Instructional-Design Theories to Support an Online Nursing Leadership Learning Community

by

Brenda J. Stutsky

A research paper submitted in partial fulfillment of the requirements for the course DCTE 870 Project in Courseware Design and Development

Graduate School of Computer and Information Sciences Nova Southeastern University

2006

Table of Contents

List of Tables iii Introduction 1 Statement of the Problem 1 Goal Statement 3 Relevance and Significance 3 Research Questions 4 Review of the Literature 5 Historical Overview 5 Learning Needs 7 Behaviors in an Online Learning Environment 8 Leadership Competencies 10 Instructional-Design Theory 12 Summary 15 Contribution of the Research 17 Conclusions, Implications, Recommendations, and Summary 19 Conclusions 19 Implications 22 Recommendations 24 Summary 25 Reference List 27

ii

List of Tables

Tables 1. Instructional-Design Theory 20

iii

1

Introduction

Statement of the Problem

Background

In 2004, the average age of a registered nurse in Canada was 44.6 years, and nurses

over the age of 44 represented nearly 53% of the workforce (Canadian Nurses

Association [CNA], 2005). The percentage of registered nurses working in nursing

leadership positions including managers, directors, and chief nursing officers was only

5.5% in 2004 (CNA, 2005). As a result of work restructuring and budget limitations in

the 1990s, many nursing leadership positions were deleted leaving front-line nurses with

less support and guidance (Canadian Health Services Research Foundation [CHSRF],

2006). CNA (2003) noted, “Professional nursing organizations have never had a harder

time filling key leadership positions…” (p. 1).

As the majority of nurses progress towards their retirement years, succession

planning is needed to recruit qualified nurses into leadership positions (CNA, 2003).

Formal leadership training and professional development have been identified as key

components in the succession planning process (CHSRF, 2006; CNA, 2003). Little

support for continuing education in the workplace, decreased financial resources, and the

inability of nurses to attend educational sessions in the workplace have been identified as

barriers to professional development (CHSRF, 2006). Electronic programming is seen as

an innovation that facilitates access to education for nurses (CNA & Canadian

Association of Schools of Nursing, 2006).

The Winnipeg Regional Health Authority (WRHA) Nursing Leadership Council

2

(NLC) , in Manitoba, Canada, adopted a framework used by the Dorothy M. Wylie

Nursing Leadership Institute in Toronto, Ontario, and have further developed the

framework by identifying leadership competencies within each of the various

components of the framework. The development of the WRHA NLC (2006) framework

and future educational plans related to the framework in part fulfills the recommendations

of the CNA (2003) and the CHSRF (2006) to enhance the leadership skills of nurses

through professional development.

The concept of using the Internet as the delivery method for nursing leadership

education is in keeping with the thought that electronic programming facilitates access to

education (CNA & CASN, 2006; Jeffries, 2005); however, the use of Internet technology

brings opportunities as well as challenges. Researchers have found that the computer

literacy level in nurses is low (Wilbright et al., 2006); however, nurses are satisfied with

online learning environments (Billings et al., 2006; Maag, 2004), and have positive

attitudes towards technology (Maag, 2006). Online nursing learning communities have

been found to promote connectedness, improve reflective ability, engage students in

critical thinking, improve writing skills, and enhance the sharing of ideas (Maag, 2005;

Maag & Fonteyn, 2005).

How does one begin to develop an online learning community? Morrison, Ross, &

Kemp (2004) indicate that learning theories describe how learning takes place,

instructional theory, known as instructional-design theory, prescribes specific teaching

strategies, while an instructional-design model or plan applies instructional-design theory

to create an effective lesson. As a starting point in the process, the author identified

researching instructional-design theories.

3

Problem Statement

The problem was that there is a shortage of nurses who possess the leadership

competencies required to fill a projected increase in nursing leadership vacancies.

Effective nurse leaders are an important member of the health care team for they

increase group cohesion, empower nurses, reduce turnover, and ultimately improve

patient care (CHSRF, 2006). Nurses no longer have numerous career-laddering

opportunities in leadership because of decreased nurse leader positions resulting from

years of restructuring and budget cutbacks (CHSRF, 2006). With just over 5% of nurses

in leadership positions and an aging nurse population (CNA, 2005), one can assume that

with impending retirements, the vacancy rate for nurse leaders will continue to increase.

Goal Statement

The goal was to explore instructional-design theories that would support the

establishment of an online learning community to enhance leadership competencies in

nurses employed within the WRHA.

Given the identified need for nursing leadership training across Canada (CHSRF

2006; CNA, 2003), one would predict that there are few opportunities for online

leadership training. The establishment of an online learning community for nurses was

identified as a potential effective mechanism to increase the human resource pool of

qualified nurse leaders.

Relevance and Significance

Leadership courses are commonly included in nursing curricula, and with increasing

availability of online courses, nurses are gaining access to online nursing leadership and

management courses (Barker, 2004). The establishment of online learning communities is

4

a relatively new concept for professional working nurses, as many researchers have

focused their efforts on examining online learning within the context of a university or

college environment. The establishment of an online learning community for professional

nurses could prove to be beneficial to nurses, employers, and ultimately patients.

The scope of the study was closely related to the goal, and was to explore

instructional-design theories that would support the establishment of an online learning

community. Testing of the instructional-design theory was not within the scope of the

study; however, if an appropriate instructional-design theory was developed to support

the enhancement of leadership competencies, Reigeluth (1999) would agree that a

significant contribution would be made to the field of instructional-design theory and

computing technology in education.

Research Questions

The following research questions were explored:

1. What are the learning needs of nurses participating in an online nursing leadership

learning community?

2. What behaviors and leadership competencies are expected to improve in nurses

participating in an online nursing leadership learning community?

3. What instructional-design theory will best enhance an online nursing leadership

learning community?

