By Southernwood, Julie
Abstract The recent development of a market economy in higher education has resulted in the need to tailor the product to the customers, namely students, employers and commissioning bodies. Distance learning is an opportunity for nurse educators and institutions to address marketing initiatives and develop a learning environment in order to enhance continuing professional development It provides options for lifelong learning for healthcare professionals – including those working in community settings – that is effective and cost efficient Development of continuing professional development programmes can contribute to widening the participation of community practitioners in lifelong learning, practice and role development
This paper considers the opportunities that web-based and online education programmes can provide community practitioners to promote professional skills while maintaining a work-life balance, and the role of the lecturer in successfully supporting professionals on web- based learning programmes.
Distance learning, continuing professional education, healthcare professionals, lecturers
Community Practitioner, 2008; 81(10): 21-3.
The need for flexibility in the delivery of healthcare professional education has been identified by various initiatives, such as widening participation, continuing professional development (CPD) and the emergence of the specialist practitioner role.1 The Standing Nurse and Midwifery Advisory Council2 supported different approaches to learning that develop a computer-literate workforce, as a method to enhance the lifelong learning that is required for CPD.
Distance learning is an approach that supports this, and is capable of providing increased flexibility, access and cost- effectiveness in healthcare professional education.3 Consequently, distance learning is increasingly being looked toward by many higher education institutions as an economical way of expanding their activities, widening opportunities for students around the world, and making effective use of the new technologies that are rapidly emerging.4 By working collaboratively with health providers, developments can be made to make CPD more accessible for healthcare professionals, allowing them to fulfill their professional body’s expectation of lifelong learning and skill development.
Maintaining professional skills can be difficult for community practitioners. The demands of an ever-increasing workload due to staff shortages and workforce cuts can put CPD at the bottom of the list of priorities for practitioners and managers. Development of distance and online CPD programmes could contribute toward a more efficient and manageable way to maintain professional development for community practitioners.
Distance learning: utilising online and web-based education
Distance learning is a term given to study undertaken with the support of a teacher outside the classroom environment.5 It is a process that connects learners with distributed learning resources and takes a wide variety of forms. In recent times, it has used electronic resources to enable students to access curriculum materials and facilitate learning.6 Study is usually enhanced by a study package – written materials, computer software and online material – to promote the student’s learning experience, while the role of the lecturer is to facilitate students through the course work and encourage collaboration.
The theory underpinning distance learning is constructivist, with roots in the work of Piaget, Bruner and Vygotsky, and assumes that learners build up their own meanings and understanding of a topic and discover basic principles for themselves.7 Constructivists generally assert that knowledge is actively constructed by individuals, and that social interactions with others also play an important role in the construction process. Constructivist learning environments should provide students with the opportunities to negotiate ideas, conduct inquiry and reflect their thoughts, thus enhancing cognitive and metacognitive outcomes.8
Nurse education programmes developed by the Open University embrace these theories of learning, providing students with study packages that incorporate learning through practice experience, online collaboration and computer programme activities, in order to encourage them to search for information on the topic and increase their knowledge.
This theory is well suited to Healthcare professional education, as the role of practitioner is often critiqued and developed through day-to-day interactions with colleagues and patients that enhance and inform performance and the construction of new knowledge.
Distance learning has become increasingly popular, with student numbers increasing by 70% since 1995.9 Through the development of appropriate course pathways, distance learning can contribute positively to Healthcare professional education by increasing flexibility, access and cost-effectiveness in CPD education.10 This element of flexibility attracts many healthcare professionals who have to balance study, work and home life, as there is no requirement for constant and/or synchronous contact between teacher and learner.11 This increases the opportunities for many healthcare professionals to participate in lifelong learning and enhance their practice as required by the NMC.12
Web-based learning programmes can contribute to lifelong learning by fulfilling CPD obligations, particularly in specialisms such as community specialist practitioners – health visitors, school nurses, community nurses and occupational health nurses. It can also enhance the professional development of support workers such as community nursery nurses and peer support workers, when class sizes would otherwise be too small and so not viable.13 By developing webbased learning, training in specialist areas will be widened to those individuals who may otherwise not be able to undertake traditional study. It should therefore encourage a diversity of skills and knowledge for healthcare professionals to build upon.
By embracing the flexibility of distance learning, students can explore particular areas relevant to their profession or practice and encourage a deep approach to learning.14 This is essential in healthcare professional education, where a key element of any education programme is to enable students to make the links between theory and practice.13 For some professionals a return to the classroom is quite daunting, as it may be many years since they last undertook a formal education programme. A positive element of distance learning is the evidence that it provides a less threatening environment for students. There is greater access to support through the use of email, which also provides privacy and is less threatening. In addition, it provides timely feedback for learners, supporting meaningful learning through informative, rapid interaction.15,16
Role of the lecturer
Lecturers play a central role in the success of distance learning courses, as the best module design and learning resources are potentially useless to students unless supported by human contact.17 The lecturer needs to build a positive relationship with the students. The interaction between lecturer and learner facilitates learning concepts, motivates and invigorates the learner and encourages clarification of the course content, promoting reflections upon practice.11
In order to ensure that reflection upon practice takes place, it is suggested that nurse educators need strategies, for example incorporating Blooms taxonomy into programme development and evaluation, for developing critical thinking and collaborative problem-solving skills online.18 These skills are essential for nurses and increase the ability to make links between theory and practice,13 and this type of learning would also benefit community practitioners wishing to develop specialist skills, such as in tuberculosis health promotion, youth health promotion and child protection. In developing critical thinking skills, online learning offers some significant advantages over traditional, classroom- based courses,18 giving students more time to look objectively at collaborative dialogue and think more carefully about their participation in it, enhancing critical and problem-solving skills.
