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Nursing Education at a Distance Nursing CE Course

1.0 ANCC Contact Hour

About this course:

The purpose of this module is to explore online nursing education and the opportunities for alternative delivery of program curriculum by nurse educators.

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The purpose of this module is to explore online nursing education and the opportunities for alternative delivery of program curriculum by nurse educators.

By the completion of this module, the nurse should be able to:

  • Explore online education and its implications for nursing.
  • Consider the pros and cons of online nursing education.
  • Explain the basic elements of an online classroom.
  • Examine special circumstances in nursing education and online learning opportunities.

Terminology varies among faculty and students, but the following definitions of learning are universally accepted:

Online learning is course work that is most often completed asynchronously inside the learning management system (LMS) and does not occur in the classroom. While some programs require immersions or time inside a lab or clinical setting, the actual online class does not hold these elements. The asynchronous learning supports reflective thinking and allows the student time to independently research or read the course materials, and subsequently apply, synthesize, or analyze the course materials, then formulate a post for the discussion that is shared with either a small group or the entire class. An online class can be accessed anywhere, at any time (Kennedy, 2017).

Blended or hybrid learning is course work that includes a combination of classroom and online activities (Kennedy, 2017).

Distance education is learning and teaching from a distance and has a synchronous element in which students and faculty are all online in the LMS at specific times during the week. The students and faculty can talk to each other but are not in a single location. This type of learning allows the faculty and students to have the experience of a classroom without traveling to a campus. There is less time for reflection or research as the faculty interacts with the students in real time. Studies have shown that faculty teaching online in this type of environment, with synchronous activity, did not report significant differences from a face-to-face classroom experience (Kennedy, 2017).

Nursing Education at a Distance

Learning from a distance is not new to the US education system. As early as the 1950s, distance learning was occurring from elementary to graduate school and became very popular in the 1970s. This growth can be attributed to new communication technology, the sophistication of printed materials, improved designs of instructional materials, and support systems for students in remote settings through phone calls (Willis, 1994). Willis (1994) further notes that "effective distance education focuses on the needs of the learners, the requirements of the content, and constraints faced by the teacher" (p.44). At that time, distance education consisted of faculty mailing lessons and assignments to a student; the work was completed and mailed back to the faculty for grading. As computers became the norm in many households in the late 90s, the phenomena of online education began and has continued, transforming how students learn outside brick and mortar institutions (Harting & Erthal, 2005).

Educators have many options for the delivery of course content these days; whether in the live classroom or online, many modalities for educating students exist. Many educators report a preference for the live experience in a classroom over online teaching, yet there are many benefits to either technique. Many educators view a live lecture as the gold standard in delivering educational material and find online education less valuable, and often describe it as a second-class opportunity for students. While learning outside the physical classroom has been around for decades, the number of options has exploded over the last two decades. The online educator has the opportunity to deliver a consistent experience to all students by implementing lessons, discussions, and learning activities inside the virtual classroom. While there is concern among some educators regarding the effectiveness of online education, a study by Nguyen (2015) demonstrated no difference in the performance outcomes of students taught in the online environment versus the traditional classroom setting. Nursing programs have followed the trend of online education by augmenting campus courses with online learning, known as "hybrid" courses, and transitioned certain courses to entirely online platforms (Major, 2015). Fully online nursing programs have been developed across the country, and they vary in their quality and consistency. Currently, there are 388 online pre-licensure (before taking the NCLEX national licensure examination) nursing programs in the US with 56 programs in Texas alone. There are even more online post-licensure (after passing the NCLEX) and graduate nursing programs across the US, offering many opportunities for online nurse educators (Guide to Online Schools, 2020).

For some schools, the decision to deliver nursing education online is not their preference. However, due to disasters (i.e., weather and other natural disasters), or most recently, a global pandemic, the decision to transition traditional education courses to the online environment is the best way to ensure that their students’ education is not disrupted. Online classes are very popular for busy students, particularly those who are also juggling several family, work, and personal demands. These challenges limit students’ availability for participation in synchronous, campus-based courses; even outside of the current mandatory online teaching due to a global health disaster, online classes have likely become an industry standard due to heightened demand (Darby, 2020). This module will explore the basics of delivering a course in the online environment, in addition to an overview of the potential pros and cons.

