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Nurse prescribing: A comparison between nurses undertaking e-learning and conventional courses

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Eleanor Bradley, PhD, MSc, CPsychol, is reader in mental health, Staffordshire University; Joan Burgess, MSc, RGN, RNT, is programme leader, Open Learning School of Health Sciences, University College Winchester; Mary Ring, BSc, RN, HV, is regional lead for nurse prescribing, Coventry PCT; Peter Nolan, PhD, MEd, BA, BEd, RMN, RGN, DN, RNT, is professor of mental health nursing, Staffordshire University

ABSTRACT: Bradley, E. et al (2006) Nurse prescribing: A comparison between nurses undertaking e-learning and conventional courses.


ABSTRACT: Bradley, E. et al (2006) Nurse prescribing: A comparison between nurses undertaking e-learning andconventional courses.



AIM:This study aimed to elicit what differences, if any, exist between nurses who elect to train asprescribers via e-learning and those who choose a conventional university-based course, and what they see as the attractionsand challenges of their respective courses, in the hope of providing information that may be useful in planning courses in thefuture.



METHODOLOGY:Two universities participated in the study, one in the West Midlands and one in South WestEngland. Both provided courses for the preparation of nurse prescribers, one through e-learning and the other via a traditionalcourse. A questionnaire was designed and distributed to students to ascertain during their nursing background, their previousinvolvement with medicines management, their reasons for choosing the course they were following and any concerns they hadabout the course.



RESULTS:The reasons for nurses choosing an e-learning rather than a traditional course were somewhatpredictable. Respondents appear to have been influenced in their choice according to whether they had done an e-learning coursebefore and by their assessment of their IT skills. Those who felt they had good IT skills were more likely to choosee-learning. Also interesting to note was that nurses who had spent more time in medications management prior to taking theprescribing course were also more likely to be e-learners.



CONCLUSION:It is not their nursing background that influences students’ choice of course; all nurses mightfollow e-learning courses given sufficient IT skills. Given the growing need for accessible training and education forhealthcare professionals, there is an urgent need to ascertain whether e-learning can deliver outcomes as good as, or perhapseven better than, those of traditional courses.







Information technology is set to transform the way patient care is managed and health personnel are educated and trainedfor specific jobs. Such will be its impact that thousands of NHS staff - from the most senior consultant to the most juniorhealthcare assistant - will have instant access to information (Department of Health, 2005). The growing demand for healthcareis creating a pressing need for more qualified people to strengthen the workforce (Bargagliotti,2006).



The belief informing nurse education since its inception has been that nurses are a homogeneous group who acquireknowledge and skills in a similar way. Traditionally, courses have therefore tended to be similar in content and delivered in aclassroom situation by a tutor acting sometimes as facilitator and more often as pedagogue (Doster, 2004). Studies in adultlearning have demonstrated that such an approach is not always appropriate and much more attention is now being given tostudents’ reasons for undertaking a course, their pre-existing knowledge and previous experiences, their learning styles andthe intended application of the acquired learning and skills (Connors et al, 2002) The need to create and support a workforcethat is fit for purpose in the health services requires lifelong learning made available through easy access to programmes thatare flexible enough to enable individuals to incorporate learning into their working lives. E-learning is set to make aconsiderable contribution to the delivery of healthcare, both in the way that professionals are prepared for their work and inhow patients and the public are informed and educated about their health needs (Laaksonen et al, 2005).








It is now generally accepted that mostmature students do not need the degree of mediation that has traditionally beenoffered to them. Adult learners are motivated by many different factors and have developed their own unique learning styleswhich vary according to context, task and the age of the learner (Figueira, 2006). The opportunity to choose how to receive andengage with course material, the pace at which that material is delivered and the flexibility to apply material gradually inthe workplace is very appealing to some people. It has also been suggested that educational programmes have most impact whenthey accommodate individual learning styles by providing different kinds of learning opportunity and sufficient and immediatefeedback (Dobrovolny, 2003).



Education in all contexts has responded to such insights; however, Mason (2002) argues that e-learning has advantages overtraditional approaches to education, particularly for adults. Although a definition of what exactly constitutes e-learning hasyet to be agreed, Mason offers his own, stating that e-learning is ‘learning that is delivered, enabled or mediated byelectronic technology, for the explicit purpose of training in organisations. It does not include stand-alone technologytraining’.



Thornbury (2003) finds that the real value of e-learning is realised when there is the opportunity to integrate workingwith learning in the workplace, while Hoyle (2002) suggests it is most effective when combined with traditional forms oflearning. Both authors identify the advantages of e-learning for organisations as:



? Ease of access;



? No travel costs;



? No lengthy periods away from work;



? Opportunity to study when convenient to the employee and employer;



? Flexible programmes more suited to individual needs.



