By Zarqa Ahmad, BSc-EnvtChem	Jennifer Anderson, BSc-Bio, CDA
Jenna Bissoondatt, BSc-Bio	Porsche Campbell, BSc-Nut
Tany Dhaliwal, BSc-Kin	Gurjeevan Dhami, BSc-Bio
Megan Durrant, BA-HSc	Abbi Fowler, BBA-HR
Tenaia Gatland, BSc	Manpreet Gill, BSc-MicroBio/Immun
Emily Hannaford, BA-Counsel	Haylee Hamsvall, BSc-Phys-Pharm
Michelle Harbott, BSc-Kin	Rachel Hendry, BSc-Kin
Sarah Hillsdon, BSc-Kin	Michael Izatt, BA-Phil
Aliya Khan, BSc	Magdalena Marzec, BSc-Kin
Annalise McLean, BSc-Kin	Anna Montabello, BEd, MA
MacLean Myers, BSc-Kin	Chelsea Reimer, BSc-Mol.Gen
Hannah Roy, BA-MedGeo	Emily Shergill, BA-Crim
Gurneet Tatla, BA-Soc	Elise Teleron, BSc-MicroBio
Matthew Tucker, BSc-Kin	Cassidy Wald, BA-Crim
Athena Williamson, BA-Geog	June Kaminski, RN MSN PhD(c);

Background and Philosophy

It is undeniable that there has been a tremendous shift toward technology- centred societies worldwide.  Specifically, the prevalence of online learning has unfolded in this wake. Online and partially online (hybrid) learning, like anything else, present both strengths and weaknesses. Condon and Garcia (2014) argued that online education could potentially minimize obstacles that may otherwise prevent the furthering of education. Such obstacles are defined in the article as “financial, social, and geographic barriers” (Condon & Garcia, 2014, p. 1).  Maximizing the opportunity to further education via the use of technology can have far-reaching societal benefits.

In contrast to the benefits technology can serve in a learning environment, disadvantages are also important to consider. If online education is improperly facilitated, Condon and Garcia noted that it runs the risk of being “disengaging, impersonal, and costly” (2014, p. 1).  Such factors could discourage the pursuit of further education.

Nursing education prepares nurses with the tools to thrive in the highly demanding work environment of working in a hospital and other healthcare settings. The goal of nursing education is to prepare nurses that can adapt to new information, while using new technology and making complicated judgement calls to provide the best care in competent ways (Bromley, 2010). Nursing education poses unique challenges when using conventional online learning environments which has caused many nursing educators to question if the online environment is an effective delivery style for student nurse learning.

Online learning has its advantages and disadvantages as outlined in a study by Bromley (2010) focused on the use of online learning in nursing education. In this study, Bromley found that disadvantages created by online learning were minimized by ensuring easy access to the technology needed for a program, technology support and having sufficient facilitation of both the online and clinical areas. Bromley (2010) also found that quality online learning helps to promote critical thinking with higher order thinking skills, while allowing the student nurses to attain their own teachable moments. As well, the online nursing education environment allowed students to learn in their selected environment thus they did not have to leave their home, family and friends to learn.

Technology has become a part of everyday life and resources that were once almost impossible to attain are now available right at people’s fingertips through the online world. Parker and Wassef (2010) analysed the use of online learning for graduate nursing students and found that programs varied in effectiveness. The more effective programs promoted online participation and interaction, and students appreciated programs that offered a sense of community as well as flexible hours (Parker & Wassef, 2010). Inconsistencies between program delivery methods should motivate different programs to analyse their own effectiveness in teaching and learning to improve the online learning environment. With the increase in online learning environment use to lead many more students to the workforce, there is controversy over whether these students can meet the high demands of the working reality of healthcare.

Research results regarding the use of technology in postsecondary education have proven to be variable (Henderson, Selwyn & Aston, 2015). This emphasizes the relevance of conducting a qualitative study to examine the perceptions of second degree students related to their experience with using various technologies within a hybrid nursing program.  A phenomenological approach was used to explore the perceptual themes of the nursing students’ lived experience in using technologies to learn nursing theory and prepare for nursing practice.

Study Design

Phenomenology is a science and a philosophy used in research that focuses on human lived experience with a certain event or phenomenon of interest (Streubert & Carpenter, 2011).  Phenomenological nursing research is valuable, as it fits with a holistic, responsive approach which involves treating humans as a whole, listening perceptively, and empathizing without bias (Balls, 2009).  This research study on nursing student’s perceptions and unique experiences in using various technologies in a hybrid nursing program used a phenomenological, qualitative approach. This approach fit because as Balls (2009) described, “it is a person’s ‘lived’ experience in relation to what is being studied” (p. 30).  Studying student nurses’ perspectives in using various technologies in their specific programs has likely been studied before.  However, LoBiondo-Wood, Haber, Cameron & Singh (2013) argued that “phenomenological research is an important method with which to begin studying a new topic or a topic that has been studied but needs a fresh perspective” (p. 169).  Using the phenomenological approach gives value to each individual experience, as no one person can have the same exact experience as another person (Streubert & Carpenter, 2011; Balls, 2009).

Streubert & Carpenter (2011) explained that nurses may be faced with “practice, education, and administrative experiences that seem to present patterns that are familiar to us.  To validate our perceptions, research must be conducted to explore and describe phenomena fully and accurately” (p. 97).  Although patterns can be familiar to us, researchers should enable bracketing, which means that the researcher identifies their own experiences, thoughts and beliefs about the phenomenon, and separates them out of the data collection process and the research study, as illustrated in Figure 1.

The steps we used to carry out this research project included: Identifying the phenomenon and philosophy, structuring the study (Design, Research Question, Researcher’s Perspective, and Sample Selection), Data collection (online qualitative survey), Data analysis, Literature review and describing the Findings (LoBiondo-Wood et al., 2013).

Figure 1: This diagram illustrates the steps involved in carrying out this research study. (adapted from LoBiondo-Wood et al, 2013, p. 172-178).

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Methods in phenomenology research should include purposive sampling by selecting participants that will provide knowledge of an experience and will therefore make the research purposeful, then interviewing (or in this case, surveying) each participant about the phenomenon of interest to provide an exhaustive description of the lived experience (Streubert & Carpenter, 2011).  We administered an anonymous survey with six demographic and 20 qualitative, open-ended questions as our method of collecting data.  The questions were not leading, but did probe the participants to share many details of their experience.  This survey was made available in a secure forum to the members of each student cohort from semesters one, four, and seven of the hybrid program during the fall 2017 semester.  Older data from the literature was considered when investigating the phenomenon of using various technologies in an online based or hybrid degree nursing program, as this valuable research gives perspective and shape to the current study.  Our data collection approach represented a simple, non-invasive way to gather information from a reasonably large sample size, using a medium that was relevant to the research question.  The anonymous nature of the survey was expected to encourage participants to share their views candidly.

This methodological approach fit with the research question, as it used an online tool to gather information from students regarding their perceptions of using various technologies in a hybrid program. Thematic analysis was used to interpret the data. Thematic analysis involves reviewing the data from the sample and identifying unifying concepts or themes that appeared (Streubert & Carpenter, 2011).  The resultant themes were further explored to determine how they related to one another. This is referred to as an “exhaustive description” of the phenomenological experience being studied (Streubert & Carpenter, 2011, p. 46).

