A variety of computer-mediated communication tools can be used to enhance instruction. This article describes an interactive discussion process, facilitated by experts in the field, to encourage student discourse about course content, to enhance writing skills, and to develop expertise in the use of technology.
A rapidly increasing number of health care agencies are selecting
and implementing computerized applications and automated information
management strategies at their work sites. Information technology
is transforming health care, being used to support decision making
both in the clinical and the administrative financial arenas.
Nurses and other health care professionals need to make informed
choices related to software and hardware selection, implementation,
and usage. Advanced practice nurses, expected to be organizational
leaders, need knowledge and expertise in health care informatics.
Students in the course in Health Care Informatics (HCI)
have varying levels of education, computer knowledge, and nursing.
HCI introduces graduate students to two competing aspects of electronic
technology: (a) computer use to access current, accurate, practice-related
information and (b) computer selection, implementation, and use
in health care organizations to enhance patient care. Most of
the students have never accessed the Internet before enrolling
in the course. Students' questions range from learning what the
Internet is, to learning how to teach others in the work place
the appropriate use of computers in their jobs. Most students
are employed full time, have significant family obligations, and
are enrolled in the master's program on a part-time basis. Several
are full-time doctoral students.
A major technological adjunct to HCI was a World Wide Web (WWW)
interactive discussion forum called the Discussion Board,
a mechanism for discussion in response to questions posted to
the board each week (cf. Roger Akers).
The Discussion Board is an example of asynchronous computer-mediated
instruction; asynchronous communication applications allows students
to access the media at the time and place of convenience. Students
can have peer-to-peer interaction, share ideas and pose questions
without the influence of the instructor (Ellsworth, 1995).
Reasons for making this experience an integral part of the course
included: (a) means of discussion of topical issues related to
the course content on-line, while using new technology; (b) means
of posing and answering questions related to the week's content
in a thoughtful dialogue with others at a time and place convenient
to the student; and (c) means of creating an additional writing
experience for students to improve their writing skills while
learning to be comfortable with a public display of their thinking.
Another important reason for including the discussion forum as
a course activity was to engage the participation of nursing informatics
experts from around the world. Discussion board assignments required
each student to respond (at least four times during the semester)
to questions posted weekly on the discussion board by content
experts. Students were asked to include website URLs or literary
citations and to make their responses factual rather than opinion-based.
Students were to read all responses to all questions whether or
not they chose to participate in the discussion around that question.
Recruitment of volunteer discussants. Volunteer discussants
(content experts) were recruited from subscribers to a listserv
(Nrsing-L) that focuses on issues in nursing informatics. A message
sent to the listserv described the course and stated the purpose
of the discussion forum as part of the course requirements; the
message included expectations and qualifications of volunteer
discussants. Subscribers were to indicate their interest in participating
by e-mail and to include current position title and responsibilities,
areas of expertise, and educational and professional credentials.
All respondents received the URL for the course, so they could
explore the site, better understand the focus of the course, and
examine course objectives and the topical outline.
Twenty eight respondents indicated interest in participating as
volunteer discussants; 13 were chosen based on qualifications,
relevancy of areas of expertise to the course content, and availability
to post and monitor questions during the semester. Volunteer discussants
represented academic, business, and health care organization settings.
They came from a variety of geographic areas (California, Connecticut,
Illinois, Maryland, Massachusetts, Minnesota, New York, North
Carolina, Pennsylvania, and Utah). One discussant is from Australia.
Procedure. After establishing a weekly schedule and negotiating
individual assignments, each volunteer discussant was assigned
a specific week in the semester to post a question relevant to
the course topical outline and individual areas of expertise.
Questions were submitted to the instructor, edited, and in some
cases resubmitted for approval.
A new question (based on the content for the following week) was posted the morning after each class; the volunteer discussant monitored responses. During the scheduled week, the volunteer guided and directed discussions, reframed questions when clarification was needed, and provided additional information by including relevant websites and literary citations. Some volunteers summarized the week's responses. Students indicated that the weekly summaries were very helpful. Later in the course, students were asked to summarize the discussions at the end of their assigned weeks.
Interestingly, other volunteers (not responsible for the week
in question) lurked in the background and, often, contributed
their opinions and additional WWW links or relevant literary citations.
In other words, the students received input from a variety of
experts in the field on most topics.
An additional, unplanned and unanticipated, learning experience
occurred; one of the volunteer discussants, a faculty member at
a large university in the Pacific Northwest, asked if her graduate
students in informatics could participate when she posted her
question. The ensuing joint venture between the two groups of
students expanded the discussion, encouraged collaborative work
between the groups of students, and provided perspectives and
ideas that exceeded those from the group enrolled in the course.
