Exploring the Use of Blog Narratives as a Method of
Informing
Nurse Practitioner Curriculum Evaluation
E. Staples, S. L. Ray, & C. Iwasiw
Abstract
The purpose of this research
study was to gain insight into the educational experiences of students and
graduates of a nurse practitioner (NP) program in Ontario, Canada to inform
curriculum evaluation. Participants were asked to provide narratives of their
experiences via two separate limited-access blog sites on the program's
NP–Education Network. An interpretive qualitative analysis of participant
narratives revealed the program is preparing graduates for practice but there
are areas for improvement that require attention. From the emerging themes,
recommendations are proposed for improving the curriculum of the NP program.
Literature
Review and SignificanceCurriculum
Evaluation
"Curriculum
evaluation is conducted ... to determine the curriculum strengths, weaknesses,
merits, and deficits. Additionally, identification of possible future
directions for the curriculum is typically an outcome of the evaluation process
(Chen, 2005). As a quality control mechanism, the intent of curriculum evaluation
is to assure that the curriculum, its courses, the processes undertaken, and
student achievement of intended outcomes are meeting the required standards” (Iwasiw,
Goldenberg, & Andrusyszyn, 2009, p. 281) and that the curriculum is
relevant for its context. Students and graduates provide important data for the
evaluation, typically by completing questionnaires and participating in focus
groups (Iwasiw, Goldenberg, & Andrusyszyn; Jacobs & Koehn, 2004;
Oermann & Gaberson, 2006; Sauter, Johnson, &
Nightingale
Gillespie, 2009).
Evaluation of the PHCNP Program and Graduates
Although
the NP program has undergone previous curriculum evaluation (Andrusyszyn, van Soeren,
Laschinger, Goldenberg, Di Censo, & the Nurse Practitioner Evaluation
Group, 1999: Caty,
Michel, Wong, & Stewart, 2000, 2001a, 20001b,2002), the narratives of
students and graduates have not been sought after or obtained.
Blogs
Blogs have been
a feature of the internet since 2003, and came into prominence through
eye-witness accounts of the Iraqi war (Martindale & Wiley, 2005). “The
word, blog comes from ‘Weblog’, a
publicly accessible personal journal for an individual (Todoroki, Konishi, & Inoue, 2006, p. 246). However, unlike
most personal journals, web journals are shared with other people over the web.
Blogs are a means for people to easily create and
quickly share content online (Al-Hasan, & Adamic, 2007). In addition
to personal blogs to which others may not contribute content, there are
community blogs, to which others do contribute content (Silva,
Goel, & Mousavidin, 2008).
Features of blogs. Weblogs generally have certain
features, including: automatic formatting of content in the form of
“headlines”, followed by “entries,” or “stories”; time- and date-stamp of
entries; archiving...; a search function...; a “blogroll” – a list of other
blogs read by the author(s) of the current blog; a section associated with each
entry where readers can post comments...;a simple syndicator of the site
content via RRS Syndication)” (Martindale & Wiley, 2005, p.55-56). These
features are supported by blog server software. Thus, programming or formatting
is unnecessary to create a technically sophisticated and visually appealing
website. From a visitor’s perspective, a weblog is merely a website.
From
an analysis of Meta-Filter, a blog with 30,000 registered members, Silva
et al. (2008) concluded that a community blog is brought about by several
features. These are explicit ground rules about membership and
participation; presence of moderators; availability of information about
participants and identification of the person posting a comment; ‘net
etiquette’; tacit rules for discerning pertinent posts; and responses to
inappropriate posts to limit them.
Motivation for, and
benefits of, blogging. In an analysis of three blog communities, Ali-Hasan and
Adamic (2007) reported that the most frequent reason for blogging was a desire
to express oneself. Blogs were also used for personal journaling; expanding
social networks; and enriching and maintaining existing offline relationships.