Sample Selection

Participants eligible for the study included all nursing students in the program enrolled in their first, fourth or seventh semester in the 2017 fall semester. This participant pool included 36 participants enrolled in their first semester, 38 were in their fourth semester and 35 were in their seventh semester. All participants were recruited through purposive sampling using the criterion that they were enrolled in the hybrid program. Purposive sampling is a common sampling technique used in qualitative studies to examine, inquire and explain participant knowledge and experiences (Streubert & Carpenter, 2011). The current study met the requirements of a purposive sampling method as the preselected criteria for inclusion was predetermined to be students in the hybrid program (Grand Canyon University, 2017).

The sample of students were contacted through their university email and sent a link directing them to the online 26-item anonymous survey located on the Moodle LMS. The program is hybrid (blended) in nature with several students living hundreds of kilometers away from the university, therefore, contacting students in person would not be an appropriate method. The use of email was an efficient, cost effective technique allowing contact with students all over the country.

Demographic data was collected including participant age, gender, ethnicity, race, region and technology experience. Identifying these demographics enabled researchers to examine any relationships among the variables and the influence they may have on perception. By collecting data on region, it was possible to determine whether or not geographical location played a factor in the perceptions of using technology. Researchers also examined technology experience among participants. Experience with technology is an important element that may influence the perception of using technology and ultimately participants’ responses when reporting their experiences.  Table 1 presents a summary of the participant responses related to experience with technology within a post-secondary environment.

Table 1. Responses to Question: How many years have you extensively used various types of technology within post-secondary education?

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Ethical and Legal Considerations

Four student researchers prepared an institutional Research Ethics Board (REB) application within the course-based, Minimal Risk Research category. As outlined in the REB guidelines: Minimal Risk is defined in the Tri-Council Policy Statement version 2 (TCPS 2) as: “if potential subjects can reasonably be expected to regard the probability and magnitude of possible harms implied by participation in the research to be no greater than those encountered by the subject in those aspects of his or her everyday life that relate to the research then the research can be regarded as within the range of minimal risk” ((Government of Canada, 2014, Chapter 2, part B).

Informed Consent

A letter of informed consent was developed to provide information about the study to the hybrid program students in semester one, four, and seven in the fall 2017 term. This consent document outlined how an online anonymous survey tool was being used to gather information from students regarding their perceptions of using various technologies in a hybrid degree program. They were informed that the survey consisted of six demographic and 20 qualitative questions installed in select program courses in the Moodle LMS. They were assured that online survey participants could withdraw at any time prior to the completion of the online survey by simply abandoning the survey, and that research participants who clicked the “submit” button at the end of the survey would have their responses included in the data analysis and final report.

Minimal Risk

The document also outlined that there were no known risks if they took part in the study, but they were free to refuse to answer questions or stop the study at any time they experienced any discomfort. They were assured that their responses to the survey questions would not have any impact on your education, and that their identity would be protected at all times.

Confidentiality

The potential participants were also assured that their privacy and confidentiality would be protected throughout the study. They were told that electronic data (survey results) would be stored on a password protected memory stick. All information and data collected, including any hard copy items, would be stored in a locked filing cabinet in the principal investigator’s office. Information from the online survey would be coded to preserve participant anonymity and confidentiality, and summarized in anonymous format, in the body of the final report. Finally, they were assured that the identity of each participant would be received in an anonymous manner within the Moodle LMS, so that even the researchers would not know participant identities. At no time would any specific comments be attributed to any individual since identity is unknown. When participants clicked on the Answer the Questions link beneath the online version of the informed consent (in Moodle), they accepted the Letter of Consent, with full awareness that their data was being entered anonymously and their identity was unknown to the researchers.

Ethics Preparation

All 29 students who worked on this project as part of their Qualitative Research course assignments showed proof of completion of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans Course on Research Ethics (TCPS 2: CORE) tutorial and certification (Government of Canada, 2017).

Data Collection

What is a Phenomenological Approach in Qualitative Research?           

The fundamental objective of phenomenology is to investigate a particular phenomenon of interest, through a lens of lived experience (Streubert & Carpenter, 2011). The phenomenological approach does not strive to uncover causes of the phenomenon but rather to understand the various meanings and significance of the phenomenon through the individual’s lived experience (Penner, 2008).

How to formulate a phenomenological research question

There are guidelines available to help researchers formulate questions, while adhering to a phenomenological approach. In most cases, questions are asked through the process of either an interview or self-reported in a survey. These questions need to illuminate and reveal the participants personal experience with the phenomenon in question. It is essential that researchers pose the questions in a way that does not direct the participant or suggest a desired response. However, it is appropriate to support the individual in giving a full description, which includes: emotions, sensations, thoughts, images, feelings, as well as the event of the actual experience (Waters, 2017). It is common in a self-reported survey that the researcher may need to clarify answers with the participants. Clarifying the answers will help prevent the researcher from interpreting what the participant was saying, and supports an accurate analysis of the participants’ lived experience with the phenomena of interest. When clarifying answers, it is essential that researchers do not direct or suggest answers to the participant since this could lead to contaminated results (Waters, 2017).

What is a data collection tool?

A data collection tool is used to gather information regarding a topic of interest or a research question (Streubert & Carpenter, 2011). There are a variety of methods of data collection used in qualitative research. Some methods include observations, textual or visual analysis (e.g. from books or videos), surveys, questionnaires, and interviews (individual or group). The most common methods of data collection used in qualitative healthcare research are interviews and focus groups (Chang, et al., 2006). In this study, the researchers presented the phenomenological questions to the participants using an online anonymous survey to record their answers (Streubert & Carpenter, 2011).

Data Collection Tool Development

To begin the process of constructing the questions and data collection survey tool, the four student researchers responsible for the data collection aspects of the study needed a space to share their ideas and start collaborating with one another.  The students created a document in Google Docs that they all had access to where content could be added and edited simultaneously. This is where the students brainstormed a variety of ideas and suggestions for the data collection questions. From there, each of these four students formulated questions that pertained to nursing student experience of working with various technologies in a hybrid (blended) degree program. As a group, the students came up with twenty-seven open ended questions that was then narrowed down to twenty based on the questions they thought were of the highest quality. (see Appendix A). The questions were then set up in the Moodle LMS as an anonymous questionnaire in existing semester one, four, and seven courses during the Fall 2017 semester.

Data Analysis

Analysis of the data commenced after all questionnaires had been completed, with the primary objective to identify themes that accurately reflected the student’s’ experience in technology-based learning.  Inspired by the work of Braun and Clarke (2006), a six-stage thematic analysis process was selected to provide a flexible qualitative method that facilitated organization and rich data description.  The analysis team consisted of five student researchers (with support from the principal investigator),  who initiated analysis by completing multiple readings of the responses to become deeply familiarized with the data. Once sufficiently immersed, the entire data set was systematically assessed, giving complete and equal attention to the responses for each question from each participating semester group. More specifically, key terms and concepts were identified and colour coded on a per response basis, and subsequently organized within a Microsoft Excel spreadsheet. This coding phase allowed for specific labels to be identified that were representative to the important features of the data (University of Auckland, n.d.). For a visual perspective of the process, elements of the coded data can be viewed in the various tables throughout this paper

Segmenting the experience rich responses into basic codes allowed the researchers to analyze the data in a meaningful way and describe the phenomenon of interest (Braun & Clarke, 2006). The search for themes was enhanced by quantifying the occurrence of determined keywords in reference to each response, as it highlighted the most relevant candidate themes. From here, a collaborative effort was undertaken to review and refine identified themes in order to describe the essence that each captured. The set presented below represents the fully analyzed themes, that were refined to produce  predominant patterns. Direct participant quotes were included to increase accuracy, and provide the reader with a more enriched view of the student’s experiences.

