Distance learning: An innovative approach to nursing education

Distance

Learning: An Innovative Nursing Education

JOE FULMER, MA, * MARYHAZARD,

Approach

to

PHD, FAAN,‘f SUSANJONES,MSN,$

AND

KATHERINE KEENE, MSN$

This article presents four views encompassing one nursing department’s experience using distance learning technology. The challenge of presenting a nursing class through distance technology is discussed from the perspective of the telecommunication faculty providing the technological support, the nursing faculty teaching the on-campus course, the off-campus nursing faculty coordinating the course at the outreach site, and the head of the Department of Nursing. Review of course grades demonstrated that off-campus students achieved higher grades than oncampus students. All students evaluated the teacher as being effecthfe; however, off-campus students were not as strong in their opinion. (Index words: Distance learning; Interactive television; Nursing education; Telecommunications; Television class) J Prof Nurs 8:289-294,7992. Copyright 0 1992 by W.B. Saunders Company

W

ESTERN KENTUCKY in Bowling

ing distance

learning

Green,

University

(WKU),

KY, is a pioneer

technology

to educate

in us-

nurses in

western Kentucky. In April 1975, WKU received a request from the nursing staff and administration of Oswensboro-Daviess County Hospital, Owensboro, KY, for courses leading to the bachelor of science in nursing degree. Owensboro, 70 miles from the main campus, is the third largest city in Kentucky, with a population associate

of 50 thousand. degree

nursing

The city is served by one program

that graduates

ap-

proximately 25 associate degree nurses each year. The nursing leaders of Owensboro expressed the need for more baccalaureate-prepared

nurses in the region.

At

*Associate Professor and Producer/Director, Media Services, Western Kentucky University, Bowling Green, KY. tprofessor of Nursing and Head, Department of Nursing, Western Kentucky University, Bowling Green, KY. *Associate Professor of Nursing, Western Kentucky University, Bowling Green, KY. SAssistant Professor of Nursing, Western Kentucky University, Bowling Green, KY. Address correspondence and reprint requests to Dr Hazard: Department of Nursing, Western Kentucky University, Bowling Green, KY 42101. Copyright 0 1992 by W.B. Saunders Company 875%7223/92/0805-0009$03.00/O

f@@Mi of PrOfeJsiOOnalNursing,

the time Nursing

of the request

the WKU

was in the planning

sion, 2-year program

in nursing

the request for an outreach tional priority nursing

Department

of

stage for an upper diviand could not meet

program.

The first educa-

was to provide an accredited

on-campus

program.

In December registered

1979, the baccalaureate

nurses was granted

initial

the Board of Review of the National

program

for

accreditation

by

League for Nurs-

ing. Interest in having a baccalaureate program in Owensboro continued. In summer 1980, the WKU Department of Nursing surveyed the registered nurses in Owensboro and the surrounding counties. Survey results demonstrated the need for baccalaureate education and a desire by nurses in the area to pursue the baccalaureate degree in nursing. There were 535 registered

nurses

with a diploma

the Owensboro

or associate

area. Of this number,

they were interested in enrolling further their nursing education. Department

of Nursing

degree

in

153 indicated

in part-time study to In 1984, the WKU

admitted

the first class into

the Owensboro outreach program leading to the bachelor of science in nursing. Equivalent high-quality nursing education on and off campus was the goal of the WKU nursing faculty. Faculty

believed

that academic

should

be maintained

wished

to duplicate

standards

in the outreach the on-campus

and quality program

and

curriculum

as

closely as possible for the students off-campus. end, faculty felt that the off-campus students

To this should

be exposed to a variety of faculty viewpoints and expertise rather than be taught exclusively by a limited number of off-campus faculty. Considering the logistics and expense of moving faculty to students, the WKU faculty chose distance learning to help meet the goal. This article will present four views encompassing the WKU Nursing Department’s experience in using distance learning technology to provide a 3-credithour class in pharmacology. The challenge of presenting a class through distance learning technology will be discussed from the perspective of the telecommu-

Vol 8, No 5 (September-October),

1992:

pp

289-294

289

FULMER ET AL

290

nications

faculty providing

the nursing the

faculty

off-campus

ing Department distance

teaching

nursing

course at the outreach

support,

The phone

the course on-campus,

the microwave

the technological faculty

coordinating

the

site, and the head of the Nurs-

discussing

the costs and benefits

of

learning

at WKU

balloon

site one evening

campus

at the off-campus

teaching

in Owensboro

into the telephone

an instructor

dents

by television

Owensboro.

activities

at Bowling

Green.

for The

site see and hear the in-

structor

via television

and may ask questions

ticipate

in discussions

via a conference

and par-

telephone.

