusions provided for each theme.
When asked about their experience of being a student over the previous 10 to 12 weeks most talked about the many and competing demands on their time as adult learners. As adult learners with multiple roles, these participants found self-direction, self-discipline, and reorganization of their time essential to their ability to proceed in the course regardless of group treatment assigned. Time became a highly valued commodity for them. It was necessary to set priorities among the many competing demands in their lives, and added to that was the new role of learner. This created an additional burden in their already taxed existences.
The theme of transition from one demanding role to another was paramount in the lives of these adult learners. A period of passage to adjust to the new demands and role of student life was necessary in all five groups. These women spoke about their husbands, children, full-time jobs, as well as various other social and community commitments. Learning to study again after extended periods out of the school environment was a major commitment that these women took on. They spoke of a transition period when they learned to juggle time between family, friends, work, and study. They saw themselves as responsible for their own actions and learning and wanted to be involved in planning and directing their learning activities.
My mom was sick and just a lot of that stuff that is hard to deal with. And then to do the school work on top of that, plus deal with my whole family. I’m at the stage where you have to look after your parents. (CD-ROM group)
The biggest thing is in the guilt. My 7-year-old, when I come in the driveway still jumps me. She is so excited and she says, “Mommy do you have to study tonight?” ... I feel really guilty about that. I hadn’t seen her for 3 or 4 days. (Print-based group)
In understanding the experience of life as a distant learner, another idea that emerged from all five groups was the flexibility that distance education afforded these students. The ability to schedule convenient times for studying, to progress at a speed best suited to the individual, and to be able to go over material multiple times was considered a benefit to all those involved. The flexibility also allowed these women to continue working full time and to spend time with their families.
The fact that I can do it when I want, how I want, as long as the ultimate goal is that I do it. I’m still in control, I’m controlling it, and I think I really enjoy that. (Print-based group)
Interim conclusions. Whether print-based or CD-ROM students, the women interviewed had generally positive comments about the ability of distance education to accommodate their busy schedules and enable access to education. Due to the time pressures on these women from their many commitments and multiple roles, it was beneficial not to have to take extra time to travel to a classroom or to find babysitters for their children. This valuing of limited time and conflicting demands must be taken into account in the construction of learning experiences and the integration of technology into course materials and assignments for adults. All five focus groups appeared life-centered, that is, they all spoke about important matters in everyday life, and being a student was just one more role for them. This suggests that educators working with adults must focus the learning situations in the context of real-world situations. Adult learners, particularly women, focus on dealing with problems they encounter in their particular life-work situation and actively seek solutions to these problems. Therefore, it is important for educators to structure the distance education learning environment such that it enables the adult learners to feel they are effectively learning new knowledge, skills, and attitudes with the minimum amount of disruption as possible to other aspects of their life.
Regardless of the many responsibilities, the desire these women have to return to school and to do well is strong. They are motivated to increase their knowledge and skills and to become better people. The decision to continue their education is for the most part personal and not pressured by outside forces. Four of the five groups spoke about internal motivators such as increased self-esteem, goal attainment, personal choice, and control.
The value of the baccalaureate program served as a motivation to continue their education. Students realized early in the program just how valuable it really was to them. It gave them a greater sense of professionalism and a broader knowledge of nursing. They spoke of understanding why they did something, and not just how to do something.
I was halfway through my course when I realized how badly I needed this. After the knowledge I had gained from what I was reading I was thinking, “You live in a very small world.” I thought all the knowledge that I have learned, I learned how to do technical things; it has always been technical based, and I thought, I have taken different courses before, my ACLS and those type of things, but they were all technically related. Nothing was ever social or spiritual or psychological. (Print-based group)
A sense of pride and accomplishment was evident in the interview comments of all groups. To go back to school after being out in the work force for so long and to do well gave the participants a feeling of empowerment and accomplishment. The empowerment theme was particularly strong in the CD-ROM groups who in addition to learning new nursing content also felt liberated from their fears of computers by learning to use this new technology during the course.
