Asynchronous Format Research Articles

Building an Educational Model that Promotes Competence Through Innovation

NURSING PRACTICE DEMANDS COMPETENCE, BUT NURSE EXECUTIVES REPORT THAT CURRENT NURSING EDUCATION DOES NOT PREPARE STUDENTS FOR THE REALITIES OF THE ACUTE CARE ENVIRONMENT. New graduates who lack understanding of the real world of nursing often leave the profession shortly after entry into practice (Institute of Medicine, 2011). Nurse educators must engage in revitalizing nursing curricula using innovative methodologies that also meet growing practice demands.Innovative methodologies and technologies that push the envelope of learning, particularly in the areas of cognitive knowledge acquisition and clinical reasoning, are currently employed on a wide but limited basis. For instance, online learning, once on the fringes of nursing education, is now an accepted teaching and learning modality. High-fidelity human patient simulation (HFS) has also taken student clinical learning to a new level of assumed competence. However, it is rare to find the two modalities paired together, particularly in pre-licensure nursing education.This article describes an innovative, multistate, online baccalaureate nursing education model used by Western Governors University College of Health Professions. The model combines online didactic methods with high-stakes, HFS assessment and a pioneering clinical coaching model. Graduates are competent scientists, detectives, and leaders in the healing environment.The CTUS Model Competence is key to nursing education and practice (Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009). This innovative, online approach to pre-licensure education is built on the newly developed CTUS model ( ognitive knowledge, ask skill knowledge, situated se of knowledge and ynthesis of knowledge and ethical comportment), developed by J. Jones- Schenk to ensure that all aspects of nursing competencies are mastered (Personal communication, November 9, 2010). Cognitive knowledge is attained through online course work, followed by mastery of task/skills and situated use of knowledge in simulation. Use of a coached clinical immersion model leads to synthesis of knowledge and the development of ethical comportment. Competence is assessed using a variety of appropriate methods. Competencies become increasingly complex as students progress through the curriculum.Program outcomes (competencies) were derived from a comprehensive set of national, state, professional, and institutional standards and the contributions of nationally recognized nurse professionals and leaders. Faculty then identified measurable course competencies and objectives and determined the type of assessment that would measure students' mastery. All students must demonstrate competence in all assessments to graduate.CONTENT KNOWLEDGE A variety of learning resources are used to deliver content in an asynchronous online format, including electronic textbooks, tutorials, and case studies. Content knowledge is assessed using standardized objective examinations, essay examinations, projects, or performance-based tasks. While students may participate in didactic content at their convenience, specified components must be completed in order to advance to the learning lab and clinical setting. Students must pass summative assessments for each course in order to progress to subsequent courses.TASK SKILL KNOWLEDGE/SITUATED USE OF KNOWLEDGE An underlying assumption of the model is that clinical education can be substantially transformed through the use of high-fidelity simulation. Clinical learning labs precede acute care clinical learning and build skills and confidence. The simulation curriculum is standardized across onsite clinical learning labs and includes scenarios designed to address high-risk, high-volume patient diagnoses across the lifespan. Scenarios reflect Health Cost and Utilization Project (H-CUP) hospitalization data (www.ahrq.gov/data/hcup/) and current quality and safety patient care initiatives.Since this online program does not have a physical campus, regularly scheduled simulation boot camps take place in simulation labs rented from schools of nursing and/or hospitals; the labs carry a full complement of high-fidelity simulators: adult, child, and mother-baby. …

To Hybrid or Not to Hybrid, That is the Question! Incorporating VoiceThread Technology into a Traditional Communication Course

Courses: This exercise can be applied to any course or discipline, particularly those that utilize public speaking techniques, interviewing skills, or media Objectives: • Students will identify key concepts from course readings and deliver verbal responses to the instructor's question, photo, and/or video example. • Students will learn to effectively communicate and organize ideas around the course readings. • Students will engage with technology that will enhance the in-class learning experience. • Students will produce competent communication dialogue and discussion in an asynchronous online format.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BackgroundThere is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.MethodsWe ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.ResultsMHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.ConclusionsThe anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

InnovationCENTER: Synchronous Online Role Play for Enhancing Community, Collaboration, and Oral Presentation Proficiency

