1. Nurse Education in Practice 11 (2011) 124e130
Contents lists available at ScienceDirect
Nurse Education in Practice
journal homepage: www.elsevier.com/nepr
Using problem-based learning in web-based components of nurse education
Tonia R. Crawford*
Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia
a r t i c l e i n f o
a b s t r a c t
Article history:
Accepted 17 October 2010
Problem-based learning (PBL) is a student-centred method of teaching, and is initiated by introducing
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
for potential implementation in a Bachelor of Nursing program.
In view of the evidence, students accessing online nursing subjects would seem to benefit from webbased PBL as it provides flexibility, opportunities for discussion and co-participation, encourages student
autonomy, and allows construction of meaning as the problems mirror the real world. PBL also promotes
critical thinking and transfer of theory to practice. It is recommended that some components of practicebased 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 problemsolving activities, and tutor facilitation.
Ó 2010 Elsevier Ltd. All rights reserved.
Keywords:
Problem-based learning
Online education
E-learning
Web-based nurse education
Introduction
As technology has evolved, web-based learning has gained
popularity with students, and increasingly, higher education
institutions have recognized the benefits of utilizing this technology as a strategy to enhance student recruitment and retention
(Parker et al., 2005); to remain relevant, convenient, flexible and
accessible (Care and Scanlan, 2000); and to promote autonomous
lifelong learners (Howatson-Jones, 2004). According to O’Neil and
Fisher (2008), the changing profile of nursing students and
demands of the healthcare environment have prompted schools of
nursing to deliver or support education using information
technology.
Problem-based learning (PBL) is a student-centred method of
teaching, and is initiated by a clinical problem aimed to foster
learning through active inquisition, and to encourage students to
take the major responsibility for their own learning (Tavakol and
Reicherter, 2003). Web-based PBL can develop self-directed
learning and problem-solving skills using real life problems, while
addressing some of the time, travel and access constraints for
students. Consequently web-based PBL is of particular interest for
the development of online interaction/communication in an
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
* Tel.: þ61 2 9487 9608; fax: þ61 2 9487 9625.
E-mail address: tonia.Crawford@avondale.edu.au.
1471-5953/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nepr.2010.10.010
strengths and limitations of PBL, this paper will describe web-based
learning and PBL before reviewing the literature on web-based PBL
for nurse education.
Web-based learning
Online education is seen to create access to learning (Pawan,
2003) as it is independent of geographic and temporal boundaries, and increases learner control allowing for greater flexibility
and autonomy. It also provides ready access to resources, allowing
for interaction and communication with other students and
educators via email and synchronous or asynchronous discussion
forums (Prows et al., 2004). Synchronous methods include
discussions, virtual classrooms or video-conferencing where
interactions occur in real time and need to be pre-planned. Asynchronous activities such as use of websites, problem-solving
scenarios, and online discussions are self-directed and allow for
greater choice of process, pace and location (Larsen et al., cited in
Howatson-Jones, 2004). Increased demand for distance education
has prompted nursing faculties to implement information and
technological approaches to provide education opportunities that
cater for the diversity of learners needs (Udod and Care, 2002).
Problem-based learning
PBL was introduced in the 1970s in health profession curricula at
McMaster University in Canada, and has been used in various
graduate and undergraduate settings such as engineering, business,
2. Table 1
Review of primary research on web-based PBL.
Description
Edwards et al.,
1999
Canadian study used pre and
post-course questionnaires to
compare learning satisfaction
between nursing students who
attended the PBL course faceto-face (control group), and
those who received the course
via teleconferencing
Oliver and
Omari, 1999
Australian study in which
online PBL was employed with
a group of on-campus
undergraduate students to
explore the practical issues and
responses of the learners
Cooke and
Moyle, 2002
Australian study of 100 student
evaluations of PBL
(face-to-face) in an
undergraduate-nursing degree
Results
A small percentage of students finding the
adjustment to PBL difficult
The item receiving the highest satisfaction rating
was ‘group functioning as a PBL team’, with similar
satisfaction ratings for the course between
face-to-face and distance students.
