Canadian Journal of Nursing Informatics

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This article was written on 23 Sep 2013, and is filled under Volume 8 No 3 & 4.

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Undergraduate Online Program Development, Implementation and Evaluation: A Pilot Study

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by Priscilla O. Okunji, Ph.D., RN-BC, INS;

& Mary H. Hill, DSN., RN

Howard University, School of Nursing and Allied Health, Washington DC
Division of Nursing

Corresponding Author: Priscilla O. Okunji, Ph.D., RN-BC, INS
Email: priscilla.okunji@howard.edu

Abstract

 This article presents an exploration of the development,  evaluation and program review of a newly implemented online undergraduate RN (Registered Nurses) to BSN (Bachelor of Science in Nursing) degree program. This process included the incorporation of informatics into the new curriculum, development of a program brochure and flyers for student recruitment, course module design, development of the synchronized and a-synchronized learning platform, student and faculty need assessment and orientation tools as well as development of data sets and analysis for the program evaluation. A one year academic review indicated that the overall assessment of the program was confirmed and predicted by the faculty characteristics, students’ professional/personal gain and level of satisfaction. Faculty dedication and students satisfaction of the program were highly significant when compared with overall quality of the program with 99.6% of the predictors explained in this study. Hence, this study has demonstrated that faculty dedication and student satisfaction are critical variables when planning the integration of online teaching and learning in any institution of higher learning.

Keywords: Online, Undergraduate, Informatics, Integration, Curriculum, nursing education, program review, curriculum development

Introduction

Today, many educators and policy makers view online education as the wave of the future. Students are eligible to apply for financial aid (a change in recent years), online delivery provides schedule flexibility, cost effectiveness and does not require students to relocate to a new place to attend classes or forgo full time employment. This mode of learning favors international students and military personnel working overseas. Taking online classes allows students to not only remain in their current positions in their respective countries while attending classes but could save space, time and money for both students and educational institutions. These benefits can provide more time for faculty scholarly activities and added value to the bottom line of any institution and group of students. This approach also supports the accumulation of documents, transcripts, virtual classroom activity, wiki discussions and training materials that can be archived and recorded. Online instructors are virtually available, respond quickly through email, and generally are prepared to work with diverse student needs. If done well, online nursing programs can enable nurse educators to better facilitate optimal educational experiences for students (Cobb, 2011).

 Background

Online learning can be seen as a wave of the future that provides access to career advancement opportunities for many people – especially for associate degree holders who want to advance their career to a higher degree in a particular field. Although methodologies used to deliver online learning are diverse and well documented in the education and technology literature, ranging from video conferencing, satellite access, and Internet delivery (webinars, Skype, Ovo, learning management systems, and so on), the learning and development experiences derived from designing an online RN to BSN program could be valuable and replicated in many other institutions and developing countries.

As post-secondary education is becoming more accessible than ever and online education is viable for those with busy lifestyles, associate degree nursing (ADN) holders seem to be a ripe target for such technology ventures. This is especially pertinent since some states in the United States are deciding whether to finalize Bills that would mandate all ADN nurses must obtain a baccalaureate degree in nursing (BSN) to continue working in acute care hospitals. According to Hart and Morgan (2010), although online programs are relatively new in nursing education, the number continues to expand due to the demand. However, they also point out that it is important that the planning of any distance learning program starts with the development of effective learning communities. Learning communities offer a social context for learning that greatly enhances the knowledge acquisition of students ( Tilley, Boswell, and Cannon, 2006).

Many institutions, particularly in developing countries are finding it very difficult to develop online programs due to a lack of qualified personnel who can train faculty instructors to use new technologies (Rajesh, 2003). Likewise, it is challenging to keep all personnel abreast of forever changing learning technologies. A lack of adequately trained personnel is an impediment to the smooth growth of any online distance learning program.

Costs of system maintenance are included in the planning phase. This is due to the fact that frequent usage may render the system non-functional thus maintenance needs to be continuously supported. As well, sufficiently trained staff, high capacity servers, and system-friendly attitudes, knowledge and skills in the users are all essential for risk reduction during the planning phase (Ranesh, 2003).

