Efficacy of Web-Enhancement on Student Technology Skills


Maria A. Smith, DSN, RN, CCRN



Healthcare institutions have increased technology use in patient management prompting integration of technology into nursing education.  Transitioning courses from place-based (on-site) to web-based can be time intensive and stressful for students and faculty.  Web-enhancement can serve as a transitioning technique, which would allow gradual introduction to software applications throughout the semester for both students and faculty.   Access to faculty and course materials can be facilitated with this technological intervention.  Through web-enhancement, students can take an active role in their learning.  Web-enhancement can facilitate integration of technology competencies into nursing curricula. 

Key Words:  Web-enhanced, Online education, Technology, Instruction, Web-based


Efficacy of Web-Enhancement on Student Technology Skills


Technology has evolved to be an integral part of nursing education.  This evolution has stemmed in part from the integration of electronic networks in health care.  These networks connect nurses to multidisciplinary team members and each other.  This connectedness facilitates information sharing with clients and healthcare professionals across the country.

It is important for academic institutions to prepare students to function in an ever-increasing technologically driven health care environment (American Association of Colleges of Nurses [AACN], 1997, 1998).  The need for technology skills in nursing is well documented in the literature (Bachman & Panzarine, 1998; Carter & Axford, 1993; Saba & Riley, 1997; Walker & Walker, 1994; Simpson, 1998; Simpson, 1999; Vaderbeek & Beery, 1998).  In order to achieve preparedness of students, faculty must begin to integrate technology skills into course delivery (Khalili, & Shashaani, 1994; Armstrong & Mahan, 1998).


Delivery of most undergraduate nursing courses continue to be in a place-based (on-sight) presentation format.  Lectures predominate information delivery in this format.  Students are exposed to information at one place within a designated timeframe.  Faculty may use technology in course delivery but there is no expectation of student technology use.  Place-based course web-enhancement expands student course information exposure beyond place and time limitations.  It captures dimensions that are beneficial to online instruction (online access by students at anytime from any site) and extends them to the place-based format.  It also promotes student technology skill acquisition (Oliver & McLoughlin, 2001).


Learning technology skills in addition to coursework can be perceived as stressful.  This stress may extend to students (Parker & Gemino, 2001; Serwatka, 2002) as well as faculty (Dexter & Anderson, 1999; Englebardt, 1997).  Student stress can result from the frustration of learning to access information and increased time required to navigate in an unfamiliar environment.  Faculty stress can result from the increased amount of preparation time required to incorporate technology and the steep learning curve for new software .  A substantial time investment can be required to organize course content.  Few faculty are prepared for the infusion of technology into the educational environment (Duhaney, 2001; National Center for Education Statistics, 2002; Roblyer & Edwards, 2000; Willis & Mehlinger, 1996).  Web-enhancement offers gradual introduction to software applications throughout the semester for both students and faculty.  It also promotes active learning of course material and shared learning responsibility (Wang, Hinn, & Kanfer, 2001).  Web-enhancement provides students with an opportunity to connect new course material to an existing knowledge base.


This study was undertaken to describe the level of technology skills prior to and upon completion of a web-enhanced course.  It investigated student perceptions related accessing course materials and whether technology assisted them to take a more active role in learning course content.  This study also addressed barriers to the successful use of technology by students.



A university based software package was used for course web-enhancement.  Enhancement components included course syllabus, lecture notes (PowerPoint and MS Word format), helpful web links, online grade book, online practice quizzes (multiple choice, puzzles and matching format), and case studies with graphics and sound.  Enhancement components were available for the full course semester.


This study used a convenience sample of 27 undergraduate baccalaureate senior nursing students.  Most participants were white (n=21, 80.8%) females (n=22, 84.6%).  Mean participant age was 24 years (SD=4.148).  Completion of the technology questionnaire was completely voluntary.  Anonymity and confidentiality were assured.


Data Collection

A Technology Evaluation Tool was used to collect data.  Section one obtained self-reported technology levels of students.  Skill components included:  (a) word processing and professional formatting, (b) email and course specific listserv, (c) introduction to the use of computers and related software, (d) introduction to the internet and basic searches, (e) retrieving course materials, assignments and forms from the internet, (f) complex internet searches, (g) use of internet based interactive learning modules, and (h) evaluation of internet sources for applicability and quality.  Each item had a scale of 1 (no knowledge) to 10 (expert use).  Section two consisted of a 5-point Likert scale which retrieved student perceptions to course access and whether technology assisted them to take a more active role in their learning course content.  Section three addressed perceived barriers to the successful use of technology in the course.



Mean scores for technology skill levels prior to the course ranged from 6.28 to 8.05 and upon course completion from 7.70 to 8.96.  Mean before (B) and after (A) scores for each technology skill follow:  (a) word processing and professional formatting (B=7.72, A=8.12), (b) email and course specific listserv (B=7.52, A=8.70), (c) introduction to the use of computers and related software (B=7.17, A=7.83), (d) introduction to the internet and basic searches (B=8.05, A=8.68), (e) retrieving course materials, assignments and forms from the internet (B=6.80, A=8.96), (f) complex internet searches (B=6.63, A=8.04), (g) use of internet based interactive learning modules (B=6.28, A=7.70), and (h) evaluation of internet sources for applicability and quality (B=6.31, A=7.78). 


Mean Likert scale scores for section two statements were more indicative of agreement with statements related to access, use of technologies in their career and their role in the learning process.   Mean scores for responses were: “I had better access to the faculty” (M=3.74),  I had easier access to course material/information” (M=3.81), “I had access to more course related resources” (M=3.96), “The technologies presented in this course will be useful in professional practice” (M=4.00), and “My experiences with technology assisted me to take a more active role in my learning” (M=3.65).


Students cited several barriers to their successful use of technology in completing course requirements.  Most were system and personal barriers.  System barriers included: (a) university system downtime (n=6, 22%), (b) PowerPoint download time on home computers (n=8, 29.6%), (c) single phone line (n=1, 3.7%), (d) inability to print from home computer (n=1, 3.7%), (e) no internet access at home (n=5, 18.5%), and (f) lack of home PowerPoint program (n=4, 14.8%).  Personal barriers related to: (a) lack of computer knowledge (n=7, 25.9%), (b) procrastination (n=2, 7.4%), (c) fear and anxiety (n=1, 3.7%), and time (n=4, 14.8%).  Other barriers cited by students included: (a) some teacher’s inexperience with technology and unwillingness to use it effectively (n=1, 3.7%), (b) too many website resources (n=3, 11.1%), and lack of access to all library resources off campus (n=1, 3.7%).



Analyses revealed that all mean after scores were higher than mean before scores for investigated technology skills.  Student’s expressed better access to faculty and course related materials and resources.  Students identified that the technologies presented in the course would be useful professionally.  Students also stated that with technology they were able to take a more active role in their learning.


Barriers identified to the use of technology included system and personal barriers.  University system downtime and download times on home computers for lectures in PowerPoint format were the greatest system barriers.  Lack of knowledge predominated the personal barrier category.



This study indicated the positive impact of web-enhancement on student technology skill acquisition.  It also identified barriers that are controllable by faculty that need to be considered when incorporating web-enhancement into course content.  Web-enhancement may serve to facilitate integration of technology competencies into nursing curricula.  Funding for this effort was obtained from Middle Tennessee State University.



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