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The challenges of online nursing education

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DOI: 10.1016/j.iheduc.2009.06.007

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 Internet and Higher Education 12 (2009) 98–103

Contents lists available at ScienceDirect

Internet and Higher Education

The challenges of online nursing education

Glenn Gordon Smith a,⁎, Denise Passmore b, Timber Faught c
a
University of South Florida, 4202 E. Fowler Avenue, EDU 162, Tampa, FL 33620-5650, United States
b
University of S. Florida, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL 33612-4766, United States
c
University of S. Florida, 3418 Winder Dr. Holiday, FL 34691, United States

a r t i c l e i n f o a b s t r a c t

Keywords: To meet the current critical need for qualified nurses, many colleges have initiated online programs, primarily
Online instruction aimed towards registered nurse (RN) to BS students. Despite the growing number of online nursing
Nursing programs, there is little research on instructor views of online learning. This study used interviews to
Healthcare
investigate nursing instructor experiences in online learning. Results revealed instructor concerns with
e-learning
identifying the most effective assessment methods to judge students' ability to apply their lessons in real-
Distance learning
world settings. Online nursing exhibits unique challenges, such as providing nursing students with online
authentic learning experiences that relate to real-world nursing situations, which comprise both high-stake
medical and interpersonal elements. Results also indicated that providing support and ensuring that the
faculty have sufficient time to develop effective courses, with adequate assessment for the students, is
necessary to ensure the quality of online nursing education.
© 2009 Elsevier Inc. All rights reserved.

1. Introduction deep. Teaching online demands not only an understanding of the

Currently, there is a healthcare crisis in the United States due to the
shortage of qualified, professional nurses (Stotts, Smith, Edwards-
Schafer, Schmidt, & Smith, 2002). Nurses with Bachelor's and Master's
degrees on average have better critical thinking skills than their peers
with Associate's degrees and hospitals that employ more nurses with
higher level degrees tend to have lower mortality rates (Aiken, Clarke,
Cheung, Sloane, & Silber, 2003). Therefore, hospitals strongly
encourage their RNs to return to school to obtain Bachelor's and
Master's degrees. Online programs provide a cost effective option for
both institutions and students, enabling registered nurses (RNs) who
may not have access to traditional academic settings to pursue a
baccalaureate degree (Bolan, 2003; McAlpine, Lockerbie, Ramsay, &
Beaman, 2002; Ostrow & DiMaria-Ghalili, 2005). However, despite the
growth of online programs, there is little research on the discipline-
specific challenges that online nursing instructors face in the delivery
of their courses. The purpose of this study was to identify particular
challenges and issues that the online nursing faculty might face in the
delivery of their particular discipline online.
1.1. Review of literature
It is simplistic to point out that teaching online and teaching face-
to-face are different. They obviously have different platforms of
delivery, but the depth of the difference is surprisingly broad and
⁎ Corresponding author. Tel.: +1 813 974 7922; fax: +1 813 974 3837.
E-mail addresses: GSmith@coedu.usf.edu (G.G. Smith), dpassmor@health.usf.edu
(D. Passmore), Tholmes3@mail.usf.edu (T. Faught).
content, but also an understanding of how to present the content,
provide a learning environment using technology (Conceição, 2006),
and take advantage of the unique learning affordances of online
learning environments. O'Neil and Fisher (2008) described differences
in experiences for nursing students who were taking an online course
versus a traditional face-to-face course, despite both courses being
taught by the same professor. Students in the online class felt that they
worked harder, but also felt like they were more part of a group.
Although the technology presented a barrier and was sometimes
challenging, they were able to revisit lessons online at any time and felt
the asynchronous nature of the course was beneficial. These students
were often placed in small groups for discussion online, helping to
promote the social interaction of the course. This is particularly
interesting since students often talk about feeling alone or lost when
they are in an online environment (Trenholm, 2007). Assessment can
also provide certain challenges in online learning. Challenges include
verifying identity (e.g., is the person taking the test the person signed
up for the course?) (Trenholm, 2007), the use of non-allowed outside
materials, and alignment of the assessment with the learning outcome
(e.g., the tendency online to assess at a lower level than the learning
outcome). Many of the methods used by professors in face-to-face
classes cannot be employed in an online class.