In contrast to this personal focus, Silva et al.(2008) assert that participating in a
community of practice (i.e., a group that is distinguished by a particular
practice that is more salient than other attributes such as culture) serves two
functions for individuals: learning by enacting and reproducing the practices
of the community, and at the same time, forming and reinforcing the community’s
identity.
The shared practice of community members becomes
evident through stories, experiences, and ways of solving problems. Therefore, seeking
identity and being regarded as knowledgeable motivates individuals to move from
the periphery to the centre of a community.
In
a study of participants’ motivation in three blog sites about computer
technology, Wasko and Farrai (2000) concluded that successful communities have
members who acted out of community interest rather than self-interest.
Participants had a strong desire for intellectual exchange with a community of
practice and did not use the technology to socialize. They enjoyed helping
others and considered sharing knowledge the right thing to do. Somewhat
differently, in a network of 7000 legal practitioners, directly aimed at
problem-solving, people contributed their knowledge and experience when they
believed this would add to their professional reputation, with no expectation
of reciprocity (Wasko & Farrai, 2005).
Use of blogs for research. Existing blogs have been analyzed to
determine technical features (MacDonald &Ounis,2006) and motivation for
participation, (Ali-Hasan & Adamic, 2007;
Silva et al., 2008; Wasko & Farai, 2000, 2005). Use of a limitedaccess blog for
communication by a research team has been described (Todoroki,
Konishi, & Inoue, 2006).
Summary
Curriculum evaluation data provides
a basis for subsequent curriculum changes, and students and graduates provide
important evaluation data. Research about the motivation for, and benefits of,
blogging is limited, although intrinsic and other-oriented motivation has been
identified. Blogs have been used as a communication site for a research team,
but no literature was found in which a blog was used as a site for collecting
data for curriculum evaluation or to provide data for research goals that
pre-date the establishment of the blog. Furthermore, no
literature was found about the use of blogs in Nurse Practitioner education or
about narratives of students and NPs.
Purpose
The
purpose of the study was three-fold:
1.
To
gain insight into the educational experiences of students enrolled in the NP program;
2.
To
gain insight into the education and practice experiences of graduates of the NP
program;
3.
To
propose recommendations related to curricular issues requiring attention in the
NP program.
Significance
Students in the NP program
communicate with each other and their faculty primarily online via the
program's NP–Education Network. Students also have a private online space where
they can safely express thoughts, ideas, trials and tribulations. It may be
that they discuss program and course related experiences within this space;
however, faculty and program leaders are not privy to this dialogue. An
underlying hypothesis was that if students and alumni were asked to share their
stories, it would yield rich narratives that could inform program evaluation by
shedding light on issues, concerns, questions, and challenges faced in the
program. Interpretive analysis of the narratives can provide insights about the
program's curriculum that will be of benefit to the program’s evolution. This study
is the first use of students’ and NPs’ narratives in evaluation of the NP program
and possibly the first use of blogs as a deliberate site for data collection.
Design and Data Collection
Design
This
study utilized an interpretive narrative study design. Interpretive analysis
reveals "commonalities in meanings, situations,
practices in the depiction of the lived experience" (Rather, 1992, p. 48).
Students and practitioners were viewed as separate communities of
practice, each with its own blog site. The separation of the groups was ensure
that “a contextual coherence in [participants’] experience
is there from the start, based on a set of expectations and shared interests” (Pachler
& Daly, 2009, p. 5).
Data Collection Procedures
Ethical approval and permission was obtained
to access the program's NP–Education Network for data collection; access
students enrolled in the NP program; and send an electronic invitation to alumni
who were registered via the NP–Education Network. The Nurse Practitioners' Association of Ontario
(NPAO) granted permission to send an email through their website describing the
study and seeking participants from past NP graduates.
Two blog sites were created, one for
current NP students and one for NP
graduates. A notice
was posted on the NP–Education Network announcing the study and directing
interested participants to more detailed information. Unfortunately, due to
information technology delays, the blog sites were not ready until late
November; a busy time in the NP program. Therefore, a decision was made to wait
until the beginning of Term 2 to begin data collection. The message via NPAO's
website to NP graduates was not sent out until February. As planned, an RA
monitored the blog sites and tried to prompt narratives.