Participant Demographics

109 potential participants were invited to complete the online survey for this study. A total of 31 students (28.4%) chose to participate: 21 students were in semester one, 9 in semester four, and 1 from semester seven. 27 of the 31 participants were female, with a mean age of 27 years old for semester one participants, 30 years old for semester four, and unknown for the single semester seven participant.  The majority of the participants classified themselves as White for race (71% semester one, 67% semester four, 0% semester seven). As well,  most of the respondents lived in local or  other provincial urban areas (76% in semester one; 89% in semester four; 100% in semester seven) while the remainder lived in local or other provincial rural areas.

Positive factors associated with technology-based learning

Taking part in hybrid learning facilitated life balance. Regardless of the amount of time within the program, students viewed the hybrid set-up as a structure that helped promote harmony among important life factors outside of school. Commonly mentioned topics included an ability to maintain employment (Table 2), and increased time to connect with and help family members (Table 3).

Table 2. Responses to Question: How has the hybrid (blended) nature of the program supported you to keep part-time or full-time employment more easily than being on campus full time?

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A semester 1 student said: 

“I can still hold a reasonably good job because I’m still able to work in the daytime. Most student jobs are evening and weekend positions, which are traditionally in customer service / restaurant/ retail positions which don’t pay as well and are less desirable.”

A semester 4 student commented:

“Blended/hybrid learning has allowed me to take on a heavy course load while balancing work and leisure activities as I prefer. It also has allowed me to structure time off or time out of town without it affecting my education.”

Table 3. Responses to Question: How does technology based learning impact your ability to spend time with your loved ones and families?

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Three semester 1 students shared:

“It allows me to spend more time. I am able to work my school work around work and time I spend with family. I do not have to miss events because of class. However, it requires you to have a strong work ethic and time management skills.” 

“I have a very flexible schedule thanks to technology-based learning and as such can meet with friends and visit out-of-province family more frequently.” 

“The increased learning flexibility is incredible – no longer do I have to spend hours every day traveling to and from campus, only to sit in lectures that I don’t find helpful or that are suddenly cancelled without much warning. I can’t imagine going back to school if I had to make daily or weekly trips to campus.”

Likewise, some semester 4 and 7 students responded:

“We are able to make our own schedules and it has allowed me to masterfully balance work and home life along with school.” 

“It improves my time with family allowing me to complete school while they are at school or work.”

 “This form of learning has definitely helped me spend more time working from home. I don’t have children but I do get to see my boyfriend and parents more often.”

 “I have been able to spend more time at home in a relaxing environment.”

 The hybrid style of learning facilitated students that preferred learning independently. It allowed students to skim through materials that they felt more comfortable with and focus on areas where they needed more clarification. Increased independence also allowed students to set priorities and goals that were self-monitored and self-assessed along the way.

A semester 1 student shared:

“No one is constantly keeping tabs on you or “holding your hand”, so you are forced to become more independent and responsible when it comes to your own learning, and figure out what works best and most efficiently for you in terms of time management.”

 A semester 4 student commented:

“I choose the hours I wish to work on assignments/study and there is no need to leave my office space right at home if I don’t want to. Learning from a distance has its ups and downs but the flexibility and freedom to scheduling your desired “class time” is what appealed to me.”

Diverse learning styles and preferences were identified by a number of students, which the various technologies supported. A number of students commented on how they appreciated the change from lecture-based classes.

“It allows for variety. In this program, we have seminars, read, watch videos, write, make movie clips and there is a lot of different medium that we use. It’s not all lecture based which is really nice because I feel that I have a short attention span in lectures!”

“Offers an array of ways to learn and provides complete control of preferences for the most part.”

“Technology-based learning allows students to pick a preference that’s best suitable for their own needs.”

“I am a visual learner so it can be helpful to search for diagram explanations online or watch videos.”

“The use of technology gives me access to resources such as videos, concept maps, podcasts etc. that help enhance my learning.”

“The instructors are always looking for the best ways to engage with us and to help us understand the information.”

“I learn well when given creative projects which allow us to interpret our learning.”

“I like the multi modal approach (video, HESI), being able to work at my own pace in my own home. Having the freedom to take frequents breaks.”

 

The online learning experience allowed students to consciously and efficiently control their time spent on specific activities. They saved time by not having to travel to campus on a daily basis and subsequently used this extra time to better juggle work, school, and family commitments. Self-motivation and self-discipline contributed to students’ ability to use time efficiently, which in turn, helped students manage their time more effectively.

Semester 1 students said:

“It supports my style of afternoon learning, where I don’t have to attend an 8 am lecture. It gives me the opportunity to only read what’s important and meaningful, instead of feeling like I’ve wasted my time attending a lecture that is not applicable to my learning.”

“I think it allows students to plan their life around school really well. The program is great in that it clearly outlines what is expected each week and throughout the semester making it easy for the students to plan out their schedules.”

“You can navigate the associated sites easily to see what needs to be done on a weekly basis then judge the time you can devote to each assignment.”

 

Three of the semester 4 student added:

“It allows me to learn on my own pace where I can spend extra time on the area where I don’t understand.” 

“It challenges us to prioritize well and time manage effectively.”

 “It allows us to see the assignments ahead of time and formulate a plan of when and what to complete first.”

It was also important to note that several students stated they felt more supported by faculty and fellow students in this hybrid program compared to the support they received while completing their first degree program (Table 4). This is often a challenge in a hybrid program, since presence and engagement take work and careful planning to achieve especially in the online aspects of the program.

Some student responses that give credence to this support included:

“I actually think I feel more supported in the hybrid learning environment. I feel that the instructors really try to make themselves available to us because they know that we don’t have that face to face meeting.”

“Even though this program is predominantly online, I feel way more supported by the faculty. This might be due to the fact that it is a much smaller program than I experienced in my undergrad, but I really do feel like the teachers are here to help us succeed. It helps that each teacher knows you by name and you’re not just another number in a class of 150+ students. I find that is much more personalized through this hybrid learning environment. “ 

“I would say this faculty takes a very calculated, intentional and active role in supporting our learning. I felt supported in my undergrad, but so far, I feel even more supported in this program.”

 

Table 4. Responses to Question: Compared to your previous degree, how do you feel more or less supported by faculty within the hybrid (blended) learning environment?

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Since the diversity of technologies used in the program was high, it was valuable to find out which ones were most effective in supporting the student’s learning and were preferred by students. Responses indicated that the majority of participants favoured the Moodle based learning activities and online practice-related reviews and resources, as well as NCLEX style quizzes, although some students shared that they enjoyed the more creative and mobile technologies used in the program.

As some students indicated:

“I find the Evolve online resources very helpful and interactive. I also like how everything is laid out week by week on Moodle, in the same format.” 

“I really like the Evolve learning portal, it has helped me to keep up my skills as well as do practice NCLEX tests.  I also really like Moodle it is very organized and easy to follow.” 

While others shared:

“iPad apps such as Show me, Educreations, inspiration and skills modules.” 

“I use Anki constantly for flash carding review, and Skitch to pull diagrams from the textbook and insert into my notes or flashcards.” 

“Google Drive, Blue Jeans, Creative apps, Computer and my iPad.” 

“Creative apps, ePortfolio, word processing.”

Reflection and mindfulness are important abilities that all successful nurses need to provide expert, empathetic care within a fast -paced environment. Beginning in semester one, students are taught to practice both within their theory courses and in practice with clients. Participants were asked how technology-based learning allowed them to practice mindfulness and reflection during their studies. Approximately two-thirds of the student respondents felt that both reflection and mindfulness were well supported.

Some of the responses included these statements:

“It allows me to complete my work in the quiet environment of my home. I don’t have to complete my assignments with a lot of noise and this allows me to take mindful breaks if I need them.” 