5

Review of the Literature

Historical Overview

As the research goal was to explore instructional-design theories that support the

establishment of an online learning community, it is important to examine the evolution

of instructional-design theory. Hutchins (as cited in Reigeluth, 1999) notes that when a

societal system changes in significant ways, related subsystems must also change to

survive, as each subsystem essentially meets the needs of one or more of its

supersystems. Reigeluth notes that if the supersystems for instructional systems change

significantly, then the instructional system, and consequently instructional-design theory,

needs to change or risk the chance of becoming obsolete. Reigeluth describes how

supersystems have evolved from the agrarian age where businesses were organized

around the family, for example, the family farm, to the industrial age where the family

was replaced by bureaucracy and departments, to the information age. In the information

age, businesses are organized around holistic processes, and employees are organized

into teams with considerable autonomy to manage themselves within the boundaries of

the corporate goals and vision.

The evolution of business fits within the definition of systemic change of a

supersystem; therefore, the subsystem of instruction needs to change or become obsolete.

Reigeluth (1999) describes how the paradigm of instruction needs to change from

standardization to customization, from teacher-directed to student-directed learning, and

from passive to active learning. Reigeluth’s comments equate to the evolution of learning

approaches described by Alessi and Trollip (2001). Alessi and Trollip present the

6

evolution of learning approaches starting with a behavioral approach, moving to a

cognitive approach, and finally a constructivist learning approach.

Lee (2006) agrees that paradigm shifts in educational philosophy along with

technical advances in instructional technology are the driving forces behind changes in

distance learning practices. Educators are transitioning from delivering information to

remote learners, to constructing a community of learners (Lee, 2006). Lee notes that

curriculum delivery is the focus in traditional face-to-face or online educational

environments, and the development of a community, as a foundation for learning, is often

ignored. In addition, Lee claims that the misapplication of learning approaches, such as

implementing a behavioral approach as opposed to a constructivist approach to shape the

development of a learning community remains an obstacle in online learning, as

constructivism is emerging as the preferred learning approach when creating an online

learning community.

Overall, a shifting of paradigms appears to be a common theme when reviewing the

literature. Instruction is shifting from a teacher-directed approach to a learner-centered

approach (Fay, Johnson, & Selz, 2006; Lee, 2006; Reigeluth, 1999). Learners are being

required to shift from a passive mode of learning in a traditional face-to-face classroom

environment dominated by lecturing, to an active mode of learning in an online

environment (Barker, 2004; Ryan, Hodson-Carlton, & Ali, 2005). Resultant behaviors

demonstrated by learners in an online environment exhibit the shifting paradigm. Finally,

instructional-design theory is shifting from a teacher-directed approach to a learner-

centered approach to best attain instructional goals (Reigeluth, 1999).

7

Learning Needs

When examining the current state of nursing education in regards to online learning,

it was found that information technology skills might be present in curricula; however,

given the questionable skill level of nurse educators in regards to computer technology, it

is not evident that educators are teaching the content (McNeil et al., 2003). The fact that

students may not be exposed to information technology is concerning, for Maag (2006)

and McNeil et al. found a clear perceived need for information technology skills in

nursing curricula. A consequence of a lack of exposure to information technology and

computer training in either basic nursing education programs or continuing education

programs is that nurses are not prepared to manage the information systems in the clinical

areas (McNeil et al., 2003; Wilbright et al., 2006).

Wilbright et al. (2006) noted that many clinically experienced nurses have limited

basic computer skills, because clinically experienced nurses would have graduated when

computer training was not considered an essential component of a nurse’s basic

education, nor were computers prominent in clinical units. Wilbright et al. analyzed the

responses of 454 nurses who responded to a 15 question self-assessment survey

pertaining to computer skills. Wilbright et al. found that nursing department staff reported

fair to poor computer literacy skills, with limited proficiency in basic skills such as using

a mouse, minimizing windows, saving files, dragging and dropping files, using email, or

using a web browser. Kozlowski (2004) noted similar findings in regards to computer

literacy skills.

Researchers have identified various computer related competencies important for

learners enrolled in online nursing programs, and the author was able to extrapolate

8

computer related competencies from two models: one designed for nursing faculty who

teach online (Ryan et al., 2005), and the other used to explain persistence in continuing in

an online distance education program despite obstacles (Rovai, 2003). Overall, it was

found that learners participating in an online learning environment require basic

computer and word processing skills, the ability to send and receive email with

attachments, and the ability to use and understand Internet protocols (Barker, 2004;

Kozlowski, 2002; McNeil, Elfrink, Beyea, Pierce, & Bickford, 2006; Rovai, 2003; Ryan

et al., 2005). Learners also require hardware competencies such as troubleshooting

computers (Barker, 2004; McNeil et al., 2006; Ryan et al., 2005). McNeil et al. noted that

education related to discussion groups, asynchronous and synchronous chats, and online

learning programs was important. A significant point to note is that older students who

enter an online program may have poor computer skills initially, but will exit with highly

improved skills (Ostrow & DiMaria-Ghalili, 2005). Kozlowski (2004) also found that

that a student’s ability to use the Internet increased over time.

Behaviors in an Online Learning Environment

In order to determine the behaviors expected to improve in nurses participating in an

online nursing leadership learning community, a review of behaviors associated with an

online learning environment was required. An online learning environment appears to

enhance critical thinking (Kozlowski, 2004; Lee, 2006; Maag & Fonteyn, 2005; Pethtel,

2005) and foster reflection (Kozlowski, 2004; Maag & Fonteyn, 2005; Ryan et al., 2005).

It was noted that learners are able to construct new knowledge (Lee, 2006; Maag &

Fonteyn, 2005) and apply concepts learned in an online course to their nursing practice

(Billings et al., 2006; Jeffries, 2005; Kozlowski, 2004).

9

There are opportunities in an online learning environment for sharing of creative

ideas (Maag & Fonteyn, 2005; Pethtel, 2005). The ability to communicate clearly online

was a skill that developed over time, and the potential for miscommunication was

believed to be a major barrier to student success (Kozlowski, 2004). Writing skills also

improve in an online environment (Maag & Fonteyn, 2005).