Teachers in online situations cannot think exclusively of them-
selves and their students, as they are also interdependent on other
agencies and individuals, including instructional design and technical
support and faculty peers who have also created online courses. These
changes have also increased the workload of many faculty who were
not expecting technology to be central to their careers (Hartman,
Dziuban, & Brophy-Ellison, 2007; Passmore, 2000). The differences

1096-7516/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.iheduc.2009.06.007
 G.G. Smith et al. / Internet and Higher Education 12 (2009) 98–103
between online classes and face-to-face classes are real and must be
considered. However, different disciplines lend themselves better or
worse to online learning, an important consideration in the instruc-
tional design of online learning. Each discipline has unique demands,
which may require unique online learning solutions.
There is a voluminous body of research about online learning.
However, the vast majority of such research tacitly assumes homo-
geneity between disciplines. For example, common theoretical con-
structs, such as community of inquiry (Rourke, Anderson, Garrison, &
Archer, 1999) and social presence (Short, Williams, & Christie, 1976;
Rourke et al., 1999) are typically discussed without regard to
disciplinary differences. Social presence in online courses has been
strongly correlated with satisfaction with online distance learning
(Gunawardena & Zittle,1997), and is thus often suggested in the design
of online courses. One might wonder whether feeling socially
connected would matter in an online physics class as much as in an
education course.
A small but growing number of scholars have started to research
online learning through the disciplines paradigm, exploring the
disciplinary effects in online learning. Instructors of mathematics
and mathematics-related courses are significantly less satisfied with
online learning and course management tools than are their peers
teaching non-mathematics-related courses (Smith, Ferguson, & Gupta,
2004; Trenholm, 2006; Trenholm, 2007). Online mathematics instruc-
tors often create their own technical solutions to overcome the failure
of online course management systems to meet the unique needs of
mathematics (Smith et al., 2004). Attrition is significantly higher in
mathematics-related online courses than in non-mathematics-related
courses (Smith & Ferguson, 2005), a difference that does not exist in
equivalent face-to-face courses. Since assessment of online courses is
problematic, some experts recommend proctored examinations
(Trenholm, 2007). Arbaugh (2005) has also researched similar
disciplinary questions in the context of online business education, as
have Hornik, Saunders, Li, Moskal, and Dzuiban (2008), who have
shown that student grades are significantly higher and withdrawal
rates lower for courses with high paradigm (hard discipline)
development (e.g., Biology, Computer Science) than for courses with
low paradigm (soft discipline) development (e.g., Sociology, English)
(Smith et al., 2008).
Despite these disciplinary differences, it is important to under-
stand that there are many salient features of the online learning
experience that are common across disciplines, while there are also
important differences between disciplines (Smith, Heindel, & Torres-
Ayala, 2008). The differences have important implications for
instructional design of online learning. The challenge of the
discipline-specific online learning research paradigm is to differenti-
ate what is common to all online learning, and what is unique to
specific disciplines. Since participants in studies of online learning
may have only been involved in one discipline, they may have no idea
about what is unique to their discipline, nor how these differences
may interact with the online modality (Smith et al., 2008). Differences
between online and the traditional face-to-face modes of learning
may be much more salient to people immersed in one discipline.
Therefore, it is important to conduct research about online learning
across disciplines, sorting out what is unique to specific disciplines
and how the unique challenges of disciplines interact with online
learning (Fig. 1).
One way to understand the differences in the different disciplines
relevant to online learning is Biglan's taxonomy, which divides up
academic disciplines along two dimensions: hard versus soft and pure
versus applied. Hard disciplines, such as chemistry, have an agreed-
upon, ordered, seemingly objective knowledge base, while soft
disciplines, such as sociology, have knowledge bases relatively more
open to interpretation and different schools of thought (Neumann,
Perry, & Becher, 2002). The pure versus applied dimension is based on
whether the discipline implicitly involves real-world application of the
99
Fig. 1. Biglan's taxonomy of academic disciplines. (Smith et al., 2008).
knowledge (Neumann et al., 2002). Engineering, an applied field, is the
application of pure knowledge bases such as mathematics and physics.
