Roland, E. Joyce, Charlene Johnson, And Deborah Swain. Blogging as an Educational Enhancement Tool for Improved Student Performance a Pilot Study in Undergraduate Nursing Education

8/9/2019 Roland, E. Joyce, Charlene Johnson, And Deborah Swain. Blogging as an Educational Enhancement Tool for Improv

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New Review of Information Networking, 16:151166, 2011Copyright Taylor & Francis Group, LLCISSN: 1361-4576 print / 1740-7869 onlineDOI: 10.1080/13614576.2011.619923

BLOGGING AS AN EDUCATIONAL ENHANCEMENT

TOOL FOR IMPROVED STUDENT PERFORMANCE: A

PILOT STUDY IN UNDERGRADUATE NURSING

EDUCATION

E. JOYCE ROLAND, CHARLENE JOHNSON, and DEBORAH SWAIN

North Carolina Central University

Improving learning andsynthesisof newknowledgeis often a challengefornursingfaculty in the twenty-first century. Faculty are urged to use new technologies and

to embrace methodologies that include more interactions by the student. Todaysstudents are less adept in written and oral communication and, consequently,more hesitant to speak out or write independently for fear of ridicule by others.

These same students, by virtue of their adaptation and immersion in technolog-ical advances, need support in using these same mechanisms to improve their

communication skills. Interpersonal communication across many levels is very

important in nursing. This article summarizes a study of nursing students atNorth Carolina Central University in the spring of 2011 and their use of socialnetworking to communicate about nursing education and medical errors. Thisqualitative pilot study used new social media known as web logs (blogs) to enable

students to become more secure communicating with one another. The tool was aGoogle-based blog. Thenursing students interaction styles were evaluated based on

topics and inter-connections. Visualizations of the social network communicationsas maps are provided with the article to illustrate data analysis results.

As a pilot study the research may be used for system design requirements for

a medical educational environment that promotes sharing information and col-

lecting data related to quality care and learning. Potential social media tools forfuture consideration include Facebook, Twitter, blogs, electronic journals, forums(or chat rooms), and wikis (group-authored encyclopedia/information sites) asfound on the web, on smart phones and in online education tools. This research

project was based on an earlier study of nursing students using blogs and sharing

This pilot research was made possible through a grant from the Office of AcademicAffairs and the Provost at North Carolina Central University, in Spring 2011. The primarygoal of the grant was to provide an opportunity to involve students in research. Student

participation included undergraduate Bilal Aleem (School of Business) and was enhancedby the subject involvement of 12 undergraduate nursing students. Additional, technicalassistance was available from Jason Prince Department of Nursing


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152 E. J. Roland et al.

medical error information in confidence. The researchers on the 2011 projecthave found that analyzing, for example, how students support each other duringschool, learn about drug calculations and NCLEX examination preparations, by

means of social networking could lead to ways to reduce errors as students developcommunication habits, share knowledge, and pay more attention to tasks.

Keywords:blogs, informatics, knowledge management, nursing, social networkanalysis, reflective learning

Introduction

Blogs (web logs) seem to be growing in popularity and are a

phenomenon of the Internet. Could blogging be an innovativetool for knowledge management (KM)? This article looks at theconcept of using blogs to store and share knowledge about health-care and healthcare education. A general research question iswhether information systems (IS) incorporating intranet-basedor restricted blogs might provide an innovative, user-friendlymethod for improving medical training and for identifying andpreventing medical errors. The researchers looked at a way touncover explicit and tacit knowledge about human-system situated

processes associated with nursing. Quality improvement infor-mation needed to be uncovered without threatening healthcareprofessionals in terms of ethics, legal problems, or job security.As a result, use of a confidential blog was established in a pro-tected, anonymous-posting system and was provided as an inter-active medium where the student nurses could share informationand develop knowledge securely.

As a form of KM, a blog is a web page with reverse chrono-

logical sequences of dated entries, usually with sidebars of profileinformation and usually maintained and published with the helpof a popular blog authoring tool (Kumar et al. 2004). A weblog user (a blogger) creates an Internet-based journal and/orresponds (posts) to statements by someone else on the web.Blogs provide a specific form of personal communication withthe public. On the Internet, they have even become a telecom-munications channel for the mass media (newspapers, magazines,

and television). However, blogs are not just a one-way presenta-tion of personal opinions, events, or interests; they can also be aninteractive medium for a community


