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The role of open learning in nurse education. Does it have a place?
Article
The role of open learning in nurse education. Does it have a place? Farnaz Heidari, Kathleen Galvin
Farnaz Heidari MSc, BSc, RM, RGN, Research Fellow, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK. Tel: +44-1202-504182; Fax: +44-1202504-194; E-mail: fheidari@ bournemouth.ac.uk Kathleen Galvin PhD, BSc, RGN, Reader in Research, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK. Tel: +44-1202-504182; Fax: +44-1202504-194 (Requests for offprints to FH) Manuscript accepted: 19 June 2002
A perceptible shift has begun, away from mass lectures towards more flexible, novel and adaptable methods of teaching and learning. A variety of terms (open, distance, flexible) have been used to describe such instructional methods, a key characteristic of which is that they do not require constant and/or synchronous contact between teacher and learner. This paper explores students’ views of a distributed learning initiative within a University in the South of England. The initiatives were in response to increase in the number of students in each intake which was just one of the recent changes called for by the Government. This evaluation consisted of a longitudinal research project following two cohorts of nursing students (n=288) through the first two years of their education (and will continue in the final year). The study assessed the perceived influence of distributed learning (DL) on their academic education and professional training as well as their satisfaction with the workbooks. The evaluation used a mixture of qualitative and quantitative data collection, questionnaires and focus groups. DL was seen as a flexible way of studying for students. Students were able to study a topic area at their own pace and at a time convenient to them. The activities in the workbook stimulated discussions and triggered ideas and thoughts for both students and lecturers. With the commencement of the workbooks lecturers were given the opportunity to reflect on their teaching styles and were encouraged to utilise a number of different teaching and learning methodologies. ª 2002 Elsevier Science Ltd. All rights reserved.
Introduction and background literature Central government has called for the development of a culture of life-long learning for health professionals. ‘A First Class Service’ (Department Of Health 1998) argues for Continuing Professional Development (CPD), where higher education providers and local education consortia will have a key role in CPD advancement, including innovative approaches to work based learning. The government pledged to work with professional and educational bodies to explore a range of practical issues, including the role of technology and distance learning in maximising learning opportunities and customising the process (DOH 1998). Some of
0260-6917/02/$ - see front matter ª 2002 Elsevier Science Ltd. All rights reserved doi:10.1016/S0260-6917(02)00133-8, available online at http://www.idealibrary.com on
these innovations have also begun to be introduced in pre-registration nursing education in order to familiarise and accustom nurses from the early days of their training. A perceptible shift has begun, away from mass lectures towards more flexible, novel and adaptable methods of teaching and learning. Open learning has therefore opened up access for many rural or place-bound students (Carr 1999). A variety of terms (open, distance, flexible) have been used to describe such instructional methods, a key characteristic of which is that they do not require constant and/ or synchronous contact between teacher and learner. According to Mcmanus and Lyne (1992) open learning has not been brought into
Nurse Education Today (2002) 22, 617–623 617
Does open learning have a place in nurse education?
mainstream nurse education and was initially used for ‘problem’ areas in nurse education such as conversion and return to practice courses and those who could not access traditional methods of study (Clark & Robinson 1994). However, Le Var (1992) advocated that open learning will not remain a peripheral occurrence but will have a major role in nursing, midwifery and health visiting education in the future. The use of open learning is now filtering into both pre and post-registered courses and as with conventional teaching quality materials, quality teaching and quality administration systems are necessary (Young et al. 1999). These have implications for faculties and universities that need to be recognised. In the universities investigated by Young et al. (1999) none were found to have an administration system which could meet the needs of both conventional and distance learning systems. Nevertheless Robinson and Shakespeare (1995) stress the need to have the ability to work both within conventional and open learning methods. It equips students with capacities for life-long learning and transferable skills to become independent learners. A workbook accompanied most modules in the first two years. Lectures were replaced by seminars and workbooks on alternate weeks. All students were given workbooks that complemented the seminars and needed to be completed before the seminars. This paper explores students’ views of a DL initiative within a University in the South of England. The initiatives were in response to increase in the number of students in each intake which was just one of the recent changes called for by the Government. The University decided to use the terminology distributed learning as it seemed that the workbooks used a mixture of open and distant learning approach. Therefore references from the literature were termed as open and distant and allusion to the University approach continued to be called DL. The aims of this study were: • To examine the views of students and lecturers using the DL workbooks • To investigate area of improvement identified by students and lecturers.
618 Nurse Education Today (2002) 22, 617–623
Study method This evaluation consisted of a longitudinal research project following two cohorts of nursing students ðn ¼ 288Þ through the first two years of their education (and will continue in the final year) to assess the influence of DL on both their academic education and professional training. The evaluation used a mixture of qualitative and quantitative data collection, questionnaires and focus groups. According to Robson (1993) the use of multiple methods of data collection provides a means of testing one source of data against another, suggesting that if two sources generate the same or very similar messages, they cross-validate each other to an extent. Self-completed questionnaires were used as they could reach a wider sample of students quickly and was therefore efficient in terms of researchers time and effort. One disadvantage, however, was that data could be potentially superficial and therefore by using a combination of methods (questionnaires and focus groups) more a more in-depth picture can be obtained.
