THE USE OF INSTRUCTIONAL TECHNOLOGY IN ENHANCING THE TRAINING OF NURSING STUDENTS IN FAKO DIVISION

Abstract
This study titled “The use of instructional technology in enhancing the training of nursing students in Fako division focused on the different technologies like simulation and computers used in training nursing students, how they are used in evaluating nursing students and the challenges faced in using such instructional technologies.

The work was guided by three research objectives and three research questions.

The main research question was, to what extent does the use of instructional technology in nursing enhance the training of student nurses in Fako division of the Southwest region of Cameroon?

Specifically, the work identified the different instructional technologies (simulation, computers, games, informatics, computer assisted instructions and windows applications) used by nurse educators to train students nurses in Fako Division and the challenges (insufficient tools, poor training, already loaded curriculum,) faced by nurse educators when using Instructional Technology in Fako Division.

The study reviewed theories like the Cognitive Apprenticeship model, Social cognitive theory and Instructional learning theory.

Empirical review was also done objective by objective.

The review showed that some previous studies have indicated that the use of technology is important in training nursing students and can contribute to better health care, but most of the studies focused on nurse educators’ perception, implementation and benefits of the various technologies.

One hundred and two participants consisting of 58 females and 44 males within the age range of 20 – 60 were sampled from three different nursing schools of the Fako division South West region of Cameroon.

The cross sectional and descriptive survey research designs were used and the sample of the study emerged through the simple random sampling technique.

One questionnaire for teachers was designed and administered on the participants for data collection based on the two variables of the study.

Data was entered using the Epi-Info 6.04d entry template (CDC, 2007).

The data entry template was designed based on the study of the questionnaire and the code list developed during the pre-coding exercise.

The template included check command to minimize data entry error.

The template was tested by a panel of three persons. At the end of the pre-test exercise, some corrections were made to the template and the final template was validated for data entry.

Data was then entered and exported to SPSS for analysis.

Exploratory statistics carried out to identify outliers and invalid codes using box plots for scale variables and frequency distribution for categorical variables.

The quantitative data was subjected to descriptive statistical analysis using Statistical Package for the Social Sciences (SPSS) Version 17.0 (SPSS Inc. 2008).

This software is used for descriptive data analysis and comparisons between groups (Nana, 2008b). Descriptive statistics was used to present the distribution of subjects between and within subsets using frequencies, proportions and Multiple Response Analysis.

Statistics was summarized in statistical tables and charts plotted in Microsoft Office Excel 2007.

Findings revealed that instructional technology involves using technology, training the mannequins to mimic scenarios nurses might see in clinical practice(57.84%) and this enables nurses already working in hospitals to use their knowledge and clinical skills to facilitate learning of students nurses in hospitals (33.3%), facilitates the teaching learning process (85.29%), build confidence in student nurses before they enter the clinical site and improve on their learning outcome (84,31%) and trainers face the challenge of limited skills to manipulate the technology and reluctance of some staff to use them (76.47%). Two demographic variables; qualification and working experience was linked to knowledge and use of the different instructional technologies.

The researcher has some recommendations: nursing schools assisted by the government should provide resources materially, human and financially that will enable the use of instructional technologies to be a reality, to make this more effective in-service training programs should be organized to upgrade ad update nurses on the use of modern instructional technologies in the medical field so as to improve on their awareness and skills in teaching the nursing students. Suggestions for further research have been included.
CHAPTER ONE
GENERAL INTRODUCTION
1.1 Introduction
This chapter is made up of background to the study, statement to the problem, objectives to the study, research question, and significance of the study, scope of the study and operational definitions of terms.
1.2 Background of the study
The use of new information technologies in health has brought significant changes to the education paradigm for health in nursing, promoting new ways of teaching and producing knowledge and driving new behaviors among health professionals. Technological advances have influenced work processes in health, even in the nursing field, and induced changes in various professional contexts.

In the context of education, these innovations are reflected in the creation of virtual learning environments-VLE (Berndt 2014).
According to Campbell, (2014 ) in a climate of exponential growth of knowledge, it seems appropriate to reflect on the access, locations, and means that professionals use to share and disseminate information, especially in education, and information technology is one of the effective ways.

