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Editor’s Note
: In a lecture, attention and learning degrade rapidly unless techniques are used to periodically refresh or redirect the learner’s attention, or heighten or vary level of interaction. There are similar needs in distance learning to vary the repertoire to avoid attention fatigue and loss of motivation. In the teaching-learning transaction, instructor attributes include charisma and challenge while learner attributes include commitment and time. 

Attention Fatigue and the Effect of Debriefing
in a Web-Enhanced Graduate Nursing Course

Mary-Anne Andrusyszyn and Dawn Yankou


The authors are grateful to the graduate student participants for helping us learn more about online learning.

This research was based on papers presented at the 13th Annual Conference sponsored by the University of Western Ontario, School of Nursing and the Iota Omicron Chapter of Sigma Theta Tau in May 1999, and the National Nurse Educators’ Conference in Vancouver, BC in Feb 2000.


Changes in directed attention and the influence of debriefing on attention fatigue were examined in eight students completing a graduate nursing course, of which three weeks were online.  Data were collected at three time points. No changes in attention were found between times one and two.  Attention scores were highest following a debriefing experience (time three). Students noted online learning was effortful, and required time and commitment. Online learners can benefit from educational strategies that facilitate reflection and recovery of directed attention.

Introduction and Review of Literature

Access to higher education through electronic means is fast becoming the norm in many disciplines.  Few programs remain untouched by this sweeping influence.  Distributed learning through the use of technology, regardless of the medium, offers greater flexibility and access to educational opportunities (Clark, 1998; Whittle, Morgan & Maltby, 2003).

Internet-based computer-conferencing (CC) has been used in the graduate nursing program at a Canadian university in Southwestern Ontario to deliver portions of courses for several years.  Most students, new to technology, are often overwhelmed with the volume and intensity of online interaction.  This is not unusual as constructing knowledge and learning from multiple, often-disconnected bits of shared information can be mentally challenging and fatiguing.  Students can also experience feelings of uncertainty about the quality of personal contributions, particularly when they are anxious about having these documented in a permanent online transcript (Andrusyszyn & Davie, 1995). 

Struggling to function effectively and maintain cognitive clarity by inhibiting distractions and by attending, reflecting, and making sense of learnings that emerge from multiple messages, require directed attention (Kaplan, 1983).  Prolonged use of directed attention can lead to attention fatigue (Kaplan & Kaplan, 1989; Kaplan, 1995), a decreased capacity to attend. This fatigue often manifests in increased errors and the declining ability to concentrate, achieve clarity, problem solve, carry out plans, and behave in socially appropriate ways (Kaplan & Kaplan).

Tennessen and Cimprich (1995) suggest that university students are at an increased risk of developing attention fatigue.  When directed attention becomes fatigued, reduced selectivity and inhibitory control central to information processing may result (Kaplan, 1995).  Information processing is a key activity in all learning environments, particularly in the asynchronous online medium. In this environment, knowledge is constructed collaboratively and interactively through written dialogue, and all textual cues must be processed in a meaningful and efficient way. 

The quality of learning depends a great deal upon the ability to focus or concentrate and clarity.  Clarity, "a state of mind characterized by a strong focus and the suppression of distraction" (Kaplan & Peterson, 1993) is a central concept to psychological wellbeing.  Being focused feels good while being confused is disconcerting (Kaplan & Kaplan, 1982).   Clarity can motivate an individual to learn more, foster the capacity to organize, make plans and decisions, and facilitate making sense of one’s world.  It plays a central role in one’s willingness to take action (Kaplan & Peterson, 1993).

One way to help learners gain conceptual clarity and enhance the meaningfulness of their experiences is through reflection (Andrusyszyn, 1996; Mezirow 1990).   Reflective activities allow individuals to examine their experiences and consider new understandings (Boud, Keogh & Walker, 1985). This personal process, arising from the cognitive and affective synthesis of ideas, may be strengthened through dialogue (Andrusyszyn) 

Reflection can enhance clarity by helping learners shift information from surface level knowing to higher-order understanding and knowledge development (Cinnamond & Zimpher, 1990; Scardamalia, Bereiter & Steinbach, 1984). It is a process that may be facilitated (Boud, Keogh & Walker).  Debriefing, “purposeful reflection by an individual or group” (Pearson & Smith, 1985), is one strategy that can be used to facilitate reflection (Boud, Keogh & Walker).   In this study, researchers explored the influence of reflection through debriefing on attention fatigue in a web-enhanced graduate course using computer conferencing.