Interim conclusions. Results suggest that post-RN students are intrinsically motivated to continue their education through distance education. Motivation is a key factor in all types of learning. It is important for educators to realize that adults such as these are often motivated to some extent before instruction begins, but it is important to understand the source of that motivation and build so as to to maintain and enhance it throughout the educational encounter. These adults appeared eager to engage in learning new skills and knowledge that would improve the overall quality of their professional as well as personal lives. They were willing to participate actively in the process by engaging in tasks necessary to complete their goals. An important element in maintaining their motivation was the notion of challenge. For the CD-ROM groups the presence of computer technology enhanced the challenge. Students commented on the value of having their minds opened to new ideas and the need to question their actions. Many motivational theories suggest that individuals prefer activities involving an optimal level of challenge. Educators need to remember this and plan activities that are not so easy and repetitive of prior learning that the participant becomes bored, nor so difficult that the learner is frustrated by the experience and withdraws from the learning opportunity.
Adult learners often actively seek to attain new skills in order to better meet their goals and solve real-life problems. This theme was dominant in all the interviews. In both the print-based and the CD-ROM groups the participants spoke about the need to develop new ways of learning and knowing in nursing, although the skills thought to be important varied somewhat by group. The switch from classroom learning to distance learning, in addition to being away from formal study for as long as 20 years for some, resulted in changes in how these participants studied. One noted change was switching from an audio to a visual learner, meaning that instead of listening to a professor lecture to them, they developed the ability to identify important concepts selectively from reading the required material. This was particularly noted in the print-based group, but did not come through as strongly in the CD-ROM group, as these groups were able to rely on the professor reading the highlights of each unit to them on the CD as a means of identifying key points and concepts.
So I guess my skills have changed in that sense, because I was a good listener in class. I retained a lot in class, whereas now I do more reading. Before I didn’t feel I had to because I could just listen to the faculty member. Now I need to develop my reading skills and work on my retention. (Print-based group)
Related to this change was developing the ability to be critical and selective in the material that one is reading. Being able to read massive quantities of material and pick out the important and relevant information is a skill that most of these participants developed quickly in order to be more time-efficient.
For the students in the CD-ROM group there was an extra sense of accomplishment from learning an entirely new repertoire of skills related to use of the computer technology. The challenge of using a computer efficiently was a new experience for these learners and initially provoked much anxiety.
I loved it by the end, but that first month was very traumatic. You think that you are going to ruin the whole thing. You learn very quickly that almost anything you are going to do can be undone. So the intimidation factor goes away once you learn that. (CD-ROM group)
Interim conclusions. New skills emerged as part of the process of learning by means of distance education. Although both groups were presented with common nursing content in a different format, the skills required to learn this information varied somewhat depending on the group to which they were assigned. Some skill development was common to both groups.
In developing their learning materials, whether print-based or technology-based, educators should be cognizant of the skill set that is required of adult learners. Clarity and relevance are key principles in presenting information to adult learners who are active participants with little time to waste. Clarity means the learners should be able to direct their attention exactly where it needs to go to learn the concepts that must be mastered. Relevance means the course material and assignments relate to what they need to know as nurses and educated citizens. Distance learning materials should present information and materials that are directly related to the tasks at hand. Do not confuse learners by providing them with extraneous materials that are not related to course goals and objectives. The important point is to consider the characteristics of the learners and to choose strategies that enable them to move successfully through the steps of learning in order to master important skills. It appears that participants in the focus groups were action-oriented, independent, motivated, and solution-seeking.
Regardless of what group they were in, the participants identified a number of factors that were beneficial to their learning. Social support was a major theme that emerged from the interviews. The distance program was structured so that much of the learning was done on an individual basis and supported with regularly scheduled group meetings. The group meetings were found to be helpful by all five groups. The students noted that coming together in a group allowed them to validate their ideas and beliefs and promoted a sense of connection. The meetings provided a source of social support for the participants where they could engage in a reciprocal process that provided encouragement, information, and comfort. The groups tended to affirm each other and helped individuals realize their own strengths and potential.
