Distance learning and perioperative nursing

AORN Journal, March, 2007 by Barbara J. Gruendemann

This is an unsettling time in nursing education. Faculty shortages, research and scholarship priorities, and adaptation to new technologies are just a few of the challenges that nursing educators are facing. Added to these challenges is the growing pressure to incorporate distance learning into the curricula of nursing schools.

Distance learning, fueled by exponential development of web-based technology, is arriving with dizzying speed at most institutions of higher learning. The rapid shift from face-to-face learning (ie, in traditional classrooms) to web-based learning environments (ie, distance learning) in nursing programs is here to stay, even though online programs are still relatively new and thus have not endured the same scrutiny as classroom education. (1) The rapid arrival of distance learning, the theme of which is woven into many journal articles, conferences, and meetings, is surely the reason why faculty members and learners struggle to incorporate new teaching and learning pedagogies, altered roles, and differing ideas of what constitutes distance learning.

Changing patterns in education, such as implementing distance learning, lead to anxiety, uncertainty, and confusion. For some, distance learning arrived on the scene with a "tsunami effect"--quickly, stunningly, and with a magnitude of massive proportions. New web-based technology arrived before faculty members and students had ample opportunities to prepare and plan for it. As the wave of distance learning swept over schools of nursing and specialty education such as perioperative nursing, however, the pressure to "get on board" was evident. Some schools of nursing and perioperative educators are beginning to develop online distance learning programs, many are experimenting with designs and have established programs, and some are still in the beginning stages. Some educators are reporting their progress in descriptive research studies, (2-4) but there is work yet to be done in describing, planning, and studying the relationship of technology to effective learning modalities, especially in nursing.

Distance learning has been slower in coming to perioperative nursing. There are, however, some examples of "hybrid" distance learning courses, such as programs that include online text and graphic content that the learner can access at home or from another remote location, which then is enhanced by clinical conferences and learning experiences on site in a health care facility. Some distance learning activities are programs produced and implemented by individual facilities; others are created by schools of nursing and commercial companies and are aimed at general perioperative nursing audiences.

DISTANCE LEARNING DEFINED

Distance learning, also known as online learning or distance education, is described as a "connecting point" for nursing faculty members and students who are separated by time or place or both time and place. (5,6) Distance learning occurs in "real time" (ie, synchronous learning) or "delayed time" (ie, asynchronous learning). The technologies used to connect learners and faculty members may be print, audio, video, or computer.

Billings, (7) a pioneer in distance learning, also labels distance learning as mobile learning and "just-in-time learning." Other terms used for distance learning are

* web-based teaching,

* e-pedagogy,

* e-tutoring,

* distributive learning,

* technology-mediated instruction, and

* online teaching and learning.

The overarching definition of distance learning, however, seems to be education, now web-based, that takes place in an environment in which the learner and teacher are separated but which, in some cases, may be reinforced by specified face-to-face learning sessions. Similarly, Clark and Ramsey (8) define distance learning as learners receiving instruction in a place other than where the faculty member is located.

In articles discussing distance learning, an array of courses is described. Some authors describe distance learning programs that include practicums and occasional face-to-face campus or health care facility meetings and clinical conferences that accompany the distance learning component. These combination programs are considered hybrid or blended courses. Distance learning takes place in undergraduate programs, RN-to-BSN programs, refresher courses, and graduate programs, but the heaviest enrollments are by far in the RN-to-BSN completion programs? Distance learning also takes place in health care facilities in which RNs are learning new skills in clinical specialty areas, such as in the OR and critical care units. Distance learning is most successful with learners who are risk-takers; are assertive; take responsibility for their own learning; and take the initiative to let faculty members know "where" they are (ie, how comfortable they are with distance learning). (10)

VIEWS OF DISTANCE LEARNING FROM TWO NURSING ORGANIZATIONS

In 1999, the American Association of Colleges of Nursing (AACN) issued a white paper on distance learning, which stated that technology-mediated teaching strategies can dramatically change the way teaching and learning occur, challenging the traditional relationship of students to academic institutions. (11) Questions were posed regarding the relationship of technology to the teaching of humanistic, practice-oriented care that is the hallmark of the nursing discipline. The AACN suggested that greater precision in outcomes measurement is needed to determine differences among teaching methods, even in distance learning.