The development of educational technology has been either praised as a necessary component to education or has been castigated as a movement which reduces students to robots and dismisses the teacher altogether. The subject is rarely treated with neutrality (Braun, 1980). Computer-Aided Instruction (CAI) is the process whereby written and visual information is presented in a logical sequence by a computer. The student learns by reading the material or observing the graphic information displayed on the scope. The primary advantage the computer has in comparison to other technical instruction is that there is automatic interaction and feedback. Another advantage is that the program can be so designed that multiple paths through the course material can be taken by the student. This has problemsolving qualities, a valued educational experience in higher education today.
Perhaps the first use of a computer in education was in testing. A computer is an ideal test giver; it not only gives immediate feedback, but it records the number of correct and incorrect answers, and a score is computed. The most widely used type of CAI has been for the presentation of practice problems and exercises to reinforce learning gained from another source. The second most widely used form of CAI has been the tutorial type of program whereby programmed instruction is implemented on a computer. This type of instruction is much more aptly described as ComputerManaged Instruction. Computer-Aided Instruction has the quality of dialogue; the computer and student essentially carry on a conversation. The interaction leads to learning or understanding of a subject. Perhaps the most challenging mode of learning is having the computer programs simulate an actual occurrence of actions providing the student an opportunity to test various input conditions and make changes in various contexts to see the outcome.
The concept of CAI has existed for a long time. Dr. Sidney Pressey invented a machine in 1924 (Frenzel, 1980). It was used for grading multiple-choice examinations. The computer as a device for teaching came about as an outgrowth of the programmed instruction strategy of teaching. The content is linked in a frame so that as soon as the student reads a fact or concept, he is tested on it. Most programmed instruction was available in printed form, but eventually it was transcribed on film for presentation. According to Frenzel (1980, p. 86), this use of the teaching machine never became popular or widely used because of the lack of standards and teaching materials. However in the 1960s, programmed instruction was implemented on computers with the rationale that the programmed instruction frames could be presented with greater flexibility. Thus, an innovative teaching strategy evolved. The interest waned rapidly however, because the cost was prohibitive. Few institutions or companies could afford the large computer systems needed to implement these programs.
IBM and RCA companies attempted to produce commercially viable CAI systems; many people said that this way of teaching would revolutionize education! But, again because of cost, momentum did not build. An effort indicative of support of the use of computers in education by the National Science Foundation was when it funded a major project in the early 1970s. Control Data Corporation's PLATO is a CAI system implemented on a very large, time-sharing computer. Time and cost are still major problems identified with this approach. The newest surge of interest in CAI came with the marketed microcomputers. Cost was drastically reduced and accessibility within many institutions was realized.
Studies indicate that CAI does make a difference in higher student achievement and reduces attrition. Community Colleges in Ontario, Canada, found that the use of the computer lowered the attrition rate or conversely increased the attendance rate of students in a remedial basic mathematics course from a dropout rate of 60% with traditional instruction to a rate of only 20% attrition with the CAI mathematics course (Gerhold, 1978). Braun reviewed some research done by two other men. Vinsolnhaler and Bass studied a series of elementary education drill and practice programs which compared the use of CAI with traditional instruction. They found that augmenting classroom instruction with CAI brought about superior performance on standardized aptitude tests. Two other researchers indicated that there was support from their studies for use of CAI as a supplemental instruction leading to higher achievement by the students. Braun (1980, p. 108) presented a table with a summary of results from 32 studies on the effectiveness of computerized simulation and testing in the classroom. The majority of these studies show savings in the learner's time to complete a course of study, greater efficiency of achievement per unit of time, and improved skills. Articles and/or studies described application of CAI to all levels of education: elementary, secondary, higher education, and continuing education. Cost is still a factor to consider; unless the teaching strategy of computer use is valued, it is not budgeted and thus economically it is not accessible. The greatest problem undoubtedly, is the lack of instructional materials.
Time is needed for development of instructional materials. Teachers may be interested, but do not have or are not granted the time necessary for package development. In addition, for those who find it personally satisfying to develop instructional packages, there has been little remunerative evidence.
Another area of development is the need for regulation and standardization of programs. Wade (1980) suggests that it might be unwise to establish specific standards for the evaluation of programs at all levels, however, there are some general principles of successful learning which can lead to use of similar criteria by the evaluator of a computer program. These five categories are identified by Wade as: the learning must be right (the content is in harmony with the philosophy and goals of the curriculum), the learner must be ready, learning needs must be managed or facilitated (learner informed of objectives and expected performance), assimilation must be practicable, and the learning must be efficient (cost-time effective). These criteria are certainly sound and apply to all program of studies and content to be learned.
Brown and EUinger (1978) indicate that the neglected step in CAI package development is the evaluation. They offer some points on formative evaluation and summative evaluation to be considered when creating instructional materials. The points offered by them are intended to help developers work toward quality and transferability. Their model is a systems approach for development of instructional materials. While formative evaluation should depend most heavily on actual student performance, consultations with content experts would also be involved to insure that the material is factually correct. Secondly, the program must be free of logic or coding errors. There should be no abnormal endings and it should provide for recovery from totally inappropriate responses. The next step is obtaining performance data from small groups of students.. Based on data from the small group, the most severe and obvious inadequacies of the material can be detected and corrected. Then large group formative evaluation follows. By utilizing a group of 25 or more, the stability in patterns of performance can be identified so that the developer can detect relatively minor deficiencies within the instructional material.
