Evaluating a Web-Enhanced bachelor of Nursing curriculum: Perspectives of third-Year students

Debra K. creedy, PhD; Marion Mitchell, PhD; Philippa seaton-sykes, PhD; Marie cooke, PhD; Elizabeth Patterson, PhD; christine Purcell, PhD; and Patricia Weeks, PhD

Little is known about nursing students information literacy skills and perceptions of Web-enhanced educational approaches. This study examined graduating Bachelor of Nursing (BN) students perceptions of a Web-enhanced learning environment, their computer literacy skills, and use of technology, and how these influenced their satisfaction. This Australian survey produced a 64% (n = 170) response rate. The 3-year BN program provides Web-enhanced learning opportunities by incorporating online activities and content such as quizzes, videos, and virtual laboratories that augment on-campus and off-campus learning approaches. Upon graduation, 61.4% of the students reported having competent information literacy skills. The quality and usefulness of the Web-enhanced material was rated fair to above average. The students perception of technical and faculty support for Web-enhanced learning was low. Overall satisfaction with the Web-enhanced program was associated with level of information technology (IT)

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skills and perceived quality and usefulness of the Internet material. A regression analysis of factors contributing to students overall satisfaction of a Web-enhanced learning environment (IT literacy skills, access, and perceived quality, usefulness, and support) accounted for 18.5% of variance. As more nursing programs use Web-based resources, greater attention should be given to the initial assessment and development of students information literacy skills. Students with good IT skills are more likely to perceive Web-enhanced material as useful.

Received: December 8, 2004 Accepted: January 20, 2006 Professor Creedy is Dean, Dr. Mitchell is Deputy Head of School (Logan), Dr. Seaton-Sykes is Web Learning Coordinator, Dr. Cooke is Deputy Head of School, Associate Professor Patterson is Head of School, Dr. Purcell is Senior Lecturer, Research Centre for Clinical and Community Practice Innovation, School of Nursing & Midwifery, and Dr. Weeks is Educational Designer, Griffith Flexible Learning Assistance Service, Griffith Health, Griffith University, Queensland, Australia. This study was supported by the Griffith University DVC Strategic Teaching-Learning Fund. Address correspondence to Debra K. Creedy, PhD, Dean, Research Centre for Clinical and Community Practice Innovation, School of Nursing & Midwifery, Griffith Health, Griffith University, PMB 50 Gold Coast Mail Centre, Queensland 9726, Australia; email: D.Creedy@griffith.edu.au.

he use of technology in nursing education is growing exponentially, but available studies report wide variability in student perceptions of Web-based learning, ranging from enthusiasm to very negative attitudes (Ali, Hodson-Carlton, & Ryan, 2002; Kaas et al., 2001; Wills, Stommel, & Simmons, 2001). This variability may be due in part to student characteristics (e.g., age, preferred learning style) and prior experience with information technology (IT) (Andrusyszyn, Cragg, & Humbert, 2001; Halstead & Coudret, 2000; Mastrian & McGonigle, 1997). In addition, Web-based learning environments in nursing programs encompass significant variations in their structure, processes, style, and extent. There is a need to develop an understanding of student experiences when using different modes of educational technology. According to Billings (2000), little is known about the factors that contribute to positive student outcomes with this teaching and learning medium. Few studies evaluate Web-based teaching and learning in nursing. Available studies related to online learning have focused on individual courses and not the program they comprise (Cheek, Gillham, & Mills, 1998; Kaas et al., 2001). This is problematic because study programs are founded on and driven by curricula grounded on particular educational principles (McAllister & Mitchell, 2002). Stand-alone course
