majority were Just beginning to use microcomputers

Instructional Uses of Microcomputers in Nursing Education Programs KJ. Mikan, Ph.D., R.N. University of Alabama at Birmingham Birmingham, AL 35294 ABSTRACT The purpose of this study was to Investigate the use of microcomputers at the undergraduate level In college-based nursing programs in 15 Southern states. Data from a regional survey adminlstered by the Southern Regional Education Board in 1985 as part of the three-year Nursing Special Project Grant (DlONU24198) were used to examine differences, 1f any, In uses of microcomputers In associate and baccalaureate degree nursing education programs. The findings Indicated the programs used microcomputers as a tool to support learning more frequently than as an instructional delivery system In the nursing curriculum. The major purposes of microcomputers as an Instructional delivery system were to supplement and to enrich learning experiences. INTRODUCTION The availability of microcomputers in institutions of higher education has continued to expand since they were Introduced In 1977. Microcomputers are present on most college campuses. However, availability on campus does not necessarily mean that microcomputers are being used in the nursing curriculum. The extent of curricular applications In schools of nursing Is unknown. Computer use In nursing education had Its beginnings In an associate degree program during the late 1960s when a mainframe computer was used to teach a maternal child nursing course [1]. Since that time computer applications In nursing education have expanded. The recent accelerated rate of expansion in nursing education appears to be related to the increased uses of computers in health care agencies where the graduates of nursing education programs practice. RELATED STUDIES Access to a computer Is an essential determinant of Its use as an Instructional delivery system as well a tool to support the teaching and learning processes. In 1982, Hales reported that 51 percent (N=261) of the respondents in nationwide survey had access to microcomputers; 22 percent of this sample reported the nursing departments owned a computer [2]. In 1983 and 1984, 5 percent and 11 percent (respectively) of the deans In baccalaureate degree nursing programs had a computer In their offices [3, 4]. These studies, however, fall to address the use of computers as an instructional delivery system. Microcomputer use surveys in NLN accredited baccalaureate and higher degree programs conducted by Thomas revealed faculty and students (graduate and undergraduate) used microcomputers as well as mainframe and minicomputers [5]. Undergraduate students reportedly used microcomputers more than graduate students [6]. However, these studies do not Indicate whether the microcomputer was used In pre-nursing or nursing courses. In 1983, the Southern Regional Education Board (SREB) conducted a survey of all college-based nursing programs (N=342) in the SREB region [7]. Eighty-nine percent (N=257) of the responses indicated microcomputers were available to students enrolled In non-nursing courses, I.e., mathematics, science, engineering. Only 30 percent of the Institutions reported nursing majors received prenursing or non-nursing instruction via microcomputers. Although 36 percent (N=93) of the nursing programs had microcomputers available, only 14 percent of the programs reported use in nursing courses. The use of microcomputers in different types of nursing education programs was studled by Thompson In 1984 [8]. Thompson visited 18 baccalaureate degree programs, one associate degree, and one Institution with both associate and baccalaureate degree programs. The programs were located in 15 different states. She found that while these programs initially indicated they were using computers, the majority were Just beginning to use microcomputers for instructional purposes. Generally, administrative applications preceded the use of microcomputers as an instructional delivery system. 0195-4210/0000/0450$01.00 1987 SCAMC, Inc. 450

Bolwell and Thomas reported 77 percent of 162 NLN accredited baccalaureate and higher degree nursing programs used microcomputers for instructional activities 16]. Although data about the specific types of learning activities for undergraduate education were not reported, this study did reveal the use of microcomputers to support the learning experiences, e.g., statistical analyses (59 percent), Information retrieval (53 percent), and word processing (14 percent). Although the amount of nursing-related software has Increased tremendously, Information about the actual use of computer software In nursing content areas Is limited. References in the literature regarding computer software use addresses primarily Its selection, development or evaluation. Utilization reports refer to the use of selected software packages In specific nursing courses at a particular program for a targeted group of learners. While the pedagogical promises of computer technology are boundless, current uses as an Instructional delivery system In college-based nursing programs merit study. PURPOSE