Mental health with Online courses
TRADITIONAL CLINICAL conferences with psychiatric nursing students are designed to help students integrate theoretical concepts and knowledge with clinical practice. An effective clinical conference has three important goals: the experience of being a member of a group, mastery of the course objectives, and exploration of personal feelings and attitudes about their work with individuals who have psychiatric disorders (Wink, 1995). These goals reflect cognitive, behavioral, and affective domains of learning. Since psychiatric care is delivered interpersonally, clinical conferences are especially valued by faculty because they foster self-reflection and sensitivity to others. It is not clear if these goals can be realized in clinical conferences conducted online using an asynchronous threaded discussion. The present study describes the group process and content topics of five online clinical conferences to evaluate if they meet course objectives.
Review of the literature
Most research on Web-based courses has examined student satisfaction and perceptions (Conrad 2002; Haythornthwaite et al 2000 and Thurmond et al 2002), while some researchers have compared face-to-face courses with online courses (Herod 2000 and Thornam, C.L. and Phillips, S., 2001. Interactivity in online and face-to-face sections of a graduate nursing course. TechTrends 45 1, p. 34. Full Text via CrossRefThornam and Phillips 2001). Fewer researchers, however, have examined the interactions in online course discussions, though measures are available (Li 2001–2002 and McKlin et al 2002). Analyzing real time or synchronous interactions, Lobel and colleagues (2002) developed a program to evaluate participation by undergraduate student groups during an online class session. Tu (2002) reviewed student ratings of social presence, the degree of salience of another person in an interaction. He reported students perceived that email communications have more social presence than bulletin board communications indicating that the type of computer mediated communications may influence interaction. Examining the amount of structure needed for interaction, (Land and Dornisch (2001) found students required guidelines and strategies about how to respond to others online.
Kanuka and Anderson (1998) using a constructivist learning theory, examined transcripts generated by 25 managers participating in a 3-week discussion on creating online workplace learning centers. Using Gunawardena, Lowe and Anderson’s (1997) five-phase model to analyze the construction of knowledge, they found that most interactions involved sharing and/or comparing information; phase-one of knowledge construction. Interactions about differences and inconsistencies, a higher phase of knowledge construction, were infrequent. The investigators conjectured that it may be easier for participants to ignore differences in online discussions than in face-to-face interactions.
Although participants may not have the same experience as found in face-to-face groups, a sense of community still appeared to exist in online courses. Fahy (2003) examined peer-to-peer support in three online courses using the Transcript Analysis Tool. Although there was no difference in supportive interactions by gender, wide variation occurred across individuals. The most frequent type of support was in the form of referential statements, i.e., direct answers or reference to specific preceding statement of other participants. Likewise McDonald (1998) found the majority of speech segments, i.e., messages with single themes, were initially directed to the group. However, with time a greater proportion of messages were directed at specific individuals. Though the content of segments was cognitive in nature; participants interacted in an interpersonal level sharing personal thoughts and experiences. The online groups appeared to progress through similar stages of development as occur in face-to-face groups.
The present study differs from previous research by examining online interactions in an established group; a cohort of graduate nursing students who had been together in three previous online courses and met face-to-face on several occasions. The online clinical conference replaced a bimonthly telephone clinical conference for the students’ final practicum course in advance practice psychiatric mental health nursing. The purpose of the present study was to examine the range of topics and quality of interactions in an online clinical conference. Specific questions addressed were:
1. What topics were discussed in an online clinical conference and did they meet objectives of the conference?
2. What were the characteristics of the interactions among students in the online conference?
Methodology
Sample
Ten students enrolled in the course, nine of which comprised a group who had taken the previous three psychiatric nursing courses and two practicum courses together online. The tenth person was a doctoral student in nursing and new to the group. Students’ practicum settings were in outpatient community mental health agencies, private psychiatric offices and inpatient units. All but one of the preceptors was an advance practice psychiatric nurse.
Setting
The School of Nursing at the University of Kansas Medical Center under the direction of Dr. Helen Connors has a history of distance learning, first with telecommunication and more recently with the Internet. The goal of the distance education program is to prepare advance practice nurses who will work in rural underserved areas. In spring 2000, the School of Nursing faculty made a commitment to put the graduate psychiatric nursing courses online. Psychiatric nursing faculty partnering with the second author of this paper, an expert in learning technology from the Department of NetLearning at the University of Kansas Medical Center, designed the online courses. Students taking online courses are supported by a number of services including a Help Section and Tip sheets and an extended hour call in help line for trouble shooting problems.
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