by

Esther Christian, EdD (c), MSN, RN

Abstract

This study investigated the nursing students’ and nursing educators’ perceptions of their knowledge and use of computer-assisted instruction (CAI). Technology in education has advanced significantly from the overhead projectors as the primary teaching aid in the traditional classroom. Currently in the traditional classroom, there are new methods of instruction that include the use of electronic mail, search engines, chat rooms, Internet, and software programs such as Microsoft Excel and Microsoft PowerPoint. The reality is that technology is playing a critical role in teaching and learning.

Keywords: computer assisted-instruction, computer use, computer knowledge, nursing, perception

Technology in education has advanced significantly from overhead projectors as the primary teaching aid in the traditional classroom. Educators’ messages were amplified by being projected on a screen. In this setting, educators lecture while students listen and take notes. Students’ activities include answering questions listed at the end of the chapters, copying diagrams, drawing, writing, and taking quizzes (Kozlowski, 2002; Young, 2002; Burkill, 1998; Baldwin, Johnson, & Hill, 1994). There are new methods of instruction in today’s classrooms that include the use of electronic mail, search engines, chat rooms, Internet, and software programs such as Microsoft Excel, and Microsoft PowerPoint (Mallow & Gilje, 1999; Scollin, 2001).

The reality is that technology is playing a critical role in teaching and learning. Education has evolved to more than lecture and class discussion. Compared to the traditional classroom, technology can be both an effective enhancement and supplement (Ryan, Carlton, & Ali, 1999; Semple, 2000). Students are learning from more than just interacting with educators. The differences in learning styles support the fact that some students will learn better in a course in which they can interact with the educator in person and through technology. Thus, technology should serve as a vehicle for delivering and learning course content (Scollin, 2001; Semple, 2000; Yoder, 1994).

Background

Educators have added computer-assisted instruction to compete for students’ attention and to accommodate and to recognize the differences in students’ learning styles (Simon, 2000). This accommodation has caused a paradigm shift in higher education from traditional classroom instruction (TCI) to computer-assisted instruction (CAI) (Ryan, Carlton, & Ali, 1999). Results from technology use, brevity, movement, and color have been added to education (Young, 2002). This shift is requiring changes in both the way educators teach and students learn. Communication and interaction skills have been affected and reshaped by technology (Young, 2002; Ryan, Carlton, & Ali, 1999).

Technology affects the structure of learning institutions, methodology of teaching, and the style in which we learn. The physical structures of learning institutions, methodology of teaching, and learning styles have been affected by technology (Leasure, Davis, & Thievon, 2000). Individual students learn differently, even when the course format and content are the same (Haar, Hall, Schoepp, & Smith, 2002; Kozlowski, 2002). With technology, educators can now adapt their teaching to fit the students’ learning styles as well as aid in influencing information processing and academic achievement. If educators do not recognize and adapt to these changes, but continue to cling to the traditional ways of teaching, they may be teaching to empty classrooms.

Computer-assisted instruction allows the students to be active participants in their learning and therefore students can progress at their own pace (Huppert, Yaakobi, & Lazarowitz, 1998). “CAI may help students develop creative abilities and induce changes in the cognitive and affective outcomes” (Huppert, Yaakobi, & Lazarowitz, 1998, p. 236). According to Burkill (1998), CAI serves the purpose of providing flexibility in developing new knowledge and supporting competence in the use of information technology.

Literature Review

Information technology is part of the healthcare professionals’ daily life. A review of related literature revealed that nurses must learn how to use technology (Rankin & Hoaas, 2002; Oermann, 1997; Halloran, 1995). However, the acceptance of new teaching styles are not quickly embraced or adopted through technology. Skills are needed in accessing, managing, and examining information (Young, 2000). Computers enable practitioners to process information that is accurate, unduplicated, error-free, and accessible from remote areas by multiple persons at the same time (Young, 2000). Interactive media offers learning that appeals to every learner with the sounds, images, and words being available at the same time.

Halloran’s (1995) research evaluated the differences in traditional classroom lecture and an experimental group taught using CAI. The results of this study were that students felt that CAI made class more interesting and highly organized. The use of CAI allowed for integration of learning and increase students’ involvement in the class without feeling self-conscious. Disadvantages in this study were that the faculty needed more time to develop the CAI materials and technical support. However, the researcher reported that it was easier to revise lecture materials with CAI. Rankin and
Hoass (2001) reported that technology innovations have made it easier and less time consuming for educators to teach.

According to Woo and Kimmick (2000), students in the CAI classrooms were attending class more consistently and offered more verbal comments than students in the traditional classrooms. Students reported rarely leaving their seats when a computer activity was involved and if they did leave, the students communicated the reasons for doing so to the instructors. Computer interactions made class more dynamic and immediate feedback was provided when students did not understand a concept. Some of the disadvantages were the increase in the amount of time need for planning had increased, technical support was critical for success and students reported being restless when technical complications occurred.

