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Article history: Problem-based learning (PBL) is a student-centred method of teaching, and is initiated by introducing
Accepted 17 October 2010 a clinical problem through which learning is fostered by active inquisition (Tavakol and Reicherter, 2003).
Using this teaching and learning strategy for web-based environments is examined from the literature
Keywords: for potential implementation in a Bachelor of Nursing program.
Problem-based learning In view of the evidence, students accessing online nursing subjects would seem to benefit from web-
Online education
based PBL as it provides flexibility, opportunities for discussion and co-participation, encourages student
E-learning
autonomy, and allows construction of meaning as the problems mirror the real world. PBL also promotes
Web-based nurse education
critical thinking and transfer of theory to practice. It is recommended that some components of practice-
based subjects such as Clinical Practice or Community Health Nursing, could be implemented online
using a PBL format, which should also include a discussion forum to enable group work for problem-
solving activities, and tutor facilitation.
Ó 2010 Elsevier Ltd. All rights reserved.
Introduction strengths and limitations of PBL, this paper will describe web-based
learning and PBL before reviewing the literature on web-based PBL
As technology has evolved, web-based learning has gained for nurse education.
popularity with students, and increasingly, higher education
institutions have recognized the benefits of utilizing this tech-
Web-based learning
nology as a strategy to enhance student recruitment and retention
(Parker et al., 2005); to remain relevant, convenient, flexible and
Online education is seen to create access to learning (Pawan,
accessible (Care and Scanlan, 2000); and to promote autonomous
2003) as it is independent of geographic and temporal bound-
lifelong learners (Howatson-Jones, 2004). According to O’Neil and
aries, and increases learner control allowing for greater flexibility
Fisher (2008), the changing profile of nursing students and
and autonomy. It also provides ready access to resources, allowing
demands of the healthcare environment have prompted schools of
for interaction and communication with other students and
nursing to deliver or support education using information
educators via email and synchronous or asynchronous discussion
technology.
forums (Prows et al., 2004). Synchronous methods include
Problem-based learning (PBL) is a student-centred method of
discussions, virtual classrooms or video-conferencing where
teaching, and is initiated by a clinical problem aimed to foster
interactions occur in real time and need to be pre-planned. Asyn-
learning through active inquisition, and to encourage students to
chronous activities such as use of websites, problem-solving
take the major responsibility for their own learning (Tavakol and
scenarios, and online discussions are self-directed and allow for
Reicherter, 2003). Web-based PBL can develop self-directed
greater choice of process, pace and location (Larsen et al., cited in
learning and problem-solving skills using real life problems, while
Howatson-Jones, 2004). Increased demand for distance education
addressing some of the time, travel and access constraints for
has prompted nursing faculties to implement information and
students. Consequently web-based PBL is of particular interest for
technological approaches to provide education opportunities that
the development of online interaction/communication in an
cater for the diversity of learners needs (Udod and Care, 2002).
Australian Bachelor of Nursing (BN) program as the course is
operated over two campuses and students can attend from a wide
geographical area. While there has been much written on the Problem-based learning
1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nepr.2010.10.010
Table 1
Review of primary research on web-based PBL.
125
Table 1 (continued )
126
Authors Description Results Limitations Reason for inclusion
Dennis, 2003 A comparison between online Computer-mediated communication in PBL Study size was small (17 in each group) Study used a medical/surgical
versus face-to-face group resulted in significantly longer Not a nursing program component of an allied health
learning. Post-test only control time-on-task as face-to-face groups, and that The online component minor as the study was program, and investigated PBL
group to investigate the effects technological problems played a role in the conducted using two scenarios/problems with in an online format.
of earning conditions on percentage of off-task time for online PBL face-to-face laboratory session.
learning outcomes and students. Despite this, there was no difference in
processes in a US physical learning outcomes between the two groups
therapy program. The use of a chat room for PBL tutorials proved to
be as effective for learning as face-to-face formats,
but that the process was less efficient
Recommended cautious implementation of online
PBL due to greater time needed for similar
outcomes
Valaitis et al., Canadian study of 22 nursing Online learning increased flexibility, by allowing Cohort is small and extends over a short period The results and recommendations for
2005 students’ perceptions of PBL students to learn at their own pace, and in of time, using students who are actually on- carefully planned training sessions for
over a 4e6 week period a manner that suited their learning style, time and ampus, who met face to face in concurrent PBL tutors and students, and a period of
location classes adaptation to online
Students valued taking a more active role with the PBL are a useful guide.
information nurse educators can use in designing innovative cautious implementation of online PBL due to greater time needed
teaching programmes. for similar outcomes.