Focus groups Focus groups are a qualitative research method, which use guided group discussions to generate an understanding of participants’ experiences and beliefs. One advantage of this approach is the use of the group members to generate the questions and ideas rather than the researcher or just one participant (Holloway & Wheeler 1996). They assert that the strength of focus groups is the production of data through social interaction, whereby participants build on the answers of others in the group. Findings from the questionnaires informed the focus group interviews with students and lecturers by providing some guidelines and possible starting questions. A total of seven focus groups were undertaken. The sample for the questionnaire consisted of all the students who were in the two cohorts selected making it a purposive sample. For focus groups both cohorts of students and lecturers were utilised. In an attempt to ensure that a variety of opinions about the use of DL materials were obtained, the sample for the
ª 2002 Elsevier Science Ltd. All rights reserved
Does open learning have a place in nurse education?
focus groups was randomly selected. However, the uptake by those individuals randomly picked was minimal and hence a general call was made for volunteers amongst both cohorts and lecturers. Randomisation is clearly not always successful in obtaining the range of opinion or of individual respondent types. Participants involved in the focus group interviews were invited to participate on a voluntary basis. Focus group interviews were tape-recorded and participants were reassured about confidentiality. The questionnaires were analysed using the Statistical Package for Social Sciences (SPSS). Thematic analysis was used for both the focus groups and the open questions in the questionnaire, which allowed us to identify themes and patterns in the data.
Questionnaires The study was divided into different parts following two cohorts of nursing students. During the first year of this evaluation questionnaires were used to examine students’ views about the use of DL in their training. Questionnaires can be both a qualitative and a quantitative method of data collection, depending on the type of questions asked. For this questionnaire a combination of open and closed questions were used. We devised the questionnaires after extensive study of existing instruments in the area of open learning evaluation and advice from a steering group.
Ethical considerations Ethical approval was obtained from the University’s Research Committee in accordance with the University’s procedures at the onset of the study. On its approval questionnaires were sent to all students giving full information about the study and by completing the questionnaires students were giving consent. In the second year participants were asked to come forward on a voluntary basis and full information was again provided. At the beginning of the focus groups all participants were asked if they were happy to take part in the interviews and by doing so they consented. Anonymity and confidentiality were ensured and participants were informed that they could withdraw from the study at any time. No names were used in any of the reports. Questionnaires, interview tapes and transcripts were locked in a draw and access was only available to the researcher.
Findings and discussion The content of the workbooks was generally positively evaluated as demonstrated in Table 3. The rest of the scores were from participants who were unsure about the comments relating to the workbooks. This article is mainly based on the findings from the focus groups and the qualitative findings, which can be divided into the following themes: • Advantages of workbooks • The role of the lecturer • Practical use of workbooks.
Sample size See Tables 1 and 2.
Examples of some questions were: Have you previously studied using Open or (1) Distributed Learning Materials? (2) All instructions and the path through the workbook have been clear (3) The presentation was visually attractive (4) The presentation was user friendly (5) What is your overall impression of the Distributed Learning material?
ª 2002 Elsevier Science Ltd. All rights reserved
Yes Strongly Agree
No Agree
Unsure
Disagree
Strongly Disagree
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Table 1 Response rate for questionnaires Cohorts
Number of students
Number of student completed questionnaires
Response rate %
One 215 134 62.3 Majority of participants were female (92%), between the ages of 15 and 25 (75.4%), with ‘A’ Levels or Highers (46.2%) and on the Advanced Diploma in Adult Nursing (70.1%). Two 72 46 63.8 Majority of participants were female (91.5%), between the ages of 15 and 25 (61.7%), with ‘A’ Levels or Highers (21.3%) and on the Advanced Diploma in Adult Nursing (66.2%).
Table 2 Information of focus groups Participants Lecturers Cohort one Cohort two
Number focus groups
Number of participants
2 3 2
12 19 14
Table 3 Scores for the content of the workbooks Comments Instructions clear Presentation attractive User friendly Readable and stimulating Required to participate Motivated learning Clearly explained Relevant material Adequate references Up to date references Tested individual learning
Agreed % Disagree % 53.6 45.1 63.6 52.6 47.3 24.4 50.4 63.4 88.8 70.2 38.4
30.4 41.2 20.4 26.8 0.8 15.9 23.6 10.6 5.2 6 42.5
(Reinert & Fryback 1997). The workbooks helped students learn in their own way as they all came from different work and educational backgrounds. Activities in the workbooks allowed students to reflect more on the topic area. Workbooks initiated discussions during seminars and resulted in triggering ideas and thought for both students and lecturers. Lecturers could refer to the workbooks in seminars and students revisited them at future dates. References were very useful for some students particularly for exams and assignments. Workbooks allowed students to maintain all notes on the Unit together. Lecturers also believed that if students used the workbooks they entered the seminars with some knowledge base of the subject which lead to more in-depth discussion.