This backup link with the

when a metallic

struck a transformer

KY,

the usual instructional

a class at the main students

off-campus

involves

a class in Owensboro,

while conducting

system develop problems.

should

building.

helium

and wiped

Class contin-

ued like an old time radio show, with the instructor

Telecommunication Faculty’s Perspective Distance

backup

phone line was the only communication

out power in the off-campus

learning.

teaching

line serves as an audio

The

gathered

around

Videotape

tape is also a backup

and the off-campus the

conference

recording

majoring

Bowling equipment,

an undergraduate

in broadcasting

Green

in

or VHS

possibility.

After 2 to 3 weeks training, dent

phone

on J/d-inch

stu-

system.

establishes

The

operates student

the return

the entire sets

up the

audio from Owensin setting

up

the off-campus students, but they can hear their comments through the conference telephone. Therefore, learners are dispersed, not truly distant. WKU’s Tele-

the monitor and conference telephone, operates three cameras, three mikes, and switcher during class, and shuts down the system when finished.

the the

communications

From the telecommunication faculty’s perspective the major difficulties instructors face include: ( 1)

faculty and students

at the on-campus

Center

began

site cannot

its distance

see

learning

program in August 1984. During the past 6 years 23 classes have been telecast by microwave from Bowling Green

to Owensboro,

including

chemistry,

English,

boro, assists the person

stu-

learning to look directly into the camera whenever they are talking to the off-campus class, (2) remem-

management, geography, and twelve nursing classes, for a total of over 1,000 hours of instruction. Nursing

bering

classes represent

ing to depend

courses, length.

with

more than 5 1 per cent of the televised each class averaging

2 to 4 hours

in

The originating site is a normal-size classroom containing up to 30 individual side-armed desks and the necessary television equipment. Two color cameras move on remote pan/tilt heads. One camera covers the instructor,

blackboard,

maintains comments

coverage of the Bowling Green students’ and questions. A third camera (mounted

overhead

and maps,

and beside the instructor’s

etc, and the other

podium)

in Owensboro

to include

the off-campus

cussion and question-and-answer on aural,

rather

students periods,

in the disand (3) hav-

than visual,

feedback

from the off-campus students. The Telecommunications Center staff feel that some improvements would enhance the distance learning setup. These include a return video signal from Owensboro allowing twoway video and audio communication and a facsimile machine in each classroom handouts and materials.

to provide rapid transfer of

On-Campus Faculty’s Perspective

is used

for reproducing pictures, outlines, transparencies, and small items. The output of this camera goes to a 25-inch monitor in the front of the on-campus classroom and a cuts-only switcher for feeding the Owensboro outreach classroom. The class in Owensboro watches the class on a 25inch monitor. Their questions and responses are sent back to Bowling Green through a portable conference set. The Bowling Green class hears what is happening in Owensboro through an identical conference telephone set placed behind the instructor. No television return from Owensboro to the on-campus site in Bowling Green exists at this time. Students at the off-campus site can see the instructor and the oncampus class, but the instructor and on-campus students can not see them.

Using modern technology to teach a 3-credit hour course in pharmacology simultaneously to nursing students 70 miles apart is a demanding but rewarding experience. Ingredients blended to provide quality instruction include careful planning, effective communication skills, flexibility, and a consistent method of presenting the material and evaluating the performance of students. PLANNING

Organizational skills, with attention to detail and previous planning, are essential for teaching a course using distance learning technology. The method prohibits the instructor from procrastinating and waiting hours before the class to engage in preparation. For

DISTANCE LEARNING

example, shown

291

a decision during

before the scheduled media obtain

regarding

class must

the audiovisual

be made at least

class. This allows ample time for

services to contact the copyright a release to broadcast the material.

outs for the class must be developed off-campus teaching

site at least

a class via distance

learning

that previously

were not clearly

transmitted

the television

camera.

transparencies

was transcribed

information overhead

visible

class.