I feel like I’m in this little cocoon or pocket. That’s why I enjoyed being in the group. There is always interaction, and when you work in pediatrics or any other specialized area you don’t even know what is going on with other nurses. I really looked forward to our group meetings when everyone got together and kind of reinforced that you are not the only one who feels like this. (Print-based group)
In most groups reference was made to the family as a source of natural support. The encouragement and family support the participants received was an issue of great importance. All the women reported having strong support from family or friends. The support was shown through words of praise and encouragement, sensitivity to the needs of the mother or spouse, offers of help and assistance with household tasks, as well as academic support from older children in university.
The three CD-ROM focus groups spoke about the sense of connection that they felt to the campus. Watching the video clips on the CD and having an opportunity to see and hear the professor highlight the key points of each lesson orally and visually enhanced learners’ identity as university students. The print-based group found the course manuals user-friendly. This was important to them in creating a sense of connection between the learner and the professor.
Watching the video clips made you actually feel like you were part of it, because we are not on campus every day I do not have that feeling of being a university student, but watching the videos sort of made me feel like I was actually a student, and I really am part of the university family. (CD-ROM group)
The students enrolled in the CD-ROM course spoke of additional factors that enhanced their learning. The novelty of the computer was a theme that emerged consistently in the interviews. Students noted that the computer added a stimulus for them to learn not only the course content, but also the skills of operating the technology. The novelty of working and studying on a computer, being interactive with the program, and the visual and auditory stimulation added incentive to study.
I think there was a component of novelty, that you are always more interested if something is more novel to you. And the novelty of learning on the computer I think actually helped me because I was keen. (CD-ROM group)
Another issue that emerged from the CD-ROM groups was the potential of the computer to provide stimulus and reinforcing material effectively. This tended to increase the students’ perceptions that they were able to learn the course material more efficiently than if they were exposed only to a print version of the course. The computer offered both aural and visual stimulation, which enhanced and provided reinforcement for the students. According to the participants, the use of the computer provided extra exposure to the information being presented. They read the information, they heard the information, and they typed the important points in their journals. The computer provided the capacity to use a variety of methods in presenting the stimulus material. This was an important feature because what worked for some learners might not work for others. The computer offered students freedom to work at their own pace and individualize their learning to the extent that they had a clear understanding of what goals and objectives they must meet.
I really am a visual learner; I know that for a fact. So for me to see a picture on the screen, I then remember what that is about, you see. Whereas to read it without a picture—I just learn easier with the picture. (CD-ROM group)
I think it reinforced, I mean when you listen to the videos it cued you for what was significant in the context of the text. You were listening to someone else’s perspective of what the highlights were. So it prompted you to sort of focus. (CD-ROM group)
Access to learning resources was an idea discussed in all groups. The CD-ROM group had the benefit of Internet use, which allowed access to a variety of highly relevant learning materials. This was the first exposure that most of these women had to the Internet, and so it was an opportunity to develop a new skill for researching, whether for educational or other purposes. It also was a source of contention between the two groups as some in the print-based group felt they were at a disadvantage in terms of accessing additional resources. On completion of the course the computers were returned to the university, causing students from the CD-ROM group frequently to comment about the loss of this important resource to them.
I would come across a patient with such and such a disorder, I would go home and look it up and take all the information off, and there it was. It helped everyone at work. Then when I lost it and didn’t have the time to do it I was mad, because I know I can do that now (access information from the Internet). (CD-ROM group)
A conflicting idea that emerged in the interviews was the ability of the computer to facilitate learning through the creation of a supportive and comfortable environment. For some participants working with the computer program offered a stable and fixed location for studying. This was something that the students found helpful when studying at home. It required sitting at a desk and being focused on what was being presented. According to the participants, it made it easier to focus for a longer time and resulted in fewer distractions.