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evaluations outside their theoretical context are therefore of limited value. There is a need to investigate the integration of Web-based teaching and learning across a study program. In addition, there is a paucity of research on programs designed and implemented as Web enhanced, rather than Web based. Web-enhanced educational courses seek to create learning communities and support learner-centered approaches for students studying on campus (Billings, 2000). The Web-enhanced Bachelor of Nursing (BN) program that is the focus of this study incorporates a variety of Web learning activities in all of its 22 core courses to provide students with a flexible means to augment, prepare for, and consolidate on-campus and off-campus learning. This school continues to teach students through lectures, tutorials, clinical laboratory sessions, and off-campus clinical placements, but the Internet material provides an adjunct resource. Therefore, we refer to our method of incorporating online learning activities within the BN program as Web enhanced, rather than Web based. The development of IT literacy skills are explicitly identified in the learning objectives of some first-year and third-year courses. There is a competency-based assessment item in one first-year course that is graded pass/fail. This school has three campuses, located 85 kilometers apart. Campuses A and C have a 12-year history of traditional face-to-face teaching, but campus B was established in 1999 and has been oriented toward flexible learning. It was believed that the exiting cohort of students from these three campuses could provide valuable insights into the experience of Web-enhanced learning. We discuss one component of a larger program evaluation that is framed by the concepts identified by Billings (2000). This study presents the results of a survey of students completing the third year and their perceptions of a Web-enhanced BN program. In particular, the survey sought information on students computer literacy skills, use of technology, perceptions of support (e.g., ease of access, overcoming difficulties), and outcomes, as measured by students satisfaction with the Web-enhanced program. The development of the survey was underpinned by a review of the literature and expertise of the research team that shaped the identification of the major areas to be surveyed and the specific items to be measured. EvAluAtiNg stuDENts PErcEPtioNs There is scant evidence in the nursing literature about the most effective tools for evaluating Web-enhanced educational courses or entire programs. The range of available evaluation tools varies considerably. Although some studies used the same standardized evaluation tools used for classroom evaluations, these do not adequately address the online educational experiences (Rosenlund, damaskBembenek, Hugie, & Matsumura, 1999); others devised new tools specifically for evaluating online educational courses. Generally, reliability and validity are not reported. Although some studies evaluated educational courses that had both face-to-face and online components (Brown, Kirkpatrick, & Wrisley, 2003; Ryan, Carlton, & Ali, 1999),
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these aspects are treated as a summation of already known entities, rather than regarding Web-enhanced educational courses as offering a different kind of learning (Seaton-Sykes, 2003). Such differences highlight the need for specific programs of evaluation that address these pedagogical issues. To date, Billings (2000) is the only author to publish a conceptual framework for evaluating technology-based educational approaches, specifically in nursing. evaluation of technology in nursing programs and accreditation standards for online nursing education have not yet been integrated systematically in nursing education (Billings, 1999). Billings framework is structured around five major concepts: outcomes, educational practices, faculty support, student support, and use of technology. Relationships among these aspects are conceptualized thus: The use of technology affects educational practices, which are influenced by faculty and student support and affect outcomes. A limitation of this model relates to the linear and unidirectional relationships depicted between concepts (Thurmond, 2002). It is more likely that the influence of each aspect may be multidirectional. evaluation programs therefore need to consider both the concepts outlined by Billings and the interrelationships among these variables. Incorporating Billings framework with other previous evaluation studies identified four main areas: computer literacy, Internet access, approaches to learning (Ali et al., 2002; Andrusyszyn, Iwasiw, & Goldenberg, 1999; Cartwright & Menkens, 2002; Kozlowski, 2002; Mastrian & McGonigle, 1997; Roberts et al., 1998), and faculty support (Rose, Frisby, Hamlin, & Jones, 