For most learners, anxiety, fears, and concerns ease over time in an online learning

environment (Kozlowski, 2004). Learners need to adapt to a different type of faculty to

student relationship, different pedagogies, and a different learning environment (Ryan et

al., 2005). Ku, Cheng, and Lohr (2006) reported that for students to work well in an

online group collaborative setting, members needed to practice the five C’s:

communicate, cooperate, compromise, complement, and commitment. Tilley, Boswell,

and Cannon (2006) found that in an online environment there is a supportiveness and

open sharing of oneself, learners build interpersonal relationships (Rovai, 2003), and

establish networks (Pethtel, 2005). Learners experience a connectedness, are better

acquainted, and challenge each other (Maag & Fonteyn, 2005). It is agreed that

socialization occurs in online learning environments (Billings et al., 2006; Kozlowski,

2002; Lee, 2006; Tilley et al., 2006).

Barker (2004) identified that educators as well as learners struggle with the paradigm

shift from traditional teaching to learning that is engaging, deep, long lasting, and

achieved in an online format. Barker noted that learners must accept the active and

engaging learning model that is different from a traditional passive model of listening to

lectures, and for learners to make the transition, learners need to be self-directed and have

good time management skills. Kozlowski (2004) and Rovai (2003) would agree that good

10

time management skills are needed, and Kozlowski (2004) would agree that learners

require self-direction and self-discipline.

Leadership Competencies

In the second research question, the author examined two components, namely,

behaviors and leadership competencies. In reviewing leadership competencies, Mahoney

(2001) claimed there is a need for nurse leaders to move from a traditional to innovative

role that involves risk taking and planning for the future. Mahoney also noted that great

leaders practice and develop their skills over time, and are aware of their own beliefs and

values.

The Registered Nurses’ Association of Ontario (RNAO) (2006) recently completed a

leadership best practice guideline. Five transformational leadership practices identified as

fundamental to transforming nurses’ work settings into healthy work environments for

nurses include: building relationships and trust, creating an empowering work

environment, creating an environment that supports knowledge development and

integration, leading and sustaining change, and balancing competing values and priorities

(RNAO, 2006). The five practices of exemplary leadership described by Kouzes and

Posner (2002) including model the way, inspire a shared vision, challenge the process,

enable others to act, and encourage the heart, are incorporated into the RNAO best

practice guideline.

Nursing leaders have been described as knowledgeable (Henrikson, 2005; Wieck,

Prydun, & Walsh, 2002), trustworthy (Henrikson, 2005; Mahoney, 2001; Murdoch,

2001), respected, competent and confident individuals (Mahoney, 2001) who possess an

inspirational motivation (McGuire & Kennerly, 2006; Shultz, 2003; Wieck et al., 2002),

11

and are motivated by the excitement for the work (Stanley, 2006). Leaders have passion

(Henrikson, 2005; Stanley, 2006), are proactive, transformational, and are driven by the

heart and spirit (Stanley, 2006). Leaders are visionaries (Henrikson, 2005; Mahoney,

2001; Murdoch, 2001; Shultz, 2003; Stanley, 2006), mentors, and delegators (Heller et

al., 2004) who empower patients and staff (Mahoney, 2001; Upenieks, 2003; Wieck et

al., 2002).

Good communication and listening skills have been identified as essential qualities

of a nurse leader (Heller et al., 2004; Murdoch, 2001; Shultz, 2003; Upenieks 2003;

Wieck et al., 2002). It is important for nurse leaders to be self-directed (Shultz, 2003),

and have good time management skills (Heller et al., 2004). Leaders believe in the power

of a team (Henrikson, 2005; Wieck et al., 2002), collaboration (Heller et al., 2004;

Upenieks, 2003), networking, and developing partnerships (Heller et al., 2004). Leaders

are people oriented (Upenieks, 2003; Wieck et al., 2002), visible, accessible (Upenieks,

2003), and approachable (Wieck et al., 2002). Leaders have an essential relationship with

the organization, will associate with anyone and everyone, and approach the future by

creating opportunities (Stanley, 2006). Leaders are honest, supportive, and have a

positive influence in an organization (Upenieks, 2003; Wieck et al., 2002). Being able to

celebrate success is important for a leader, whether it is celebrating accomplishments and

goals, or lessons learned from mistakes (Mahoney, 2001).

Leaders need to be able to display creativity (Mahoney, 2001) as well as facilitate

change (Murdoch, 2001; Shultz, 2003; Stanley, 2006). Conflict resolution skills and the

ability to use conflict constructively is important for a nurse leader (Heller et al., 2004;

12

Stanley, 2006), and Hocking (2006) describes that reflection is an important method to

remedy conflict.

Ready (2002) identified two essential criteria for developing potential leaders,

namely, leadership is most appropriately learned within the context it will be practiced,

and leadership lessons are best learned from trusted and well respected individuals. The

two criteria combine into one powerful method of building leadership effectiveness:

storytelling. Ready noted that effective stories are context-specific, have drama, are told

by respected role models, have high learning value, and are framed at an appropriate level

so participants can visualize themselves in the story and reflect on appropriate actions.

Instructional-Design Theory

Lee (2006) noted that constructivism is emerging as the preferred learning approach

for creating an online learning community. Bolliger (2006) stated that constructivism, as

a learning approach used in the field of instructional-design and technology, has gained

acceptance and is highly valued by educators. Shachak, Ophir, and Rubin (2005) would

agree that an instructional-design theory supporting exploration and interactivity might be

a better option, for Shachak et al. found that a behavioral instructional-design theory,

namely the Conditions of Learning, based on the work of Robert M. Gagné, was not

optimal when used in the development of graduate level bioinformatics workshops.

Deubel (2003) would argue though, that a mixed learning approach might be the

preferred direction.

In a constructivist learning environment, situated learning experiences (Bolliger,

2006; Cooperstein & Kocevar-Weidinger, 2004) are used to engage learners in a sense-

making process where learners investigate, (Bolliger, 2006), discover, and explore (Ali,

13

Hodson-Carlton, & Ryan, 2004; Bolliger, 2006). Learners create structures (Bolliger,

2006), build new learning on prior knowledge (Cooperstein & Kocevar-Weidinger, 2004;

Deubel, 2003), and construct their own meaning to concepts (Bolliger, 2006; Cooperstein

& Kocevar-Weidinger, 2004). Concepts central to the idea of constructivism include

critical thinking (Ali et al., 2004; Lee, 2006) active learning (Bolliger, 2006; Fay et al.,

2006), and reflection (Ali et al., 2004; Bolliger, 2006; Deubel, 2003). The conditions for

learning are a social context (Ali et al., 2004; Bolliger, 2006; Cooperstein & Kocevar-

Weidinger, 2004) where students are viewed as autonomous, independent, self-

motivating, engaging (Ali et al., 2004; Bolliger, 2006; Deubel, 2003), and interactive

individuals (Fay et al., 2006).