I found I concentrated more. For me anyway, when I was at the computer, I was at the computer. I didn’t hear anything or see anything cause I had the speakers on listening to the videos and everyone would just get up and leave the room. (CD-ROM group)
For other participants the computer created problems in terms of the learning environment. The issue of portability was a real concern for many who because of their busy lifestyles resented the fact that they could not transport the desktop computer easily. Those who select the media should consider the special needs of the learner for it to be accepted by the learner.
Interim conclusions. Many factors facilitated learning for this group of adult participants. Some were common to both the print-based and CD-ROM groups, and others were exclusive to the media used to present the course. It appears that learner acceptance and dependence on media and technological applications is high if the media meet the special needs of adult learners, are congruent with instructional strategies in the course, and with the characteristics of adult learners (active participants, self-pacing, independent learners), and promote individualization of the learning process. It is clear that CD-ROM technology has the potential to support and enhance learning experiences. It is important, however, that students as well as faculty maintain a sense of adventure and playfulness about technology as they integrate it into the learning environment. This will allow students to develop a positive attitude toward the technology and its applications.
Computer anxiety, inadequate knowledge of computer technology and software applications, lack of time to assimilate knowledge related to computer applications, technological malfunctions, limited time to learn course content, and concerns about permanency of information were dominant themes that emerged in the CD-ROM focus group interviews. Participants expressed anxiety about using computers, yet indicated enthusiastic interest about learning more about them. The print-based groups expressed similar anxiety levels, but this was in relation to the sheer volume of reading and course material that they were given in the two-inch-thick course manual.
The friendliness of the computer and CD-ROM-application was a theme discussed at length in the three CD-ROM groups. The new users felt anxious when faced with hardware and software that at first seemed part of an alien world to them. It was clear that not only were students learning how to use the CD-ROM, but they appeared to be developing a relationship with the computer and the software. This was difficult for some students, however, because they were competing with new nursing content and limited time resources to master both simultaneously.
At first I found that I would read through things four times and realize that, Oh my God, I’m so focused on the idea that I’m on a computer and I have to push a little button here, and you know, my concentration was actually on working the computer and making the mouse go where I wanted it to. I wasn’t actually taking in what I was reading. It took me a long time to get past that. (CD-ROM group)
Lack of control of the learning environment and fear of missing important information or erasing it were themes expressed by the CD-ROM groups. Students questioned whether they were using the CD appropriately and getting everything out of the program that was appropriate. In contrast to the print-based group who could flip through the pages of their manuals to see what was coming in future lessons, the CD-ROM group did not have this same sense of control.
Is Patsy reading something that I’ve never seen because I don’t know where to click? It took me a long time to learn where things were, for example, when you went to the research thing and you clicked on required readings and objectives and it came up and told you what the required readings were for each module. I felt so good when I finally mastered that; it took me a long time, however, even though we were shown that in our orientation. (CD-ROM group)
Technological glitches and malfunctions were dominant in two of the focus group interviews. These problems were primarily limited to problems with the e-mail system and use of the Internet. In some cases the students already felt overwhelmed by the technology, so they did not pursue this matter further as they realized it was not critical to completion of the course.
Interim conclusions. It appears that the integration of multimedia into the learning environment, and specifically into required course delivery, requires planning and preparation well in advance of course delivery. It is important to assess learners for specific entry competences (knowledge, skill, and attitudes) related to computer use before introducing such media as a part of the learning process. The initial analysis of learner competences, the reinforcement of correct applications of the technology by the learner, and the final evaluation of chosen media in aiding the learner’s attainment of course objectives are important steps to consider in dealing with the deterrents to learning in distance education. Appropriately preparing the learner to use the technology well in advance of the course start date may help overcome some of these deterrents. When learners are well prepared to use the technology they are more active participants in the learning process, more capable of taking advantage of the full scope of the technologies capabilities, and more likely to see the full relevance of the technology to their learning.