Tutor feedback to distance students is inherently
more difficult than in
face-to-face situations
Found PBL cognitively demanding, which tended
to lessen enthusiasm for participation
Web-based PBL strategies provide
considerable scope for developing
information literacy, metacognition and selfregulating skills, important for lifelong learning
Problem-based activities contributed substantially
to learning, and that the environment was
enjoyable and stimulating
Using collaborative groups in the problem-solving
process allowed students to choose the extent to
which they participated, with large discrepancies
in effort among students
Students valued the input of the teacher
PBL strategies encouraged students to take control
of their own learning by promoting involvement,
self-direction and identification of learning needs.
PBL promoted critical thinking skills, as they were
able to problem-solve in
situations that replicated clinical
situations in nursing practice
They were expected to synthesize various aspects
of knowledge, make clinical
decisions based on their learning, and provide
rationales for their clinical reasoning
The teacher’s role in PBL was more
interactive and responsive, and helped them to
develop critical thinking skills by questioning and
challenging students
PBL assisted the theory to practice transfer as
students reported that their learning was
purposeful and relevant to their practice as future
nurses
Group contribution and participation was
rewarding, discussions creative, and students
learnt effective group-processing skills
Limitations
Reason for inclusion
Only 9 of the 30 students were from distant
sites with the distance students together
physically as a group, with the facilitator at
a distant location, rather than each individual
being linked via electronic means
Conclusions add to the evidence of
other studies
Only 57 participants
The authors did not identify what the
undergraduate degree program was
Action research was carried out with data
gathered at several stages consequently the
results could change over time
Despite not being a nursing study, and
participants being on-campus, the
conclusions are useful in informing
decision-making about designing
online PBL
On-campus, PBL was not online, with the study
extending over a 4-week period.
No discussion regarding measures taken to
ensure trustworthiness of the data.
Higher number of respondents gives
results that are more indicative of
students generally, and provides useful
information that nurse educators can
use in designing innovative teaching
programs
T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
Authors
(continued on next page)
125
3. 126
Table 1 (continued )
Description
Dennis, 2003
A comparison between online
versus face-to-face group
learning. Post-test only control
group to investigate the effects
of earning conditions on
learning outcomes and
processes in a US physical
therapy program.
Valaitis et al.,
2005
Canadian study of 22 nursing
students’ perceptions of PBL
over a 4e6 week period
McLinden et al.,
2006
Phase 2 of a pilot study
concerned with the
development and evaluation of
online resources using PBL for
use with postgraduate teachers.
Results
Computer-mediated communication in PBL
resulted in significantly longer
time-on-task as face-to-face groups, and that
technological problems played a role in the
percentage of off-task time for online PBL
students. Despite this, there was no difference in
learning outcomes between the two groups
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
Online learning increased flexibility, by allowing
students to learn at their own pace, and in
a manner that suited their learning style, time and
location
Students valued taking a more active role with the
PBL format
Used a ‘real’ client to promote authentic learning
Web-based PBL offers opportunities for
interdisciplinary learning through online
communication
Students initially had difficulty
setting learning objectives, and group decisionmaking was difficult
Asynchronous discussion threads confusing for
some students to follow
Preliminary communications were
monologues rather than discussions as students
were reluctant to reply critically to peer’s
messages
Students clearly valued tutor guidance, wanting
direction with teacher expectations, and
guidelines for online contributions
High degree of apprehension among students at
the start of the program (76%), with initial
hesitation about participating in online group
work
Fast pace of synchronous chat rooms intimidating
despite having completed induction activities
Asynchronous discussions enabled students to
take time to think about their responses
Almost two-thirds of participants reported technical difficulties in access the program during the
first scenario, having to contact technical support
for guidance (40%)
Use of technology must be informed by sound
pedagogical principles, and
structured support must be provided during the
early stages of the program to maximize learner
engagement
Limitations
Reason for inclusion
Study size was small (17 in each group)
Not a nursing program
The online component minor as the study was
conducted using two scenarios/problems with
face-to-face laboratory session.