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Blogging as an Educational Enhancement Tool 153

to nursing students present a challenge. Over the last few years,teaching methodologies and information sharing that impact thelearning capability of students in successful nursing educationprograms have been examined and overhauled. Within the lastfive or six years, social media such as Facebook, Twitter, and otherweb-based programs have excited healthcare students and havebeen used as an instrument of information sharing (Lee et al.2011; Maag 2005). In the fast- paced teaching of nursing stu-dents, information vital to health improvement through nursingeducation is often difficult to embrace and interpret, as well asimplement in an orderly fashion in a clinical situation. Most of

todays students focus on learning techniques used in high school:rote memorization and regurgitation. These learning strategies donot work very well in the acquisition of nursing knowledge neededto assess, plan, implement, and evaluate health care outcomes inthe clinical setting. Student nurses have few opportunities to enterinto in-depth conversation with faculty members or their class-mates in exploring the massive amounts of data they take fromone clinical situation to another.

Review of Literature

According to Schroeder (2003), blogs are Internet-basedinformation-disseminating tools that originated in the late 1990s,and have been described as a hierarchy of text, images, mediaobjects, and data, arranged chronologically on a web browser.They have also been described as automated, updated self-archived web pages that provide Internet links and permit openpublic responses. In the past tools such as journals (preferablytyped) have been used to motivate the student nurse to reflect onwhat has been learned. The journal allowed the learner to put hisor her own words down to express what they have learned. Using ablog or other web-based tools and phone apps, the student nursewould have the opportunity to receive reaction to postings andbe challenged by their instructor or other learners with regard towhat was learned on a particular day. With new technology, nurses

also will have the opportunity to respond critically to what oth-ers have written. In this pilot study, an Internet blog were chosen


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and evaluated in a non-threatening manner, or better still, theyevaluate themselves, then a more effective interactive learningexperience might be possible.

Health informatics is defined as the systematic applicationof information and computer science and technology to pub-lic health practice, research, and learning (Yasnoff et al. 2000).The project described in this article investigated blogging as aknowledge management tool for a healthcare environment inthe United States, where automated, information systems arebeing introduced to medical schools, hospitals, and clinics at afast pace. Emerging issues associated with healthcare manage-

ment and improving medical care worldwide make this researchpertinent and timely.

Furthermore, as OCarroll (2002) has defined capability orcompetency levels for IS in public health, the second level of com-petency in health informatics is the management of informationtechnology projects to improve the effectiveness of care, measure-ment of quality, or for research. Many medication errors are notreported in full or critical elements may not be captured due

to traditional, labor-intensive reporting mechanisms and/or dataentry techniques. Yet, quality improvements and effective cost cut-ting in healthcare depend on the accurate analysis and continualcorrection of errors in treatment and care.

Those who introduced the idea of blogs state that bloggingdaily will improve writing skills, instill confidence in written self-expression, and at the same time promote reflective thinking thatwill eventually permit the learner (writer) to appreciate ones ownpersonal thoughts or ideas (Schroeder 1999). Others also suggestthat the blogger will feel a sense of empowerment when writtenwork created by him or her is published on-line for others toread or react to (Jonassen et al. 1999). In other words, the blogbecomes a learning tool whereby the learner is required to inter-act with others using the written word. The learner becomes morecomfortable expressing him/herself in writing by daily bloggingand becomes adept at reviewing and challenging the written con-tributions of others (faculty and classmates). The blog, as seen

by the investigator, is another tool for student learning usingreflection.


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proved or disproved is that restricted-access blogs can be usefulin KM health informatics at hospitals. The first objective of thisstudy was to collect blog data from student nurses for one monthin order to analyze the text for health informatics and commu-nications data about training and process improvements. Eachparticipant was a consenting volunteer, and all names and identi-ties have been kept confidential. This study gave the investigatorsa chance to validate and verify the data collection methodologyand the conceptual theory of bridging information gaps (Dervin1992) in new media of blogs.

As Steve Cayzer (2004) discovered at Hewlett-Packard, blogs

can be the basis for a semantic network and provide a tool fordecentralized, informal knowledge management. In business andother environments, regularly using blogging tools can provide aframework to share and reuse information and data across applica-tions, enterprises, and user communities. In healthcare facilities,specific standards and practices must be followed, but processesare constantly revised as part of the learning environment associ-ated with quality assurance in medical care. Hospitals and clinics

must be learning organizations to survive as businesses and toattract both patients and healthcare workers.Concerning blogs and knowledge management, the research

on online personal logs is in a period of early research theoryformulation. Recent research shows that both social networking(Murphy 2009; 2010) and mapping have a place in healthcareand education (Lee et al. 2011). The variety of blogs and num-ber of users is astounding. Early blog research explored as manyas one million blogs worldwide (Kumar et al. 2004). Today thereare several million blogs on the web.

