Making continuing nursing education available and accessible to practicing nurses continues to present challenges to providers. Problems are compounded if the population to be served lives and works in sparsely settled rural areas. For example, nurses often find it difficult and expensive to travel to distant urban sites to attend continuing education offerings. Staffing and financial constraints often restrict the number of nurses that health care agencies can send to outside courses. Further, providers find that there are limitations as to the number of workshops and conferences that can be presented in multiple locations throughout a large geographic area.
Broadcast television has been used to address some of the problems that nurses have in gaining access to available continuing nursing education.14 It brings learning opportunities to large numbers of nurses in their own homes and work settings. When broadcast television cannot be used, cable television should be considered. The Intercollegiate Center for Nursing Education (ICNE or Center) has found this to be an attractive alternative; however, references to this mode of delivery were not found in the literature. This article describes the ICNE's experiences in producing videotape courses for transmission over cable television systems. The Centers experiences may be valuable to others seeking alternative approaches for providing continuing education.
The Center, as a member of the Cable Advisory Board for Learning and Education (CABLE) in Spokane, Washington, had access to air time on a franchised educational television channel. This stimulated the Assistant Dean for Continuing Education and the Director of the Learning Resources Unit to consider developing a series of videotapes for viewing by registered nurses in their homes. They believed that the convenience of this mode of delivery would be enhanced by multiple showings of each program. In addition, they saw cable television enabling the Center, as a major provider of continuing nursing education, to more effectively serve the needs and interests of registered nurses in the Inland Empire. This predominantly rural area includes eastern Washington, northern Idaho, western Montana, and northeastern Oregon (Figure 1).
An investigation of potential commercial programming determined that there was a scarcity of prepared nursing material available for cable television distribution. Video materials that might be appropriate either did not have written supplemental materials or had prohibitive airing royalty fees which decreased their desirability for the Center's projected use. Additionally, registered nurses served by the ICNE programs had identified specific content needs which were not addressed by commercially-prepared programs.
In 1980 the Center received a mini-grant from the Cable Advisory Board for Learning and Education. These funds had been made available to this local television consortium by the Department of Health, Education and Welfare to promote the initiation of television production by Cable member educational institutions. This mini-grant of $2,035 was used by the Center to partially support the production of a 12-part videotape series entitled "Physical Assessment of the Young and the Elderly: Special Considerations and Techniques." The series was aired over cable television in four eastern Washington communities and also was rented to numerous health care agencies throughout the Pacific Northwest and several other states.
THE INLAND EMPIRE
DESCRIPTION OF THE TELECOURSE
The six-hour physical assessment series emphasized the anatomic and physiologic variations associated with infants, children and the elderly and described the assessment adaptations necessitated by developmental and age differences. Each program in the series was 30 minutes long, including introductory information, titles, and credits. The first program, entitled 'Tour Changing Body - Did You Know?" provided an introduction to the series and was followed by a program about scoliosis screening. The remaining ten segments covered nursing assessment of the integument; the musculoskeletal system; the neurological system; the eyes; the ears, nose and mouth; the respiratory tract; the gastrointestinal tract; and the cardiovascular system.
The instructors for the series were two members of the ICNE faculty. They contracted to be responsible for the content of each program, development of the scripts, and performance of the nursing assessments on the tapes. In addition, they arranged for the persons who served as clients in the various assessment scenes. These persons were friends, employees of the Center, neighbors, relatives of faculty, and other interested parties. All participants signed a permission form which allowed the Center to air programs over television and retain all profits from the sale or rental of the tapes.
The graphics and illustrations shown in each of the segments were developed by ICNE audiovisual personnel with content guidance from the instructors. The entire series was produced in the television studio of the Nursing Center by the faculty and members of the audiovisual staff. Available staff were a media engineer, an electronic media producer, a media technician, and a graphics illustrator. Both the faculty and the staff had limited production experience; however, they became more proficient as each succeeding program was developed.
A 150-page manual was prepared by the faculty to accompany the videotaped series. This manual provided instructions for participating in the televised course and contained objectives, outlines, supplemental content, graphics, readings, and learning assignments for each of the 12 programs. A copy of the manual was mailed to each nurse who enrolled in the course. Weekly evaluation exercises were completed by the participants and mailed to the instructors who critiqued them and returned them to the learners. Participants also were encouraged to contact the instructors by telephone if. they had questions and many availed themselves of the opportunity to do so. Some also enclosed letters with their weekly exercises to which the instructors responded.
The television course was approved for professional continuing education recognition points through the Washington State Nurses' Association. It was not offered for academic credit. Participants who wished to receive continuing education credit were required to register for the course, pay a fee, and complete the weekly learning assignments. They received certificates upon completion of the course. The registration fee covered marketing, manual, and postage costs.