Dennis (2003) used a post-test only control group to compare
the outcomes of PBL between synchronous online groups and face-
Critical thinking
to-face tutorial groups in a medical/surgical component of a US
physical therapy program. Statistical analysis was used to investi-
Critical thinking in nursing is important as it enables students to
gate the hypothesis that the final course grade would be no
solve clinical problems and provide rationales for their clinical
different between groups. Thirty-four participants were drawn
reasoning and decision making, with the ability to transfer
from second year students, and seventeen randomly assigned to
reasoning strategies to new problems (Hmelo-Silver, 2004; Cooke
either a computer-mediated PBL group or a face-to-face PBL group
and Moyle, 2002). Students in Cooke and Moyle’s (2002) study
(control). The number of participants was small and the online
reported that PBL promoted critical thinking skills, as they were
component minor as the study was conducted using two scenarios/
able to problem-solve in situations that replicated clinical situa-
problems in a Women’s Health component of a medical/surgical
tions in real life nursing practice. Student nurses were expected to
conditions course with a face-to-face laboratory session. The results
analyse and synthesize various aspects of knowledge, make clinical
were obtained from one test consisting of 30 multiple-choice
decisions based on their learning, and provide rationales for their
questions and two case-based short answer questions, reducing the
clinical reasoning. The teacher’s role in PBL was more interactive
generalizability of the results. While it was not a nursing program,
and responsive, and helped them to develop critical thinking skills
it was useful as the medical/surgical component of an allied health
by questioning and challenging students. This process assisted the
program would have some similarities to nursing programs, and
transfer of theory to practice as students reported their learning
while limited, it investigated PBL in an online format.
was purposeful and relevant to their real life practice as future
McLinden et al. (2006) reported on phase two of a pilot study
nurses. Valaitis et al. (2005) used a ‘real’ client to promote authentic
concerned with the development and evaluation of online resources
learning, and students gained new perspectives about the day-to-
using PBL in one unit of a distance education postgraduate teach-
day struggles from the client. The authors found that web-based
ing program. Participants (34) were allocated to one of six online
PBL offered tremendous opportunities for interdisciplinary learning
PBL tutorial groups, which were required to submit a group
through the use of online communication. Students perceived that
assignment with individual contributions. On completion of two
the various problem-based activities contributed substantially to
case scenarios, an anonymous questionnaire (using a 4-point Likert
their learning, and that the environment was enjoyable and stim-
scale) was used to collect feedback regarding participation of the
ulating (Oliver and Omari, 1999).
online PBL component, and information related to the design and
In contrast to these positive findings, Oliver and Omari (1999)
relevance of the two case scenarios. The authors found a high degree
also reported that some students found this type of activity
of apprehension among students at the start of the program (76%),
cognitively demanding, which tended to lessen enthusiasm for
with initial hesitation about participating in online group work and
participation. Generally, however, responses regarding the devel-
finding the fast pace of synchronous chat rooms intimidating,
opment of personal skills suggested that web-based PBL strategies
despite having completed induction activities. Asynchronous
provided considerable scope for developing information literacy,
discussions however, enabled students to take time to think about
metacognition and self-regulating skills, which were critical for
their responses. Almost two-thirds of participants reported tech-
lifelong learning (Oliver and Omari, 1999). In this study, online PBL
nical difficulties in accessing the program during the first scenario,
was used in a core unit of an unspecified undergraduate program
with 40% of that group having to contact technical support for
with a group of 57 on-campus students to explore the practical
guidance. These findings suggested that use of technology must
issues and responses of the learners. Action research was carried
be informed by sound pedagogical principles, and that structured
out during implementation of the courses, with data gathered at
support be provided during the early stages of the program
several stages from questionnaires and interviews, consequently
to maximize learner engagement. This study had a small number
the results could change over time. Despite not being a nursing
of participants, and involved teachers with some face-to-face
study, and participants being on-campus, the conclusions were
components such as residential school and study days. However,
useful in informing decision-making about designing online PBL as
the majority of the course was online, strengthening the results
it highlighted the importance of ongoing input of the teacher to
regarding the use of PBL in an online environment, as compared to
provide adequate access and open lines of communication for the
studies where the online component was a very small part of a face-
students.
