Distance education is an increasingly popular means of providing post-RN baccalaureate education. Distance education provides an efficient means of reaching nurses separated from educational institutions by geography or other circumstances that make face-to-face instruction difficult. One of the objectives of post-RN baccalaureate education is to change nurses' attitudes and values from a technical, hospital, and illness orientation to a broader, health-oriented, professional perspective. This process of professional resocialization in a university program is facilitated by a number of factors present on campus: the academic milieu, frequent personal contact with faculty and students, availability of many human and scholarly resources, and exposure to a variety of new ideas and experiences. Because distance education provides limited contact with faculty and isolates the student from the institution and other students, it might be predicted that the professional resocialization process is less effective from a distance.
As part of a larger qualitative study on the distance learning experience of 24 post-RN nursing students taking distance courses in Nursing Issues from Canadian universities (Cragg, 1990), the students' responses reflecting learning and attitude change were analyzed. Subjective reports of distance learning were collected from students of four universities using two different approaches to providing distance education. The responses were analyzed to determine whether professional resocialization occurred and whether different distance delivery methods produced different responses.
Nurses are particularly appropriate targets for distance education. They live throughout the country, in the most remote locations as well as in university centers. Most are employed in hospitals and are shift workers. The overwhelming majority are women, and working women often have family responsibilities that make it impossible to relocate. In Canada, with its scattered population, long distances between educational sites, and harsh winter climate, distance education oners many attractions for institutions seeking to increase accessibility to post-RN baccalaureate education and for nurses who want to upgrade academically.
While distance education offers many advantages, it is important to assess the effectiveness of both general and specific distance methods in achieving educational objectives. Apps (quoted by Coggins, 1986) noted that distance educators were good at providing technical learning, but not so good at teaching other aspects. Nursing educators hope that a paradigm shift will occur among post-RN students so that they will see the world from a new and different perspective (Duff) 1989). It may be questioned whether a paradigm shift can be accomplished through the isolated conditions of distance education.
Approaches to Distance Education
Two major approaches to distance education have been identified (Barker, Frisbie, & Patrick, 1989; Calvert, 1986; Hohnberg, 1983). The first seeks to simulate the circumstances of the face-to-face classroom as closely as possible. Instruction is aimed at the group. Students meet together and can interact electronically with the distant instructor and other groups of students. Discussion, questions, and spontaneous interaction are all possible. The time is fixed because all participants must be present. Audioteleconferencing, where the teacher is linked by telephone lines to groups of students at a number of distance locations, is an example of this approach.
The other approach to distance education is aimed at the individual learner. Several teaching strategies may be used, and students may choose to meet together to study, but the focus is on the individual studying alone at his or her convenience. The correspondence course, with written materials supplemented by audio and/or video tapes and telephone conferences, is an example of this approach.
Nursing baccalaureate programs have tended to use the technology already in use in their universities to provide distance education. As a result, both individual- and group-oriented approaches are used by different Canadian universities to teach similar nursing content. In the study, two of the universities, identified as A and B, used the group-oriented simulated classroom approach by audioteleconference. Universities identified as C and D used the individual-oriented correspondence approach.
Many resources are currently devoted to developing distance education programs for nurses, but research into the consequences of teaching nurses at a distance is just beginning. It seems reasonable to assume that the learning experience will differ with differing approaches. Teleconference has the advantages of some direct peer contact and regular opportunities for interaction with faculty. Individualized correspondence study removes the constraints of time and place that shift nurses find so difficult. Beyond convenience, it is important to discover the factors that contribute to a positive learning experience, and whether students in professional courses like Nursing Issues are becoming professionally resocialized.
Nursing Issues was the course selected for the study because the curricula in all Canadian university post-RN nursing degree programs include courses on nursing trends and issues. They are theory courses that seek to enhance the practitioners' understanding of the scope of nursing, to promote positive attitudes toward the profession and its organizations, and to encourage students to become more active members of the profession. These courses are a means of promoting professional resocialization of students who have already been socialized as members of the nursing profession.
Professional Socialization and Resocialization
On entering nursing school, whether in a hospital, community college, or university, the student nurse becomes part of the process of professional socialization. Much of the work on professional socialization has been conducted on nurses. A transformation in behaviors and attitudes occurs in the metamorphosis from lay person to full-fledged member of the profession (Atkinson, 1983). Much of the early work on socialization of nurses occurred within the context of educational institutions preparing new practitioners (Oleson & Whittaker, 1968; Simpson, Back, Ingles, Kerckhoff, & McKinney, 1979). There are also reports of the resocialization that occurs when the student must adapt to the realities of the workplace (Kramer, 1974).
One view of professional socialization is that a series of transformations occur as the neophyte becomes a student, a graduate, a practitioner, and a specialist. Professional socialization is a process, rather than an outcome (Conway, 1983). Hinshaw (1977) points out that resocialization of nurses occurs not only when they return to school, but also when they take refresher courses, get specialist training, enter the job setting, and change positions.
