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1 Enhancing Traditional, Televised, and Videotaped Courses with Web-based Technologies: A Comparison of Student Satisfaction Mary Lou Sole, RN, PhD, FAAN Mark Lindquist, RN, BSN, MA Background: Varied distance learning strategies can be used to deliver nursing courses, including interactive television, videotape, and Web-based approaches. Purposes: (1) To assess student assess student satisfaction with a critical care elective course offered simultaneously via traditional and distance learning formats in which Web-based strategies were added, and (2) to compare satisfaction of students taking the traditional course versus those taking the class via distance technology. Methods: Students (n = 113) who took the course during the spring 1998 and 1999 semesters completed a teacherconstructed evaluation at the end of the semester. Findings: Mean ratings on the evaluation were positive. Ratings of interaction, communication with instructor, and facilitation of learning were higher from students who took the traditional course. Conclusions: The application of Web-based technologies may be one factor for the overall course satisfaction. However, it is important to continue to evaluate strategies that work best for students taking courses via distance technology. The information explosion has resulted in changes in nursing education. Technologic advances provide opportunities to increase the quality of instruction and access to nursing education. 1 Expanded use of distance learning technologies, including Web-based instruction, is a big component of this explosion. Nursing faculty members are developing Web-based courses and entire programs to meet the demands of students for innovative instructional technology, flexibility in completing course work, and reduced time commuting to campus for classes. 1 Although Web-based instruction is growing rapidly in nursing education programs, other distance education technologies continue to be used for course delivery. Interactive television and videotaped courses are 2 methods that facilitate instruction to students at sites located away from the main college or university campus. These methods of delivery allow students to take courses in the more conventional lecture/discussion format while providing students the opportunity to take courses closer to their homes. The American Association of Colleges of Nursing issued a White Paper in 1999 which addressed issues in distance education. 1 The American Association of Colleges of Nursing recognizes the growth of distance education programs and the need to evaluate them. Distance learning technologies create opportunities for innovation in instruction with emphasis on learning rather than teaching. It is possible to combine various distance-learning technologies into 1 course. The purpose of this article is to describe the use of Webbased technologies to enhance classes taught in 3 modes: live traditional, interactive television, and videotape. These technologies have been incorporated into a critical care nursing elective course for the past 2 years. Results of evaluation research on students perceptions and satisfaction with course delivery with the use of these technologies are described. BACKGROUND Strategies for distance learning vary. This evaluation incorporated a variety of technologies, including Web-based strategies, into course delivery. Interactive television allows the instructor to teach a course in a live, traditional mode while having simultaneous audio and video communication with students at remote learning sites. Mary Lou Sole is a professor at the University of Central Florida School of Nursing, Longwood. Mark Lindquist is a doctoral student at the University of Central Florida and a staff nurse at South Seminole Hospital, Orlando. Nurs Outlook 2001;49: Copyright 2001 by Mosby, Inc /2001/$ /1/ doi: /mno Interactive Television Interactive television allows the instructor to teach a course in a live, traditional mode while having simultaneous audio and video communication with students at remote learning sites. Modes of transmission include satellite, microwave, and fiberoptic. A high degree of technical support is needed to produce interactive television courses, to assist faculty members in course development and delivery (including 132 VOLUME 49 NUMBER 3 NURSING OUTLOOK

2 Table 1. Numbers of students by type and method of course delivery RN-BSN Generic BSN Total Traditional classroom setting Remote live broadcast of class Videotaped Total graphics and other media), and to troubleshoot problems associated with broadcasts and transmission. 2,3 Classes that are broadcast by interactive television can also be videotaped. Videotapes may be placed on reserve at libraries for central use by students or sold to students for individual use, depending on copyright policies. Videotape clips can also be streamed to students on demand through a central computer server. Suggestions for effective instruction when teaching by way of interactive television include interacting with students across sites and maintaining an accurate database of student information. The preparation and organization of materials for students at the remote sites before class and good audiovisuals for viewing are essential when courses are taught by way of television. 