Study used a medical/surgical
component of an allied health
program, and investigated PBL
in an online format.
Cohort is small and extends over a short period
of time, using students who are actually onampus, who met face to face in concurrent PBL
classes
The results and recommendations for
carefully planned training sessions for
tutors and students, and a period of
adaptation to online
PBL are a useful guide.
A number of techniques used to
increase the trustworthiness of the
findings.
Small cohort of non-nursing participants with
some face-to-face components e.g. residential
school
Majority of the course was online, as
compared to studies where the online
component was a very small part of the
course.
These results could therefore be more
generalizable, and used to inform the
development of online components of
a nursing program.
T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
Authors
4. T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
educational psychology and administration and K-12 education
with extensive support from literature (Hmelo-Silver, 2004;
Williams and Beattie, 2008). According to Tavakol and Reicherter
(2003), PBL was developed to address the perceived lack of
problem-solving skills required by medical students, and has been
adopted in combination with traditional methods in many medical,
nursing and allied health curricula.
PBL is an approach in which students work in small, collaborative groups to solve a series of problems that are presented in the
context in which the students are likely to encounter. Real clinical
situations are used to promote clinical reasoning responses in
students as they learn what they need to know to address the client
problems in the same way they would as practitioners, thus integrating theory and practice (Cooke and Moyle, 2002). In this
process, the student gains knowledge, and acquires problemsolving and self-directed learning skills (Wilkie, 2000; Rideout and
Carpio, 2001), an important aspect of adult learning as adults have
a self-concept of being responsible for their own decisions, and
need to be seen by and treated as being capable of self direction
(Knowles et al., 2005). According to Azer (2008, p. 5) the primary
goals of PBL in health related programmes are claimed to ‘foster
clinical reasoning, problem-solving skills, self-directed learning,
communication skills and deep understanding of concepts and
principles in the curriculum’. The sharing of knowledge to solve
problems (case scenarios) that are real life in context, encourages
critical thinking and engagement. Students are encouraged to make
decisions about their learning focus, needs and resources (HmeloSilver, 2004; Oliver and Omari, 1999; Valaitis et al., 2005); and
present and discuss new information at their next session, reflect
on the outcomes and make modifications. Students can apply their
knowledge to the problem in a practical way, for example, developing a plan of care (Pawan, 2003; Valaitis et al., 2005). With this
learning strategy, the teacher is a facilitator rather than an information provider (Azer, 2008). The 4-stage cycle of learning theory,
developed by Kolb (1984), supports this process, arguing that
students learn best when they are active, take responsibility for
their learning, and are able to apply it to their own context. Kolb
(1984) outlined adaptive learning modes as concrete experience,
reflective observation, abstract conceptualization and active
experimentation, suggesting that learning was a process where
knowledge was created through the transformation of experience,
which could be facilitated through the PBL process.
Web-based PBL
PBL is recognized as an alternative to traditional lecture-laboratory approaches in health profession programs, and can be easily
adapted to online environments to meet the increasingly diverse
needs of students (Dennis, 2003). Further, Edwards et al. (1999)
argue that the interactive nature of PBL also provides for direct
involvement that web-based education may lack. By having PBL in
web-based units, students will be taking an active role in solving
problems that mirror real life scenarios through the use of case
studies, and utilising an online discussion forum to discuss
hypotheses and solutions. This approach encourages self-direction
in learning.
Self-directed, active learning where the teacher is a facilitator
who allows students to construct new knowledge while promoting
interpersonal communication is necessary in the e-learning environment using PBL. This process uses constructivist (Bruner, 1966)
and humanistic learning principles (Rogers, 1983; Magnussen,
2008) as these skills develop metacognitive abilities, which also
assist nurses to make a better transition to clinical settings (Peters,
2000).
