Editor’s Note: Blended learning combines classroom instruction with distance learning. Courses can be designed to incorporate the advantages of both learning environments. Also, it eases both teachers and students into new roles and responsibilities associated with teaching and learning on the Internet.

Using Blended Learning to Prepare Future
Distance Learning: A Technology Perspective

Jinyuan Tao, Carolyn Ramsey, Marlene Watson
USA

Abstract

The Associate of Science of Nursing (ASN) programs in the United States typically adopt face-to-face teaching mode due to nursing field’s practice-oriented characteristic. Recently, more and more ASN programs have migrated to a blended mode where lectures are pre-recorded and hosted in a robust Course Management System, and the traditional face-to-face teaching is still conducted on regular basis to reinforce learning. For the RN-BSN programs, however, the online mode is the main format for support of full time working registered nurses. This paper presents an exploratory evaluation of a blended learning mode adopted by an ASN program in terms of students’ technology competence. The aim of this study is to investigate whether the blended learning mode of an associate nursing program can technologically prepare its students for their future distance education.

Keywords: technology competency, blended learning, nursing education, e-learning, f2f, classroom learning, online learning, distance learning, asynchronous learning, synchronous learning

Introduction

Blended learning is commonly defined as an integration of traditional classroom-based approach and newly Internet-based approach to deliver instruction (Garrison & Kanuka, 2004; Graham, 2006; Macdonald, 2008). In the blended learning mode, the students have the benefit of taking courses face-to-face (f2f) with an online component or e-learning component, using sophisticated course management systems (CMS) such as Blackboard (including former WebCT and Angel Learning), Moodle, or Sakai. Blended learning mode provides students with greater time and place flexibility and improved learning outcomes; however, students initially encounter various issues such as time management, taking greater responsibility for their own learning, and lack of support when using sophisticated technologies (Vaughan, 2007).

With blended learning, teachers can use online tools and web-based resources as part of their daily classroom instruction. Students' learning toolkit in the past only consisted of notebooks, paper assignments and "stand and deliver" classroom presentations; nowadays the toolkit has also included online learning tools (such as synchronous chat and asynchronous discussion forum, etc). This expanded toolkit helps students better develop their higher education and workforce skills (Pape, 2010).

However, Jones, et al. (2004) criticized the assumption that most students have the ability to use those new learning tools within an educational setting, and suggested that many undergraduate students entering the university had limited experience with the internet and had very little information technology (Arif, 2001). In fact, distance education tools might seem to be unfamiliar or difficult to learn for many students, so they might not be enthusiastic about participating in online activities (Hong, Ridzuan, & Kuek, 2003; Xie et al., 2006). Hence, it is essential that students should have basic computer/internet skills to augment their e-learning outcome.

In the meantime, American Association of Colleges of Nursing (AACN) estimated a shortage of 500,000 registered nurses is expected by 2025 in the United States (U.S) alone. According to AACN’s report on 2008-2009 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 49,948 qualified applicants from baccalaureate and graduate nursing programs in 2008 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost two-thirds of the nursing schools responding to the survey pointed to faculty shortages as a reason for not accepting all qualified applicants into their programs (AACN, 2009).

A central strategy, recognized by the AACN, is to increase access to nursing education by distance education. Distance education, or e-learning, is planned learning that occurs in different places from teaching, requiring interactive technology in delayed (asynchronous) or real time (synchronous) (Novotny & Wyatt, 2006). A 2002 survey of 365 AACN member nursing institutions reported that 187 (51%) offered distance education courses. The survey also determined that 162 accredited nursing distance education programs reported that the heaviest enrollment was online registered nursing Bachelor of Science in nursing (BSN) completion programs (90.73%), followed by Master’s degree (3.65%), and doctoral degrees (0.06%) (Hodson-Carlton et al., 2003). In 2010, AACN reported that among the 634 RN to BSN programs that are available in the U.S., more than 400 are offered at least partially online.

Overall, it appears that blended learning provides students with greater time and place flexibility and exposes students and instructors with various computer/internet-based learning technologies. However, little is known on how well students are technologically prepared for their future distance education. At the same time, distance education seems to be considered as one of the effective strategies to solve nursing and nursing faculty shortages. This paper intends to investigate if the nursing students from an ASN program that adopts blended learning are technologically prepared for their future distance learning.

Conceptual Framework

In the well cited “Technology Acceptance Model” (TAM) framework by Davis, Bogzzi, & Warshaw in 1989, computer use is determined by behavioral intention that is formed by perceived usefulness and perceived ease of use (Davis, et al, 1989). In 2008, Sahin and Sheleey further developed the TAM model into the “Distance Student Satisfaction Model” (DSSM). The DSSM framework has four constructs: a) computer knowledge; b) flexibility of distance learning; c) usefulness of distance learning, and d) distance learning satisfaction, that lead to higher levels of use of distance education (Sahin & Shelley, 2008). Four constructs from the TAM framework and the DSSM framework are utilized in this study: 1) computer/internet knowledge; 2) perceived ease of use of computer/Internet in learning; 3) technology use satisfaction in learning; and 4) perceived usefulness of computer/Internet skills in learning. A descriptive study design was used to answer the research question: Does blended learning in the ASN nursing program technologically prepare nursing graduates for their future distance learning?