With graduate nursing education delivered largely via online technologies, predominantly in the asynchronous format to accommodate the many needs of adult learners, one must ask whether online education adequately prepares graduates for the roles and skills needed to transform practice in an ever-evolving health care system (Kalisch & Begeny, 2010; Tucker, 2004). Communication tools within course management systems widely used for online course delivery enable students to develop skills in asynchronous, text-based communication but may not provide opportunities for graduate students to develop the effective oral communication skills (Cornelius & Glasgow, 2007; Smith, Passmore, & Faught, 2009) expected in professional practice, including the ability to articulate ideas clearly and succinctly and defend positions through extemporaneous question-and-answer exchanges with an audience. For online nursing programs to evolve beyond the mere teaching of the content, attention must be given to fostering an educational approach that uses real-world contexts to facilitate proficiency in oral and written communication and equips students with the skills needed for practice. This article examines the effectiveness of synchronous role play as a teaching strategy to enhance oral presentation proficiency in online learning environments. The selection of appropriate technology to enable synchronous role-play activities and the development of strategies for supporting student learning in technology-rich, collaborative learning environments are discussed. Background Most graduate students at this large public university are geographically dispersed, work full-time or part-time, represent different generations, practice with varying levels of professional experiences, and juggle multiple family and educational responsibilities. To accommodate their needs, all graduate online courses are offered asynchronously without required visits to campus. An Applied Technology in Health Care course was developed to provide doctor of nursing practice (DNP) students with the knowledge and skills needed to inform decision-making about patient care and health care systems and provide leadership within health care systems and/or academic settings. The course aligns with competencies outlined by the American Association of Colleges of Nursing (2006), the National League for Nursing (2008), and the National Organization of Nurse Practitioner Faculties (2006) to provide a framework for graduate nurse education built on computer literacy, information literacy, informatics, and communication competencies. Nurse practitioner master's degree and certificate students, as well as PhD students, enroll in this course, along with all DNP students, creating a diverse learning community of students of different ages, backgrounds, professional experiences, and levels of comfort and expertise with technology and online education. The challenge for the course designers was to provide flexible learning that would meet the needs of all types of learners and ensure that diversity resulted in a richer learning experience. Instructional Design Approach The focal unit in today's health care system is the interdisciplinary team. Without practice in developing effective collaboration and communication skills, including the ability to speak extemporaneously and defend positions and answer questions on the spot, graduate-prepared nurses may not be adequately prepared to be successful team players and deliver professional presentations and proposals to management or to stakeholders. To enhance collaborative skills and oral presentation proficiency, the course instructor worked with an instructional designer to simulate a real-world context of presenting and defending a proposal in front of a management team. This learning activity supported the following course objectives: * Apply computer and information literacy skills to the health care setting. …

Ethical, Academic, and Practical Considerations for Online Teaching: Does the Search for Quality and Integrity Come at the Expense of Academic Freedom?

The Internet has evolved to be the new revolution in educational delivery. A 2008 Sloan Consortium report on the state of online education in the United States revealed some startling information. For example, at the turn of this century approximately 10 percent of post-secondary enrollments at degreegranting institutions were in online courses or programs; but, by 2007, the number had grown to over 20 percent. This growth translated into an average annual increase of nearly 20 percent at a time when overall enrollment growth in higher education averaged only around 2 percent. Schools recognized that students were voting with the click of a mouse, and, by 2007, the percentage of schools defining online education as critical to their long-term strategy had grown to more than 70 percent of public institutions and more than 53 percent of private colleges and universities. Online courses and programs are now offered by universities large and small, including many of the nation’s most prestigious schools. As schools throughout the nation have looked to the rapidly evolving technological medium as a solution to education delivery challenges and as a way to expand existing education markets, the medium and its accompanying technologies have evoked mixed reactions among students, administrators and faculty. The pervasiveness and visibility of online instruction has served not only to magnify its strengths (e.g., the benefits that accrue to an asynchronous format) but to reveal areas of concern (e.g., maintaining academic/ethical integrity, especially in online testing, and issues relating to oversight and academic freedom) as well. It is the purpose of this paper to illuminate and elaborate on these complex issues from administrative, practical, ethical and academic perspectives, with a view toward generating further discussion on overcoming the evolving tensions related to online teaching.