Biglan's taxonomy provides a useful lens for analyzing disciplinary
differences in online courses. For example, a study spanning five years
that analyzed Blackboard tool-usage patterns, student attrition rates,
and student course evaluations suggests that online learning in pure
disciplines has become more commoditized, while online learning in
applied disciplines has become more oriented to community practice
and more diversified (Smith et al., 2008).
The lead author of the current publication has written publications
on the discipline-specific effects of mathematics, a hard-pure discipline,
in online learning. In Nursing, a soft-applied discipline, the lead author
has made a deliberate choice of a discipline that is opposite along both
dimensions of Biglan's taxonomy. Online nursing education delivers
applied information in a human interactive environment. This means
that the knowledge learned in the discipline is applied to people and is
therefore unpredictable and requires critical thinking skills to be used by
the students. Nursing is a high-demand field with highly specific needs
for the students. The issues of nursing are in many ways different than
the issues of other disciplines and thus require the online delivery to be
modified in unique ways. By understanding the issues within the
domain, the online education of nursing can be more productive.
Beyond the content, Frith and Kee (2003) contend that withdrawal
due to technical issues can be devastating to online nursing programs.
It is vital that online curriculum is supported by sound instructional
design to foster critical thinking and clinical decision-making
paramount to nursing education and practice (Bolan, 2003). Providing
nursing students with a well-constructed online course that targets
their needs is part of a coordinated curriculum. This, plus responsive
technical support, allows assessment to be provided in a timely
manner, thereby creating a course with higher completion rates (Frith
& Kee, 2003). Successful online courses for nurses provide frequent,
short assignments and discussion forums centered around thought-
provoking questions that integrate course content as well as illustrate
the student's individual experience (Spangle, Hodne, & Schierling,
2002). An online nursing course should create an environment that
fosters reflection and increases critical thinking about practice by
allowing time for the students to develop cohesive written responses
(Ali, Hodson-Carlton, & Ryan, 2004). By doing this, the students can
share their personal experiences supported by research, helping not
only to solidify their own learning, but also to bring more experiences
to their fellow students who may face similar situations once they are
in the field.
1.2. Gaps in the research literature
More research on a soft-applied discipline would be helpful for this
research paradigm, discipline-specific effects on e-learning. With its
real-world consequences for practitioners, nursing is an appropriate
choice. Further, with the rising demand for nursing associated with
the aging of the U.S. population and the rapid growth of online nursing
100 G.G. Smith et al. / Internet and Higher Education 12 (2009) 98–103
programs, an examination and dissemination of critical online needs
of nursing could help instructional designers implement better online
solutions for nursing programs. Since the stakes of nursing education
are so high, it is vital to make sure online nursing is effective. Thus, the
current exploratory study asked the main research question: In the
perception of online nursing instructors and instructional designers,
what are the unique challenges of teaching nursing courses online?
2. Method
Participants for this study were seven instructors and two
instructional designers within colleges of nursing at major research
universities in the states of Florida and New York. Individuals were
invited to participate if they had taught, or were teaching, one or more
online classes or were involved in the design of online classes. All
faculty interviewed had taught online nursing for more than two years.
This qualitative, descriptive, multisite study consisted of open-ended
questions designed to motivate the participants to reflect upon
experiences associated with teaching and development of online
nursing courses. Interviews were conducted face-to-face or by tele-
phone. The interviews were conducted to uncover the most pressing
differences between traditional face-to-face and online courses. Inter-
viewers asked five initial questions focusing on issues such as the unique
challenges of teaching nursing in the online environment versus face-to-
face. Following the answer to each question, the interviewers often
asked follow-up questions addressing issues that the interviewee
seemed to emphasize as important. The four initial questions included:
1) What are the unique challenges of teaching your discipline across all
teaching modalities (whether face-to-face, e-learning, or point-to-point
distance, etc.)? 2) How do instructors in your discipline address the
unique challenges and pedagogy in the e-learning environment? 3)
What unique learning opportunities for your discipline does the e-
learning modality afford, which are not available face-to-face? 4) What
critical insights into teaching your discipline via e-learning were not
covered by the preceding questions?
