Supervising RN Students in an RN to MSN Program
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Vanderbilt University School of Nursing In Distant Education
The characteristics of registered nursing (RN) students that require distance education approaches include social role commitments and adult learner attributes. RNs are working adults who fulfill family roles, such as spouses and parents (Gomez, Ehrenberger, Murray, & King, 1998). RNs have identified the need for flexibility in scheduling and location of educational programs (Krawczyk, 1997).
Learner Characters Support Distant Education
Distinctive adult learner characteristics that support the use of distance learning as an educational methodology include:
(a) desires independence
(b) exhibits self motivation
(c) values relevancy of new knowledge and skill
(d) responds positively to active learning
Distance learning provides an environment to foster independence and autonomy that is desired by the adult learner (Gomez et al., 1998; Herrin, 2001). Self directed learning by identifying one's own learning needs and objectives is supported by distance learning methodology (Koeckeritz, Malkiewicz, & Henderson, 2002). In many distance learning offerings, the facilitation of collaborative learning events is evident.
The participants create their own content (Cragg, 1994). The adult learner responds best when new knowledge and skills are associated with prior learning. Application of RNs' problem-solving skills to new knowledge and skills is an effective reinforcer of learning. The distance learning process promotes an active learner (Ryan, Carlton, & Ali, 2004; Sternberger, 2002).
Distance education programs have been reported to increase RN student enrollment in BSN programs (Gomez et al., 1998). As the trend to offer distance learning courses at institutions of higher education escalates, a paradigm shift is occurring that supports the use of the Internet for content delivery and processing (Ryan et al., 2004; Sternberger, 2002).
With this higher education paradigm shift in mind, the faculty of a nontraditional graduate nursing program redesigned the educational methodology for RN students. The RN student (admitted after completing 78 hours of prerequisite course work) was expected to meet objectives equivalent to a BSN program at the end of two semesters of full-time study.
The purpose of redesigning the traditional instructional methodology was to increase RN student enrollment while maintaining the educational quality and rigor of the program. The goal was to weave and blend traditional and nontraditional approaches to increase flexibility related to time and location of the educational offerings, producing a modified distance learning component of the RN to master of science in nursing (MSN) program.
The synchronous or face-to-face interaction between teachers and students was altered by scheduling 4-day or 5-day block classes approximately three to four times during a traditional 14-week semester. A variety of asynchronous formats were used.
These formats included compact discs (CDs) with combinations of videotaped lectures, voice over PowerPoint (VOPP) and voice over psychomotor skills demonstrations, e-mail, online conferencing, and student selected, faculty approved preceptors or agencies located at the student's location.
Integrated Synchronous And Asynchronous Instructional Design In Distant Education
In the first semester, full-time RN students were expected to complete five required courses for a total of 14 semester credit hours. The one clinical course this semester focused on basic health assessment content and skills. The didactic component was completed by use of CDs with VOPP and voice over demonstrations of focused and head-to-toe examinations.
Students were given a month to view the psychomotor CDs and practice before returning to campus for instructor-monitored lab practice and lab practical examinations and write-ups. Seventy clinical hours were spent with advanced practice nurses or physician preceptors who were selected by the student and approved by the faculty.
The relationship between the student and preceptor provided opportunities for the students to experience professional practice socialization, which is clearly identified as a desired educational outcome of Web-based nursing courses (Billings, Connors, & Skiba, 2001; Bolan, 2003).
E-mail and telephone communication was used for addressing students' and preceptors' questions. The students were required to submit two complete histories and physical write ups on patients (due dates at midterm and end of semester). History and physical write ups and instructor feedback comments were exchanged with faculty members electronically (fax or e-mail attachments) or through mail.
During the semester, quizzes were administered via computer, covering content from VOPP and required readings. Midterm and final clinical performance evaluation feedback forms were submitted by fax or mail.
The second required course in the first semester fostered critical thinking, lifelong learning, and professional role development. This 3-hour didactic course uses a block lecture format spread throughout the semester.
Because of the focus of this course, the face-to-face, instructor to-student contact allowed for professional socialization, role modeling, and mentoring that have been reported as deficient in distance learning methodologies (Billings et al., 2001; Milstead & Nelson, 1998). Use of a journal-writing learning activity focused on developing critical thinking abilities throughout the entire semester.
The use of e-mail for faculty and student interaction and student-to-student interaction was encouraged. The importance of group projects such as student group issue presentations used in this course have been found to be difficult for geographically distant students, but were valuable in fostering student to student interaction (Cartwright & Menkens, 2002; MacIntosh, MacKay, Mallet- Boucher, & Wiggins, 2002).
Evaluation strategies employed in this course were a role paper assignment, critical thinking journal activity, and oral presentation by a student group on an issue important to nursing practice.