4-6 Online delivery of courses is a current trend in nursing and higher education. Web-based Course Delivery Online delivery of courses is a current trend in nursing and higher education. Electronic tools and components of Webbased courses include links to Web resources, bulletin boards, syllabi, supplemental course materials, learning modules, discussion and/or chat rooms, and testing. 7-9 A Web site can be used for students to submit papers to the instructor or to conduct electronic presentations to the class. Small private groups can be established for students to discuss issues and to collaborate on projects. Software designed to implement Webbased courses provides automatic responses to inquiries, automatic test scoring, and immediate results to students and summaries of students access to Web pages. 9 Web-based instruction requires additional time to set up and to administer courses, which is frequently cited as a major disadvantage To be successful in an online course, students must be oriented to the Web format, learn adequate computer skills, and have access to hardware and Internet service providers. Students must also be able to tolerate and troubleshoot technical difficulties. 10 Students self-motivation and self-discipline are an integral part of Web-based learning because the focus is on independent learning rather than on teaching. NURSING OUTLOOK MAY/JUNE 2001 To be successful in an online course, students must be oriented to the Web format, learn adequate computer skills, and have access to hardware and Internet service providers. Strengths and Limitations of Distance Learning Technologies Distance learning technologies, including Web-based instruction, can increase the effectiveness of instruction and improve students academic performance, class participation, and attendance. Ayoub et al 10 reported that students who interacted electronically with the instructor and each other benefited from the visual and kinesthetic learning. Students who did not usually participate during discussions in traditional classes felt less threatened during online discussions and became more actively involved in the class. Electronic brainstorming helped students to discuss key ideas and issues. Students perceptions regarding interactive computer classrooms were positive; they noted that it enhanced the application and understanding of subject material. 10 Distance learning is also associated with disadvantages. Distractions of home and family may make it more difficult for the distance learner to focus on the assignments. The feeling of isolation and a lack of connectedness are of concern for any distance learning classroom, and the faculty member must prevent students sense of isolation. 14 Faculty members spend more time planning and implementing distance learning strategies that are successful. Evaluation of Interactive Television Used With Additional Distance Technology Limited research has been conducted that evaluates distance learning alternatives to traditional lecture classes. In 1998, Lewis and Kaas 14 described growth in distance education by 50% over a 4-year period. They used a variety of strategies, including interactive television and electronic mail, to teach graduate students in psychiatric-mental health. They conducted a formal evaluation of the course by asking students to rate several items on a 5- point Likert-type scale from strongly agree (5) to strongly disagree (1). Student satisfaction was positive in the areas of connectedness that included contact with instructor, participation, and contact with fellow students; scores ranged from 3.68 to Students at the on-campus site ranked most items higher than did students who were off-campus. Overall satisfaction with the course was rated between 3.4 and 3.5. Students mean scores on whether they would take another interactive television course were between 3.91 (on-campus) and 4.14 (off-campus). Student attrition in courses was low, and faculty satisfaction was high. 14 Lewis and Kaas 14 also cited disadvantages to the interactive television delivery of the course. The amount of time required of the faculty members was more than in a regular lecture classroom. Initial set-up time and the development of the classes were substantially more involved. Additional time was needed for collecting and distributing course-related materials and assign- 133

3 ments, and responding to many student inquiries (phone or electronic mail). Some instructors traveled to the distant learning sites to meet with students, putting additional demands in teaching the course. Flexibility and patience from the faculty member were identified as essential attributes for success. Discussion was limited in the interactive television format because students were required to access the microphone to speak, rather than reply spontaneously. 14 Clark 11 described incorporating Web-based instructional strategies into a traditional nursing issues course. Students cited learning skills in using the Internet and electronic mail as positive components of the course. Goodwin et al 15 compared student and faculty perceptions of online versus interactive television courses. Students and faculty members were supportive of these new delivery systems for courses. However, students who did not miss face-to-face instruction rated the courses higher than those who preferred face-to-face interaction. They concluded that distance education is a viable alternative for course delivery, but not for everyone. 