A Comparison of Telecourse and Other CE Offering Attendance
The television series was initially advertised through the ICNEs semi-annual Continuing Education Calendar which was mailed to persons and agencies throughout the state of Washington as well as regionally. This was followed by mailing descriptive brochures to individuals and institutions in or near the specific viewing area. Approximately two weeks before the course began, it was advertised through the cable television channel over which it was to be aired.
The number of persons who viewed the telecourse in each of the cable television areas is not known; however, 86 registered nurses enrolled for continuing education credit in Spokane, 13 in Pullman, 15 in Yakima and 10 in Walla Walla. Spokane was the only area where the number of enrollees in the telecourse exceeded the average number of nurses who attend other, more traditional continuing education offerings (Table). The reasons for the enrollee differences are not known; however, a follow-up survey might provide some valuable information for future planning. Approximately 64% of those who enrolled in the course for continuing education credit completed all of the requirements and received a certificate.
The telecourse was relatively costly to produce and market. Faculty were compensated for developing the videotapes and the manual and for critiquing the weekly learning assignments. The production staff was paid only for overtime. Other expenses included airing fees; syllabus materials and reproduction; advertising; postage associated with mailing the manual and the weekly assignments; videotape purchase; and the mailing of the videotapes to the television stations. It was anticipated that the minigrant and the registration fees would cover these expenses; however, costs exceeded income in three of the four viewing sites.
During the pilot telecourse in Spokane, the viewers were given an opportunity to telephone the Nursing Center at the completion of the second and sixth programs of the series to give evaluative input. A total of 15 persons responded, seven on the first call-in and eight on the second. According to consultants at the Spokane Public Broadcasting Station, one respondent on a television call-in survey represents 100 actual viewers. This meant that approximately 1,500 viewers watched portions of the series.
Ten of the callers were registered nurses, one was an LPN, one a physician, and three were teachers. Nine of the 15 telephoners were enrolled in the course. Most of the viewers (43%) were 50 to 60 years of age, 29% were 30 to 40 years old, 14% were 40 to 50 years old, and 14% were 20 to 30 years old. Eighty percent of the respondents were women. Two-thirds of those who telephoned had learned about the television course through the mailed ICNE brochure. The remainder had learned about it by "word of mouth." Forty percent of the respondents had viewed only one program, with 27% having viewed six and two programs, respectively. An overwhelming majority of the respondents (93%) found the programs informative and liked the televised approach to continuing education.
Upon completion of the entire series, the nurses who had enrolled in the course in each of the four communities were asked to evaluate it by completing a written questionnaire. In general, the series was given a very favorable rating. Approximately 90% of the nurses liked taking a continuing education course through television. They liked the content of the series (85%), found the syllabus helpful (85%), and indicated that the weekly study questions provided meaningful feedback in terms of their achievement (72%). Most of the respondents (85%) felt that the course objectives had been well met. They took notes during the programs (94%), found the illustrations effective (99%), and believed that sufficient visuals had been used throughout the series (90%). A large majority of the respondents (83%) felt that the assessment demonstrations had clarified the content presented in the series. They found the faculty knowledgeable and skillful (91%) and well-organized in their televised presentation (82%). Most of them (79%) indicated, however, that they needed to view each program a second time in order to be certain that they had not missed important information.
Spokane was selected as the initial broadcast site since CABLE membership provided air time on a local franchised cable television channel. This obviously lowered ICNE costs which then reduced registration fees. Offering the series within Spokane also increased the ease of piloting the project as distance was not a factor in communicating with participants or with the cable channel personnel. Making arrangements for central viewing sites were also expedited. The three distant sites, which serve rather large geographic areas with rural populations, were selected on the basis of cable access in those communities and the indicated interest of registered nurses living in the areas (Figure 2).
Pullman, Washington, the second airing site, is the home of Washington State University (WSU), one of the ICNE's three sponsoring institutions. Several factors, primarily economic, influenced the choice of Pullman as a broadcast site. First, Washington State University provided access to the Pullman Cable System and did not charge an airing fee. Second, the site was relatively close to Spokane and frequent faculty trips to the WSU campus eliminated the cost of mailing the tapes. Lastly, few continuing education offerings had been scheduled for Pullman that year which made a television course an attractive addition.
Contracts for air time were subsequently negotiated with two other eastern Washington community cable systems in Yakima and Walla Walla. Nominal broadcast fees were charged by these television agencies who were interested in the experiment of providing continuing nursing education via this mode of delivery and were also interested in providing new programming on their channels.
Airing hours and dates in all sites were mutually arranged between the ICNE and the cable channels based on local programming, available air time and consideration of traditional work schedules of registered nurses. Each program was repeated at least three times a week at different hours to accommodate these needs. For example, in Pullman, the series was shown on Mondays and Wednesdays at 10:30 am, 4:30 PM and 7:30 PM.