Bolliger (2006) noted that introducing a constructivist approach is difficult if the

learners are not accustomed to taking responsibility for their own learning. Educators

need to act as a coach (Deubel, 2003) and a facilitator that creates a supportive and social

learning environment (Ali et al., 2004). Educators must be dedicated to the approach, and

be flexible to accommodate progress or non-progress of course content (Bolliger, 2006),

as time is a challenge when trying to incorporate constructivist principles into lessons

(Cooperstein & Kocevar-Weidinger, 2004).

When determining an appropriate instructional-design theory, it is also important to

consider adult learning theory. Trotter (2006) reviewed a variety of adult learning

theories and identified three key themes: experience cannot be ignored as adults use

experience as a resource, adults have their own educational interests and need to plan

their own learning path, and the promotion of individual development should be the aim

of adult education focusing on reflection and inquiry.

14

Goals, values, and methods are the component parts of an instructional-design theory

(Reigeluth, 1999). Instructional-design theories were analyzed in an attempt to determine

the theory or theories in which the goals, values, and methods would be applicable to an

online nursing leadership learning community. Starting with goals, Bielaczyc and Collins

(1999) identified advancing the collective knowledge and skills of individuals, while

supporting the progression of individual knowledge and skills, as the goal of their

instructional-design theory. Hannafin, Land, and Oliver (1999) and Jonassen (1999)

developed theories with the goal of examining ill-defined or ill-structured problems. The

development of skills in problem-solving, critical thinking, and content knowledge in

complex domains was the primary goal identified by Nelson (1999). Synder (2002) drew

from learner-centered and collaborative learning environment research to develop an

instructional-design theory with the goal of fostering the online sharing of information,

knowledge, skills, and experiences among older adults with common interests and goals.

Three to seven values were identified in each of the instructional-design theories

reviewed. Bielaczyc and Collins (1999) value a culture of learning as a collective effort

and sharing of knowledge, and also respect and appreciate all members of a learning

community as well as their differences. Nelson (1999) values collaborative processes,

problem-solving, and rich social contexts for learning. Cultivating supportive, respectful

relationships among learners, as well as between learners and the instructors, is an

important value identified by Nelson. Both Nelson and Hannafin et al. (1999) value

divergent thinking and multiple perspectives. Hannafin et al. value self-directed learning,

while at the same time value providing tools and resources to aid learning efforts.

15

In reference to methods, Nelson (1999) and Jonassen (1999) both speak of the need

for a resource for the learner who will coach and guide the learner as required. In

addition, Nelson and Jonassen both incorporate problem-based learning as a major

method in their respective instructional-design theory. Mayer (1999) refers to selecting

relevant information, organizing the information for participants, and integrating

information as constructivist learning methods. Stone-McCown and McCormick (1999)

use an eight-step process tool called, the Trumpet Process, as the major method for

making discoveries about and acting on issues associated with emotional intelligence. It

is important to note that emotional intelligence is a key element with the WRHA nursing

leadership development framework (WRHA NLC, 2006).

Summary

In determining what is known and unknown about the main subject areas discussed

in this paper, it is important to note that the sample population in the proposed research

study, namely professional working nurses, was not the focus of study for the majority of

researchers whose work was reviewed. Therefore, aside from the few studies in which the

researcher focused on a similar sample population, such as Wilbright et al. (2006) who

studied the computer literacy level of working nurses, and those researchers who

identified nursing leadership competencies, much knowledge still needs to be gained

about the learning needs of nurses participating in an online learning community, the

behaviors and leadership competencies expected to improve in nurses participating in an

online learning community, and the instructional-design theory that will best enhance the

establishment and ongoing development of an online nursing leadership learning

community.

16

To summarize the learning needs of nurses participating in an online nursing

leadership learning community, an effort was made to identify the basic skill level of

nurses in relationship to technology, and the technological skills that nurses need to

participate in an online learning community. Overall, the author found that the computer

literacy level of nurses is questionable, and although computer literacy was identified as a

necessity for clinical practice, computer technology is not consistently included in

nursing education programs. The author found that at minimum, learners require basic

computer skills including word processing, and the ability to use email and the Internet to

participate and be fully engaged in an online learning community. Being able to

troubleshoot hardware and software was seen as an advantage. If a learner has weak

computer skills when starting an online program, it was found that a learner’s computer

skills would improve by the end of the program.

A variety of behaviors associated with online learning communities were identified

in the review of the literature. Leadership competencies identified were not specifically

related to an online learning community; however, it appears that there may be

similarities between online behaviors and leadership competencies. Behaviors and

leadership competencies common in both the literature pertaining to online learning as

well as the literature pertaining to nursing leadership include the following: reflection,

constructing and supporting knowledge development, relationship building, establishing

networks, self-directedness, creativity, and good communication and time management

skills.

In determining what instructional-design theory would best enhance an online

nursing leadership learning community, the author first needed to determine whether a

17

behavioral, cognitive, or constructivist learning approach should underpin the

instructional-design theory. A shift in the paradigm of instruction from teacher-directed

to student-centered appears to be common theme in the literature, thus supporting a

constructivist learning approach. A number of instructional-design theories were

reviewed, and there are values and methods in each of the instructional-design theories

that could be combined to establish an instructional-design theory specifically for an

online nursing leadership learning community.

