World Education Market 2002: <br> Nurses reach sisters online

May 17, 2002

Informal chatrooms are aiding professional development in nursing. Peter Murray reports

Late one evening, worried about what she had seen in the ward she was working on, a nurse sat at her computer and sent an email detailing her concerns about her observations of poor infection control practice to an online discussion forum.

Over the next few days, nurses from around the world, some working in similar hospital settings, some working in education, and some with a research interest in infection control, contributed to a lively email discussion on the issues raised. The nurse was able to take a consensus of opinion, backed by research evidence, to her co-workers, to attempt to persuade them to change their practice. All this followed from a discussion in the type of online forum that many would deride as capable only of being an area of idle chat with little educational benefit.

This is one of many examples of nurses using what is becoming, for them and other health professionals, an important part of their life and their professional support mechanisms. Email-based discussion forums are used for many purposes - including idle chat and the exchange of jokes and gossip. They are also being used for more serious purposes.

Email-based discussion forums are perhaps the latest manifestation of what Kim Walker, an Australian nurse and academic, describes as the way in which nurses share stories. Through what Dr Walker describes as "late-night-early-morning-all-day conversations", there is a slow accrual of common sense and folklore, theories and knowledge. Such forums provide the opportunity for informal communities of practice and a potential mechanism, if reflection on the experience is documented, to provide evidence for continuing professional development.

The use of a variety of forms of online discussion is becoming commonplace within formal education that leads to some academic award. The Open University has used computer conferencing, and other structured discussion areas, within courses for a number of years. Robin Mason, one of the UK's leading researchers in this area, has concluded that forms of asynchronous discussions and individual messaging are an important component of most models of online courses. In order to encourage discussion, she says, it is important for course designers to structure the online environment. This involves devising stimulating individual and group activities, providing small group discussion areas and supporting students through facilitative rather than instructive moderating.

Virtual and managed learning environments, such as Blackboard and WebCT, are becoming commonplace in many UK universities. Yet many educators struggle as to how best to make use of them for effective learning, and in particular, how to encourage students to participate in discussions. From personal experience of using WebCT in teaching on masters courses, and of many other online discussion forums, I know how difficult it can be to encourage students and others to contribute to discussions.

In the US, many nursing colleagues are using structured email-based discussion areas within their classes, often as an adjunct to classroom-based, rather than distance, courses. Patricia McCartney, a nursing professor in Buffalo, New York, has seen her students develop critical thinking skills and change their practice as a result.

There is an assumption that, because students, or list subscribers, do not actively contribute to a discussion, they are gaining no benefit from it. Yet do we also assume that students who do not contribute in a classroom discussion gain no benefit from the interactions they hear? Listening is an important part of speech-based dialogue and discussion, and its online equivalent is equally important. "Lurking" - the practice of reading online discussions but rarely, if ever, contributing - is often described as a passive activity, but perhaps even passive learning is better than no learning at all. The ways in which many lurkers actually engage with online discussions is an under-researched area, but participants in virtual focus groups indicate that it may be a more active process and with more learning occurring than many have assumed.

Nursing is only one example of a practice-based discipline that requires its constituents to continually take account of and update their professional practice. The issues explored could equally well apply to many other disciplines. The National Health Service is exploring e-communities (online discussions) ahead of the development of the NHS University. Much of what we learn, and often apply within our work, comes not from formal courses, but from the informal, late-night-early-morning-all-day conversations with colleagues. We have much evidence from formal education of the benefits of online discussion; now is the time to explore the potential of the many informal opportunities that exist.

Peter J. Murray is executive secretary of the Association for Learning Technology

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