2000; Udod & Care, 2002). computer literacy Researchers consistently report a lack of computer and Internet literacy among nursing students (Ali et al., 2002; Cartwright & Menkens, 2002; Todd, 1998). Oliffe (2001, 2002), in an evaluation of an Australian undergraduate course that used a Web-based patient simulation scenario, noted that not all nursing students were computer literate when they entered their programs. Similarly, Ribbons and Vance (2001) found that 67% of undergraduate students had never used e-mail prior to enrollment in a program. These findings may reflect the student profile in BN programs in Australia, where many students enter BN programs several years after graduating from secondary school. Students who enter the program immediately after secondary school have often been exposed to computer technology, but this may not be the case for some older students who have worked in health care as licensed practical nurses or nurse aides and frequently do not have computer access or exposure to computer-based instruction. Consequently, these students need time and support to gain confidence with this new learning technology (Kozlowski, 2002). It has been noted that students who are initially resistant become more enthusiastic as they gain skills and confidence in computer and Internet technologies (Andrusyszyn, Iwasiw, et al., 1999; Kozlowski, 2002; Kenny, 2002; Mastrian & McGonigle, 1997). In addition, gender inequity still exists in relation to computers and Internet use (Washer, 2001). The reticence of female
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students toward computer and Internet use continues to be of concern for faculty. despite an increase in the number of male nurses in Australia from 7.6% in 1997 to 8.6% in 2003, women constitute the largest group in nursing (Australian Institute of Health and Welfare, 2004). internet Access Technical problems with computer hardware, software, and Internet connections are a source of difficulty for students. The inability to connect or an interruption of services causes considerable frustration and dissatisfaction for students (Ali et al., 2002; Cartwright & Menkens, 2002; Halstead & Coudret, 2000; Harden, 2003; Todd, 1998). The espoused increased flexibility offered with Web-enhanced courses is nonexistent when connections fail. Understandably, technical difficulties may result in negative student learning experiences. Approaches to learning Findings related to the effects of Web-based learning environments on communication and interaction between faculty and students, as well as among students, are contradictory. Participants in several studies found online communication to be positive and to enhance learning (Ali et al., 2002; Cunningham & Plotkin, 2000), whereas others found it difficult or felt isolated (Atack & Rankin, 2002; Halstead & Coudret, 2000). Some students (often those characterized by faculty as quiet in class) contributed more readily in an online environment (Kaas et al., 2001; Kozlowski, 2002; Martyr, 1998; Siktberg & dillard, 1999). Both teachers and students have described student communications in some online discussions as in depth and critical, with an evident increased level of feedback between students (Andrusyszyn, Iwasiw, et al., 1999; Halstead & Coudret, 2000; Kaas et al., 2001; Oliver & Naidu, 1997). Conversely, other students described contributions as repetitive and shallow (Martyr, 1998). Therefore, demands are placed on faculty to manage student learning and engage with students through notice boards, chatroom discussions, and e-mail. Faculty support Students have identified a lack of support and training related to computer and Internet use (Roberts et al., 1998). The demands of teaching a high level of content in a course may leave little time to teach computer and Internet skills (Leasure, davis, & Thievon, 2000). Understanding content is often hindered until students become sufficiently competent to manage the technical demands of course delivery (Mastrian & McGonigle, 1997). It could be argued that demands for online learning support are greater than the support needed in a classroom situation, as computer technologies promote flexible online study options and students can access material 24 hours per day. University-based support systems, by way of technical software and procedural assistance, need to be readily available for timely support. There is a need for comprehensive and ongoing evaluation of Web-based learning environments in nursing education. Although the problems of unreliable connections, difficult ac462