The Basics

To deliver a course online, the student and faculty must have access to the necessary technology. This typically means a personal computer (PC), laptop, tablet, or another device that can access the internet and minimum software requirements to access the LMS that will house the school's courses. At a minimum, the faculty must have a syllabus loaded into the LMS, assigned passages from textbooks, assignments, and methods of submitting any required work such as a DropBox. Even schools that are primarily campus-based typically have access to an LMS such as Canvas, Blackboard, or Moodle, which is generally used to house the course syllabus, handouts, course documents, and the course gradebook. Faculty may be tempted to use social media as a platform for courses, but due to privacy and Family Educational Rights and Privacy Act (FERPA) Concerns, the use of the college's approved LMS is preferred. Further, students should have access to technical support from the college in the event of issues while using the LMS that may not be available with other social media platforms (Moore & Hodges, 2020). New faculty members who are unfamiliar with online delivery of courses should carefully consider the following:

  • How will the course will be delivered?
  • How many assignments should be given online versus an in-person setting?
  • How to establish that the student was present “in class” the required number of hours to justify their successful completion of the course (Moore & Hodges, 2020)?

Many of these important details are established through careful development of the course syllabus that defines the program outcomes, course outcomes, and weekly objectives. Just as faculty teaching in the classroom setting is required to develop learning plans, a course calendar, and other necessary learning assessments, the basic framework for an online course is the same. Other concerns about online delivery are related to academic integrity in assessments and assignments that are completed outside of a proctore


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d environment (Moore & Hodges, 2020). Three principles of online pedagogy include the following:

  • Students should do the majority of the work, not the faculty, and this may be through engaging discussions, sharing presentations, or care-based learning activities such as case studies.
  • Interactivity is the heart and soul of effective asynchronous learning.
  • Faculty members should strive for presence.

Being available and providing the support that facilitates students’ learning is foundational to success in the online environment (Kennedy, 2017).

The Advantages and Disadvantages of Online Education

The obvious benefits of online education include its superior flexibility for both students and faculty. Students or faculty may not live close to the campus, and the online opportunity allows them to attend without the time or expense of commuting to campus. During a disaster or pandemic, online access to education can provide a flawless completion of course work without loss of valuable time and give employment opportunities to faculty members despite the closure to the physical campus. Online classrooms have less structure than a traditional campus and require the student to remain focused and responsible for the completion of their course work. For this reason, student engagement is vital within distance learning. The other cons of online education can vary. Faculty and students commonly have misconceptions about online education, such as the notion that online students are more likely to procrastinate and avoid doing their classwork than students present in a conventional classroom. However, many online students are very independent high performers who may simply need added flexibility due to scheduling conflicts. Some of the challenges to online education include faculty or students that are not technologically prepared or a lack of student or technology support for troubleshooting. Students and faculty may feel isolated and miss the human interaction found in a traditional classroom (Porter et al., 2014).

The LMS

Online classes are typically housed within software or a platform called the LMS, and most institutions purchase the rights to use a specific LMS for all courses, including online. The LMS platform includes ways to communicate, deliver content, and assess students. Typically, the following elements and functions are contained in a school's LMS:

  • File storage area;
  • Webpages that allow a syllabus and lessons as well as videos or recorded lectures to be uploaded;
  • Assessment tools such as testing software;
  • An area to submit assignments, such as a DropBox or uploading tool;
  • Modules or tabs that allow weekly or topical division of course work;
  • Discussion forums to stimulate conversations on major topics;
  • A gradebook with all graded assignments listed for student and faculty tracking (Darby, 2020).

Course Elements 

Syllabus

Typically, the syllabus is either created as a Word document and loaded into the course files or created as a webpage with all the necessary information as required by the individual school. Syllabi usually include a course description, course number, title of the course, credit hours, and any pre- or co-requisites for the course. Required and optional textbooks should be listed on the syllabus, along with any policies regarding late assignments or attendance in class, as well as assignment or exam expectations. The syllabus is the course contract between the faculty and students, and where conflict arises, the syllabus is usually the determining factor for any reviews. Many schools require a legal disclaimer on the syllabus, such as: "The above schedule, policies, procedures, and assignments in this course are subject to change in the event of extenuating circumstances, by mutual agreement, and to ensure better student learning". Faculty contact information should be included along with virtual office hours, or preferred method of contact (Nilson, 2016, p. 37).

