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Integrating computer-based learning in nursing

Andrea Surridge
Lecturer/ Practitioner District Nursing Bro Morgannwg Trust
Swansea University

Developing a CD-ROM can be both challenging and exciting, yet does the investment in terms of time and human resources during its production make the effort worthwhile? Working as a lecturer/practitioner has given me insight into the advantages and disadvantages of working with information technology (IT). This article attempts to explore what the potential benefits and drawbacks are in both the development and use of the CD-ROM by the teacher and the learner.

Study at your own pace
Computer-based learning is becoming more of an everyday occurrence, providing learners with the opportunity to study at their own pace and thus enabling ownership and control of learning.(1) If used appropriately, learning technology can potentially enable the student to reproduce their ideal learning environment, providing an opportunity to learn as and when they choose in a manner that best suits the individual.
It is paramount to remember that learning styles vary enormously; not all individuals respond to the same teaching techniques, and many learners thrive on change. Technology, however, is changing the way people teach and learn. The current political climate is urging the need to integrate IT into nurse education;(2) however, despite advances in IT, often only low-level learning is achieved.(3) Producing a CD-ROM does not automatically mean that individuals will use it to reinforce their learning. A CD-ROM can often be meaningless and the subject matter inappropriate to the learner. There have been occasions when, at the end of a training session, I have been offered a CD-ROM, the belief being that the CD-ROM will provide me with the opportunity to revisit the subject matter as and when I feel it necessary - however, for those among us who are fearful of technological advances or prefer to work in small groups, we may find that the CD-ROM actually ends up sitting on a shelf or in  desk drawer. Colleagues often indicate that they prefer to work collaboratively with others in a small group as this has the added benefit of being able to ask each other questions that they would otherwise be afraid to ask in a larger group; this could well be perceived as providing a way for students to discover what they understand and what they just think they understand.
Yet, if IT is to be part of the future landscape of learning, knowing when to use it (and when not to) is the first step towards making sense of computer-based learning. When used inappropriately, for the wrong reasons, or without adequate resources in place, it is likely to be slow, expensive and inefficient. Virtual environments can enable the exchange of ideas, solve problems and explore alternatives while creating new meanings.  This is in part a response to the 1997 Dearing Report, which emphasised the growth of technology in higher education.(4) The report dictated that nurses should be competent in using common software packages, able to undertake literature searches and use the internet as a key information source in order to provide evidence-based care. However, students should be reassured that, despite computer-based learning being seen as the way forward, what is most important is that the most "appropriate" strategy is in place for students to learn through and that this is supported by technology.(5) Hence, could the CD-ROM be a stepping stone to online learning?

Changed thinking
The integration of IT into nurse education requires a dramatic change in thinking. The learning curve is steep for both the student and educator. Anxiety, apprehension, fear and dread are words used by learners and teachers alike; negative attitudes towards computer technology affect both its use and access, yet for younger students, who have been brought up surrounded by computer technology, the opportunity to discover new modes of delivery may be exciting.Computer-based learning encourages the role of the educator to become facilitative rather than merely didactic, providing greater flexibility and freedom.
While accepting that computer-based learning is different, whether it actually makes things better is still open to debate. IT has been slow to be rolled out in healthcare, and only time will tell whether the quality of student learning will be improved. The advantages of IT include flexibility for the learner to access educational resources; however, a major stumbling block can be lack of suitable equipment (hardware) and software.  Trainers repeatedly find that software packages are of poor quality and that they were not consulted on the most appropriate packages.(5)

Why develop an electronic learning tool?
Teaching should be a process of guided interaction between the teacher, the student and the materials of instruction.(6,7) Being faced with the task of providing some additional support to encourage colleagues to enhance their prescribing practice, the debate was whether the development and use of a CD-ROM could be a means of narrowing the theory-practice gap? An appropriate software package may enable reinforcement of the subject area by the learner group. The aim of the CD-ROM I worked on was to provide the necessary reinforcement of competencies, effectively encouraging and supporting active prescribing. Changing practices and changing thinking are inextricably linked - new practices bring new thinking and vice versa - but will not automatically lead to learning enhancement. Education is not just the transmission of knowledge, but also the transformation and development of people's critical thinking skills.(8) Critical thinking provides learners the opportunity to draw on their previous learned knowledge to answer appropriately. Interactive software would enable the learner to have the opportunity to process, reflect upon and interact with information rather than simply learning presented data. However, critics still argue that e-learning has not yet fulfilled its potential or achieved the perceived benefits as promised.(1,4,5,7,9,10)
During my experience developing a CD-ROM for nurse prescribing, it became apparent that the investment in terms of time was very intensive, and unfortunately due to licensing restrictions (which had not been previously thought through adequately by the author) the CD-ROM could not be utilised as initially planned. But despite this, I still feel that computer technology/e-learning can improve the quality of a learning experience, providing individualised learning reinforcement and support, flexible study and the potential to encourage creativity through small-group discussions. The teacher who is involved in the development of a software programme is more likely to effectively use the software as part of their teaching session as the design specifically meets the student group needs. But again, it must be remembered that computer technology should never completely replace the teacher.

Key questions
From my own experience of the process of developing a CD-ROM, I feel that the following key questions could aid development:

  • Why is a CD the most appropriate tool for the subject area?
  • What type of information could/should be included?
  • Are there any hyperlinks to websites that would enhance or support the proposed content, and if so, do copyright issues need to be explored?
  • What type of information or navigational activity would motivate you to use this package; what would maintain your interest?

The ideal package is one that not only offers learners a step-by-step guide through the subject area, but also one that offers learners the opportunity to explore any topic in any sequence, thereby suiting their individual needs. It is evident that there are certain advantages and disadvantages to developing and using a CD-ROM to enhance learning (see Tables 1 and 2).



It is important to consider whether the learner population will have the means to use computer technology and whether technology will in effect actually make any difference. Computer-based learning offers a means to increase the flexibility and accessibility of education provision for nurses, and the use of technology has the potential to enhance the learning experience, but technology itself cannot be used as a quick fix for courses that are poorly developed or lack appropriate content, or for which there is inadequate tutorial support.
Computer-based learning is a medium to enable maintenance of lifelong learning. IT in teaching and learning will surely be most valuable when it is integrated with other approaches and when it is used to mediate learning. Further research examining the effectiveness of this type of learning tool is required. 
The integration of IT into nurse education requires a dramatic change in thinking, and the learning curve is steep for both the learner and educator, with many issues needing consideration. 


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