VOL. 29, No. 3
The purpose of this study was to identify supports beyond the educator that contributed to undergraduate and graduate nursing students’ ability and motivation to learn online. Case study methodology similar to Stake (2000) was bounded or contained by undergraduate and graduate online courses. Twenty-nine undergraduate and graduate nursing students, a majority of whom were women over the age of forty, studying part-time, working and raising children, participated in the study. Participants reported that four supports: informational, instrumental, emotional, and affirmational, were essential for them to complete their online course. Results from this study provide insight into the types of social support that would be beneficial to nursing students to enhance their online learning experience and promote completion of their programs.
Le but de cette étude était d'identifier les soutiens au-delà de l'éducateur qui ont contribué à la capacité et à la motivation des étudiants en sciences infirmières de premier cycle et de cycles supérieurs à apprendre en ligne. La méthodologie par étude de cas similaire à celle de Stake (2000) a été délimitée ou contenue par des cours en ligne de premier cycle et de cycles supérieurs. Vingt-neuf étudiants en sciences infirmières de premier cycle et de cycles supérieurs, dont la majorité était des femmes âgées de plus de quarante ans, étudiant à temps partiel, travaillant et élevant des enfants, ont participé à l'étude. Les participants ont signalé que quatre soutiens: informationnel, instrumental, émotionnel et affirmationnel, ont été essentiels pour eux afin de terminer leur cours en ligne. Les résultats de cette étude donnent un aperçu des types de soutien social qui seraient bénéfiques aux étudiants en sciences infirmières pour améliorer leur expérience d'apprentissage en ligne et pour promouvoir la réalisation de leurs programmes.
A review of the body of literature in the fields of education (Swan 2002), business (Hammond & Wiriyapinit, 2005), and nursing (Melrose & Bergeron, 2007; Plante & Asselin, 2014), revealed a focus on the relational aspects of online learning that are found in interactions with peers and educators. To a lesser extent, literature (Mann, 2014; Melrose & Bergeron, 2007; Plante & Asselin, 2014) exists about the specific attributes of educators that contribute to nursing students’ online learning, such as their ability to develop relationships, provide prompt feedback, engage students online and facilitate networking. After the initial research study on coping strategies (Munich 2009) was completed, a second review of the data exposed another theme not evident earlier. The purpose of this study was to identify factors beyond the educator that support students’ ability and motivation to learn in online courses. To date there are few known studies on what nursing students perceive as supportive and helpful in their online learning beyond what the educator provides (Cragg, Andrusyszyn & Fraser 2005). In particular there is a dearth of studies about nursing students’ experiences that address the four key determinates of social support: emotional, affirmational, informational or instrumental support (House, 1981).
Researchers from the field of education addressed how computer conferencing created a sense of community (Garrison & Anderson, 2003; Kanuka & Anderson, 2004). Hammond and Wiriyapinit (2005) noted that the online interactions of graduate students in business were not collaborative (i.e., working together to build knowledge) but cooperative (i.e., doing what needs to be done to complete the course). Andrusysyzn et al.’s (2000) international study on computer conferencing demonstrated that Norwegian students were highly positive about the experience while Canadian students were not. The Canadian students did not have the option of face-to-face collaboration that the Norwegian students did.
More recent studies have focused on how the educator positively influences the students’ experience. For example (a) students were more likely to stay in a course when there was evidence they were developing effective relationships with their educators (Atack, 2003); (b) when educators provide a caring environment and detailed feedback on assignments (Mann 2014); and (c) when educators were consistently online, answered students’ questions quickly, encouraged networking, and supported students to resolve group work conflict, (Melrose & Bergeron, 2007). The present study resulted from analysis of a primary investigation (Munich 2009) that was designed to address a gap in the literature regarding nursing students’ perceptions of online learning. An underlying theme that was illuminated from the primary investigation was the importance of social support within the student experience.
For the study described in this paper, social support is defined as, “the exchange of verbal and non-verbal messages conveying emotion, information, or referral, to help reduce one’s uncertainty or stress” (Walther & Boyd, 2002, p. 154). Several studies (Ireys, Sills, Kolodner & Walsh, 1996; Lin & Bhattacherjee, 2009; Stewart, Letourneau, Masuda, Anderson & McGham, 2011;Sullivan-Bolyai & Lee, 2011) have used a variation of House’s (1981) social support theory. Social support in this context includes (a) emotional support—providing concern and compassion, (b) informational support—providing advice or information to support decision making, (c) instrumental support—providing practical help and resources, and (d) affirmational support—providing positive feedback about the person’s behaviors and decisions (House, 1981). The social supports that nursing students identified as helpful in their online learning from the current study are described in this paper.In the primary study (Munich, 2009) a qualitative inquiry design using a case study approach similar to Stake (2000) was utilized. The modification of the case resulted from students’ perspectives of taking online courses. The cases in the study described in this paper were a bounded system limited by the university and contained the online courses, the individual participants, the educator and the online discussion boards. The three case studies consisted of a collection of undergraduate family nursing courses, a master’s level pharmacology course and a master’s level philosophy in nursing course.
