Online Teaching And Learning In A Graduate Course ( n Nursing Education

Information technology has a potential to be the answer to one of Africa’s most pressing problemsproviding education to a number of geographically dispersed learners, who currently have to leave their countries for a number of years in order to pursue their studies elsewhere. The School of Nursing at the University of Natal launched an online graduate course in nursing education at the beginning of the year 2000 for the first time as part of a masters degree programme.


Introduction
No where else in the world is the idea of distance education more ideal as in Af rica.Poor postal services have greatly affected both the efficiency and effective ness of traditional distance education programmes in this continent.Informa tion technology has a potential to be the answer to one of Africa's most pressing p ro ble m s-p ro v id in g e du catio n to a num ber of g eo grap hica lly dispersed learners, who have had to leave their countries in order to pursue their stud ies elsewhere.It is not really known, how many of those who leave their countries to study elsewhere, ultimately return to their countries of origin on completion of those studies.It can be argued, how ever, that quite a few do not, with result ant loss in human capital in a number of countries across the continent.Furthermore, the cost of higher educa tion for the returning adult African stu dent is high.Most have the added re sponsibility of paying for their children's education.Leaving their jobs in pursuit of further and higher education is often not seen as a viable option.Computer m ediated com m unication (CMC) pro vides a viable alternative for this group of so-called 'non-traditional' learners.Westwell (1999: 1) highlights that "CMC has a potential to overcome what have been 'historically two of the major tech nical barriers to human communication,

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Curationis September 2000 that is, time and space" .Whether or not Africa exploits this unique environment for teaching and learning will depend on (a) accessibility, financially and techno logically, (b) attitudes of teachers toward change and (c) willingness on the part of the teachers to share control and re sponsibility for teaching and learning with the learners.For most educational institutions, however, adopting CMC is no longer a matter of willingness on the part of the teacher, but a reality which can no longer be ignored.Declining stu dent enrollment in higher education in stitutions makes distance education an imperative rather than a choice.

The context
In 1996 a masters degree programme in progressive education for health pro fessionals was implemented at the Uni versity of Natal's (UND) School of Nurs ing.The aim of the program is to pre pare specialist educators in health pro fessions, who would be able to design, implement and evaluate community and problem-based learning programmes.This programme was initiated with finan cial assistance, including student bursa ries, from the Kellogg Foundation.Abil ity to study full-time was a requirement.During the first two years of implemen tation, we had no problem recruiting and selecting students.When foreign fund ing dried up, the numbers of admissions dropped.However, the programme was still in demand.Applicants requested that we examine the possibility of parttime study.The idea of offering the pro gram m e o nline was born.R ebholz, (1995) in reference to a continuing edu cation programme in engineering, raises an important point in observing that not all courses are amenable to computer conferencing.The course progressive education for health professionals was seen as appropriate for CMC.Critical discussion of literature related to the content area is the major focus of whole programme.Besides, the face-to-face (f2f) classes in the program m e had placed emphasis on cooperative learn ing as well self-directed learning from the programme's inception.
None of the teaching staff in the School of Nursing, however, were familiar with online teaching and learning.As the pro gramme coordinator and facilitator I en rolled with the University of London's Institute of Education on a course in online education and training (OET99/ 00).Being an OET student provided me with first hand experience as an online learner, while at the same time vicari ously learning about teaching online.Experiences gained as a learner were invaluable in helping me anticipate and 'understand' some of the problems en countered during implementation of the online course at UND.The candidate pool for the course Pro gressive Education for Health Profes sionals II are educators in the health pro fessions who have a teaching qualifica tion.In addition, the students must have taken and passed courses in founda tions of educational philosophy, curricu lum developm ent and foundations of educational psychology.The course in volves an in-depth study of global trends in the education of health professionals.Furthermore, contemporary approaches to curriculum are dealt with, specifically those approaches that place emphasis on experiential education, including: co m m u n ity-b a se d e du catio n (CBE), problem -based learning (PBL), casebased learning (CBL) and service learn ing.The course ends with a brief over view of student assessment and evalua tion in professional education.