Our online program came into being in July 2010 when Howard University, Division of Nursing  in Washington, DC decided to integrate the first online RN to BSN degree with the already existing traditional undergraduate program in order to extend the strategic planning of the Health Sciences division. This program was designed to meet the needs of adult students, especially Associate Registered Nurses, who seek baccalaureate study in preparation for career advancement.

At present, the third cohort will be graduating in May 2013 and 100% of the second cohort students initially enrolled in this program have been retained. Program support, technology support, and social support from peers encouraged the RNs to “stay the course” and complete the requirements to graduate ( Davidson, Metzger, and Lindgren, 2011). Hopefully, review of this program will contribute to the health sciences goal of identifying best strategic planning practices, so that online programs are sustained in terms of quality, effectiveness, and accountability. As this article reflects, the initial efforts in the program assessment are a starting point but small sample size and developing instruments may restrict accurate interpretation of a concrete summative evaluation in this study.

 Methods

The RN to BSN Track is a program of study for the RN with an associate degree or diploma to study for a BSN Degree. Students are awarded thirty one credit hours from their previous nursing program of study and may complete the degree requirements in a minimum of one year of full-time study or longer for part-time study. The program of study starts in the summer and continues for two full semesters or more for part-time students. Students can complete all courses and graduation requirements through synchronous and asynchronous online distance learning.

The online program was implemented in four phases. The initial phase started with the development and incorporation of informatics into the new curriculum according to the American Association of Colleges of Nursing objectives. This led to phase two which entailed the development of a program brochure and flyers for RN recruitment from the University hospital and ended with student admissions. The third phase was focused on the expansion of online examinations in the entire undergraduate program. The fourth phase focused on the integration of e-documentation which will prepare students to fit into the paperless status that all acute hospitals in the United States must assume in 2014.

Our online program commenced with two consecutive weekend orientations to familiarize the students with the activities of the program. For the first weekend, a mandatory face-to-face workshop was offered to preview the Division of Nursing customized course web page. In these “Orientation Days,” advisory sessions were also offered and conducted. The incorporation of recommendations such as introducing a uniform course web page, providing orientation to e-learning systems and promoting the usefulness of the e-learning system have made the online program more user-friendly for the students . Additional information about synchronous and asynchronous learning methods, scholarly writing, APA format, plagiarism, literature search, search engines, and portfolio presentation were also included in the orientation. Technology training is also made available to new students during Orientation Days as well as through the school computer laboratory by our Informatics nurse throughout the semester.

Traditionally, the Division of Nursing used the Blackboard learning management system for student communication and grading but few instructors have incorporated instructional technology beyond the use of e-mail for communication and the Internet for assignment submissions. The launch of this new program included the development of online syllabi organized in distinct modules, course activities and assignments to meet the existing traditional course objectives within an online environment. The Division of Nursing expanded the use of Blackboard add-on capabilities as well to enhance synchronized and a-synchronized teaching methods for the new online program.

A phase-in period of two semesters allowed this development from traditional to partially online with a 100% online program available within six months. The faculty course development was not funded and no workload credit was awarded, thus the process took longer than usual to complete. The program uses multiple technologies such as e-mail, student-produced video to present an assignment, wikis, blogs, and the virtual classroom in Blackboard, as well as Webinars for one of the elective courses.

The Review: Online Survey Design and Analysis

At the end of the second semester, student qualitative data were collected via a survey with two main sections, focused on:

(i) students’ satisfaction about the program and perspective about the online faculty and

(ii) impact of the online program on student professional and personal growth.

As well, an online survey about the students’ satisfaction of the online program, students perspective about the online faculty and the impact of the online program on the students professional and personal growth was conducted using a 6 point Likert scale questionnaire {(very low (1), low (2), medium (3), high (4), very high (5), not applicable (0)} to generate quantitative data about the online program.