and the limitations information

onto light

lettering,

to the off-campus

of

on the

blue paper

semester

perspective.

with the off-campus

after this visits,

and it is

that the visit be made as early in the

as is feasible. FLEXIBILITY

are not perfect,

Technical

difficulties

the teaching-learning flexible

and adapt

occurrences.

to these infrequent

For example,

The malfunction

occurred

On the average,

less than

an explanation

of how the system works, with an orientation to equipment, especially the cameras, is advantageous for both the students and the instructor. An explanation presented by faculty from the Telecommunicafor interaction

between

Organizational skills . . are essential for teaching a course using distance learning technology.

is not

while holding

delivered

a telephone

shortly

must be

unpredictable

one instructor

students

via the

lecture

technology

can occur and interrupt

process. The instructor

2?&hour

The instructor must constantly use communication skills that reinforce that the off-campus students are part of the class. Initially,

perfect.

which made the

camera.

tions Center sets the stage both groups of students.

always improves

recommended

Just as humans

site

COMMUNICATION SKILLS

an integral

students

and interaction

for the first time, used transparencies

Necessary

Communication

When

to the off-campus

due to the size of the lettering

l-inch

holder and Any hand-

classroom and the class from the student’s

and mailed to the

3 days before

it was discovered

using approximately

to be

1 month

a

receiver.

before class began.

one class per semester

is

plagued with technical problems. It is wise to prepare an alternate learning experience, such as a take-home project or group work, that can be substituted in both classrooms. Students off-campus feel left out of the class if the instructor continues to teach the oncampus

students

undermines an integral

when

the transmission

the outreach students’ part of the class.

perception

fails.

This

of being

One’s teaching style needs to be adapted to the situation. Walking while talking is curtailed due to the limitations imposed by the microphones and cameras. Due to the time involved in interacting, a slight decrease in the amount of materials covered has been noted.

l

Because eye contact is a basic skill in communication, the instructor must remember to look directly at the camera in the rear of the room when addressing students on the off-campus site. Also, calling the unseen students by name transmits respect and decreases Human nature directs us to turn depersonalization. toward sound when spoken to; however, this move-

CONSISTENCY

The instructor’s goal has been to provide a consistent course for both the on-campus and off-campus students. The same course objectives, weekly quizzes, and examinations are given to all students. Examinations and quizzes are graded by the same faculty and returned to all students 1 week after taking the tests. This rapid turnaround requires speedy grading, prompt postal service, and frequent conversations between the on- and off-campus faculty.

ment would be very distracting when teaching because the students’ voices come from behind the in-

The grades earned by the 50 students completing the 3-credit hour pharmacology course during the last 2 years are shown in Table 1. No generalizations can

structor. At least once during the semester the instructor invites a guest lecturer for the on-campus site and travels to meet the off-campus students. These visits are extremely meaningful. The instructor not only meets and interacts with the off-campus students, but the experience allows the instructor to evaluate the

be made due to the limited sample size. The preliminary results of this pilot study indicate that the offcampus students achieved higher grades, with 92 per cent receiving As and Bs compared with 72 per cent of the on-campus students receiving As and Bs. It is interesting to note that the off-campus students earned fewer Cs and Ds than the on-campus students.

FULMER ET AL

292 The on-campus sitywide

instructor

teacher appraisal.

participates Each student,

off-campus,

is given

the opportunity

instructor’s

teaching

effectiveness

several statements

including

is an effective teacher.” students

agreed

that

teacher; however, strong

in a univerboth on- and

to evaluate

the

by responding

to

“Overall,

the off-campus

On-Campus

Appraisal: Overall, My Is an Effective Teacher Off-Campus

(N = 24)

SA

A

U

D

SD

SA

16 67 7

a 33.3

0

0

0

a 333

A

(N = 26) U

D

SD

0

0

0

Abbreviations SA. strongly agree, A, agree, U, undecided, disagree, SD, strongly disagree

D.

my instructor

As illustrated

in Table

the instructor

Instructor Instructor

2.

TABLE

2, all

was an effective

students

were not as

in their opinion.

Off-Campus Faculty’s Perspective

N %

control,

and

the process

16 677

for dealing

with

technical

problems. Although

the WKU

has had almost learning

1,000 hours experience

technology,

is a new experience learning

Telecommunications

technology

class by television for the nursing can present

Center

with distance and telephone

students.