“Since you can take your technology everywhere, I think practicing mindfulness outside of the classroom is the most beneficial as it inspires deeper thought.” 

“The online journals I contribute in on a weekly basis has allowed me to be mindful and reflect on my self-learning and nursing practice. It allows me to reflect on theory and my learning experiences. It allows me to record and analyze the development of my insights.” 

“It allows for more alone time and thus, deeper thought, critical thinking, and subsequent understanding.” 

“As mentioned before, I feel that I have time for myself each day, I don’t feel overwhelmed with homework and my time is not wasted in a lecture hall.  I feel way less stressed in this program than I ever did in University.”

“I would say that the structure of the program appeals to my introverted tendencies, affording me isolation and peace to review my work and set my own learning goals for the day, without my daytime hours being co-opted by lectures or travel time. The countless hours that I save driving to/from campus and between classes are instead re-appropriated to review time, self-care time, and time I can spend with my loved ones. For me, the mental and emotional benefit is priceless.” 

“Mindfulness and reflection takes time to develop, and I need to have time alone to be able to think hard about the concepts – the ability to work on your own without interruption of your thought process benefits my mindfulness and reflection ability.” 

“It has allowed us to reflect on our work through discussion and journal writing I also enjoy that the ePortfolio allows us to look back on our progress learning and accomplishments.” 

Working with the various technologies supported students in becoming familiar with emerging technological trends and helped them to feel more comfortable using a variety of resources, systems and devices.

 Some semester 1 students reflected: 

“I think technology is something that we need to be competent with because it is never going  away. Taking our schooling this way keeps us up to speed with technology…” 

“It has been eye opening to all the technology out there.” 

“It forces me out of my comfort zone to become more comfortable using technologies.” 

“It teaches you new skills that you can use in your future career.” 

As well, some semester 4 students added: 

“We live in a technological world, and it is constantly advancing. Incorporating modern advances into our degree only helps to prepare us for a fast-paced workforce.” 

“It prepares me to be more adaptive to the use of technology in my future career.” 

Participants provided some insights by answering the question, “How does the diverse technologies used in the program address any gaps in your learning that could arise by attending a hybrid (blended) program?” Responses varied such as the following:

“Different mediums allow the information to settle in my brain more. More mediums of exposure for the course material help me to retain the information.”

“If one technology does have the resources you need there is probably another technology that does.”

“The lack of face-to-face connection with faculty is partially made up for through the online seminars (like Blue Jeans). These provide valuable time with instructors in smaller group settings.”

“I think the program does a good job at providing several learning resources that students can use if they do not understand something. For example, there are links to videos provided, online modules, textbook resources and much more.”

“The technologies help address the gaps in that everything you need to do is listed on the portals.  You don’t have to make a list or keep referring back to the syllabus every day.  The technology helps me stay on track.”

“We have discussion groups which force us to communicate with one another, we use Facebook for questions and input from others. Mahara is nice so you can see what ideas other people have had for assignments and get a better understanding of what the professor expects.”

The program provides students with a diverse list of creative and other apps that they can use for various assignments. Students choose the creative apps they prefer to engage in the appropriate learning activities. Some students seem to find it difficult to use these apps, while others voiced appreciation for the alternative learning that emerges as they use them. Some related responses from participants included:

“I think the online learning activities are very suitable to the program. Some creative apps never made sense to me at first. But the more I did it,  I realized it was a great reflecting and meditative process for me. The program is teaching us how to be critical thinkers, reflective, use relational engagement, holistic care, etc. Being able to use these skills in our practice is what is going to shape our identity as health care professionals and provide the best client-focused care we can possible provide.” 

“I learn well when given creative projects which allow us to interpret our learning.” 

“I really enjoy hands on experiences but also reading and watching videos and using my creative side of the brain.” 

“Too many creative app activities sometimes I don’t feel like i learn anything from those but they are often time consuming.”

 

Areas of limitation associated with technology-based learning

Completing the majority of coursework in an online setting presented unique challenges to communication. Although a preference towards face to face interaction was addressed among the semesters, it was a more substantial barrier with students just starting the program. Connecting via emails and instant messages left new students feeling that objectives were often vague and uncertain, and the lack of nonverbal communication made it difficult to pick up on someone else’s tone. The lack of in-class structure, with students completing assignments at individual schedules, also led to long response intervals.

A semester 1 student stated:

“Sometimes nuances can be hidden through technology. Reading emails can give different vibes than is meant to be communicated.”

Another semester 1 student commented:

“I find that it is hard to clarify concepts from a distance. Yes, the teachers, as well as other students, are prompt in responding to any issues I voice, however I prefer to talk my problems out face to face in order to make sure I fully understand the clarified concept in question.”

 The student’s experiences in building relationships with classmates were mixed. Engaging predominantly in a digital world did not prevent peers from building collaborative and social relationships, and the high level of group work even fostered frequent contact. However, there was evidence that the depth of friendship was on a more superficial level, especially in comparison to their traditional classroom experiences.

A semester 1 student revealed:

“It has helped in establishing communication with other students as a whole, through our Facebook group, but perhaps it has hindered our ability to develop deeper friendships. I feel like I can only really get to know other students when we are on campus together, and it’s difficult to become closer to those who live out of town. It also distances students from faculty by taking away the important face-to-face aspect of teaching and learning.” 

Similarly, a semester 4 student responded:

“The activities that are online don’t have peer to peer interactions which can be a hindrance because it doesn’t have the social aspect of learning in person.” 

Another consideration that naturally emerged with technological requirements is the issue of cost. Responses were varied to the question, “How did the requirement of using multiple technologies (for example, the cost of a tablet, apps and software) impact you financially?”  Approximately half of the respondents stated the cost was prohibitive, while close to 40% said it had no impact on their finances. General responses are summarized in Table 5. 

Table 5. Responses to the Question: How did the requirement of using multiple technologies (for example, the cost of a tablet, apps and software) impact you financially?

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Another common problem that often accompanies the use of technology is the issue of technical failure or faulty operations. Participants were asked to comment on their experiences with technical ‘glitches’. Over half of the students in semester 1 expressed frustration with technical issues. Table 6 provides a summary of all responses to this question.

Table 6. Responses to the Question: Please describe your experience with the handling of technological glitches in a technology-based program.

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Participants did acknowledge that technical failures and frustrations existed as they navigated the program, but fail-safes and remediation were available through the course faculty, peers, and the institutional technical support personnel.

Some semester 1 students provided further insights on this process:

“Technology glitches can be annoying. Luckily so far, my peers and instructors have caught them early so it hasn’t been a big issue for me.”

“Tech glitches do tend to be quite frustrating. I tend to call a help desk, re-start my technology, leave and then come back, as well as talk to other people to see if they are having the same problems.”

“There have not been a ton of glitches in this program, but when there are, the faculty try to remedy it as best possible. “

“I would say that I am very proficient with technology and avoid many of the glitches people experience. What has been useful to me is to have a backup plan. For example, if you have a weaker internet connection and need to be in a video call make sure to have a laptop or iPad available so that if your computer starts glitching you can move to another room.”

“There haven’t been too many glitches and the instructors have always been accommodating when anything has come up.”

“Surprisingly, I’ve had very few, if any, technological glitches. I think setting up our Mahara profiles as a group was a really good idea because that is an area where things could have gone wrong.”

Semester 4 students appeared to take technical challenges more in stride, which may be related to their enhanced experience with working in the online environment. They also seemed better able to troubleshoot problems in a self-reliant way.

“I have been using technology for over 5 years and have not had any issues with this.” 