Information is an important element in the decision-making process of professionals and improvements in nursing practice.
Given the rapid technological progress in our day, nurses should equip themselves with technological means and use them carefully and consciously in favor of building a new proactive image, becoming active and participating professionals who use these new technological resources to promote new forms of health care.

Increased implementation of technology will increase students’ comprehension of content and development of skills in such areas as analytical reasoning, problem solving, information evaluation, and creative thinking (Bond, 2004).
In Nursing, there is a dire dearth and paucity of information regarding the effect of technology usage on learning achievement.

The reality is that technology is playing a critical role in teaching and learning. Education has evolved to more than lecture and class discussion.

Compared to the traditional classroom, technology can be both an effective enhancement and supplement (Ryan, Carlton, & Ali, 1999; Semple, 2000). Students are learning from more than just interacting with educators.

The differences in learning styles support the fact that some students will learn better in a course in which they can interact with the educator in person and through technology.

Thus, technology should serve as a vehicle for delivering and learning course content (Scollin, 2001; Semple, 2000; Yoder, 1994).
Arguably, the primary goal of schooling is to provide students with a safe and engaging environment and ample opportunities to learn.

A large portion of a student’s typical school day is allocated towards providing these opportunities.

However, once lunch, recess, and passing periods are accounted for, the amount of time teachers allocate for learning is far more than the amount of time students are actually engaged in learning. Martella, Nelson, and Marchand-Martella (2003) report that students only spend about 42% of their school day engaged in learning.

It is important to acknowledge that engaged time is more than a behavioral concept; it also encompasses the emotional commitment to academics (VanDeWeghe, 2006).

For example, students should demonstrate behaviors such as writing, participating in tasks, reading aloud, reading silently, and asking questions; they should also be attentive, interested, and invested in their learning (Greenwood, Horton, & Utley, 2002; Marks, 2000).
Some research concludes that engaged time is the most important influence on academic achievement (Greenwood et al., 2002; Marks, 2000; Slavin, 2003).

Over the past number of years, one of the most commonly used student-centered approaches to teaching has been case-based learning (or the case method).

This has particularly been the case in professional education (Law, Business, Education, and Medicine, for example), but is increasingly being used in the Sciences, Social Sciences, and Humanities.

The case based method is defined, by the Association for Case Teaching, as “a means of participatory and dialogical teaching and learning by group discussion of actual events” and (Dunne and Brooks, 2004, 9).
Computers are readily available in modern classrooms, since they are essential tools for 21st century students and replace the utilities of pen and paper.

They not only give students the means to conduct online research and master the technology skills they need, but they also give teachers the opportunity to enhance their lessons.

The ability to deftly operate a computer is a critical 21st century skill.

Computing devices greatly assist in teaching and learning and make them more engaging and effective.
In modern classrooms, students are actively engaged in what they learn.

Students participate in more active learning by working in groups or on computers and complete projects and other interesting activities that help them discover new skills.

Students can learn actively by talking and listening, writing, reading and reflecting. When students are encouraged to take an active interest in learning, they are more likely to retain the knowledge they’ve accumulated.
With the expanding needs of the healthcare system, nursing education has been charged with developing programs that further enhance the knowledge and skills of nurses as they enter the healthcare workforce (Institute of Medicine [IOM], 2010).

Nursing faculty has responded to these increasing educational needs through the use of technological formats for both classroom and clinical instruction.

While encouraging and taking advantage of the vast technological advances made in the past decade, nursing programs have only begun to track the use of that technology (Cahill & Li, 2011; Doyle, Garrett, & Currie, 2014; O’Connor & Andrews, 2015; Revell& McCurry, 2010; Ventola, 2014; Williams & Dittmer, 2009).
Understanding, evaluating, and documenting how students, faculty, and support staff perceive and use technology in practice is required to validate whether these devices enhance student and individual learning and the ability to provide safe nursing care. Positive behavior support (PBS) is typically set up as a multilevel model of intervention and involves a school-wide structure of support for teachers that adopt evidence-based programs (Freiberg &Lapointe, 2006), and small group and individualized programs for students who do not respond to the school-wide structure and need more support (Robinson &Griesemer, 2006). At the school wide level, teachers and staff create a positive school culture by clearly defining positive expectations that are taught to all students and adults (Bradshaw, 2014).
Use of laptop computers, personal digital assistants (PDAs), iPads, iPods, and smart phones in both the classroom and clinical setting have increased (Ventola, 2014; Cahill & Li, 2011). Use of these devices is often introduced without a clear plan for implementation or coordination of use in nursing education (Williams & Dittmer, 2009). Current students, predominantly of the millennial generation, are touted as being increasingly tech-savvy (Revell& McCurry, 2010).
Educators have added computer-assisted instruction to compete for students’ attention and to accommodate and to recognize the differences in students’ learning styles (Simon, 2000). This accommodation has caused a paradigm shift in higher education from traditional classroom Instruction (TCI) to computer-assisted instruction (CAI) (Ryan, Carlton, & Ali, 1999). Results from technology use, brevity, movement, and color have been added to education (Young, 2002).