All participants described their learning experiences in positive terms. Students were actively engaged in their learning and challenged by the course, regardless of treatment group assignment. The perception of a successful course experience emerged as a dominant theme in the five focus groups. Both print-based and CD-ROM groups would recommend their respective experiences as distance adult learners to their peers. Both groups believed the course as they experienced it was better or comparable in quality to classroom-based courses.
Absolutely! Yes! I think it [CD-ROM] was better because you have more opportunity to redo, to go over, and you listened to your lecturer at your leisure and you could re-listen to the lecturer at your leisure. (CD-ROM group)
I thought the course was wonderful. It was very different from anything that I’d ever taken before. But I really think this course sets the stage for the degree program. I don’t know if it is what they use everywhere, but I think if not it should be. (Print-based group)
Although participants were overwhelmingly satisfied with the educational experience, they did offer some unique suggestions to consider in creating the “ideal learning situation.” The major issues presented related to various aspects of the computer and CD-ROM technology. Suggestions that emerged included: use of laptop computers rather than desktops, integration of more interactivity into the course design, enhanced computer capability to run a couple of screens so that you can alternate between activities simultaneously, inclusion of a click-and-drag function so that the text can be dragged onto a notebook or some sort of journal function, inclusion of more audio clips, and more visual or video clips, and provision of both the CD-ROM and the print-based manual to students at the beginning of the course. Process-oriented suggestions included: a hands-on training session with the computer and CD-ROM before course initiation, early receipt and use of the computer several months before the course start date, and making a technical support person available in each community where students are located.
Interim conclusions. Overall, students perceived that learning was positively affected by the computer technology as well as the print-based delivery of course content. Both groups of students were motivated, challenged, and surprised by the amount of learning that occurred. Most of the students became obsessed with mastering the computer (e-mail, Internet, journaling, CINAHL applications, etc.), whereas some continued to believe the computer interfered with their learning, although there was a general trend to develop competence as the course proceeded. Learning was slowed at first for most students until their computer literacy skills improved. The most frequently cited advantages of the CD-ROM technology included repetition and reinforcement of material, variety in approach, self-pacing of learning, increased interaction, expanded learning resources, and novelty. The most frequently cited disadvantages were initial anxiety, fear that information would be lost, and additional time demands to learn about the technology.
Through qualitative focus group interviews this project identified the learning needs, concerns, and experiences of adult nurses related to the use of print-based and CD-ROM technology. In particular, this research project was a critical step in legitimizing the use of CD-ROM technology with adults in distance nursing education. As institutions of higher education and their schools of nursing create learning communities that are convenient, accessible, and student-centered, multimedia technology will be used increasingly to support and enhance the teaching-learning process in these communities. This project contributes to our understanding of how the role of students can and will change and be affected by the learning technology. It also presents new information to guide the selection and use of technology in nursing education. Extrapolation of data from the focus group interviews suggests that the following principles may be useful in guiding technology selection and use in nursing education.
Results suggest that students were positively affected by both the CD-ROM and print-based experience of learning nursing at a distance from a university center. Focus group respondents repeatedly spoke favorably about the reinforcing value of the combined audio and visual stimulation that the CD-ROM provided. Participants perceived this as a factor that enhanced information processing and recall. CD-ROM participants spoke about the ability to go back over material two, three times, and so on by clicking on the computer screen. This, in addition to having key concepts and ideas orally highlighted by the professor in the video clips, added value to the CD-ROM. However, caution must be exercised in attributing learning value to the CD-ROM because there may be a novelty effect from use of the computer and interactive technology. Most participants in this study had limited computer skills and hence were motivated to learn about this new educational tool that held great promise for them. It is difficult to partial out the impact of novelty on the overall learning experience for this group of adult participants.