Contribution of the Research

Reigeluth (1999) stated, “…in order for instructional-design theory to make this

transformation to a new paradigm, we desperately need more people working to develop

theories…” (p. 27). Given Reigeluth’s statement, it would appear that much research is

needed in the field of instructional-design theories, especially related to theories that are

based on a constructivist learning approach. The development of a new instructional-

design theory, grounded in constructivist learning, for an online nursing leadership

learning community would be a significant contribution to the field of instructional-

design theory, as the author has not identified an instructional-design theory specifically

designed for an online nursing leadership learning community.

An instructional-design theory for an online nursing leadership learning community

will aid in the development of online learning communities for nurses within and beyond

the WRHA. Instructional designers and nurse educators will be able to use the methods

outlined in the instructional-design theory to ensure that online learning communities are

designed to meet the specific needs of nurses who aspire to enhance their leadership

competencies. The development of an online nursing leadership learning community will

18

give nurses an opportunity for professional development that has not been available in the

past. Via the Internet, nurses will be able to dialogue with colleagues at all stages of

leadership development, share their stories and experiences, and be able to be coached by

one another to assess, plan, intervene, evaluate, and ultimately enhance their own

leadership competencies. As the number of nurses who participate in the online learning

community grows, it is expected that the number of nurses prepared to assume formal

nursing leadership roles would also increase. An increase in nurses who possess the

leadership competencies required to fill a projected increase in nursing leadership

vacancies addresses the problem identified in this research study.

19

Conclusions, Implications, Recommendations, and Summary

Conclusions

As the proposed research study was not actually conducted, the conclusions for the

study need to be viewed with caution. The findings from the review of the literature were

used to generate tentative preliminary conclusions; however, it is difficult to generalize

the findings in the study.

Research Question One

What are the learning needs of nurses participating in an online nursing leadership

learning community? The answer to the first research question was that nurses require

basic computer skills such as word processing, the ability to use email and the Internet,

and the ability to troubleshoot minor hardware and software problems.

Research Question Two

What behaviors and leadership competencies are expected to improve in nurses

participating in an online nursing leadership learning community? In analyzing the

second question, as well the related literature, it was found that due to the fact that there

are essentially two parts to the question, it might have been better to ask two separate

preliminary questions, namely, one pertaining to behaviors and one pertaining to

leadership competencies, before combining behaviors and leadership competencies into

one question. Nevertheless, the answer to the second question was that nurses

participating in an online nursing leadership learning community would improve their

communication, time management, and self-directed learning skills. Creativity would be

enhanced along with improved reflective abilities. The ability to construct and support

20

knowledge development, along with relationship building and networking skills were

seen as important behaviors and leadership competencies that improved while

participating in an online nursing leadership learning community.

Research Question Three

What instructional-design theory will best enhance an online nursing leadership

learning community? It was concluded that the behaviors and leadership competencies

expected to improve in an online learning community were more closely related to

constructivism than behaviorism or cognitivism; hence, a constructivist approach was

found to be the most suitable underpinning for the instructional-design theory. An

instructional-design theory specifically supporting online nursing leadership development

was not found, nor was an instructional-design theory located that included all of the

values and methods necessary for an online nursing leadership learning community;

therefore, the Instructional-Design Theory for Online Nursing Leadership Learning

Communities was developed (see Table 1).

Table 1. Instructional-Design Theory Instructional-Design Theory for Online Nursing Leadership Learning Communities Goal To foster leadership development through facilitated online communication,

relationship building, collective construction and support of knowledge development, and reflection. An instructional-design theory primarily intended for nurses.

Values Some of the values upon which this theory is based include the following: • a culture of learning as a collective effort with sharing of knowledge

(Bielaczyc & Collins, 1999); • rich social context as conditions for learning (Ali et al., 2004; Bolliger,

2006; Cooperstein & Kocevar-Weidinger, 2004; Nelson, 1999); • cultivating supportive, respectful relationships among participants

(Nelson, 1999); • creating an environment that supports knowledge development and

integration (RNAO, 2006); • self-directed learning (Hannafin et al., 1999);

21

Table 1 (continued). Instructional-Design Theory Values • divergent critical thinking, multiple perspectives, and reflection (Hannafin

et al., 1999; Kozlowski, 2004; Lee, 2006; Maag & Fonteyn, 2005; Nelson, 1999; Pethtel, 2005; Ryan et al., 2005);

• personal experience (Trotter, 2006); • providing tools and resources to aid learning efforts (Hannafin et al.,

1999); • knowledge translation and application of learning to nursing practice

(Billings et al., 2006; Jeffries, 2005; Kozlowski, 2004). Methods Process Activities 1. Create Readiness (Nelson, 1999). • Provide an overview of the process and roles (Nelson, 1999). • Confirm member expectations (Snyder, 2002). • Set ground rules for how communication takes place (Stone-

McCown & McCormick, 1999). • Provide instruction and practice in group process skills (Nelson,

1999). 2. Form Groups (Nelson, 1999). • Form small homogeneous groups in terms of level of professional

nursing responsibilities (Ready, 2002). • Establish relationships and trust (Diekelmann & Mendias, 2005;

Lock, 2006; RNAO, 2006; Snyder, 2002). • Encourage groups to establish operational guidelines (Nelson, 1999). 3. Select an Appropriate Problem (Jonassen, 1999). • The problem should be interesting, relevant, and engaging to foster

participant ownership (Jonassen, 1999). • The problem should be authentic and professionally relevant

(Jonassen, 1999). 4. Provide Related Cases or Stories (Jonassen, 1999; Ready, 2002) • Effective cases or stories are context-specific, level-appropriate,

presented by respected role models, have drama and high learning value (Ready, 2002).

5. Engage in the Trumpet Process (Stone-McCown & McCormick, 1999) to Dialogue About Cases or Stories

The Trumpet Process includes the following steps for participants to take:

a. Share experiences to provide a common reference point for discussion.

b. Inventory responses: What was unique? What was common? c. Recognize patterns of unique behavior. d. Own your patterns and understand how each serves you. e. Consider the consequences of each pattern including benefits and

costs. f. Allow alternative patterns, and explore options. g. Evaluate the alternatives. h. Choose the best one for each situation.

