Author: Mary Oliver and Som Naidu

University of Southern Queensland

Keywords: Nursing education, post registration nursing students, RN, collaboration, computer supported collaborative learning, CSCL, reflective learning, remote area, isolation, CAUT, University of Southern Queensland.

Article style and source: Moderated. Original ultiBASE publication

Contents

• Abstract
• Introduction
• Project Description
• Use of effective instructional technology
• Curriculum Planning
• Unit Content
• Computer Software
• Results/Outcomes
• Attitudes developed towards collaborative learning
• Value of knowledge gained via collaboration
• Value of skills developed via collaboration
• Value of attitudes developed via collaboration
• Perception of learning experience compared to that of other courses
• Benefit gained from collabotrative learning
• Summary/Conclusion
• References

Abstract

Introduction

This environment combines affordable technology with potent and proven learning and instructional strategies such as critical thinking and problem solving to create a dynamic instructional situation within a social context of learning. This project is about building an alternative model of learning and teaching at a distance that is based on the principles of collaborative and authentic learning that is facilitated by asynchronous computer mediated communication.

The CSCL environment was particularly suited to the learning needs of RNs because these practitioners often work in isolated and remote areas with little or no peer support. The use of CMC allowed these RNs to solicit each others opinions and support on clinical problems as these emerged in practice and explore solutions to these problems within a collaborative environment. It also enabled them to develop an on-going support network to overcome their professional isolation experienced through their geographical location.

Project Description

The course was structured to enable students to move from a position of isolation and independent correspondence mode to a networked community of learners with the ability to access other learners, tutors, and faculty members and resources such as data bases and catalogues, electronically from the convenience of their study centre or workplace.

Use of effective instructional technology

Collaborative learning is only one strategy used in this course, other learning strategies were concerned primarily with observing and recording evidence of two higher level cognitive skills (problem solving and reflective learning). In the context of this course, reflective learning is the main skill being developed and observed, and that metacognitive task is carried out in a computer supported learning environment. Our principal aim is concerned with the development of the skill of reflection-in and reflection on- learning rather than problem solving which may be fortuitous, because CMC is not thought to be conducive to group problem solving. Group problem solving requires synchronous group communication facility.

Reflection-on-action enabled students to reflect on a critical incident from their own area of practice and identify specific learning that may have occurred as a result of the experience. Reflection-in-action, required students to use what they had learnt from the past situation in their current practice, enabling them to examine practice from a learning perspective. The role and behaviour of the teacher is of prime importance in the success of reflective practice of the learners, and what is important to students is the "coach's ability to negotiate the ladder of reflection" (Schon, 1987, p. 168).

We believe that strategies such as collaborative learning and reflection-in and reflection-on learning were important to enhance the students clinical decision making skills in practice. A critical incident based computer supported collaborative learning model (CI-CSCL) was articulated in this course to enable students to familiarise themselves with the four phases involved in submitting a critical reflection.

While CMC is not new, the way it was being used in this course was quite revolutionary, because CMC technology was used to overcome the distance and personal communication barriers and allowed students to study at their own pace and at times that suited them. Within a CMC environment students take the responsibility for helping peers and they are also responsible for their own learning (Mason, 1993). CMC environment also enables teachers, and fellow students to monitor each other. Unlike a traditional conventional classroom, the students cannot 'hide' in a computer conference, the quality of individual student's work is visible to every one and this is an incentive for students to submit good work. The conferencing software tracks who does what and when and creates a permanent information base that can be accessed for later review and update.

The paradigm shift associated with CMC is from a teaching environment to a learning environment and in keeping with this philosophy, the value of collaborative learning was emphasised to the distance students at the beginning of the course (Bruffee, 1993). Through collaboration, students were able to explore the work of their peers using computer mediated communication. CMC was a supportive environment which allowed students to engage in peer discussions on clinical practice issues, professional issues as well as other issues concerning the course.

Curriculum planning

Medical and surgical nursing practice is one of the most fundamental areas of practice. It is currently given to many changes facing the health field and these changes are recognised as being both intrinsic and extrinsic to the discipline of nursing. By examining the thrust of these changes (new developments), students are able to ensure that their practice is appropriate to meeting the demands of clients/patients.

This unit is made relevant to the area of students' practice, because inherent in this unit are topical issues which will enable the student to explore their own clinical areas. Although this unit is not intended to provide practitioners with hands-on field experience, it utilises practice-based exemplars to provide meaningful information that is relevant to current practice.

