E-LEARNING IN NURSING EDUCATION – CHALLENGES AND

OPPORTUNITIES
Prof Dr Peter Kokol1, Helena Blažun1, Prof Dr Dušanka Mičetić-Turk1,
Prof Dr Patricia A. Abbott2
1
University of Maribor, University College of Nursing Studies, Žitna ulica 15, Slovenia
2
Johns Hopkins University, School of Nursing
e-mail:kokol@uni-mb.si

ABSTRACT: Quick changes on the field of informational communication technologies forces educational and other
institutions to think about different ways of teaching and learning in both formal and informal environments. It addition it is
well known that due to fast a dvancement of science and technology the knowledge gained in schools is getting out-of-date
rapidly, so life long learning is becoming an essential alternative. As a consequence we are facing a rapid development and
use of new educational approaches such as e-learning, simulations, virtual reality, etc. They brought a revolution to learning
and instruction. But in general the empirical results of e-learning studies are somewhat disappointing. They cannot prove the
superiority of e-learning processes over traditional learning in general, neither in specific areas like nursing. In our
international study we proved that eLearning can have many benefits and that it can enhance learning experience in nursing
education, but it has to be provided in correct manner.

KEY WORDS: E-LEARNING, NURSING CARE,
INFORMATION COMMUNICATION TECHNOLOGY
(ICT)
1. Introduction
Quick changes on the field of informational
communication technologies forces educational and other
institutions to think about different ways of teaching and
learning in both formal and informal environments. It
addition it is well known that our knowledge gained in
school is getting out-of-date so life long learning is
becoming a necessity. As a consequence in the last decade
we are facing a rapid development and use of new
educational approaches such as e-learning, simulations,
virtual reality etc. They brought a revolution to learning
and instruction. But in general the empirical results of e-
learning studies are somewhat disappointing. They cannot
prove the superiority of e-learning processes over
traditional learning in general nor in specific areas like
nursing. In our international study we proved that
eLearning can have many benefits and that it can enhance
learning experience, but it has to be provided in correct
manner. Our empirical results identified obstacles, but
interestingly the obstacles differs in different countries.
Our empirical results identified obstacles, but interestingly
the obstacles differs in different countries, but not
wisthanding there are also many similarities.
In the next section we briefly present the use of eLearning
paradigm in nursing education. Then we introduce the
study performed in the scope of the DENED project,
present the results and conclude the paper with some
challenges for future research.
2. Distant education and eLearning
Distance education is known for almost 200 years [1]. The
term distance education as used in educational literature
covers the various forms of study at all levels which are not
under the continuous, immediate supervision of tutors
present with their students in lecture rooms or on the same
premises but which, nevertheless, benefit from the
planning, guidance and teaching of a supporting
organization [2].
It can be defined as teaching and learning where students
are not required to be physically present at a specific
location during the term as the process of providing
instructions when students and instructors are separated by
physical distance, time or both. Frequently regular mail
was used to send written material, videos, audiotapes, and
CD-ROMs to the student and to turn in the exercises.
Recently e-mail and the Web are used for this manner.
Initiation of life long learning in educational process lead
[3] to new forms education and alternative educational
programs. More and more educational institutions follow
new forms of education, which are frequently supported by
ICT [4]. With rapid development of informational
communication technology and “fast life style”, the distant
education is more and more and attractive and interesting
form of education, mainly because of globalization as
consequence of global developments [5].
2.1.Distance education and eLearning in nursing care
Study of nursing care demands a combination of theoretical
knowledge and practical skills. Students and professors can
use Internet for browsing and searching literature, web, etc.
More advanced forms include e-mail, videoconferences,
virtual classrooms, discussion groups, forums, digital
learning materials, virtual laboratories, simulations and
similar. Because nursing care is very specific [6,7] verbal
interpretations and conversations must be combined with
computer supported education. Internet and WWW offer
options for nurses which were a few years ago only a dream
[8]. But Malow and Gilje [9] stress the importance of
critical judgment of professors in introduction and
influence of information technology, and a lot of people
have doubts about using too much technology in nursing
profession and education. When we are thinking about
implementing distance education in nursing care we have
to realize that we can support nursing care theoretically but
on the other hand we can not overlook the importance of
clinical practice which is the most important part of
education of nurses and it has to be taught in clinical
environment beside real patients.
2.1.1. eLearning at the University College of Nursing
Studies
In last decade the University College of Nursing Studies at
the University of Maribor felt the need to follow the
development of ICT and modern educational trends and to
support nursing care education with ICT based educational
methods (ODIN and NICE EU projects). Distance
education model, which was developed at Faculty for
electronics, informatics and computer science was
redesigned for the students and professors of University
College of Nursing Studies as a part of an EU project called
ODIN with the objective to teach fundamental and
theoretical principles for specific fields of nursing care.
The content is presented using various multimedia
techniques based on different audio-visual means which
thematically supplement theoretical content.
3. The international study - DENED project
In the scope of DENED project we developed eLearning
tools and materials both at the University College of
Nursing Studies University of Maribor, Slovenia and
School of Nursing Johns Hopkins University, USA and
empirically followed their use and the satisfaction of
students and lecturers. We are also comparing the results
with a similar Austrian study and currently we are
performing the some study in Japan, Finland and Greece.
3.1. The method
Within the qualitative and quantitative research at
University College of Nursing Studies University of
Maribor and School of Nursing, Johns Hopkins University
we interviewed full time and part time students at both
institutions about attitudes and opinions regarding distance
education. The research was performed among 125
students (36 in Slovenia and 89 in USA). Research in
Slovenia was carried out face-to-face. Questionnaire for
qualitative research was composed from 17 questions
mainly about advantages and disadvantages of distance