“Hmm most of the glitches in technology have been my fault, just not knowing what to do. Looking up the syllabus or even googling how to fix the problem is what I do.” 

“It was complicated to figure out the way to work with technologies, but it gets easier after a while.” 

“I only called tech support once and was impressed to find that they are always available.” 

“I haven’t had any major problems so far.  It’s the most time-consuming at the beginning just figuring out what apps/programs to use, how they work, etc.”

The semester 7 participant also appeared to feel more self-responsibility when dealing with technical challenges but did voice frustration as well:

“If it doesn’t work then my stress levels significantly increase as I know I have limited skills in fixing technological issues. Sometimes I have no way of fixing it but then it’d still be my fault as I was “not prepared”.

 

Predominant Pattern

The feeling that technology-based learning provides flexibility, was continuously represented in the students’ responses. Through analysis of the data, it was evident that there was value placed on being able to create a more individualized structure and determine one’s own unique schedule. This pattern was most positively observed in experiences with maintaining previously held employment, and not wasting valuable time in transporting to campus every day. However, the more open structure of the distance program also promoted increased experiences with miscommunication, sometimes leaving students feeling unsure about many of the course goals and requirements.

Despite the challenges of studying online using various technologies, over half of the participants affirmed that they would consider completing graduate studies using a similar program configuration (summarized in Table 7).

 Table 7. Responses to the Question: What are your feelings about pursuing graduate studies using a technology based program?

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As one semester 1 student summarized:

“This is something that I have though long about. It is my goal to pursue a Masters degree in Nurse Practitioner and have been researching online programs. Nurses live busy lives and their schedules can be chaotic. Therefore, I feel that more hybrid programs should be offered at the masters and doctoral level to encourage more Nurses to pursue further education.”

 

Literature Review

As hybrid learning becomes increasingly more prevalent throughout undergraduate programs, the consideration of student experience related to technologically-enhanced learning is essential for gaining a deeper understanding of this phenomenon, and subsequently improving the structure of hybrid degree programs. In this study, the experiences of students in a hybrid nursing program reflected six major themes that described the general attitudes towards this phenomenon. The positive attitudes of hybrid-based learning included better life balance, flexibility, independent learning and time management. In spite of the benefits, students also reported difficulties in communication and forming relationships with peers and faculty. Also the initial cost of equipment and potential technical problems or glitches complicated the process, especially for semester 1 respondents.

In regards to life balance, our study found that students expressed positive attitudes towards balancing schoolwork with other life responsibilities. The ability to spend more time with loved ones while still maintaining employment outside of school-related commitments gave students the opportunity to achieve harmonized work-life balance. In similar studies, students also reported an improved sleep schedule as they were not required to attend early morning lectures (Wall Parilo & Parsh, 2014). In addition, mothers were able to provide care for their young children at home while managing schoolwork, therefore saving on daycare expenditures (Bennett & Glover, 2008).

The students’ positive attitudes regarding flexibility in hybrid learning environments was a predominant pattern in our research as students appreciated the ability to determine their own unique schedule and individualized learning plans. A study conducted by Edington and Holbrook (2010) discussed the flexibility that students found in setting their own pace with regards to study habits, as they were able to choose when they wanted to review lecture material in their pharmacokinetics class. For students who lived a substantial distance from the university campus, online learning was reported as being convenient since it allowed them to gain easy access to information and minimize transportation time and costs (Bennett & Glover, 2008). In a study conducted by Sung, Kwon and Ryu (2008), the description of phenomenology of attitudes with medication administration via e-learning and face-to-face instruction identified flexibility as being another benefit of hybrid learning. Use of a web-based learning program by a group of new nurses facilitated flexibility through the ability to conveniently access lessons at any time or place.

Independent learning arose as a major theme in our study as students felt encouraged to take control of their own education. Feedback was positive with regards to the ability to skim through familiar material while spending more time focusing on challenging new concepts. This reduced repetitive monotonous lecture time that could be better spent on aspects requiring deeper understanding. Furthermore, independent prioritization allowed for students to set customized personal goals. According to four of the participants involved in the study conducted by Bennett and Glover (2008), blended learning allowed the ease of “rewind[ing] back over the areas that they needed to repeat so a better understanding of the content could be obtained” (p. 256). In another study, students also voiced the convenience of viewing lectures in archives. The online course delivery method benefited their learning, retention and reiteration of knowledge (Wall  Parilo & Parsh, 2014). Themes related to independent learning were also mentioned in Hsu and Hseih’s (2013) study where hybrid programs were said to “provide a venue for learners to actively make use of their metacognitive powers by organizing, planning, monitoring and evaluating their learning” (p. 238). Due to differences in student learning styles, Rigby, Wilson, Baker, Walton, Price, Dunne and Keeley (2012) found that blending face-to-face sessions with e-learning components proved to be the most effective and acceptable form of delivery to accommodate unique learning needs.

The last of the positive attitudes reflected in this study reflected time management and the subsequent full control over the amount of time spent on schoolwork within an environment where they generally felt well supported. Time management coincides closely with the other two themes of life balance and flexibility. The self-discipline and self-motivation that is associated with blended learning allows students to manage their time more efficiently. Phillips, Schumacher and Arif (2016) stated that “students spen[d] 24%-28% less time than was allocated for the online lecture than a face-to-face lecture” (p.7). The study conducted by Rigby et al. (2012) presented similar findings, as student participants felt that they were able to spend less time on schoolwork within a blended learning program as a result of increased independence.

Despite the benefits associated with hybrid-based learning, students also expressed negative attitudes towards communication and the ability to form quality relationships and establish connections with both peers and faculty. Especially among the students entering the nursing program, the need to connect with faculty and peers via email and instant messaging left them with a sense of misdirection while waiting for responses. This is consistent with the previous research of Edington & Holbrook (2010) and Wall Parilo  & Parsh (2014), where students expressed concerns about  adequate communication with others to clarify their questions and receive timely feedback. Furthermore, technology can limit the presence of meaningful discussion due to the lack of personal interaction and voice tones. For example, students expressed difficulty in communicating in Blackboard as they could not talk to each other in rapid dialogue (Rigby et al, 2012).

Lastly, the final negative theme for our study reflected on the deficit of building relationships with faculty and peers. Students found that their connections with others remained superficial as there were limited opportunities to engage in face-to-face interactions and build relationships. The participants in Wall Parilo  and Parsh’s (2014) study expressed a similar concern, stating that “live lecture gives […] the opportunity to get to know […] instructors better and interact with […] classmates in a greater capacity” (p.162). Overall, live lectures were seen as the most effective way to facilitate student connection. However, in this study, students also reported feeling more supported in the hybrid program compared to their first degrees done on campus.

Although there were many similarities with previous studies, there were a few studies that had conflicting results. In regards to independent learning, some students found this method detrimental because they found themselves distracted at home and they found it difficult to focus (Wall Parilo & Parsh, 2014). Other students preferred to “be told what to do and not left to [their] own devices” (Rigby et al, 2012, p.306). Since the students in this hybrid program were older (average age of our participants was 27 years old), they likely have a more mature need for independence and less need for sustained concrete direction, as long as expected work is clearly outlined.

The ideas about the importance of connection and relationships were contrary to Cobb’s (2011) findings in which participants felt more satisfied with their online environment as they felt comfortable interacting and relating to each other.  Some participants in our study did comment that they appreciated their solitary learning, and found it easier to be reflective and mindful when using the hybrid environment. However, others expressed a need for more real time contact with faculty and peers, preferably in face to face encounters. Such findings from previous research show that not all results on the topic of hybrid learning are consistent, and although many major themes are evident, some variability still exists throughout the data.

