Our society is in the midst of a technological revolution that touches every aspect of our lives. The use of technology for education is no longer a matter of choice; it has become an expectation. Most of the innovative ideas associated with education in the past decade have involved technology, most notably, Web-based learning applications.
The emergence of a new pedagogical application known as virtual communities has generated increasing interest among nurse educators because of the potential to frame nursing in a way that is realistic and relevant to all learners. One prototype of virtual communities is known as The Neighborhood. The original vision of The Neighborhood was to facilitate student-centered learning by providing context to nursing concepts and to reduce excessive content load common to nursing curricula (Giddens, 2007).
Innovations in education are challenging for multiple reasons. Gaining initial support for developing what seems like an unusual idea, implementing the idea, and then diffusing the idea takes a great deal of vision, persistence, and faith. The scholarship of teaching and learning supports the notion of educational innovation, but innovative ideas must be followed by outcomes assessment.
The rapid rise of interest in virtual communities has resulted in a need for outcomes-based evaluation. Because virtual communities are literally in an infancy stage of pedagogical development, little is known about actual learning outcomes associated with the application. It is important that nurse educators critically appraise such applications; gaining an understanding of what and how students learn from virtual communities should precede rapid expansion in this area. This article reports initial outcomes associated with students’ perceived benefits related to this teaching modality.
Description of The Neighborhood
The Neighborhood is a virtual community involving the stories of 40 featured characters within 11 households and 4 health care agencies. The characters represent individuals from various cultural groups across the age, health-illness, and socioeconomic spectrums, as well as the nurses who treat them. Household characters typify an array of health-related issues representing biophysical and psychosocial problems correlating to the incidence and prevalence in population groups.
Six nurse characters include inpatient staff nurses, a community-based geriatric nurse, a school nurse, and an advanced practice nurse. These nurse characters depict issues common to professional nursing practice. All character stories—along with a Neighborhood newspaper—unfold weekly for three academic terms. Stories are enhanced further with photos, video clips, and medical records.
There is little in the nursing literature about the use of virtual communities for nursing education. Giddens (2007) described the features and purpose of The Neighborhood and the expected uses and benefits for nurse educators and learners. In a follow-up article, Giddens (2008) described the potential value of virtual communities to the education of diverse learners because of the multicontextual linkages they represent.
Another virtual community, known as Stillwell, recently has been developed by a nurse educator at the University of Cumbria, in the United Kingdom. This project has many features similar to The Neighborhood (i.e., multiple characters in a community enhanced by medical records, photos, and videos); however, the educational focus is specifically for nurse practitioner students (University of Cumbria, 2007).
Nurse educators from Ohio State described the process undertaken to develop a virtual community known as Mirror Lake. This virtual community features 165 people in 62 households, a medical complex, a retirement center, and a skilled care facility (Curran, Elfrink, & Mays, 2009). Similar to The Neighborhood, medical records and community facts are provided for enhanced learning. One of the foundational assumptions described by the authors is the need to know the patient. It is assumed that the characters and families within the Mirror Lake community provide a deeper connection to understanding the patient than can be gained through traditional case study.
Skiba (2007) described Second Life, another type of virtual world, as a Web-based technology with the potential to facilitate learning within nursing education and health care education. In Second Life, users take on a life within the virtual world through an avatar (a virtual person that represents the computer user). The avatar interacts with other avatars and situations within the Second Life community.
A perceived benefit to learners using Second Life is that it represents a user-generated application as opposed to a user-passive perspective because of the avatar interactions. Skiba (2007) commented on the distractions within Second Life as being similar to those users might experience when surfing the Web. Second Life also requires significant technological development and maintenance because of the complexity of the interactions.
Because The Neighborhood is a new innovation to which few comparisons can be made, the initial intent of the researchers was simply to solicit initial feedback from students related to their perceived benefits using The Neighborhood. Two general research questions were addressed in this study.
The first research question was: Are there differences in perceived benefits among students using The Neighborhood based on self-reported demographic characteristics? Because The Neighborhood represents a multicontextual application that in theory supports the learning needs of diverse learners (Giddens, 2008), we anticipated underrepresented minority students would have stronger preferences compared with Caucasian students.
The second research question was: Do the perceived benefits among students increase during three successive academic terms of using The Neighborhood? One of the assumed benefits of using a virtual community application such as The Neighborhood is the enhancement of learning because it occurs over time. This argument links to the notion of knowing the patient, previously described by Curran et al. (2009). For this reason, we anticipated the benefits reported by learners would strengthen over time.