cess, technology failure, and students lack of knowledge on how to use the technology have been consistently reported, many evaluations show generally positive perceptions of and satisfaction with learning. However, the more complex questions about learning across a program of study and outcomes for both students and the discipline are not well understood. To determine the specific effects of learning online from a students perspective, formal investigation is required. This study aimed to promote quality teaching and inform learning processes within various constructions of Web-based learning environments. The study also aimed to examine graduating BN students perceptions of a Web-enhanced learning environment, their computer literacy skills, and use of technology, and how these influenced their satisfaction. MEthoD Participants Surveys were distributed during teaching sessions at each of the universitys three campuses to all students (N = 266) completing the third year of a BN program. This enabled comparisons between one campus (B) that was specifically oriented at the institutional level to flexible learning and campuses (A and C) that are developing a flexible learning approach. Measures The survey tool reflected components of Billings (2000) framework and was derived from focus group discussions with students and staff, a review of the literature, and expert review by members of the research team. The tool comprised 65 items and addressed 7 areas. Students provided information regarding their age, gender, status on enrollment into the program (immediately after graduation from secondary school versus later), personal computer and Internet access at home, and IT competence at enrollment. Information Literacy Skills. Students rated their information literacy at the completion of their BN program on a 5-point Likert scale (1 = incompetent to 5 = very skilled). Scores can range from 8 to 40, with a high score indicating that the students perceived themselves to have a high level of information literacy skills. example items for this subscale were Using search engines to find new information, Participating in chat rooms and discussion forums, and Using electronic databases. Students ranked the importance of these skills for the success of their studies. The internal reliability coefficient for this subscale was 0.86. Development of IT Literacy Skills. Students indicated how useful certain resources were for developing their information literacy skills (e.g., Library tour and search tutorial, Family and friends). Students responded on a 5-point Likert scale (1 = did not use to 5 = extremely useful). Scores can range from 9 to 45, with higher scores indicating that most of the resources were useful to the development of the students information literacy skills. The internal reliability for this subscale was 0.78. Frequency of Access to Internet Course Material. Students indicated how frequently they accessed course mateJournal of Nursing Education

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rial, such as Notice board, TablE 1 Course lecture notes, and Communication tools, on Sample Characteristics, by Campus (N = 170) the Internet. Students reCharacteristic Campus a Campus b Campus C Total sponded on a 5-point Likert Age scale (1 = never accessed to 5 = accessed most days of Mean 27.23 29.43 29.33 28.68 the week). Scores can range Range (SD) 19 to 49 (8.8) 20 to 49 (9.3) 19 to 50 (8.8) 19 to 50 (8.9) from 11 to 55, with high Gender scores suggesting frequent access to most of the course Female 51 (98.1%) 52 (83.9%) 48 (85.7%) 150 (88.2%) material on the Internet. Male 1 (1.9%) 10 (16.1%) 8 (14.3%) 19 (11.2%) The internal reliability coEnrollment immediately after secondary school graduation efficient for this subscale Yes 24 (46.2%) 23 (37.1%) 17 (30.4%) 64 (37.6%) was 0.90. Perceived Quality of InNo 27 (51.9%) 39 (62.9%) 39 (69.6%) 105 (61.8%) ternet Material. For this Computer access at home component, students inYes 48 (92.3%) 58 (93.5%) 54 (96.4%) 160 (94.1%) dicated the quality of the Internet material for speNo 4 (7.7%) 4 (6.5%) 2 (3.6%) 10 (5.9%) cific third-year courses, Internet access at home such as The Internet maYes 30 (57.7%) 30 (48.4%) 23 (41.1%) 83 (48.8%) terials for Leadership and No 21 (40.4%) 30 (48.4%) 30 (53.6%) 81 (47.6%) Management were of high quality. Responses were Perceived information technology skill level at enrollment based on a 5-point Likert None 5 (9.6%) 11 (17.7%) 7 (12.5%) 23 (13.5%) scale (1 = poor quality and Limited 9 (17.3%) 7 (11.3%) 13 (23.2%) 29 (17%) 5 = extremely good quality). Scores can range from Basic 15 (28.8%) 17 (27.4%) 12 (21.4%) 44 (25.8%) 5 to 25, with high scores Competent 22 (42.3%) 18 (29%) 21 (37.5%) 61 (35.9%) suggesting that most of Advanced 6 (9.7%) 3 (5.4%) 9 (5.2%) the course material on the Internet was of high quality. The internal reliability Note. Sample size varies due to missing scores for the characteristics. coefficient for this subscale was 0.66. Perceived Usefulness of Internet Material for Learning. Students rated the useresponded on a 5-point Likert scale (1 = strongly disagree fulness of the Internet material for their learning in the to 5 = strongly agree). Scores ranged from 5 to 35, with high courses. Responses were made on a 5-point Likert scale (1 = scores suggesting satisfaction with the Web-enhanced learnstrongly disagree to 5 = strongly agree). Scores can range ing environment in the BN program. The internal reliability from 5 to 25, with high scores indicating that the Internet coefficient for this subscale was 0.93. material was useful to students learning. The internal reliability coefficient for this subscale was 0.64. Procedure Perception of Support. This aspect measured students The survey was distributed to all third-year students perception of technical and faculty support for Web-en(N = 266) at the end of the second semester on completion hanced learning, with items such as I access Internet maof a class for a core course in the BN program at each of terials from my home computer, as well as the quality of IT the three campuses. Completion of the survey took approxiand faculty support, with items such as If I have difficulmately 15 minutes. Participation was voluntary, no identities, I contact the course convenor. Students responded on fying information was required, and confidentiality was asa 5-point Likert scale (1 = never to 5 = regularly). Scores can sured. Nonresponders could not be identified and there was range from 14 to 70, with high scores suggesting percepno follow up. Approval to conduct the study was obtained tions of being supported. The internal reliability coefficient from the universitys Human Research ethics Committee. for this subscale was 0.72. Satisfaction. Students rated their satisfaction with the rEsults Internet material. Items included I recommend that all courses develop Internet materials and Internet materials A response rate of 64% was achieved. Of the total of 170 provide greater flexibility for me when studying. Students university students from all three campuses (A, B, and C)
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TablE 2 Survey Results Reflecting Third-Year Students Perceptions of the Web-Enhanced Program
95% Confidence Interval Survey Component Information literacy skill rating (range = 8 to 40) Campus A Campus B Campus C Total Development of information literacy skills (range = 9 to 45) Campus A Campus B Campus C Total Frequency of access to Internet material (range = 11 to 55) Campus A Campus B Campus C Total Quality of Internet material (range = 5 to 25) Campus A Campus B Campus C Total Usefulness of Internet material (range = 5 to 25) Campus A Campus B Campus C Total Perception of support (range = 14 to 70) Campus A Campus B Campus C Total Satisfaction (range = 5 to 35) Campus A Campus B Campus C Total 51 59 54 164 27.14 29.23 29.34 28.63 5.12 6.06 5.41 5.63 25.70 27.68 27.89 27.77 28.58 30.78 30.79 29.49 51 59 54 164 47.37 49.05 46.39 47.65 6.66 8.70 8.48 8.07 45.50 46.78 44.08 46.41 49.25 51.32 48.70 48.90 51 59 54 164 17.73 17.37 18.46 17.84 3.03 3.22 2.84 3.05 16.87 16.53 17.69 17.37 18.58 18.21 19.24 18.31 51 59 54 164 16.22 16.90 17.61 16.92 3.53 3.25 2.92 3.27 15.22 16.05 16.81 16.42 17.21 17.74 18.41 17.42 49 59 50 158 29.78 34.41 29.96 31.56 6.73 9.21 7.49 8.22 27.84 32.01 27.83 30.27 31.71 36.81 32.09 32.86 51 59 54 164 23.71 25.73 23.59 24.40 5.46 7.79 6.39 6.71 22.17 23.70 21.85 23.36 25.24 27.76 25.34 25.43 46 47 49 142 31.22 33.45 32.41 32.37 4.75 4.08 4.62 4.55 29.81 32.25 31.08 31.61 32.63 34.64 33.74 33.12 Number Mean SD lower Upper

Note. Sample size varies due to missing scores for the survey components.

who participated in the survey, 150 (88.2%) were female, 19 (11.2%) were male, and 1 (0.6%) did not specify gender.
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Sample characteristics are provided in table 1. Students ages ranged from 19 to 50 (mean age = 28.68, SD = 8.9).