In keeping with the global philosophy of the BN course, in this unit, the individual who seeks health care is considered from a holistic perspective. This means that our concern for the individual is not limited to their health problem but rather involves their physiological, psychological, social, spiritual and cultural dimensions which influence their health status. This is an important perspective which enables the practitioner to identify the unique needs of individuals.

Unit content

  This unit examines the independent and collaborative role of the nurse as an equal member of the health care team. In dealing with advances in Biophysical Nursing the unit focuses on four major areas. First, the nursing process and the application of the nursing process to the health needs of individuals is considered. The formulation of nursing diagnoses is fundamental to the nursing process and is a key strategy for identifying client/patient health problems. Therefore, students are encouraged to use nursing diagnosis to identify patient/client problems. Second, the use of conceptual models in nursing to guide nursing practice and the following models have been included in this unit. Roger's life processes model, Orem's self care model, Roys' adaptation model and Johnson's behavioural systems' model. Nurses have a crucial role to play in pain management and nursing measures utilised in effective pain management is the third section examined. Finally, wound healing and management, nursing practice was examined in the light of current trends in these areas.

This unit (Advances in Biophysical Nursing) consists of an introduction and four modules. The introduction deals with the concept of becoming an effective practitioner and highlights the needs for utilising the most up to date knowledge and techniques in a wide variety of practice settings. The subsequent modules incorporate the following:

• Clinical decision making utilising the nursing process framework;
• Nursing models;
• Pain management; and
• Wound management.

In this unit, the nursing process framework was used as a means of providing comprehensive documentation in validating client/patient care. The nursing models were used to guide practice, whilst pain management and wound management was reviewed in the light of current developments in these areas.

The above issues underpin the independent and the collaborative roles of the nurse, enabling nurses to become equal to other disciplines of the health care team. Traditionally, nurses have not been able to position themselves as equal partners within the multidisciplinary health team. However, the current changes that are occurring in the health care system (ie, decentralisation of the health service, formalisation of primary health care, recognition of independent nurse practitioners etc) enable nurses to assert themselves as equal partners in the delivery of health care.

In order to become successful in this regard nurses need to acquire a knowledge base that is grounded in theory and has application in clinical practice. This unit provides such a framework in some aspects of medical-surgical practice, thereby enabling RNs to achieve their goals in professional practice. The learner centred instructional design employed in this study is presented in Figure 1. The foci of this design are reflection in and on action, computer mediated communications and collaborative learning.

Figure 1: Critical Incident-Based Computer Supported Collaborative Learning.

Critical Incident-Based Computer Supported Collaborative Learning (CI-CSCL)
Phase 1: Identifying Critical Incident
Identify	Describe	Attributes	Learning
Learners identify an incident from their workplace which they consider as being significant to their roles as nurses.	Learners describe this incident in terms of what happened, when, where and how without revealing names.	Learners identify the special attributes or aspects of this incident that sets it apart from all the others in their experience	Learners reflect on what happened to them in terms of the learning gain for them as nurses
Phase 2: Presenting Your Learning Log
For our purposes in this unit your "reflections" will be called Learning Logs. Your learning log for each one of the critical incidents should: help you remember what happened as part of that critical incident; explain to you and others reading it, why you did what you did; evaluate your action and that of others who were involved in the incident; outline what you should or shouldn't have done, in retrospect; how you would behave given a similar incident in the future; describe what you believe you learned from that critical incident.
Phase 3: Discussing Learning Logs
Presenting your learning log, in the manner described, is the first task as part of this exercise. After you have done that, carefully study all the learning logs presented on the system by the other students. Attempt to make insightful comments and observations on other's learning logs directly and by offering empathy, encouragement and helpful suggestions, both from your own knowledge base and your personal experiences.
Phase 4: Theory and Practice
This last phase has to do with you making the connection between theory (what you are being presented with as part of your nursing education) and practice (what you are being confronted with as a part of your daily work). This process should lead to a summary Critical Reflection which should focus on: extent to which you feel that the theory (what you learned in this unit) helped you cope with the critical incident you encountered at work. adequacies and inadequacies of your theoretical knowledge base with regard to your performance during that critical incident. enlightenment you may have gained from reflecting on the learning logs of your peers and the reflections of your peers on your own learning logs.

