Journal of Nursing Education

Major Article 

Nursing Students' Preferences in the Use of Computer Assisted Learning

Eric W. Koch, MSc, RGN, RNT; James A. Rankin, MSc, RGN, CBiol, RNT, DipN; Richard Stewart, BSc, RGN, RNT

Abstract

One hundred and ten student nurses in the second year of a 3-year diploma program were surveyed following their use of computer assisted learning (CAL) programs. The questionnaire was designed to elicit responses concerning the preferred number of users per terminal, the level of supervision (supervised/unsupervised) and their general affective response to this type of learning.

The results showed that the majority (56.4%) of students preferred to work in a group (a group constituted no more than three students per terminal). Whereas 31.8% preferred to work through the program alone, just over 50% would rather be supervised while running the program, and 26.4% expressed a preference for no supervision. There was no relationship found between program content and running the program alone or with others. However, in 10% of the sample there was a positive relationship found between the need for supervision and program content. The reasons given for these preferences and the advantages and disadvantages of CAL, as perceived by the students, are also discussed.

Abstract

One hundred and ten student nurses in the second year of a 3-year diploma program were surveyed following their use of computer assisted learning (CAL) programs. The questionnaire was designed to elicit responses concerning the preferred number of users per terminal, the level of supervision (supervised/unsupervised) and their general affective response to this type of learning.

The results showed that the majority (56.4%) of students preferred to work in a group (a group constituted no more than three students per terminal). Whereas 31.8% preferred to work through the program alone, just over 50% would rather be supervised while running the program, and 26.4% expressed a preference for no supervision. There was no relationship found between program content and running the program alone or with others. However, in 10% of the sample there was a positive relationship found between the need for supervision and program content. The reasons given for these preferences and the advantages and disadvantages of CAL, as perceived by the students, are also discussed.

Introduction

In a previous study (Rankin, Koch and McGuire, 1986) the attitudes of student nurses to computer assisted learning (CAL) programs were examined with particular reference to the factors which they felt either enhanced or detracted from program quality. This exercise provided much useful information for those nurse teachers involved in the specification stage of program generation. With a variety of CAL programs available to students, it was felt that the next logical step in evaluation was to assess the students' preferences in relation to the environment of use, for example, the number of users per terminal, level of supervision and their general affective response to this type of learning. Prentice and Kenny (1986) considered these parameters in the context of medical education and found that their students expressed a preference for supervised use. It was decided to carry out a similar study with student nurses at Forth Valley and Fife Colleges of Nursing and Midwifery, Scotland.

Materials and Method

Population

All 110 students (102 females and 8 males) were in their second year of a 3-year diploma program. Their ages ranged from 18.5 years to 28 years and the average age was 19 years. A questionnaire was designed to elicit students' preferences, and reasons for these, in relation to the environmental factors stated above. The questionnaire was initially piloted on 50 students and as a result of this exercise it was revised and refined.

Every time students used the computer to run a program they were requested to complete the revised questionnaire and return it to a “posting-box” in the computer room. A variety of programs were used all of which included features of instructional and revelatory paradigms as proposed by Kemmis, Atkin and Wright (1977). All students were allowed to experience individual and group use, as well as supervised and unsupervised use. No time limit was imposed for completion of the questionnaire, however the following protocol was adhered to:

  • no conferring was permitted when responding;

  • the questionnaire had to be completed immediately after using a CAL program;

  • the students completed the questionnaire anonymously and were only required to state at which stage they were in their nursing program.

Results

The following results were obtained from the respondents (n = 110). Table 1 indicates students' preferences for one of two conditions, namely using the computer alone, or with other students.


Students' Preferences in the Use of CAL in Relation to the Number of Users

Table 1:

Students' Preferences in the Use of CAL in Relation to the Number of Users

As may be seen from Table 1 the majority of students (56.4%) stated a preference for using the computer with their peers. It was noted that the student group, on average, constituted no more than three students per terminal. Whereas less than a third of the respondents (31.8%) preferred to use the computer alone. The reasons which the students gave for selecting the conditions stated in Table 1 are outlined in Table 2. There were numerous reasons given, which on examining the data, were found to be quite clearly conceptually linked. Therefore, it was decided to collapse the data into the categories shown below. It should also be noted that over 4.5% of the respondents thought that the nature of the program would not determine their preference for use, while 7.3% did not express any preference.