Intended (earning outcomes
On completion of this course the learn ers should be able to:

Teaching and (earning experiences
This course is offered online through WebCT.
• Except for teaching practice, online conferencing is the only delivery mode.
• Group discussions, Case-Studies and various form s of com puter m ediated communication for independent learning are used.(Example: Learning Logs and/ and a R eflective T eaching P ractice record).Hiltz (1995) and Turoff (1995) warn de signers of CMC courses about the vol ume of messages coming through the conference areas each day and/or week.According to Hiltz with classes of about 20 to 30 students, one should expect at least about 100 messages a week.This might lead to information overload for both the students and the moderator.To which she (Hiltz, 1995: 5) recommends that the "instructor must establish regu lar rhythms and schedules, based on dividing the course into modules which last a w e e k,... or half, or two weeks each so that participants can plan ahead in term s of when they will need to sign online, when work will be due, and so that the groups move through the top ics in an orderly manner" .Similar views were echoed by Pincas (1999).Hence, it was decided to breakdown the themes of the course into weekly or two weekly sessions depending on the depth and breadth of the topic for discussion.Astin (1993: 233) asserts that "A critically important task in any assessment project is to define the relevant outcomes and to choose the m ethods for assessing th e m " .He further argues that values underpin assessment practices, not only in terms of what we decide to assess, but also in how we decide to assess it.According to him, talent development is the core of educational practice and that assessm ent should aim at providing feedback for both the learner and the teacher.Contextual issues however, de mand that both formative assessment, whose main aim is to promote learning and development, and summative as sessment, aimed mainly at making de cisions regarding failure and/or success are essential components of the higher education assessment system.Hence, for the present course both formative and summative assessment were used.Formative assessment consisted of in dividual and group feedback posted in the bulletin board weekly or during the course of a week's activities.Summative evaluation on the other hand consisted of two assignments and an end of the semester open-book conventional ex amination.

Assessment and evaluation
The choice of an open-book conven tional examination rather than an elec tronic examination was based on the paucity of "guidelines" and or discourse on the use of open-ended questions, especially those requiring argum enta tion in CMC.Most of the available exem plars found used multiple choice ques tions.Lamenting on the US higher edu cation institutions' overreliance on mul tip le c h o ic e e x a m in a tio n s , A stin (1993:55) contended that perhaps, the ease with which such examinations can be administered and scored, together with the ease with which they yield quan titative scores, might be a contributing factor to their popularity.He notes, how ever, that the multiple choice test " is an inappropriate technology for assessing many types of creative outcomes that are highly valued not only by the academic comm unity but also in later life" .Like wise, the type of content dealt with in this course, as well as the expected learn ing outcomes do not lend themselves very well to m ultiple choice examina tions.

Course structure
Literature attests to the importance of structure in curriculum design.Various softw are p ro gram m es such as First Class, Merlin, WebCT etc, offer different facilities for organisational structure in CMC .My experience with online learn ing as an OET99/00 student indicated that I would need various facilities or " learning spaces" in order to ensure a manageable course structure for both myself and the students.However, my institution did not have First Class-the only conferencing system with which I was familiar.The available system at the University of Natal is WebCT, hence most of the facilities which I believed I needed 21 Curationis September 2000 in order to create a workable structure for the course were just not available.With the help of an experienced compu ter-based instructional design expert from the University's Information Tech nology Department, we planned to use a (a) main bulletin board, (b) private mail facility, (c) chat facility, (d) course con tent area, (e) calendar (f) student records area and (g) whiteboard.