Web-based educational programmes require lecturers to act as facilitators of learning rather than as information-givers, stimulating discussion, reflection and learning.19 The lecturer must have the skills needed to help the student explore the issues that pertain to their practice.13 Lecturers need to adapt to a facultative role, relinquishing control of information and working in partnership with the student and their identified learning goals.20 A particular criticism of webbased education is that the focus on learner-centredness may seem to ‘abandon’ the learner, giving them too much responsibility and becoming isolating for them. However, by negotiating roles between the lecturer and student, equality of status and mutual trust can be fostered1 in order to reduce fears of isolation and to focus the expectations of both parties.
Ensuring that learning goals are clear and accessible and providing clear lines of communication between participating students and the lecturer, the online learning experience can be of great value to learners in terms of opportunities for developing collaborative and critical thinking skills. It enables learners to think more critically about a problem, to consider their own and others’ perspectives more fully in their decision-making, and to reflect on their role in the collaborative process.21 These skills will contribute to individuals’ professional development, enabling them to either enhance their current role and development of skills, or to introduce new specialist skills to practice and promote their contribution to service development.
I have had the opportunity of working on one of the many distance learning programmes offered by universities. The particular module was developed for undergraduate nurses, and the experience has proved very rewarding. It has provided me with insight into how valuable webbased learning programmes are, and into the benefits of encouraging collaboration between commissioners and higher education institutions in order to develop and promote programmes for community healthcare professionals.
My responsibilities as the lecturer on the web-based module were to provide directions for independent study, encourage online collaboration and facilitate four group tutorials within the year of study. The cohort were all mature students and the majority disclosed that distance learning was the only viable opportunity for them to access nursing education. This highlights the benefit that distance learning can have in terms of professional development for a significant number of people.
A noticeable difference between my perceptions of students on this course and those on traditional courses was the increased motivation of learners to participate both in the tutorials and the online collaboration. This may well be due to the environment of distance learning, enhancing the student’s autonomy, addressing or even challenging the student’s prior knowledge, and facilitating student-to-student as well as student-to-teacher interactions. In this way, learners are engaged in meaningful learning and higher- order thinking8 – they take the opportunity to influence their learning from their experience and skills, in order to achieve professional development that is meaningful to them and their workplace. This was evident in their positive evaluation of the course and recognition of tutor support within the distance learning environment, and may well be a factor in the low attrition rate of students.
As a lecturer working within a traditional higher education setting, I found that my skills were easily transferable to working on a distance learning course. I also found the process of the virtual learning experience and online collaboration one that has enhanced my technological skills and enabled me to consider more innovative ways to engage students. It was possible to encourage critical thinking skills successfully in this type of education facilitation, as I found it congruent with incorporating problem- solving approaches to all the learning areas.
Web-based learning should be viewed as a powerful tool that is based on sound learning principles, which can maximise the educational potential of CPD. Access to appropriate distance learning materials, facilitated student interaction and adequate tutorial support may provide the most effective and efficient option for today’s healthcare professionals and education purchasers.13
It must be acknowledged that despite its benefits to students and commissioners, web-based learning may not be an effective education tool for every student. The quality of web-based learning must be considered in order to guard against poor practice offered under the guise of diversity and flexibility of learning,22 and in order to ensure that the quality of provision and security of academic standards are as they need to be and adhere to the standards set by the NMC.12
Through the continued development of healthcare programmes, distance learning can enhance CPD education relevant to the needs of changing healthcare provision especially in terms of specialist areas of knowledge such as those of community practitioners – and has the potential to contribute positively to healthcare professional education. It provides a more flexible approach to learning, allowing the students to incorporate CPD successfully and still achieve a work-life balance. Past knowledge and experience is utilised, and by providing increased responsibility for their own learning within a supportive framework, participating students can meet their individual learning needs more adeptly.17,23
In a climate in which community practitioners have demanding caseloads24 and little time to consider the obligation they have to the NMC to maintain professional development and lifelong learning,4 distance learning could alleviate the difficulties some of them may face in maintaining an up-to-date professional portfolio that provides evidence of their developing roles and skills. It could also provide managers with a cost-effective way to promote staff development.
* Higher education institutions should broaden web-based curriculums for community practitioners
* Education purchasers should provide widespread CPD opportunities to all community practitioners by embracing web-based education as a viable and economical way in which to promote specialist learning
* Community practitioners should view web-based learning as a flexible way in which to promote their technological skills, maintain lifelong learning and develop professional knowledge.
* Distance learning programmes utilise web-based and online learning activities that are facilitated by a lecturer
* This is an economical and flexible form of education that can be used to maintain lifelong learning and CPD requirements
* Higher education institutions should collaborate with commissioners in order to promote opportunities to access well supported web-based education programmes that are aimed at community practitioners
* Community practitioners can adopt distance learning as a way to enhance CPD and lifelong learning while maintaining a work-life balance
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Julie Southernwood MSc, BSc(HV), RGN
Senior lecturer, University of Huddersfield
Copyright TG Scott & Son Ltd. Oct 2008
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