Students' Reasons for Stated Preference in Relation to the Number of Users

Table 2:

Students' Reasons for Stated Preference in Relation to the Number of Users

The overwhelming reason given for preferring to work with other students was that they could collaborate and work together through the program. Whereas the majority of those who preferred to work alone stated that this was due to the self-paced nature of CAL. When considering their opinions in terms of supervision the majority of students (52.7%) stated that they preferred to be supervised whereas just over a quarter (26.4%) indicated an orientation to unsupervised use. This is shown in Table 3. It was also noted that 10% of the respondents stated that the need for supervision depended on the type of program being used.


Students' Preferences in the Use of CAL in Relation to Supervision

Table 3:

Students' Preferences in the Use of CAL in Relation to Supervision

The reasons given by the students in qualifying their preferences for supervised or unsupervised use are presented in Table 4, and were treated in the same manner as Table 2 in that the data were collapsed.


Students' Reasons for Stated Preferences in Relation to Supervision

Table 4:

Students' Reasons for Stated Preferences in Relation to Supervision

Two broad categories emerged in relation to supervision. The students preferred the nurse teacher to be present to help with either anticipated difficulties of computer use, such as crashing the program or to provide additional information and clarification which the computer does not provide. The unsupervised students preferred to work independently of the nurse teacher and discuss the material with their peers.

Finally the students were asked to comment on the advantages and disadvantages of using CAL as a learning resource. Once again since many of their statements were conceptually linked the data were collapsed as shown in Table 5. As may be seen from Table 5, the main advantage of CAL, as perceived by the students, is that it provides self-paced learning. Whereas the main disadvantage was perceived as non-human interaction.


Students' Perceptions of Advantages and Disadvantages of CAL

Table 5:

Students' Perceptions of Advantages and Disadvantages of CAL

Discussion

Of the students who responded by means of the questionnaire, the majority (56.4%) showed a preference for using the computer with other students. The main reasons which they gave for this was that group use provided the opportunity to discuss and compare answers with other students, and supply peer group assistance with material when individual students experienced difficulties. This is interesting from a teaching point of view as the authors feel that any teaching method which encourages the learner to actively participate in the learning process is to be encouraged. Furthermore they stated that using CAL with others helped to engender a sense of teamwork. Thus using CAL appeared to encourage feelings of social cohesion and peer support within the group. Since students are expected to work in a multi-disciplinary team, CAL may also have something positive to offer in the development of interpersonal skills, if used in a group setting.

On the other hand, 31.8% of students stated a preference for using the computer alone, the main reason given for this was the ability to progress through the material at their own pace, rather than that dictated by the teacher or their peers. This serves to underline one of the main tenets of CAL, that is it is self-paced and allows students to work through the material in their own time. It also provides the students opportunity to have more control over their own learning experiences. A number of students indicated that they found working on their own less distracting than working with others and that it removed peer group pressure, which they found inhibiting. This serves to highlight the ability of CAL to provide for varying types of learning preferences, in that it may be used either alone, or in groups. We have found that the best way to cater for all choices is generally to allow students free access to the CAL facilities and to choose the optimum number of users for themselves.

Several students stated that they preferred feedback on their individual performance rather than group performance and this was mainly mentioned in the context of revision work. This seems reasonable as students who are reviewing areas of knowledge deficit would rather establish this without their deficit being made public to their peers.

Prentice and Kenny (1986) stated that their students preferred supervised use of CAL as they would frequently disagree with an answer and require further explanation. We found that 52.7% of students also opted for supervised use, not because of disagreement or need for an arbiter. Rather they felt that a nurse teacher should be present to discuss material covered in the program, when difficulty was encountered or to provide alternative explanation for specific points. This serves to highlight the students' perception of the role of the teacher which was mainly consultative and facilitative rather than supervisory. They also stressed that the presence of the teacher be non-obtrusive. It was interesting to note that students mainly depended on the teacher for the human attributes of communication and discussion, not provided by the computer. We were interested in these comments as the computer has sometimes been seen as dehumanizing (Peele 1983), and in this particular instance the use of the computer served to demonstrate the particularly human attributes which the teacher can bring to a learning environment, qualities often emphasized by humanistic educationists such as Bruner (1960) and Rogers (1969).