The main bulletin board
The main bulletin board is used as a main discussion forum .It is the only space in which group work is carried out.Overtime it became clear that this was not enough.Hiltz (1995:2) maintains that "minimally acceptable technology foun dation is a conferencing system that al lows the instructor to set up different conferences for different purposes..." .The other side to provision of separate conference areas for different purposes is that just how much is not too much.One of the students in the OET course (99/00) identified navigability as one of the essential features for a conferencing system.In CMC context, navigability is dependent both on the num ber and uses of conference areas.It is clear that too many conference areas might be too confusing to students as was the case with the above student who stated that "it (navigation in First Class) is not diffi cult, however, the constant disappear ing into different layers w ithout being sure where you'll come out is annoying" .An observation with which I concur.
The latter problem, however, was not an issue with the designing of the present course.The major problem encountered was the lack of a facility to set up differ ent " learning spaces" for different pur poses.Hence, the main bulletin became clogged with masses of information too soon.Needless to say that the modera to r's inexperience with WebCT was a problem.Perhaps it is possible to retrieve only the section of dialogue you want to work with in WebCT, but so far it has only been possible to retrieve either unread or new messages, or all the messages from the beginning of the course.This is extremely frustrating.The main bulletin is currently functioning as a the notice board, the discussion area, as a well as a "social" gathering area.

Private mail
The availability of a private mail facility in CMC c a n n o t be ta ken fo r g ra n te d .Anderson (1996a: 12) based on study examining student and faculty percep tions about the importance of various features of an online course offered at Massey University College of Education came to the conclusion that " Email lists have proven to be a valuable pedagogi cal tool and appear to have been critical in helping students collaborate in learn ing and to establish support m echa nisms..." .Private mail became invaluable during the course of the semester.It was used mainly for contacting individual stu dents, either to respond to individual questions, provide feedback, as well as to encourage participation for those stu dents who tend to disappear from the "screen" from tim e to time.Also, stu dents use this facility to communicate with each other and the course modera tor.
An adjunct use for the private mail facil ity arose out of a need to establish small groups.The idea was really to encour age "communities of learners" where the sm all groups of four students w ould work together on various course projects w ithout the other group being able to access other groups' work-in-progress.At the end of the allotted time for com pletion of small group tasks, groups were expected to post their contributions in the main bulletin board.

Chat facility
The initial plan was to use the synchro nous communication facility mainly for meetings rather than learning.The idea was that once a month we would sched ule a "virtual" meeting.The items for dis cussion at this meeting would be de cided by both the moderator and the stu dents.That is, once a date for a meeting was scheduled each student was al lowed to post an item for inclusion in the agenda on the main bulletin board.Selection of items for discussion at the m e e tin g w as s o le ly based on the number of students interested in them.Items of individual student interest were dealt with through the private mail facil ity.

The whiteboard
This is an area where every course par ticipa nt could scribble social, educa tional and adm inistrative issues.The plan was to use the whiteboard both for m ally and inform ally.For instance, I thought that this area would be perfect for notices regarding scheduled chat sessions, w ishing som eone a happy birthday, reminders about assignment due dates and so on.As will be revealed later in this paper, this was the part of the course which was a total 'fiasco', and continues to be.

Experiences with online teaching and learning
Although this section focuses mainly on 22 Curationis September 2000 difficulties encountered with CMC, there were some positive experiences as well.Specifically, the ability to think through what a student says and be able to offer well thought feedback rather than reac tionary feedback as is likely to occur in f2f situations.Similarly, the permanency of both the moderator's contributions as well as the students' contributions make it possible for the moderator to retrieve the discussion transcripts and evaluate these both in terms of quality and quan tity in order that improvements based on learning from this course can be made in designing and delivering the same or other courses online.There seems to be no paucity of literature on the positive aspects of CMC.Consequently, a deci sion was made to highlight those areas w hich w ere m ore p ro b le m a tic than pleasant as well as how they were dealt with.

