1. Billings, Diane M.

Article Content

Increasing numbers of nurses and nursing students live at distances from educational institutions providing basic or continuing nursing education. As improved television, telephone, and Internet technologies become available and affordable, these barriers can be eliminated. Distance education, using information technologies to overcome the separation of teacher and student, can be used by nurse educators to provide access to educational programs. This three-part series discusses a variety of issues related to distance education in nursing. This column introduces the concept of distance education, differentiates the various distance education delivery systems, and discusses the advantages and disadvantages of using them for nursing education. The next Connecting Points explains how to adapt courses and programs for distance education. The final column examines the roles of faculty and students teaching and learning at a distance.


Distance Education

Distance education uses a variety of information technologies to connect students and faculty who otherwise are not able to meet because of barriers of time or space. Because the student and teacher are not in the same classroom, distance education focuses on designing instruction that transcends the classroom, supporting the learner who must assume additional responsibility for learning, and promoting meaningful interaction that overcomes the separation of the teacher and student.


Distance education can occur in "real-time" or "delayed-time." In synchronous distance education, the teacher and student, although separated, are participating in the educational experience at the same time (for example, live, interactive television or on-line computer "chats"). In asynchronous modes, the student and faculty are not participating at the same time (for example, independent study modules, videotapes, and computer conferencing). The synchrony of the medium influences the design of the instruction, the course delivery, and how students interact with the content, faculty, and peers.


The Technologies of Distance Education

The technologies for connecting learners and faculty may be print, audio, video, or computer and vary in complexity and cost. In many instances, one or more of the technologies can be combined to maximize the advantages of each.



Courses and programs can be delivered through printed materials, usually exchanged between the faculty and student through the mail. Although rather "low-tech," print-based distance education is relatively inexpensive to develop and disseminate and yields effective learning outcomes. Examples of print-based distance education include independent study/self-paced instruction1-3 and correspondence instruction.4 Print technologies are particularly appropriate when other technologies are not available.



For audio programs, telephones and speaker phones are used to connect teachers and students at two or more sites (two-way audio, audioconferencing).5,6 Audio conferences can be supplemented by using graphical tablets (audio graphics) that transmit text and graphics over the telephone lines.



The use of television, often called videoconferencing or interactive television, is the most common technology used in nursing education. Classes are transmitted to distant sites by telephone, cable, satellite, or microwave. The transmission may be "one-way video, two-way audio," in which audio transmission goes to the origination and reception site but only the visual images are transmitted to the reception site, or "two-way video, two-way audio," in which both the origination and reception site have video and audio transmission capabilities.7-9 Transmission of courses can be live or delayed for use at a convenient time.10 "Desk-top video," a more futuristic application, involves a video card in a computer with a small camera on top of the computer. The signals are transmitted from the computer through dedicated telephone lines. Although the transmission quality and the range of view of the camera are limited, this approach can be useful for conducting conferences and training sessions. Televised courses require an investment in equipment and transmission capabilities (telephone, cable, satellite) and thus require significant start-up funds.



Instruction can be delivered using the computer and the capabilities of the Internet. Computer conferences and complete courses can be offered in this way.11,12 As access to the Internet and the World Wide Web increase, there will be increased applications for computer-based distance education. Although there is an initial investment in course development, on-going use and delivery of the instructional materials is relatively inexpensive when faculty and students have easy access to the Internet.


Advantages of Distance Education in Nursing

The primary value of using information technology to connect teachers and students is that learning opportunities can be accessible to students who live a distance from the faculty, and learning opportunities can occur "on demand" at a time and place (often the work site or home) convenient for the learner. Distance education can be used to deliver credit courses and entire curricula, continuing education, and on the job or just-in-time training. Offering courses using distance education strategies also can serve as a vehicle for recruitment and retention for schools of nursing8,9 and health care agencies.13 From the instructional view-point, course work can be designed to be consistent, reproducible, and used at multiple locations.