The role of the lecturer Advantages of workbooks Over 80% of both cohorts of students had no previous experience of open/distance learning. Workbooks were perceived as a main part of the course. They were seen by lecturers to provide a balance approach towards self-directed study and taught sessions. As students and lecturers became more accustomed to using the workbooks they found them more beneficial. Passage of time gave lecturers more experience and hence the ability to help students use the workbooks better. Advantages of the workbooks were mentioned in particular the flexibility of the books. Students could work through the books, at their own pace, in their own surroundings and to the level and depth suited to their needs
620 Nurse Education Today (2002) 22, 617–623
Lecturers play a central role in the success of open learning course (Kelly & James 1994, Carr 1999). They can facilitate the learning concepts, opinions and facets within the material delivered, as well as promoting reflections upon practice. Participants acknowledged that lecturers had an important role in the delivery of the workbooks. Variations in the way lecturers approached the workbooks and seminars were revealed which impacted on the students’ experience. Students could identify lecturers who used the workbooks well. One student mentioned that the workbooks that she learnt more from were the ones she associated with the excellent lecturers. I do feel that the ones that have meant most have been the ones where actually the teaching’s been very good as well. The ones
ª 2002 Elsevier Science Ltd. All rights reserved
Does open learning have a place in nurse education?
that I haven’t learnt so much are the ones maybe the teaching has not been so good any way. (FG C student) Students believed that lecturers could enthuse, motivate and direct them to use the workbooks. Treistman and Fullerton (1996) assert that the learner/lecturer interaction endeavours to motivate and invigorate the learner and encourages clarification of content. All participants believed that lecturers could help students become familiar with using the workbooks. By explaining links between theory and practice lecturers could make workbooks and seminars more significant and edifying for students. This was seen as a challenge by some lecturers. Its all part of the educational process, I don’t think its wrong to actually use the material, but it just presents that challenge then to the lecturer doesn’t it, how you actually make that meaningful to students who are actually at quite a junior level in their knowledge base. (FG F staff) A major benefit for some lecturers in using the workbooks was the impact on their teaching styles. Lecturers believed that the process had made them review and think about their teaching, different learning styles, the learning process and helped them use various teaching methodologies. Its made us think about what we’re doing and I think for me it certainly has brought together a number of strands of teaching methodologies and brought them together in one place and made us think about what we’re doing. So no I don’t think it’s entirely worthless at all actually. (FG G staff)
Practical use of workbooks Students also expressed a sense of achievement when they worked through the books and completed the activities in the books. This in itself gave them motivation. . . .its nice to have something that you’ve got to go away and do and when you do sit down and do them you do feel quite pleased with yourself because you’ve done it really, because it is a little bit of
ª 2002 Elsevier Science Ltd. All rights reserved
homework, you’re quite pleased that you’ve done your homework, but that’s it really for me. That’s all I find that’s beneficial about them. (FG B student) Both students and lecturers alluded to the need for links to be made between workbooks and seminars. It was perceived that discussion in seminars were important and enhanced learning. There were difficulties experienced when the topic in the workbook was totally different to the seminar session. This led to a sense of disintegration of subject matter. Due to the amount of work needing to be covered it was not always possible for lecturers to associate the workbooks with the seminars and at times tenuous links were made with difficulties. However, students unanimously agreed that time should be given in seminar sessions to review the workbooks and the activities. There were two-week intervals between seminars that allowed students time to complete the workbooks and to find time for tutorials. Some felt this was a useful time for reflection while others found they forgot what they had done in that time particularly if they had completed the activities the same day as the seminar. That the workbooks related to practice was the strongest viewpoint that emerged from the data. Students believed that both the material and the activities would be more meaningful if they were linked to their practice or involved them finding answers and solutions from placements. Lecturers also believed that students should be asked to carry out activities in practice. However, students acknowledged that this could be difficult for some Units particularly as students were all in different placements at any one time. Students saw the number of workbooks given out simultaneously at the beginning of a semester daunting and confusing. They mentioned the possibility of the workbooks being introduced gradually over the three years. More time was given in semester one for completing the workbooks and was reduced in subsequent semesters. Lecturers agreed that not enough time was given for students to complete the workbooks, affirming the difficulties of balancing between theory and practice times.