to-face course. These results could therefore be more generalizable,
and used to inform the development of online components of
Technical/time issues a nursing program.
for the course between face-to-face and distance students. This (2005), resources available in the online environment were
Canadian study used pre- and post-course questionnaires to highly valued. Online instruction is a viable instructional method,
compare learning satisfaction between nursing students who and has been used with success in a number of situations (Valaitis
attended the PBL course face-to-face (control group), and those et al., 2005; Oliver and Omari, 1999; Cooke and Moyle, 2002). Web-
who received the course via teleconferencing in two terms of based PBL has the potential to enhance student recruitment and
a ‘traditional’ nursing program. From the 51 students who retention (Parker et al., 2005) due to increased flexibility, assisting
completed the initial set of questionnaires, 30 students and six units to remain relevant and accessible (Care and Scanlan, 2000), as
tutors completed the second questionnaire yielding a post-course students will be able to access information and group discussion
response rate of 58.8% for students, and 100% for tutors, however anywhere. According to Magnussen (2008), the success of a web-
the sample size for this study was the number of problem-solving based program requires thoughtful planning, a committed faculty,
groups rather than the number of students, and hence the sample and investment in technical support and equipment in an effort to
size for a number of comparisons was small. The post-course reduce technical difficulties. With sound planning, the benefits of
response rate from students was low and only nine of the 30 providing quality, accessible and convenient education are worth to
students were from remote/distance sites as opposed to being ‘on- the investment.
campus’. Furthermore, the distance students in this research were In order to reduce the limitations of web-based PBL (such as
together physically as a group, with only the facilitator linked via apprehension and time taken to adjust to the PBL style of learning
teleconferencing, rather than each individual being linked via with group work), the course should include an orientation and
electronic means, thus allowing students to be engaged in active a period of adaptation to the PBL, along with a technological
face-to-face group process. This reduced the strength and utility of induction to the online environment (Valaitis et al., 2005; Beadle
the evidence, however the conclusions added to the evidence of and Santy, 2008). The program should include training for the
other studies. tutors, and tutors should be encouraged to make regular contribu-
Valaitis et al. (2005) reported that students initially had diffi- tions to the discussion forums to encourage collaboration and
culty setting learning objectives, and group decision-making was exploration, as well as learning of cognitive skills for problem solving
difficult with asynchronous discussion, with some students finding (Tavakol and Reicherter, 2003).
discussion threads confusing. In addition, preliminary communi- To implement a web-based programme a number of measures
cations were monologues rather than discussions as students were are recommended. Firstly, the teacher would need to be responsive
reluctant to reply critically to peer’s messages. to student contributions but also to make regular contributions to
Beadle and Santy (2008) described the delivery of an online the discussion forum, both in the form of simple acknowledgements
undergraduate-nursing module in the UK, using a PBL approach that or requests for further information (Brookfield, 2006). Brookfield
was previously delivered face-to-face as part of a classroom-based (2006) recommends that instructors need to be present and
preregistration program. They found from student evaluations that participate even more in an online discussion than face to face to
while PBL was useful in making links between theory and practice, enhance their social presence and keep the discussion focused on
there were difficult group dynamics with some students ‘not pulling the topic by inserting questions and comments, and giving timely
their weight’, along with logistical difficulties when delivering PBL feedback. Secondly, requesting all participants begin their remarks
face-to-face to large numbers, thus making it unpopular with the by commenting on the previous participant’s observations, using
students. This improved significantly with the use of online sessions, these as a springboard for their own encourages wider participation,
with the discussion groups useful in enhancing student learning and and preventing a few people dominating the discussion (Brookfield,
engaging them in discussion, consequently this lead to students 2006). Asynchronous communication is recommended for student
reporting they felt more comfortable participating online. The contributions as the fast moving nature and fragmented discussions
authors claimed web-based PBL was a useful method for varying of synchronous chat rooms can intimidate some students. Asyn-
delivery approaches in teaching healthcare students about practice, chronous discussions can take place over several days and provide
and the theory that underpinned it. time for students to think about their responses (McLinden et al.,
2006), which is useful for international or travelling students.
