Recent advances in computer technology offer several advantages and opportunities that can be incorporated into teaching and learning strategies. Nurse educators can take advantage of these technologies and create materials for course delivery. Students who participate in courses incorporating these elements have the opportunity to acquire computer-based skills which are increasingly important in today's health care environment (Kooker & Richardson, 1994; Patterson, 1992).
Four existing graduate (master's degree) courses in nursing administration (two clinical, one theory, and one financial management) were revised to incorporate several computer-based elements. These revisions focused on contemporization of the course content to reflect the rapid evolution in the field. They also reflected faculty belief in seven principles of learning which have particular relevance within the context of adult education.
Review of the Literature
The principles that guided faculty through course design and revision promote educational strategies that build on the students' intrinsic motivation to learn (Keller, 1987), foster the students' active involvement in the learning process (Fulford & Zhang, 1993), and are complemented by immediate and constructive interactive feedback (Gagne, 1984; Levengood, 1987).
These principles are summarized as follows:
* Intrinsically motivated learning enhances the learning process. Intrinsically motivated learning is linked to factors such as self-efficacy, the perception of personal control, and the perception of relevance (Keller, 1987).
* The relevance of learning must be emphasized. This increases learner confidence with the information and promotes satisfaction with personal performance (Keller, 1987).
* Student interaction (real or perceived) is fundamental (Fulford & Zhang, 1993).
* Instructional interactivity, which gives the learner some control over the pace and sequence of instruction, should be maximized (Levengood, 1987).
* Time should be allowed for the elaboration of information. This increases recall and makes information more meaningful (Gagne, 1984).
* Feedback needs to be both immediate and delayed. Feedback (immediate) to incorrect responses, which is directed to the correction of misconceptions, is more essential than to correct responses (delayed) (Gagne, 1984).
Current electronic technology includes telecommunication strategies, the electronic classroom (including e-mail), computer-assisted and computer-mediated instruction (Antunano, 1993; Clark, 1993; Parks & O'Shea, 1995). A recent metaanalysis summarizes the recent advances in this field (Cohen & Dacanay, 1994). Several recent studies have focused on the experiences of studente educated within these new educational designs. Cragg (1994) studied graduate nurses enrolled in a computer-mediated conference course. Cragg (1994) found that the degree of frustration experienced by students was directly related to satisfaction and success and recommended that a strong technical support and advisory system was essential if computer-mediated distance learning was to be a successful teaching-learning mode.
Russell, Miller, and Czerwinska (1994) evaluated the use of computer-assisted instruction as a strategy for teaching the principles of epidemiology. Students indicated that this learning strategy, which was very relevant for the field of practice, was a particularly effective method for dissemination of the content. Donabedian and Donabedian (1993) reported similar findings among senior nursing students enrolled in a study of the diagnosis and management of breast cancer.
A computer-based tutorial for teaching nursing financial management concepts (Edwardson & Pejea, 1993) provided students the opportunity to experience the manipulation of data spreadsheet programs. This report clearly acknowledges the need for increasing computer sophistication and competencies among students of this discipline. This theme is strongly endorsed by Anderson, Dobal, and Blessing (1992) in their discussion of decision making and the planning process within the context of a course in nursing administration.
Interactive Learning. The learning principles dictated a focus on student interaction with the learning process. Incorporating the available electronic technology enabled increased student control.
Pre-Course Elements: Support for Intrinsically Motivated Learning. Tutorials were developed on the use of email, preparation of a document for electronic transmission, uploading and capturing e-mail documents, and use of spreadsheets. Any or all of the tutorials are available to students 3 weeks prior to the first class day on disk or via e-mail. The course syllabus, all course problems, and course examinations are also available on disk 3 weeks prior to the first class day. Students can peruse the material or begin work on it before formal instruction begins, if they so choose. All local students have an e-mail account. E-mail serves as the primary method of communication between faculty and student.
A computer-assisted instruction (CAI) package was developed for financial concepts. The CAI is a totally interactive package which contains questions and practice problems for each financial concept. The CAI enhances student control and decreases anxiety because it can be practiced as many times as the student feels is necessary. In addition, this package is available for students to use on their personal computers. Students are not necessarily constrained by lack of access to shared computer facilities.