Design and structure
The essentiality/importance of structure becam e a p p a re n t very e arly in the course.More than 10 years ago, stud ies on effective schools in the US re vealed that more often than not, it is not the substantive aspects of the curricu lum , but its org an isatio na l structure which makes a difference in terms of ef fective teaching and learning.This ap plies even more so to online courses.In online teaching/learning such a view is supported by Hiltz (1995) She identifies richness of media, tim ely responsive ness, organisation and interaction as the four basic principles for CMC.Sadly, however structural design in education, especially computer mediated teaching and learning, is usually compromised by administrative and infra-structural issues.University courses do not run forever, there is a limit to how long a semester or a term lasts.The quality of software avail able depends both on financial co n straints as well as what the University's IT department staff are familiar with.
As mentioned earlier WebCT had only one conference area for all asynchro nous discussions including posting no tices.This conference area became over loaded very fast.The students just sim ple did not use the whiteboard, which was initially targeted for notices.Mes sages poste d in the w h ite b o a rd re mained unread until the system auto matically erased them.A plan had to be made.Private mail was then used to di vide the students into groups of four each.They were then required to work in these small groups before posting their contributions as a group in the main bulletin.The moderator was a non-participant member of each group.This im proved the problem of the volum e of messages in the main bulletin as well as focusing the discussion on scheduled themes and/or topics.
Most literature on CMC supports the need to include a week or two in the beginning for introducing students to this mode of delivery.In the case of Smith (1999) among other things, orientation activities included information on both the concept of CMC, and the teaching/ learning process chosen for the course on leadership development at The Open Polytechnic of New Zealand.The OET99/ 00 course placed emphasis on familiar ising students with First Class as well as course structure.However, issues such as norms for participation, teacher and learner expectations regarding both the quantity and the quality of participation were not really discussed during the ori entation period.Hence, as the course progressed, problem s related to non participation, over-participation, as well as what exactly is meant by participation were raised.
For the present course students were invited early in the programme to discuss participation norms, netiquette, as well as familiarise themselves with WebCT.To my disappointm ent, however, the stu dents just simple did not respond to this invitation.Hence the course progressed without ever coming to a decision about what is "acceptable" behaviour for the class participants, what would be con sidered rude and what would not be, what would really count, the quantity or the quality of participation.A mistake for which both the moderator and the stu dents paid dearly in the end.For in stance, two months into running of the course, some of the students voiced concern that the weekly individual and group activities were not graded.Yet, some felt that grading "class" discus sions would lead to increased levels of anxiety, in an environment that they were not very familiar with.Needless to say, these concerns could not be accommo dated this late in the semester.Another course is planned for online delivery in the se co n d sem ester.For the new course both quality and quantity of par ticipation will be taken into consideration in making examination entry decisions.Paulsen (1995) identifies a number peda gogical strategies amenable to online teaching and learning.He/she d istin guishes between (a) one to many, (b) one to one and (c) many to many strate gies.The one to many strategies are no more than the trad ition al te ach er-di rected classroom activities found in the face-to-face (f2f) teaching/learning envi ronment, whereas one to one strategies refer to such teaching/learning proc esses as research supervision and con tract learning.The many to many peda gogical strategies on the other hand, in clude a number of active learning and student-centered strategies associated with cooperative learning, communities of learning and so on.

The teaching and learning process
For the graduate course in nursing edu cation we chose the many to many and the one to one strategies.We believed that both approaches were congruent with intended learning o utcom es.A number of lessons have been learned from this experience.These were related to (a) participation and/or interaction, (b) quality of students' contributions, and (c) lack of closure and isolation.A brief dis cussion of each of these problems fol lows.