The focus of this investigation was to identify the major purposes and uses of microcomputers In two types of undergraduate nursing programs and determine If the two types of nursing programs have different purposes and uses. More specifically, the data analysis tested the null hypothesis that there is no difference In the use of the microcomputer as tool to support learning or as an Instructional delivery system in associate degree and baccalaureate degree nursing programs In 15 Southern states. Definition of terms METHODOLOGY For the purposes of this study Instructional uses of microcomputers were divided arbitrarily into two categories--as a tool and as a delivery system. A microcomputer may be used as a tool to support learning, for example, word process- Ing, data management, test scoring, and preparation of transparencies/slides. It may also be used to deliver Instruction In specific content areas. Data collection The data reported In this study were extrapolated from the results of a regional survey conducted during the fall of 1985 as part of a three-year Nursing Special Project Grant (D10NU24198) administered by the Southern Regional Education Board (SREB). The original study population Included all college-based nursing education programs (N=424) In the SREB states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia). Instrument The questionnaire consisted of 55 Items that were categorized as follows: demographic Information (5 Items), current use of microcomputers (18 items), faculty perceptions of the extent of implementation of computer-supported education in nursing (29 Items). Some Items had multiple parts. For the purposes of this study, the aggregate data for six of the current use Items were extrapolated and analyzed. The specific questionnaire items addressed In this study are: #6: Does your program currently have its own microcomputers available for Instruction In nursing courses? #10: Does your school of nursing have microcomputers available for Indirect Instructional uses, e.g., administrative? #12: What types of learning activities are provided by microcomputers within the undergraduate nursing courses In your school? #13: What nursing-related content areas are being taught, in whole or part, by microcomputers in the undergraduate nursing courses In your school? #14: What are the major Instructional uses of microcomputers within your undergraduate nursing courses? #15: What are the major Instructional purposes for which microcomputers are being used within the undergraduate nursing courses at this time? Respondents were asked to Indicate Yes or No to questions #6 and #10. If the response to #10 was Yes, then the respondents were directed to indicate on a check list all of the Indirect Instructional uses that were being made of microcomputers. Check lists were also provided on the questionnaire for responses to questions 12, 13, 14, and 15. (The Items that were on the checklists appear In Tables 3-7.) The statistical technique used to test the null hypothesis was the chi square test of Independence. The significance was set at the.05 level. FINDINGS Description of sample Although the original sample Included data from Institutions that offered either the assoclate degree, baccalaureate degree or both the associate degree and baccalaureate degree programs, the analysis reported here Is based on data from Institutions that offered only one level of nursing education, I.e., an associate degree or baccalaureate degree. The sample Included 304 college-based nursing programs In 15 Southern states. The nursing 451

programs were located in public and private institutions. This sample represents 76 percent of all institutions that offer either an associate degree (A) or a baccalaureate degree (B) In nursing (Table 1). A majority (63 percent) of the responses were from institutions offering only assoclate degree programs. Table 1 Distribution of Nursing Programs Population 264 66 135 34 399 100 Sample 193 73 111 82 304 76 Sample distribution 193 63 111 37 304 100 NOTE: f refers to frequencies. Microcomputer Used As A Tool A higher percentage (85) of the nursing education programs reported using microcomputers as a tool rather than an instructional delivery system. The percentage difference In the responses of associate degree programs and baccalaureate programs was small (Table 2). Analysis of the data relative to specific uses of the computer as a tool to support instruction revealed the two most frequently reported uses were word processing (90 percent) and student data/records (66 percent). The third most frequently mentioned use was test construction (Table 3). Test scoring/grading and calculation ranked fourth among all programs. Less than 20 percent of the programs reported using microcomputers to forecastproject, to prepare transparencies, to prepare graphics or to use an authoring system. Table 2 Distribution of Uses of Microcomputers as Tools and Instructional Systems [N=193] [N=111] [N=304] Tools 157 81 102 92 259 85 Delivery system 95 49 64 58 159 52 Table 3 Microcomputers as Tools [N=157] [N=102] [N=259] Word processing 138 88 95 93 233 90 Student data records 102 65 69 68 171 66 Test construction 82 52 48 47 130 51 Test scoring/grading 67 43 43 42 110 42 Calculation of grades 68 43 42 41 110 42 Generation of reports 56 36 32 31 88 34 Electronic spreadsheets 34 22 42 41 76 29* Recruitment data 43 27 32 31 75 29 Inventory 45 29 24 24 69 27 Data management 34 22 29 28 63 24 Data analysis 32 20 30 29 62 24 Graphics 23 15 23 23 46 18 Authoring 23 15 20 20 43 17 Transparencies 18 11 19 19 37 14 Forecasting/projections 22 14 10 10 32 12 *p < 0.05 452