The disadvantages include the:



? Exclusion of students who have little or no access to computers, or poor IT skills;



? Isolation of students;



? Inability to network and exchange ideas with other practitioners;



? Possibility that students may be unable to judge the quality of the material available.



Berke and Wiseman (2003), however, are confident that e-learning not only provides choice but also streamlines theeducational process by freeing educators to focus more on knowledge brokerage and learning transference, thereby increasingefficiency and productivity while reducing training costs.



In a wide-ranging review of the quality and effectiveness of e-learning, Barron (2003) concluded that training based one-learning was reasonably effective and that participants were moderately satisfied with their courses. However, students werecritical of the technologies currently available to support e-learning, and the quality of the content of e-learning courses.They wanted more scope to learn in their own way as well as more opportunities to express themselves rather than usingstandardised materials with pre-set outcomes.



Some observers are therefore cautious and argue that the wholesale adoption of e-learning would be disastrous for thenursing workforce. Todhunter (2006) argues that e-learning cannot enable students to acquire such skills as social interaction,engagement with patients, reflection, listening and caring. Although it may be appropriate for certain kinds of courses, itwould be unwise to abandon conventional training approaches that enable peer support, increase understanding through theexchange of ideas, and provide face-to-face encouragement in applying knowledge and skills in the real world. In addition, areport written for the DH (Rafferty and Waldman, 2003) concluded that information literacy on the part of staff, their criticalappraisal skills with regard to online literature, and variable access to computers would all need to be addressed before thefull potential of online resources could be realised.



Given the need for a nursing workforce that is ‘fit for purpose’, it seems inevitable that the ability to embrace newtechnology and to track and evaluate the changes that follow from it will be critical in shaping the future of the profession(Simpson, 2004). The aim of study was to elicit what differences, if any, exist between those who elect to train as prescribersvia e-learning and those who choose a conventional university-based course. It was hoped that this would help to clarify theattractions, challenges and potential future direction of both traditional and e-learning prescribing courses and inform courseplanners of the likely needs of their potential students.








Two universities were invited to participate in the study, one in the West Midlands and one in South West England. Bothwere providing courses for the preparation of nurse prescribers, one through e-learning (EL) and the other via a traditionalcourse (TC), which was largely classroom-based and managed by lecturers. Both universities agreed to identify groups ofstudents undertaking courses towards the end of 2005. A questionnaire was designed to ask students about their nursingbackground, their previous involvement with medicines management, their reasons for choosing the course they were following andany concerns they had about the course.



Questionnaires were distributed during the courses and respondents were asked to complete them in their own time andreturn them to the module leader, who would then forward them to the researchers. Some students chose to complete theirquestionnaire immediately upon receiving it, while others handed them in later. Of 36 students in the EL group, 24 (67%)returned completed questionnaires; of the 46 in the TC group 33 (72%) responded.








Fifty-seven trainee nurse prescribers returned completed questionnaires. Those in the TC group had been qualified for amean of 18.85 years (range 6-31) and the EL group for a mean of 18.29 years (range 6-36). The TC group had been in theircurrent post for a mean of 3.6 years (range 2 months to 21 years) and the EL group for a mean of 4.3 years (range 2 months to16 years).



The majority of the EL group (22, 92%) stated that, before beginning their course, they had spent more than 50% of theirtime in medication management activities, compared with only 12 (36%) of the TC group. Sixteen of the TC group (48%) estimatedthat they had spent 25-50% of their time in medication management, while five (15%) said that they had spent less than 25% oftheir time involved with medication management.



Significantly more nurses in the EL group (20/24, 83%) than those in the TC group felt they had had a choice ofprescribing courses; only three (9%) of the TC group said that they had been aware that there was a choice.



Three (9%) of the 33 TC group and five (21%) of the 24 EL group had previously taken e-learning courses. Unsurprisingly, ahigher proportion of the EL group 15 (63%) assessed themselves as proficient in IT, compared with 15 (45%) in the TC group.



In relation to the support provided during their courses, there were no significantdifferences between the two groups; 18(55%) of the TC group and 13 (54%) of the EL group stated that they had access to support whether it was automatically providedby their employing organisation or something they initiated by themselves. No sizeable differences were found between thegroups in terms of protected time for study; 18 (55%) and 11 (46%) of the EL group of the TC group had been granted protectedtime to complete their studies.



Table 1 summarises the job titles of the nurses prior to commencing their prescribing courses. The majority were advancednurse practitioners (TC group: 11/33, 33%; EL group: 18/24, 75%). Other roles mentioned by more than two nurses were communitymatron (five TC nurses), and sister (four TC nurses).




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