Telecommunications Learning In Nursing Education

Learning In Nursing Education and Telecommunications

What Is Telecommunications Learning, Computer Learning Resources In Nursing Education, CAI Advantages In Nursing Education.

What Is Telecommunications Learning

    Telecommunications is a means by which information can be transmitted via television, telephone, related modes of audio and video teleconferencing, and closed-circuit, cable, and satellite broadcasting. Telecommunications devices have allowed messages to be sent to many people at the same time in a variety of places at great distances (Austin & Husted, 1998; Tones & Tilford, 2001).

    Television. The television a very common device in homes worldwide-has been used for many years as an entertainment tool. Today, there are more televisions than telephones in private residences in the United States. The TV is also well suited for educational purposes and has become a popular teaching-learning tool in homes, schools, businesses, and healthcare settings (MDM Commercial, 2015). 

    TV has been found to be more effective than using only written information and as effective as any other audiovisual tool based on a review of over 30 studies on the use of the TV as an education aid. This medium has a definite role to play in increasing knowledge and skills and influencing behavior change (Nielsen & Sheppard, 1988; UNESCO, 2007). 

    The power to influence, cognitive, affective, and psychomotor behavior is well demonstrated by television commercials, whose messages are simple, direct, and repetitive to effectively influence the behavior of intended audiences. Cable TV is legally obligated to provide public access programming by offering channels for community members and organizations to air their own programs. 

    Health education, if placed on the cable system, can be seen in any home with cable access. The advantage of this national and international option is that distribution of programs is relatively inexpensive (Palmer, nd). The disadvantage is that there is no control over who is watching, and this medium cannot serve as an interactive question and answer experience unless call-in phone lines are provided.

    Closed circuit TV, in contrast, allows for education programs to be sent to specific locations, such as patient rooms or staff units. The learner can request a certain program at any given time, much like a guest in a hotel can choose on demand from a variety of movies day and night (Falvo, 2010). 

    Such telecommunications technology allows programs to be played intermittently or continuously, with program availability clearly advertised. Because the learner controls program viewing, the nurse educator must follow up to answer questions and determine whether learning has, in fact, occurred.

    Satellite broadcasting a much more sophisticated form of telecommunications can reach far more distant locations and carry a variety of programs at any given time. Because of its expense, not many institutions send health information via this mode, but many receive it. More types of satellite systems are being developed to make this form of communication for educational purposes available on a world wide basis.

    Video teleconferencing for continuing education and staff development has the potential to maintain the quality and viability of continuing education programs in a cost effective manner across large geographical areas (Scott & Shankar, 2015). In addition, several health networks, such as Lifetime, transmit programs to cable companies and hospitals. 

    Telephones. It is almost impossible to imagine being without the telephone as a daily tool. Americans have come to depend on their wireless cell phones and land-based phone lines as fundamental means of communication. It is not surprising, therefore, that the telephone can be used effectively for education.

    In recognition of this fact, many healthcare associations have begun to provide telephone services with messages about disease treatment and prevention. The American Cancer Society, for example, has established a toll-free number for the public to obtain short typed messages about various types of cancer. Hospitals, too, have set up call-in services about a variety of health-related topics and sources for referral. 

    Telephones for support and education interventions have been used to help patients adjust to breast cancer as well as carry out self-care management of diabetes and other chronic diseases (Chamberlain, Tulman, Coleman, Stewart, & Samarel, 2006; Handley, Shumway, & Schillinger, 2008; Kivela, Elo, Kyngas, & Kaariainen, 2014; Mons et al., 2013). 

    Telephone consultation also is becoming a popular strategy for patient follow-up after hospital and clinic visits (Eisenburg, Hwa, & Wren, 2014; ElHalwagy & Otify, 2009), and telephone support has been used to motivate patients to increase their physical activity levels (Green et al., 2002).

    Such services are relatively inexpensive and can be operated by someone with minimal medical knowledge because the typed message by experts contains the substance of the content. Moreover, this type of service is available in most cases around the clock. The disadvantage is that there is no opportunity for questions to be answered directly.