Although there were slight variations in the percent of programs reporting In each category, the top five uses reported were consistent for both associate degree and baccalaureate degree programs. The chl square test revealed that the differences in responses of associate degree and baccalaureate degree programs were statistically significant for only one of the identified uses (electronic spreadsheets). More of the baccalaureate than associate degree programs reported using electronic spreadsheets. Microcomputer As Instructional Delivery System The most frequently reported use of microcomputers as an Instructional system included tutorials, drill and practice, simulations, testing/evaluation, and word processing (Table 4). Less than 10 percent of the nursing programs Indicated data bases, statistical analysis, computer programming, Interactive videotape, electronic spreadsheets, or Interactive videodisk were used for instruction. The chi square test showed differences In responses of associate degree and baccalaureate degree programs were statistically significant for four of the 12 Identified uses. Associate degree programs reported a higher percentage of microcomputers used for drill and practice than did the baccalaureate degree programs. On the other hand, baccalaureate degree programs reported a higher percentage of microcomputers used for word processing, data bases, and statistical analysis. At least one-third of the programs Indicated the following three nursing-related content areas In which microcomputers were used to provide instruction: calculations (drugs and solutions), basic mathematics, and clinical case studies (Table 5). Less than 10 percent of the programs reported using the microcomputer as an Instructlonal delivery system for clinical topics, medical terminology, literature searches, statistical analysis, anatomy/ physiology, nursing leadership, community health, and pathology. The chi square test indicated the differences In responses of assoclate degree and baccalaureate degree programs were statistically significant for 14 of the 23 Identified nursing-related content areas. A higher percentage of the associate degree programs used the microcomputer to teach calculations, clinical decision-making, adult nursing, maternity nursing, mental health nursing, nursing process, and clinical topics. In contrast, more of the baccalaureate degree programs used the microcomputer for nursing management, research, medical terminology, literature searches, statistical analysis, computer literacy, and community health. Over 35 percent of all programs reported the "major Instructional uses of microcomputers" were enrichment, testing, and evaluation, and remedial learning (Table 6). The chi square test indicated differences in responses of associate degree and baccalaureate degree programs were statistically significant four of Table 4 Microcomputers as Instructional Delivery Systems (Learning Activities) Tutorials 54 57 37 58 91 57 Drill/practice 59 62 27 42 86 54* Simulations 50 53 33 52 83 52 Testing/evaluation 30 32 21 33 60 38 Word processing 20 21 23 36 43 27* Games 18 19 13 20 31 20 Data bases 4 4 11 17 15 9* Statistical analysis 0 0 11 17 11 7* Computer programming 5 5 5 8 10 Interactive videotape 7 7 2 3 9 6 Electronic spreadsheet 2 2 5 8 7 4 Interactive videodisk 3 3 2 3 5 3 *p > 0.05 453

Table 5 Microcomputers as Instructional Delivery Systems (Nursing Content Areas) Calculations (drugs/solutions) 45 47 19 30 64 40* Basic mathematics 39 41 17 27 56 35 Clinical case studies 33 35 19 30 52 33 Clinical decision-making 34 36 9 14 43 27* Adult nursing 36 38 6 9 42 26* Computer literacy 18 19 22 34 40 25* Pediatric nursing 23 24 8 13 31 20 Maternity nursing 22 23 4 6 26 16* Mental health nursing 20 21 4 6 24 15* Nursing process 21 22 1 2 22 14* Pharmacology 12 13 8 12 20 13 Psychomotor skills 10 11 9 14 19 12 Nutrition 12 12 5 8 17 11 Research 1 1 17 27 18 11* Clinical topics 13 14 1 2 14 9* Nursing management 1 1 11 17 12 8* Medical terminology 4 4 9 14 13 8* Literature searches 2 2 10 16 12 8* Statistical analysis 0 0 11 17 11 7* Anatomy/physiology 4 4 4 6 8 5 Nursing leadership 2 2 5 8 7 4 Community health 0 0 5 8 5 3* Pathology 0 0 2 3 2 1 *p> 0.05 Table 6 Microcomputers as Instructional Delivery Systems (Major Uses) Enrichment 32 34 31 48 63 39 Testing/evaluation 43 45 17 27 60 38* Remedial learning 39 41 16 25 55 34* Self-awareness/self-help 30 32 11 17 41 26* Basic learning (required) 26 27 19 30 45 28 Diagnosis 2 2 6 9 8 5* *p < 0.05 the six possible selections. A higher percentage of the associate degree programs reported use of microcomputers for remedial learning, testing and evaluation, self-awareness/self help. In contrast, a higher percentage of the baccalaureate degree programs than associate degree reported using microcomputers for diagnosis. Differences in responses regarding use of microcomputers for enrichment or basic learning were not statistically significant. Sixty-four percent of all programs reported the "major Instructional purposes" of using the microcomputers were to supplement classroom learning; 54 percent indicated these were to enrich classroom learning (Table 7). Differences in responses were not statistically significant. The least reported purpose was as a replacement/substitution for clinical learning. 454