Within the cases, the patterns and formulations of the course were the assignments and online discussions contained within the same learning platform and that used the same format of large group discussions. By using three cases the author of this paper was able to identify how undergraduate and graduate nursing students coped with online learning within the university settings. Therefore, the case approach increased understanding of the complexity of the students and of the online courses within the different universities.
While the original study conducted by Munich (2009) focused on coping strategies, instrumental case study methodology was used in this study to develop insight into understanding what social support nursing students used in their online learning. The cases played a supportive role for each other that enhanced understanding of the data collected rather than being comparative (Stake, 2000). An inductive content analysis method using the software Nvivo 6 identified themes, patterns, and relationships contained within the data to develop the analytic framework that was utilized. Ethical approval was provided by Deakin University’s Human Research Ethics Committee (DUHREC) and the ethical review boards of two western Canadian universities.
Case Study 1 consisted of undergraduate nursing students (n = 6) from one university. Case Study 2 consisted of graduate students in a pharmacology course (n =13); Case Study 3 consisted of graduate students (n = 10) enrolled in the philosophy of nursing course. Participants from Case Study 2 and 3 were from the same university.
Administrators in two Schools of Nursing posted a short summary of the study for the identified courses and the contact information for the researcher. In addition, snowball sampling (Patton, 1990) was used to identify additional participants because of the very low uptake of participants at the start of the study. Students who expressed interest were provided with an explanation of the study and completed an online demographic survey including age, gender, previous experience with computers, occupation, geographic location, previous degree, and the reason for taking the course online rather than face-to-face.
Telephone interviews were conducted with each participant at “Time 1”, when they were part way through their online course, and then at “Time 2”, after they had finished the course and had gained some experience with online learning. Time 1 semi-structured telephone interview questions were based on the literature and the expertise of the researchers. Questions included student experiences with (a) online learning, tools and resources available, (b) self- evaluation of learning, (c) study and life schedules, (d) creating time to study, and (e) group assignments. Each interview was transcribed and returned to the participant for verification.
Time 2 interview questions were developed based on the results from Time 1 interviews and end-of-course questions. The questions addressed student perceptions about online learning, the benefits and challenges of online learning and what factors augmented one’s ability to cope. Field notes on the researcher’s interpretation of the interviews were recorded to provide another insight for analysis.
Four key online discussion forums were identified from the two graduate courses as relevant to the study: (a) the introduction forum where students could introduce themselves and share personal information, (b) unit one, where course content was discussed, (c) unit three, same as unit one, and (d) the coffee room discussion forum where students could conduct social conversations. To respect the privacy of the non-participants, online discussion forum analysis was delayed until the courses were archived at the end of the semester.Themes and relationships related to social support while learning in online environments were identified. The deeper analysis of these findings is presented at this time to articulate the richer meaning of students’ perceptions about online learning. Students received social support from their peers online, and offline they received support from family, nursing colleagues, employers and preceptors in their communities. Informational, instrumental, emotional, and affirmational support was reported to be critical to students’ online learning. For the purposes of illustration, these are presented as discrete entities in the following sections; however, in actuality, several types of social support were determined to occur at once and they were often overlapping in different components of online learning.
Informational support, the act of providing advice or information to assist decision-making, was evident in the online courses in this study and in the students’ offline support network of family and colleagues. In the online coffee room forum, students posted about where to take computers to be repaired, problem-solved how to resolve technical issues, asked questions regarding how to write assignments, and shared academic resources. Students also used the coffee room forum to network on how to find preceptors and set up their own practicums. They stated that the inability to locate physicians or nurse practitioners to act as mentors or preceptors negatively affected their stress levels, until they asked for help in the coffee room forum and their peers helped locate suitable preceptors. This was an example of how the coffee room forum was one of the most helpful and stress reducing resources for the students. Participation in the coffee room forum promoted the development of a supportive network that assisted newer students, built online rapport and demonstrated how social support could decrease stressful situations. Large group discussions provided informational support by providing new knowledge about different types of nursing in different locations, such as cardiac care or intensive care nursing. “I am very impressed with everyone’s knowledge and I really appreciate the different backgrounds. I come from a community background and many of my peers are hospital-based nurses whose perspective is quite different. It was a good learning experience” (Jane, personal communication, November 16, 2004).