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Of the students, 64 (37.6%) enrolled in the university immediately after completing secondary school, 105 (61.8%) enrolled later, and 1 (0.6%) did not respond. One hundred sixty (94.1%) students reported having a personal computer at home, and 10 students (5.9%) reported they did not. Access to the Internet at home was reported by 83 (48.8%) of the students, with 81 (47.6%) not having access and 7 (3.5%) not responding. One third of the students (n = 65, 38.2%) perceived themselves to be competent IT users on entering the nursing degree, 44 (25.8%) reported a basic understanding, 29 (17%) had limited experience, and 23 (13.5%) had no experience. Several students (n = 9, 5.2%) reported having advanced IT skills. On completion of the BN, 89 students (61.4%) reported having competent information literacy skills, but 56 (38.6%) reported limited skills. Two thirds of the students (n = 83, 68.6%) perceived that competent IT skills were important or essential to their studies (mean = 33.21, SD = 3.55). One-way analyses of variance (ANOVAs) were conducted to examine differences across the three campuses on scales concerning the Web-enhanced resources. Six students were not included in the analysis due to violation of the assumption of normality. The homogeneity of variance assumption was violated (p < 0.05) for two scales (development of IT skills, 9 items; perceptions of support, 14 items). The ANOVA results were considered robust because group size was approximately equal and the largest variance was not more than 4 times the size of the smallest variance. There were no significant differences across the three campuses regarding students age, enrollment status, computer access, Internet access, and IT experience. There was a slight difference in gender, with a higher proportion of female students at campus A than at campuses B and C. On average, students accessed the Internet material weekly. There was a significant difference across the three campuses on frequency of access to Internet material (F[2,155] = 6.00, p = 0.003). A Bonferroni adjustment was made to the alpha level to account for the number of comparisons made. Thus, the alpha level was 0.006. Post hoc analysis demonstrated that students at campus B accessed Internet material more frequently (mean = 34.41, SD = 9.21) than did students at campus A (mean = 29.78, SD = 6.73) or campus C (mean = 29.96, SD = 7.49) (table 2). Students from the three campuses rated the quality and usefulness of the Internet-enhanced material for the third-year courses as fair to above average. There was a significant difference across the three campuses on ratings of usefulness of the Internet material for the BN program courses (F[2,160] = 5.50, p = 0.005). A Bonferroni adjustment was made to the alpha level to account for the number of comparisons made; thus, the alpha level was 0.006. Post hoc analysis demonstrated that students at campus A (mean = 17.73, SD = 3.03) and campus B (mean = 17.37, SD = 3.22) viewed Internet material as somewhat less useful than did students at campus C (mean = 18.46, SD = 2.84) (table 2). Students perception of support for Web-enhanced learning identified deficits (mean = 47.65 of a possible 70, SD =
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8.07). Across the three campuses, students reported that learning resources and support were somewhat useful to the development of their information literacy skills. Overall satisfaction with Web-enhanced learning was good (mean = 28.63 of a possible 35, SD = 5.63). There were no statistically significant differences between campuses on these subscales. The six components of the Web-enhanced learning environment being evaluated in this study were statistically correlated with overall satisfaction. In particular, there was a consistent association between development of IT skills (r = 0.266, p < 0.01), perceived quality of material (r = 0.401, p < 0. 01), and perceived usefulness of material (r = 0.334, p < 0.01), with overall satisfaction. A regression analysis of factors contributing to the students overall satisfaction of a Web-enhanced learning environment was significant (F[6,110] = 4.16, R2 = 0.185, p < 0.001) but accounted for only 18.5% of the variance. DiscussioN The findings of this study provide useful benchmarking data and identify areas for consideration and improvement when using technology in nursing education. There are few published Australian studies on student perceptions of Web-enhanced learning environments. Approximately 60% of the students in this study reported no or minimal IT literacy on enrollment in the program. This finding is consistent with earlier studies (Kozlowski, 2002; Oliffe, 2001, 2002; Ribbons & Vance, 2001) that found a significant number of nursing students lacked experience with IT literacy. On completion of the BN program, 61.4% of respondents reported IT literacy competence. Results identify that more needs to be done to increase the proportion of students who are IT competent and ensure that such skills are obtained early in a program of study. This study identified a relationship between IT skills and satisfaction. Providing opportunities and support for students to continually gain IT literacy skills during both their education and clinical lives is paramount to the development of the profession. Student access to the Internet needs to be considered as part of program development (Ali et al., 2002; Harden, 2003). Although the majority (94.1%) of students in this study reported having a computer at home, approximately half did not have Internet access. Relevant social determinants of this student cohort underpinning Internet access may have included low socioeconomic status and poor availability of Internet facilities in their geographic location. The reported lack of access certainly hampered students learning opportunities off campus. Students Internet access must be considered by faculty when planning approaches to learning. Online approaches to learning offer students a high degree of flexibility (Kozlowski, 2002; McAlpine, Lockerbie, Ramsay, & Beaman, 2002). Internet learning requires students to be self-directed and active learners, but students readiness for this varies (Cartwright & Menkens, 2002). This study identified differences across campuses in terms
