at SciVerse ScienceDirect
Nurse Education in Practice 13 (2013) 524e528Contents lists availableNurse Education in Practice
journal homepage: www.elsevier .com/neprTeachers experiences of teaching in a blended learning environment
Pirkko Jokinen*, Irma Mikkonen 1
Savonia University of Applied Sciences, School of Health Care, P.O. Box 1028, FI-70111 Kuopio, Finlanda r t i c l e i n f o
Article history:Accepted 19 March 2013
Keywords:Blended learningLearning technologyNurse education* Corresponding author. Tel.: 358 44 785 6466.E-mail addresses: email@example.com (P.
savonia.fi (I. Mikkonen).1 Tel.: 358 44 785 6469.
1471-5953/$ e see front matter 2013 Elsevier Ltd.http://dx.doi.org/10.1016/j.nepr.2013.03.014a b s t r a c t
This paper considers teachers experiences of teaching undergraduate nursing students in a blendedlearning environment. The basic idea of the study programmewas to support students to reflect on theoryand practice, and provide with access to expert and professional knowledge in real-life problem-solvingand decision making. Learning was organised to support learning in and about work: students workedfull-time and this provided excellent opportunities for learning both in practice, online and face-to-facesessions. The aim of the study was to describe teachers experiences of planning and implementingteaching and learning in a blended-learning-based adult nursing programme.
The research method was qualitative, and the data were collected by three focus group interviews,each with four to six participants. The data were analysed using qualitative content analysis.
The results show that the blended learning environment constructed by the combination of face-to-facelearning and learning in practicewith technology-mediated learning creates challenges thatmust be takeninto considerationwhen planning and implementing blended teaching and learning. However, it providesgood opportunities to enhance students learning in and about work. This is because such programmessupport student motivation through the presence of real-life and their relevance to the students ownplaces of work. Nevertheless, teachers require knowledge of different pedagogical approaches; they needprofessional development support in redesigning teaching and learning.
2013 Elsevier Ltd. All rights reserved.Introduction
Health care practice has been transformed by changes in science,technology, and the nature and settings of nursing practice. Theemphasis on client-centeredness has also had a role in this trans-formation. The demands of complex practice require better-educated nursing professionals. There is a need for competentnurses who have the knowledge, skills and abilities that enablethem to work effectively. The four features that describe a compe-tent nurse are: professional practice, critical thinking and analysis,the provision and coordination of care, and collaborative and ther-apeutic practice. In addition, a competent nurse has to be ready forlife-long, and often self-directed, learning (Benner et al., 2010).
Changes in nursing practice have implications for nursing educa-tion. Educational organisations have to respond to challenges in thesociety and work environments. Such challenges may comprise, forexample, a shortage of nurses, an increase in the number of adultnursing students entering education, as well as taking into accountlearners versatile needs. Life-long learning and multiple approachesJokinen), irma.mikkonen@
All rights reserved.are required to meet these challenges. Furthermore, the practice-education gap constitutes a challenge that forces educational organi-sations and working life to find new ways to educate nursing pro-fessionals. New understanding of the nature of the curriculum andpedagogy, and changes in the pathways to nursing competency areneeded. A blended learning approach might be a useful way to meetthe challenge. Garrison and Vaughan (2008, 148) define blendedlearning as the organic integration of thoughtfully selected andcomplementary face-to-face andonlineapproaches and technologies.