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Yes in the first year they were manageable and we had time because we were only in practice one day and we had to do visits on one day, they were much more manageable, but in the second year hardly any time. (FG A students) A proposal made by some participants was to provide students with the outcomes of each Unit and appropriate material and allow the students to learn in their own way that suited them. Lecturers believed that students learnt through other methods themselves and more encouragement should be given to students to discover the information for themselves rather than channelling them in one direction. It was perceived that focus was mainly on the delivery of the material. Both students and lecturers expressed the need for incentives in order for students to complete the workbooks. Workbooks not being assessed were a major concern for many who believed that by making the workbook activities part of the Unit assessment it would encourage students to complete them. There was a request by most students that the workbooks needed to be reviewed so that students could be sure they were covering the correct area and completing the activities correctly. Rowntree (1992) asserts that feedback is an important feature of an open learning package and feedback on activities in particular helps the learner confirm or think again about their responses. Some lecturers also highlighted the importance of realistic assessment and examination of workbooks to ensure that students have covered the syllabus since it was felt that sections of the curriculum could be missed if students do not use the workbooks effectively. Marking the workbooks was mentioned as an option but lecturers stressed the workload consequences of this. I think essentially the reason they don’t do it is because of not being assessed on it, that’s how I perceive it, why should I do this, you’re not going to mark it. (FG F staff) Few students suggested the use of one extensive workbook, which integrates all the subjects rather than a large number of different workbooks. Also lecturers recommended a
622 Nurse Education Today (2002) 22, 617–623
portfolio incorporating the workbooks which would test both knowledge and skills, providing the books with more impetus. I’m not saying that the workbook as it is in its present form will be the form of assessment, its having the time to actually re-write a book that is say in portfolio form that’s actually going to have some meaning for them and its actually going to demonstrate to us that they understand. (FG F staff) Preparation was one of the first major requirements for students as well as lecturers who were using this method of teaching for the first time in their teaching career. Also resources were seen as a necessary component for the success of the implementation of such teaching methods as well as their continued use. For example, more books would be needed if reference was made to particular books in the workbooks. Journal articles were some times difficult to obtain hence requests were made for photocopies of articles. The participants identified some areas of improvement, which included: • Providing the outcomes for each module of study and permitting students to use whatever means to achieve the outcomes • More links between the activities in the workbooks and clinical practice whereby answers are found in placements • Activities in the workbooks to be part of the assessment for the module • Providing the DL material in other formats besides workbooks i.e., computer based • Key journal articles to be incorporated into the workbooks (where copyright and costs allow) • Improving access and resources at local hospital libraries.
Conclusion DL was seen as a flexible way of studying for students. Students were able to study a topic area at their own pace and at a time convenient to them. The activities in the
ª 2002 Elsevier Science Ltd. All rights reserved
Does open learning have a place in nurse education?
workbook stimulated discussions and triggered ideas and thoughts for both students and lecturers. With the commencement of the workbooks lecturers were given the opportunity to reflect on their teaching styles and were encouraged to utilise a number of different teaching and learning methodologies. It was clear that DL workbooks were accepted as part of adult learning but there were areas that needed to be explored and improved in order for the books to be used more effectively. These included better preparation for students and lecturers in the use of the workbooks, more links to practice, workbook activities included as part of assessment of Unit, more library access and resources and utilisation of different formats besides workbooks. Although this was a small scale study, the lessons learnt from this study are extremely useful for those delivering post-registration courses. With CPD there is a need for more innovative ways of providing courses for qualified nurses who already have pressures placed upon them. Using the listens learnt from this study other institutions can ensure some of the above measures are in place before the introduction of DL courses. Acknowledgements The authors would like to thank Professor Iain Graham, Professor of Nursing Development and Academic Head of Nursing & Health visiting, Bournemouth University and Mr Clive
ª 2002 Elsevier Science Ltd. All rights reserved
Andrewes, Practice Development Co-ordinator, Bournemouth University, for their support. References Carr K 1999 Creating an off-campus/distance learning courses for midwifery education. Journal of NurseMidwifery 44(1): 57–63 Clark E, Robinson K 1994 Open learning: the state of the art in nursing and midwifery. Nurse Education Today 14: 257–263 Department of Health (DOH) 1998 A first class service: Quality in the new NHS. DOH, London Holloway I, Wheeler S 1996 Qualitative research for nurses. Blackwell Science, Oxford Kelly J, James C 1994 The process of facilitation in open learning. Conference Paper, Nurse Education Tomorrow Conference. Durham University, Durhan Le Var R 1992 Current initiatives in open learning. Nursing Standard 6(52): 34–35 Mcmanus M, Lyne P 1992 Mainstream or margin? Open learning in the changing world of nurse education. Monograph for the English National Board of Nursing, Midwifery and Health Visiting Reinert BR, Fryback PB 1997 Distance learning and nurse education. Journal of Nursing Education 36(9): 421–427 Reinharz S 1992 Feminist Methods in Social Research. Oxford University Press, Oxford Robinson K, Shakespeare P 1995 Open Learning in Nursing, Health and Welfare Education. Open University Press, Buckingham Robson C 1993 Real World Research. Blackwell, Oxford Rowntree D 1992 Exploring Open and Distance Learning. Kogan Page, London Treistman J, Fullerton J 1996 Computer-mediated distributed learning. An innovative program design in midwifery education. Journal of Nurse-Midwifery 41(5): 389–392 Young G, Marks-Maran D, Macklin J 1999 Developing a distance learning honours degree in health promotion for delivery using the internet. Nurse Education Today 19: 488–494
