Implementing Web-Based Instruction in a Baccalaureate Nursing Program

Judith A. Halstead
Associate Professor
Director, Instructional Services and Resources
University of Southern Indiana
School of Nursing & Health Professions
8600 University Boulevard,
Evansville, IN 47712
(812) 465-1162
jahalste@usi.edu

Nadine A. Coudret
Dean of the School of Nursing and Health Professions
University of Southern Indiana
School of Nursing & Health Professions
8600 University Boulevard,
Evansville, IN 47712
(812) 465-1151
ncoudret@usi.edu

The World Wide Web is increasingly identified as a creative way of using computer technology to provide asynchronous instruction to students. Faculty, in many institutions and across all disciplines, are considering Web-based instruction and the best ways to use the rich resources of the Web to promote student learning. Web-based instruction in becoming more and more mainstream in its application in higher education.

The purpose of this paper is to describe the process used for implementing Web-based instruction into the curriculum of the University of Southern Indiana baccalaureate registered nurse completion program. In the summer and fall of 1997, all seven required nursing courses in the fourth year of the nursing curriculum were offered over the Internet to RN students enrolled in the program. This paper discusses the needed resources and strategies used to accomplish this project in one year’s time, as well as the faculty and student development issues that were addressed during the development phase of the project.

Background of Project

In 1996, two factors moved the USI nursing program to develop Web-based instruction and implement it in the curriculum. First, it became increasingly apparent that health care practitioners are accessing the resources of the Internet for the latest information in health care and delivering health services via Telehealth. The phenomenon is not limited to health care professionals: patients are also beginning to use the Internet to obtain health care information, frequently presenting this information to their care providers for answers to their health questions. Leading medical research journals have come on-line and now provide access to research findings and treatment protocols that previously took years to disseminate into practice. Although USI nursing faculty had made revisions in the curriculum of the undergraduate nursing program, it became clear to faculty that knowledge and treatment breakthroughs were occurring faster than the traditional curriculum revision process could accommodate. It was imperative that students learn how to access health care information through the Internet so that they could use these skills in their practice.

The second factor that influenced the USI nursing faculty’s decision to use the Internet in course delivery was the increasing difficulty that registered nurses were encountering when they returned to school to earn their BSN degree. Indiana nursing education programs have been leaders in efforts to increase access for nursing students through distance learning. The USI nursing program has used IHETS TV, a one-way video two-way audio system via satellite, to provide selected nursing courses to nursing students in the Vincennes and Jasper communities. However, this delivery system requires students to travel weekly to a designated location for class at a specified time. Work schedules that include day/evening shifts and mandatory overtime have made it very difficult for registered nurses to return to school to complete their baccalaureate. The use of the Internet and Web-based instruction provides these students with the flexibility necessary to combine their work and school schedules.

On the basis of health care changes and the challenges that students were encountering when they attempted to return to school, nurse faculty discussed incorporating Internet learning activities throughout the nursing curriculum and preparing the fourth year nursing courses for Internet delivery. The faculty’s initial reaction to the proposed Internet delivery project was mixed. While all nurse faculty were using email, few were using other Internet applications. Home pages had been developed for the nursing program and approximately 50% of the faculty. Staff within the School of Nursing and Health Professions had limited HTML coding knowledge. University support staff for academic programming consisted of one computer staff position and a director of distance education.

While faculty believed that graduates needed to develop Internet-related skills for their practice roles, the perceived lack of equipment, staff support and expertise related to teaching on the Internet were cited as reasons to delay the project to a later time. After further discussion, it was determined that the learning and timing advantages associated with the Internet project made it appropriate to move the project forward. Nursing program administration’s promise that the necessary resources would be made available contributed to the faculty’s decision to implement the project. The project goals and work plan identified below were developed in fall 1996 with a 1997 fall semester implementation timeline.

Project Goals

Project Work Plan – Phase I (August-September 1996)

The first step in implementing the project was to identify other Web-based instruction efforts occurring in colleges and universities, as well as other nursing programs. This environmental scan helped administration and faculty identify colleagues at other institutions and programs with whom they could potentially consult with as the project was implemented.

Another priority during Phase I was clearly identifying what University resources would be available to support faculty efforts in course development and Internet delivery. We needed to work closely with the Computer Center to assure technical support of faculty and students and the Director of Distance Education to ensure that student support services would be available to off-campus students. It became clear that the School would need to have additional support personnel to work with faculty to prepare courses for Internet delivery. A student worker was hired to do HTML coding of the courses and a secretary was allocated half-time to the Internet project.