Findings

Of the 109 students invited to participate, 31 completed the questionnaire. Participants were predominately female (95%) and the ages of participants ranged from 23 to 43 years (median = 27). All responses were recorded anonymously to protect participant confidentiality and encourage openness and transparency in the participant responses. Resultant themes that emerged from the data could be summarized as “adaptability,” “communication,” “flexibility,” “personal growth,” and “inadequate physical interactions.” 

Adaptability

Most participants embraced the various technologies used in the hybrid program, since they felt it prepared them for current and future employment and professional development. Participant responses suggested that using different technologies enabled them to more quickly adapt to society’s ever-growing advancements, but at a manageable pace.

One semester 4 participant stated:

“It prepares me to be more adaptive to the use of technology in my future career.”

Participants were cognizant of the quick-paced and busy work environments that nurses face in their everyday careers. This is highlighted in another semester 4 participant’s response. This participant also described the dynamic nature of technological growth and the benefits that come with adapting sooner as opposed to later: 

“We live in a technological world, and it is constantly advancing. Incorporating modern advances into our degree only helps to prepare us for a fast-paced workforce.”

Responses from semester 1 participants aligned with those of semester 4 students. One semester 1 student shared: 

“I think technology is something that we need to be competent with because it is never going away. Taking our schooling this way keeps us up to speed with technology and makes a school/work/life balance more acceptable.”

As highlighted by most participant responses, using an array of technologies in blended education programs facilitates adaptation, which will be an inevitable demand of participants’ future career choices in nursing.  

Positive Support 

Faculty Support: Though hybrid programs largely reduce the physical presence of faculty, several participants felt more supported by staff and their peers. One semester 1 participant stated:

 “I feel more supported by faculty because of the nature of online learning. I feel like I have needed to rely on my instructors more because I don’t get that face-to-face time.”

As explained by the participant above, education programs that utilize multiple technologies to facilitate learning place students and faculty in a position where they need to connect at a level that may not be attainable through campus-based learning. While one semester 4 participant stated that they received support, they mentioned that was not due to the “online” nature of the program, but because of the faculty member’s own desire to help: 

“There has been a mixture of both better and worse support. I have found it is incredibly individual based on who the faculty member is. I do not think it is better or worse due to the online environment. I believe that there should be more involvement in a hybrid setting where we are not required to meet or see each other daily or weekly. Certain professors clearly care and are passionate about being involved in our learning experience while not only adding their personal insight and experience, but challenging us to think beyond assignments and letter grades.  Other faculty have been absentee in our learning and have either not checked in at all…” 

Student Support: Participants felt that programs that were partially delivered via multiple technologies helped to better foster support among peers as opposed to campus-based education programs. One Semester 4 participant described how one social platform helped to connect her with her peers: 

“I have connected well with faculty and my cohort. I think relying on our Facebook group for ‘private’ communication about the program where we can discuss freely has been a key aspect of connecting with the classmates.”

The use of social media platforms can help build relationships between students in a hybrid learning program. A semester 1 participant also stated that the use of online chat and video platforms helped them to feel more connected to their peers when compared with their experiences with campus-based learning.

The participant states: 

“Through the use of forum discussions and video conferencing I feel a lot more connected then I did in other courses I took in my previous degree. I would show up to the final exam and not know anyone’s name.”

Based on participant answers, the use of technologies as a form of communication in hybrid learning does not affect students’ abilities to connect and support one another. 

Flexibility and Convenience

The integration of online technologies into an accelerated nursing program, produced a positive trend associated with flexibility and convenience.  Having the ability to access course content freely using laptops, phones, and tablets was received positively by a large majority of students.

Because the program was developed for students who have already completed an undergraduate degree, the average age of students was determined to be 27 years old.  This older age demographic indicated that many students had responsibilities outside of school, which required that they have more control (or autonomy) over their schedule.  The ability to better manage school and work load is highlighted in the following participant’s response: 

“I am on maternity leave and this program fit my lifestyle.  I need something flexible that I can work around looking after my daughter” 

“The main thing I like about this program being online is flexibility.  Mainly, I can still hold a reasonably good job because I’m still able to work in the daytime” 

“Taking our schooling this way keeps us up to speed with technology and makes a school/work/life balance more acceptable”

While it promoted flexibility, the use of technology-based learning did spur a mixed response about its ability to allow students to spend time with their loved ones.  Some participants did indicate that they could schedule time with their loved ones, while others stated that the workload was their primary challenge (not the technological aspect).  Some participants prioritized school and work before time with loved ones, so that they could complete assignments on time and try to manage the workload.  However, had there not been technological interventions in this program, achieving this balance would have been considerably more challenging: 

“Technology based learning has helped with flexibility where I have been able to spend time with my loves ones when the opportunity presents itself” 

“I get to spend more time at home, so I have been able to hang out with the family. The technological aspect doesn’t take time away from my family and loved ones, but the work load does.” 

“Even though the nature of the program is intense, technology-based learning has provided me with sufficient time to spend with my loved ones and family. When learning is online you do not waste time in sitting in traffic, or waiting for the bus”

While the majority of participants live in the immediate area, many also live in more distant urban areas, or in local or other rural provincial regions.  The convenience of not having to commute to school every day because all course materials and assignments are accessible online, was indicated as a preference for both non-local and local students.  The use of technology within the program allows students to access content whenever and wherever they choose.

According to students:

“More convenient in terms of commuting and access” 

“I liked the fact that I could attend and not have to commute to campus everyday”

 Responsibility

The findings indicated that a hybrid learning program promoted self-growth for students, especially for those who already preferred learning independently. Even those who were new to this type of learning format assumed the responsibility of balancing school with their other activities. This had a lot to do with time management, as students voiced that one of the greatest benefits of this type of learning format was the ability to make their own schedules. As one of the semester one participants pointed out: 

“It would provide me with the opportunity to create my own schedule and work while I go to school.”

Another participant stated: 

“I think it allows students to plan their life around school really well.”

This fostered a self-motivated and independent learning style, as students need to be able to organize and prioritize school work alongside other responsibilities such as part time or full-time jobs and family and household duties. Furthermore, being able to properly manage their time and make such schedules was a way in which the students learned what worked out best for them. Specifically, in cases where students had little experience with online learning and hybrid programs, it was an opportunity to grow in terms of finding out what learning style/method was most efficient for them individually. 

Independence

The hybrid program also promoted a more independent learning style in that it allowed students to focus on the concepts that they felt they needed to spend more time on. Some students pointed out that lectures tend to be more generalized and aim to address the broad concerns of most students. However, with online learning, students felt they could go at their own pace by spending less time on material they already felt comfortable with and instead, focusing their time on concepts they struggled with. This personalized approach to the material sat well with a majority of students, as it was more convenient and efficient. The flexibility of the program enabled students to fit in other things into their schedule, work from home or other locations and also study on their own time. Thus, it appeared a hybrid online learning format fit in with students’ lifestyles, as they did not have to compromise  other activities in their lives.

A semester one student stated the following: 

“I find that I really have to create my own schedule. I have to write down what I am going to do on each day otherwise I fall behind. This in itself has helped me to manage my time and provide me with time for work and time for myself and family.” 

Self-motivation

Making schedules and organizing their time could not be done without some sort of self-motivation and understanding the importance of taking charge of their own learning. This was voiced by participants, as they mentioned the hybrid and online learning format required them to take on more ownership of their learning, as no one was there to constantly ‘remind them’ when assignments were due, or ‘hold their hand’ through the program.

