An exploratory analysis of alternative approaches in distance learning programmes for nurses.
Kortenbout, Wilhelmina Petronella.
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An exploratory retrospective study conducted on two differing educational programmes, both of which were for the diploma in community health nursing. The aims of the study were: i) To propose a conceptual framework in order to compare distance learning programmes in community health nursing. ii) To describe and compare two such programmes based on this framework: one content-based and the other community / problem based. The research design used case study methodology, after the development of a model for the education of professional nurses which was derived from literature. The constructs of the model were used as propositions in a case study protocol. The four constructs were each made up of two elements and each element consisted of the poles of a continuum by which that feature in a programme could be identified. The constructs were: a) The Conceptual Programme which included the elements of Base and Structure; Base being either institution or community and structure either content or process. b) The Student with elements of Professional or Personal attributes. Professional attributes were either empowered or disempowered and personal either self directing or passive. c) The Context which had Components and Relationships as elements. The former comprised either limited formal health services or all-embracing health related sectors, whilst the latter specified relationships would either be seen as linkages with unilateral formal communications or partnerships where collegial relations impacted on both parties involved. d) The Concrete Resources included both human and material resources. Human resources were either limited or additional and material either limited or varied. Application of the Conceptual Programme analysis demonstrated that programme A was institution and content based whilst programme B was community / problem (process) based. Programme documentation and student assignment and projects were analyzed in terms of the remaining three constructs. An interview with a tutor for each programme followed after they had read the case reports. A third interview was then held with a key person who had overseen both programmes and read case and interview reports in order to validate both content and the use of the model as framework for analysis. The following trends emerged: i) The content programme was associated with more disempowered and passive students as those were defined in this study. ii) The content programme also used more limited formal health sector settings for learning and in this linkage type relationships dominated although three instances of partnerships did occur, and some community based groups were used by students. iii) The content programme used one tutor per contact session for lectures with students and, cost, in 1991 currency, R150 per student to deliver. iv) The community / problem based programme showed a stronger trend to empowered and self directing students with several clear instances being documented. v) There was a greater variety of settings used for learning in this programme. vi) Several instances of partnership relationships occurred despite the limited contact time between students and communities or health settings. vii) The community / problem-based programme needed two facilitators per contact session at a cost of R1130 (1991) as small group discussions were the main strategy for learning. viii) Student evaluations of both programmes showed that students viewed them in much the same way despite the differences that were found. This indicates that student evaluations on their own provided insufficient evidence about the nature of a programme. ix) The community / problem based programme cost about 20% more to deliver than the content programme out of a total expenditure of R186 000 (1991 value). x) The model was revised to collapse professional and personal attributes into one element and to add another element 'metacognition' to the construct student. 'Access' was also recommended as an additional construct with elements of barriers and supports. This new model needs to be tested and reviewed by peers. The revised model for the education of professional nurses could be a useful yardstick for evaluating existing educational programmes, selecting newly proposed programmes and guiding policy formation.