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Teaching and Learning Forum 2005 [ Refereed papers ]
"Including a voice": Trialling a tool to improve the educational experience of external nursing students

Janette Young and Sheila Scutter
Division of Health Sciences
Lyn Barnes
School of Nursing and Midwifery
University of South Australia

This paper reports and reflects on the trial use of CaptureCAM-PRO, a PC screen and sound recording program which combines high quality video with small file size and which can be emailed or downloaded from a website. Flexible delivery is one of the teaching and learning commitments of the University of South Australia, linked with intelligent use of emerging technologies. The undergraduate nursing program at University of South Australia is offered entirely in flexible mode, using the online teaching and learning environment for most courses. In 2003, of a total of 1663 students enrolled in the Bachelor of Nursing at the university, 45% were externally enrolled and 19% were undertaking a mixture of internal and externally delivered subjects. Although this method of delivery increases flexibility for students and academics, it can reduce the "connectedness" that students feel with academic staff, other students and the communication between students and staff can be limited to transfer of information by email and discussion pages. Seeking alternative educational tools and techniques from traditional higher education processes is imperative. CCP offered the opportunity to augment the visual experience of learning that predominates in distance education with aural information and "contact". Overall the feedback from students was very positive with regard to the usefulness of CCP as an enhancement to their learning experience. This was qualified with concerns that technical difficulties needed to be addressed before CCP was relied on as a core source of information.


Introduction

In order to improve access of non-traditional student groups into nursing education, the undergraduate nursing program at University of South Australia is offered entirely in flexible mode, using the online teaching and learning environment for most courses. Although this method of delivery increases flexibility for students and academics, it can reduce the "connectedness" that students feel with academic staff, other students and the communication between students and staff can be limited to transfer of information by email and discussion pages.

Initially nursing literature expressed caution as to the impacts upon student learning and satisfaction in regard to web and IT based as versus traditional methods of face to face interactions between students and educators (Thiele, 2003; DeBourgh, 2003). However more recently a number of studies have revealed a complex array of impacts on nursing student education. Buckley (2003) could identify no differences in the learning outcomes for students undertaking web based as versus traditional methods of learning, although the mean course satisfaction score by students who undertook the online course was lower. Kearns, Anakwe & Kessler (2004) in comparing outcomes for students undertaking web based as versus traditional methods of learning scored higher on key performance measures, although they also scored lower in terms of course satisfaction than students undertaking study via traditional modes. Thiele (2003) identified that those students who undertook an online learning program reported an increase in trust of their own judgments, and that they delved into the material better.

Flexible delivery is one of the teaching and learning commitments of the University of South Australia. The University has a commitment to equity and diversity as core values, linked with intelligent use of emerging technologies, flexibility and student centredness. The data from 2003 reveals that of a total of 1663 students enrolled in the Bachelor of Nursing at the university, 36% were internal students (undertaking study in a face to face traditional mode), 45% were externally enrolled and the remaining 19% were undertaking a mixture of internal and externally delivered subjects. Nursing is one of the few health science courses within the university that can be undertaken totally via external means. This is a choice that has been driven in the School of Nursing by concerns for access and equity, providing opportunities for people from non-traditional backgrounds to enter into the professions. As can be seen from the numbers and proportions above, seeking alternative educational tools and techniques from traditional higher education processes is imperative.

Context

In 2003 a review of the external nursing program at the university was undertaken. This was in response to concerns about high rates of attrition and low rates of satisfaction (as identified through the Graduate Course Evaluation Questionnaire) for external nursing students. The review, which involved focus groups with students and staff, reviewing student feedback on courses and programs evaluations and other data, produced a raft of findings. Of pertinence to this paper was the core information that communication with lecturers was an issue, with external students often feeling neglected and isolated (Scutter & Munn, 2003). Finding easy to use, convenient methods of enhancing communication within the context of large volumes of students, the flexibility of student availabilities (a factor consistently seen as a major positive for students and often the reason for them even undertaking study) and the realities of students generally not possessing sophisticated computers, has lead to seeking tools which could diminish the sense of isolation from the university often experienced by external students.

Kearns, Anakwe & Kessler (2004) note that delivering education via electronic means requires "instructors to adopt new and innovative ways to nurture learners and compensate for the lack of nonverbal cues and social isolation inherent in the Web based environment". This paper reports and reflects on the trial use of CaptureCAM-PRO (CCP), an easy to use PC screen and sound recording program which combines high quality video with small file size and which can be emailed or downloaded from a website. Using CCP, it is possible to augment the visual experience of learning that predominates in distance education with aural information and "contact".