The role of the facilitator Thirdly, assigning students to small groups helps manage multiple
postings and promotes interaction. Finally, the course should be well
The importance of the role of the facilitator was a recurring organised so that the students clearly understand from the begin-
theme. Valaitis et al. (2005) found that students clearly valued tutor ning what the expectations are for the class, marking criteria for
guidance, wanting direction with teacher expectations, and guide- participation and group work, what the ground rules for participa-
lines for online contributions. According to Oliver and Omari (1999), tion, and can clearly see how the interaction is linked to the content
students continually reminded them that they valued the input of modules of the class (Brookfield, 2006).
the teacher. Edwards et al. (1999) found that tutor feedback to Web-based PBL could be implemented in a Clinical Practice or
distance students was inherently more difficult than in face-to-face Community Nursing subjects with the uploading of case studies in
situations due to the reliance on written communication. They various contexts with various clinical problems (which could also
suggested providing an opportunity to meet the tutor might over- be case studies for assignment questions). Students work in
come this problem. Assigning a group member to the role of group assigned groups to discuss the case and what they need to research
facilitator may also be a useful adjunct to the distance tutor. in online discussion forums, then present their findings and discuss
various management options and hypothesize about possible
Discussion outcomes/complications. If group assignments are produced as
a result, marks could be assigned to individual’s participation to the
In view of the evidence, students accessing units in a Bachelor of group and individual’s section of the assignment. The instructor
Nursing program could benefit from web-based PBL. Not only does would monitor the group discussion and participate with questions
it provide a social learning environment with opportunities for and comments to promote interaction and focus on the topic. Price
discussion and co-participation, encouraging student autonomy (2000) recommended PBL for a skills development component
and construction of meaning with real world problems consistent within the curriculum, while cautioning against its broad use across
with PBL approaches generally, but according to Valaitis et al. the whole nurse education program.
130 T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
Conclusion Dennis, J.K., 2003. Problem-based Learning in online vs. face-to-face environments.
Education for Health 16 (2), 198e209.
Edwards, N., Hugo, K., Cragg, B., Peterson, J., 1999. The integration of problem-based
It is proposed that some components of the Bachelor of Nursing learning strategies in distance education. Nurse Education 24 (1), 36e41.
programs, for example, the practice-based subjects such as Clinical Hmelo-Silver, C.E., 2004. Problem-based learning: what and how do students learn?
Practice or Community Health Nursing, be implemented online Educational Psychology Review 16 (3), 235e266.
Howatson-Jones, L., 2004. Designing web-based education courses for nurses.
using a PBL format prior to or after students going on clinical Nursing Standard 19 (11), 41e44.
placement as these experiences enhance critical thinking and self- Knowles, M.S., Holton, E.F., Swanson, R.A., 2005. The Adult Learner: the Definitive
directed learning (Kolb, 1984). Web-based units should include Classic in Adult Education and Human Resource Development, sixth ed.
Elsevier, Burlington, MA.
a discussion forum that enables group work for problem-solving Kolb, D.A., 1984. Experiential Learning: Experience as the Source of Learning and
activities, with tutor facilitation. In order to reduce some of the Development. Prentice-Hall, Englewood Cliffs, New Jersey.
challenges of web-based PBL, an initial period of adaptation, with Magnussen, L., 2008. Applying the principles of significant leaning in the e-learning
environment. Journal of Nursing Education 47 (2), 82e86.
carefully planned training sessions for students and tutors in PBL McLinden, M., McCall, S., Hinton, D., Weston, A., 2006. Participation in online
processes, technological aspects and defined expectations is rec- problem-based learning: insights from postgraduate teachers studying through
ommended (Valaitis et al., 2005; Beadle and Santy, 2008; Price, open and distance education. Distance Education 27 (3), 331e353.