    Telecommunications as an instructional tool is becoming increasingly popular and refined. Many hospitals and healthcare agencies have already established hotline consumer information centers, which are staffed by knowledgeable healthcare personnel so that information can be personalized and appropriate feedback can be given on the spot. The poison control hotline is a good example of the use of this medium. 

Computer Learning Resources In Nursing Education

    In our technological society, the computer has changed lives dramatically and has found wide spread application in industry, business, schools, and homes. Only recently, however, has computer-assisted instruction been used for education in healthcare settings, such as a medical office or clinic waiting rooms (Andersen, Andersen, & Youngblood, 2011; Wofford, Smith, & Miller, 2005) . 

    The computer can store large amounts of information and is designed to display pictures, graphics, and text. The presentation of information can be changed depending on user input. Although computer technology is a relatively recent addition to the educational field, it is becoming very common, especially with the rapid increase of computer literacy among students, professionals, and the public (Duren Winfield, Onsomu, Case, Pignone, & Miller, 2015; Rice, Trockel, King, & Remmert, 2004).

    Computers, as a multimedia approach to teaching and learning, usually stimulate learners and transform learning into “an active, engaging process” that promotes problem solving and the development of critical-thinking skills (Huang, 2005, p. 224).

    Computer assisted instruction (CAI), also called computerbased learning and computer based training, promotes learning in primarily the cognitive domain (Grunwald & Corsbie-Massay, 2006). Research has revealed that CAI increases both the efficiency of learning and the retention of information (Fox, 2009; Lewis, 1999). 

    Computers are an efficient instructional tool, computer programs can influence affective and psychomotor skill development, and retention of information potentially can be improved by the interactive exchange between learner and computer, even though the instructor is not actually present (DiGiacinto, 2007). Illustrations (visual information), along with narration (verbal information) via computer, increase learners' recall and comprehension.

    Lewis (1999) and Fox (2009) summarized the findings from a significant number of studies on computer-based education and concluded that teaching and learning by computers is an effective strategy for transfer of knowledge and skill development in patients. For example, telemedicine technology has been found to be as effective an educational tool as in-person teaching for diabetes control (Izquierdo et al., 2003). 

    In addition, interactive videodisc programs show promise in improving retention and understanding of information (Green et al., 2004).Flash based online resources, which are available to educators and students for free or at low cost, provide high quality Internet materials for instruction (Lamb & Johnson, 2006). Adobe Flash is required to access such resources, but if it is not already installed on. a computer, it is easily downloaded to run on both Windows and Macintosh platforms with any browser. 

    Three key elements of Flash animation, interaction, and multimedia give the resulting programs great appeal and versatility. The QuickTime format also is frequently used for digital video. Smith and Lombardo (2005) describe development of a patient education workshop on CD-ROM that used Flash, QuickTime, and Acrobat Reader to provide streaming video clips, audio segments, case studies, and interactive practice activities.

CAI Advantages In Nursing Education

    Instruction can be individualized to the learner, lessons can be varied readily, and the learner can control the pace of the learning experience (Heinich et al., 2002). Without time constraints, the learner can move as quickly or as slowly as desired to master content without penalty for mistakes or performance speed. For instance, many educational computer games are designed to teach a subject at a variety of skill levels. 

    Instructions that present to learners more problems with increasing complexity at a pace of the learners' own choosing can be selected. The ability of computers to internally change the rules or the format of games makes them endlessly challenging and novel to the user.Another advantage of CAI is that an instructor can easily track the level of understanding of the learner because the computer asks questions and analyzes responses to perform ongoing learner assessment. 

    Computers can be programmed to provide feedback to the educator regarding the learner's grasp of concepts, the speed of learning, and those aspects of learning that need reinforcement. The inter active features of this medium also provide for immediate feedback to the learner. 