The purpose of the summative evaluation is to communicate the findings to others to a degree that potential adopters of the instructional material have a comprehensive description of target population, requisite skills, entry behaviors, adjunct materials, role of the teacher, and a detailed procedural description for using the package.
If educators can be assisted to first recognize the value of microcomputer technology in extending their teaching effectiveness and second participate in the development of computer-assisted instructional materials for use within their curriculum, CAI may yet become a viable, well-used teaching strategy. Once development of a computer program is considered on the same par as manuscript publication, educators will have additional motivation to work as subject matter experts in software development.
Microcomputers have removed many of the inhibiting factors for the advancement of CAI. However, educational computing could deteriorate into the proliferation of amusement level computer games or low quality programmed instruction. It is up to educators themselves to grasp the significance of this interactive teaching medium and participate in fostering excellence rather than mediocrity in its use.
Computerized instruction adapts quite well to nursing education. Although drill and practice, tutorial, problem-solving, and simulation strategies can all be used, simulation represents the more appropriate computerized nursing instructional application, providing an intellectual challenge and clinical practice opportunities. The use of non-computerized simulation as a teaching strategy is already regarded as a prerequisite to bona fide clinical assignment. Clinical decision-making practice facilitates transfer of learning to real life clinical situations (Huckaby, 1979). The advantages of simulation (no risk of harm to patients; practice in clinical skills; active learning experience; opportunity for cognitive/behavioral change) hold true for computer-based simulations in nursing. Computer simulations also provide the student with learning experiences in the cognitive domain.
Self-paced computer simulations provide experiences conducive to the recognition of the self. The immediate feedback received by the student as an effect of his manipulation of data and selection of an alternative, enhances his view of himself as a causative agent (Meadows, 1977).
Computer-based simulations in nursing involve the student as participant in a situation, primarily clinical, in which nursing process is used to arrive at a successful conclusion to the scenario. The situation is textual in form, projected to the viewer's vision on a cathode ray tube (CRT) screen and the student interacts by means of a keyboard, set up similarly to a typewriter keyboard. The learner is given the simulation's learning objectives, instructions on using the program, background information on the patient, family, and situation, and then is expected to make some informed judgments via nursing process. Depending on how the module has been designed, the learner may be responding to multiple-choice options or asking the patient open-ended questions. Crisis situations especially lend themselves to computer simulations, since the crisis can usually be solved in the "real" time that the student is actually at the terminal.
The crux of the simulation technique is allowing the student to make judgments and recognize mistakes by outcomes. A poor choice is ultimately recognized by the learner through the consequences of that choice. A well- designed simulation will allow extensive branching on decisions. Branching involves going on to the next set of circumstances based on the previous learner decision. For example, if a student has not considered appropriate safety measures for a patient, the next frame may reflect a response to this oversight, such as the patient falling out of bed. Learning occurs as the student perceives the need to behave differently when it becomes obvious through a poor outcome that optimal decisions were not made. This is especially apparent in computerized simulations when the prognosis deteriorates due to inappropriate clinical judgments. A drastic outcome is not always necessary or desirable in terms of accomplishing learning objectives. Scoring is usually an optional feature of computer simulations.
Both decision-making and simulation programs for nursing have been developed at the University of Texas at El Paso College of Nursing under the sponsorship of an DHHS grant entitled, "Safeguarding Patients Via Tri-Simulation In Nursing." At present, eight microcomputers dedicated to instructional computing are being utilized within an undergraduate nursing student population of 250 and graduate student population of 125. Approximately 20 modules have been completed, and are being assigned primarily as supplemental and enhancement material for existing course requirements. Faculty participate as authors and consultants within the areas of their expertise. Development of programs is coordinated by a nurse qualified to serve on faculty, who is knowledgeable in instructional design and programming techniques.
Simulations and decision-making programs are excellent applications of educational computing in nursing. Since nurse educators are aware of what needs to be taught, their knowledge is essential in originating the subject matter from which a computerized instructional program, simulation or otherwise can be developed. Nurse educators are beginning to understand the need for computer literacy and active participation as users of materials currently available and as subject matter experts for software development. If nurse educators do not become involved at either level, nursing education may not reap the benefits of this new technology. To participate effectively as subject matter experts, nursing educators need to become computer literate - to possess a basic understanding of how a computer system works, to be aware of the limits of its instructional potential, to project what a computer-based educational future will be like. Microcomputers have provided an inexpensive easily managed tool. The responsibility has thus shifted from the technologist to the educator in insuring that this powerful new medium is not misused.
- Braun, L. (1980). Computers in learning environments: An imperative for the 1980's. Byte, 5(7), 7-10, 101-114.
- Brown, B. & Ellinger, R. (1978). Evaluation: The neglected step in CAI package development. The Best of Pipeline, Fall, pp. 38-43.
- Frenzel, L. (1980). The personal computer-last chance for CIA? Byte, 5(7), 86-96.
- Gerhold, G. (1978). Teaching with a microcomputer. Byte, 5(12), 124-126.
- Huckaby, L., et al. (1979). Cognitive, affective, and transfer of learning consequences of computer-assisted instruction. Nursing Research, 28(A), 228-233.
- Meadows, L.L. (1977). Nursing education in crisis: A computer alternative. Journal of Nursing Education, 16(5), 13-21.
- Wade, TE., Jr. (1980). Evaluating computer instructional programs and other teaching units. Educational Technology, 20(9), 32-35.