Proposal and Research Methodology

The investigators proposed developing and offering an environ-ment on the Internet where the student nurse might examine,reflect, accept, and challenge opinions of others in a settingthat allows a free flow of ideas, allows positive written exchange

between students, and also illustrates a process that in the endwill enable the learner to adopt new thinking that arises out


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clinical area, or from conclusions drawn by the student based ontheir own exposure to new ideas and new ways of problem solving.

Creation of a blog is not costly and can be created in threeeasy steps: establish login, define blog, and open blog to users.The goal is to assist the student in becoming more adept in writtencommunication and to assist in developing critical reasoning skillsto allow them more success in their nursing classes. They mightalso gain confidence in their ability to write and respond criticallyor objectively to the written work of others.

Because of the emphasis placed on regulations, charts, andprocedures, it was proposed that a blogs chat-like environment

might help nursing students share both explicit (procedure-based) and tacit (intuitive and less shared) knowledge moreeasily. Volunteers were recruited from a nursing course at NorthCarolina Central, a blog with limited access was established usingGoogle tools, and the nursing students were encouraged byinformation science research bloggers to share questions and dis-coveries. The subjects invited to participate voluntarily made upthe convenience sample of junior and senior nursing students.

Textual data would be used in qualitative analysis of primary top-ics and social network analysis of communications. As suggestedby a previous study (Swain 2006), an iterative application of tablesto sort and identify main topics was used. The results provideda summary of four major issues of concern. In addition, SocialNetwork Analysis (SNA) maps were created to illustrate the pat-tern of connections and flow of information in a blog-based socialnetwork.

Data Collection

Thirty students in a nursing course were invited to participate in asimple blog where privacy was maintained by invitation only to thewebsite and by using unidentified e-mail addresses so names werenot known to the bloggers or social media researchers. (Note:40% of the class participated voluntarily.) Subjects were juniorand senior nursing students invited to participate in an exercise

that should help propel their understanding and ability to synthe-size a large amount of information which they can then use todesign implement and evaluate nursing situations The prelimi


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A total of 60 postings (55 from student-subjects only) werecollected for analysis from the blogs of 12 participants (exclud-ing entries by researchers). The data included initial introductionof ideas or questions in blog entries, emotional expressions ofangst and joy, comments or responses to other blogs, and linksor references to news and educational information. Two collec-tions were conducted for study during iterative analysis and tableconstruction to document and record the textual data in the blog.Communication threads of networking were tracked using a basicSNA method. SNA maps were constructed to illustrate visually theblogging connections and the electronic social network.

Data Analysis

Initially data was manually sorted by blogger code name, numberof blogs, topics, and connections/responses to other blogs; then, atable was built showing this basic activity. Next, additional sortingand pattern mining of the textual data were done. A second tablewas constructed from the collected data for subject analysis after

the six weeks of blogging. Using subject analysis of the text, thedata was classified into four basic functional types covering themajor issues or concerns of the students:

Expression of stress or relief. Invitations, planning, and suggestions for study, exam prepara-

tion, learning, and time management. Resource sharing and specific web links to interesting articles or

news. Specific learning and education issues including criticism and

recommendations for nursing school programs and pedagogy.

Within these subject categories, the most common sub-topicsincluded:

Getting through semester exams Forming study groups Real world (compared to school) Ignoring self to care for others


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NCLEX Exam (for licensure) Resources (web sites and tools to help study) Techniques for relaxing Upcoming school year

Table 1 shows blog entry samples of the four functional typesand early analysis comments on the study. Preliminary analysisincluded evidence of a community of practice (CoP), a featureof knowledge management.

While the text-based table was used for qualitative data anal-ysis of topics, the SNA map was used to illustrate quantitative

participation and to show networking patterns of communicationand authority (who was responded to most often, for example).See Figure 1.

Social Network Analysis

As shown in Figure 1, analysis of immediate responses or commu-nication patterns produced a social network that identified two

very active knowledge participants posting original entries thatothers wanted to comment on (#6 and #8). Note: codes for 2 and9 not included (as they were introductory from researchers).Subject #8 was most active in responding to different bloggers andas shown in Figure 2, many wanted to respond to #8. The major-ity of other subjects only participated two or three times. Figure 2shows topic or theme connections among all bloggers comparedto Figure 1 that illustrates immediate responses (sequentially intime).

Concerning connections and themes, one blogger(#1) posted a comment that many responded to by topic ordirectly, but did not connect to other blog comments. However,another participant (#11) posted controversial comments aboutthe lack of hands-on work and political stress in nursing schooland then both received comments and responded further toother bloggers about the value of learning versus grades for over15 total postings. Subject #8 appears to be the primary knowledge

gatekeeper both issuing and receiving comments: making twelveoriginal postings and receiving the most (eighteen) responses.