Table 7 Microcomputers as Instructional Delivery Systems (Major Purposes) Supplements: classroom learning 59 62 43 67 102 64 clinical learning 42 44 19 30 61 38 Enriches: classroom learning 55 58 31 48 86 54 clinical learning 38 40 18 28 56 35 Replaces/substitutes: classroom learning 8 8 8 13 16 10 clinical learning 6 6 1 2 7 4 DISCUSSION Despite the focus in the literature on computer-assisted instruction, it was not the Microcomputers were used more to support learning activities, that is, word processing, student data records, test construction, or This supports findings of an primary use of microcomputers In this sample. test scoring. earlier study by Thomas and Bolwell. The use of microcomputers as a tool and an instructional delivery system in nursing education programs, though diverse, is fairly similar for the two types of programs in this sample. However, the authors cannot reject the null hypotheses that no differences exist in the use of microcomputers among associate degree and baccalaureate degree programs since statistical significances were observed for several items. This study signals the need for additional investigations to determine factors that influence the differences observed in responses of associate and baccalaureate degree nursing programs. Differences in how microcomputers are used may be related to the philosophy, purposes, goals, and curricular designs of these programs. Other determinants may include access to software and hardware, faculty preparation and experience, level of learners, and attitudes (student and faculty). Implementation issues merit attention in future studies of computers as tools and instructional delivery systems. SUMMARY The availability and use of microcomputers as tools to support and deliver instruction Southern college-based nursing programs increased drastically between 1983 and 1985--from only 14 percent of the college-based nursing programs in 1983 to 53 percent in 1985. This illustrates the rapidity of microcomputers becoming accessible as instructional tools in collegiate nursing programs. This study indicated at least 50 percent in of the study sample used microcomputers as tools to support learning or as an instructional delivery system. The data analysis revealed similarities and differences in the use of microcomputers in associate degree and baccalaureate nursing programs. Differences were noted in the uses and purposes reported by associate and baccalaureate degree programs. The chi square test for independence reflected statistical significance (p=0.05). Therefore, the investigator cannot reject a null hypothesis that no differences exist in uses and purposes reported by associate and baccalaureate degree programs. However, the findings are This study indicates the need for inconclusive. additional at different levels of nursing education. References investigations of microcomputer uses [1] Bitzer, M. & Boudreaux M. (1969). Using a computer to teach nursing. Nursing Forum. 8, 234-254. [2] Hales, G. & Rothenberg, L (1982). Preliminary analysis of survey. Computers in Nursing, 1 (3), 3. [3] Johnson, B. (1983). Microcomputers in nursing dean's office. In Dayhoff, R. (Ed.). Proceedings of the seventh annual symposium on computer applications in medica: care. Silver Spring, MD: Computer Society Press. 528. [4] Johnson, B. (1984). Improving decisionmaking in the dean's office. In Cohen, G. (Ed.). Proceedings of the eighth annual synposium on computer alications in medical care. Los Angeles: IEEE Computer Society. 610-613. [5] Thomas, B. (1985). A survey study of computers in nursing education. Computers in Nursing, 3 (4), 173-179. [6] Bolwell, C. & Thomas, B. (1986). The use of microcomputers for educating nurses in the United States. In Salamon, R., Blum, B., & Jorgensen, M. (Eds.). Medinfo 86. North- Holland: Elsevier Science Publishers. 955-959. [7] Spector, A. (Ed.). (1983). Survey of microcomputer use in southern nursing education. Atlanta, Georgia: Southern Council on Collegiate Education for Nursing. [8] Thompson, M. (1985). Computer-assisted instruction in nursing education: a survey study. In Thomas, B. (Ed.). Proceedings instructional computing in nursing education. The University of Iowa, Cedar Rapids, Iowa. 31-41. Acknowledgment The author acknowledges the assistance of SREB data processing coordinator, Barbara Bohanon, and the Continuing Nursing Education in Computer Technology project staff. 455