Two hypotheses were tested.  Students enrolled in a web enhanced graduate course that integrates computer-conferencing will:

1.       Demonstrate a decrease in attention function on measures of attention function following a three-week online experience compared to baseline data.

2.       Demonstrate an increase in attention functioning on measures of attention function following a debriefing experience compared to data collected at the end of the online period.


All eight students enrolled in the graduate nursing course were invited and agreed to take part in the study. The women ranged in age from 18 to 50 years with a median age between 41 and 45 years.  Two were full-time students, six part-time.  Three were employed full-time; the others had part-time employment.  Years of experience in nursing practice ranged from 2 to 31 years with the majority between 13-31 years.  All students had access to the Internet from home, place of employment, or the university.


The Attention Function Index (AFI) (Cimprich, 1990) was used to measure perceived attention or effectiveness in purposeful activity requiring attention.  It consists of 16, 100mm linear analog scales on which participants place a mark at the point that best describes how they feel they are functioning in each of the 16 areas.  These include such items as:  getting started on activities you intend to do; planning activities; and keeping your mind on what you are doing.  A single overall score ranging from 0-100 (0=not at all; 100=extremely well), with higher scores reflecting higher perceived attention function, is computed for the AFI.  Internal consistency reliability coefficients ranging from .89 to .94 have been demonstrated (Cimprich; Yankou, 1996). 

The Necker Cube Pattern Control (NCPC) (Cimprich)  is an objective measure of attention. It consists of a drawing of a three-dimensional cube that can be perceived from two alternate perspectives resulting from reversal of the foreground and the background.  The frequency with which the cube appears to flip or change perspectives is counted at two time points.  The first or baseline count involves the participant indicating the number of times the cube flips randomly.  The second involves counting the number of flips as the participant attempts to hold one perspective, that is, control the number of cube reversals. The percent reduction in pattern reversals is derived from the rate of reversals during the baseline score and the holding score.  Greater attention capacity is indicated by the ability to control the reversal of perspectives or flips (Cimprich). Cimprich  conceptualized the Necker Cube as a direct, objective measure of attention capacity.


A one-group pretest-posttest design was implemented.  The study was carried out during a three-week online period integrated into a traditional 13-week face-to-face graduate seminar course on nursing leadership facilitated by one of the researchers.  Participation during this time was not graded to relieve any anxiety students may have felt about using technology.  Six weeks prior to the formal online period the virtual space was opened; students were encouraged to practice using the system; and an orientation to the Internet-based asynchronous CC program was held. 

Case studies about nursing leadership and access to a nursing leader as an online guest expert provided focus and context to the discussion.  Students were encouraged to share new insights about the cases and the literature with colleagues so they could all benefit from the wealth of ideas within the group.  As well, students were encouraged to reflect on how these new understandings applied to their individual knowledge and experiences.   The reflection-in-action (Schon, 1987) took place during the three-week online period.  No face-to-face classes were scheduled during this period.  

Quantitative data were collected at three different time points.  The self-administered AFI questionnaire and the NCPC, were given to participants at the beginning (time one), at the end of the online experience prior to debriefing (time two), and within 3 days of the reflective debriefing (time three).  Demographic data were obtained at time one. The reflection-on-action (Schon) took place at the end of the 3-week online period through the 90-minute debriefing exercise. During that time researchers audiotaped and transcribed the dialogue.  Content analysis was then used to identify themes derived from the dialogue. 

Descriptive statistics were used at all three data collection time points to describe and summarize the data.  Bivariate statistics were not used due to the small sample size.



The majority of students were comfortable with word processing, using email, and the Internet.  At least five students (62.5%) used their computers for word processing, email, and accessing the Internet daily or often.  None had prior experience with CC.

There were very slight changes in attention function as measured by the AFI (or the NCPC between the beginning of the online learning experience (time 1), and the end of the online experience (time 2). The scores on the AFI were higher at time 3, that is following the reflective debriefing experience (M=71.46 (s.d.17.72) than at either of the other two time points (time 1=64.97(s.d.19.37); time 2=65.81(s.d. 22.83). This finding, in the hypothesized direction, suggests attention function improved following the debriefing.  The percent reduction in Necker cube pattern reversals declined slightly over time suggesting attention function got worse after debriefing. 