Disadvantages of Distance Education

Distance education is not for all teachers, all students, or all instructional activities, and nurse educators must make careful choices about using distance education technologies. Distance education requires additional course preparation and role changes for faculty and students. Finally, distance education involves the costs of managing such a program, additional faculty time, and technology, and initial efforts to develop distance education programs may be possible only with additional funding. Although the benefits of distance education, such as public relations, recruitment to a campus, and access for students, can be achieved through distance education, economic benefits to the provider (school and university, health care agency) come from large enrollments, access to experts, or salary savings when faculty are not employed at multiple sites, and the costs and benefits may or may not be revenue-neutral.



Distance education has proved to be an effective delivery system for nursing education.14 Studies comparing distance education with traditional classroom experiences find that academic achievement, socialization, and mentoring opportunities are comparable or improved by using distance education.15-17 In addition, students report satisfaction with learning at a distance, probably because of the convenience of being able to take courses at their chosen time and place.


Summary and Conclusions

Although not for everyone, distance education is a "connecting point" for faculty and students who are separated by time and space. As technology becomes increasingly available to nurse educators, the instructional and public relations advantages become significant benefits to nurse educators.




1. Lethbridge DJ. Independent study: A strategy for providing baccalaureate education for RNs in a rural setting. J Nurs Educ. 1988;27:183-185. [Context Link]


2. Rufo KL. Effectiveness of self-instructional packages in staff development activities. Journal of Continuing Education in Nursing. 1985;16:80-83. [Context Link]


3. Goldrick B, Appling-Stevens S, Larson E. Infection control programmed instruction: An alternative to classroom instruction in baccalaureate nursing education. J Nurs Educ. 1990;29:20-25. [Context Link]


4. Billings D, Marriner A, Smith L. Correspondence courses: An alternative instructional method. Nurse Educ. 1986;14:12-16. [Context Link]


5. Henry P. Distance learning through audioconferencing. Nurse Educ. 1993;18:23-26. [Context Link]


6. Hardy DW, Olcott Jr D. Audioconferencing and the adult learner: Strategies for effective practice. Am J Distance Educ. 1995;9:44-60. [Context Link]


7. Clark CE. Telecourses for nursing staff development. J Nurs Staff Development. 1989;5(3):107-110. [Context Link]


8. Billings D, Frazier H, Lausch J, McCarty J. Videoteleconferencing: Solving mobility and recruitment problems. Nurse Educ. 1989;11:31-37. [Context Link]


9. Boyd S, Baker CM. Using television to teach. Nursing and Health Care. 1987;8:523-527. [Context Link]


10. Heidenreiter TJ. Using videoteleconferencing for continuing education and staff development programs. J Continuing Educ Nurs. 1995;26:135-138. [Context Link]


11. Halstead J, Hayes R, Reising D, Billings D. Nursing student information network: Fostering collegial communications using a computer conference. Comput Nurs. 1995;13:55-59. [Context Link]


12. Lyness AL, Raimond JA. Electronic communication to promote consensus-building skills: An innovative teaching strategy. J Nurs Educ. 1992;31:331-334. [Context Link]


13. Maltby D, Drew L, Andrusyszyn MA. Distance education: Joining forces to meet the challenge. J Continuing Educ Nurs. 1991;22:119-122. [Context Link]


14. Billings D, Bachmeier B. Teaching and learning at a distance: A review of the nursing literature. In: Allen LR, ed. Review of Research in Nursing Education. New York, NY: National League for Nursing; 1994:1-32. [Context Link]


15. Parkinson CF, Parkinson SB. A comparative study between interactive television and traditional lecture course offerings for nursing students. Nursing and Health Care. 1989;10:499-502. [Context Link]


16. Keck JF. Comparison of learning outcomes between graduate students in telecourses and those in traditional classrooms. J Nurs Educ. 1992;31:229-234. [Context Link]


17. McClelland E, Daly J. A comparison of selected demographic characteristics and academic performance of on-campus and satellite-center RNs: Implications for the curriculum. J Nurs Educ. 1991;30:261-266. [Context Link]