22

Table 1 (continued). Instructional-Design Theory Methods 6. Synthesize and Reflect (Nelson, 1999). • Identify learning gains (Nelson, 1999). 7. Provide Closure (Nelson, 1999) • Formalize group adjournment through a closure activity (Nelson,

1999). Supportive Activities 1. Provide a Coach (Ready, 2002). • An advisor, specializing in leadership, who assists the facilitator

(Ready, 2002). • Acts as resource and tutor (Nelson, 2002) to the facilitator. 2. Provide an Online Facilitator (Diekelmann & Mendias, 2005). • Creates a supportive presence, and attends to and facilitates

participants’ knowing and connecting with one another (Ali et al., 2004; Diekelmann & Mendias, 2005).

• Acts as resource and tutor (Nelson, 2002) to the participants. • Formulates questions to focus participants on important aspects of

content and learning processes (Nelson, 1999). 3. Provide Just-In-Time Learner-Selectable Information (Jonassen, 1999). • Utilize the Internet as an extension of the learning community

boundaries (Snyder, 2002). • Select relevant information, organize the information for

participants, and integrate information (Mayer, 1999) into a nursing leadership website.

• In the nursing leadership website, provide both static and dynamic relevant and easily accessible resources (Hannafin et al., 1999; Jonassen, 1999).

Implications

As the instructional-design theory needs to be tested, the implications of the study

are tentative, and need to be viewed with caution. First examined were the learning needs

of nurses participating in an online learning community. Nurse educators and

administrators need to be cognizant of the computer literacy level of nurses, and provide

nurse participants with a list of expected computer competencies that must be attained

prior to enrollment in an online learning community. If nurses do not meet the

prerequisite computer competencies, then nurses need to have access to either onsite or

external computer training. There are human and resource implications for administrators

23

that include providing orientation to nurses participating in an online learning

community, as well as providing ongoing technical support. A dedicated facilitator to

support learners and facilitate online discussions is also required.

Next, the enhancement of specific behaviors and leadership competencies through

the participation in an online learning community has direct implications for professional

practice environments as nurse leaders transfer learning from the online environment to

their work environment. As noted in the Problem Statement section of this paper,

effective nurse leaders are an important member of the health care team for they increase

group cohesion, empower nurses, reduce turnover, and ultimately improve patient care

(CHSRF, 2006). The behaviors and leadership competencies discovered by answering the

second research question are behaviors and competencies needed by nurse leaders to

establish and develop a health care team that will improve patient outcomes. There are

also implications for the online facilitator in the area of behaviors and leadership

competencies, for the facilitator must ensure that discussion and questioning is directed

towards the enhancement of particular behaviors and leadership competencies.

Finally, an instructional-design theory for an online nursing leadership learning

community has significant implications for nursing leadership development worldwide.

Instructional designers and nurse educators have access to a theory that meets the specific

needs of nurses who aspire to enhance their leadership competencies. As nurses develop

their nursing leadership competencies through an online learning community, the number

of nurses who possess the leadership competencies required to fill a projected increase in

nursing leadership vacancies will increase and help solve the research problem in this

study.

24

Recommendations

The Instructional-Design Theory for Online Nursing Leadership Learning

Communities will need to be applied in a variety of settings to determine preferability.

According to Reigeluth and Frick (1999), preferability is examined over validity, with

effectiveness, efficiency, and appeal being the three criteria that need to be manifested in

the research design for design knowledge to be generated. Further analysis of the

literature in regards to problem-based learning and storytelling is needed before the

instructional-design theory can be tested.

There is a gap in the literature in regards to online learning and online learning

communities for nurses and nurse leaders. The following research hypotheses were

developed to further investigate online learning and online learning communities:

1. Nurses who participate in a self-directed leadership development program that

includes facilitated online discussion will self-report higher communication ability,

reflective ability, and critical thinking compared to nurses who participate in the same

self-directed leadership development program without participating in a facilitated

online learning community.

2. A dedicated trained facilitator will increase socialization, interpersonal relationships,

and connectedness among participants in an online learning community compared to

an online learning community without a dedicated trained facilitator.

3. Manager’s leadership competency scores will be higher after participating in an

online learning community compared to pre-participation scores.

4. Nurses whose manager participates in an online nursing leadership learning

community will report higher empowerment in their work environment than nurses

25

whose manager does not participate in an online nursing leadership learning

community.

5. Computer literacy scores will be higher in nurses who participate in an online

learning community compared to nurses who do not participate in an online learning

community.

6. Nurses’ satisfaction scores with e-learning will be higher in those nurses who

participate in an online learning community compared to nurses who do not

participate in an online learning community.

Summary

The research problem was that there is a shortage of nurses who possess the

leadership competencies required to fill a projected increase in nursing leadership

vacancies. The goal of the study was to explore instructional-design theories that would

support the establishment of an online learning community to enhance leadership

competencies in nurses employed within the WRHA. Three research questions were

explored with the focus on instructional-design theory as well as learning needs,

behaviors, and leadership competencies of nurses participating in an online nursing

leadership learning community. A review of the literature was conducted to answer the

three research questions.

It was found that nurses need basic computer skills to participate in an online

learning community. A relationship was found between behaviors and leadership

competencies expected to improve in an online learning community. The Instructional-

Design Theory for Online Nursing Leadership Learning Communities was developed out

of the need for a constructivist instructional-design theory to guide nurse educators and

26

administrators in the establishment of online nursing leadership learning communities.

Included in the recommendations was the need to determine the preferability of the newly

developed instructional-design theory.

Overall, the goal of the research study was met. It will be a number of years;

however, until it is determined whether there are a significant number of nurses who

develop nursing leadership competencies as a result of participating in online nursing

leadership learning communities.

27

Reference List Alessi, S. M., & Trollip, S. R. (2001). Multimedia for Learning: Methods and

Development (3rd ed.). Boston: Allyn and Bacon. Ali, N. S., Hodson-Carlton, K., & Ryan, M. (2004). Students’ perceptions of online

learning: Implications for teaching. Nurse Educator, 29, 111-115. Retrieved August 31, 2006, from Journals @ Ovid database.