This descriptive and comparative study involved a convenience sample of undergraduate students enrolled in a baccalaureate nursing program in a southwestern university using The Neighborhood as a teaching application across the curriculum. The study underwent human subjects review and received institutional review board approval.
The sample included six cohorts of undergraduate nursing students who were enrolled in the first through third terms (levels 1, 2, and 3) taking junior- and senior-level upper-division nursing courses between the spring 2006 and spring 2008 terms (N = 248). Students attended classes on three campuses: main campus (n = 216) and two rural campuses (n = 32). Rural campus students completed the identical curriculum as main campus students; most of the courses were delivered via interactive television from the main campus.
After each of the three terms, study participants completed a written evaluation survey of The Neighborhood. The survey included questions about general demographic characteristics, including gender, age, ethnicity, and previous degree, as well as students’ expected course grade. Students evaluated the virtual Neighborhood by answering eight questions using a 5-point Likert scale (1 = low, 5 = high), with a potential score range of 0 to 40. Cronbach’s alpha for the scale was 0.89.
The survey questions asked students how interesting they found the stories, whether they felt the stories extended their learning, whether they were helped by connecting character problems to course concepts, and the extent to which they searched for references to better understand the conditions experienced by the characters. Additional questions asked about the frequency of The Neighborhood use within class assignments, the regularity and frequency of use by students, and linkages within the stories across course content at different levels within the curriculum. There also were four open-ended questions for qualitative student feedback.
Surveys were collected by the course instructors around the same time students were completing end-of-term course evaluations. Completion of the survey was voluntary and anonymous; course faculty submitted completed surveys to the research team.
To avoid any potential bias, data management and analysis were completed by an experienced researcher not involved with the development of The Neighborhood. Data were analyzed using SPSS version 16 software (SPSS Inc, Chicago, IL). Data analysis included checking for assumptions of parametric statistical analysis, using a t test to determine differences in student responses based on demographic variables, and using analysis of variance to determine the significance of changes over time by level.
Results of data analyses are reported for both the overall sample and division levels. A total of 695 student surveys from 248 students within six cohorts were collected during the study (not all participants completed all three surveys). Demographic characteristics the statistical analysis results are shown in the Table.
Table: Student Demographics and Data Analysis Results for the Eight-Item Neighborhood Scale
Between traditional students (those younger than age 24) and older students (those age 24 and older), older students had greater preferences overall and in three specific areas. These three areas were the degree to which students found the stories interesting, the extent to which they searched for references to better understand the conditions experienced by the characters, and the regularity with which students used The Neighborhood.
Although there were no differences overall between main campus and distance site students, there were statistically significant differences in preferences, with main campus students finding that the character stories were more interesting and that The Neighborhood helped them understand patient conditions better. The distance site students used The Neighborhood more often, and they also saw relationships between course concepts and The Neighborhood concepts more often.
There was no difference in preferences between students with previous degrees and traditional students, nor were there differences between men and women. When students who expected a course grade of A were compared with those who expected a grade lower than an A, there was no difference overall between the two groups; however, there were statistically significant differences for two individual questions. The group expecting lower than an A reported more perceived benefits from using The Neighborhood, t(379) = 2.05, p = 0.041, and a greater perception that The Neighborhood helped them by connecting character problems to course concepts, t(379) = 2.18, p = 0.03.
Students who self-reported their ethnicity as Caucasian were compared with students who self-identified their ethnicity as a traditional minority group. Minority students reported more benefits overall (Table) and in four specific areas related to interest in the characters and how The Neighborhood helped them understand concepts.
The prediction that students would perceive increased benefits from The Neighborhood with each successive level was partially met. In this sample, students perceived increased benefits between levels 1 and 2 but not between levels 2 and 3.
Although the demographic data reported by this student sample reflected the demographics of the student body in the nursing program, there is a higher percentage of missing data than is typically reported in research surveys. Also, because student identifiers were not included on the survey, it is impossible to track individual respondent results across levels; results here are based on aggregate-level data, which significantly limits interpretation of the findings.
Another significant limitation was the lack of standardization in how The Neighborhood was used within and across courses, leading to great variability in actual teaching strategies used and faculty assigned to teach the courses. Because there were differences in instructors at each level, it is impossible to know to what extent the perceived benefits were due to the quality of the instructor using The Neighborhood, the virtual community itself, or a combination of both. It also is possible that faculty became more skilled with its use the longer The Neighborhood was available.