Participation and/or Interaction
Some students took too long to get into the rhythm of the discussion.This re quire d fre q u e n t p ro m p tin g from the moderator in the form of individual mes sages reminding them of the need to be fu lly engaged in the class activities.When the students finally participated, it became clear that in fact they were not talking to each other but along each other.This occurred even when they were required to respond to each oth ers contributions.Student A would com ment on student B's message and stu dent B would not say anything either in a g re e m e n t or d is a g re e m e n t.This prompted a long "lecture" on the impor tance of talking to each other, remind ing the students of just how beneficial talking together and to each other had been in the f2f classes.Henri (cited in A nderson (1996b: 2) states that " .. Most authors equate the interactive process with participation: when they report on an experiment in training with CMC, they im ply that to measure participation is to measure in teraction.Thus it is presumed that any and all messages recorded in a telecon ference are in te ra c tiv e ..." .Anderson (1996b: 2) rightly responds that " How ever, this assumption is not always cor rect" .The students in the present class, although participating, were certainly not interacting.According to Anderson a number of factors foster interaction in an online course.These include (a) pro gramme wide factors, (b) online activi ties, (c) staff teaching skills, and (d) stu dent skill and attitude.All of these fac tors were seen to operate in the course discussed in this paper.
Programme wide issues were related to the fact that this was a second year course of a traditionally f2f programme.All of the previous year's courses had been offered f2f with the same group of s tu d e n ts .F u rth e rm o re , o th e r p ro gramme demands such as working on research proposals m ight have p re vented students from paying attention to what their colleagues were saying and just saw participation as a "chore" which they just had to do in order to move on to the next important activities in their student lives, whatever those might have been.
The online activities them selves were designed to encourage student-student interaction.It seems that this was not enough.As Wells (cited in Anderson, 1996b: 2) notes "where student-to-student interaction was encouraged but not required (either in the form of a manda tory number of messages per week or form al group work), strictly voluntary usage was c o n s id e ra b ly low er than course designers had anticipated" .Al though group activities were required in the present course, initially, the modera tor had no way of monitoring the group in the process of learning and working on the group project.Students simple worked out their own strategy to "meet" and work on the assignment.Only the finished "group" project was posted in the main bulletin.The only means of monitoring interaction was through the required responses to each other's mes sages.Structural changes as well as the emphasis on student-to-student discus sion helped improve interaction over time.

Quality of Student Contributions
Initially students' contributions were ex tremely superficial and uncritical.This is contrary to what has been said about the quality of students' contributions in CMC.There seems to be a tacit understand ing in some of the literature on CMC that asynchronous discussion will necessar ily lead to reflective thinking and im proved quality of learning and therefore, s tu d e n t c o n trib u tio n s (H iltz, 1995;Kimball (date unknown: 7).For instance Kimball states that "Because participants have more time to observe what others have said, reflect on the ideas, and com pose their own thoughts, they can ex press themselves more clearly" .This did not automatically happen in the present course.
The quality of students' contributions is to a great extent a function of teaching skills, student skills and attitude towards learning.CMC teaching and learning skills take time to develop.Bennett (cited in Westwell, 1999: 4) contends that " it is hard to exaggerate on the importance of a skilled facilitator" .Online teaching and learning literature is inconclusive as to exactly what the role and functions of the moderator entail.Furthermore, just how much intervention from the modera tor is acceptable without he/she taking over the direction of the discussion is a question.Needless to say that this di lemma is not peculiar to CMC.More that 20 years of f2f educational approaches embracing teaching and learning strat egies that place emphasis on learnerdirected classroom discourse have not resolved issues related to facilitator roles and functions.Problem-based learning (PBL) literature, for instance, is indica tive of this observation (Albanese & M itchell, 1993;Kaufm an & H olm es, 1993).To which it can be concluded that there can be no universal rules regard ing the amount of facilitator intervention that is appropriate in teaching/learning settings.Contextual issues such as the level the facilitator's experience with fa cilitating learning, as well as the nature of substantive knowledge of the disci pline concerned will determine just how much facilitator intervention is appropri ate.The same can be said for online learning.In the present course, the mod erator played a very active role, albeit in the form of posing questions rather than lecturing.Questions aimed at helping students analyze their meaning perspec tives, authors' frames of reference, and therefore apply a more critical outlook tow ard literature helped im prove the level of students' contributions.