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The role of open learning in nurse education. Does it have a place? Farnaz Heidari, Kathleen Galvin
Farnaz Heidari MSc, BSc, RM, RGN, Research Fellow, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK. Tel: +44-1202-504182; Fax: +44-1202504-194; E-mail: fheidari@ bournemouth.ac.uk Kathleen Galvin PhD, BSc, RGN, Reader in Research, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK. Tel: +44-1202-504182; Fax: +44-1202504-194 (Requests for offprints to FH) Manuscript accepted: 19 June 2002
A perceptible shift has begun, away from mass lectures towards more flexible, novel and adaptable methods of teaching and learning. A variety of terms (open, distance, flexible) have been used to describe such instructional methods, a key characteristic of which is that they do not require constant and/or synchronous contact between teacher and learner. This paper explores students’ views of a distributed learning initiative within a University in the South of England. The initiatives were in response to increase in the number of students in each intake which was just one of the recent changes called for by the Government. This evaluation consisted of a longitudinal research project following two cohorts of nursing students (n=288) through the first two years of their education (and will continue in the final year). The study assessed the perceived influence of distributed learning (DL) on their academic education and professional training as well as their satisfaction with the workbooks. The evaluation used a mixture of qualitative and quantitative data collection, questionnaires and focus groups. DL was seen as a flexible way of studying for students. Students were able to study a topic area at their own pace and at a time convenient to them. The activities in the workbook stimulated discussions and triggered ideas and thoughts for both students and lecturers. With the commencement of the workbooks lecturers were given the opportunity to reflect on their teaching styles and were encouraged to utilise a number of different teaching and learning methodologies. ª 2002 Elsevier Science Ltd. All rights reserved.
Introduction and background literature Central government has called for the development of a culture of life-long learning for health professionals. ‘A First Class Service’ (Department Of Health 1998) argues for Continuing Professional Development (CPD), where higher education providers and local education consortia will have a key role in CPD advancement, including innovative approaches to work based learning. The government pledged to work with professional and educational bodies to explore a range of practical issues, including the role of technology and distance learning in maximising learning opportunities and customising the process (DOH 1998). Some of
0260-6917/02/$ - see front matter ª 2002 Elsevier Science Ltd. All rights reserved doi:10.1016/S0260-6917(02)00133-8, available online at http://www.idealibrary.com on
these innovations have also begun to be introduced in pre-registration nursing education in order to familiarise and accustom nurses from the early days of their training. A perceptible shift has begun, away from mass lectures towards more flexible, novel and adaptable methods of teaching and learning. Open learning has therefore opened up access for many rural or place-bound students (Carr 1999). A variety of terms (open, distance, flexible) have been used to describe such instructional methods, a key characteristic of which is that they do not require constant and/ or synchronous contact between teacher and learner. According to Mcmanus and Lyne (1992) open learning has not been brought into
Nurse Education Today (2002) 22, 617–623 617
Does open learning have a place in nurse education?
mainstream nurse education and was initially used for ‘problem’ areas in nurse education such as conversion and return to practice courses and those who could not access traditional methods of study (Clark & Robinson 1994). However, Le Var (1992) advocated that open learning will not remain a peripheral occurrence but will have a major role in nursing, midwifery and health visiting education in the future. The use of open learning is now filtering into both pre and post-registered courses and as with conventional teaching quality materials, quality teaching and quality administration systems are necessary (Young et al. 1999). These have implications for faculties and universities that need to be recognised. In the universities investigated by Young et al. (1999) none were found to have an administration system which could meet the needs of both conventional and distance learning systems. Nevertheless Robinson and Shakespeare (1995) stress the need to have the ability to work both within conventional and open learning methods. It equips students with capacities for life-long learning and transferable skills to become independent learners. A workbook accompanied most modules in the first two years. Lectures were replaced by seminars and workbooks on alternate weeks. All students were given workbooks that complemented the seminars and needed to be completed before the seminars. This paper explores students’ views of a DL initiative within a University in the South of England. The initiatives were in response to increase in the number of students in each intake which was just one of the recent changes called for by the Government. The University decided to use the terminology distributed learning as it seemed that the workbooks used a mixture of open and distant learning approach. Therefore references from the literature were termed as open and distant and allusion to the University approach continued to be called DL. The aims of this study were: • To examine the views of students and lecturers using the DL workbooks • To investigate area of improvement identified by students and lecturers.