127
Literature review
A search of PBL approaches in online education over the last 10
years was conducted using the online databases ERIC, Cinahl, and
Medline. Keywords used in the search included ‘problem-based
learning’, ‘problem-based scenario’, ‘online education’, ‘web-based
education’, ‘e-learning’, ‘nurse education’, case-based learning’, and
‘independent learning’. Criteria for inclusion were English language
publications from 1997 to 2008 discussing PBL and web-based
education for nurses. There was a significant amount of information
on PBL generally (441), however, a paucity of articles combining
PBL and web-based nursing education was revealed. There were
only six primary research articles and four reviews/reports discussing web-based PBL in nurse education (Table 1). Many of the
studies were conducted in the general education context and were
not transferable to this situation, therefore excluded. Allied health
education was included due to similarities in training and work
environments. Themes that emerged include: increased flexibility,
motivation and autonomy; improved critical thinking; technical/
time issues; group work; and the role of the facilitator.
Increased flexibility, motivation and student autonomy
A Canadian study of 22 nursing students’ perceptions of PBL
over a four to 6-week period (Valaitis et al., 2005) reported that
online learning increased flexibility, by allowing students to learn
at their own pace, and in a manner that suited their learning style,
time and location. The respondents also reported that asynchronous communication between students, used with web-based PBL,
provided them with more time for reflection, consequently allowing for much more in-depth discussion on the problem they were
working on. The majority of students, who expressed favourable
opinions regarding this aspect of web-based PBL, recognized the
value of taking a more active role with the PBL format (Valaitis
et al., 2005).
This study was relevant as it involved students from nursing,
midwifery and a graduate neonatal program using web-based PBL.
Individual’s weekly reflections throughout the experience, and
semi-structured focus group interviews related to online PBL
environment would have provided a wealth of data, however, the
cohort was small and the study extended over a short period of
time as part of the face-to-face program which included concurrent
PBL classes, consequently the strength of the evidence is reduced.
However, the authors described a number of techniques used to
increase the trustworthiness of the findings, such as checking with
the focus groups for transcription errors, similarities and differences in coding between researchers were compared and discussed, constant comparison of the main themes, and triangulation
of individual reflections and focus group interviews. Further to this,
the results and recommendations indicated that carefully planned
training sessions for tutors and students, and a period of adaptation
to online PBL provided a useful guide to developing web-based
nursing programmes.
An Australian study of 100 student evaluations of a 4-week trial
of face-to-face PBL in a ‘traditional’ nursing degree (Cooke and
Moyle, 2002) supported the findings of Valaitis et al. (2005) with
many respondents reporting that PBL strategies encouraged them
to take control of their own learning by promoting involvement,
self-direction and identification of learning needs. This suggested
students were more motivated and responsible towards this type of
learning. However in this study, students were on-campus with the
study extending over a 4-week period, and PBL was not online.
Despite this, the number of respondents gave results that were
more indicative of nursing students generally, and provided useful
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T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
information nurse educators can use in designing innovative
teaching programmes.
Critical thinking
Critical thinking in nursing is important as it enables students to
solve clinical problems and provide rationales for their clinical
reasoning and decision making, with the ability to transfer
reasoning strategies to new problems (Hmelo-Silver, 2004; Cooke
and Moyle, 2002). Students in Cooke and Moyle’s (2002) study
reported that PBL promoted critical thinking skills, as they were
able to problem-solve in situations that replicated clinical situations in real life nursing practice. Student nurses were expected to
analyse and synthesize various aspects of knowledge, make clinical
decisions based on their learning, and provide rationales for their
clinical reasoning. The teacher’s role in PBL was more interactive
and responsive, and helped them to develop critical thinking skills
by questioning and challenging students. This process assisted the
transfer of theory to practice as students reported their learning
was purposeful and relevant to their real life practice as future
nurses. Valaitis et al. (2005) used a ‘real’ client to promote authentic
learning, and students gained new perspectives about the day-today struggles from the client. The authors found that web-based
PBL offered tremendous opportunities for interdisciplinary learning
through the use of online communication. Students perceived that
the various problem-based activities contributed substantially to
their learning, and that the environment was enjoyable and stimulating (Oliver and Omari, 1999).