Savonia University of Applied Sciences in Finland launched acompetency- and practice-based nursing education programme inthe autumn of 2010. The curriculum is based on the blendedlearning approach, and the purpose is to develop nursing studentssituated knowledge, skills and ethical consciousness. In the pro-gramme, blended learning environment was constructed bycombining face-to-face learning and learning in practice withtechnology-mediated learning. The basic idea of the curriculum isto invite the students for dialogue between theory and practice, andprovide access to expert and professional knowledge, skills andattitudes in real-world problem solving. For example, the studentsare triggered to use context-specific theoretical and practicalknowledge together with professionals in solving patient relatedproblems; it is suggested that this helps the students to gain deeperunderstanding of the situation, to get an insight to expert and
P. Jokinen, I. Mikkonen / Nurse Education in Practice 13 (2013) 524e528 525professional knowledge, and promotes the integration of theoryand practice. The education is part of the EU-funded project: SaWee To become a competent nurse in networks and nets, 2010e2013.The aims of the project are to develop an innovative educationmodel for adult nursing learners in collaboration with health carepersonnel, and to construct a model which combines nursing stu-dents learning with development of health care practices. A total of45 adult full-time working undergraduate students started theprogramme. The programme includes approximately 30 contactdays per year, and the main portion of the study is implemented atwork, supported by eLearning.
As a framework for the curriculum, the blended learningapproach enables the students to be exposed to a variety of learningexperiences. A blended learning environment involves, for example,face-to-face and online lectures, simulations, work-shops, self-directed learning and online discussions and learning. New inter-active technological equipment, such as desktop videoconferencingsystems, combined with the blended learning environment mightpromote students social presence and interaction in learning (Kligerand Pfeiffer, 2011). As advantages of blended learning have beenmentioned flexibility (Graham, 2006; Ocak, 2010), freedom of timerestrictions (Ocak, 2010), pedagogic richness and cost-effectiveness(Graham, 2006). One of the many challenges in all education is howto increase students autonomy as learners; how to maximize theirself-direction, content choice and becoming central to their ownlearning process (Reynard, 2007; Rigby et al., 2012). There is evi-dence that blended learning may increase learner autonomy(Reynard, 2007) and encourage life-long learning (Ireland et al.,2009; Rigby et al., 2012). These are both factors that have beenviewed as essential skills of a competent nurse (Benner et al., 2010).
The review of literature concerning blended learning reveals thatthere are many issues that teachers have to take into considerationwhen creating blended learning. In particular, the teachers mustthink the pedagogical implications through carefully, and make newdesigns for instruction and course delivery (Mccown, 2010;Mohannaet al., 2008; Reynard, 2007). They must choose the methods that areappropriate to the aims of the course (Mccown, 2010). Ocak (2010)has categorized factors of potential barriers to the use of blendedteaching into three groups: instructional processes; communityconcerns; and technical issues. Instructional processes e includingthe complexity of the blended learning environment, a lack of timefor preparation and planning the teaching, challenges in encouragingstudents to use the online section of the course and time manage-ment e were the most commonly mentioned reasons for not usingblended teaching. Community concerns, that is, a lack of institutionalsupport and the demands of changes in the teachers role, mightprevent a teacher from putting blended teaching into operation.Potential barriers impeding the embracing of blended learning couldalso be linked with teachers and students discomfort with tech-nology, insufficient technical support and inadequate hardware.However, well-organized technical resources promote the studentsengagement in the learning process (Kliger and Pfeiffer, 2011; Rigbyet al., 2012), and increase teachers involvement in programmingblended teaching and learning (Reynard, 2007).
The purpose of this article is to raise discussion about the use ofa blended learning approach in nurse education from the teachersperspective. The combination of face-to-face, online and practice-based learning creates challenges that have to be taken intoconsideration when planning and implementing blended teachingand learning.
Aim of the study
This study was designed to obtain an insight into how teachersrespond to the use of blended learning in nurse education. The aimof the study was to describe teachers experiences of planning andimplementing teaching and learning in a blended-learning-basedadult undergraduate nursing programme.