Oermann (1997) suggested that research is needed to assess nursing education programs. Computer skills will soon be prerequisite for information-related disciplines and those who possess computer skills will have an edge over those without such skills. Kominiski and Newburger (1999) indicated that 54% of adults reported using the computer. The proliferation of information imposed new requirements on formal education. Formal education’s shortcomings are notorious in keeping pace with contemporary concerns, financing, and issues. Faculties are being challenged to prepare graduates to meet the job market requirements. Professional nursing must be ready as information technology evolves. Leaders in nursing education must work to ensure that faculty and students will be aware, understand, and apply technology appropriately.

Purpose

The purpose of this project was to determine nursing students’ and nursing educators’ perceptions of their knowledge and use of computer-assisted instruction. The following hypotheses were tested.

Hypothesis 1: There is no significant difference in level of CAI knowledge between nursing students and educators.

Hypothesis 2: There is no significant difference in the extent to which students and faculty members in a baccalaureate degree nursing program use and experience information technology.

Subjects

Subjects were selected from a baccalaureate-nursing program within a public institution of higher education in West Tennessee. The students were completing their first semester of their senior year. The nursing faculty was from the same institution. After receiving IRB approval, the chairperson of the nursing department was contacted for approval and to set dates for administering of the questionnaire. The questionnaire was given to 13 faculty and 31 students. They were provided information on the content of this study. They were given a choice of participating in or withdrawing from this study and the individual consent to participate was the return of the questionnaire.

Methods and Data Analysis

The Staggers Nursing Computer Experience Questionnaire (1994) was modified and used for this study. The 26-item questionnaire addressed the respondents’ perceptions of their use and knowledge of computers and included activities such as word processing, electronic mail, statistical analysis, bibliographic retrieval, presentation graphics, and Internet capabilities. The instrument is a paper-and-pencil self-report that uses a 5-point Likert scale ranging from 0 (none) to 5 (extensive) for past or present computer uses and from 0 (none) to 4 (considerable) for computer knowledge. A demographic section was included in the questionnaire to access descriptive data that included personal characteristics of subjects. The test/retest Cronbach’s alpha reliability for use and knowledge for general computer application has been reported as 0.86 (Staggers, 1994).
The past and present general computer applications use and knowledge were added to get total scores. The SPSS statistical computer application using the one-way ANOVA and Tukey HSD post hoc with a significance level of 0.05 was used to analyze the data. The Tukey HSD post hoc analyses were used to identify which group means differed significantly, where ANOVA effects were found significant.

Results

Description of Subjects

Thirty-one female students and eight female educators in a baccalaureate degree-nursing program at a higher educational institution in West Tennessee completed the questionnaire. The results indicated that 84% of the nursing students were between the ages of 20 to 29, 13% were between the ages of 30 to 39, and 3% were between the ages of 50 to 59. Six percent reported being divorced or separated, 61% were single, and 33% were married. Fifty-four percent of the students reported having work experiences in healthcare, three percent had worked as a secretary, and 35% reported having no work experience. Sixteen percent of the students reported that they had a degree other than nursing and that degree was biology/premed, one student left this section blank.

Demographic information completed by the eight nursing educators results revealed that 12% were between the ages of 20 to 29; 38% were between the ages of 30 to 39; 25% were between the ages of 40 to 49; and 25% were between the ages of 50 to 59. Thirteen percent were instructors, 74% were assistant professors, and 13% were associate professors. Thirteen percent had been nursing educators for less than three years, 24% four to six years, 13% seven to ten years, and 50% had more than 11 years of experience. Thirty-seven percent had been a nursing practitioner between six and ten years, 26% had practiced 11 to 20 years, and 37% had practiced more than 21 years.

Analysis of Data

Hypothesis 1. There is no significant difference in level of CAI knowledge between nursing students and educators. All of the students (n=31) and 62 percent of the faculty returned the completed questionnaire. The average score for the nursing students was 32.32 indicating that they perceived themselves as having little knowledge of general computer applications. The participants were asked how much about informatics or computer systems they had read on-line, in computer magazines or in books. The results of the nursing students were 87% had one college level computer science course and 4% had two. Seventy-seven percent reported not having college-level information system management courses. The reply to the number of short courses (less than one week) on computer applications such as Word, 84% had none, 13% had one, and 3% reported they had two. Fifty-eight percent reported not reading about informatics or computer systems, 26% read a few, and 16% reported they read on the average (Table 1).

