Online Nursing Education: General Impression
It is evident that nursing education embraces online
teaching and learning and integrates technology use from a broad and diverse curricular perspective. The adoption of online nursing education is well-
established, with mechanisms for evaluation described in the literature. However, with the research conducted thus far, it is difficult to make straight
comparisons and draw definitive conclusions, as the studies are diverse, lack depth of focus, or are often fragmented due to the breadth of research
Populations of Interest. The predominant populations of interest are graduate students at the master’s level or students in
baccalaureate completion programs. Traditional prelicensure students are the second most often studied population, followed by nursing faculty. Of the
entire dataset, nursing faculty was a nominal population of research interest, with representation in a mere six of 36 articles (Tables A–
C). Students at the doctoral level were the least studied student population. At least seven studies integrated populations of interest, and
the authors found that this complicated their report of findings. An overall comparison of the populations of interest reflects inconsistent levels and
depth of the population description (Caudle, Bigness, Daniels, Gillmore-Kahn, & Knestrick, 2011; Hall, 2010; Johnson, 2008; Kavanaugh et al., 2009). The broad, and sometimes nonspecific, description of populations makes it
difficult to compare similar populations or delineate differences across diverse populations.
Focus of Evaluation. Similar to the populations
of interest, the overall focus of evaluation practices in online nursing education is diffuse with pockets of focus at different levels of inquiry and
domains of learning. In regard to what is evaluated in online nursing education, the primary emphasis in the empirical literature has been on the affective
domain of learning, with student satisfaction, perception, preference, and experience with the online environment central to inquiry. Researchers are
largely interested in student engagement with perception of community, connectedness, and social presence, as well as factors that best promote these
attributes to influence student-perceived learning and satisfaction.
The context of the online learning environment was explored in almost half of
all of the empirical studies (Tables A–B). Of
these, only one provided a comparison between the online learning environment and the classroom learning environment (Hart & Morgan, 2010). In that study, the researchers examined the outcome of student attitudes toward academic integrity and
cheating within the different learning environments.
Another central focus of evaluation is the effectiveness of educational practices or
instructional strategies within the online environment, and it is sometimes compared with traditional teaching–learning environments. In eight of the
studies, the authors described instructional strategies to develop an online course, integrate concepts or programs through online delivery, or develop an
online program (Kavanaugh et al., 2009; Kelley & Klopf,
2008; Kidd, Morgan, & Savery, 2012; Leners et
al., 2007; Manning & Frisby, 2011; McDonald &
Walters, 2009; Robbins & Hoke, 2008; Zsohar &
Smith, 2008). Two studies lacked focus on delivery of online education and were about how to augment standard instruction with the use of
technology (Rutledge et al., 2008; Xu, Martin, & Gribbins,
2010). In addition, teaching strategy effectiveness tends to dominate the evaluation focus within the theoretical and descriptive literature
when compared with the empirical literature. Consistent with what Billings (2007) described as the “no
significant difference comparison” phenomenon (p. 122), researchers continued to report similar comparative studies (Guzic et al., 2012; Wells & Dellinger, 2011), despite past recommendations for
future research. Student and faculty experience with content delivery, activity integration, and overall use of technology in the delivery of online
education was most prevalent in the descriptive literature.
Method of Evaluation. Used across the majority of quantitative empirical studies
was a consistent evaluation method of descriptive and inferential statistical analysis based on established valid and reliable scales and questionnaires.
This method of evaluation was most often coupled with a researcher-developed survey or evaluation (Table
B). Of the established valid and reliable scales, the Social Presence Scale and Classroom Community Scale were the most often utilized.