This shift is requiring changes in both the way educators teach and students learn.
Communication and interaction skills have been affected and reshaped by technology (Young, 2002; Ryan, Carlton, & Ali, 1999).Technology affects the structure of learning institutions, methodology of teaching, and the style in which we learn.

The physical structures of learning institutions, methodology of teaching, and learning styles have been affected by technology (Leasure, Davis, &Thievon, 2000).Individual students learn differently, even when the course format and content are the same (Haar, Hall, Schoepp, & Smith, 2002; Kozlowski,2002).
With technology, educators can now adapt their teaching to fit the students’ learning styles as well as aid in influencing information processing and academic achievement. If educators do not recognize and adapt to these changes, but continue to cling to the traditional ways of teaching, they may be teaching to empty classrooms. Computer-assisted instruction allows the students to be active participants in their learning and therefore students can progress at their own pace (Huppert, Yaakobi, &Lazarowitz, 1998).

“CAI may help students develop creative abilities and induce changes in the cognitive and affective outcomes” (Huppert, Yaakobi, &Lazarowitz, 1998, p. 236). According to Burkill (1998), CAI serves the purpose of providing flexibility in developing new knowledge and supporting competence in the use of information technology.
Five theoretical frameworks come together to support collaborative learning. While they differ somewhat, each theory predicts that collaboration will promote learning and support growth and critical thinking.

These theories, individually and together provide support for collaborative learning, that is, students working together to learn.
Contextually, the researcher observed that nursing training schools within Fako division which are fundamentally responsible for training most of the health personnel working within health facilities in the division and its environs are not equipped for the task.

The learners ought to be trained theoretically and practically not just through the internship programs but by observing and been taught how to manipulate modern gadgets that can enhance the health of patients.

Some of these instructional technologies include simulations, computers, projectors, microscopes Also to facilitate understanding it is required that trainers use instructional technologies that are up to date so as to facilitate understanding of lessons and permit nursing students get insights of the situation on the ground that is in hospitals.
1.3 Statement of the problem
The survival and progress of any nation depends largely on the way of life of the individual members of the society and the various professions that the society is made up of.

These professions specifically the nursing professionals are supposed to be groomed and trained in a safe and in the best environment possible with the best instructional technology that are available.

This will permit the students nurses to subsequently integrate into the society as competent and skilled upright professional nurses and future leaders in the various hospitals and nursing schools in the society.
The education of nurses requires that the nurse should be well trained to be competent and full of skills.

This can be achieved better when nursing students are motivated to learn.

The use of instructional technology for better learning outcome in nursing education as adequate learning will fail to take place if nurse educators fail to use instructional technology effectively.
It has been noticed with great dismay that some nursing training schools seem to be slowing down in their role of molding students through the use of new technology.

As observed, some student nurses and teachers are not competent and familiar with the use of these new technology which are seemingly indispensable for the training of nurses in the 20th century within the training.

Based on this, this study seeks to investigate the use of instructional technology in enhancing the training of nursing students in Fako Division.
1.4 Research questions
This study has two research questions the general questions and specific research questions.
1.4.1 General research question
To what extent does the use of Instructional Technology in nursing enhance on the training of nursing students in Fako Division?
1.4.2 Specific research questions
What are the different types of Instructional Technology used in nursing training?
How do Nurse Educators in Fako Division evaluate students using Instructional Technology?
What are the challenges faced by nurse educators when using Instructional Technology in Fako Division?