Some students wished a nurse teacher to be present because they either lacked confidence in computer use and foresaw possible technical problems, such as equipment breakdown or “crashing the program.” This emphasizes the need for an introduction to computers and their use, prior to formal CAL sessions, with “hands-on” experience to help gain familiarity with keyboard usage, and thus increase student confidence.

However 26.4% of students felt that supervision was not required as they thought this would encourage students to work out problems for themselves, rather than rely on teaching staff, Furthermore they felt that the function of the teacher was more appropriate to other methods of learning such as tutorials and lectures. This underlines the fact that the use of computers in an educational context does not so much affect the amount of teacher-student contact, more the nature of it. This concurs with the experience of Maddison (1982).

Ten percent of students stated that either supervised or unsupervised use was acceptable and thought that the mode of use depended on the type of program, as programs which only required a single key response such as “y” for yes, or “n” for no, were less likely to need supervised use than more complicated interactive programs. This point was made by students who used CAL both individually and in groups, in other words the type of program and level of sophistication appear, in part, to determine whether supervision is preferred or not.

In response to the request to identify the main advantages and disadvantages of CAL, the students felt that one of the main advantages was the self-paced nature of this learning tool, a point previously mentioned in relation to students' preferences for individual use. Furthermore CAL allowed the student to have a one-to-one relationship with the “teacher” in the form of the computer program. They also found the graphics in certain biological programs helpful in aiding their understanding of biological processes, which had previously been abstract or difficult to visualize. This underlines the importance of providing effective and representative graphics in such programs (Larson, 1984). The availability of CAL programs, which allowed students to run them whenever they wished, was also seen as an advantage, in contrast with nurse teachers, who due to other commitments are not always available for consultation. It is also encouraging to see students actively seek out the teacher to gain access to the computer room and utilize the CAL resources during their study periods. The students felt that some programs encouraged them to think critically by adopting a problem-solving approach to learning. With increasing acceptance of the nursing process and the necessity for student competence in assessment and evaluation skills, CAL programs which allow students to practice a problem solving approach to learning may be of value in the preparation of nurses to meet the challenge of delivering patient centered care. Programs which allow the student to practice decision making have proved popular as they see them as directly relevant to clinical practice and more challenging. In this context the students saw the provision of immediate feedback as an advantage of CAL as they could obtain information and ongoing evaluation of their performance rather than wait until each examination, where feedback is much later, and often too late. It is interesting to note that CAL can also be used to allow students to take an examination at a terminal, as demonstrated by Sweeney, O'Malley & Freeman (1982).

Students are not uncritical of their acceptance of CAL and have cited their views on the disadvantages of CAL. Many of these relate to the quality of software and have been discussed more fully elsewhere (Koch & Rankin, 1987). However, those teachers involved in the specification or writing of educational software should note the demotivating effects of poor quality programs. It behooves the nurse teacher to be aware of programs which fail to provide branching or help facilities, make use of repetitive and single key entries, present copious amounts of “on-screen” text and generally fail to tax the user (Koch and Rankin, 1987). Those students who wished supervision tended to view prior knowledge required to use a computer as a disadvantage, but as stated earlier, this problem can usually be overcome by provision of tuition and “hands on” experience. The other main source of criticism was the inability of the computer to discuss or provide an alternative explanation in comparison with teacher interaction. Some students who made this point qualified it further by saying that the CAL program helped them to identify points which they then discussed at a later date with their teacher. In this context it has proved helpful to provide students with a print out of decisions made while using the program, and use these as a basis for further discussion, (unfortunately not all programs have this function). By exposing students to CAL the strength of human interactions in the teaching-learning context were highlighted.

Conclusion

The students who responded to the questionnaire were, although generally positive in their orientation to CAL, not uncritical in their acceptance of this form of learning resource. Indeed they provided useful information, as how best to use existing CAL resources, and plan for the future, especially in the preparation of those learners who have had no previous experience of computer use. The positive attitude of students toward CAL confirms previous findings (Bitzer & Bizter, 1973; Bratt & Vockell, 1987; Koch, Guice & Ellis, 1988).