Three common themes emerged from the researchers’ analysis of the debriefing session.  The first was commitment.  Students spoke about the importance of commitment to themselves and others during the online period.  They observed they had to be present and active online as others depended on their contributions.  This was a double-edged sword in that students “...carried guilt of not participating more....” They feared letting the group down, while simultaneously, agonizing over written responses as they perceived these to be  “a big investment”.  They also expressed the importance of being committed to themselves and responsible for their own learning.  “...I had to be a lot more responsible for my own learning ... when you’re in the classroom you can depend a lot more on other people...”

The second theme was challenge.  Students felt disadvantaged by not being able to “see” or gauge responses in the way they had become accustomed in a face-to-face classroom.  They perceived themselves as being more spontaneous in real life.  One student stated:  “when you’re forced to say something, you think it should be profound or meaningful”.  Maintaining a commitment to meaningful learning for themselves and their peers was challenging.  Making meaning from the volume of dialogue keeping track of what was said and extending the discussion in a meaningful way was also a challenge.  One student shared it “...was difficult for me to express myself... like following a play...”.  Several noted it was a challenge to share work related personal experiences fully because they knew each other from the nursing practice area.   Once student noted she might have shared more if co-learners had been strangers. Since the focus of the online discussion was on specific cases, and students were encouraged to reflect on these experiences in relation to their professional practice, they became conscious about what examples and experiences they could and could not share online.  They did not want to commit their experiences to writing, fearing that “sharing experiences [online] was just too risky...we are more guarded”.

The final theme emerging from the reflective debriefing related to time.  It “took more time to process [information]” and “...it took longer to come up with an answer....”  In other words, “work expanded to the time allotted”.  They noted that “online is ongoing...face-to-face has a beginning, middle, and an end and an interlude to the next week”.  It “took longer to get through...[and]...requires organization and prioritization”.  The group also noted the importance of “being respectful of other peoples’ time”.


Discussion and Limitations

Learning activities that take place in web-based learning environments, such as computer-conferencing, require directed attention.  When dialogue occurs online, a large volume of information is exchanged in text form.  This information, to be meaningfully applied to one’s personal context, must be read, analyzed, synthesized, and transformed into knowledge.  The process of transforming information to knowledge and personal understanding requires directed attention.  It was hypothesized that the process would be fatiguing. 

Previous research has shown that ongoing use of directed attention leads to attention fatigue and reduced effectiveness in activities requiring attention (Kaplan & Kaplan, 1989).  In this study, researchers did not find a decrease in attention function over time.  This may have been due to students’ relatively brief exposure to web-based learning.  A longer online experience may have been perceived as more fatiguing. The small sample size must also be acknowledged. It is also possible that since participation was not graded, the sense of pressure to meet course expectations was diminished.  Conversely, it is important to consider whether the lack of grading reduced the degree of attention students dedicated to the experience since “it did not count”.  However, the researchers’ assessment of the quality of contributions and students’ expressed commitment to the experience suggests this was not the case.

Since the majority of students (75%) took courses part-time, the flexibility of fitting online dialogue into their schedules may have been attractive, thus the online experience was not perceived as attentionally fatiguing.  It should be acknowledged that AFI scores for participants in this study were quite high on entry into the study suggesting good attention function. 

The final debriefing was intended to provide an opportunity for students to examine what they had learned, the learning process, as well what they learned about themselves and their colleagues.  The focus of the debriefing gravitated to the learning process more than the content.  Sharing these perspectives seemed to be foremost in the students’ minds.  Participants also noted what they learned about themselves, particularly about the importance of time, organization, and making meaningful contributions. 

Although researchers did not find a change in attention function from time one to time two, an increase in attention was demonstrated following the reflective debriefing (time 3).  The trend was in the hypothesized direction, suggesting there is a relationship between the process of reflection and attention.  Given the sample size, however, no definitive conclusions can be made.  This relationship  is worthy of further examination and has relevance for educators in online learning environments. 