Lack of Closure and Feelings of not Being Heard
It became clear early on, that we were never going to offer all the "content" that we were used to offer in the f2f course.In the CMC environment, it took too long to arrive at 'closure' on discussion of any one particular theme.Ordinarily, in a f2f classroom, a particular theme or topic is scheduled for a specific lecture period.More often than not, whether clarity and/ or resolution has been attained, the dis cussion moves on to the next theme, or topic.Perhaps there is an unwritten code of practice in conventional classrooms, which allows participants to let go and move on to new themes and issues for discussion in recognition of the fact that some issues can never be resolved no matter how much discussion or time is spent on them.This was not easy to do in the present CMC course.O ften we ca rried one week's activities to the following week, simply because there was a feeling that the discussion was nowhere near clo sure.At the "end" of each week or two weeks depending on how much time was initially scheduled for learning ac tivities, the moderator compiled a sum mary of the week's discussion, highlight ing areas which were left unresolved, lost or ignored opportunities for responding to critical questions raised by a c o l league, as well as areas which were seen as indicative of misconceptions and or misinterpretations.Because the miscon ceptions were not "corrected" for the stu dents but were simply highlighted, to gether with reasons why they were seen as such, the students raised concerns that they were left without a forum on which to test their new understandings of the issues under discussion.In fact during the initial chat session students reported that they had perpetual feelings of never " com pleting" learning tasks.The same feelings were experienced by the moderator.Furthermore, because the main bulletin became flooded with too many messages it became very dif ficult to keep track of the various points of view.Hence, some students felt that they were not being listened to.Pincas (1999) reported a similar problem with her online courses.
A number of structural changes were made to try and deal with these prob lems.In order to achieve some sense of closure w ithout necessarily spending "too much" time on the same topic two changes were made.Firstly, the chat fa cility instead of the private mail was used as a working space for smaller groups of students.WebCT has five chat rooms, four of which allow for recording of the conversation.Each small group was al located one of these rooms.The small groups could then work in this relatively 'public' area before posting their work in the main bulletin.Secondly, at the end of each theme or unit a whole class chat session was scheduled.This served as a forum for clarifying issues as well as obtaining some sense of "closure" on in dividual themes.Students responses to this change have been very positive.They have actually stated that they pre fer the synchronous to the asynchronous session.This, however, does not mean that the synchronous sessions did not create their own set of problems.
The problems reported by Pincas (1999) regarding turn taking in conversation were exaggerated in the first chat ses sion.It seemed that each student came " in " with own agenda rather than the agreed upon agenda.Managing such situations required a balance between being too directing or allowing for a com pletely "uncontrollable" situation.Sub sequently, the students realised that if they were to benefit from synchronous discussions it was important to keep to the planned agenda and only venture to "new" topics if and only if time permits.Issues of importance to the whole group could then be scheduled for a subse quent chat session.In addition, a con scious effort is made to make sure that each student is responded to at least every other week.That is, in compiling the summary, the excerpts used as ex amples from the discussion to highlight a point, are chosen deliberately both for content and making students aware that they are being "listened" to.

Conclusion
In conclusion, online teaching and learn ing has been an invaluable experience for me.I am not sure what the future h o ld s in te rm s of g ra du ate stu d e n t enrollment in South Africa.The current economic climate is not very encourag ing.It seems, therefore, that residential higher education for adult students is soon becoming a thing of the past.Les sons learned from this year's course have been very h e lp fu l in pla nn ing changes for the present as well as sub sequent online courses.Essentially, con scious and deliberate inclusion of every student is a must.No student wants to complete a whole semester course with out ever having been referred to 'in name' by the teacher, contrary to popu lar beliefs about m aturity and self-de pendence.F urtherm ore, lack of a d equate facilities should not be an impedi ment to designing and delivering CMC courses.Teachers and students need to learn to make the most of what is avail able to them.This is more true for devel oping countries where lack of 'sophisti cated" conferencing systems is a norm rather than an exception.Lastly, the role of the m oderator in CMC cannot be overly emphasized.Skilled questioning and sensitivity to "interpersonal' relations are essential for effective online teach ing and learning.