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The benefits of E-learning for cancer nurse education

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VOL: 103, ISSUE: 09, PAGE NO: 30

Mark Irving, BSc, DipHE, RGN, is clinical nurse specialist at Cumberland Infirmary, Carlisle

Ray Irving, BA, MBA, and Stuart Sutherland, PGCE, MA, are both e-learning consultants at the University of Warwick, Coventry; all are also volunteers at the charity Nurse Learning ( is a website developed by Nurse Learning, a UK-based registered charity t… ( is a website developed by Nurse Learning, a UK-based registered charity that develops and provides free online courses for nurses and cancer carers around the world. The courses are developed using the stand-alone model as it offers learners flexibility when they work through the courses and it also enables us to reach out to a global audience. The main drawback of the stand-alone model is the reduced interaction between learners that a collaborative model would offer, thereby reducing the opportunity to learn from others. In an attempt to address this deficiency, online discussion forums are to be integrated into the website within a new design planned for launch in the spring of 2007.





Each course is written by experts in the relevant subject area. The material submitted by the writing team is then extensively reviewed by an international panel of experts identified from the nursing press or contacts obtained through the website. Following publication, all courses are formally reviewed on an annual basis, although any changes in practice that are identified by learners or the website team within that time are investigated and integrated immediately, if appropriate. courses are currently being evaluated by a UK university so that learners who want to obtain an accredited certificate and credit accumulation and transfer (CATS) points will have the opportunity to do so.



At the end of 2006, there were eight courses available on the website:



- Cancer of the oesophagus;



- Graseby syringe drivers in palliative care;



- Management of hypercalcaemia in malignant disease;



- Introduction to cancer in children and young people;



- Introduction to palliative care nursing;



- Management of skin-tunnelled central venous catheters;



- Peripherally inserted central catheters and PICC chemotherapy;



- Cancer of the prostate.



Features of the online learning environment


The online learning environment offers the following resources and features:



- Material developed by experienced nurses, using images whenever possible to illustrate aspects of care bearing in mind that over-use of images may affect browsing for those with slower connection speeds;



- Self-assessment tests;



- A glossary of key terminology with a facility to request that a term be considered for inclusion;



- ‘Ask the expert’ facility to contact the course authors/reviewers for clarification;



- Frequently-asked questions;



- Personal learning log - a private, personal record, which is not formally assessed;



- Record of achievement - a printable certificate that can be used as proof of course completion and can be included in a learning portfolio.



Organisational benefits


In addition to the benefits enjoyed by nurses with this type of learning, individual organisations are now integrating the courses into their own training plans (Bye, 2006). A number of paediatric oncology wards, for example, are making it a requirement for all new nurses to complete the course on cancer in children and young people.



However, this involves more than simply asking nurses to go away and do the courses. As there are no timetables or deadlines within the learning environment it requires learners to be motivated unless deadlines are set for them, and employers must ensure they are able to use the internet.



Perhaps the key benefit to organisations is that the courses are free and can be undertaken in the nurses’ own time. As trusts face a growing battle to reduce costs, online training is likely to become increasingly attractive. But this raises two questions. First, will nurses be prepared to learn in their own time? And second, is this learning effective in improving standards of care? The learner feedback in the following section provides some insight into these issues.



Learner feedback


All learners completing a course are asked to provide feedback, which is used to both improve and adapt the courses and provide future learners with information on how their peers have used the material.



Of the 11,000 learners registered on the website, 98% who completed a course found the content valuable and useful, while 85% felt the courses improved their knowledge and understanding of that particular subject and 83% felt the care they provided would improve significantly as a result. Although this data is subjective, it suggests that stand-alone e-learning courses can lead to improvements in quality of care. Further investigation is needed to determine the true value to patients.



A number of issues have emerged from free-text feedback from learners. The most frequently occurring comment has been in relation to the flexibility of the online learning environment. Learners suggest that this flexibility makes learning in their own time both attractive and convenient and they enjoy being able to learn in the comfort of their own homes. This is most apparent for those who find it difficult to access traditional face-to-face training, such as those working night shifts, community nurses and those having problems with childcare.



Another issue mentioned frequently by learners is that the courses provide them with increased confidence to practise. This has been referred to by learners completing all courses and most frequently by those completing practical courses.



Finally, learners have indicated that they have found online learning fun. They enjoy being responsible for their own learning, provided that suitable structured resources exist to facilitate this.



Although the feedback has been very positive, the data presented here should be interpreted with caution due to its subjective nature and, more importantly, because this may well be a self-selecting group of motivated nurses whose comments cannot be applied to the wider nursing population.





E-learning offers many positive possibilities and advantages as it can provide the necessary flexibility in times of massive workplace change.



It is envisaged that in the near future all nurses will come into contact with internet-based learning, whether through third-party sites such as or government initiatives. Whatever the origins of the learning environment, it is vital that strict quality-control mechanisms are in place that promote evidence-based practice and provide learners with confidence that the material they access is of the highest standard.





- Educating cancer nurses presents significant challenges as increasing demands on their time prevent them from accessing educational opportunities. While face-to-face learning remains the gold standard for delivering education, developments in web-based technology have created new opportunities to provide high-quality educational material for cancer nurses worldwide.



- There is evidence to suggest that online learning can promote flexibility of learning while, at the same time, lead to improvements in practice and patient care (Atack et al, 2005; Atack and Rankin, 2002; Blair, 2004; Blair, 2002).



- E-learning encompasses all forms of electronic-supported learning and teaching that contribute towards the learning process (Tavangarian et al, 2004). These electronic resources range from the provision of straightforward text via web pages to fully integrated learning management systems that use a variety of multimedia components.



- The selection and utilisation of technological resources depend on the model of e-learning selected. These models can be expressed on a continuum - at one end lies collaborative e-learning, where learners work in tutor-facilitated teams, sharing their knowledge and experiences and learning together, while at the other is stand-alone e-learning, which usually involves learners being provided with a core body of knowledge in either text or multimedia format.





Since the launch of the website in the spring of 2003, a number of lessons have been learnt about providing this form of online learning for nurses:



- Nurses like to test their existing knowledge of a subject area before they invest time in further study;



- Modular courses divided into manageable chunks, that can be studied as part of a whole course or individually, offer a popular and sometimes essential flexibility;



- Self-assessment tests are a convenient way to assess knowledge and understanding, and motivate nurses to increase their score if they do not achieve a high mark at the first attempt;



- E-learning can bring training and education to nurses in any geographical location;



- Simple technologies work best. Internet connection speeds and the technological ability of learners must be considered when selecting a model of e-learning.



This article has been double-blind peer-reviewed.

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