In contrast to these positive findings, Oliver and Omari (1999)
also reported that some students found this type of activity
cognitively demanding, which tended to lessen enthusiasm for
participation. Generally, however, responses regarding the development of personal skills suggested that web-based PBL strategies
provided considerable scope for developing information literacy,
metacognition and self-regulating skills, which were critical for
lifelong learning (Oliver and Omari, 1999). In this study, online PBL
was used in a core unit of an unspecified undergraduate program
with a group of 57 on-campus students to explore the practical
issues and responses of the learners. Action research was carried
out during implementation of the courses, with data gathered at
several stages from questionnaires and interviews, consequently
the results could change over time. Despite not being a nursing
study, and participants being on-campus, the conclusions were
useful in informing decision-making about designing online PBL as
it highlighted the importance of ongoing input of the teacher to
provide adequate access and open lines of communication for the
students.
Technical/time issues
Although a number of studies have identified positive aspects of
online PBL, there have been challenges noted, and one major issue
identified was the time needed to adjust to online PBL with the
often associated frustrations of slow content downloads, time
stressors, time zones and technical difficulties (Valaitis et al., 2005).
A comparison between online versus face-to-face group learning
(Dennis, 2003), found that computer-mediated communication in
PBL resulted in significantly longer time-on-task as face-to-face
groups, and that technological problems played a role in the
percentage of off-task time for online PBL students. Despite this,
there were no differences in learning outcomes between the two
groups. Dennis (2003) concluded that 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, and recommended
cautious implementation of online PBL due to greater time needed
for similar outcomes.
Dennis (2003) used a post-test only control group to compare
the outcomes of PBL between synchronous online groups and faceto-face tutorial groups in a medical/surgical component of a US
physical therapy program. Statistical analysis was used to investigate the hypothesis that the final course grade would be no
different between groups. Thirty-four participants were drawn
from second year students, and seventeen randomly assigned to
either a computer-mediated PBL group or a face-to-face PBL group
(control). The number of participants was small and the online
component minor as the study was conducted using two scenarios/
problems in a Women’s Health component of a medical/surgical
conditions course with a face-to-face laboratory session. The results
were obtained from one test consisting of 30 multiple-choice
questions and two case-based short answer questions, reducing the
generalizability of the results. While it was not a nursing program,
it was useful as the medical/surgical component of an allied health
program would have some similarities to nursing programs, and
while limited, it investigated PBL in an online format.
McLinden et al. (2006) reported on phase two of a pilot study
concerned with the development and evaluation of online resources
using PBL in one unit of a distance education postgraduate teaching program. Participants (34) were allocated to one of six online
PBL tutorial groups, which were required to submit a group
assignment with individual contributions. On completion of two
case scenarios, an anonymous questionnaire (using a 4-point Likert
scale) was used to collect feedback regarding participation of the
online PBL component, and information related to the design and
relevance of the two case scenarios. The authors found a high degree
of apprehension among students at the start of the program (76%),
with initial hesitation about participating in online group work and
finding the fast pace of synchronous chat rooms intimidating,
despite having completed induction activities. Asynchronous
discussions however, enabled students to take time to think about
their responses. Almost two-thirds of participants reported technical difficulties in accessing the program during the first scenario,
with 40% of that group having to contact technical support for
guidance. These findings suggested that use of technology must
be informed by sound pedagogical principles, and that structured
support be provided during the early stages of the program
to maximize learner engagement. This study had a small number
of participants, and involved teachers with some face-to-face
components such as residential school and study days. However,
the majority of the course was online, strengthening the results
regarding the use of PBL in an online environment, as compared to
studies where the online component was a very small part of a faceto-face course. These results could therefore be more generalizable,
and used to inform the development of online components of
a nursing program.