Distance

an impersonal

me-

dium. The challenge for the nursing and telecommunication faculty is to understand how the student is affected by distance learning, to minimize the disadvantages,

and to highlight

Students are initially uncomfortable with distance learning technology. Discussion between on-and-off campus

class groups

discuss a question

faculty

dent off-campus

faculty

ing coordinator

between

member

m

.

who serves as ongo-

the off-campus

process

as needed

dents or on-campus faculty. In addition to the orientation

students

and

by the stu-

to the distance

learn-

ing process provided by the on-campus faculty, students in Owensboro are oriented to the “nuts and bolts” of the equipment in the off-campus classroom. Off-campus students’ class participation increases after familiarization with the phone hook-up, volume

1.

before deciding faculty.

have chosen to have a resi-

the students with a “live” faculty member to answer questions, assist with the equipment, and facilitate

TABLE

themselves

Students and repeat often will

the off-campus students achieved higher grades . , .

the on-campus faculty. The off-campus faculty initially meets each distance learning class, presenting

the teaching-learning

difficult.

the advantages. .

nursing

among

if they wish to ask the on-campus

USER FRIENDLY

WKU

is especially

may need to move closer to the microphone themselves to be heard. Outreach students

Grades Earned Two Classes Off-Campus Students (N = 24)

by Students

in

N

%

N

A B

9 13

37.5 54.5

12 8

for questions

and pauses in the lecture

%

46 31

C

1

4

3

11.5

cl

1

4

3

11.5

by on-campus

faculty decreases the problem. Interaction is enhanced when on-campus faculty personalize the interaction by addressing the outreach students by name or by directing specific questions to students based on their expertise. As a product of requesting information or clarification of class or examination materials in writing, off-campus students have increased their ability to formulate clear and concise written documentation of their point of view. Thus, limitation in verbal interaction

has increased

SATISFACTION

On-Campus Students (N = 26)

Grade

Off-campus faculty encourage the students to state their points clearly and distinctly. Frequent requests

their written

skills.

OF THE LEARNER

The number of distance learning courses a student takes, the number of hours the course entails, and whether the course is team taught seems to affect the satisfaction of the learner. In the authors’ experience, 3-credit-hour lecture courses taught by a single faculty member and coordinated by off-campus faculty are received the best. Students become more frus-

DISTANCE LEARNING

293

trated when course variables faculty,

lecture

hours,

such as multiple

or lecture

components

increase.

the Bowling

Green and Owensboro

to presenting

course with clinical

clude

effort on the part of

attributed

A concerted

an organized

and off-campus

student

class session or $825 per semester.

teaching

to on-

rental,

learning

by doctorally and minimal

search of the literature articles

were identified. nated

University

in England

British example,

Open

on distance

at the University

University

and it began

1971 (Moore,

distance

faculty

in nursing

education

origi-

of London.

is probably teaching

partment

was conducted,

learning

has allowed

doctorally

prepared

The

prepared

faculty.

would be unable at the outreach

The department

audiovisual

for presentation

to

so that a per-

courses are taught

Without

this, the de-

to have doctoral-prepared

site.

of nursing

has used this medium

of both theory

and clinical

courses.

From one to three courses have been offered each se-

the best-known

its first students

in

mester

since the inception

“open learning”

is

material

for the clinical

1987). In England,

be

the department

faculty

centage of both on- and off-campus

Nursing Administrator’s Perspective

could

and other costs.

maximize

A computer

salary that

the course or the costs incurred

the course such as printing,

Distance

needs.

of faculty

to teaching

in teaching

faculty is essential

course responsive

the proportion

This does not in-

the fastest growing area of education, and nurse educators have considered distance learning for meeting the learning needs of nurses (Clark, 1989). In Canada, the University of Ottawa School of

of the program.