Course Set-Up

Most LMS programs have a navigation bar with tabs such as syllabus, modules, grades, or announcements as seen in Figure 1.

Figure 1

Sample Course Navigation Bar

The tab names may be predetermined by the school's technology or educational departments and simply need to be populated by the faculty. Most of the course activities are located under the modules tab. A module may be organized by period (I.e., weekly), or by topic area within the course. The modules should be ordered sequentially and contain all the materials needed to complete the learning activities for that specified timeframe or topic. For example, if the first module is for Week 1 and the course calendar covers oxygenation during Week 1, then any lectures, discussions, videos, learning activities, or assessments regarding oxygenation should be included in that module. In some LMSs, the module tab opens into another page that allows for loading various weeks or topics. Modules may open into a page with a folder/section for each week/month, and each of those may open into another page with tabs for lessons, discussions, assignments, and files (or any other areas the faculty may want to cover). Regardless of the layout, consistency is important so the students can find necessary course work to successfully complete all requirements (Darby, 2020; Morgan, 2018).

A course calendar is essential to guide the students through the course work since most courses are completed asynchronous (students are in the virtual classroom and do the work on their own time throughout the day or week, rather than everyone in the classroom at the same time). Tasks should be listed for a specific timeframe on the calendar. However, the student should be allowed flexibility to complete the task as their schedule permits during the determined timeframe. An example is that all Week 1 work should be completed by May 10, 2020, and students can start on Week 1 work on May 3, 2020. The student can complete the required work at any time during that week, but clear expectations should be listed on the course calendar. Occasionally, a live webinar or other synchronous activity may be scheduled, requiring everyone in the class to attend simultaneously. There should be recordings where possible to give anyone unable to attend the live event the opportunity to listen at a later time. Faculty members can also set up virtual office hours. This can be via a webinar room such as Zoom or Webex, or through phone calls during specified times. The faculty should post an announcement listing their availability and how to contact them (Darby, 2020; Morgan, 2018).

Course assignments should have detailed instructions, just as they would in a traditional classroom. Rubrics can be used to guide the students regarding expectations and support their success. Discussions and assignments should align with the course outcomes to facilitate competency of the knowledge and skills required in a particular course. Many faculty members create videos explaining an assignment to students and post this within the virtual classroom as part of the guidelines. Best practice for online education includes weekly announcements that guide the students through the upcoming week's expectations, and a summary announcement closing the previous week with encouraging messages. During the week, faculty members should check into the online classroom daily for student questions, responding promptly. Students should be aware of the grading schedule, and the faculty should complete grading in the timeframe promised. The most successful online faculty are those who are present in the virtual classroom. Students are most likely to be present in the classroom when they see faculty that are engaged. Just as faculty and students enjoy the random interactions in a hallway or office of a conventional campus, online interactions can be equally engaging. The interactions may come through phone calls, texts, video chats, or whatever technology platform is mutually agreed upon. Just as privacy is vital in the traditional classroom setting, the same consideration should be utilized in an online environment. Communication is important as well and faculty should be considerate of tone and etiquette in the written word. Faculty members should be mindful to avoid feedback that is overly negative or harsh (Darby, 2020).

It is easy for the students to become confused, miss assignments, or fail to locate all the expected work for a week. To avoid this frustrating situation, faculty members should give clear directions regarding the expected work for each week or module and send a reminder mid-week, and at week's end when possible. This is much like the reminders posted outside the classroom or on bulletin boards in the hallway of brick and mortar schools. It is crucial to set the course materials up in a way that is easy to navigate and place directions throughout the course, including hyperlinks or lists. When possible, courses should be visually appealing with approved clipart and attractive fonts, as well as links to approved websites or videos. Faculty members should be sure to discuss the use of outside resources with institutional leadership to avoid copyright issues. Student examples of assignments such as PowerPoint presentations or written papers can be posted for additional clarity. This can offer the student a starting point to create their own assignment and may avoid academic integrity issues related to students using others’ work that may be available online (Darby, 2020; Moore & Hodges, 2020).