15 Application of Distance Technology One author (M.L.S.) has taught an elective course in critical care nursing for several years. The class has been offered as a traditional 3-semester hour-long lecture class to senior level students and registered nurse (RN) to Bachelor of Science in Nursing (BSN) students. Course evaluations are consistently positive. Since 1998, the course has been taught to a live traditional section of students and has been broadcast simultaneously by way of interactive television to 4 branch campuses. The class is also videotaped and offered as a videotape section to another branch campus that does not have access to interactive television. The rationale for offering the course by way of distance learning strategies is to increase the opportunities for students to enroll in the course, especially the RN to BSN students. Strategies for Success Several strategies have been implemented to facilitate course implementation and management. An Internet site was established for the course using WebCT courseware (WebCT, Inc, Lynnfield, Mass). The site is password protected, and access is limited to those students who are enrolled in the course. Several features of Web-based course delivery are used to enhance the class offered by interactive television and videotape. An outline of each class session is posted on the Web before each class. Students can print notes before class to facilitate listening while the didactic content is presented. The strategy allows for a good pace for television delivery and viewing by those in the videotape section, because students do not ask the instructor to stop so they can write everything down. Class syllabi, materials, forms, and sample projects are available online so that students can review these materials as needed. Items usually posted to hallway bulletin boards during traditional courses are uploaded to the Web site, which allows all students access to materials. Access to course-related materials reduces the number of individual messages between the faculty member and students. A forum (bulletin board) is established for communication. The purpose of the forum is for faculty members to post messages for all students and for students to post general questions for the faculty members. The intent is to use the bulletin board in place of electronic mail for general course questions so that all students benefit and to reduce the number of individual electronic mail messages. Students also use the forum feature to respond to critical thinking challenges posted by the instructor and to post materials for each other s use. Sample test questions are posted as online quizzes before each examination. This allows students the opportunity to take practice examinations and to clarify material. Some of the questions are modified and used on the scheduled examinations to encourage students to take the online quizzes. Evaluation of Delivery Mode Enhanced by Online Technologies Multiple distance education technologies are used to deliver this critical care elective, which requires additional time for planning and implementation. Therefore, it is important to evaluate the effectiveness of the strategies. Detailed Purpose The purposes of this evaluation were to assess student perception and satisfaction with courses offered by distance technology and to identify whether differences in perception existed between students who were enrolled in the traditional section versus those students who were taking the course at remote sites. It was hypothesized that the use of Web-based strategies would result in a high level of connectedness and satisfaction. The specific research question was Is there a difference in student perceptions and satisfaction with taking a critical care nursing elective in a traditional classroom setting, a live broadcast of the class at an off-campus site, or by videotape? METHODS Students enrolled in the critical care elective in the spring 1998 and 1999 semesters were asked to participate in the evaluation. The students who agreed to participate completed a teacherconstructed course evaluation at the end of the semester, after the final examination and all course requirements were completed and graded. Anonymity and confidentiality were assured. The evaluation tool consisted of demographic information, 8 questions that asked students to rate Web-based strategies, and an overall evaluation of the course. A 5-point Likert-type scale was used. Students were asked to rate items from strongly agree (5 points) to strongly disagree (1 point). The items were derived from questions generated by a core group of faculty members who teach Web-based courses in the School of Nursing. The internal consistency of these 8 items was α =.85. Students were encouraged to write additional comments about course delivery and management. RESULTS Subjects The evaluation was completed by 113 students. No significant differences were noted in the method of taking the course (live, 134 VOLUME 49 NUMBER 3 NURSING OUTLOOK