Oliver, R., Omari, A., 1999. Using online technologies to support problem-based
2000). Providing access to teachers along adequate lines of learning: learners’ responses and perceptions. Australasian Journal of Educa-
communication (Oliver and Omari, 1999) should be encouraged tional Technology 15 (1), 58e79.
throughout the implementation of the program. Students and O’Neil, C., Fisher, C., 2008. Should I take this course online? Journal of Nursing
Education 47 (2), 53e58.
teachers should be given the opportunity to provide feedback at
Parker, E.B., Riza, L., Tierney, S., Barrett, A., 2005. Interdisciplinary collaboration: an
regular intervals throughout the program, as further research will effective approach for developing web-based courses. CIN: computers, infor-
need to be undertaken regarding the effectiveness, efficiency and matics. Nursing 23 (6), 308e313.
sustainability of web-based PBL in this program and setting. Pawan, F., 2003. Reflective teaching online. TechTrends 47 (4), 30e34.
Peters, M., 2000. Does constructivist epistemology have a place in nurse education?
Journal of Nursing Education 39, 166e172.
Price, B., 2000. Problem-based learning the distance learning way: a bridge too far?
Acknowledgements Nurse Education Today 20, 98e105.
Prows, C.A., Hetteberg, C., Hopkin, R.J., Latta, K.K., Powers, S.M., 2004. Development
I would like to thank my colleagues, Athena Sheehan and Alison of a web-based genetics institute for a nursing audience. The Journal of
Continuing Education in Nursing 35 (5), 223e231.
Smedley for their constructive feedback and support during the
Rideout, E., Carpio, B., 2001. The problem-based learning model of nursing educa-
writing of this paper. tion. In: Rideout, E. (Ed.), Transforming Nursing Education through Problem-
based Learning. Jones and Bartlett Publishers, Sudbury, Massachusetts, pp.
22e23.
References Rogers, C., 1983. Freedom to Learn for the 80s. Charles E. Merrill, Ohio.
Tavakol, K., Reicherter, E.A., 2003. The role of problem-based learning in the
Azer, S., 2008. Navigating Problem-based Learning. Elservier, Marrickville, NSW. enhancement of allied health education. Journal of Allied Health 32 (2),
Beadle, M., Santy, J., 2008. The early benefits of a problem-based approach to 110e115.
teaching social inclusion using an online virtual town. Nurse Education in Udod, S.A., Care, W.D., 2002. Lessons learned in developing and delivering web-
Practice 8, 190e196. based graduate courses: a faculty perspective. The Journal of Continuing
Brookfield, S.D., 2006. The Skilful Teacher: on Technique, Trust and Responsiveness Education in Nursing 33 (1), 19e23.
in the Classroom, second ed. Jossey-Bass, San Francisco. Valaitis, R.K., Sword, W.A., Jones, B., Hodges, A., 2005. Problem-based learning
Bruner, J., 1966. Constructivist Theory. http://tip.psychology.org/bruner.html online: perceptions of health science students. Advances in Health Sciences
(accessed 18.06.10). Education 10, 231e252.
Care, W.D., Scanlan, J.M., 2000. Meeting the challenge of developing courses for Wilkie, K., 2000. The nature of problem-based learning. In: Glen, S., Wilkie, K. (Eds.),
distance delivery: two different models for course development. The Journal of Problem-based Learning in Nursing: a New Model for a New Context? Mac-
Continuing Education in Nursing 31 (3), 121e128. millan, Basingstoke, pp. 11e13.
Cooke, M., Moyle, K., 2002. Students’ evaluation of problem-based learning. Nurse Williams, S.M., Beattie, H.J., 2008. Problem based learning in the clinical setting e A
Education Today 22 (4), 330e339. systematic review. Nurse Education Today 28, 146e154.
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