Assessments

Assessments in the virtual classroom can include quizzes, exams, written papers, or presentations. Since most students have access to video equipment through their smartphones or computers, many faculty members create assignments that require a presentation from the student that is recorded and uploaded. It is good practice to have quizzes, questions, or case studies within the lessons or at the end of specific content. For instance, the faculty may teach about infection control, then ask four to five questions that allow the student to demonstrate competency. These may or may not contribute to the students’ overall grade for the class, but are used to facilitate student learning and competency of the content. Exams and quizzes should be protected to ensure academic integrity. This can be achieved through testing software or online proctoring of exams. Most LMS programs have exam software as an option in course delivery. Lockdown browsers are available for online testing, which force the students to stay within the exam and will cut the test off if they browse elsewhere during of the exam. Testing software may include webcams that allow the faculty to review the exam to ensure academic integrity. Regardless of the software or tools utilized, it is important to make all rules for the exam clear to the students at the start of the exam. Academic integrity is a concern with online exams, but one method of maintaining the integrity of test questions includes variable exam items (test questions) that assess the same competency. These questions can be alternated among students in the same class or can be traded out so that students are not able to share the questions with the next class. Many experts suggest that online testing is excluded from summative assessments since they are at risk for publication on the internet or sharing among students. Research papers or projects offer a demonstration of competency without that risk. Regardless, quizzes and exams are valuable tools for assessing competency and should be used throughout the course in some capacity (Kennedy, 2017).

Academic Integrity

As previously noted, a significant challenge in the online setting is academic integrity. Ensuring the student's work is their own can be difficult for the most seasoned educator. Most assignments within online courses are completed as written papers, PowerPoint presentations, or discussions. Many of these can be submitted through online plagiarism detectors such as Turnitin, Grammarly, or iThenticate. In some cases, these plagiarism checkers are already integrated into the LMS dropbox (submission upload area for assignments) or may be utilized as a separate resource for faculty to check originality of assignments. The choice of plagiarism checker varies among institutions, but they all function by comparing the student’s submitted work against a variety of sources including published work, internet sites, and other papers that have previously been submitted. Although unlimited access to information on the internet makes it easier for students to cut corners or use someone else’s work, it is also easier for faculty members to identify plagiarized work through the use of these tools. Students may not be aware that what they are doing is unacceptable, and may require support from faculty to understand the proper way to cite information, paraphrase, or synthesize their own thoughts (Solomon, 2018).

Being Successful in Online Education

While many educators have become accustomed to developing and delivering a lecture on a topic and may add in a video or other media such as PowerPoint, they are not as comfortable creating an online lesson. Long written lectures are not as stimulating as short, focused ones. Using video clips or directing the students to articles, websites, or alternative methods of getting the lesson's main points across are preferred (Darby, 2020). To promote interest in the online classroom for students, faculty members should consider the following:

  • Incorporate learning activities, interactive tools, media, and visuals;
  • Streamline the course organization and make it visually attractive, yet as easy to navigate as possible;
  • Keep the interactions positive and optimistic in the discussions and announcements;
  • Demonstrate caring and compassion for online learners and consider their busy schedules;
  • Be respectful of time expectations by limiting synchronous activities and notifying students well in advance;
  • Be engaged and visit the classroom frequently, answer questions promptly, and actively participate in the discussions (Darby, 2020).

Instead of simply instructing a student to "capitalize the first letter of each word in a journal name in your references," they should consider saying "You did a nice job on most of your APA formatting in the reference list, but there are a couple of areas that need work. Be sure to capitalize the first letter of each word in a journal name. Otherwise, I was impressed by the number of quality articles you used. Good job!" By sandwiching the negative with positives on both sides, there is less opportunity for the student to hear the feedback as all negative and become defensive. Giving recorded feedback may be another excellent way to personalize the feedback to students and "humanize" the online experience. The LMS used by many schools has audio and video options built in (Moore & Hodges, 2020).