education, access to Internet at home or work, the purpose
and frequency of Internet usage etc.
Questionnaire for quantitative research was composed
from 37 questions, divided on two parts. First part – 24
questions were closed ended-questions (dichotomous,
multipe) and open ended questions (unstructures). Part two
was composed from 13 questions where we have listed
potential barriers to distance education that have been
found in the literature. Based on their own personal
opinion they rated each barriers of how strong or how weak
they thought each barrier may be to them considering
taking a distance education class.
4. The results
After the introduction of eLearning courses we performed
a study aiming to analyze the student attitudes. Quantitative
analysis showed that we can state that eLearning like in
many other studies
o Improved the quality of educational process
o Improved the presentation of nursing problems;
o Better prepared students for application of
theoretical content in clinical practice;
o Improved the possibility of multidisciplinary
usage;
o Enhanced the creativity, motivation and quality of
work of students in nursing care;
o Enlarged the accessibility of educational contents
regardless of time and place;
o Enhanced the students ability for analyzing,
synthesis and critical thinking;
But qualitative analysis revealed that that was not the
opinion of all students and teachers and we were not able
to achieve the consensus that eLearning is clearly superior
to classical learning. Additionally the qualitative analysis
showed that:
 it is not only important to create and prepare the
materials, but also to present the model of e-
learning to students and make the instructions for
students, tutors and teachers how to use online
courses.
 the main problem for teachers is how to create
complicated knowledge presentations, providing
text files, scanned text or self made explanations
to topics.
 In aspects of online courses, teachers want to rely
on reliable authors, reliable and tested knowledge
providers, as they do with the use of paper based
books.
 the students are supporting the e-learning as and
addition to ordinary but much shortened courses
especially as an asynchronous way of learning.
 e-learning requires different pedagogical
approaches for both teaching and learning and that
nor teachers nor students are aware of it.
 The different student motivation and abilities
require individualization and personalization of
elearning courses.
It was very interesting that for instance self-control and
motivation is disadvantage for full time students and
advantage for part time students. We also found out that
more percentage of part time students prefer distance
education as full time students. The reasons can be find in
the fact that part time students are employed so they
already have some practical experiences, have families and
therefore less time for studying. Full time students want
traditional education with real teachers and professors
because they never had opportunity to work in clinical
environment. Online learning can be a satisfactory Before we actually offer distant e-learning study
experience for nurses who are shift workers or with programme we must to take into consideration all aspects
competing demands from family, work and professional – from students and teachers prospective.
development to access continuing education.
So for the improvement of eLearning paradigm in nursing
4.1. Obstacles in eLearning we will follow the recent research which found out that
Above study was also aimed to identify the barriers which intelligent systems can support different learning styles
hinder the success or introduction of eLearning practices in thus sustaining individualized learning and teaching. Some
nursing education processes. The space limitation doesn’t other studies showed that learner models representing
allow us to report it in more detail, but some interesting learning styles can be built and used with success in
conclusions regarding barriers are shown in Table 1. intelligent tutoring systems. In general such learning’s
called self regulative and it has been shown that the level
Table 1. The main barriers hindering elearning at UCNS of self-regulation is highly correlated with the learning
and John Hopkins SON performance. Another very important recent finding is that
till recently it was assumed that an individual’s ability to
Barrier % for % for Statistically learn is fixed. But current research showed that this
strong or strong or significant assumption may be wrong. Learning may be a skill, not a
very very difference hard-wired trait and people can improve their capacity to
strong strong between learn at any age. So our idea is to integrate the “how to
barrier at barrier at UCNS and learn” intelligent tutoring systems into elearning
UCNS SON SON environments. Additionally we will upgrade e-learning
Lack of 27.8 58.8 Yes environments with tools that will enable teachers and tutors
knowledge of to learn how to prepare and manage course materials easily
information and efficiently.
technology
Lack of 73.6 21.9 Yes Only by realizing what is the most suitable for students and
personal professors we can create useful tools with advance
contact information technologies which will enable them necessary
Access to 11.7 27.4 Yes flexibility and independence. Nonetheless, we must accept
internet the fact that technology alone does not automatically
Fear of 28.7 16.4 Yes improve the learning progress. In order to be successful,
technology the focus must be on teaching and learning, not merely the
Trust of 68.1 77.4 Yes technological issue. A major challenge in adopting the
transfer online learning mode is to enhance human interaction so as
to provide a facilitative environment for establishing peer
From the Table 1. it is interesting to note that barriers support, developing academical dialogue and socialization.
differ on the statistically significant level between the
Slovenian and United State School. A significant barrier in 6.Acknowledgement:
both environments is the Trust of transfer (which is the
main barrier in SON). The main barrier at UCNS is lack of The authors wish to thank all research team members who
personal contact and the second main barrier at SON is contributed their efforts in data collections.
Lack of knowledge of information technology. The The authors are gratefully acknowledge to the Slovenian
Slovenian nurses have more Fear of technology then in Research Agency for sponsoring this research within
United states and surprisingly the United state nurses have bilateral project DENED. Special thanks to Prof Dr Patricia
more problems with the access to internet then Slovenian A. Abbott and Prof Dr Dušanka Mičetić-Turk for
nurses. reviewing the questionnaire.
Most importantly, the study would not have been possible
5. Conclusions and Future plans without the participation of the students in this study.

Our study showed that many of the potential benefits of 7.References

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materials, and teaching practical skills and proper
communication within a team and toward the patient. We
also found out that eLearning should provide
personalization and individualization for students and
support for preparing teaching materials for instructors.
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