4 Table 2. Mean scores on evaluation items according to method of course delivery Live Remote Videotape Item (n = 54) (n = 31) (n = 28) P value Post hoc Adequate class interaction Remote and videotape sections rated lower than live section Able to communicate effectively with instructor Remote and videotape sections rated lower than live section Instruction facilitated learning Remote and videotape sections rated lower than live section Electronic mail effective method of communication Remote section rated lower than live section Internet site for course communication effective Videotape section rated lower than live section Ability to use Internet and electronic mail increased N/A Grades available in timely manner Remote section rated lower than live section and videotape section Notes (on Internet) facilitated learning N/A Overall an excellent course Unequal variances; no differences detected among groups Scale: 5, strongly agree; 4, agree; 3, neutral; 2, disagree; 1, strongly disagree. remote, or videotape) by year offered (chi-square, P =.56), so data for the 2 years were combined for analysis. Table 1 shows the numbers of students who were enrolled by method of course delivery. Eight-four percent of those students who were enrolled in the traditional live course were generic students, while 70% of those students who were taking the course at a remote site or by videotape were RN to BSN students. This finding was significant when analyzed by chi-square (P =.000) and reflects the population of RN to BSN students who choose to take classes nearer to their home or workplace. Comparison of Students Ratings Mean scores were computed for each item and compared, with the use of analysis of variance, to determine whether students rated items differently according to the method of course delivery: attended traditional classroom setting, attended live broadcast at remote site, or viewed the videotapes. Statistical significance was set at a probability value of.05. Post hoc analysis was performed with either Tukey s test (equal variances) or Tamhane s test (unequal variances). The Statistical Package for the Social Sciences version 10.0 software (SPSS, Chicago, Ill) was used to analyze data. Mean ratings on each item per group were positive, ranging from 3.48 to Significant differences were noted among groups for several items. Table 2 shows the mean scores of each group on the 8 items related to the use of distance learning technologies and the overall evaluation of the class. Statistical significance is noted along with results of post hoc analyses. Analysis of Findings Overall ratings of items were high. The lowest ratings (still within acceptable range) were from the videotape section on NURSING OUTLOOK MAY/JUNE 2001 items rating class interaction and facilitation of learning. Ability to Use the Internet No differences were noted among groups for increasing ability to use the Internet and electronic mail. This finding is attributed to the high number of students who use these technologies. All university students are provided access to electronic mail and the Internet. Computer laboratories are available at all campus locations. Listservs are easily established for group communication. The generic students have been using these resources extensively throughout their upper-division program. Faculty members often communicate electronically with students to relay courserelated information and to respond to individual questions. Findings from this study are in contrast to findings reported in 1998 by Todd, 16 whose study found that nearly two thirds of undergraduate students in a child health course had no experience with the Internet or electronic mail. One reason for the difference in findings may be the increased use of electronic communication among the public since Todd s article was published. Differences may also be attributed to resources provided by our university and to faculty expectations of students for using the Internet and electronic mail. Available Notes No differences were noted among groups about having notes available for the class lectures. Notes for this course have been made available for students for many years to facilitate listening, class discussion, and television delivery. Students have consistently found notes to be a good class resource, so a difference among groups was not expected on this item. Having notes and resources before class is stated as an essential component of course delivery by interactive television