Interviews averaged approximately 45 minutes in length. All
interviews were taped, transcribed, segmented and coded indepen-
dently by two research assistants with an interrater-reliability of
84.6%. The codes were analyzed with the whole interview as the unit
of analysis (IUA), i.e., which codes occurred at least once in the
interview. Multiple occurrences of a code in one interview did not add
to its frequency. IUA frequency was counted by the number of
interviews in which a code appeared once or more.
3. Results
Table 1 shows the most common codes and their frequencies. The
code names are italicized in the results reported below so the reader
can read about the common themes in a prose context.
A careful examination of the interviews revealed that assessment
was not just the most common theme, but also ran through all the other
Table 1
Nursing—frequency of codes/themes using interview as unit of analysis.
Code Frequency Percentage
Assessment 9 100%
Delivery method 8 89%
Tools 8 89%
Academic integrity 7 78%
Blended 7 78%
Feedback 7 78%
Interaction 7 78%
Authenticity 6 67%
CMS 6 67%
Research skills 6 67%
Student attributes 6 67%
common themes. Online nursing instructors discussed delivery meth-
ods, tools and academic integrity in the context of their concerns about
assessment. Assessment issues permeated all of the interviews with
online nursing instructors.
Creating authentic assessments was a significant concern to partici-
pants. Most discussion of delivery method and tools was ultimately
related to how these factors were utilized in the implementation of
assessments. One of the most commonly utilized forms of assessment in
online learning is testing. Testing in an online environment, however,
provides unique challenges and opportunities not always encountered in
classroom testing. One instructor discussed the advantage of providing
computerized testing: “In Florida, RNs must take a rigorous computerized
test in very secure conditions. They need opportunities to prepare for
that.” The online testing experience gives students a chance to practice
with this mode before having to sit for state board exams.
Academic integrity is always a concern with online tests. Though
one instructor permitted students to use notes and textbooks, other
concerns were expressed about groups of students taking tests
together: “You wonder who is in the room when they are taking the
test.” Instructors discussed ways in which they attempt to minimize
cheating such as randomized test pools and time limits. One instructor
described her experience with a test pool that she began creating
during her very first semester: “That test pool is still being used after
five years.... The students are still scoring 65% to 100%. They have not
gotten the answers out there.” It was expressed that “mature students
will handle it well. Students with high integrity.” However, there was a
definite concern for those students who do not fall into that category.
One of the disadvantages mentioned in online testing was the lack
of statistics provided by the Blackboard Course Management System
(CMS), which was the system used by most of the participants in this
study. Faculty asked for “more options for analysis with testing,”
specifically a method for “the breakdown of information on the items
for each test.” Without these tools, it was difficult for the faculty to
compare online test results with live tests. Online nursing instructors
discussed both desires for more tools within Course Management
Systems, as well as teaching opportunities afforded by their Course
Management System.
Writing assignments were one of the most frequently mentioned
forms of online assessment. In fact, one instructor stated that it was
preferable to assess writing online: “Much of the interaction for
writing and publication is appropriate on paper, such as critiques.
exchange of manuscripts on Blackboard is efficient. Papers are easily
shared.” Others expressed the comparability to live courses: “Assess-
ment is similar to face-to-face. They write papers. They get credit for
their weekly discussions.”
One instructor, who taught a class of adult students returning to
college, used writing assignments to help students get comfortable with
the process of being a student and utilizing the electronic features that
enabled sharing papers back and forth: “I had a lot of formative and
summative papers for them.” The use of formative papers enabled
students to gain familiarity with the system, getting feedback prior to
submission of the actual final paper. Using word processing simplified the
task of giving feedback and additionally gave students an opportunity to
improve their computer skills.