Because of these limitations, interpretation of findings is difficult. In addition, the sample represents one nursing school in the Southwest; therefore, it is unknown whether the findings can be generalized to nursing programs in different regions with a different demographic mix or to other types of academic programs based on size, degrees offered, or focus (e.g., private, state funded). The fact that statistically significant differences were found among some variables, most notably minority student characteristics and students’ expected grade in the course, provides initial confirmation of the claim that multicontextual applications (such as The Neighborhood) support the learning needs of these learners and is consistent with findings reported by Ibarra (2001).
The unfolding of stories over time allows for a different level of exposure and different context of content for students; it is possible that the increase in perceived benefits over time (between levels 1 and 2) reflects students’ awareness of what they are learning because of links made between classroom content and clinical experiences to character stories. This represents a constructivist process, whereby the learner makes conceptual connections and restructures previous knowledge, leading to deep understanding (Fosnot, 2005).
The results showing the greatest gains were made between the first and second terms may be related to the fact that students spent more effort focusing on learning how to use The Neighborhood and on learning about the characters in the first term than in the second term, when they were more familiar with the characters and therefore more focused on content applications. The true impact of the learning over time can best be determined in a more robust study involving multiple schools and in which student data are matched. However, the fact that statistical significance was found in this sample of students provides justification for further study so that these findings can be better understood.
Because virtual communities are emerging, they represent a fertile area for future educational research. The number of possible research questions is endless, but ultimately, research questions should focus on evidence of student learning and outcomes associated with teaching practices.
The survey used in this study included four open-ended questions. A significant amount of qualitative data exist, requiring analysis in the context of the qualitative measures as well as the evaluation of individual cohorts; however, the reporting of these results are beyond the scope of this article.
The next steps in this program of research include expanding data collection to multiple sites and expanding the research efforts to focus on learner engagement, the impact on integrative approaches to learning, differences in outcomes based on learning styles and preferences, effects and benefits for learners in both onsite and distance courses, and the impact of virtual communities on faculty satisfaction and worklife. In all cases, a need for stronger fidelity in how the application is used will need to be addressed in future studies.
- Curran, C.R., Elfrink, V. & Mays, B. (2009). Building a virtual community for nursing education: The town of Mirror Lake. Journal of Nursing Education, 48, 30–35. doi:10.3928/01484834-20090101-03 [CrossRef]
- Fosnot, C.T. (Ed.). (2005). Constructivism: Theory, perspectives and practice (2nd ed.). New York, NY: Teachers College Press.
- Giddens, J.F. (2007). The Neighborhood: A web-based platform to support conceptual teaching and learning. Nursing Education Perspectives, 28, 251–256.
- Giddens, J.F. (2008). Achieving diversity in nursing through multicontextual learning environments. Nursing Outlook, 56, 78–83. doi:10.1016/j.outlook.2007.11.003 [CrossRef]
- Ibarra, R. (2001). Beyond affirmative action: Reframing the context of higher education. Madison: University of Wisconsin Press.
- Skiba, D.J. (2007). Nursing education 2.0: Second Life. Nursing Education Perspectives, 28, 156–157.
- University of Cumbria. (2007). Soap opera gives an insight into the future of nurse education. Retrieved from http://www.cumbria.ac.uk/AboutUs/News/Research%20News/Nursing%20soap%20opera.aspx
Student Demographics and Data Analysis Results for the Eight-Item Neighborhood Scale
|Variable||No. Surveys||tTest & ANOVA Results|
| <24||220||t(375) = −2.32, p = 0.021|
| Missing data||320|
| Female||353||t(391) = 0.71, p = ns|
| Missing data||304|
| Main campus||605||t(695) = 0.25, p = ns|
| Branch campuses (2)||90|
| Missing data||0|
|Type of student|
| Traditional||307||t(391) = 0.60, p = ns|
| Missing data||304|
| White||228||t(393) = −1.80, p = 0.035*|
| Missing data||302|
|Expected course grade|
| A||211||t(379) = 1.75, p = ns|
| Less than A||168|
| Missing data||316|
|Neighborhood scale by level||F(2, 695) = 3.72, p = 0.025; Post hoc Scheffe results:|
| Level 1||248||Level 1 versus level 2: significantly different|
| Level 2||215||Level 1 versus level 3: not significantly different|
| Level 3||232||Level 2 versus level 3: not significantly different|