    An excellent example demonstrating the efficacy of CAI is research conducted on mental health training for long term staff using computer based interactive videos (Rosen et al., 2002). The authors of this study partnered with Fox Learning Systems, a company that specializes in eldercare program development using CD-ROM and e-learning formats (http://www.foxlearningsystems.com).

    Computers also represent a valuable instructional tool for those persons with aphasia, motor difficulties, visual and hearing impairments, or learning disabilities. Assistive technologies, such as screen readers that convert electronic text to spoken language, are available to individuals with learning or visual disabilities. 

    However, learners with various disabilities are likely to encounter ongoing challenges in trying to access computer files. software programs, and websites, largely because webpages are created in the HTML file format. Other common file formats include Adobe Acrobat's Portable Document Format (PDF) and PowerPoint. 

    Hoffman, Hartley, and Boone (2005) address specific problems of access to computer resources for individuals who are disabled. They provide an excellent resource list for educators and learners who want more information on organizations and websites specializing in assistive technologies. 

    In addition, the Center for Applied Special Technology is a nonprofit educational, research, and development organization whose mission is to expand opportunities for individuals with disabilities through the development of innovative, technology-based educational resources and strategies (http://www.cast .org). Educators can visit this organization's website for additional information. 

    The major disadvantage of CAI is the expense of both the hardware and the software which makes this option not feasible for implementation in some learning situations. In most cases, programs must be purchased because they are too time consuming and too complex for the educator to develop (Encyclopedia Britannica, 2016; Huang, 2005).

    Another barrier to via computer education is the lack of computer literacy or comfort level with computers among some learners and even some health professionals (Prensky, 2001). Lashley (2005) describes the importance of institutional support for faculty development in the use of technology for the successful design and delivery of computer-based instructional methods and materials. Many older adults are computer shy, are computer illiterate, or lack easy access to computers even if they understand how to use this technology. 

    This situation is beginning to change, however, as computers become more of a household item. Although multimedia resources may be important tools to enhance learning in the older adult, much more research also needs to be conducted on age-related cognitive changes that could have implications for the design and use of multimedia learning environments for this growing population of learners (Pass , VanGerven, & Tabbers, 2014).

    In addition, people with reading problems unfortunately may experience some degree of difficulty in making sense of the information on the screen. A recent study on CAI with patients of varying health literacy levels found that those who had low health literacy also had limited computer experience. 

    Nevertheless, most of these patients completed the computer based educational program on screening for colorectal cancer without assistance and claimed they understood the information better than they would have if asked to read a brochure (Duren Winfield et al., 2015) . Also, learners with physical limitations, such as arthritis, neuromuscular disorders, pain, fatigue, paralysis, or vision impairment, may similarly find computers challenging to use.

    Moreover, it should not be forgotten that the computer is a machine, so the learner is necessarily deprived of the personal, compassionate, one-to-one interaction that only a teacher can provide to facilitate learning. Because of the in- dependent nature of the computer learning experience, the CAI format is not recommended for nondirected or poorly motivated learners.

    Despite these caveats, the tremendous growth of the Internet has opened new doors for many learners to gain access to libraries and to direct learning experiences, such as online discussions with educators at great distances. TABLE 12-7 summarizes the basic advantages and disadvantages of computer learning resources.

Evaluating Instructional Materials In Nursing Education

    Choosing the right tools for client education calls for judgment on the part of the nurse educator, who must take into consideration the variables of the learner, the medium, and the task. Decisions as to which instructional materials are or are not appropriate depend on the size and characteristics of the audience, the preset behavioral objectives to be achieved, and the effectiveness and availability of media resources. 

    The values of these three variables in combination with one another result in the selection of different teaching tools by the educator, who is faced daily with multiple situations, different learners, and varying circumstances. The evaluation of tools for teaching involves appraising the content, the instructional design, the technical production, and the packaging of any given instructional materials. 

    Printed materials, as the most popular tool available for client education, require the nurse to determine the reading levels prior to distribution to learners. This is an essential factor when selecting brochures, pamphlets, information sheets, and the like to be sure they are suitable for a given audience of learner. 