The example of one semester 1 student summed it up as follows:

“No one is constantly keeping tabs on you, or “holding your hand,” so you are forced to become more independent and responsible when it comes to your own learning, and figure out what works best and most efficiently for you in terms of time management.”

When students had questions or concerns, it was up to them to contact instructors or do the necessary research to find answers to their questions. As one of the students stated: 

“…I’m learning independently, but there are still resources for me to ask questions and have discussions.”

However, some participants found that the lack of face to face communication also had its drawbacks. One concern was the length of time between correspondences with instructors or faculty. Moreover, participants pointed out that with emailed responses it was difficult to pick up on nuances or tones of the text. In terms of verbal communication, participants said that they felt they could better understand the concept being explained to them and could also ask for further clarification to facilitate their understanding, the same did not appear to be true with non-verbal communication. One semester 1 participant mentioned:

“I find that it is hard to clarify concepts from a distance…I prefer to talk my problems out face to face in order to make sure I fully understand the clarified concept in question.”

Specifically, participants who were new to this hybrid style of learning felt that this lack of face to face communication left certain concepts or objectives vague. Thus, there appeared to be a benefit to verbal communication when it comes to areas that students are unsure of. 

Lack of Face-to-Face Interaction

A common theme throughout participant answers in this study was the lack of face-to-face interaction experienced as a result of the program being offered online. When asked how technology hinders their leaning experience, an overwhelming number of students mentioned the lack of face-to-face interaction. As a semester 1 participant mentioned: 

“[There’s] not a lot of face to face communication, when we DO get to see each other you always realized how alone you were feeling”

Another semester 1 participant stated: 

“I find that it is hard to clarify concepts from a distance. Yes, the teachers as well as other students are prompt in responding to any issues I voice however I prefer to talk my problems out face to face in order to make sure I fully understand the clarified concept in question.”

These two responses embody the sentiments of a strong majority of semester one students. However, while it is important to mention how semester 1 students are mere months into their program and may be experiencing these sentiments as a result of being relatively new to the program, when examining the responses of semester 4 and 7 students, the theme of lack of face-to-face interaction and isolation were still an issue. As one semester 4 student stated: 

“I think the most connectedness I felt was when we had the on-campus sessions, as we were actually able to connect in a more social way that is not solely professional.  I think it is very hard to feel connected to other students online.”

Similarly, a semester 7 participant added: 

“The feeling of connectedness was quite lost in my opinion…”

As illustrated with the responses above, many participants from all three semesters (representing the program’s beginning and end) mentioned how the lack of face-to face interaction in this technology-based program, in their experience, impacts their  overall learning.

When asked a series of other questions related to technology and connectedness, students still referenced the lack of interaction with both students and faculty. For example, when asked how technology-based learning provides students with a feeling of connectedness, some students continued to vocalize their dismay with the lack of interaction and how it contributes to feelings of isolation. According to one semester 1 student: 

“Honestly, I don’t really think it does. The most helpful technological component that has connected me to other students has been our group Facebook page where we post questions about assignments, funny nursing student memes, stuff like that.”

Another semester 1 participant continued to address this theme: 

“I don’t believe that (the institution) has instigated any particular strategies for increased connectedness, but our class has formed a Facebook group that has been immensely helpful. As the majority of the program’s syllabi are out of date and have not been appropriately updated, I turn regularly to the Facebook group to find fellow students who have clarified issues with instructors already.”

Participants expressed the need to find other ways to communicate with students and enhance feelings of connectedness outside of the program’s official structure with social media groups like Facebook. Facebook, as many students frequently mentioned, has become the main source of communication amongst students in an attempt to remedy the lack of face-to-face interaction students experience throughout the technology-based nursing program. However, some students did point out that technology is also used to promote more synchronous class interactions such as Blue Jeans, group discussions, and seminars.

As pointed out by a semester 4  students: 

“The lack of face-to-face connection with faculty is partially made up for through the online seminars (like Blue Jeans). These provide valuable time with instructors in smaller group settings.”

Recommendations

While common themes exist within the literature on hybrid-based learning, the current literature also demonstrates the variability that exists in the research on hybrid learning environments which suggests the need for further inquiry. Based on the common theme of negative attitudes in regard to communication and building relationships in hybrid-based learning, further research may help to explore ways to enhance or develop more meaningful means of communication, especially for students transitioning from a traditional learning environment to a hybrid environment.

One of the major limitations of this study was the lack of responses from student participants.  Due to the amount of open-ended questions posed, the survey may have been too time consuming for nursing students. Moreover, students were given a short period of time (two weeks) to complete the survey which may have posed difficulty for students who had multiple priorities. This suggests that other methods of data collection should be considered.  Perhaps decreasing the number of questions, or providing both close-ended as well as open-ended questions on the survey would facilitate better responses and valuable data and analysis of common themes as well as demand less time from participants. A larger sample size in future studies might also facilitate findings that are more statistically representative and generalizable.

Future studies could also use a quantitative approach to derive important facts from the data including preference trends and differences between groups or demographics.

The majority of responding participants were students from the first semester cohort.  While this could be for numerous reasons that are independent of the nursing program, it could also suggest that first semester students were more vocal due to a strained transition from a traditional into a hybrid learning environment.  Researching ways of easing the transition between a traditional versus a hybrid environment may be beneficial to not only students but also nursing instructors and other individuals involved in program development.

Limitations

With a phenomenological approach, the focus is on understanding the various meanings and significance of the phenomenon through lived experience. The results of this study allowed participants to share their experiences and opinions on the benefits and disadvantages of a hybrid nursing program.  While the use of this type of research design allows for researchers to gain first-hand knowledge based on the participant’s experiences, it can also result in bias embedded throughout the research.  Further areas of concern can arise from the fact that the students working on and developing the study were both the researchers and some undoubtedly served as participants (21 out of 36 semester 1 students responded) which could challenge the overall credibility of the study or at least introduce a narrative approach to the research in addition to a phenomenological one.

When interpreting data, researchers may need to clarify answers with participants to ensure that the data is being correctly interpreted and accurately represented the lived experiences of the participants with the phenomena of interest.  Since the researchers were not able to clarify answers with participants due to anonymity, misinterpretation of the data could have resulted, potentially leading to another limitation of the study.

The study was distributed to three different semesters of students, totaling 109 students. However, a total of only 31 students responded to the survey, resulting in a relatively small sample size which limits the overall generalizability, but fulfills the sample quota needed for a preliminary exploratory qualitative study. Still, the lack of overall response to the survey suggests that further investigation of the barriers preventing students from participating in the survey may be warranted.

As previously discussed, the majority of responses (67.7%) came from first semester students, with only 1 response (3.22%) coming from a seventh semester student.  This may have led to different data and results due to varying experiences with online learning during different phases of the program. In future, a representative number of participants from all three semesters would provide more representative data.

Conclusions

Findings of the current research align with the results of past literature.  Both positive and negative themes arose from students using a hybrid-learning environment, indicating the need for further research to determine strategies to improve hybrid-learning, specifically with regards to communication and developing relationships. With technology becoming more and more integrated into everyday life, finding ways of improving a hybrid-learning environment is of great importance, due to the increasing popularity of using hybrid or online programs in disciplines like nursing.

References

Balls, P. (2009). Phenomenology in nursing research: methodology, interviewing and transcribing. Nursing Times, 105, 30-33. Retrieved from https://www.nursingtimes.net/clinical-archive/leadership/phenomenology-in-nursing-research-methodology-interviewing-and-transcribing/5005138.article

Bennett, P., & Glover, P. (2008). Video streaming: Implementation and evaluation in an undergraduate nursing program. Nurse Education Today, 28(2), 253- 258.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oa

Bromley, P. (2010). Online learning: anywhere anytime education for specialist nursing. Neonatal, Paediatric & Child Health Nursing. 13(3), 2-6.