Group work
Conflicting results were returned about the use of group work in
PBL. Oliver and Omari (1999) report that using collaborative groups
in the problem-solving process allowed students to choose the
extent to which they participated, resulting in large discrepancies
in effort among students. However, Cooke and Moyle (2002) stated
that respondents reported group contribution and participation
rewarding, discussions creative, and effective group-processing
skills were learnt.
Edwards et al. (1999) found that, despite a small percentage of
students finding the adjustment to a new approach such as PBL
difficult, the item receiving the highest satisfaction rating was
‘group functioning as a PBL team’, with similar satisfaction ratings
6. T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
for the course between face-to-face and distance students. This
Canadian study used pre- and post-course questionnaires to
compare learning satisfaction between nursing students who
attended the PBL course face-to-face (control group), and those
who received the course via teleconferencing in two terms of
a ‘traditional’ nursing program. From the 51 students who
completed the initial set of questionnaires, 30 students and six
tutors completed the second questionnaire yielding a post-course
response rate of 58.8% for students, and 100% for tutors, however
the sample size for this study was the number of problem-solving
groups rather than the number of students, and hence the sample
size for a number of comparisons was small. The post-course
response rate from students was low and only nine of the 30
students were from remote/distance sites as opposed to being ‘oncampus’. Furthermore, the distance students in this research were
together physically as a group, with only the facilitator linked via
teleconferencing, rather than each individual being linked via
electronic means, thus allowing students to be engaged in active
face-to-face group process. This reduced the strength and utility of
the evidence, however the conclusions added to the evidence of
other studies.
Valaitis et al. (2005) reported that students initially had difficulty setting learning objectives, and group decision-making was
difficult with asynchronous discussion, with some students finding
discussion threads confusing. In addition, preliminary communications were monologues rather than discussions as students were
reluctant to reply critically to peer’s messages.
Beadle and Santy (2008) described the delivery of an online
undergraduate-nursing module in the UK, using a PBL approach that
was previously delivered face-to-face as part of a classroom-based
preregistration program. They found from student evaluations that
while PBL was useful in making links between theory and practice,
there were difficult group dynamics with some students ‘not pulling
their weight’, along with logistical difficulties when delivering PBL
face-to-face to large numbers, thus making it unpopular with the
students. This improved significantly with the use of online sessions,
with the discussion groups useful in enhancing student learning and
engaging them in discussion, consequently this lead to students
reporting they felt more comfortable participating online. The
authors claimed web-based PBL was a useful method for varying
delivery approaches in teaching healthcare students about practice,
and the theory that underpinned it.
The role of the facilitator
The importance of the role of the facilitator was a recurring
theme. Valaitis et al. (2005) found that students clearly valued tutor
guidance, wanting direction with teacher expectations, and guidelines for online contributions. According to Oliver and Omari (1999),
students continually reminded them that they valued the input of
the teacher. Edwards et al. (1999) found that tutor feedback to
distance students was inherently more difficult than in face-to-face
situations due to the reliance on written communication. They
suggested providing an opportunity to meet the tutor might overcome this problem. Assigning a group member to the role of group
facilitator may also be a useful adjunct to the distance tutor.
Discussion
In view of the evidence, students accessing units in a Bachelor of
Nursing program could benefit from web-based PBL. Not only does
it provide a social learning environment with opportunities for
discussion and co-participation, encouraging student autonomy
and construction of meaning with real world problems consistent
with PBL approaches generally, but according to Valaitis et al.