Barker, A. (2004). Using online learning technology to develop nurse leaders. Nurse

Leader, 2(5), 32-35. Retrieved August 25, 2006, from ScienceDirect Reference Works database.

Bielaczyc, K., & Collins, A. (1999). Learning communities in classrooms: A

reconceptualization of educational practice. In C. M. Reigeluth (Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 269-292). Mahwah, NJ: Lawrence Erlbaum Associates.

Billings, D. M., Jeffries, P. R., Daniels, D. M., Rowles, C., Stone, C. L., & Stephenson,

E. (2006). Developing and using online courses to prepare nurses for employment in critical care. Journal for Nurses in Staff Development, 22, 87-92. Retrieved August 3, 2006, from Ovid MEDLINE database.

Bolliger, D. U. (2006). Creating constructivist learning environments. In M. Orey, V. J.

McClendon, & R. M. Branch (Eds.), Educational Media and Technology Yearbook 2006 (Vol. 31, pp. 119-126). Westport, Connecticut: Libraries Unlimited.

Canadian Health Services Research Foundation (2006, March). What’s ailing our nurses?

A discussion of the major issues affecting nursing human resources in Canada. Retrieved August 3, 2006, from http://www.chsrf.ca/research_themes/ pdf/ What_sailingourNurses-e.pdf

Canadian Nurses Association (2003, March). Succession planning for nursing leadership.

Retrieved August 2, 2006, from http://cna-aiic.ca/CNA/documents/pdf/ publications/ succession_planning_e.pdf

Canadian Nurses Association (2005, October). 2004 workforce profile of registered

nurses in Canada. Retrieved August 2, 2006, from http://www.cna-nurses.ca/ CNA/documents/pdf/publications/workforce_profile_2004_e.pdf

Canadian Nurses Association, & Canadian Association of Schools of Nursing (2006,

June). Registered nursing education in Canada: 2004 snapshot. Retrieved August 2, 2006, from http://www.cna-nurses.ca/CNA/documents/pdf/publications/ Nursing_Education_Snapshot_2004_2005_e.pdf

28

Cooperstein, S. E., & Kocevar-Weidinger, E. (2004). Beyond active learning: A constructivist approach to learning. Reference Services Review, 32, 141-148. Retrieved August 8, 2006, from ProQuest database.

Deubel, P. (2003). An investigation of behaviorist and cognitive approaches to

instructional multimedia design. Journal of Educational Multimedia and Hypermedia, 12, 63-90. Retrieved August 3, 2006, from WilsonWeb database.

Diekelmann, N., & Mendias, E. P. (2005). Being a supportive presence in online courses:

Attending to students’ online presence with each other. Journal of Nursing Education, 44, 393-395. Retrieved October 29, 2006, from Journals @ Ovid database.

Fay, V. P., Johnson, J., & Selz, N. (2006). Active learning in nursing education (ALINE).

Nurse Educator, 31, 65-68. Retrieved August 17, 2006, from Ovid MEDLINE database.

Hannafin, M., Land, S., & Oliver, K. (1999). Open learning environments: Foundations, methods, and models. In C. M. Reigeluth (Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 115-140). Mahwah, NJ: Lawrence Erlbaum Associates.

Heller, B. R., Drenkard, K., Esposito-Herr, M. B., Romano, C., Tom, S., & Valentine, N.

(2004). Educating nurses for leadership roles. The Journal of Continuing Education in Nursing, 35, 203-210. Retrieved August 30, 2006, from Journals @ Ovid database.

Henrikson, M. (2005). Great leaders are made, not born. Association of Women’s Health,

Obstetric, and Neonatal Nurses Lifelines, 9, 473-477. Hocking, B. A. (2006). Using reflection to resolve conflict. Association of Perioperative

Registered Nurses Journal, 84, 249-259. Retrieved August 30, 2006, from Journals @ Ovid database.

Jeffries, P. R. (2005). Development and testing of a hyperlearning model for design of an

online critical care course. Journal of Nursing Education, 44, 366-372. Retrieved July 21, 2006, from Ovid MEDLINE database.

Jonassen, D. (1999). Designing constructivist learning environment. In C. M. Reigeluth

(Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 215-239). Mahwah, NJ: Lawrence Erlbaum Associates.

Kouzes, J. M., & Posner, B. Z. (2002). The Leadership Challenge (3rd ed.). San

Francisco, CA: Jossey-Bass.

29

Kozlowski, D. (2002). Using online learning in a traditional face-to-face environment. Computers in Nursing, 20, 23-30. Retrieved September 10, 2006, from Journals @ Ovid database.

Kozlowski, D. (2004). Factors for consideration in the development and implementation

of an online RN-BSN course: Faculty and student perceptions. CIN: Computers, Informatics, Nursing, 22, 34-43. Retrieved August 17, 2006, from Journals @ Ovid database.

Ku, H., Cheng, Y., & Lohr, L. (2006). The cultivation of group collaboration in web-based learning environments. In M. Orey, V. J. McClendon, & R. M. Branch (Eds.), Educational Media and Technology Yearbook 2006 (Vol. 31, pp. 127-138). Westport, Connecticut: Libraries Unlimited.

Lee, J. (2006). Under construction: Scaffolding the expansion of online learning

communities through computer-mediated communication. In M. Orey, V. J. McClendon, & R. M. Branch (Eds.), Educational Media and Technology Yearbook 2006 (Vol. 31, pp. 51-64). Westport, Connecticut: Libraries Unlimited.

Lock, J. V. (2006). A new image: Online communities to facilitate teacher professional

development. Journal of Technology and Teacher Education, 14, 663-678. Retrieved October 29, 2006, from WilsonWeb database.

Maag, M. (2004). The effectiveness of an interactive multimedia learning tool on nursing

students’ math knowledge and self-efficacy. CIN: Computers, Informatics, Nursing, 22, 26-33. Retrieved July 21, 2006, from Ovid MEDLINE database.

Maag, M. (2005). The potential use of “blogs” in nursing education. CIN: Computers,

Informatics, Nursing, 23, 16-24. Retrieved July 21, 2006, from Ovid MEDLINE database.