It was also important during this time to do a formal assessment of faculty’s current use of computer-mediated instruction, including e-mail and other Internet applications, in their courses. It was determined that all faculty had office computers with Internet connections available to them. Workshops were planned to help increase faculty’s knowledge of the Internet and examples of Web-based instruction were shown to them so that they could begin to plan their course development.

Project Work Plan – Phase II (September – November 1996)

During this phase two School-sponsored educational workshops on the topic "how to teach on the Internet" were held for faculty. Three faculty volunteers agreed to teach three 1997 spring semester courses on the Internet as a pilot project. Bi-weekly Internet project meetings were held throughout this time period so that faculty could share and discuss ideas with each other while they prepared to revise their courses for Web-based instruction. Faculty identified colleagues who would agree to provide feedback on their course design as it was being developed. Staff were identified who would be responsible for coding and placing the courses on the Web.

Project Work Plan – Phase III (January 1997 – May 1997)

During the 1997 spring semester all faculty who were responsible for developing a course for Web-based instruction in fall 1997 received three credit hours of release time in accordance with University policy. This provided faculty with the time necessary to develop their course for Web-based instruction, work with staff on course design, and attend bi-weekly meetings where progress and questions were shared with their colleagues. Faculty who were participating in the pilot program shared their experiences and student responses with the rest of the faculty. Through this pilot effort, additional faculty and student development issues related to Web-based instruction were identified.

Faculty Development Issues

Incorporating Web-based instruction into course design is a new learning experience for most faculty, and for some, a challenging one. For faculty who have always found personal and professional satisfaction in classroom interactions with students, the thought of teaching their course on the Web, interacting with students primarily through a keyboard, can provoke a profound sense of unease. A number of faculty development issues need to be addressed when planning a Web-based course. Attention to these issues can help eliminate some of the anxiety that will occur when faculty first enter the world of Web-based instruction. These issues can be divided into the following categories: instructional design of the course, faculty-student interactions, time management, and technology management.

Instructional Design. The first issue faculty had to grapple with was deciding how to convert a course that they had previously taught in the traditional classroom format into an on-line format for the Web. While course content and the desired outcomes certainly influence the choice of course design, there are several considerations that are applicable to all courses, regardless of content.

The graphic design of the courses’ Web pages was one area where the faculty decided it would be important to utilize consistency across the courses. Because we have students who enroll in more than one Internet course at a time, we decided to use a similar template design for the Web page layout in all the nursing courses. This allowed students to develop a familiarity with where to find the menu bar for the course syllabus, class schedule, weekly assignments, etc., allowing students to spend more time on-task with the course content and less time navigating the Web site to search for course information.

It is also helpful for faculty and students alike if a consistent design format is adopted for use throughout a given course. For example, faculty can identify weekly reading assignments and pertinent Internet links, discussions questions to guide study, critical thinking applications for the content, and experiential learning activities that will help students apply the knowledge they are learning. Since learning in a Web-based course requires more self-direction on the part of the student, clarity of faculty expectations is essential. Using a consistent format throughout the course allows students to become familiar with the course design and to understand better what their responsibilities are in the learning process. When students are comfortable with the course design, they are more likely to spend their time on task learning the content, instead of trying to decipher course organization.

We found that the most logical way for faculty to begin converting their courses into an on-line format was to "chunk" or organize the course material into weekly content units. For some faculty, this approach differed little from the way they organized the course for the classroom. However, for a Web-based course, the content needs to be presented in a manner that clearly helps the student identify the key course concepts and interact with the material in a more self-directed manner than is usually expected in a classroom setting. It is important for faculty to avoid the temptation of simply loading their weekly lectures onto their course’s Web site. The "electronic page turning" that results from this approach does not foster active student interaction with the course material and can result in a dreadfully dull course. Identifying and embedding Internet links to Web sites that are germane to the course, selecting graphics that illustrate the concepts, and developing learning activities that require the student to further explore the content are examples of techniques that faculty used to engage the student’s attention. When faculty decided that it was necessary for a large amount of text to be presented on the Web site of a particular course, thought was given to how the text could be present in a visually appearing manner. Sometimes faculty decided it was more appropriate to simply provide the students with hard copies of selected course materials.

As the courses were developed, faculty sought feedback from their colleagues about the course design and development. Asking for critique from colleagues who were familiar with the course’s content as well as those who were not resulted in valuable guidance to further course development. Seeking input from students who previously took the course in the classroom setting was also beneficial for some faculty as well.