This quantitative data were analyzed to determine the outcomes of the program using 24 variables as depicted in Tables 1 and 2. The data were subjected to descriptive, chi-square, and analysis of variance (ANOVA) statistics to analyze these variables and guide model development.

Table 1: Student Perception and Satisfaction of the Program

Okunji_table1

 

Table 2 showed the frequency of the student professional and personal growth responses according to different levels from very low to very high and not applicable as shown below.

Table 2: Professional and Personal Growth Responses

Okunji_table2

 Findings

Out of the eight students that were initially enrolled in the program, twenty five percent had previous online learning experience while seventy five had none. The study shows that the students preferred the flexibility of the online learning compared with the traditional classroom instruction experience. Career preparation/job enhancement was a significant factor when quality of education was compared to other online education the student had (see Table 3).

Table 3 shows that career preparation and job enhancement were significant, X2 (2, N = 8) = 8.000, p = .018 when the quality of education at Howard was compared with other online education attended.  

Table 3: Quality of education compared to other online educational programs attended versus Career preparation/Job enhancement

Okunji_table3

 

Faculty dedication and faculty satisfaction were highly significant when compared with overall quality of the program with 99.6% of the predictors explained in this study (see Table 4).

Multivariate Analysis

Table 4 shows that faculty dedication and accessibility were highly significant, R2 = .996, F(6, 8) = 75.593, p < .013, when compared to the overall quality of the program with 99.6% of the predictors explained.

Table 4: Multivariate Analysis — Linear Regression Model

Okunji_table4

 

Finally, the linear regression model generated from the statistical output showed that overall assessment of the program was predicted by the faculty characteristics, professional/personal gain and level of satisfaction (see Figure 1).

Figure 1 shows the comparison between instructions of flexibility with the traditional classroom instruction experience.

Figure 1: Instruction in terms of flexibility compared with traditional (classroom) instruction experienced before or since

Okunji_figure1

This model could be used in the future by any institution planning on integrating online teaching/learning tools into their program. This model has shown that faculty characteristics, students’ professional/personal gain and satisfaction of the program must be considered prior to implementation of any online learning.

 

Discussion and Conclusion

A significant difference was found in perceived professional values depending on level of nursing education, position or title, and professional organization membership. The highest level of perceived professional values was expressed by RN-BSN students when compared to other registered nurses with associate or lower degrees in nursing ( Kubsch, Hansen, and Huyser-Eatwell, 2008). RN to BSN students described their pursuit of a BSN as a “journey of being” and “becoming professionals” (Rush, Waldrop, Mitchell, Dyches, 2005).

Our RN to BSN online program is a positive venture to empower registered nurses who may not be able to obtain their BSN due to numerous responsibilities and busy schedules. The choice of system and design of online programs are of paramount importance to ensure that the objectives and goals of the project are met and fulfilled. In the planning phase when considering which system to use, the school should consider acquiring a server that would meet and exceed the capacity of the program activities as it grows, as well as its cost effectiveness, user friendliness and pedagogic value. Results from the present study provide collaborative evidence regarding students’ satisfaction related to this particular online program. Most of the students embraced the online program and wanted all of the traditional nursing courses and programs to be offered online.

Significance of this study

Additional courses using hybrid programs have been developed and implemented in our Nursing Leadership and Informatics and Technology courses. The Graduate Nursing Division has launched a online Nurse Educator track in January 2012 due to the success of this RN-BSN online initiative. Finally, other universities and colleges could replicate the Nursing model for online implementation with good strategic planning that resist impending risks. Similarly, courses could be developed to meet the needs of people living outside the United States.

Recommendations

Overall, there should be consideration for qualified personnel, continuous system maintenance, faculty training, tools needed for delivery, flexible methods, friendly usability, likeability, knowledge and incorporation of adult learning principles and incentives for instructors to develop their online teaching knowledge and skills. Future study would also be enhanced by using more students (higher sample size) for more reliable and validated results.