Young people’s views on sharing health-related stories on the Internet

There is an increasing interest in the use of stories in healthcare practice and education. However, there are few stories from young people concerning health and little is known about their views on sharing such stories on the Internet. The aim of this study was to explore young people's perspectives in this area. A qualitative method was used and a project website was purposely built to facilitate data collection. An online focus group with 13 young people was carried out in an asynchronous format. Participants valued highly the therapeutic effect of storytelling and the use of digital stories to share feelings and experiences with a wide range of audiences, suggesting that well-produced stories could be a useful learning resource. A number of concerns were also raised, including embarrassment, reaction of other people and online safety. Having stories available on the Internet can be beneficial; however, concerns especially about safety associated with Internet use and support for storytellers should be taken into consideration. A better understanding of young people's perceptions can provide valuable insights for future work with this age group on storytelling.

Distance Learning through Synchronous Interactive Television

The advent and popularity of asynchronous online learning has somewhat obscured a standby technology developed over the last two decades. Interactive videoconferencing, sometimes called "interactive television," though not as glamorous and popular a topic at distance-learning conferences, is still alive and well at many institutions. Three or four years ago, many of us were led to believe that interactive television would go the way of the dinosaurs-everything would soon be in an asynchronous format or on individual desktops. There would no longer be any need for elaborately designed classrooms, networks, and operations staff. To date, this prediction has not come true. In fact, synchronous interactive television has experienced significant growth as newer, easier, and cheaper technologies allow institutions to reach more students with less resource investment. Faculty and students, while appreciating the convenience of asynchronous delivery, still express a need for synchronous communication. This article explores the issues involved in synchronous distance education, the current technologies and proposed future developments, and best practices in terms of classroom design, faculty use, and operational issues. It is not a research article but an anecdotal case study based on Washington State University's experiences over the last 20 years in developing and adapting to new synchronous technologies and creating the support and technical infrastructure to best deliver academic courses through this medium.

A comparison of outcomes of virtual school courses offered in synchronous and asynchronous formats

As part of the formative evaluation of Alabama's pilot of its virtual schooling system (the Alabama ACCESS Distance Learning Program), the Alabama State Department of Education examined outcome data from courses offered in the two distance delivery systems: web-based course management and interactive videoconferencing (IVC). In light of Bernard et al's. [Bernard, R., Abrami, P., Lou, Y., Borokhovski, E., Wade, A., Wozney, L., et al. (2004). How does distance learning compare with classroom instruction? A meta-analysis of the empirical literature. Review of Educational Research, 74(3), 379–434] recent meta-analysis finding that asynchronous distance environments generally had more positive outcomes than synchronous ones, a comparison of online (asynchronous) and IVC (synchronous) platforms provided an opportunity to explore and shed more light on outcome comparisons between synchronous and asynchronous platforms. Though there were some outcome differences, the dominant finding was of no differences between platforms.

It's About Time: Using Electronic Literature Discussion Groups With Adult Learners

This article describes what happened when adult learners in a literacy education class participated in online book discussions. Forty students, enrolled in a graduate literacy class, talked about the book Roll of Thunder, Hear My Cry by Mildred Taylor in an asynchronous online discussion. Findings included a higher level of satisfaction with online discussions than with face-to-face discussions during class. Students' comments about the experience clearly suggest that the electronic discussions provided things that could not be made available in class, such as varying amounts of time individual students had for reflecting and responding and affording students opportunities to participate in ongoing discussion. Students reported that the online discussions provided them with “think time” and that this time for reflecting and responding improved the quality of their discussions. They also reported that the asynchronous format allowed them to complete their thoughts without interruption. In addition, students noted that quieter classmates participated more fully online than during class. However, students also reported that prior face-to-face discussions were crucial for the success of the electronic experience in terms of building rapport, comfort level, and their willingness to take intellectual risks.