RNs in the baccalaureate program are part of such ongoing professional socialization. They have already been socialized as nurses, through the educational process and assimilation into the workplace. With baccalaureate education, they are expected to become part of the professional segment within the mass of nurses (Throwe & Fought, 1987).
Woolley (1978) argues that post-RN education attempts to achieve more than just an increase of knowledge or gaining university credits. "Instead it is a whole behavioral change - in their attitudes, role and functions" (p. 103). However, she acknowledges that not all post-RN students are willing to make the desired changes.
Among the attitudes that could be anticipated are positive feelings about baccalaureate education, a respect for nursing theory and research, and a broadening of perspectives on the place and scope of nursing in society. Degree programs promote leadership and an interest in professional issues, demonstrated by reading of professional literature, active participation in professional organizations, and actions to promote a more positive image of and greater influence for the profession.
Lawler and Rose (1987), studying professional orientation and educational preparation among graduating students from generic, associate degree, and post-RN programs found that the post-RN graduates scored consistently higher than the other two groups on professionalism scales and showed less professional role dissonance. They speculate that this is because the workplace is a significant site of socialization and that post-RN students, having worked, begin as more fully socialized. They also point out that the returning RN is "more mature, committed, self-directed, and wiser in the ways of the world" (pp. 21-22) and may therefore be more "ripe for socialization to the professional role" (p. 22).
Krouse (1988), studying post-RN and associate degree students concluded that the RN baccalaureate students had more attitudes in common with generic baccalaureate graduates than with the community college students they had once been. Lynn, McCain, and Boss (1989) found that greater changes occurred among generic students over the course of the baccalaureate program than among post-RN students. The RN students, however, started out closer to the referent group of faculty.
A number of factors have been identified as important in the professional socialization process. Certain influences foster the acquisition of attributes of the socializing group. Among these are the institution, teachers, peers, and the workers in the profession (Bucher & Stelling, 1977; Oleson and Whittaker, 1968). After studying 250 nursing students in four generic baccalaureate programs to determine if there was a correlation between their perceptions of environmental influences and their development of professional identity, Dalme (1983) concluded:
Since the student's perception of faculty and staff nurses seems to be related to professional identity development, there is a need to have the student associate with faculty and staff nurses who demonstrate excellence in the practice setting and who can serve as appropriate role models (p. 137).
Isolation within a limited social context and development of a common vocabulary have also been identified as part of the process of developing professional attitudes and identity (Lum, 1978).
While resocialization of post-RN baccalaureate students is acknowledged to occur in face-to-face classes, some have expressed concern that distance education may hamper the process.
The traditionalists argue that only by having students physically together for a period of time, usually several years, can a sense of professional ethics and commitment to a particular philosophy of the profession be developed. On the other hand, there is the argument that such socialization can better occur if students are learning within their community and the organization in which they will be working (Farrell & Haughey, 1986, p. 34).
Carey and Peruniak (1982) acknowledge the problem. "Socialization [into baccalaureate thinking] . . . will not occur quite as thoroughly with reduced group work in courses and reduced exposure to faculty" (p. 61). Rogers (1986) reports changes in attitudes in courses from the Open University in Britain, but concludes that these changes depend on the face-to-face group discussions included in the courses. Gray (1980), reviewing her experience with post-RN students and her reading, calls for more research:
We have assumed that the role models of the faculty, the climate of the university campus, the access to the library, and the interaction of students all contribute to professional socialization, but do they indeed? (p. 18).
While concerns have been raised, no research on the resocialization of distance students in nursing has been reported.
Telephone interviews were conducted with students who had been enrolled in Nursing Issues courses offered by four Canadian universities. Universities A and B offered their courses by audioteleconference; universities C and D provided distance education by print-based correspondence, supplemented with tapes and telephone conferences. Six distance students from each university were interviewed in telephone conversations that lasted from 50 to 90 minutes. All were enrolled in baccalaureate degree programs requiring a half course in Nursing Issues. Semistructured interviews explored the students' demographic, educational, and professional backgrounds, their experiences in the course, learning strategies, and learning. Open-ended questions were followed up by more specific probes on relevant subtopics. The interviews were taped and the transcripts were analyzed using methods outlined by Strauss (1987) and Miles and Huberman (1984).
Results and Discussion
All the students interviewed were women. All had experience working as registered nurses. Most were general duty nurses in hospitals. Others worked in community health, supervision, and inservice education. Half were employed part-time. Except for two students at University D (correspondence), all were part-time students. Their ages ranged from 25 to 55 years, with the majority in their 30s. All the teleconference students and 7 of the 12 correspondence students were married. All but five respondents had children who ranged in age from infancy to adulthood. Taking the course by a distance method did not mean that the respondents lived far from the university. At University A (teleconference) and University C (correspondence), the majority of the students lived within 1 hour's commuting time.