Several students indicated that they received informational support from their classmates, particularly in online discussions in which their peers shared ideas and knowledge. For example, in the pharmacology course, the students stated that they had gained new knowledge about medications they could share with their patients or nurse colleagues. One student who worked as a community health nurse in a town without a doctor stated that the informational support she received in the online course was not just an extended knowledge of pharmacology but the ability to apply what she learned from her course and from her online peers to supplement her ongoing practice (Pam, personal communication, November 12, 2004). In another example, a student, who was a nursing instructor, indicated he used the knowledge he gained from his own online course to improve the courses he taught at his place of employment (George, personal communication, November 11, 2004). The coffee room discussion forum provided a venue for the development of peer relationships and was invaluable in locating preceptors.
Family provided informational support, for example, one student and her husband studying for online degrees edited each other’s assignments while juggling the care of two small children, one full time job and one casual position. She explained:
Most people would be going to the movies on a Saturday night and we would be studying. The juggling of so many roles was often hard . . . By the end of it we had it down to a science. We would edit each other’s papers: he is very helpful when I am stuck. (Ann personal communication, November 23, 2004)
Instrumental support, the act of providing practical help and resources, was a strong theme in this study, for example, students received online support in the form of guidance from classmates on how to find information technology (IT) professionals who could remove viruses and install anti-spyware on their computers. The online library, which offered links to required readings and informative websites were aspects of instrumental support that students used for researching their assignments and preparing for their discussion forums. Students also posted website links and references in the coffee room forum to facilitate each other’s learning. In the coffee room, one student posted a request on how to write their first paper. Katie responded with the following advice:
My struggle is always getting the information into an actual paper. What might be helpful for you is to talk to someone who knows nothing about this and just start describing. If you are a factual person, then you should have no problem explaining your point. What will come from your discussion is your philosophy of the information. (Katie, personal communication, November 10, 2004) The response provides practical instrumental support for other new online students and promoted a discussion on other ideas for writing by the more experienced students.
Outside the course, almost every student identified spouses, children and extended family as supportive when they took over childcare and household responsibilities, releasing the students to use their limited time to study. “My husband is my partner in this degree. He does a fair amount of housework and manages the family. My oldest two children are cooking more to help and I supervise them” (Justine, personal communication, November 5, 2004). These family members took care of household responsibilities including meals, grocery shopping, and childcare. “You need a very supportive partner. It would not work in an environment where you weren’t supported. My husband picks up the pieces. He has been doing it now for 4 years; I could not have done it without him” (Cathy, personal communication, November 9, 2004).
Students indicated the instrumental support they received from their workplaces was integral to their success as online learners. For example, several students received time off work to complete assignments, were encouraged to study during quiet times on their wards, used workplace computers, or were given flexible work schedules to accommodate exams. This expression of instrumental support enhanced the students’ ability to manage their course loads and complete their assignments. The students indicated that they reciprocated this support by applying knowledge gained from their online courses to their nursing practice:
I am very fortunate to be able to go online at work during the day to post and read postings. If my work was not 100% supportive, I do not think I would have been able to finish as quickly. I am able to work on my assignments and study at work when possible (Katie, personal communication, November 10, 2004).
The preceptors who guided students through the advanced role of a nurse practitioner were also instrumental in building confidence as well as their abilities to consolidate online studies with nursing practice. Several students worked with fellow nurses who were also taking online courses, which resulted in the sharing of resources for assignments and editorial assistance. The combination of employer support and the opportunity to consolidate learning may explain why students, despite their busy lives, did not give up their practice to attend school full-time.
Emotional Support
Students identified many sources of emotional support, such as concern or compassion, either online from their peers or off line from their families. Within the course, the coffee room discussion forum was invaluable as a means to connect and develop relationships online. It became a safe place for students to share experiences and support one another through life events such as family illness, surgery, looking for work, and adjusting to new jobs, leading to a sense of community. Some students commented that they would miss the online interaction after the course ended:
A positive low, if you can call it that, is the feeling of emptiness at the end of each semester as we say goodbye to our classmates. It is a sign of the interesting group dynamic of online learning, in my opinion! It is fascinating how we can create bonds that last with people we have never seen face-to-face. (Angela, personal communication, November 23, 2004)
Peer support, defined as the support students receive from their classmates, evolved during discussion forums. Students developed a community where they felt safe to project themselves ‘socially’ and ‘emotionally’ leading to a mutually supportive environment within the course (Garrison & Anderson, 2003, p. 49).
Other students found their main source of emotional support outside of the course. A few wrote about how they never felt connected to their peers online but, instead, indicated that they would not have completed their degrees without the emotional support of their families, friends, employers and nursing colleagues. Only two students had husbands who found it difficult to adjust to their wives’ busy study schedules but, overall, supportive families facilitated students’ learning online. “I see my son as my biggest fan, if I am saying ‘Oh I’m just overwhelmed, I can’t do this’ he says ‘Mom, you can do it, I know you can’” (Jenny, personal communication, November 2, 2004).