Didactic

courses is presented

route, and either a part- or full-time based in Owensboro is responsible teaching on site.

via this

faculty member for the clinical

Nursing offered courses on the Telephone Distance Education Network beginning in 1983 (Du Gas & Casey, 1987). In 1980, the University of Alberta be-

People are the key to success in distance learning. These include motivated students, full- or part-time faculty at the outreach site for clinical supervision and liaison, flexible on-campus faculty, and knowledge-

gan distance learning which now has been expanded to multiple sites (Kerr, 1987). In the United States,

able telecommunications personnel. course requirements, quality control,

distance

sessment are critical.

learning

technologies

Chico State (McIntosh,

have

been

used

at

1984), Boise State University

(Spitzer, 1989), and Northern Michigan University (Kech, 1987). Nursing programs at Weber State College in Utah (Parkinson & Parkinson, 1989) and Ball State University in Indiana (Arndt, 1990) also have used distance learning. Distance learning provides an opportunity to meet the needs of place-bound

registered

class. Rather

than spending

in as-

These measures can be developed

or nationally

standardized

examinations

may be used.

People are the key to success in distance learning.

nurses who desire

a baccalaureate degree in nursing. Teaching students in multiple locations allows for small classes at a variety of sites to be combined

by faculty,

Consistency and outcome

to make a cost-effective time on the road, faculty

have more time for the essentials: teaching, scholarly activity, and service. WKU nursing faculty are proud to contribute to the pool of professional nurses in western Kentucky, and distance learning technology helps make this a reality. The initial cost exclusive of the microwave system used by WKU was approximately $40,000. The initial costs for a two-way television are between $200,000 and $300,000. This is a more ideal system because it allows both audio and video feedback for the instructor. Costs that must be calculated per course include the hourly rate for the operator and costs for the monthly phone bill. For a three-credit course, the operating costs are approximately $55 per

One of the prime advantages ing university

courses available

not otherwise

be able to pursue

The majority

of the system is makto students studies

of the authors’ students

who would at this level.

work full-time,

have families, and are place-bound. Many come to class after a full day of work and after caring for their family. Consistent with reports in the literature (Parkinson, 1989; Arndt, 1990; Boyd, 1987, Paulet, 1987), students find it a definite advantage to have classes in their home community.

Summary Nursing education needs to continue to explore both remote and interactive teaching projects. Interactive communication presents both potential and promise for meeting the needs of distance learning.

284

Removing

FULMER ET AL

the barriers

to the baccalaureate

ter’s degree for registered cost-effective

nurses is still a problem.

way to deliver

active television.

Television

and mas-

courses is through teaching

A

inter-

is a team effort,

both

sites.

active television Television lenge

expanding

cess; a cordless mike,

mechanisms

the front of the instructor,

and a fascimile

machine

at

information

for the benefit

changes

for using of nursing

need to be made

Some of these include

and computer

instruction

to administrators,

and planning is the key to success. WKU has made several changes to enhance the teaching-learning proaudio from the phone moved to

Additional

funds become available.

linkage

provides faculty,

as

inter-

between

sites.

an exciting

chal-

and students.

The

age beckons communication

us to consider technologies

and nurses.

References Arndt, M. J. (1990). Nursing education via the airwaves. N~lrse Educator, 15(l), 10. Boyd, N. J., & Baker, C. M. (1987). Using television to teach. Nursing and Health Care, B(9), 523-527. Clark, E. (1989). Learning at a distance. NWW TimeJ, 85, 69-71. Du Gas, B., & Casey, A. (1987). Teleconferencing. Canadian Nurse, 83, 22-25. Kech, J. (1987, February). Distance education with interactive television in northern Michigan. Unpublished paper presented at AECT Conference, Atlanta, GA. Kerr, J. (1987). History of off-campus programs and distance education at the University of Alberta. Alberta Association of Registered Nwses Newsletter, 43(3), 19-20. McIntosh, D. K. (1984). Interactive distance learning

technologies. Educatmal and IndmtrmL ‘IY~CZ~IJI~IN. lh(8). 47-48. Moore, M. G. ( 1987). Universrty distance education ot adults. Techological Trends fhv Lraders & Education crnd Trarnq. j?(4), I 3- 18. Parkinson, C., & Parkinson, 5. ( 1989). A comparattve study between mteractive television and tradittonal lecture course offerings for nursing students. NuninK 6 HKa/th Carr, If)(g), 499-502. Paulet, R. ( 1987). Counseling distance learners. T&VZW logiicll Trends fhr Leaders & Education and Education Tralnirq. Z(4), 26-28. Spitzer, D. ( 1089. July). Computer-medtated conferring and distance education. Unpublished paper presented at AECT Conference, Atlanta, GA.