618 Nurse Education Today (2002) 22, 617–623
Study method This evaluation consisted of a longitudinal research project following two cohorts of nursing students ðn ¼ 288Þ through the first two years of their education (and will continue in the final year) to assess the influence of DL on both their academic education and professional training. The evaluation used a mixture of qualitative and quantitative data collection, questionnaires and focus groups. According to Robson (1993) the use of multiple methods of data collection provides a means of testing one source of data against another, suggesting that if two sources generate the same or very similar messages, they cross-validate each other to an extent. Self-completed questionnaires were used as they could reach a wider sample of students quickly and was therefore efficient in terms of researchers time and effort. One disadvantage, however, was that data could be potentially superficial and therefore by using a combination of methods (questionnaires and focus groups) more a more in-depth picture can be obtained.
Focus groups Focus groups are a qualitative research method, which use guided group discussions to generate an understanding of participants’ experiences and beliefs. One advantage of this approach is the use of the group members to generate the questions and ideas rather than the researcher or just one participant (Holloway & Wheeler 1996). They assert that the strength of focus groups is the production of data through social interaction, whereby participants build on the answers of others in the group. Findings from the questionnaires informed the focus group interviews with students and lecturers by providing some guidelines and possible starting questions. A total of seven focus groups were undertaken. The sample for the questionnaire consisted of all the students who were in the two cohorts selected making it a purposive sample. For focus groups both cohorts of students and lecturers were utilised. In an attempt to ensure that a variety of opinions about the use of DL materials were obtained, the sample for the
ª 2002 Elsevier Science Ltd. All rights reserved
Does open learning have a place in nurse education?
focus groups was randomly selected. However, the uptake by those individuals randomly picked was minimal and hence a general call was made for volunteers amongst both cohorts and lecturers. Randomisation is clearly not always successful in obtaining the range of opinion or of individual respondent types. Participants involved in the focus group interviews were invited to participate on a voluntary basis. Focus group interviews were tape-recorded and participants were reassured about confidentiality. The questionnaires were analysed using the Statistical Package for Social Sciences (SPSS). Thematic analysis was used for both the focus groups and the open questions in the questionnaire, which allowed us to identify themes and patterns in the data.
Questionnaires The study was divided into different parts following two cohorts of nursing students. During the first year of this evaluation questionnaires were used to examine students’ views about the use of DL in their training. Questionnaires can be both a qualitative and a quantitative method of data collection, depending on the type of questions asked. For this questionnaire a combination of open and closed questions were used. We devised the questionnaires after extensive study of existing instruments in the area of open learning evaluation and advice from a steering group.
Ethical considerations Ethical approval was obtained from the University’s Research Committee in accordance with the University’s procedures at the onset of the study. On its approval questionnaires were sent to all students giving full information about the study and by completing the questionnaires students were giving consent. In the second year participants were asked to come forward on a voluntary basis and full information was again provided. At the beginning of the focus groups all participants were asked if they were happy to take part in the interviews and by doing so they consented. Anonymity and confidentiality were ensured and participants were informed that they could withdraw from the study at any time. No names were used in any of the reports. Questionnaires, interview tapes and transcripts were locked in a draw and access was only available to the researcher.
Findings and discussion The content of the workbooks was generally positively evaluated as demonstrated in Table 3. The rest of the scores were from participants who were unsure about the comments relating to the workbooks. This article is mainly based on the findings from the focus groups and the qualitative findings, which can be divided into the following themes: • Advantages of workbooks • The role of the lecturer • Practical use of workbooks.
Sample size See Tables 1 and 2.
Examples of some questions were: Have you previously studied using Open or (1) Distributed Learning Materials? (2) All instructions and the path through the workbook have been clear (3) The presentation was visually attractive (4) The presentation was user friendly (5) What is your overall impression of the Distributed Learning material?
ª 2002 Elsevier Science Ltd. All rights reserved
Yes Strongly Agree
No Agree
Unsure
Disagree
Strongly Disagree
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Does open learning have a place in nurse education?
Table 1 Response rate for questionnaires Cohorts
Number of students
Number of student completed questionnaires
Response rate %
One 215 134 62.3 Majority of participants were female (92%), between the ages of 15 and 25 (75.4%), with ‘A’ Levels or Highers (46.2%) and on the Advanced Diploma in Adult Nursing (70.1%). Two 72 46 63.8 Majority of participants were female (91.5%), between the ages of 15 and 25 (61.7%), with ‘A’ Levels or Highers (21.3%) and on the Advanced Diploma in Adult Nursing (66.2%).
Table 2 Information of focus groups Participants Lecturers Cohort one Cohort two
Number focus groups
Number of participants
2 3 2
12 19 14
Table 3 Scores for the content of the workbooks Comments Instructions clear Presentation attractive User friendly Readable and stimulating Required to participate Motivated learning Clearly explained Relevant material Adequate references Up to date references Tested individual learning
Agreed % Disagree % 53.6 45.1 63.6 52.6 47.3 24.4 50.4 63.4 88.8 70.2 38.4
30.4 41.2 20.4 26.8 0.8 15.9 23.6 10.6 5.2 6 42.5
(Reinert & Fryback 1997). The workbooks helped students learn in their own way as they all came from different work and educational backgrounds. Activities in the workbooks allowed students to reflect more on the topic area. Workbooks initiated discussions during seminars and resulted in triggering ideas and thought for both students and lecturers. Lecturers could refer to the workbooks in seminars and students revisited them at future dates. References were very useful for some students particularly for exams and assignments. Workbooks allowed students to maintain all notes on the Unit together. Lecturers also believed that if students used the workbooks they entered the seminars with some knowledge base of the subject which lead to more in-depth discussion.