Blended Learning Mode

The Department of Nursing at the authors’ college started to migrate to a blended teaching and learning mode at the beginning of 2008. By the end of 2009, all nursing courses were using the blended learning mode. The blended learning concept is defined in the college’s Academic College Bulletin and is quoted below: 

"Blended learning includes content and activities delivered in a web-based format, while other content and activities are offered in a traditional classroom setting. The blended course promotes learning that is interactive and engaging for the student in the classroom but also allows them the autonomy to learn at their own pace outside the classroom. In the blended format, a portion of the course activities will be completed on campus to provide face-to-face contact with course instructors. Course activities may include, but are not limited to: lecture content, case scenarios, chat or discussions, exams, and clinical involvement."

There are two parts of the blended learning mode: i) the traditional face-to-face (f2f) teaching part, where students and instructors meet, typically once a week, to participate in various learning activities such as case studies, clinical scenario analysis, tests, quizzes, games, simulations, stories, videos, practice questions, and discussions; and ii) the e-learning part, where course materials including Flash-based pre-recorded lectures, all the assignments, take-home quizzes, and other learning activities are hosted in the Course Management System (CMS).

Figure 1: A typical Flash-based lecture content interface hosted in the LMS.

Figure 1 is a typical recorded lecture interface that is Flash-based. Text pops up on the screen while synchronized with the voice over. The recorded lectures allow students to have multiple accesses twenty-four hours a day, and seven a week. Students are able to pause and skip certain parts during their lecture viewing. It is required that students go through those recorded lectures and required textbook reading before they come to class to attend live (f2f) lectures. 

Figure 2: A learning activity was provided during the lecture content.

A variety of different interactive activities are embedded periodically throughout the lectures to reinforce concept learning (Figure 2). Students must complete the activities in order to move on.

The E-Learning Skills
Basic Computer/Internet Skills

Before being admitted into the ASN program, students are required to take the “Introduction to Microcomputers”, a pre-requisite course, where they learn basic computer skills such as Microsoft Word, Excel and PowerPoint, Internet, and browsers skills (Table 1). Due to the blended learning mode that the ASN program adopts, the majority of the course materials are hosted in the CMS for students to access 24/7., Students submit their electronic assignments via the web, and tests and quizzes are administered online. Therefore those basic computer and Internet skills are reinforced while they are beginning to take ASN courses.

With computer-based testing in National Council Licensure Examination-Registered Nurse (NCLEX) as a driving force, the nursing department at the authors’ college embarked on a laptop initiative around 2004. The nursing faculty felt that engaging the students in taking timed computer-based assessments would better prepare the undergraduate nursing students for what they would experience when they sat for their NCLEX. The notebook/laptop was the chosen device for the students to use because it was portable. Scheduling one classroom equipped with computers for any time a student was available to take the NCLEX was next to impossible due to the security of the testing in nursing courses. The nursing faculty and IT Department worked together to develop an image set for the custom-factory imaged DELL Latitude model.  A wireless network was installed and configured for the college. In addition to the goal of computerized testing in the classroom, laptops can also be integrated into regular teaching and learning. Since the campus migrated from traditional face-to-face teaching to blended learning mode, various computer/Internet-based technologies were introduced to the classroom. The laptop initiative is the “one stone that killed two birds”.

Table 1

Computers

Asynchronous Learning Skills

Asynchronous learning pedagogy is defined as teaching and learning that occurs when the interaction between the instructor and students is not constrained by time and place. It is based on the constructivist theory, and is a student-centered approach that emphasizes the importance of peer-to-peer interactions.  Zsohar & Smith (2008) have identified three distinct benefits of asynchronous learning: students: 1) have an increased amount of time to prepare their responses, 2) can not interrupt other students when posting or speaking, and 3) have access to all written records of all discussions for later references. Disadvantages of using asynchronous learning include: i) loss of direct personal contact such as eye contact or facial expression, ii) loss of spontaneity when responding to questions, and iii) limitations to the type of discussion faculty can pose (Zsohar & Smith, 2008 and Anderson, 2009).

The CMS (course management system) is an electronic environment that helps the instructor and students communicate, exchange information, manage and schedule the learning process. It is a major component of today’s online program: it hosts all the course materials and it is the central place where students and instructors meet. Since Blackboard Learn acquired WebCT and Angel Learning, the CMS market is dominated by Blackboard Learn. Students in the ASN program are exposed to the following CMS-based asynchronous learning tools: folders that contain course materials, discussion forums, emails, and assignment dropboxes.

Table 2

Presentation and Feedback

Synchronous Learning Skills

Synchronous learning is defined as the pedagogy where instructors and students participate in the same learning activity at the same time. Chat rooms and video conferencing are the two main synchronous learning tools in online education. Literature shows disadvantages and advantages on synchronized learning tools. Little, Passmore & Schullo (2006) reported that the advantages included: i) increased communication; and ii) increased savings in time and money due to ability to meet online versus traveling to a designated location. Disadvantages include initial technical glitches during the setup phase and high support need during the actual implementation phase.