Computer software

The computer conferencing environment - CoSy requires further explanation. CoSy was supplied by Softwords^TM in Victoria, Canada. Like most other conferencing packages CoSy enabled us to set up a separate electronic spaces for separate types of activities. In this project, the conferences were set up in the following manner. One conference was set up for posting learning logs, another conference was set up for the discussion of the unit content, while a third was set up for the discussion of the rest of the assessment requirements in the unit, and finally, a fourth was set up for posting just about any other conversation among participants. Over a period of sixteen weeks students were required to submit eight learning logs at bi-weekly intervals, as one of their assessment tasks of this course. Forty percent of the total marks was allocated to this component of the assessment. The remaining sixty percent of the marks was assigned to two written assignments which students were required to complete as a part of their assessment requirements.

Results/Outcomes

  The data that is reported in this paper was drawn from two sources. These were as follows: Learning Logs 1-7 which comprised students comments on other's logs; and Learning Log 8 which is a semi-structured evaluation designed to obtain feedback from the participating students on the efficacy of the CMC environment and their interactions on it. A detailed discussion of the outcome of this analysis is presented and discussed in the CAUT report. In this paper, we have only reported the findings from Learning Log 8 which were examined for the presence of the learning attributes we were attempting to engender in learners. These attributes are presented in his discussion in graphic form and include the following:

• attitudes developed towards collaborative learning.
• value of knowledge gained via collaboration.
• value of skills developed through collaboration
• value of attitudes developed via collaboration
• perception of learning experience compared to that of other courses.
• benefit gained from collaborative learning.

Attitudes developed towards collaborative learning

Figure 2: Attitudes towards collaborative learning

Value of knowledge gained via collaboration

Figure 3: Knowledge via collaborative learning

Value of skills developed through collaboration

Figure 4: Skills via collaborative learning

Value of attitudes developed via collaboration

Figure 5: Value of attitudes towards collaborative learning

Perception of learning experience compared to that of other courses

Figure 6: CSCL experience

Benefit gained from collaborative learning

Figure 7: Benefit from collaborative learning

Summary/Conclusion

The use of Computer Mediated Communication (CMC) is regarded as an asset by students who work and live in the rural and remote parts of the country and especially for those students who study through the distance mode, because they do not have access to face to face peer support and networking facilities. The effective use of CMC demands specific conditions and skills such as access to technology and training. The teachers and students were supported in acquiring those skills at the beginning of the course.

While technology is an important part of this new learning concept, it is important to recognise that the use of computer alone cannot yield good results. We recognise that CMC is a powerful enabling tool that allows teachers to improve the way they organise and facilitate the instructional process. It enables the teachers to shift the focus of their courses from teaching to learning.

An important aspect of using Computer Mediated Communication in instruction is that it is text-based and it requires students to read and respond to other students work. In our experience using CMC, we found that the students' ability to critically read and write improved because the students were not only writing assignments for the teacher, but they were also writing material to be reviewed by their peers. This in itself became a motivating factor for students to submit good work. We also recognised that not all students were able to express themselves well in writing, however, having the opportunity to read peer assignments and having the time to reflect on what they have learnt empowered mediocre students to perform at a higher level in writing assignments.

In summary, students who participated in the CMC experience in this course not only had the benefit of experience of the other students in the CMC environment, but also had access to critical comments of other students, and the comments of the lecturer. Those students who elected not to participate in CMC submitted their Learning Logs by conventional methods, therefore did not have access to other students work and did not have the opportunity to reflect on peer experiences.

Acknowledgment

References

Dewy, J. (1933). How We Think: A Restatement of the Relation of Reflective Thinking to the Educative process. Boston: Health.

Ertmer, P.A. & Newbury, T. J. (1996). The Expert Learner: Strategic, self-regulated and reflective, Instructional Science : 24, 1-24.

Grimmett, P. P. (1988). The nature of reflection and Schon's conception in perspective, in P. P.Grimmett & G. L. Erickson, eds., Refection in Teacher Education , (pp. 5-15). New York: Teachers Press.

Houston, W. R., Clift, R. T., & Pugach, M. C. (Eds). (1990). Encouraging Reflective Practice in Education: An Analysis of Issues and Programs , (pp. 208-222). New York: Teachers College.

Mason, R. (1993). (Ed). Computer Conferencing: The Last Word. Beach Holme Publishers Limited, Victoria, British Columbia, Canada.

Schon, D. A. (1987). Educating the Reflective Practitioner. San Francisco: Josey-Bass.

About the authors