A few restrictions were encountered during the planning phase with the outlying communities. These primarily centered around scheduling. At one location, the ICNE program time had to be changed after the announcement brochures had been mailed. This change was necessary because satellite access to national news became available to that community at the time that the course was scheduled. Cable company personnel, however, were helpful in disseminating information about this change of air time through channel announcements at no cost to the Center. The local newspaper and health care agencies all assisted by posting appropriate announcements.
Other restrictions faced in the smaller communities were lack of computer programming capabilities and/or lack of personnel to provide evening or holiday programming in inclement weather. (Two scheduled airings were missed due to a snowstorm that prevented cable personnel from reaching the station.)
Recognizing that all nurses in the four communities were not cable subscribers, provisions were made in each community for a central viewing site. In Spokane, the television facilities of the Learning Resources Unit at the ICNE were made available to the telecourse registrants. In Pullman, a room was provided in the Washington State University Murrow Communications Building. Washington Odd Fellows Home, a centrally located nursing home with cable access, opened its facilities to course participants in Walla Walla and in Yakima. The Media Center of Yakima Valley Community College was the viewing site. These arrangements not only provided access for non-cable subscribers in the community, but they also allowed nurses from outside the viewing area to participate in the program offering. Nurses within a 45-mile radius of the'community cable access areas enrolled in and completed the 12-week course.
In each instance the viewing site was made available without charge and agency administration worked cooperatively with ICNE personnel to accommodate the viewers. This arrangement worked satisfactorily in all but one of the educational locations where multiple problems occurred because there were insufficient personnel available to assist the students. The nurses were not prepared to access the television monitors to the cable broadcast system if they found the monitors set for closed circuit viewing. Many also were unfamiliar with fine tuning of the equipment and environmental distractions during the programs created some problems. Without media personnel available to handle these situations, some of the registrants became frustrated and in one instance an individual left the site and missed a program. Several nurses reported these difficulties either by long-distance telephone calls or as an addendum to their weekly mail-in assignment. The concerns were explored by ICNE personnel and discussed with the local agency administrators which helped to alleviate several of the problems.
In addition to the staffing and program scheduling difficulties, several other factors were identified from which Center personnel have benefited in planning for future television courses. First, this teaching method was new to the majority of the nurses, particularly in the smaller communities, and may have resulted in the low enrollments. Those who registered were perhaps more venturesome than many of their peers who felt somewhat skeptical toward this teaching strategy. It could be speculated that more personal communication between ICNE staff and health care agency administrators prior to brochure mailings might have increased course enrollment.
A problem identified in one locale was the competition the ICNE created for itself by offering too many continuing education options in a three -month period of time within the same geographic area. A number of nurses indicated that they could not select more than one CE offering due to time limitations and/or lack of funds for multiple registrations and chose the more traditional course in preference to the television series.
Staff inexperience and an unanticipated illness of one of the participating faculty members during the filming phase of the production created serious problems in meeting air time deadlines. There was a number of weeks when the final edited copy of a program was rushed to the local television station only hours before it was to be broadcast. Production costs were somewhat higher than anticipated due to the amount of staff overtime that was necessary for final editing of the series. In the future, program airing commitments will not be made until production of a series is completed. For the Spokane area, this will mean approximately a six-month lag time between completion of a videotape series and the availability of optimum television schedules.
RENTAL AS A CE OPTION
Recognizing the need to expand accessibility to continuing nursing education programs beyond the areas served by local cable television companies, the videotape series also was made available on a rental basis to health care agencies and nursing schools in eight western states. It was marketed through the mailing of brochures. For a minimum administrative fee, renters had the option of receiving continuing education contact hours for each program or for the entire series. Videotapes were rented separately from the syllabus which allowed agency personnel to select the video program without the additional cost of the syllabus or the continuing education registration.
Availability of the videotape series on a rental basis was advertised nationally through an exhibit at the 1981 convention of Sigma Thêta Tau. In addition to brochures, a tenminute composite videotape containing excerpts from each tape in the series was shown. This composite videotape later served as a preview tape for prospective renters.
A 12-part videotape series on alcoholism, "Loosening the Grip," produced by the University of Mid-America with a syllabus developed by ICNE faculty was offered via cable television in Spokane in the fall term of 1982. A five-part series entitled "Common Childhood Diseases: Nursing Assessment Applied" was aired in the fall of 1983 and will continue to be offered in the future.
The ICNE intends to produce at least one videotape series annually and make it available through cable television in a minimum of three Inland Empire sites each year. Options to rent these Center-produced programs will be continued. It is anticipated that this revenue base will support the development of additional television courses.
As travel and per them costs continue to rise, the provision of continuing nursing education via either broadcast or cable television to individuals or groups seems to be a viable alternative to the more traditional teaching methods. The experiences of the Intercollegiate Center for Nursing Education seem to support this conclusion.
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A Comparison of Telecourse and Other CE Offering Attendance