It is important to acknowledge that one of the researchers was the course professor.  Although participation in the study was voluntary, students may have felt compelled to participate.   Further, it should be recognized that the online experience was a course requirement.  It is possible that students who are required to participate in an online experience may be different from those who choose to participate.  However, students did not object to trying this new learning medium.  It may be interesting to examine the attention function of these two groups. It may also be valuable to compare the attention function of students taking online courses to those who are taking a course completely face-to-face.

Integrating educational strategies that encourage students to reflect may have a direct influence on students’ abilities to attend and gain conceptual clarity.  As more and more students embrace learning in distributed environments, it is incumbent on educators and their institutions to pay close attention to and integrate reflective strategies into educational programs to facilitate attention.



Clark, C. (1998). Teaching and learning at a distance.  In D. Billings,  & J. Halstead eds., Teaching in Nursing:  A guide for faculty. (pp. 331-346). Philadelphia, P.A:  W.B. Saunders,

Whittle J., Morgan, M. & Maltby J.  Higher learning online:  Using constructivist principles to design asynchronous discussion.  Retrieved March 3, 2003 from http://naweb.unb.ca/proceedings.

Andrusyszyn, M.A., & Davie L. (1995). Reflection as a design tool in computer-mediated education.  Proceedings of the Distance Education Conference, San Antonio: Texas, January 1995.

Kaplan, S. (1983).   A model of person-environment compatibility.  Environment and Behavior, 15, 311-332.      

Kaplan, R. & Kaplan, S. (1989). The experience of Nature.  A psychological perspective.  Cambridge:  Cambridge University Press.

 Kaplan, S. (1995). The restorative benefit s of nature:  Toward an integrative framework.  Special Issue:  Green psychology.  Journal of Environmental Psychology, 15, 169-182.

Tennessen, C.M. & Cimprich, B. (1995). Views to nature: Effects on attention.  Journal of Environmental Psychology, 15, 77-85.

Kaplan, S. & Peterson, C. (1993).  Health and environment:  A psychological analysis.  Landscape and Urban Planning, 26, 17-23.

Kaplan, S. & Kaplan, R (1982).  Cognition and environment.  Functioning in an uncertain world. New York:  Praeger.

Andrusyszyn M.A. (1996).  Facilitating reflection in computer-mediated learning environments.  Unpublished doctoral dissertation, University of Toronto, Ontario, Canada.

Mezirow, J. & Associates (Eds.). (1990). Fostering critical reflection in adulthood.  San Francisco: Jossey-Bass.

Boud, D., Keogh, R. & Walker, D. (1985). What is reflection in learning?  In D. Boud, R.  Keogh, & D.  Walker ed.  Reflection: Turning experience into learning. (pp. 7-17).  London: Kogan Page.

End Notes

1.        Cinnamond, J.H. & Zimpher, N.L. (1990).  Reflectivity as a function of community.  In Clift R, Houston WR, Pugach, MC eds.  NY: Teachers College Press.

2.        Scardamalia, M., Bereiter, C, & Steinbach, R. (1984). Teachability of reflective processes in written composition.  Cognitive Science, 8, 173-190.

3.        Pearson, M. & Smith, D.  (1985). Debriefing in experience-based learning.  In D. Boud, R.  Keogh & D.  Walker ed.  Reflection: Turning experience into learning. (pp. 69-84). London: Kogan Page.

4.        Cimprich B. (1990).  Attentional fatigue and restoration in individuals with cancer.  Unpublished doctoral dissertation, University of Michigan.

5.        Yankou D. (1996). Depression and directed attentional fatigue in older women. Unpublished doctoral dissertation, University of Michigan.

6.        Schon, D. A. (1987).  Educating the reflective practitioner.  San Francisco: Jossey-Bass.


About the Author

Dr. Mary-Anne Andrusyszyn, RN, EdD, is Associate Professor, The University of Western Ontario, Faculty of Health Sciences, School of Nursing at HSA #31, London, Ontario. Canada N6A 5C1. Her email is: maandrus@uwo.ca

Dr. Dawn Yankou, RN, PhD is Assistant Professor, #410, Atkinson Faculty of Liberal & Professional Studies, School of Nursing , York University, 4700 Keele St., Toronto, Ontario, Canada, M3J 1P3. Her email is dyankou@rogers.com


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