Emphasizing the Relevance of Material to be Learned. Classroom lectures were replaced with seminar discussions focusing on the work experiences of students and faculty. The seminar content is based on questions that have been raised in the students' work environments and on questions that have been previously distributed via the e-mail distribution list for general (electronic) discussion.
Elaboration of Information and Student Interaction. Students are in contact with faculty and other students via e-mail at all times between formal class meetings. The e-mail questions sent to faculty by individual students are rephrased by faculty to include directions on how one might think about resolving the issue. This material is then e-mailed, using a distribution list, to the entire class, after individual identifiers have been removed. All students then participate in the discussion of resolutions to these problems. The faculty member responds to each comment, providing feedback and reinforcement. This current process could be enhanced by the use of conferencing software, which would reduce faculty time involvement in generating the communications.
Faculty have also used a fax machine to promote the involvement of a distance learner without an e-mail account. All faculty and student communication was faxed to this individual. The student's replies were posted to the rest of the class for a response.
The interactive seminar format, including two-way video conferencing for one course, was substituted for the lecture format as the primary method of in-class instructional activity. Class seminars allowed for reinforcement of concepts and the elaboration of information through discussion of student e-mail questions, questions from readings, and questions derived from the students' actual practice within their employment settings. Seminar discussions include citations from recently published articles on administration and financial management and World Wide Web sources. Web sources, found by both faculty and students, are distributed electronically.
Feedback: The Reinforcement of Learning and the Correction of Misconceptions· The CAI, which is an elaboration of administrative financial concepts, provides immediate feedback. The CAI package contains links to assist students as they move through the problem-solving strategy. The looping of concepts provides opportunities for immediate feedback and support to students who are unsure of the content. Each correct and incorrect answer generates a narrative response. The response reaffirms the concepts that led to correct answers and attempts to amend the thinking that led to incorrect responses. As nursing administration currently requires knowledge of financial management concepts, the CAI can be used in all courses for either remedial work or part of an assignment.
E-mail provides the opportunity to receive individual responses to questions within a matter of hours (immediate feedback). The weekly seminars (delayed feedback) provide opportunities to enhance and reinforce content.
The electronic classroom is used to review any course assignment including the use of a spreadsheet. Faculty participate in this learning laboratory by reviewing the students' spreadsheet problems and offering suggestions for improvement.
To enhance student control, examinations and course requirements may be submitted to faculty at any time before the due date. Examinations for financial management may be completed at home and saved on a disk. A disk and a hard copy of the students' work are submitted to faculty. Personalized responses can then be prepared (using a text box imbedded at the appropriate point in the students' work) and returned to students on that same disk. Students' clinical logs and all papers and examinations may be submitted electronically for faculty to immediately review online or at a later time. Feedback is inserted directly in the file, and the document is e-mailed back to the student.
At the time these courses were in development, less than 20% of students reported ownership of personal computers. The School of Nursing received funding to establish an electronic classroom so these innovations in course design could be introduced. The changes were implemented gradually as student computer literacy increased, and the number of students with home computers increased to 100%.
It is difficult to compute the time and resources dedicated to the development of these courses because faculty contributed their personal and professional effort to the project. However, it is known that more than 300 hours were required for development of the CAI module.
To date, each of the classes has been delivered a minimum of four times, with approximately 10 to 12 students enrolled in each class. Evaluations from both faculty and students indicate that the course revisions were worthwhile. Students, especially those who are only able to do their assignments at late hours or on weekends, report they are more productive because they receive answers to their questions in a timely fashion. Those with family responsibilities report that not having to go to campus to use the electronic classroom or to submit assignments is a distinct advantage. Students reported they felt that no one had an unfair advantage in examinations, as all questions on an examination are clarified and distributed electronically.
Students also report that they have much more faculty-student communication, and some reported that their learning had been personalized to their needs. They also reported a discernible increase in their computer literacy. The student who did not have an e-mail address was at a distinct disadvantage, and using a fax machine for communication with this student was less efficient and more costly.
These graduate (master's degree) courses in administration were contemporized to incorporate fundamental computer-based skills that would be expected of graduates in the real world of work. Principles of adult learning offered a philosophical foundation that gu'ded course development and revision. Course delivery strategies demonstrated creativity and innovation in the application of these principles within contemporary course design. Using tutorials, faculty were able to accomplish these revisions with minimal technical support. Students mentored one another, which is appropriate within the context of adult learning.
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