It was hypothesised that Capture Cam Pro would assist students in feeling connected to the course and their lecturer, and less isolated. Using Capture Cam Pro it is possible to develop short visual and auditory recordings that can be emailed or posted on a website. The Player can be downloaded for free from the website, whilst a license for the recorder must be purchased.

The system requirements for the CCP player are:

233 MHz Pentium or compatible
64 MB RAM
WIN98SE/ME, WIN 2000, NT4, XP
DirectX 7 or higher (which can be downloaded from the CCP website)
The system requirements for the CCP recorder are greater:
350 MHz Pentium or compatible
128 MB RAM
WIN98SE/ME, WIN 2000, XP
DirectX 7 or higher (which can be downloaded from the CCP website)

Methodology

A third year summer school intensive course focusing on nursing research was chosen to trial the use of CaptureCAM Pro (CCP). This course was chosen for a number of reasons. Firstly third year students are already familiar with the university's online learning environment which includes use of email, web based research and information seeking and discussion pages and so the issues that might arise with CCP could be isolated. Secondly the use of a Summer School course for the trial ensured a smaller cohort size than is the norm (enabling the lecturer to respond to issues raised in the trial more promptly, and reducing the amount of potential data from what was envisaged as a small introductory trial of new technology). Finally the subject coordinator had an interest in the application of new information technologies as a way improving teaching and learning outcomes for students.

The course was offered entirely externally, there was no campus based interaction; all core communication was online and print based. All students undertaking the course were invited to participate in the trial using CCP.

The use of CCP was envisaged as augmenting the students' learning experience; hence no core information was only available via CCP. CCP was used solely to address specific teaching and learning issues identified during the course. The project was approved by the Human Research Ethics Committee of the University. Students were informed that this course would be used as a pilot research project, and information sheets and consent forms were obtained to enable use of their comments and feedback in regard to the technology being trialed. They received all the normal course materials in the usual way. The trial class included both rural and metropolitan based students, and a mix of males and females. A total of 50 students enrolled with 44 of these completing the subject.

The first CCP went out with a holiday photo snap of the course coordinator, and a voice over of her saying "hello", welcoming students and briefly overviewing the course. An explanatory cover email was sent with instructions on how to open the file and directions to contact the course coordinator if they had any problems with this process. Subsequent CCP clips took on the format of voice recordings accompanied by PowerPoint slides summarising key points in the course material, with mouse movements used to underline pertinent words and lines in the slides. The content of CCP clip consisted of addressing key issues arising in the discussion pages, summarising key points in the course content and clarification with regard to assessments. A total of 15 CCP clips (including the original 'welcome' recording) were produced.

The first CCP clip was sent out via email with the reader compressed in it. Subsequent CCPs were put directly onto the home page and students were informed of this via the discussion page.

Student evaluation

Feedback was obtained directly by asking students to feedback as to the use of CCP - both positive and negative experiences and perspectives, and a specific online discussion page was set up for this purpose. This was done so that the use of the CCP could be tailored to the student's needs. In addition an anonymous online Course Evaluation Instrument was used to seek feedback about the CCP at the completion of the course. The feedback focused on in this paper is the qualitative responses both on the discussion page and from the three text based, open ended questions, which had been developed from a thematic analysis of issues raised on the discussion page and the literature review. These questions were :

Results

Of the total of forty four students who completed the subject, twenty five students responded to the discussion page specifically set up for comments regarding CCP, fifteen had very positive comments to make. Sixty five percent (twenty nine individuals) of the class filled in the CEI, with twenty two of these people offering insights into what they had found most helpful about CCP recordings.

A qualitative thematic analysis of students' feedback revealed three positive thematic areas. These were:

The following quotes illustrate these thematic areas and the manner in which they interrelate with each other:
(The) spoken word reinforced material that could have been misinterpreted. The information seemed to 'stick' better. A sense that the lecturer cared and was personally addressing me.

I feel by hearing your voice you gain a better understanding of what is expected, especially when you are external.

Being able to listen to what was required in assignments. Also being able to listen to the lecturer explaining concepts. More detail was provided than in written information...It would be really good for factual courses such as Clinical sciences, and would reduce the amount of time needed to go over readings.

Capture cams were clear, if you missed a point you could replay or pause them and take time to understand what was being said. They were clear, issues were addressed and it was great to hear a voice instead of just reading, reading and more reading. This is a great tool and I would love to see more of it, it really does take the isolation out of being an external student.

For the course coordinator CCP offered the opportunity to address issues that she noticed emerging in the discussion pages, such as a lack of understanding of course content, in a verbal manner as well as a written medium, because it became as simple and easy to use as email. The observation of the course coordinator, having offered the course as an external program previously, was that students did better later on in the course, as issues had been addressed and dealt with prior to them commencing work on their assignment.