The use of writing assignments was described as an alternative to the
issues found in online testing, assuming of course that students are
writing the papers they submit. Using plagiarism detection tools is one
way to prevent issues with cheating. However, the use of writing
assignments is negatively impacted by the number of students: “Our
classes vary from a minimum that is supposed to be thirty, but some
instructors will take 60 to 70 students and say they have to use multiple
choice questions to assess the student.”
Authenticity was a major concern to online nursing instructors.
Nursing is fundamentally a human care-giving activity. There is always
the danger that didactic courses, particularly e-learning courses, seem
too theoretical and not closely related, in an authentic way, to real
 G.G. Smith et al. / Internet and Higher Education 12 (2009) 98–103
nursing situations. The following is an example of a case study used to
relate online nursing education to the human values of a real nursing
situation: According to three of the nursing instructors, one of the
human relations difficulties that nurses face every day is the diversity
of cultural attitudes about medical situations. Not only is healthcare a
technical profession where medical professionals take care of patients,
but there is also a psycho-social component that is equally important,
and it involves the cultural diversity of both the patient and the care
provider. Therefore, teaching people to be culturally sensitive when
they come from different cultural backgrounds with different cultural
norms and expectations is a challenge. This exchange works both
ways; it is not just teaching American-born, American-raised kids to
deal with people from different cultures. Nursing instructors teach
people from all over the world how to deal with people from all over
the world. It is a great challenge teaching someone who comes from a
culture where health care is based on science (United States or the
European Union) how to appreciate a patient who requests something
spiritual as part of the healing process.
One nursing instructor brought this example from her own practice
into her teaching as a case study:
We had a family whose child was very sick and dying in the emergency
room. The family wanted to do a prayer circle around the child who at
that point, based on modern medicine, required a lot of medical
intervention. In order to allow the family of six or eight people, where
only two people are allowed to visit, we had to get special permission
in a timely fashion because we had a really sick patient, to allow this
family to do this prayer ritual, when the majority of the staff would
rather have given another dose of medication.
In the medical arena, there is a constant tension between the rules,
cultural beliefs and providing the best comprehensive care for the
patient. This is a major challenge in teaching nursing. Most nursing
instructors have students from all over the world. The students come
with their own cultural beliefs and norms and they have to accept the
patient's cultural beliefs and norms.
A major theme that emerged in the data upon analysis was the use of
appropriate delivery method and tools to develop nursing courses
consistent with national curriculum standards. One instructor stated
that “we need to design assignments that help [them] students get to
higher level thinking and skill development.” The assessments must also
be applicable to real life because, as one instructor stated, “nursing is a
practice-oriented field.” Instructors spoke of the challenge of “getting that
application and synthesis” available in face-to-face courses to the same
level of assessment into the online nursing courses. The question becomes
what technology is available to create an interactive assessment for
students that will allow the students to face real-world situations and
prove they understand the concepts being taught in the class.
One of the participants in the study stated, “You really need the
students to apply the theory to the patient in that particular situation.
They are dealing with people who are having illnesses, health care crises
and so on. The students need to do more than just learn the theory that
teaches you how to do it, they have to actually be able to do it.” The
online learning environment can provide this by being adaptable to
multiple situations and creating a multi-tiered program in which
reactions to situations lead to a positive or negative result for the
student. However, a critical concern “is that if everything goes into this
cyberspace world, and we are trying to teach a profession [where]
human contact is the nuts and bolts of it. Keeping the human contact
piece going is the critical element.” One of the ways to keep the
humanity in online learning environment is to work with other students
in small cohorts or in synchronous chat sessions with other students.
The use of discussion boards allows students to work with other
students, comparing their own experiences to the experiences of
others. One of the nursing professionals interviewed explained how
discussion boards worked in one class: “They have to bring the
experience with their patients into the discussion and then they have
101
to reflect on whether they would do it different next time.” The use of
synchronous chat sessions was discussed but “with nursing there is not
a time that someone is not working. They work 24/7 so there is no time
that all students would be available.” These methods do two things for
the students: they incorporate the human or soft element into the
course and give them a sense of community, which broadens their
knowledge of the nursing community.