5 Class Interaction Regarding adequate class interaction, both the remote and videotape groups ratings were significantly lower than the ratings of those in the traditional setting. Web-based interaction was only a small component of course delivery and management, which may account for the finding. Most interaction took place in the traditional classroom. Students enrolled in the live and remote broadcast settings were afforded the opportunity for interaction; however, most of the time they did not ask or answer questions during the broadcast. Students preferred to communicate with the instructor during the scheduled breaks. Students who take the class by interactive television are often reluctant to speak during the live broadcast because they must access a microphone 14 and the camera focuses on them for all to see. The videotape group rated this item lower than any other item on the questionnaire. The faculty member went to the videotape site to meet with students 3 to 4 times per semester. The purpose of the meetings was to administer examinations, clarify content, and answer questions. The meetings were informal. Most students preferred to take the examinations, answer a few questions posed by the instructor, and leave. Interaction on a weekly basis was missing. In the future, additional interaction can be built into the Web-based component of the course. Critical thinking exercises have been used for selected units of the course; however, students are not required to respond to the questions. Building a weekly interactive component into the course that counts toward the class grade is being considered for future courses. Another option is to build interaction and formal discussion into periodic meetings at the remote site. Communication with the Instructor Students in both the remote broadcast and videotape sections rated communication with the instructor lower than did those students who took the live section of the class. These 2 sections have less opportunity for spontaneous communication with the instructor. However, the videotape section rated this item higher than the remote broadcast section, which may be attributed to the periodic, in-person meetings held between the instructor and the group throughout the semester. In the future, it may be valuable to go to each remote broadcast site 2 to 3 times each semester to meet with students. Another strategy is to make time before or after the formal class to communicate with students at the remote sites. 6 More frequent electronic interaction with students may also improve communication. The authors university has the capability of live broadcast using media (eg, PowerPoint presentations, Microsoft Corp, Redmond, Wash) only from the main campus. Availability of more sophisticated video delivery from the remote sites would allow the instructor to rotate course delivery among delivery sites, which would increase communication with all students. Many schools have this advanced technology. Facilitation of Learning Students in both the remote and the videotape sections rated facilitation of learning lower than students in the live section. These groups sat in front of a television monitor (either in a large group or individually) while the live section participated in a typical class presentation. Although many graphics and videotape clips were used to maintain students interest in the class, students may have found it difficult to sit in front of a television for nearly 3 hours at a time. An interesting finding was that several of the students in the live section viewed the tapes if they had to miss class or wanted additional review. These students stated that they liked the videotape format because it allowed them the opportunity to stop and review concepts that were unclear to them. Electronic Mail Communication The students in the remote sections gave a lower rating to electronic mail as an effective means of communication than did the students in the live section. This finding may be attributed to fewer students in the remote sections who used electronic mail. Another factor may be that the use of a centralized Web site for communication decreased the need for frequent electronic mail messages, which was one of the goals for using Web-based technologies. Web Site for Communication The students in the videotape section gave a lower rating to the course Web site as an effective means of communication than did the students in the live section. This finding may be attributed to the larger number of RN to BSN students from a rural area who were enrolled in the videotape section. From experience, these students have been less comfortable accessing the Internet for course-related information. In addition, course materials have been provided to the students at this site during previous courses, and students have not been expected to access materials themselves. Timely Reports of Grades The students in the live and videotape sections rated getting grades in a timely manner higher than did the students in the remote broadcast section. During the data collection period, grades for students at the interactive television sites were often delayed because a courier delivered this information to the branch campuses. The tests of those students in the videotape section were graded as soon as the students completed the examinations, so that group received immediate feedback on their grades. The use of a secure Web site to post grades on examinations and projects is currently being implemented to facilitate more timely distribution of grades. In the future, the administration of tests electronically with immediate scoring and reporting will be considered. Overall Evaluation The students in the live section gave a higher rating to the overall class evaluation than did the students in the other 2 sections, although all ratings were high. This finding is likely related to the increased communication and interaction with the instructor and to being present in a traditional classroom versus sitting in front of a television monitor. Lewis and Kaas 14 reported similar differences between on-campus and offcampus students. High overall ratings are reported in the study by Goodwin et al VOLUME 49 NUMBER 3 NURSING OUTLOOK