There appears to be a high level of satisfaction with both the print-based and CD-ROM based courses as useful vehicles for delivery of distance education to adult learners. A possible explanation for the high level of satisfaction with each format is that both methods were based on sound principles of adult education and shared comparable but different features that students perceived as advantages of the method. The print-based version of the course had been delivered five times in the past 10 years and had been improved based on student feedback after each offering. Hence the product had undergone rigorous testing and revisions before use in this study. Both methods allowed students to learn at their own pace and convenience, go over material they were unsure of at their leisure and as frequently as desired, and evaluate themselves; they also provided contact with the course professor, other students, and study groups. Learner satisfaction with distance education delivery systems has not been widely addressed in the literature. This study suggests that student input into decisions about adoption of distance education delivery methods or continuing use of technology in distance delivery is highly desirable. Student satisfaction with delivery methods and integration of technology should be a major consideration in the adoption process.
A recommendation of this study is the integration of CD-ROM and print-based materials as vehicles to communicate nursing knowledge rather than using exclusively one or the other. It appears both methods have merits that need to be capitalized on to provide the best learning opportunity for the student. A move in this direction requires that educators be prepared to meet the challenges that follow. Introducing novices to technology and supporting them during the learning process can be frustrating and labor-intensive and requires adequate technological support. The learning curve for participants tends initially to be quite steep.
This study suggests that it is important to design the course and related assignments and learning activities so as to prevent the demands of the technology from taking over the nursing content. Focus group interviews provided many suggestions and recommendations for improvement in this area. Participants commented that it would have been extremely beneficial to have taken a course on computers before the nursing course was delivered. Others indicated that receiving the computers several months before the course start date would have provided an opportunity for students to become familiar with the technology and learn about the many features of the computer without the additional stress and time pressures to master course content and submit assignments simultaneously. A graduated use of the technology might have been more appealing to the learners. For example, the assignments could be structured so that students move from a simple e-mail posting to class members, to collaborative discussions and group responses, and eventually to World Wide Web searches for information and integration of such information into course assignments.
It is clear from this study that multimedia technology has the potential to change the teaching-learning environment dramatically. Such technology will enable the student to move from the role of passive recipient of information to that of being engaged as an active participant who is self-directed and independent. Multimedia will also affect the learning styles of students. This study suggests that it will lead to a shift from the primacy of oral thinking to the integration of visual and oral thinking Participants in the CD-ROM group continually reinforced the value of the visual support for learning as a supplement to the auditory mode. Participants tended to benefit by integrating and using both channels for learning.
It appears that increased opportunities for access to higher education are becoming more readily available as universities move in the direction of distance education and interactive multimedia applications. Use of such applications has merit for undergraduate and graduate students as well as for those registered nurses wishing to update their professional qualifications. As technology improves, additional research is required to determine what is the most appropriate and efficacious use of the technology with the various groups of learners. New research will provide direction for use of selected paradigms, and nursing faculty will find further challenges to propel the curriculum and its applications far into the new millennium.
The authors would like to acknowledge the financial contributions of the Office of Learning Technologies, Human Resources Canada and St. Francis Xavier University for this project.
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Angela Gillis is a professor and Chair of the Department of Nursing at St. Francis Xavier University, Antigonish, Nova Scotia. Her e-mail address is agillis@stfx.ca.
Winston Jackson is a professor of sociology and the Director of the Office of Institutional Analysis at St. Francis Xavier University. His e-mail address is wjackson@stfx.ca.
Angus Braid is the Director of Continuing Education at St. Francis Xavier University. His e-mail address is abraid@stfx.ca.
Patsy MacDonald is a master’s candidate and Coordinator of the Post RN, BscN Distance Education Program at St. Francis Xavier University. Her e-mail address is pmacdona@stfx.ca.
Margie Ann MacQuarrie is Coordinator of Special Projects, Post RN, BScN Distance Education Program at St. Francis Xavier University. Her e-mail address is mamacqua@stfx.ca.