Without appropriate tools, the ability to deliver authentic assessments
is impaired. This was important to all participants in addressing the con-
tent-management system (CMS) used to deliver content, other tools used
to enhance the course, or student ability and support. Use of a CMS usually
dictates the delivery of online assessments. Another faculty member
described problems with this system: “We do not have any standards in
the college of nursing as to how we do testing online. And there is rampant
sharing of tests from students in one semester to students in another.”
However, not all individuals interviewed agreed that students were
cheating. Even with the concern of test sharing, the consensus is that
online testing also provides other benefits for nurses preparing careers in
hospitals that are completely computerized. Today, even giving a patient
an aspirin is logged immediately into a computer system, often by
scanning the patient's bracelet and then the code for the aspirin. This
familiarity with the online environment will be priceless in the new
computerized hospital setting.
Ultimately, none of these online tools are effective if students do not
use what is available. Although some instructors insist on weekly
deliverables to ensure that students are keeping up, others relied on
the student's self-directedness. However, they discovered a correlation
between time online and grades. “Some students do not check in for
2 weeks at a time. It shows the total times and hits. It seems to be
related to the grades that they earn. Students with high grades put in
many more hours and many more hits within the course than those
with lower grades.” This is important to the field of nursing, where
dedication is priceless to success and patient well being.
When asked what would make their course, which was hosted in a
Course Management System, but supplemented with additional web-
based tools supplied by instructional designers—more effective, one
instructor asked for a method that would allow students “more
interaction between themselves.” Despite inconveniences and lacks,
one faculty stated, “I think we are looking forward to more and more
high quality tools being available online and can give the student the
visualization of what is going on but also be able to get some
manipulation that goes along with that.” The assessment of these
methods might help resolve part of this issue, and give students more
time to interact with other students in the nursing program.
Technical support was mentioned as being important to the
success of both nursing students and faculty. Several instructors
mentioned having a support organization within the college, includ-
ing an instructional designer and technical support, to supplement
what is offered by the university. In this sense, online nursing
instructors are much better off than online instructors in other colleges.
Healthcare related colleges, such as nursing and public health, typically
have more resources to support the development and delivery of online
courses.
Both instructional designers mentioned that, although the online
nursing courses were officially online courses, many online nursing
instructors created blended classes by adding one or two face-to-face
class meetings at the end of the semester for final presentations or
testing: “Even though it is not merely a web-based course, some
faculty will require towards the end of the semester a meeting where
students will present papers and projects and so on.”
Both of the instructional designers and most of the online nursing
instructors mentioned the lack of immediate real-time interaction
between students and instructor, and thus the need to design in a
vehicle for students to get feedback on questions about assignments:
“You don't have the feedback that is useful from seeing them face-to-
face,” “They really want to have feedback from the instructor,” and
102 G.G. Smith et al. / Internet and Higher Education 12 (2009) 98–103
“What works the best is I often set up times during the second week so
that all students who have issues can come.”
Student attributes such as technical ability were important to nursing
instructors. Nursing students' technical ability has long been a challenge.
However, one instructor remarked that “it gets easier annually as people
get more computer literate.” It was noted that “health care is traditional
and not computer oriented,” indicating that nursing students are not as
“knowledgeable in technology as other disciplines.” Because of this, one
instructor listed another advantage to e-learning, “it does expose the
nurses to other kinds of technology; searching literature bases; commu-
nicating in groups and networking with people across the country and
across the globe to get expert input and advice.” Finally, as one faculty
member advised, “the instructor has to maintain a level of competency in
the new technology... that requires updates in training through journals,
clinical practice, conferences, meetings, in-services.” This becomes even
more important as nursing moves into a computerized era where multiple
tools are used to connect patient, nurses and doctors.
Instructors also discussed using tools to supplement the options
available on CMSs. Several mentioned using iPods and synchronous
software such as Elluminate. One instructor said, “I am using Captivate [an
Adobe multimedia development program] to supplement the Power-
Points and the students are really enjoying that modality.” Although one
instructor thought these kinds of tools were helpful for faculty, there was a
concern: “we need the tools, but we also need the time for it.”