The third 2-hour didactic course taken during the first semester focused on population based health care principles of prevention, health maintenance, and health promotion. The videotape of traditional lecture content (provided by CD and in real time on course site) was used for this course because more than 100 on-site students were enrolled in the same course.
The videotaping required more precise planning related to course schedule, technician availability, and backup plans. Some audio-visual aides required more preparation time with this course. In addition, contingency plans were needed when CDs were not received as scheduled by mail.
Online conferencing was used for questions and answers related to lecture content and home work papers. Separate student online chat rooms were available on request for student work group discussions. Evaluation methodology employed was multiple-choice quizzes administered by computer and multiple small paper assignments.
The required fourth 2-hour didactic course emphasizes concepts and skills foundational to patient education. Concepts of learning, motivation, change, and continuous improvement were addressed to explore the processes necessary to change individual self-care behaviors.
Face-to-face lectures and discussions based on case study were used to present the content. An experiential learning activity where the student identified a personal health behavior that needed changing was implemented.
Using the processes taught in the course, students developed a personal improvement project and reported their results through a poster presentation at the last block course meeting. Students provided a summary of the improvement process, results obtained, and analysis of what they learned personally and professionally from this activity.
Actively engaging the students in an experiential activity impacted all student learning styles (Bolan, 2003). Evaluation methods employed were case-study-based teaching plans and a personal improvement project.
The required fifth 4-hour didactic course examined the human experience of health and illness across the life span. The focus of the course was on complex and chronic health problems. A complete set of CDs containing videotaped traditional lecture content was provided to students in the first block. Reading assignments included textbooks and online journal articles.
The instructor was available by e-mail to address questions about content. Examinations were administered by computer with 1-week windows in which students could take their examinations at any time of the day or night and receive immediate results after submission. After closing each examination, the student could review their test, receiving the rationale for the correct answer.
Evaluation methodology employed was four multiple-choice, computer-administered examinations. The second semester consisted of five required courses. The clinical course requires 105 hours of clinical practice with a focus on the family in the community. Through didactic content and community practice, this course emphasizes epidemiological and nursing processes to support family and community health.
Clinical hours were spent at self-selected faculty approved agencies located in the student's community (eg, hospices and family shelters). Family analyzes and community assessments were required. A written community focused proposal and project were completed. E-mail communication for questions and answers and project feedback and approval were instituted.
A midterm and final clinical performance evaluation feedback form was submitted by fax or mail by the student's agency preceptor. A 2-hour seminar class addressed selected topics fundamental to the students' practice role. This course meets face to face for 1 to 2 hours, three times during the semester. The intent was to continue the professional role socialization process began the previous semester and to continue to facilitate role modeling and mentoring.
The remainder of the course activities were online conferencing with faculty and student leadership and participation. Online conference setups included forums for course announcements, questions and answers, and five topic areas.
Faculty led forum topics were mentoring, Patricia Benner's model, collaborative practice model, and credentialing/certification process. Student led forum topics were ethical issues related to specific populations (eg, dying patients and premature or deformed infants).
Online chat rooms were available to each student leadership group to allow for discussion and planning for student-led forums. Online student responses were evaluated as to quantity and quality. The frequency of interactions was recorded without regard to quality.
The quality of student contributions was evaluated for each of the forums. Numerical scores representing quantity and quality were assigned for each student's participation in the forum. Quantity was represented by a simple count of postings. Quality was represented by A = 4; B = 3; C = 2; F = 0-1 based on the overall criteria. Increased frequency and quality of student interactions were found with online conferencing. This characteristic of online conferencing has also been identified by Ryan et al. (2004).
Students were expected to carry out leadership forum responsibilities. Groups composed of three students were assigned leadership responsibilities. Each student was evaluated on his or her individual leadership contributions to their forum in the areas of organization, completeness, relevance, evidence based interactions, and communication style.
An additional evaluation strategy employed was annotated bibliographies focusing on forum topics submitted by e-mail attachments by all students.The third and fourth required courses of the second semester addressed health care systems and related issues. These two didactic courses used videotape of traditional lecture format. E-mail communication to answer questions was implemented. Multiple choice examinations were administered.
Written projects were submitted by e-mail attachments related to content on micro issues (eg, leadership, team building, communication, and managerial skills) and macro issues (eg, managed care, informatics, outcomes management, and financial management). The last required course of the second semester addressed nursing theory and research.
This 3-hour didactic and seminar course uses face-to-face lecture and discussion methods to explore the content. Content included knowledge development in nursing, theoretical and research foundations for knowledge development, practice theory, scholarly in inquiry to address professional nursing practice problems, research utilization, and evidence-based practice.
Evaluation strategies employed were examinations, papers, and presentations. The blending of a variety of synchronous and asynchronous instructional strategies has provided RN students with flexibility related to time and location of their education.
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