Usually CAL is perceived as a learning resource for individual use, however our study has shown that the majority of our students prefer to use CAL in groups. This would tend to belie the image of computers, which are often seen as dehumanizing. On the contrary, many of the students who used CAL, actually appeared to increase their interaction with both teachers and their peers, by discussion and peer group support. A fair proportion of the students wished to use CAL alone. This would seem to suggest that educators should allow students to be free in their choice of working alone or in groups rather than dictating the number of students around the terminal. At the same time educators need to be sensitive to those students who would rather work through a program in their own time and alone.

There is increasing research evidence to support the notion that students learn at least as well in terms of knowledge retention, when taught by CAL versus the lecture method (Conklin, 1983; Gaston, 1988; Warner & Tenney, 1985; Koch, Guise & Ellis, 1988). There is growing use of computers in nurse education and many aspects of CAL such as the programs themselves, the means of their use, the resultant effect on the role of the nurse teacher, must be evaluated in order to allow more advantageous utilization of this learning resource. It would appear that flexibility in the learning environment is the key to making best use of the resource. Students are capable of selecting the environment in which they feel most comfortable when running certain CAL programs.

Computers will not replace teachers in the classroom but the increasing use of computers in relation to CAL will challenge nurse teachers to re-examine their roles and the current teaching strategies that they adopt (Rankin & Koch, 1984). However, regardless of the alacrity of technological advances which contribute to the development of computer hardware, nurse teachers must address the need for the development of software which is sophisticated, intellectually stimulating and appropriate for nurse education. It is perhaps ironic that this research into the use of computers in education (with its accompanying connotation of dehumanization) has underlined what humanistic educators have been saying for years, that there is a need for greater flexibility and freedom in the adult teaching-learning environment. It is our contention, that used appropriately, computers can provide at least some flexibility and freedom in adult education.

References

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Students' Preferences in the Use of CAL in Relation to the Number of Users

ConditionNo. of StudentsPercentage
Use computer with other students6256.4
Use computer alone3531.8
No preference stated87.3
Either with others or alone54.5

TOTAL110100.0

Students' Reasons for Stated Preference in Relation to the Number of Users

Reasons for using CAL alonePercentage of studentsReasons for Using CAL groupPercentage of students
Go at own pace48.6Exchange/discuss ideas with others64.5
Lack of peer group pressure22.9Peer group assistance with material11.3
Less distracting31.4Engenders teamwork9.7
Feedback on individual performance20.0

Students' Preferences in the Use of CAL in Relation to Supervision

ConditionNo. of StudentsPercentage
Use of computer supervised5852.7
Use of computer unsupervised2926.4
Either of the above (dependent on program)1110.0
Failed to respond109.1
No preference stated21.8
TOTAL110100.0

Students' Reasons for Stated Preferences in Relation to Supervision

Reasons for supervised usePercentage of studentsReasons for unsupervised usePercentage of students
Alternative/better explanations60.3Encourages problem solving41.4
Anticipated problems of computer use56.9Teacher input more appropriate for tutorial/lectures24.0
Supervision only required initially10.3Less inhibiting24.0

Students' Perceptions of Advantages and Disadvantages of CAL

AdvantagesPercentage of studentsDisadvantagesPercentage of students
Self-paced learning29.0Non-human interaction14.5
Availability of programs11.0Software deficiencies14.5
Graphics helpful for biology10.0Inadequate time for CAL input in the curriculum3.6
Feedback on performance9.1Unfamiliar with computer usage2.0
Reinforce previously studied materials3.6
More challenging method of learning2.7
TOTAL65.4TOTAL34.6
Authors

Eric W. Koch, MSc, RGN, RNT is a lecturer in the Department of Nursing Administration and Education, Phillip Institute of Technology, Bundoora Campus Melbourne, Australia. James A. Rankin, MSc, RGN, CBiol, RNT, DipN is Assistant Professor, Faculty of Nursing. University of Calgary, Alberta, Canada. Richard Stewart, BSc, RGN, RNT is a tutor at Forth Valley College of Nursing and Midwifery, Falkirk, Stirlingshire, Scotland.

Address reprint requests to James A. Rankin, MSc, RGN, CBiol, RNT, DipN, Faculty of Nursing, University of Calgary, Alberta, Canada.

10.3928/01484834-19900301-06

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