6 Additional Findings Those students who took the class by remote broadcast or videotape were asked 2 additional questions. Nearly two thirds of students (65%) preferred to take a live, traditional class. Although these students preferred a traditional class, their satisfaction was high with distance learning technologies. Most students (80%) stated that they would take another class by interactive television or videotape. Goodwin et al 15 reported similar findings in their evaluation of distance technologies. The authors attribute these findings to the overall satisfaction with the critical care course. In addition, the distance students may value convenience of taking classes closer to home or work more than method of delivery. In the future, it would be beneficial to identify which students prefer live interaction to assist them in enrolling in courses that address learning styles and needs. Limitations Although ratings on several items were statistically significant, findings may not be significantly different in educational practice because of the high overall scores. Generalizability to other courses may be limited. Many students enrolled in the critical care elective because they were interested in critical care as a career opportunity. An evaluation of a required course, such as nursing research, may yield different findings. Findings may also be related to the type of student rather than the method of course delivery. Most of the students taking the traditional class were generic BSN students, and most of the distance learning students were RN to BSN students. However, Lewis and Kaas 14 reported similar findings with graduate nursing students. SUMMARY Student satisfaction with taking a course in a traditional versus distance learning setting was evaluated over a 2-year period. Varied distance learning strategies are currently used to provide education to students, especially those students who reside at sites away from a university setting or who have family or other commitments that prevent them from driving to a university for courses. Student satisfaction with taking a course in a traditional versus distance learning setting was evaluated over a 2-year period. Students who participated in a live, traditional class rated the critical care course higher than did the students who participated in the distance learning class. However, overall satisfaction with the course was high. The use of Web-based strategies for course delivery may be one reason for the high satisfaction among groups. Nursing faculty members have an abundance of technologic resources available to augment and deliver courses. With adequate time and support, faculty members can use these resources to provide a high-quality education to students, regardless of where the students enroll in courses. REFERENCES 1. American Association of Colleges of Nursing (AACN). AACN white paper: distance technology in nursing education. Washington, DC: Author; Clark CE. Beam me up, nurse! Educational technology supports distance education. Nurse Educator 1993;18: Clark CE. Teaching and learning at a distance. In: Billings DM, Halstead JA, editors. Teaching in nursing. Philadelphia: Saunders; Wurzbach ME. Teaching nursing ethics on interactive television: fostering interactivity. J Nurs Educ 1993;32: Hoeskel R, Moore JF. Clinical nursing education at a distance: solving instructor interaction problems. J Nurs Educ 1994;33: Jeanquart-Barone S. Tips for successful teaching through interactive television. J Manage Educ 1995;19: Anderson M. Critical elements of an Internet based asynchronous distance education course. J Educ Technol Systems 1998;26: Carlton K, Ryan M, Siktberg L. Designing courses for the Internet: a conceptual approach. Nurs Educ 1998;23: Kapur S, Stillman G. Teaching and learning using the World Wide Web: a case study. Innovations Educ Training Int 1997;34: Ayoub J, Vanderbloom C, Knight M, Walsh K, Briggs R, Grekin K. A study of the effectiveness of an interactive computer classroom. Comput Nurs 1998;16: Clark D. Course redesign: incorporating an Internet Web site into an existing nursing class. Comput Nurs 1998;16: Billings D. Issues in teaching and learning at a distance: changing roles and responsibilities of administrators, faculty, and students. Comput Nurs 1997;15: Rosenlund C, Dmask-Bembenek B, Hugie P, Matsumura G. The development of online courses for undergraduate education. Nurs Health Care Perspect 1999;20: Lewis M, Kaas M. Challenges of teaching graduate psychiatricmental health nursing with distance education technologies. Arch Psychiatr Nurs 1998;12: Goodwin BN, Micklich BA, Overall JU. Perceptions and attitudes of faculty and students in two distance learning modes of delivery: online computer and telecourse. Paper presented at the Symposium for the Marketing of Higher Education; Orlando, Fla; November ED Todd NA. Using in an undergraduate nursing course to increase critical thinking skills. Comput Nurs 1998;16: NURSING OUTLOOK MAY/JUNE

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