The role of the lecturer Advantages of workbooks Over 80% of both cohorts of students had no previous experience of open/distance learning. Workbooks were perceived as a main part of the course. They were seen by lecturers to provide a balance approach towards self-directed study and taught sessions. As students and lecturers became more accustomed to using the workbooks they found them more beneficial. Passage of time gave lecturers more experience and hence the ability to help students use the workbooks better. Advantages of the workbooks were mentioned in particular the flexibility of the books. Students could work through the books, at their own pace, in their own surroundings and to the level and depth suited to their needs
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Lecturers play a central role in the success of open learning course (Kelly & James 1994, Carr 1999). They can facilitate the learning concepts, opinions and facets within the material delivered, as well as promoting reflections upon practice. Participants acknowledged that lecturers had an important role in the delivery of the workbooks. Variations in the way lecturers approached the workbooks and seminars were revealed which impacted on the students’ experience. Students could identify lecturers who used the workbooks well. One student mentioned that the workbooks that she learnt more from were the ones she associated with the excellent lecturers. I do feel that the ones that have meant most have been the ones where actually the teaching’s been very good as well. The ones
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that I haven’t learnt so much are the ones maybe the teaching has not been so good any way. (FG C student) Students believed that lecturers could enthuse, motivate and direct them to use the workbooks. Treistman and Fullerton (1996) assert that the learner/lecturer interaction endeavours to motivate and invigorate the learner and encourages clarification of content. All participants believed that lecturers could help students become familiar with using the workbooks. By explaining links between theory and practice lecturers could make workbooks and seminars more significant and edifying for students. This was seen as a challenge by some lecturers. Its all part of the educational process, I don’t think its wrong to actually use the material, but it just presents that challenge then to the lecturer doesn’t it, how you actually make that meaningful to students who are actually at quite a junior level in their knowledge base. (FG F staff) A major benefit for some lecturers in using the workbooks was the impact on their teaching styles. Lecturers believed that the process had made them review and think about their teaching, different learning styles, the learning process and helped them use various teaching methodologies. Its made us think about what we’re doing and I think for me it certainly has brought together a number of strands of teaching methodologies and brought them together in one place and made us think about what we’re doing. So no I don’t think it’s entirely worthless at all actually. (FG G staff)
Practical use of workbooks Students also expressed a sense of achievement when they worked through the books and completed the activities in the books. This in itself gave them motivation. . . .its nice to have something that you’ve got to go away and do and when you do sit down and do them you do feel quite pleased with yourself because you’ve done it really, because it is a little bit of
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homework, you’re quite pleased that you’ve done your homework, but that’s it really for me. That’s all I find that’s beneficial about them. (FG B student) Both students and lecturers alluded to the need for links to be made between workbooks and seminars. It was perceived that discussion in seminars were important and enhanced learning. There were difficulties experienced when the topic in the workbook was totally different to the seminar session. This led to a sense of disintegration of subject matter. Due to the amount of work needing to be covered it was not always possible for lecturers to associate the workbooks with the seminars and at times tenuous links were made with difficulties. However, students unanimously agreed that time should be given in seminar sessions to review the workbooks and the activities. There were two-week intervals between seminars that allowed students time to complete the workbooks and to find time for tutorials. Some felt this was a useful time for reflection while others found they forgot what they had done in that time particularly if they had completed the activities the same day as the seminar. That the workbooks related to practice was the strongest viewpoint that emerged from the data. Students believed that both the material and the activities would be more meaningful if they were linked to their practice or involved them finding answers and solutions from placements. Lecturers also believed that students should be asked to carry out activities in practice. However, students acknowledged that this could be difficult for some Units particularly as students were all in different placements at any one time. Students saw the number of workbooks given out simultaneously at the beginning of a semester daunting and confusing. They mentioned the possibility of the workbooks being introduced gradually over the three years. More time was given in semester one for completing the workbooks and was reduced in subsequent semesters. Lecturers agreed that not enough time was given for students to complete the workbooks, affirming the difficulties of balancing between theory and practice times.