References

Cobb, S. C. (2011). Social presence, satisfaction, and perceived learning of RN-to-BSN students in Web-based nursing courses. Nursing Education Perspective. 32(2):115-9.

Davidson, S. C, Metzger R, & Lindgren, K.  (2011). A hybrid classroom-online curriculum format for RN-BSN students: cohort support and curriculum structure improve graduation rates. Journal of Continuing Education in Nursing, 42(5):223-32.

Hart, L. & Morgan, L. (2010). Academic integrity in an online registered nurse to baccalaureate in nursing program. Journal of Continuing Education in Nursing, 41(11):498-505.

Kubsch, S., Hansen, G., & Huyser-Eatwell, V. (2008). Professional values: the case for RN-BSN completion education. Journal of Continuing Education in Nursing, 39(8):375-84.

Rajesh, M. (2003). A Study of the problems associated with ICT adaptability in Developing Countries in the context of Distance Education. Turkish Online Journal of Distance Education-TOJDE, 4(2). http://tojde.anadolu.edu.tr/tojde10/articles/Rajesh.htm

Rush, K.L., Waldrop, S., Mitchell, C., & Dyches, C. (2005). The RN-BSN distance education experience: from educational limbo to more than an elusive degree. Journal of Professional Nursing 21(5):283-92.

Tilley, D.S., Boswell, C. & Cannon, S. (2006). Developing and establishing online student learning communities. Computers and Informatics in Nursing, 24(3):144-9

 

Author Biographies

 

Priscilla Okunji, Ph.D., RN-BC, INS

Dr. Priscilla Okunji has been on nursing faculty at Howard University since August of 2009. She has a Bachelor and Master’s degrees in Medical Microbiology and a Post graduate degree in Education before relocating to join her husband in United States. Dr. Okunji is the Coordinator of the first and only RN-BSN Online which she developed and implemented at Howard University in summer 2010. She is the current winner of the 2011 Center for Excellence in Teaching, Learning and Assessment (CETLA) Award for, “Teaching with Technology,” at Howard University. Dr. Okunji also has a Master’s degree in Nursing Informatics from the University of Maryland and recently earned her doctoral degree in Health Sciences with a specialization in International Health and Research.

She held several managerial positions as Clinical Coordinator, Director for Nursing Education and Quality Assurance. Her professional background merges over sixteen years of teaching, clinical and research experience in Microbiology, Nursing and Informatics. Dr. Okunji has board certification in Medical Surgical Nursing and her scholarly paper at the University of Maryland inspired her into using the Agency for Health Research and Quality (AHRQ) large database to study the “Outcomes of Diabetic Myocardial Infarction Inpatients: Patient and Hospital Characteristics” as her Ph.D. dissertation. Dr. Okunji has presented and published in peer review journals such as Circulation and Diabetes. Dr. Okunji is currently a Principal Investigator of a funded grant—“Comparative Health Disparity Outcomes of Inpatient Care”, supported in part by NIH, National Center for Minority Health and Health Disparities.

Mary H. Hill, DSN, RN

Mary H. Hill is the Interim Dean and Professor at College of Nursing and Allied Health Sciences, Howard University in the Washington District of Columbia. Dr. Hill obtained her Baccalaureate in Nursing from Tuskegee University, Masters in Nursing from University of Maryland and Doctor of Science in Nursing University of Alabama at Birmingham. Prior to joining Howard University she held many administrative positions in many colleges and universities. Dr. Hill’s Research interest includes Breast Cancer among African American Women, Obesity, Diabetes Consumer Education, Organizational Development, Cultural Diversity in Organizations and Outcomes Assessment and Evaluation. She has authored and coauthored selected peer reviewed publications. She is a renowned advocate for disadvantaged students as evidenced in her serving as a project director for many funded grants on the Scholarships for Disadvantaged Students at Howard University. Dr. Hill has had many awards including a visionary leader award which correlates to her believes that technology integration in the curriculum would lead nursing profession to a new horizon, hence the implementation of the online RN-BSN at Howard University Division of Nursing.

 

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