Table 3

Interaction

Data Collection

Adult Health Nursing III taught during the 4th trimester, and Adult Health Nursing IV are the final capstone courses in the ASN program at the authors’ college. Subjects were obtained from both courses and were surveyed. Both courses use same format of flash-based pre-recorded lectures. It is assumed by the time students are at the 4th and the final trimesters, they are:
1) proficient in using the CMS system and other technologies utilized during the nursing program; and 2) more ready to respond to the question about their willingness to continue their nursing education after the upcoming graduation from the ASN program. Therefore, forty-five out of fifty-three students in Adult Health Nursing III and thirty-eight out of forty-one in Adult Health Nursing IV completed the survey, which yielded a total of 83 students out of 94 (88%) who responded to the survey. Both groups that were surveyed had the same questions; therefore the results were combined and analyzed in the following Table 3-Table 6.

Data Analysis

Students’ perceptions of using technologies in blended learning format were measured by eight perception questions which used a Likert scale ranging from 1 (strongly disagree) to 5 (Strongly agree). The eight questions were designed based upon the four constructs drawn from the TAM framework and the DSSM framework: 1) basic computer/Internet knowledge; 2) perceived ease of use of computer/Internet in learning; 3) technology use satisfaction in learning, and 4) perceived usefulness of computer/Internet skills in learning.

1.    Computer/Internet knowledge

Table 4

Perception Survey Results * (n=83)

Table 4 shows 99% reported familiarization with laptop features such as wireless Internet connection, basic Windows operation and Microsoft office. Those skills are reinforced during the entire ASN program and will be utilized in their future online courses. Eighty nine percent reported familiarity with one or the other of two basic Internet browsers Internet Explorer or Firefox. The literature supports that higher level of computer experiences are linked to greater enjoyment of users with distance learning (Mitchell et al., 2005). In fact, “inadequate or incomplete knowledge and awareness inevitably compromises the quality and appropriateness of learning experiences which can be provided and developed” (White, 2005, p. 170). As long as students have the skills to use online tools and perceive that distance education is a useful and flexible way of learning, communicating, and sharing, their enjoyment from online instruction will be promoted. Ultimately, this satisfaction might lead to higher levels of engagement, learning, and success in the setting.

Table 4 also shows about 98% of the students are confident using the various features offered by CMS. According to a 2009 report by American Society for Training and Development, 91 percent of ASTD respondents are using CMS's in their organizations (Ellis, 2009). It is critical to have proficient computer and CMS skills such as Microsoft Word processing, emailing, discussion forum, assignment drop box, chat room and accessing online files.

2.    Perceived Ease Use of Online Learning Tools

Table 5

Perception Survey Results * (n=83)

Table 5 shows about 85% of the students reported they were exposed to asynchronous technologies such as discussion board, email, take-home quizzes, and pre-recorded lectures, and 93% reported they were familiar with synchronous tools such as chat room and video conferencing. Both asynchronous (delayed) and synchronous (real-time) learning tools play critical roles in today’s distance learning. The exposure to asynchronous and synchronous learning tools will help students better utilize them in their future distance learning.

Until recently, distance learning initiatives mainly relied on the asynchronous means for teaching and learning (Romiszowski & Mason, 2004). However, the recent improvements in technology and increasing bandwidth capabilities have led to the growing popularity of synchronous learning (Kinshuk & Chen, 2006). While asynchronous learning tools do not allow interactions between faculty and students constrained by time and place; synchronous learning allows students to interact instantly and eliminates the feeling of isolation that is inherent in asynchronous learning.

3.    Technology Use Satisfaction

Table 6

Perception Survey Results * (n=83)

Table 6 shows 85% of the students reported they were satisfied with the technology experience through the ASN program. The technology use satisfaction in learning will eventually lead to high levels adoption of distance learning.

4.    Perceived Usefulness of Technologies

Table 7

Perception Survey Results * (n=83)

Table 7 shows 92% of the students were confident and comfortable to take online courses in the future and 87% reported life-long learning was possible with proper technologies equipment. Using the blended learning method gives students a variety of ways to obtain their knowledge that is being studied as well as appealing to diverse learning styles and thus fostering independent learning. It also gives the students the ability to become lifelong learners (Pape, 2010).

Summary

It appears that the technologies and skills that nursing students learn in the blended learning program in the authors’ college can adequately prepare them for their future distance learning and even life-long learning. The study also suggests that students’ computer knowledge and perceptions, such as the perceived usefulness, perceived ease of use of computer/Internet in learning and technology use satisfaction in learning, should be considered as predictors for their success in distance learning environments. Although the data garnered from this study is far from inclusive, the findings are relevant and useful for consideration by other programs concerned with their students’ technology readiness for future distance learning. Undergraduate college programs can adopt the blended learning mode to increase students’ level of computer knowledge and emphasize the flexibility and usefulness characteristics of distance learning.

However, this study was conducted in one ASN nursing program in the southeastern United States. No student demographic data were gathered; therefore care should be taken in applying the findings of this study to other courses in different subjects.

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