Maag, M. (2006). Nursing students’ attitudes toward technology: A national study. Nurse

Educator, 31, 112-118. Retrieved July 21, 2006, from Ovid MEDLINE database. Maag, M., & Fonteyn, M. (2005). Using a collaborative learning method to enhance

mastery of pathophysiology content. Journal of Nursing Education, 44, 435-436. Retrieved July 21, 2006, from Ovid MEDLINE database.

Mahoney, J. (2001). Leadership skills for the 21st century. Journal of Nursing

Management, 9, 269-271. Retrieved August 30, 2006, from Journals @ Ovid database.

Mayer, R. E. (1999). Designing Instruction for constructivist learning. In C. M. Reigeluth

(Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 141-159). Mahwah, NJ: Lawrence Erlbaum Associates.

30

McGuire, E., & Kennerly, S. M. (2006). Nurse managers as transformational and transactional leaders. Nursing Economics, 24, 179-185. Retrieved August 30, 2006, from Journals @ Ovid database.

McNeil, B. J., Elfrink, V., Beyea, S. C., Pierce, S. T., & Bickford, C. J. (2006). Computer

literacy study: Report of qualitative findings. Journal of Professional Nursing, 22, 52-59. Retrieved August 25, 2006, from ScienceDirect Reference Works database.

McNeil, B. J., Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C., Averill, C., &

Klappenbach, C. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: A U.S. survey. Journal of Nursing Education, 42, 341-349. Retrieved September 8, 2006, from Journals @ Ovid database.

Morrison, G. R., Ross, S. M., & Kemp, J. E. (2004). Designing Effective Instruction (4th

ed.). Hoboken, NJ: John Wiley & Sons. Murdoch, P. B. (2001). Leadership: The key to quality outcomes. Journal of Nursing

Care Quality, 15, 68-73. Retrieved August 30, 2006, from Journals @ Ovid database.

Nelson, L. M. (1999). Collaborative problem solving. In C. M. Reigeluth (Ed.),

Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 141-159). Mahwah, NJ: Lawrence Erlbaum Associates.

Ostrow, L. & DiMaria-Ghalili, R. A. (2005). Distance education for graduate nursing: One state school’s experience. Journal of Nursing Education, 44, 5-10. Retrieved August 8, 2006, from Ovid MEDLINE database.

Pethtel, P. (2005). Online learning communities can provide support for nurses preparing

for certification examinations. The Journal of Continuing Education in Nursing, 36, 55-56. Retrieved September 12, 2006, from Journals @ Ovid database.

Ready, D. A. (2002). How storytelling builds next-generation leaders. Massachusetts

Institute of Technology Sloan Management Review, 43(4), 63-69. Retrieved October 29, 2006, from WilsonWeb database.

Registered Nurses’ Association of Ontario. (2006). Healthy work environment best

practice guidelines: Developing and sustaining nursing leadership. Toronto, Ontario, Canada: Author.

Reigeluth, C. M. (1999). What is instructional-design theory and how is it changing? In

C. M. Reigeluth (Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 5-29). Mahwah, NJ: Lawrence Erlbaum Associates.

31

Reigeluth, C. M., & Frick, T. W. (1999). Formative research: A methodology for creating and improving design theories. In C. M. Reigeluth (Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 633-651). Mahwah, NJ: Lawrence Erlbaum Associates.

Rovai, A. P. (2003). In search of higher persistence rates in distance education online

programs. The Internet and Higher Education, 6, 1-16. Retrieved August 25, 2006, from ScienceDirect Reference Works database.

Ryan, M., Hodson-Carlton, K., & Ali, N. S. (2005). A model for faculty teaching online:

Confirmation of a dimensional matrix. Journal of Nursing Education, 44, 357-365. Retrieved August 17, 2006, from Journals @ Ovid database.

Shachak, A., Ophir, R., & Rubin, E. (2005). Applying instruction design theories to

bioinformatics education in microarray analysis and primer design workshops. Cell Biology Education, 4, 199-205. Retrieved August 17, 2006, from Ovid MEDLINE database.

Shultz, B. J. (2003). What makes a good leader? Association of Perioperative Nurses

Journal, 78, 9-11. Retrieved August 30, 2006, from Journals @ Ovid database. Snyder, M. M. (2002). The design of online learning communities for older adults.

Dissertation Abstracts International, 67 (01). (AAT No. 3206010). Retrieved July 19, 2006, from Dissertations and Theses database.

Stanley, D. (2006). Role conflict: Leaders and managers. Nursing Management, 13(5),

31-37. Retrieved August 30, 2006, from Journals @ Ovid database. Stone-McCown, K., & McCormick, A. H. (1999). Self-science: Emotional intelligence

for children. In C. M. Reigeluth (Ed.), Instructional-Design Theories and Models: Vol. 2. A New Paradigm of Instructional Theory (pp. 537-561). Mahwah, NJ: Lawrence Erlbaum Associates.

Tilley, D. S., Boswell, C., & Cannon, S. (2006). Developing and establishing online

student learning communities. CIN: Computers, Informatics, Nursing, 24, 144-149. Retrieved August 30, 2006, from Journals @ Ovid database.

Trotter, Y. D. (2006). Adult learning theories: Impacting professional development

programs. The Delta Kappa Gamma Bulletin, 72(2), 8-13. Retrieved September 17, 2006, from WilsonWeb database.

Upenieks, V. V. (2003). What constitutes effective leadership? Perceptions of magnet and nonmagnet nurse leaders. The Journal of Nursing Administration, 33, 456-467. Retrieved August 30, 2006, from Journals @ Ovid database.

32

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34, 283-288. Retrieved August 30, 2006, from Journals @ Ovid database.

Wilbright, W. A., Haun, D. E., Romano, T., Krutzfeldt, T., Fontenot, C. E, & Nolan, T.

E. (2006). Computer use in an urban university hospital. CIN: Computers, Informatics, Nursing, 24, 37-43. Retrieved July 30, 2006, from Ovid MEDLINE.

Winnipeg Regional Health Authority Nursing Leadership Council (2006, April).

Winnipeg Regional Health Authority Nursing Leadership Council: Leadership development framework. Unpublished manuscript.