Creating a Research Literacy Course for Education Doctoral Students

Education students are often not very information literate, and doctoral students are no exception to this “rule of thumb.” The challenge of preparing doctoral students in education to use online resources as they begin the literature review process becomes even more complicated when these students are also distance students who happen to meet at various sites throughout the United States. This presentation will discuss the pros and cons of designing and delivering online and face-to-face versions of a one-credit elective course for students in Programs for Higher Education at Nova Southeastern University. The advantages and disadvantages of delivering content in synchronous and asynchronous formats are examined. Issues addressed include: (1) the relative merits of using WebCT versus using ordinary Web pages and WebBoard discussions, (2) how to incorporate active learning into both modalities for delivering the course, (3) how to pace and structure the delivery of both versions of the course to meet the needs of distance learners, (4) how to meet the needs of students with different learning styles, (5) how to assess learning outcomes, (6) how effective group work was in synchronous and asynchronous environments, (7) how much sequential and developmental learning is necessary in the instructional process for doctoral students, and (8) how the dynamics of collaboration with an academic program can impact the political realities of the design process.

Evaluation of an asynchronous teleconsultation system for diagnosis of skin cancer and other skin diseases.

We wished to assess both diagnostic accuracy and concordance among dermatologists when evaluating digital images of skin disease presented using a low-cost asynchronous (store-and-forward) format. Each of eight board-certified dermatologists reviewed 50 clinical cases presented in digital format on a 15-inch computer monitor. For each case, the teleconsultants made a primary diagnosis and differential diagnosis and indicated whether or not a biopsy should be performed both before and after reviewing a brief history of each case. Diagnostic accuracy was calculated for each teleconsultant on the basis of biopsy, culture, or wet mount results. Concordance was determined by comparing primary and differential diagnoses made by the teleconsultants on all 50 cases with those made by the dermatologists who originally examined the patients in person. For eight skin cancers, the diagnostic accuracy for the inperson dermatologist was 88% versus 90% (range, 75-100%) for the teleconsultants. For the 25 cases (including the 8 skin cancers) confirmed by either biopsy (20), culture (1), or wet mount (4), the in-person accuracy was 84% compared to 73% (range, 65-88%) for the teleconsultants. The concordance between the in-person and teleconsultant diagnoses were in agreement 77% of the time (90% if differential diagnoses were included). After evaluating the accompanying history, teleconsultants changed their primary diagnosis in 11% of the cases (range, 2-22%). Biopsy rates were not significantly different between teleconsultants (45%) and in-person dermatologists (40%). An asynchronous software application can provide levels of diagnostic accuracy and concordance equivalent to those reported using live teleconsultation.

Using web-based discussion as a teaching strategy: bioethics as an exemplar.

Using web-based discussion as a teaching strategy: bioethics as an exemplar Nurses are required to be competent in the area of bioethics based on several accreditation standards. Bioethics courses are one strategy to develop such a competency. Bioethics education itself has various goals including the need to engage in discussion and the ability to debate diverse issues. Providing an educational experience that meets both disciplinary and topic needs can be challenging. On-line conferencing through WebBoard 3.0, a web-based discussion software program, within a graduate level bioethics course successfully contributed to meeting these needs. A technical description of the WebBoard is provided in the following discussion along with a description of the integration of this device into a bioethics course. The WebBoard conferencing allowed all students to enter the class discussion and especially facilitated discussion for reticent speakers and distance learners. Evaluations of the bioethics course from both the faculty and students' perspectives were generally positive. Most students found the technique easy to use and liked the asynchronous format that allowed them to read and contribute at any hour of the day or night. Despite the labour intensive nature of this experience, the strategy ensured participation by every student, a major goal of the project. Developing an interdisciplinary situation would increase the value of such an experience.

NETWORKS: A Review of Their Technology, Architecture and Implementation

This article provides a broad overview of telecommunications and network‐related technologies. Topics covered include identification and review of network elements, analog and digital signals, synchronous and asynchronous transmission formats, transmission media and equipment, transmission techniques and characteristics, multiplexing, network types, access technologies, network architectures and topologies, local‐area network technologies and attributes, protocols and protocol issues, gateways, internetworking, local networking alternatives, equipment certification, and various aspects of network management. It is intended to provide the practicing professional in the field of library and information science with a broad, up‐to‐date technical review that might serve to support and facilitate further investigation of current developments in networks and networking. Although the broad range of topics is not treated in depth, numerous references are provided for further investigation.