One issue that came up from discussion with the instructional
designers, but was only implicitly hinted at in the instructor interviews,
was the notion of core, or clinical, versus non-core nursing courses. At
the undergraduate level, core clinical courses are typically not taught
online, for the obvious reason that nurses need to learn procedural
medical skills, which have life and death implications, in the context of
face-to-face supervision and feedback.
On the other hand, there is an increasing demand for nurses to keep
abreast of the changing medical field by conducting research online to
keep their knowledge current. Thus a lot of online nursing courses,
particularly, graduate courses, emphasize research skills: “We do a lot
as far as assigning them to go and find articles on those types of topics...
and then analyze it, summarize it, and that type of thing.” “We have a
big focus on evidence-based practice, which means basing your
practice on what evidence tells us.”
4. Discussion
Results showed that nursing instructors were concerned with
authentic assessment of e-learning. The ability to assess nursing
students in an online environment offered both positive and negative
issues for students, but overall it seems weighted toward the positive.
Many of the face-to-face aspects of the courses which are not available
online are able to be replaced by technology that is available to students
24/7.
Discussion boards were mentioned by most instructors as one of the
more effective methods of assessing students. In addition to simulations
of real-life situations, students had opportunities to interact with each
other on the boards, and through these discussions brought their own
experiences into the classroom situation. This allowed for learning from
peers as well as from the instructor, thereby creating an interactive
assessment model. Papers, journals, and case studies were also utilized
by many of the faculty as a way of encouraging students to develop
critical thinking skills regarding what they were learning.
Diversity was mentioned by the participants as being particularly
important. Incorporating multi-culturalism in an online curriculum
requires not only an understanding of one's own cultural background
and biases, but the ability to be aware and sensitive to students' needs
and beliefs.
Another area of significance to nursing is that students must apply
the information they learn to real-life situations. Instructors must find
ways to assess whether the knowledge taught online can actually be
applied by students. Assessment methods include discussions of case
studies, group projects that simulate real-life situations and journals
that describe how students apply theory to practice.
Course Management Systems were challenging, in some respects, to
all faculty either in their limitations, unreliability, lack of support, or due
to a prevalence of nursing students who tend to be less technically adept
than students in other disciplines. Faculty described how the CMSs could
either further them towards or deter them from their objectives. There
were numerous methods for creating online assessments, and faculty
even stated that there were advantages, particularly in the areas of
journaling and discussions. The lack of real-time interaction between
students was seen as a disadvantage in CMSs.
Results of the current study are consistent with previous research.
Many nursing students, especially for those coming from community
colleges, have little or no experience with online courses (Chaffin &
Maddux, 2004). Also, many nursing students complain that online
courses consume more time than traditional face-to-face classes. In
addition, nursing students often experience extra stress through a
struggle with the technology (Kozlowski, 2004). But even with those
challenges, it is important to recognize that offering tests online gives
students an opportunity to prepare for state boards that are all
computer-based (McAlpine et al., 2002). Most students also felt that
despite these challenges the ability to work asynchronously made the
challenges worthwhile (Udod & Care, 2002). From the instructor's
point of view, the challenge of preventing cheating worried instructors
and increased their reluctance to offer online testing. Other methods of
assessment were considered at least as effective as testing. However,
the number of students enrolled limits the instructor's ability to grade
and provide timely feedback to each student when using some of these
alternate assessments such as research papers.
5. Conclusion
When viewed through the lens of research on discipline-specific e-
learning, online nursing courses exhibit both similarities and differ-
ences in relation to other disciplines. Although nursing is a soft-applied
discipline, while mathematics is a hard-pure discipline, instructors in
both disciplines express concern with academic integrity in assess-
ment. However, online nursing does exhibit its own unique set of
challenges, such as providing nursing students with online learning
experiences that relate to real-world nursing situations, which
comprise both high-stake medical and interpersonal elements. Online
discussions, case studies, and research papers potentially provide such
authentic learning experiences and the means of assessing them. In
terms of solutions, online nursing education is consistent with other
soft-applied disciplines taught online (Smith et al., 2008) in that online
nursing instructors and instructional designers customize their
courses by using community-oriented pedagogy.
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