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Yes in the first year they were manageable and we had time because we were only in practice one day and we had to do visits on one day, they were much more manageable, but in the second year hardly any time. (FG A students) A proposal made by some participants was to provide students with the outcomes of each Unit and appropriate material and allow the students to learn in their own way that suited them. Lecturers believed that students learnt through other methods themselves and more encouragement should be given to students to discover the information for themselves rather than channelling them in one direction. It was perceived that focus was mainly on the delivery of the material. Both students and lecturers expressed the need for incentives in order for students to complete the workbooks. Workbooks not being assessed were a major concern for many who believed that by making the workbook activities part of the Unit assessment it would encourage students to complete them. There was a request by most students that the workbooks needed to be reviewed so that students could be sure they were covering the correct area and completing the activities correctly. Rowntree (1992) asserts that feedback is an important feature of an open learning package and feedback on activities in particular helps the learner confirm or think again about their responses. Some lecturers also highlighted the importance of realistic assessment and examination of workbooks to ensure that students have covered the syllabus since it was felt that sections of the curriculum could be missed if students do not use the workbooks effectively. Marking the workbooks was mentioned as an option but lecturers stressed the workload consequences of this. I think essentially the reason they don’t do it is because of not being assessed on it, that’s how I perceive it, why should I do this, you’re not going to mark it. (FG F staff) Few students suggested the use of one extensive workbook, which integrates all the subjects rather than a large number of different workbooks. Also lecturers recommended a
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portfolio incorporating the workbooks which would test both knowledge and skills, providing the books with more impetus. I’m not saying that the workbook as it is in its present form will be the form of assessment, its having the time to actually re-write a book that is say in portfolio form that’s actually going to have some meaning for them and its actually going to demonstrate to us that they understand. (FG F staff) Preparation was one of the first major requirements for students as well as lecturers who were using this method of teaching for the first time in their teaching career. Also resources were seen as a necessary component for the success of the implementation of such teaching methods as well as their continued use. For example, more books would be needed if reference was made to particular books in the workbooks. Journal articles were some times difficult to obtain hence requests were made for photocopies of articles. The participants identified some areas of improvement, which included: • Providing the outcomes for each module of study and permitting students to use whatever means to achieve the outcomes • More links between the activities in the workbooks and clinical practice whereby answers are found in placements • Activities in the workbooks to be part of the assessment for the module • Providing the DL material in other formats besides workbooks i.e., computer based • Key journal articles to be incorporated into the workbooks (where copyright and costs allow) • Improving access and resources at local hospital libraries.
Conclusion DL was seen as a flexible way of studying for students. Students were able to study a topic area at their own pace and at a time convenient to them. The activities in the
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Does open learning have a place in nurse education?
workbook stimulated discussions and triggered ideas and thoughts for both students and lecturers. With the commencement of the workbooks lecturers were given the opportunity to reflect on their teaching styles and were encouraged to utilise a number of different teaching and learning methodologies. It was clear that DL workbooks were accepted as part of adult learning but there were areas that needed to be explored and improved in order for the books to be used more effectively. These included better preparation for students and lecturers in the use of the workbooks, more links to practice, workbook activities included as part of assessment of Unit, more library access and resources and utilisation of different formats besides workbooks. Although this was a small scale study, the lessons learnt from this study are extremely useful for those delivering post-registration courses. With CPD there is a need for more innovative ways of providing courses for qualified nurses who already have pressures placed upon them. Using the listens learnt from this study other institutions can ensure some of the above measures are in place before the introduction of DL courses. Acknowledgements The authors would like to thank Professor Iain Graham, Professor of Nursing Development and Academic Head of Nursing & Health visiting, Bournemouth University and Mr Clive
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Andrewes, Practice Development Co-ordinator, Bournemouth University, for their support. References Carr K 1999 Creating an off-campus/distance learning courses for midwifery education. Journal of NurseMidwifery 44(1): 57–63 Clark E, Robinson K 1994 Open learning: the state of the art in nursing and midwifery. Nurse Education Today 14: 257–263 Department of Health (DOH) 1998 A first class service: Quality in the new NHS. DOH, London Holloway I, Wheeler S 1996 Qualitative research for nurses. Blackwell Science, Oxford Kelly J, James C 1994 The process of facilitation in open learning. Conference Paper, Nurse Education Tomorrow Conference. Durham University, Durhan Le Var R 1992 Current initiatives in open learning. Nursing Standard 6(52): 34–35 Mcmanus M, Lyne P 1992 Mainstream or margin? Open learning in the changing world of nurse education. Monograph for the English National Board of Nursing, Midwifery and Health Visiting Reinert BR, Fryback PB 1997 Distance learning and nurse education. Journal of Nursing Education 36(9): 421–427 Reinharz S 1992 Feminist Methods in Social Research. Oxford University Press, Oxford Robinson K, Shakespeare P 1995 Open Learning in Nursing, Health and Welfare Education. Open University Press, Buckingham Robson C 1993 Real World Research. Blackwell, Oxford Rowntree D 1992 Exploring Open and Distance Learning. Kogan Page, London Treistman J, Fullerton J 1996 Computer-mediated distributed learning. An innovative program design in midwifery education. Journal of Nurse-Midwifery 41(5): 389–392 Young G, Marks-Maran D, Macklin J 1999 Developing a distance learning honours degree in health promotion for delivery using the internet. Nurse Education Today 19: 488–494
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