    It emphasizes an important learning principle: According to numerous research studies, people retain information at a higher rate if they are actively involved in the learning process (National Training Laboratories, nd). The effectiveness of teaching and learning is, therefore, greatly enhanced when instructional materials. stimulate multiple senses and modes of learning.

    In making their final media selections, educators must ask themselves which material(s) will best support teaching and learning to achieve the behavioral outcomes for their particular audience. They must remember that active learner involvement and using materials and objects that most closely resemble the real thing (realia) are the best choices for enhancing retention of information. Above all else, nurses educators should remember that instructional materials should be used to support learning only by complementing and supplementing the teaching, not by substituting for it. 

    There is broad recognition of the need for healthcare practice, including client, staff, and student education, to be supported by evidence of its efficacy. Rather than simply perpetuating practices because they have always been done that way, today there is greater emphasis on demonstrating via evidence-based research that learning has occurred and that care has improved by the way in which information has been taught and received. 

    In education, the focus is on both the processes and the outcomes of teaching and learning. This chapter has focused on choosing, using, and evaluating instructional materials for client education, as well as for educating nursing staff and students. Some of the newest studies that validate the usefulness of the different media are cited within the chapter. 

    It is only relatively recently that research has been conducted to determine the impact of various types of tools on the acquisition, retention, and recall of information and on the satisfaction with learning. The following are examples of research studies exploring the effectiveness of written, demonstration, and audiovisual media that stimulate the senses, increase active participation, enhance critical thinking, assist with comprehension and memory of information, and provide opportunities for easier, more rewarding, and more enjoyable learning experiences. 

    Video recording and playback have become common strategies to help nursing students and staff improve clinical skills performance. Salina et al. (2012), who acknowledge the common use of videos in undergraduate nursing education to reinforce information taught in the classrooms and laboratories as well as to teach staff nurse refresher courses, studied the efficacy of videos as an instructional tool. 

    These researchers conducted a randomized controlled trial to compare the performance of two groups of students (n = 223), one receiving written instructions and the other watching a video, in learning a proper nursing technique (moving an uncooperative patient). The results demonstrated that students who viewed the video demonstrated better performance in applying the technique than those who learned by reading how to perform the skill set. 

    Brame (2016) explored three elements of educational videos (cognitive load, student engagement, and active learning) that make them effective as an important contentde-livery tool in higher education. She conducted a literature review of these elements to suggest principles and guidelines as relevant ways to maximize videos as an educational tool. 

    As another example of the application of video learning resources for teaching patients, Stellefson et al. (2014) analyzed the content of YouTube videos as a social media source for patient education about chronic obstructive pulmonary disease (COPD). The study found that YouTube has the potential as an important source for COPD education, but currently the content and quality of existing videos vary significantly. 

    Shah, Mathur, Kathuria, and Gupta (2016) explored the effectiveness of video as an instructional tool to teach prevention of oral diseases. These researchers studied 109 subjects in India who completed a pre- and postintervention questionnaire. They found knowledge scores increased after exposure to an educational video in a hospital setting.

    Learners with low literacy skills or intellectual disabilities are particularly challenging for nurse educators. Creativity by an educator can often help overcome barriers to teaching and learning in such cases. A study by Leiner et al. (2004) compared the effectiveness of printed information about polio vaccination from the CDC with the same message converted into a production of animated cartoons using marketing and advertising techniques. 

    In another study, Feldman (2004) described the development, implementation, and evaluation of self-directed learning using pictorial manuals and accompanying audiocassettes to teach basic childcare, health, and safety skills to parents with intellectual disabilities. This study indicated that a significant number of parents with cognitive disabilities improved their parenting skills with these low-cost, lowtech, self-directed materials. 

    Badruddin and Sabharwal (2010) assessed the readability of educational disabilities and suggested guidelines to improve the understanding of this type of written information tool for orthopedic patients. The challenging goal of providing effective patient education communication can be achieved by raising the awareness among healthcare providers of the importance of matching readability of written materials to the patient's level of health literacy. 