Our faculty found it desirable to have the course completely developed and on-line before implementing instruction. Faculty in the USI nursing program have also found the development of a course notebook containing a hard copy of the course’s Web site and other materials to be a valuable organizing and reference tool. The faculty member can do much to ensure course integrity and organization by thinking through the development of the entire course and clearly identifying the desired learning outcomes before engaging in the Web-based delivery of the course. This approach also allows students to anticipate future workload commitments for the course and to work ahead at a pace that best fits their needs.

Faculty-Student Interactions. When initially designing their courses, faculty spent considerable time discussing how they would foster interaction with students when not meeting face-to-face with them weekly in a classroom setting. Electronic communication can be used to promote interaction in a number of ways. Faculty in the USI nursing program decided to use a combination of computer conference discussion, e-mail, and electronic discussion lists to facilitate communication with students. Each form of technology provides a different aspect of communication to the course.

Computer conferencing software allows for asynchronous, open discussion of course content on the Web. Conference rooms can be designed to feature a selected course topic for discussion. Faculty and students post comments to the conference room for all course members to read and respond to, thus fostering on-going discussion. In order to get on-line discussion started, we found that faculty may initially need to be very explicit about the requirement that all student must participate in the discussion. Specific assignments that are structured around on-line discussion can help promote this involvement. As students gain experience and comfort with this method of communication, on-line discussion will proliferate without much additional faculty prompting. Faculty need to develop skill in keeping the discussion pertinent to the topic, summarizing the discussion and providing closure to a topic, and moving the students on to the next topic to be studied.

E-mail is useful for private communication between students and faculty. The use of a course discussion list provides the class with a means of disseminating information or questions to the entire class. The information usually takes the form of announcements that are pertinent to all members of the course, but do not necessarily require on-going discussion (i.e., a reminder that an assigned paper is due in one week, etc.).

Relying heavily on computer-mediated communication for instructional purposes can be a new experience for faculty and students alike. Initially it may seem impersonal. In our experience, however, many students are more likely to participate in computer-mediated discussion and initiate communication with faculty in that way than to participate verbally in the classroom setting. Computer-mediated communication can break down barriers that are fostered by a student’s lack of self-confidence and can prevent a few students from dominating the discussion. Communication between faculty and students can be more collegial because all have an equal opportunity to participate (Halstead, Hayes, Reising, & Billings, 1995).

No matter what technology is used for fostering communications, we found that it is very important that faculty respond in a timely manner to students’ questions. When students can anticipate that faculty will quickly respond, they feel more individually connected to the faculty and the course. Student satisfaction with taking a Web-based course greatly improves when they have adequate access to faculty. For example, faculty can set up electronic office hours when they will be available to answer questions promptly via e-mail. Telephone office hours can be established so that students can call if they need to talk directly with the faculty. USI nursing faculty have also found that holding a select number of class meetings (3-4) throughout the semester, either on-campus or through the use of video/audio conferencing, helps promote a sense of "community" among the class members and helps meet the needs of some students who prefer "in-person" interactions.

Time-Management Skills. It is probably evident by now that faculty who engage in Web-based instruction need to develop time-management skills. In the traditional course, faculty typically meet with students during scheduled class times and immediately before and after class. Most faculty also have established office hours when they are available to meet with students. On-line courses provide students with a means to communicate with faculty 24 hours a day and seven days a week - and this is exactly what they will do. Faculty can easily find themselves inundated with electronic mail and computer conference discussions that demand responses if they have not given some thought to how they are going to organize their time. Without question, faculty can expect to spend more time on the delivery of an on-line course than they would in the classroom. On-line courses do, however, provide a measure of flexibility that the classroom does not.

It is important for faculty to decide early in the course how they are going to organize the e-mail and electronically submitted assignments they will receive from students throughout the semester. Many of our faculty have found it helpful to develop individual e-mail files for each student enrolled in their course, thus providing them with a means of easily filing and retrieving each student’s work at their convenience. The use of a course discussion list can also facilitate quick communication to all class members and save faculty time.

Management of asynchronous discussion on the Web is another consideration. It is neither reasonable nor desirable for faculty to expect that they will be able to respond individually to all the comments that student post to conference rooms. Instead, faculty responses should be designed to move the discussion to the next level of analysis when appropriate, introduce information or thoughts that students may be overlooking, provide constructive feedback, and help summarize key points in the discussion. It is usually not necessary to monitor the discussion on a daily basis to accomplish these goals. Depending upon the pace of the course and the number of students, faculty may find that reviewing course discussion on the Web every 2-3 days will provide ample opportunity for them to identify emerging trends in the discussion to which they may wish to respond. Establishing a regular weekly schedule for keeping up-to-date with course communication can help decrease the feeling of being overwhelmed by course demands.