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of students frequency of access to Internet material. This may be a reflection of the learning environment on campus B, which emphasizes flexible learning opportunities. Students at campus B perceived the quality and usefulness of Internet-supported learning material higher than did students from other campuses. Therefore, the learning culture can positively influence students enthusiasm for technology in nursing education. Students perception of support for Web-enhanced learning was low and an area for improvement. Adopting an IT approach to learning increases students need for adequate levels of IT literacy skills and faculty support. In line with the findings of previous studies (e.g., Roberts et al., 1998), students participating in this study identified a lack of faculty support and tuition (i.e., formal classroom instruction) in regard to using computers and the Internet. As expected, as perceptions of support increased, so did satisfaction. This facet of teaching may become more crucial as student expectations of and sophistication with Web-based learning environments increases and requires faculty to critically examine their current practices to engage and support students more effectively. In response to this finding, we have now produced a Web-enhanced learning guidebook for students to extend support already available through the University Information Services and regularly offer continuing professional development seminars for faculty on designing resources and using the Web in their teaching. The regression model explained that a relatively low proportion of variance and other factors not measured in this study may play a role in students overall satisfaction with a Web-enhanced learning environment. According to Sit, Chung, Chow, and Wong (2004), possible factors affecting student satisfaction include convenience, ability to work through course content at ones own pace, and ease of use. Models exploring personal factors and learning outcomes such as grades may account for more variance. The majority of students from the three campuses rated the usefulness of the Web-enhanced material as fair to above average; although this aspect was associated with satisfaction, further investigation may be required. The students in this study were in their final year of the BN program, and students in other years may find the material more or less useful. Perhaps student expectations of Web-enhanced learning environments or synergies between on-campus and Web-based learning need to be investigated across the full BN program. liMitAtioNs There are limitations associated with an anonymous survey. Although a 64% response rate is reasonable, a much higher response rate was anticipated. The anonymous nature of the survey did not permit follow up of nonresponders or a comparison of responders and nonresponders. As such, there is a possibility of response bias. It is possible that students most interested in education and the use of IT responded to the survey and differed from nonrespondents.
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In addition, the survey required only self-report, and no independent measure of skills was obtained. It is also reasonable to assume a level of subjectivity when students report on the quality of Internet material. Although the survey provided opportunities for respondents to provide further comment, few actually did so. It could be that students had concerns but did not note them, perhaps perceiving their concerns as less important than the items listed. Future research could consider this response bias and conduct large multisite surveys or interviews in addition to a survey to elicit a broader range of information. The inclusion of qualitative data may elicit more meaningful data to complement outcomes obtained in this study. rEcoMMENDAtioNs For FuturE rEsEArch Many student evaluations show generally positive perceptions of and satisfaction with online learning, but the more complex questions about learning for students and the discipline are not well understood. This study provides useful baseline data for future comparisons and extended exploration. Benchmarking with other institutions will enhance the likelihood of meaningful data sets that can inform the development of Web-based learning. Such investigations are important, given the increasing use of technology in education and practice. IT literacy skills are used widely in the health care industry, and students are increasingly exposed to various kinds of IT during clinical placement. Therefore, BN programs must adequately prepare students to be IT literate and competent. This preparation is best learned in the context of nursing practice and applied to areas such as documentation, evidence-based practice, and continuing education. Studies that focus on teaching practices are needed to develop Internet pedagogies applicable to nursing education. Such pedagogies are likely to be strongly student centered and foster outcomes that are enabled by technology. Further research is needed on the nature of Web-enhanced courses and specific student learning outcomes, uses of technology, and educational practices that foster learning. Although this study investigated educational practices in part, further work is required to identify the learning activities or material students find either particularly valuable or unhelpful. Academic peer review of Web-based teaching and learning material would provide an additional dimension to the critique of Web activities. coNclusioN Students perceptions of a Web-enhanced learning environment were generally good, but these perceptions were influenced in part by their computer literacy skills and use of technology. Students studying in an environment designed for Web-based technology (campus B) were more likely to access Web-based learning resources more often and to perceive these as more useful than were students on other campuses. Greater attention needs to be given to the assessment and development of students information
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literacy skills, as well as technical and faculty support for Web-enhanced learning. As more nursing programs use Web-based resources, endeavors to further enhance student learning, the quality of Web-based learning resources, and the ability of faculty to use Web technologies effectively must be carefully evaluated. rEFErENcEs
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