Technical issues

Initially CCPs were sent to the class via email. The first Capture Cam took some time to send out as the university's IT protection system was removing the reader (an executable file) from the video clip on its way out of the system. A number of students contacted the coordinator as they had problems downloading the first CCP (which contained the reader). It was usually possible to talk students through the process successfully by telephone.

The second CCP recorded was a longer recording than the first (around 12 minutes) and this proved to be too large, even after compression for emailing. Student emails are structured to only receive up to 1 MB at a time, and the recorded information exceeded this limit and could not be sent. This experience helped to define the potential of CCP as an augment to online materials rather than a means of sending whole lectures to students. Feedback from students indicated that the length of CCPs used in the trial (5-10 minutes) was a good length. Ultimately these issues lead to CCPs being placed on the course home page with students being notified of new CCPs via the course discussion page.

The negatives reported by students were all technical issues. These fell into three areas:

The following quotes summarise the impact of technical issues encountered by students,
Initially getting started was a real bother, trying to get it to work on my computer was at times enough to send me grey!

The biggest negative with capture cam was with the initial installation. The assumption was made that all students have up to date versions of word - the older versions needed different icons to be clicked than stated in the start up message. Another assumption that everybody's hard drive can handle the larger capture cams may also need to be explored. My own h-d manages about 20 minutes worth before crashing...

They were good to have yet minor technicalities hindered its function with this course.

...no matter what I did I could not access anything but the very first Capture-Cam recording.

Apart from technical issues, the negatives that were raised were more to do with the dependency that developed upon CCP. Student feedback included requests that the recordings be made available at the beginning of the course, with some people noting a level of reliance that developed on the technology viz wanting to start a new assignment and the capture-cam not being there....

In addition some students expressed a desire for interaction and an increase in the visual process provided:

Add a body. I would like a persons body attached to the voice ...(to) see body language as well.
Even though there was no new information provided in the Capture Cams and students were informed of this, an inability to access them was stressful:
...I'm feeling so fed up with myself as I am still unable to access this simple procedure. I have had assistance today from other students from a small study group without success. I am panicking because I'm now behind...

Discussion

Overall the feedback from students was very positive with regard to the usefulness of CCP as an enhancement to their learning experience. This was qualified with concerns that technical difficulties needed to be addressed before CCP was relied on as a core source of information. The application of technology should be to enhance subject learning and professional development, not to subject students to a sense that limitations on their IT skills and/or resources, undermine this. Similar issues have been encountered by other studies, for example Frith and Kee (2003) noted a loss of students due to technical issues in their study, and identify a need for technical support to be available to students.

Debourgh (2003) notes that "it is the quality and effectiveness of instructor and instruction, not the technology that is associated with satisfaction". In reviewing the online course discussion, the rapport that the coordinator had established with students through a deliberately informal style is clearly communicated. In addition the coordinator had a level of ease with new technology, and access to both formal and informal IT expertise that facilitated problem solving. As many writers note (Kearns, Anakwe & Kessler, 2004; Bloom and Hough, 2003, Sternberger, 2002), the level of expertise and comfort with technology that educators bring is crucial to the success or otherwise of implementing online education. In addition they established technical criteria for screening (student) entry into their study, however even with covering these two key factors issues arose.

Kearns, Anakwe & Kessler (2004) identify a need to reconceptualise and convert traditional teaching materials for web based instruction, and one of the useful aspects of CCP was the ability to take established resources and simply voice over these. New resources (power point shows) were developed, however these were simple to develop, often simply cutting and pasting from resources that the course coordinator had already developed, and again providing an aural voice over to these highlighting verbally and with the cursor what were key points for students to note.

A number of recommendations were made by students including:

These recommendations are informing the current processes and further research being undertaken by the university in order to develop a pedagogy of the use of Capture Cam so that having paid the not insignificant costs of purchasing a licence, the value of this is maximised. This bigger project incudes a broad cross section of health science disciplines, undertaking a range of activities to test the use of Capture Cam. There has been excitement about the possibilities of using CCP in remote areas to teach such skills as ultrasound interpretation. This approach is supported by the findings of other writers such as Kearns, Anakwe & Kessler (2004), who note the need for reconceptualising and converting traditional teaching materials and models for online teaching, and Sternberger (2002) who notes the need for congruence between instructional methods and media.