The experience was a positive one and will be repeated later in
the semester. In addition, a second faculty member, a discussant
from Pennsylvania, requested a similar experience for her students,
to be scheduled later in the semester.
The use of the discussion forum was a positive one; however, several
issues and problems occurred.
Use of volunteers. The use of experts in the field to expand
students' learning and to create an international resource network
for them was a wonderful experience. All communication with the
volunteer discussants, not known to the instructor prior to this
encounter, occurred via electronic mail. Communications included
editing, revising, and rejecting or approving questions; developing
and negotiating a schedule for posting questions; and holding
the volunteers accountable for meeting the schedule and for monitoring
the responses to the questions.
The variability in expertise and commitment of the volunteer discussants
proved to be a problem. Inasmuch as many were self-declared experts
in a particular area of informatics, their educational and experiential
basis for participation did not always match expectations. Some
volunteers developed good questions, but some did not. Some were
reliable--posted on the day and time agreed upon--but others needed
It is difficult to ensure that negative feedback, albeit constructive,
will be responded to in the spirit in which it was given. Without
face-to-face contact, the tone of the responses was uncertain.
Early in the process, some volunteers dropped out, citing the
time commitment; subjectively, I believe some found it difficult
to meet the standards set for their contributions.
Time. The time commitment required for me to perfect questions,
ensure that questions were congruent with the course content,
and create the schedule to meet course requirements while also
attending to the scheduling needs of volunteers was greater than
anticipated. For example, one volunteer had to take an unexpected
trip, which forced me to adjust the schedule of that entire part
of the course, reschedule other volunteers and the course outline,
and inform students of the change. Additionally, I had to monitor
each week's discussion to evaluate students' compliance with course
requirements. Monitoring the discussion board included noting
how many responses there were to each question, keeping track
of which students responded, keeping count of the number of responses
per student, and evaluating the quality of the responses.
Student anxiety. Initially, students expressed a great
deal of anxiety about the use of (and access to) the technology
and about posting their comments publicly. They reported a moderate
level of intimidation and feelings of inexperience and ignorance
when discussing weighty topics with unknown experts in cyberspace.
As the semester progressed, most students indicated a decrease
in anxiety and a concomitant increase in interest in participating
in the discussions.
The discussion forum has received lots of traffic from students,
faculty, discussants, and students at other schools. The quality
of the discussions has been more scholarly than anticipated, although
some students have a tendency to share opinions rather than facts,
a problem that decreased after I requested that they insert URLs
There is a high level of student interest in this form of asynchronous
communication. The ability to participate in discussions about
topics of interest to them at their convenience (both time and
place) is especially appealing to graduate students with full-time
jobs and other personal responsibilities. There has been a high
level of volunteer compliance with expectations. Volunteers responsible
for the first questions set a high standard for others to follow,
a serendipitous factor that influenced the quality of both the
questions and the adherence to the schedule.
The unexpected interactive experience with other groups of graduate
students has been an interesting additional opportunity for students
to learn from each other. The discussion forum encouraged student
participation in their own learning in and of itself; the add-on
effect of the interaction among groups of students is yet to be
Use of a discussion forum created another experience in the development
of a sense of ease with technological skills. Students comfortable
accessing the Web now follow up on access to sites that are recommended
on the discussion board and are encouraged by the responses they
get when they recommend sites to others; this led to the establishment
of a second discussion board for the sole purpose of posting student-recommended
URLs. The name of the site identifies the discussion threads;
the recommended URL is in the first line of each message, and
there is a student critique.
Evaluation and Plans for the Future
Anecdotal evidence shows that those students who participate infrequently
in face-to-face classes are often more verbal (and eloquent) on
the discussion board. Perhaps this experience speaks to the importance
of including multiple options and methods that appeal to a variety
of learning and communication styles.
What would I do differently, and what the same? I do plan to include
a discussion board experience in this course again, and in other
courses, and I will include outside volunteer experts again. Early
identification of the most appropriate expert for the topic of
the week and early negotiation with the experts regarding scheduling
and availability to meet expectations should lessen the time commitment
during the semester. An understanding of the variability of student
computer prowess is very important. The speed with which student
expectations can be raised to a higher level is often dependent
on their ease with the technology. In the near future, students
will be arriving with a broader baseline knowledge of computers,
so that the experience will more quickly become a deeper, content-oriented
This experience has convinced me of the importance of introducing new technology in ways that match the technology to the task at hand. The critical emphasis must be the constant awareness that the goal is to facilitate the learning.
Ellsworth, J. H. (1995). Using computer-mediated communication
in teaching university courses. In Z. L. Berg & M. P. Collins
(Eds.), Computer mediated communication in the online classroom
(pp. 29-36). Cresskill, NJ: Hampton Press, Inc.