Bryman, A. & Bell, E. (2007) Business Research Methods, 2nd edition. Oxford University Press.

Chang, L., Toner, B. B., Fukudo, S., Guthrie, E., Locke, R., Norton, N. J., & Sperber, A. D. (2006). Gender, age, society, culture, and the patient’s perspective in the functional gastrointestinal disorders. Gastroenterology ,130(5), 1435-1446.

Cobb, S.C. (2011). Social presence, satisfaction, and perceived learning of RN-to-BSN students in Web-based nursing courses. Nursing Education Perspectives, 32, 115–119.

Condon, M., & Garcia, A. (2014). Policy paper: Online learning. Toronto, Ontario: Ontario Undergraduate Student Alliance. Retrieved from http://deslibris.ca/ID/242607

Grand Canyon University (2017). Qualitative Sampling Methods. CIRT – Center for Innovation in Research and Teaching. Retrieved 24 September 2017, from https://cirt.gcu.edu/research/developmentresources/research_ready/qualitative/sampling

Government of Canada. (2017). The TCPS 2 tutorial course on research ethics (CORE). Retrieved from http://www.pre.ethics.gc.ca/eng/education/tutorial-didacticiel/

Government of Canada. (2014). TCPS 2: Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Retrieved from http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/Default/

Edington A., & Holbrook J. (2010) A blended learning approach to teaching basic pharmacokinetics and the significance of face-to-face interaction. American Journal of Pharmaceutical Education, 74(5):Article 88.

Henderson, M., Selwyn, N., & Aston, R. (2015). What works and why? student perceptions of ‘useful’ digital technology in university teaching and learning. Studies in Higher Education, 42(8), 1-13. doi:10.1080/03075079.2015.1007946.

Hsu, L., & Hsieh, S. (2013). Factors affecting metacognition of undergraduate nursing students in a blended learning environment. International Journal of Nursing Practice, 20(3), 233-241.

Kaminski, J. (2017). Critical Inquiry 2: Qualitative Research [Syllabus]. Langley, BC: Faculty of Health, Kwantlen Polytechnic University.

LoBiondo-Wood, G.  Haber, J., Cameron, C. & Singh, M. (2013). Nursing research in Canada: Methods, critical appraisal, and utilization. Toronto, ON: Mosby. 3rd edition.

Matua, G.A. (2015). Choosing phenomenology as a guiding philosophy for nursing research. Nurse Researcher, 22(4), 30-34.

Parker, E. B., & Wassef, M. (2010). Flexible online learning options for graduate nursing students. Nurse Educator. 35(6), 243-347.

Penner, J. L., McClement, S., Lobchuk, M., & Daeninck, P. (2012). Family members’ experiences caring for patients with advanced head and neck cancer receiving tube feeding: A descriptive phenomenological study. Journal of Pain and Symptom Management, 44(4), 563.

Phillips, J. A., Schumacher, C., & Arif, S. (2016). Time Spent, Workload, and student and faculty perceptions in a blended learning environment. American Journal Of Pharmaceutical Education, 80(6), 1-9.

Rigby, L., Wilson, I., Baker, J., Walton, T., Price, O., Dunne, K., & Keeley, P. (2012). The development and evaluation of a ‘blended’ enquiry based learning model for mental health nursing students: “making your experience count”. Nurse Education Today, 32(3), 303-308.

Streubert, H. & Carpenter, D. (2011). Qualitative research in nursing: Advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins 5th edition.

Sung, Y. H., Kwon, I. G., & Ryu, E. (2008). Blended learning on medication administration for new nurses: Integration of e-learning and face-to-face instruction in the classroom. Nurse Education Today, 28(8), 943-952. doi:10.1016/j.nedt.2008.05.007

The University of Auckland (n.d.). About thematic analysis. Retrieved from https://www.psych.auckland.ac.nz/en/about/our-research/research-groups/thematic-analysis/about-thematic-analysis.htm

Wall Parilo, D.,  & Parsh, B. (2014). Case study: Student perceptions of video streaming nursing class sessions: 1. Journal of Nursing Education, 53(3), 161-163. doi: 10.3928/01484834-20140223-01

Waters, J. (2017). Phenomenological Research Guidelines. Capilano University, Psychology. Retrieved from https://www.capilanou.ca/psychology/student-resources/research-guidelines/Phenomenological-Research-Guidelines/

APPENDIX A: SURVEY QUESTIONS

Demographic Questions (six in total):

1. What is your current age?

2. What is your gender?

3. How many years have you extensively used various types of technology within postsecondary education?

• Less than one year
• One to two years
• Two to three years
• Three to four years
• Four to five years
• Over five years

4. What is your Race?

•  White
•  South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
•  Chinese
• Black
• Filipino
• Latin American
• Arab
• Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.)
• West Asian (e.g., Iranian, Afghan, etc.)
• Korean
• Japanese
• First Nations, Metis, Inuit
• Other

6. What are your ethnic or cultural origins (For example, Canadian, English, Chinese, French, East Indian, Italian, German, Scottish, Cree, Mi’kmaq, Salish, Métis, Inuit, Filipino, Irish, Dutch, Ukrainian, Polish, Portuguese, Vietnamese, Korean, Jamaican, Greek, Iranian, Lebanese, Mexican, Somali, Colombian, etc.)
7. What region do you currently live in?

• Urban Lower Mainland
• Rural Lower Mainland
• Other Urban BC Region
• Other Rural BC Region
• Other Urban Province Region
• Other Rural Province Region
• Other Urban Country Region
• Other Rural Country Region
• Other Urban Continent Region
• Other Rural Continent Region

Qualitative Questions (20 in total)

7. What motivated you to choose to enroll in a hybrid (blended) nursing program?

8. How do you feel that technology-based learning enhances your learning experience?

9. How do you feel that technology-based learning hinders your learning experience?

10. Compared to your previous degree, how do you feel more or less supported by faculty within the hybrid (blended) learning environment?

11. How did the requirement of using multiple technologies (for example, the cost of a tablet, apps and software) impact you financially?

12. How do you feel technology-based learning provides KPU students with a feeling of connectedness?

13. How does technology-based learning impact your ability to spend time with your loved ones and families?

14. How does technology-based learning help support your particular learning style, preferences, and students with disabilities?

15. Please describe your experience with the handling of technological glitches in a technology-based program.

16. Please describe how utilizing various technologies online helped or hindered you from forming solid relationships with faculty and other students.

17. How has the hybrid (blended) nature of the program supported you to keep part-time or full-time employment more easily than being on campus full time?

18. How do you feel technology-based learning allows you to practice mindfulness and reflection during your studies?

19. What technologies used in the program supported your learning the best?

20. How does technology-based learning allow students to better manage their time?

21. What is your experience with technology-based learning and travelling?

22. How does the diverse technologies used in the program address any gaps in your learning that could arise by attending a hybrid (blended) program?

23. How suitable are the online learning and activities to the skills and interests of the students?

24. Which technologies best support your preparation for practice in the clinical setting?

25. What are your feelings about pursuing graduate studies using a technology based program?

26. How do hybrid (blended) programs cut down on the costs of education (housing, gas, transportation, etc.)?

 

About the Authors

This study and paper was collaboratively done by 29 Critical Inquiry: Qualitative Research students in the Fall of 2017 during their course work in the BSN-AE Nursing Program at Kwantlen Polytechnic University in British Columbia, Canada. For more information about the process, read the Editorial: Collaborative Qualitative Research as a Learning Tool in Nursing Education

 

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