129
(2005), resources available in the online environment were
highly valued. Online instruction is a viable instructional method,
and has been used with success in a number of situations (Valaitis
et al., 2005; Oliver and Omari, 1999; Cooke and Moyle, 2002). Webbased PBL has the potential to enhance student recruitment and
retention (Parker et al., 2005) due to increased flexibility, assisting
units to remain relevant and accessible (Care and Scanlan, 2000), as
students will be able to access information and group discussion
anywhere. According to Magnussen (2008), the success of a webbased program requires thoughtful planning, a committed faculty,
and investment in technical support and equipment in an effort to
reduce technical difficulties. With sound planning, the benefits of
providing quality, accessible and convenient education are worth to
the investment.
In order to reduce the limitations of web-based PBL (such as
apprehension and time taken to adjust to the PBL style of learning
with group work), the course should include an orientation and
a period of adaptation to the PBL, along with a technological
induction to the online environment (Valaitis et al., 2005; Beadle
and Santy, 2008). The program should include training for the
tutors, and tutors should be encouraged to make regular contributions to the discussion forums to encourage collaboration and
exploration, as well as learning of cognitive skills for problem solving
(Tavakol and Reicherter, 2003).
To implement a web-based programme a number of measures
are recommended. Firstly, the teacher would need to be responsive
to student contributions but also to make regular contributions to
the discussion forum, both in the form of simple acknowledgements
or requests for further information (Brookfield, 2006). Brookfield
(2006) recommends that instructors need to be present and
participate even more in an online discussion than face to face to
enhance their social presence and keep the discussion focused on
the topic by inserting questions and comments, and giving timely
feedback. Secondly, requesting all participants begin their remarks
by commenting on the previous participant’s observations, using
these as a springboard for their own encourages wider participation,
and preventing a few people dominating the discussion (Brookfield,
2006). Asynchronous communication is recommended for student
contributions as the fast moving nature and fragmented discussions
of synchronous chat rooms can intimidate some students. Asynchronous discussions can take place over several days and provide
time for students to think about their responses (McLinden et al.,
2006), which is useful for international or travelling students.
Thirdly, assigning students to small groups helps manage multiple
postings and promotes interaction. Finally, the course should be well
organised so that the students clearly understand from the beginning what the expectations are for the class, marking criteria for
participation and group work, what the ground rules for participation, and can clearly see how the interaction is linked to the content
modules of the class (Brookfield, 2006).
Web-based PBL could be implemented in a Clinical Practice or
Community Nursing subjects with the uploading of case studies in
various contexts with various clinical problems (which could also
be case studies for assignment questions). Students work in
assigned groups to discuss the case and what they need to research
in online discussion forums, then present their findings and discuss
various management options and hypothesize about possible
outcomes/complications. If group assignments are produced as
a result, marks could be assigned to individual’s participation to the
group and individual’s section of the assignment. The instructor
would monitor the group discussion and participate with questions
and comments to promote interaction and focus on the topic. Price
(2000) recommended PBL for a skills development component
within the curriculum, while cautioning against its broad use across
the whole nurse education program.
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T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130
Conclusion
It is proposed that some components of the Bachelor of Nursing
programs, for example, the practice-based subjects such as Clinical
Practice or Community Health Nursing, be implemented online
using a PBL format prior to or after students going on clinical
placement as these experiences enhance critical thinking and selfdirected learning (Kolb, 1984). Web-based units should include
a discussion forum that enables group work for problem-solving
activities, with tutor facilitation. In order to reduce some of the
challenges of web-based PBL, an initial period of adaptation, with
carefully planned training sessions for students and tutors in PBL
processes, technological aspects and defined expectations is recommended (Valaitis et al., 2005; Beadle and Santy, 2008; Price,
2000). Providing access to teachers along adequate lines of
communication (Oliver and Omari, 1999) should be encouraged
throughout the implementation of the program. Students and
teachers should be given the opportunity to provide feedback at
regular intervals throughout the program, as further research will
need to be undertaken regarding the effectiveness, efficiency and
sustainability of web-based PBL in this program and setting.
Acknowledgements
I would like to thank my colleagues, Athena Sheehan and Alison
Smedley for their constructive feedback and support during the
writing of this paper.
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