    Also, Orozco, Fossi, and Arevalo (2014) emphasized the need to select written instructional tools that are effective in reaching a target audience for health education. They suggested specific approaches to simplifying written messages appropriate for specific communities. The advent of distance learning via the Internet and various interactive media has begun to blur the lines between instructional methods and instructional materials. 

    It is essential to remember that instructional materials should support learning, rather than constituting the entire learning experience. With fewer qualified nurse educators and growing numbers of learners, the challenge of meeting the needs of students is a constant pressure. The reader is referred to other studies that illustrate effective use of interactive video, the Internet, and other multimedia tools to support learning (Green et al., 2004; Jeste et al., 2008; Lashley, 2005; Martin & Klotz, 2001; Mayer, 2014).

    Rather than having educators base teaching strategies on assumptions that one vehicle for instruction is superior to another for learning, research has begun to verify the effectiveness of different tools with a variety of audiences under various circumstances. Much more evidence needs to be uncovered, but it is gratifying to see that educators and healthcare providers are taking steps to undertake such investigations into multimedia learning based on the latest research and theory in this field. 

    This chapter reviewed the major categories of instructional materials, identified how to select tools from a range of possible options based on their advantages and disadvantages, and addressed how to evaluate their effectiveness. Nurse educators are expected to be able to make choices for teaching methods and materials every day, whether it be to meet the needs of an individual learner or to design an educational program to satisfy a broader, more diverse group of learners. 

    In this chapter, the importance of considering characteristics of the learner, the medium, and the task when choosing instructional materials was emphasized, The importance of using instructional materials to supplement teaching also was stressed, as was the need to keep the behavioral objectives in focus when selecting these materials as adjuncts to instruction.

    Print media include both commercially prepared and instructor-composed materials. The problem of matching literacy and cognitive levels of learners to printed instructional tools is a real concern. The major advantages: of printed tools are that they are widely available, clients can refer back to these materials for review at any time and at their own pace, and the materials have potential to reinforce information. 

    Disadvantages include the limited opportunity for feedback. For some learners, the readability level and complexity of information may be significant barriers to their ability to take full advantage of printed tools. Several guidelines useful to educators in selecting or developing printed materials appropriate to both the audience and the task were presented (see also Chapter 7).

    Demonstration materials include many types of visual, hands-on tools, such as models and real equipment, as well as displays such as posters, bulletin boards, and whiteboards. These materials stimulate the senses of sight and touch. They are especially useful for cognitive and psychomotor skill development and may even influence attitudes, feelings, and values in the affective domain. 

    Other advantages include bringing the learner closer to reality through active involvement and the opportunity for repetition of information. The major disadvantage of demonstration materials is the potential for content to become outdated or be overused because they are often costly and time consuming to prepare. 

    Because of workload demands, nurses in the teaching role may be reluctant or unable to revise these materials frequently. In addition, most of these materials are not suitable for simultaneous viewing by large audiences, for learners with visual impairments, or for individuals with poor abstraction abilities.

    Audiovisual materials make up the fastest growing category of instructional tools. Their ability to stimulate the senses of sight and hearing enhances their power to actively engage learners and to potentially increase retention of information. Many audiovisual tools can influence all three domains of learning by promoting cognitive development, influencing attitude change, and helping to build psychomotor skills. 

    The audiovisual materials section of the chapter examines the five major categories of audiovisual media-projected, audio, video, telecommunications, and computer formats. Consideration was given to how appropriate each of these tools is depending on learner characteristics, expense of the software and hardware, and convenience of use. General guidelines for selecting and developing audio visual materials were presented, and the principal advantages and disadvantages of the five categories were described. 

    Learners with low literacy skills may benefit from most categories of these media except computer formats. Audio materials are most appropriate for learners with visual impairments, whereas projected video with captions and computer resources most benefit learners with hearing impairments.