The average score for the nursing educators was 34.13, which indicated that they perceived themselves as having little knowledge of general computer applications. Some of the general computer applications asked for their perceptions of how often they wrote reports, documents or other text, send messages to others, used data/files such as employee licensing information, researched data analysis, searched for books, articles, or other library information and created slides, pictures for presentations. The results of the nursing educators were 25% had one and 75% had two college-level computer science courses. Sixty-three percent reported not having college-level information system management courses, 13% had one, 13% had two, and 12% had three courses. The reply to the number of short courses (less than one week) on computer applications such as Word, 12% reported having none, 25% had one, 38% had two, and 25% reported they had four courses. Fifty percent reported not reading about informatics or computer systems, 25% read a few, and 25% felt they read on the average.

Overall, there were no significant difference between the nursing students and nursing educators in the general level of computer knowledge. However, there was a significant difference between students and educators regarding the number of courses taken in computer science and/or management/informatics. The educators had taken more courses in computer science and/or management/informatics than the nursing students.

Hypothesis 2: There is no significant difference in the extent to which students and faculty members in a baccalaureate degree-nursing program use information technology. The average score for the nursing students was 29.83, which indicated that they perceived themselves as having little use of general computer applications. The average score for the educators was 34.0, which indicated they perceived themselves as having little use of general computer applications, as well. There was no significant difference between the two groups in the use of information technology. The mean and standard deviation scores for the nursing students were 30.61 and 11.86. The mean and standard deviation scores for the educators were 33.88 and 13.82. The total mean and standard deviation scores for both groups were 31.27 and 12.17 respectfully. The standard deviation scores suggested variability around the mean with both groups together. The calculated F statistic was 0.171 and the significance was 0.172 which proved that there was no significant difference on the computer usages between the two groups (Table 2).

Table 1 Computer Knowledge of Nursing Students and Educators

*Sign. 0.555

*KEY GENERAL COMPUTER APPLICATION:

Little 21 to 41
Average 42 to 62
Considerable 63 to 83
Extensively 84 and above

Some of the reasons both groups listed for not using computers were that they were not interested in computers, that computers made them anxious, they did not have patience for using computers, and afraid of losing files. Twenty-five percent of the nursing educators reported that they had taught courses requiring no computer assignments, thirteen percent less than half, 25% at least half, and 37% more than half.

Table 2 Computer Use of Nursing Students and Educators

N=39
*Sign. 0.172

*KEY GENERAL COMPUTER APPLICATION:

Little 21 to 41
Average 42 to 62
Considerable 63 to 83
Extensively 84 and above

Study Implications

Since there are no established competence levels for nursing educators and students found in literature, the survey questionnaire responses could not be compared to previous competence levels or studies on knowledge and use of CAI. The responses to the first section of the questionnaire revealed that there was little knowledge of general computer applications. However, there was a small percentage that reported formal educational preparations such as college-level courses and on-line reading. This inferred that students must learn about computers from other sources and that the educators had formal computer knowledge, but was not using computers. In order for student nurses to be prepared in information technology, nursing faculty must require students to use the current technology for class work and as a resource for students in the area of information technology. Nursing curriculum must be reviewed and updated to incorporate technology courses.

There were no significance differences found between the nursing students and nursing educators in their perceived use and knowledge of computers. This identified an area of concern. Educators need to be challenged to become familiar with information systems used in healthcare and incorporate this information in the nursing curriculum. As nursing educators become more familiar with the use of technology in healthcare, they are able to facilitate student knowledge and use of technology. Educators must prepare graduates to meet the expected competence in practice. Faculty members themselves must be prepared in informatics it they are to educate nursing students in core informatics content. To assure core informatics competencies, specific outcome criteria need to be identified. Nursing educators must become familiar with initiatives to improve the knowledge and use of information technology in healthcare settings. It is the responsibility of nursing educators to assess the healthcare community to determine the needed skills of nursing graduates. In the present age of digital communication and information management, educators must also include needed technology skills in their curriculum.

It must be noted that although these findings reflected the perceptions of nursing students and educators in one institution of higher education, these findings may not reflect the perceptions of computer knowledge and use, by nursing students and educators in other institutions of higher education.

Some recommendations for future study are to explore:

1. educational offerings designed for nursing students in both general computer applications to assure that nursing graduates will be competent in using information technology in nursing practice
2. the perceived experiences of general computer applications by nursing students and educators
3. educational offerings designed for nursing faculty to become familiar with current health care information management and be able to facilitate student learning in general computer applications
4. the areas of computer applications where nursing students and educators are the strongest and weakest
5. the advanced computer skills needed by nursing students to be successful practitioners
6. the extent to which CAI is used in teaching by nursing educators.

References

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Author’s Bio

Esther Christian, EdD (c), MSN, RN

Ms. Christian is a doctorate candidate at The University of Memphis, College of Education. She is currently an Assistant Professor at The University of Tennessee at Martin, Department of Nursing. Ms. Christian teaches Community Health Nursing and is the coordinator for Foundation II. She is currently serving as president of Tennessee Nurses Association, District 10 and faculty advisor for Pi Tau Chapter of Sigma Theta Tau.