Special Situations

Pre-licensure nursing programs require a large number of clinical and lab hours to allow students experiential learning that leads to safe and effective patient care. This can be accomplished in a hospital setting, a lab, or online. Simulations have been added to most nursing curricula as an adjunct to the clinical day. Most boards of nursing currently allow simulation to satisfy a portion of the clinical requirements for nursing programs in that state. In fact, many states such as Florida allow up to 50% of the students’ clinical time to take place in a simulated environment, either in the lab or virtually. The online classroom can serve as an alternative in the event there are limited opportunities for clinical experience. There are many resources for pre-developed simulation experiences online, such as the National League for Nursing's (NLNs) vSim. This program offers the opportunity to assess clinical learning by students outside of the clinical setting (NLN, n.d.). Whether nursing faculty use pre-developed simulations and experiential learning activities to meet clinical requirements or develop their own tools, students can achieve competency to deliver safe patient care through virtual learning. An advantage of these virtual clinical simulations is that students can acquire the skills to deliver safe care without the potential risk to live patients. Medical errors are significantly higher among students and new graduate nurses entering practice. If they can practice on virtual patients, their competency increases, thereby improving patient outcomes in the actual clinical setting (Padilha et al., 2019).

Conclusion

An educator may feel intimidated by the technology or the use of an online classroom and may be hesitant to ask for help as they take on the task. Yet, online courses are designed in the same manner as a campus-based course and should follow the same outcomes-based process. The greatest challenge comes with embracing the tools available and maximizing their use to create interesting and informative materials for the students as they learn to care for patients in a safe and responsible manner. Reflection can be a powerful tool and should be used by both the student and the faculty to gain insight into future opportunities in teaching and learning.

References

Darby, F. (2020). How to be a better online teacher. https://www.chronicle.com/interactives/advice-online-teaching#2

Guide to Online Schools. (2020). 2020 online nursing and BSN programs by state. https://www.guidetoonlineschools.com/degrees/nursing

Hartin, K. & Erthal, M. (2005). History of distance learning. Information Technology, Learning, and Performance Journal, 23(1), 35-44. http://130.203.136.95/viewdoc/download?doi=10.1.1.587.5816&rep=rep1&type=pdf

Kennedy, S. (2017). Designing and teaching online courses in nursing. Springer Publishing.

Major, C. H. (2015). Teaching online: A guide to theory, research, and practice. Johns Hopkins University Press.

Moore, S. & Hodges, C.B. (2020). So you want to temporarily teach online? https://www.insidehighered.com/advice/2020/03/11/practical-advice-instructors-faced-abrupt-move-online-teaching-opinion

Morgan, B. M. (2018). The lived experience: A study in teaching online. Contemporary Issues in Education Research, 11(1). 81-86. https://files.eric.ed.gov/fulltext/EJ1175162.pdf

National League for Nursing. (n.d.). vSim for nursing. Retrieved on May 10, 2020 from http://www.nln.org/centers-for-nursing-education/nln-center-for-innovation-in-education-excellence/institute-for-simulation-and-technology/vsim-for-nursing-medical-surgical

Nguyen, T. (2015). The effectiveness of online learning: Beyond no significant difference and future horizons. MERLOT Journal of Online Learning and Teaching, 11(2), 309-319. https://jolt.merlot.org/Vol11no2/Nguyen_0615.pdf

Nilson, L.B. (2016). Teaching at its best: A research-based resource for college instructors (4th ed). Jossey-Bass.

Padilha, J.M., Machado, P.P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical virtual simulation in nursing education: Randomized controlled trial. JMIR, 21(3). e11529. https://doi.org/10.2196/11529

Porter, A. L., Pitterle, M. E., & Hayney, M. S. (2014). Comparison of online versus classroom delivery of an immunization elective course. American Journal of Pharmaceutical Education, 78(5), 96. https://doi.org/10.5688/ajpe78596

Solomon, M.A. (2018). Promoting academic Integrity In the context of 21st century technology. Kinesiology Review, 7, 314-320. https://doi.org/10.1123/kr.2018-0042

Willis, B. (1994). Distance education: Strategies and tools. Educational Technology Publications.


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