Data collection, informants and analysis
The research method was qualitative, and the data werecollected by focus group interviews. A focus group is a form ofmoderated group interview that stimulates communication andinteraction between research participants in order to generate data(Kitzinger, 1995; Krueger, 1994). The benefits of the method havebeen seen in that that it provides an opportunity to collect dataquickly and simultaneously from several people. Nonetheless, in asuccessful focus group, the participants are encouraged to talk toone another: participants ask questions, exchange opinions andattitudes, comment on each others experiences and points of view,and explore and clarify their views. (Kitzinger, 1995; Krueger, 1994;Shaha et al., 2011.) When the group dynamics work well, themoderator may remain in the background: the moderators role ismainly to stimulate a lively debate, and maintain confidentiality(Shaha et al., 2011). For the most part, this method has been usedfor exploring peoples experiences (Kitzinger, 1995; Krueger, 1994).
In this study, a total of three focus groups, each with four to sixparticipants, were conducted. The participants were the teacherswho had been engaged in the teaching and learning process of thenursing student group during the first study year. The themeinterview process was employed. The themes in the interviewswere: the common design of the course; teaching approaches inthe blended learning context; designing assessment of learningoutcomes, thoughts on technology in teaching; and experiences ofteaching in this nurse education programme. The interviews werescheduled and the participants were informed about the themes ofthe interviews beforehand. The interviews lasted approximately90 min and there were always two researchers present: one as amoderator and the other as a facilitator. Themoderators rolewas toensure that the discussion in the group ran smoothly, and thefacilitators role was to observe, and ask more detailed questionswhen necessary. The participants and researchers were teachersin the same organisation and knew each other previously. Thefocus group interviews were recorded and transcribed by theresearchers.
The data were analysed using qualitative content analysis(Elo and Kyngs, 2008). Firstly, the transcript data were arrangedaccording to the themes of interviews. Secondly, within each themethe analysis proceeded inductively through the categorisationprocess into themes which describe teachers experiences ofteaching in blended learning environment.
Ethical and reliability considerations
The researchers obtained permission from the research orga-nisation before commencing the research. Ethical approval was notrequired as this research was part of the EU-founded SaWe-projectevaluation. The project itself and evaluation within it have beenaccepted as one of the education development projects at SavoniaUniversity of Applied Sciences. Prior to the focus groups, eachparticipant was provided with both a written and verbal explana-tion of the interview and the research. Participants gave their oralconsent to being interviewed and audiotaped. Before each inter-view, the participants were informed that they were allowed torefuse to answer any question, and that they were free to withdrawfrom the research at any time. It is important to remind participantsof secrecy in focus group interviews: the confidentiality of all the
P. Jokinen, I. Mikkonen / Nurse Education in Practice 13 (2013) 524e528526information shared in the groupwas discussed before the interview(Kitzinger, 1995; Krueger, 1994).
In this study, the researchers were doing research on their ownwork environment which was an issue that required specialattention. The situation has both advantages and disadvantages(Bonner and Tohurst, 2002; Field, 1991). In this study, advantagewas that the researchers and informants were familiar with eachothere it was easy to gain acceptance, trust and co-operation in theinterviews. As the researchers worked in the organisation theyknew the culture, daily language and local conditions very well. Thedisadvantage of the insider situation might be that it poses athreat to the trustworthiness of the study (Bonner and Tohurst,2002; Field, 1991). However, personal bias was avoided by carefulcollegial peer-reflection of two researchers: the colleague was usedin all phases of the study to increase the objectivity of the processby examining critically assumptions and actions in relation to datacollection and analysis.
Nine themes emerged from the data to describe teachers viewsabout planning and implementing teaching in a blended-learning-based adult nursing programme. These were: collaborative plan-ning; integration; student group; face-to-face teaching; onlinelearning; learning activities; teaching and learning methods;learning in and about work; and confirming competences.
Collaborative planning was perceived as necessary in the teach-ers experiences about planning and teaching in a blended learningbased programme. The teachers attitude towards joint planningwas mainly positive: they experienced that collaborative planningsupported the integration of learning content. In addition, theteachers thought that the joint planning supported the develop-ment of teachers expertise as well as the development of teachingand learning. Moreover, the teachers perceived that joint planningenhanced the transfer...