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12/17


110

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FIGURE 1 Social network analysis map of blog-direct response.

comments compared to others. Popular comments providedthe most stimuli (21 out of the 55 total by students) suggest-ing broad sharing. Commenting outnumbered individual post-

ings that received no comments. Only two participants (#1 and#13) were solo or monads and posted new topics, but didnot re-post or comment on others. One participant joined latebut reviewed the whole blog, commenting on just two postingsthat started communications a month before and were popularthroughout the study period (suggestions for junior year, whichparticipants had just finished, and current summer activities forstudy, preparation, or relaxation).

In comparison, there were five participants that estab-lished chains of communication in which one posted, the otherresponded, and the original posted a response to the response.The five created four such chains or dyads. One of the dyadsrepresented five links, meaning two more responses to eachother. Such communications suggest depth in the connectionsand potential for sharing, analysis, and dialogue as required ina community of practice or educational cohort.

Discussion


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the students learn and share knowledge? As this blogging studyshows, the student is stressed and becomes unsure of him/or her-self wondering when will it all end and they make it into the realworld of work as a qualified, registered nurses.

The nurse educator is even more baffled as to why seeminglybright students almost overnight begin to doubt their capabilitiesand to lose faith in their own ability to learn. Recent informa-tion science literature leads educators and healthcare providers tobelieve that the current information age with web-based and smartphone communications that engulfs these students has suddenlybecome a force they must reckon with if they are to be success-

ful in reaching their goals. This pilot research study endeavor onblogging as a social networking activity was an effort to addresssupplemental learning modalities that student nurses might use toanalyze their own learning and to assist themselves and their class-mates in conquering the information divide that seems to detertheir mastery of available information.

The convenience sample provided insight into stress withfinal exams, skepticism about reading versus applied practices,

and supportive collaboration on studying ideas and resources,such as links on the web. The goal of the research project wasto explore the impact of blogging as a tool in synthesizing nursingknowledge. The assumption was that in this age of informationtechnology students are very astute when it comes to masteringthe use of certain communications technology. However, thesesame students often have deficits in presenting or writing infor-mation. They express themselves quite poorly in written work andare often unable to extract the essence of the messages embeddedin the masses of scientific reading and writing that they encounteron a daily basis. The study showed clear and expressive writing thatwas good grammatically and structurally with logic and few errors.Analysis of grammar and writing style showed good skills in writ-ing when the media was personal, confidential, and an extensionof formal training.

Another purpose for proposing the use of social networkingas an approach to learning was to enable and empower the student

in the acquisition of knowledge for their own sake and for theirpersonal success in reaching their professional goals as a practic-


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A statement often heard is that aspiring students do not knowhow to communicate in writing and neither do they know howto deconstruct scientific concepts into language that will helpthem be more successful in the classroom. This blog study contra-dicts that assumption. Participants showed stress at the start andlow confidence. Over time there was sharing and collaborationabout goals, as well as strong critiques of education methods andpractices.

Conclusion

The study provided proof of concept and showed that blogs cansupport communities of practice (CoP), a significant conceptin knowledge management. For students, establishing cohortsor study groups increases chances of success. Therefore, knowl-edge system architecture for web-based and smart phone sharing(blogs, instant messaging, wikis, and Facebook-style forums) mightprovide effective tools for discovering information as students,and later as professionals, trust communications to share and

uncover medical-errors. Such collected information and textualdata could be used with analytical tools to create knowledge-basedreports that improve training procedures for students and providequality assurance tools for professionals.

The study analyzed blog data about studying, stress, proce-dures, time management, quality assurance, emotional support,and work definitions, and researchers found that there is potentialin regularly using social media tools in a medical or health-care environment as a framework for knowledge architectureand management. Blogging can support sharing and reusing per-sonal knowledge to improve processes and communication inhuman-system environments where knowledge is crucial, such ashealthcare and education. Results suggest the need for furtherstudy and the application of more sophisticated tools (such asapps for handheld devices and smart phones) for collaboratinginstantly and displaying the most current information as part ofnursing training and informatics.

The overall results of this pilot study suggest there is poten-tial for using blogs to store and share knowledge about nursing


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confidence and provide new, technology-based forms of learningin school and improving practices in the real world of nursing.

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Roland, E. Joyce, Charlene Johnson, And Deborah Swain. Blogging as an Educational Enhancement Tool for Improved Student Performance a Pilot Study in Undergraduate Nursing Education