The students' responses to questions about their experienees demonstrated more commonalities than differences among the four schools and the two approaches to distance education. There was evidence that the students all knew more about professional issues. Of particular interest were the feelings the respondents expressed about the nursing profession, the amount of interest they showed in professional organizations, and the opinions they expressed about certain topics like the baccalaureate entry to practice, nursing theory, and nursing research. The majority of respondents expressed attitudes congruent with the positions of professional organizations. They reported that their attitudes were changing as a result of the course and degree program.
Because of the greater opportunities to interact regularly with faculty and student peers, one could anticipate greater evidence of attitude changes in teleconference students than in correspondence students. In fact, there were few differences. The differences that were identified among the schools of nursing were based less on the method of instruction than on the personality of the professor and/or the perceived attitude of the institution toward its distance students.
Some of the students' experiences after taking the course are described below.
* Many respondents reported that they felt more positive about the profession of nursing and their place in it.
* Others saw that the profession had weaknesses and was not living up to their ideals. Increased awareness sometimes led to anger, disappointment, and feelings of impotence.
* Several reported that as a result of the course, they had become more active in professional organizations, joining, going to meetings, and participating in activities like political lobbying.
* Some respondents mentioned specific changes in their attitudes toward such issues as baccalaureate preparation as entry to practice, the image of nursing, and the place of nursing theory and nursing research.
* Some reported that they gave patient care differently, performing different mental processes in decision-making and spending more time teaching,
* A few of the nurses said that they finished the course with the same viewpoint as before they started the degree program. Often they attributed this lack of change to a well-fixed professional identity that preceded enrollment in the program.
Because many of the respondents had been working as nurses for a number of years and some of them were already active in professional organizations, they might have acquired professional attitudes before entering the degree program (Krouse, 1988). Their decision to enroll in a baccalaureate program may have been a manifestation of such attitudes.
Minimal changes to professional attitudes reported by some students are also consistent with Woollens (1978) contention that not all students will make the changes desired. As they spoke, however, some who reported little change acknowledged that they did feel differently about some issues or that they were likely to change as time went on.
The peer group is an important factor in socialization. Members of a group who have undergone professional socialization tend to associate with professional peers. For many of the students, the professional peer group had changed. They were met with hostility or indifference from community college or hospital graduates who were not involved in studies. They therefore tended to turn to nurses who were taking courses or already had their degrees. This new peer group could provide the students with support when they had problems, or be a sounding board for the new ideas they were discovering. Thus, the attitude of the group they were leaving drove the students into a new subgroup. Seeking out these people was more difficult for correspondence students who did not have the built-in group the weekly audioteleconference provided.
Members of a professionally socialized group also share a common language (Lum, 1978). Several of the respondents talked about acquiring a new vocabulary, which sometimes set them apart. They also made jokes using the new vocabulary, indicating that they and the interviewer belonged to a group that would understand.
It can be questioned whether all the attitude changes reported were genuine. The respondents may have been expressing what they thought a representative of the nursing education establishment would want to hear. Even if this were the case, they were all aware of the desirable answers.
Several of the students, particularly in the correspondence courses, recognized the danger of indoctrination that Perraton (1981) and Rumble (1986) have identified as problems with distance education. The limitation of points of view provided by the student-teacher interaction and the teacher's choice of readings were raised as potential problems by students in correspondence. One student identified this unease as a reason for preferring teleconference with its built-in sharing of a variety of points of view. If correspondence students do not trust that their teachers are presenting a balanced perspective, they may feel trapped by their limited interaction. Attitude change may be an objective of a distance course. However, the change should be based on a thorough understanding of the options available.
This research dealt with only a small segment of the nursing population of Canada who are taking courses by distance education. The small convenience sample means that, although a number of commonalities were found within and among groups, the findings cannot be readily generalized to other courses or to other universities. Only women were interviewed. While women constitute the overwhelming majority of nurses, the male perspective is lacking. The telephone interview technique probably diminished the depth of some of the responses. Without visual cues, it was more difficult for the interviewer to establish trust and to pick up on nuances. All the data are subjective, from the viewpoint of the respondents, and the analysis may show the biases of the researcher. Some trends are indicated by the data, but application to any other situations must be approached with caution.
Distance education provides access to baccalaureate degree programs to nurses who would otherwise be cut off by the constraints of distance or life circumstances. Despite limited interaction with faculty and students, the students in both audioteleconference and correspondence courses were influenced by their studies to assume the attitudes, values, and behaviors of professional nurses. It seems that distance education can play a part in the resocialization of professionals.
It is important that distance educators in nursing recognize the influence of baccalaureate-prepared nurses in the communities where distance post-RN students live and support their participation in the resocialization process. Distance educators should also ensure in course planning that students are exposed to a range of opinions and points of view so that the choices and changes students make are based on balanced knowledge, not indoctrination.
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