Mayne and Wu (2011) performed the only study that emphasized the educational practice of active
learning, which included a standardized scale and questionnaire. Examples of other standardized instruments, scales, tools, or questionnaires reflected
across quantitative studies were the Social Presence Scale, the Satisfaction Scale, the Organizational Climate for Caring Questionnaire, the Donald-McCabe
Academic Integrity Scale–Modified, Rovai’s Self-Report Classroom Community Scale, the Social Presence Questionnaire, the Cultural Diversity Questionnaire
for Nurse Educators, the Inventory for Assessing the Process of Culture Competence–Revised, Kolb’s Learning Style Inventory, and the learner–interaction
Of the qualitative empirical studies, interpretive analysis was the primary method of evaluation and proved to be the most consistent method of
evaluation across the entire set of articles reviewed. When compared with the empirical literature, the theoretical and descriptive literature had the most
inconsistent method of evaluation. Generally, the lack of specificity by the study authors and the reliance on individual course evaluations specific to a
particular study limits the generalizability or ability to replicate and expand findings to an empirical level.
Use of Theories, Models,
Frameworks, and Best Practices. Similar to the populations of interest, foci of evaluation, and method of evaluation in online nursing education, the
use of theories, models, frameworks, and best practices lacks continuity and reflects a broad sweep of adult learning theories. A reference to theories,
models, frameworks, or best practices is not exclusive to one particular type of study. Rather, application of these theoretical underpinnings was evident
across all empirical studies, both qualitative and quantitative, as well as the theoretical and descriptive literature. Within the qualitative literature,
examples of either theoretical underpinning, philosophical assertion, or best practices included the framework of student socialization by Weidman et al.
(as cited in Holley & Taylor, 2009) and recommendations for telephone focus groups by Krueger and
Casey (as cited in Reilly et al., 2012), with the general references to theories of student
socialization, hermeneutics (Gadamer & Heidegger, as cited in McIntyre et al., 2013), Bloom’s
taxonomy, and community of inquiry and social presence disciplines and paradigms (Table A).
Examples of theoretical frameworks, learning theories, or best practices across quantitative studies included Benchmarking Best Practices in Web-
Based Courses (Billings et al., 2001), evaluating educational uses of Web-based courses, multimedia
theory, Galland’s and Drinan’s model of academic integrity institutionalization (as cited in Hart & Morgan,
2010), uses and gratification expectancy model, the constructivist theory of learning, Paivio’s dual coding theory (as cited in McLain et al., 2012), Campinha-Bacote’s conceptual model of cultural competency (as cited in Reneau, 2013), Kolb’s learning styles (as cited in Smith,
2010), Seimann’s connectivism theory (as cited in Vogt et al., 2010), and the
learner–interaction model. In addition, general references to problem-based learning, social presence theory, and general, adult, experiential, and
transformative learning theories were noted. Benchmarking Best Practices in Web-Based Courses (Billings et
al., 2001) and Mayer’s multimedia theory (as cited in Carpenter et al., 2013; Vogt et al., 2010) were the only theories or models referenced more than once (Table B).
Specific examples of learning theories, models, or best practices across the
theoretical and descriptive literature included the model of online collaboration by Palloff and Pratt (as cited in Cully & Polyakova-Norwood, 2012), the stages of critical thinking skill development by Elder and Paul (as cited in Guhde, 2010), Kolb’s experiential learning theory (as cited in
Kavanaugh et al., 2009; see also Manning & Frisby, 2011), seven principles for using
technology for good practice in nursing education, the constructivist approach, Lewin’s change theory (as cited in
Kidd et al., 2012), benchmarks and best practices for online nursing education (Leners et al.,
2007), adult learning theory, constructivist pedagogy, problem-based learning, characteristics of an exemplary online course by Hooper and
Harmon (as cited in McDonald & Walters, 2009), Campinha-Bacote’s cultural competence model (as cited
in Rutledge et al., 2008), and the cooperative model of nursing education (Table C).
The constructivist theory of learning and Kolb’s experiential learning theory (Kardong-Edgren & Emerson, 2010; Kavanaugh et al., 2009
; Kidd et al., 2012; McDonald & Walters, 2009
; Manning & Frisby, 2011; Smith, 2010) were
the most referenced learning theories. This is significant for online nursing education because these theories emphasize student-centered learning. It is
important to note that the theories, models, and frameworks used by the researchers of the studies evaluated largely reflected and supported the affective
learning domains, with minimal emphasis on evaluation of cognitive learning domains.