Conclusion

It is imperative that universities seek ways of improving the experiences of external students as there is a worldwide shortage of nurses (Kearns, Anakwe & Kessler, 2004). A point that is being actively felt within the South Australian health system with many services unable to recruit enough trained nurses. In the United States, distance education and recruitment of non-traditional students have been identified as two key strategies for responding to nursing shortages by the American Association of Colleges of Nursing (Kearns, Anakwe & Kessler, 2003). Flexible delivery of education has a major impact on the rates of access to university by non-traditional students, for example those who are older, working, geographically isolated (Christensen, Anakwe & Kessler, 2001). Nursing has always attracted high proportions of this population of students at the University of South Australia however this rate is even higher amongst students undertaking nursing via distance education. External nursing students at the University are more likely to fit within targeted equity groups than other health science courses, and to have entered university via pathways such as mature age special entry provisions or bridging programs (Scutter & Munn, 2003). Here at the University of Australia we are struggling with how to respond to these students once they have been recruited to the University!

CCP proved to be a useful tool for enhancing the learning of external nursing students in this trial program. Funds have been obtained to pursue the development of a pedagogy (how to) in regard to the use of Capture Cam-PRO by the University, with a particular focus on ironing out technical issues and experimenting with the variety of uses that such technology can offer both staff and students.

References

Bloom, K. C. & Hough, C. M. (2003). Student satisfaction with technology enhanced learning. CIN: Computers, Informatics, Nursing, 21(5), 241-246.

Buckley, K. M. (2003). Evaluation of classroom based, web enhanced, and web-based distance learning nutrition courses for undergraduate nursing. Journal of Nursing Education, 42(8), 367-370.

Christensen, E. W., Anakwe, U. P. & Kessler, E. H. (2001). Receptivity to distance learning: The effect of technology, reputation, constraints, and learning preferences. Journal of Research on Computing in Education, 33(3), 263-279.

DeBourgh, G. A. (2003). Predictors of student satisfaction in distance-delivered graduate nursing courses: What matters most? Journal of Professional Nursing, 19(3), 149-163.

Frith, K. H. & Kee, C., C. (2003). The effect of communication on nursing student outcomes in web-based course. Journal of Nursing Education, 42(8).

Kearns, L. E., Shoaf, J. R. & Summey, M. B. (2004). Performance and satisfaction of second-degree BSN students in web-based and traditional course delivery environments. Journal of Nursing Education, 43(6), 280-284.

Scutter, S. & Munn, P. (2003). Review of external nursing programs offered through Whyalla and City East, University of South Australia. http://www.unisanet.unisa.edu.au/Resources/nursing/Review%20of%20the%20School%20of%20Nursing%20and%20Midwifery/Reports/Review%20of%20External%20Nursing%20programs.doc

Sternberger, C. S. (2002). Embedding a pedagogical model in the design of an online course. Nurse Educator, 27(4), 170-173.

Thiele, J. E. (2003). Learning patterns of on-line students. Journal of Nursing Education, 42(8), 364-366.

Authors: Janette Young is currently a Research Assistant. Prior to this she has worked as a social worker and project officer in aged and psychiatric care, domestic and family violence, homelessness, community development, prisoner health. Her academic interests include critical systems thinking, power and dominant discourses and higher education access by people from low socio-economic backgrounds.

Sheila Scutter is the Dean of Teaching and Learning, in the Division of Health Sciences. In this capacity she has oversight of all programs offered by the Division, and is also an active researcher, and supervises PhD/Masters students as principal supervisor. She has a particular interest in the use of innovative approaches to supporting teaching and learning.

Lynne Barnes is a Senior Lecturer in the School of Nursing and Midwifery and was awarded her PhD in 2000. She teaches Research Literacy at Undergraduate and Post-graduate levels across allied health disciplines. Her broad research and teaching interests lie in research consumption and practice, aged care, mental health, and issues of power and control.

Contact author: Janette Young, Division of Health Sciences
University of South Australia, GPO Box 2471, Adelaide SA 5001
Phone: (08) 8302 1074 Fax: (08) 8302 1116 Email: janette.young@unisa.edu.au

Please cite as: Young, J., Scutter, S. and Barnes, L. (2005). "Including a voice": Trialling a tool to improve the educational experience of external nursing students. In The Reflective Practitioner. Proceedings of the 14th Annual Teaching Learning Forum, 3-4 February 2005. Perth: Murdoch University. http://lsn.curtin.edu.au/tlf/tlf2005/refereed/young.html

Copyright 2005 Janette Young, Sheila Scutter and Lynne Barnes. The authors assign to the TL Forum and not for profit educational institutions a non-exclusive licence to reproduce this article for personal use or for institutional teaching and learning purposes, in any format (including website mirrors), provided that the article is used and cited in accordance with the usual academic conventions.


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