Technology Management. Managing the technology required for a Web-based course can be time-demanding and occasionally frustrating. Faculty will need the support of the computer technicians on their campus to implement a Web-based course successfully. The attitude about technology that faculty bring to the situation is very important to the success of the course as well. Faculty who are easily frustrated with technology and have a low tolerance for flexibility within the teaching/learning process are probably not suited to Web-based instruction. Given the unpredictability of the Internet and computers in general, and the wide variation of hardware that students will use to access the course, it can be guaranteed that technical issues will develop during the teaching of the course.

Faculty can best handle technical difficulties by being proactive - anticipate that frustrations will occur and develop alternate plans for course activities for when problems do develop. Anticipate that the first two or three weeks of the course will probably require as much attention to the technology as to course content. Faculty may wish to design the first couple of weeks with this in mind, placing more demanding assignments later in the course. Students can be overwhelmed quickly as they try to cope with technical difficulties at the same time they are trying to learn large amounts of new material.

Student Development Issues

Enrolling in a course that uses Web-based instruction is still a new experience for many students. USI nursing faculty developed a number of interventions that were designed to help students adjust to the demands of a Web-based course and lessen potential student frustration, especially for those students who are not adept at using the computers. Some activities are implemented before the courses are taught, others during the course.

Pre-course Activities. Each faculty member sends a letter to students registered for their Web-based course approximately three or four weeks prior to the beginning of the course to make the students aware of technology requirements. This letter describes for students the minimum computer hardware requirements for the courses, as well as the need for Internet access and an e-mail address. Students are informed of any dates for in-person class meetings so that they can plan their schedules, and the phone numbers, e-mail addresses, and FAX numbers of faculty and technical support staff are provided. The importance of time-management skills, self-direction, and flexibility are also emphasized. This letter has been so useful to students that it has become a standard requirement for all of our Internet courses.

Optional technology orientation sessions are held each semester the week before and during the first week of classes. These orientation sessions provide students with an introduction to the Internet, their course, and the computer conferencing software that the USI nursing program utilizes. Electronic discussion lists and e-mail are also introduced when appropriate. An instructional technology guide that students can use as a reference throughout the semester has been developed and is distributed to all nursing students enrolled in a Web-based course. It is also available on-line on the School’s distance learning Web site.

During the course. A "help desk" conference room is established on the conference board so that students may ask for help throughout the semester as technology problems arise. This "help desk" is monitored regularly by support staff within the School so that students can receive a timely response to their questions.

Faculty have also found it useful initially to set specific deadlines for responses and assignments from students. By establishing a weekly assignment schedule, faculty can help students adjust within a given time frame to the relative flexibility of a Web-based course. Students who are not used to being self-motivated in their studies or who are not well organized benefit from these deadlines, since they can quickly become overwhelmed and forced to withdraw from the course if they do not keep up with the course work. This becomes less of an issue for most students as they adjust to the format. It is also important to for faculty actively to seek out students who seem not to be participating in the first weeks of the course. Lack of participation usually occurs for one of two reasons: either the student lacks the self-direction necessary for a Web-based course or the technology is overwhelming the student. In either case, early recognition and assistance from the faculty member can determine whether or not the student will ultimately be successful in the course.

Project Outcomes

The goal of implementing Web-based instruction in the fourth-year nursing courses has been accomplished, with faculty and students learning together in the process. Students have identified the major benefits of Web-based instruction as increased flexibility, improved computer skills, decreased travel time, increased access to information, and self-paced independent learning. Some of the disadvantages that have been cited include technology difficulties, decreased contact with faculty and peers, increased time demands, the need for self-discipline, and the cost of the technology to take the course. Faculty have cited as advantages the flexibility, ready access to information on the Web, and increased numbers of students who interact in class discussion. Faculty believe that in many cases the students’ learning has been equal to or greater than what was evident in the traditional classroom version of the course. Disadvantages cited by faculty include technology difficulties, increased time spent teaching the course, and lack of personal contact with students, even though faculty acknowledge that the use of the computer seems to allow some students a means to express themselves more freely.

Students and faculty have been positive about the opportunities for learning that Web-based instruction offers. Although continued evaluation and revisions of Web-based instruction are ongoing, the project is viewed as a success and will serve as the model for other distance education delivery of programs within the School of Nursing and Health Professions.

Reference