Affirmational Support
Affirmational support or positive feedback about the person’s behaviors and decisions was evident both online and offline. One student, who had registered for two concurrent clinical rotations to try to finish the program sooner, was relieved to read in the coffee room forum that she was not alone in trying to manage two clinical rotations with her studies and other responsibilities. Students in this research study identified how they bolstered each other’s morale and shared experiences in the discussion forums. For example, one student described how classmates supported her after her daughter’s skiing accident. She logged in daily and also enjoyed working on small group assignments and collaborating in the large group discussions, learning from the perspectives and experience of the other nurses in the class. Her main supporters were her peers
Common to all three groups of students was the learning that happened outside of the course content, through the networking and sharing of experiences between classmates in the discussion forums that could be brought back to the students’ workplace and shared. This sharing gave the students affirmational support from their colleagues at work and could have been the impetus that encouraged employers to support students’ studies.
Students who worked with nursing colleagues who were also taking courses online developed a supportive environment where they felt safe discussing course content and providing each other with feedback on their assignments. One student summed up how this affirmational support was important to her success:
I work weekends at a telephone job. Many of the nurses there also take courses online. The majority are in nursing or education and either doing their undergraduate or their masters. One weekend I put out an email for help to critique a paper I was doing. This was at 2 o’clock in the morning and I did not anticipate anyone on duty would respond since we sit in different areas of the Centre. Over the next few days my colleagues approached me with offers to help. They are very supportive and provide positive feedback for all the roles I currently perform from wife, mother, nurse, student and volunteer. (Justine, personal communication, November 5, 2004)
This study reports on the benefits of online and offline support students received while learning online that were not related to the educator. Most of the 29 participants were women, over the age of forty years, studying part time, working full time and raising children. Studies conducted to date have focused largely on what the educator contributes to support the online learner (Atack, 2003; Mann, 2014; Melrose & Bergeron, 2007; Plante & Asselin, 2014). Critics (Seiler & Billings, 2004; Sit, Chung, Chow & Wong, 2005) have suggested that online learning is mostly influenced by the student’s interactions with the educator; the notion that nursing students function in a community of practice and may be influenced in their learning by others external to the online course has not been widely explored. This study addressed the influence of online support that students received from each other within their course and how they received offline support from their families, employers, and nursing colleagues as well.
Online support occurred in the coffee room discussion forum, which was an invaluable space for connecting and developing relationships or finding emotional support online. Students conversed in the coffee room and provided informational support on where to take computers to be repaired, problem-solved technical issues and shared resources. There was a strong presence of instrumental support in the form of practical help in how to remove viruses from computers, install antivirus software and write papers. Out of all the discussion forums, the coffee room provided the richest source of support, as it became a safe place to recruit solutions and provide encouragement or affirmational support when students were overwhelmed.
The large discussion forums designed for content learning also contributed to social support. Students gained insight into each other’s specialties and enriched relationships with their peers by contributing to both emotional and informational support. According to Garrison and Anderson (2003), interacting in large group discussions challenges students to explore other perspectives of a topic, builds community and develops social presence. The discussion forums provide a place to “establish relationships and a sense of belonging” (Garrison & Anderson, 2003 p. 50) leading to a dynamic environment that encourages the students to brainstorm collaboratively.
Almost every student identified husbands, children and extended family as providing instrumental support when families took over childcare and household responsibilities, releasing the student to use their limited time to study. Families provided emotional and affirmational support by telling the students they believed the students could succeed. Employers provided instrumental support by providing time off of work, encouraging students to study during quiet times and allowing access to computers. Colleagues at work provided resources for assignment and editorial assistance or instrumental support. Employers and colleagues both provided affirmational support by telling the students they were doing a great job bringing in new knowledge to the work place.
Participants lived in isolated locations across Canada limiting contact to telephone and email, thus eliminating access to observation of non-verbal cues such as facial expression. Any additional student-to-student communication through private email or telephone calls was not included in this data. Non-participants’ online discussion contributions were excluded. Another limitation is that not knowing the full context of the online conversations may have affected the interpretation of participants’ online discussion messages.
Continuing education is important in nursing to ensure that delivery methods and learning outcomes are relevant to nurses as learners. As increasing demand for online delivery methods continues, better understanding of the sources of help that students need to support their learning is required. Identifying how social support online and offline enhances students’ online learning experiences presents some interesting information that could be beneficial to educators and administrators. Findings from this study suggest there may be benefits from better understanding the role of social support in student achievement for students studying online.
Kim Munich is an Assistant Professor of Nursing at Thompson Rivers University. E-mail: kmunich@tru.ca