Participation was anonymous; each contributor
created a pseudonym. Students
contributed
data over a three-month period. NP graduates contributed their ideas in the
last month. Both blog sites were closed at the end of three months.
Sample
Eight current NP
students posted a narrative, with only one posting more than once. Five NP alumni posted narratives, with two
posting twice each. None of the participants completed the demographic
questionnaire.
Data Analysis
Three approaches for transcript
analysis were utilized: first, transcripts were read as a whole to understand
the elements present in the text; second, transcripts were read to search for
phrases that appeared to be particularly revealing about the experience; and
third a detailed sentence-by-sentence reading of the text was undertaken to
highlight statements that were particularly essential or revealing of the
experience. As analysis of successive transcripts
proceeded, common themes among the various descriptions were noted (Van Manen, 1998). Data analysis proceeded until common themes about
experiences, curriculum, program, and the continuing education needs of NPs
were agreed upon by the researchers. The
analysis was returned to participants via the NP–Education Network for
verification.
Blog data were examined by two
members of the research team to identify common themes. Findings reported below
represent the comments of several students. Comments made by one person only
were not reported.
Findings
Participants expressed frustration at the
“disorganization” of the NP program. They pointed to issues of receiving course
materials at the last minute; not having access to program policies; and having
to navigate through several layers of a course site to find readings. The
intensity of their feelings was apparent in the narratives. As well, there was
a sense of being overwhelmed at the beginning of starting the program related
to the volume of work and the need to balance time spent in the program with
life responsibilities.
Participants were disgruntled with the inability to
review their own examinations to learn where they had been successful or
unsuccessful, and dissatisfaction about the general and vague way that
questions about the exams were responded to. They wanted to see their own
marked examinations.
The self-directed, problem-based learning (PBL) pedagogy
was also challenging at times. Having tried unsuccessfully to find answers to
learning module cases, they wanted and needed direct answers from their faculty
but this proved to be frustrating. Then, trying to engage in class seminars when
no one was sure of the answers and appropriate faculty guidance was not
forthcoming, was felt to be counter-productive and frustrating.
There were several comments about the need for improvements
in the quality of the Pathophysiology course, the responsiveness of the professor,
and the linkages between the Pathophysiology, Advanced Health Assessment and Diagnosis,
and Therapeutics courses. Occasional guest lecturers in Pathophyisology was
valued because they “shined a light” on the topic.
There was discussion about the objective structured
clinical examinations (OSCEs), specifically the difficulty in preparing for
them. There was a desire for more mock OSCE practice to develop critical
thinking skills and not just memorization.
Overall, graduates felt prepared as they began their
practice, and appreciated the ability to look at the ‘bigger picture’,
including health promotion, motivational interviewing, and program development.
As well, the value of the Roles and Responsibilities course became more apparent
after graduation.
Conclusions
and Recommendations
The low response was
disappointing. It is difficult to determine
for certain if the low number of respondents was directly related to the late
availability of the blog sites. Making the decision to postpone data collection
to Term 2 removed the opportunity to obtain narratives related to students'
experiences at the beginning of the program given they reported feelings of
feeling 'overwhelmed' at that particular time.
The late start in data collection may have therefore affected the timing
of the data collection; recruitment of students and alumni to the blog sites;
the use of blogging; the heavy workload of the program; disinterest in
evaluation of the program, or other reasons.
For example, there has always been, amongst the NP students, a sense of
'skepticism' with anonymity in sharing program or course evaluations. This has
resulted in approximately five to eight percent of students' engaging in completing
evaluation measures.
Although the response rate was low,
the length and detail of the entries allowed for some conclusions. Since
participants focused on matters that were problematic for them, the program’s weaknesses
predominated the narratives.
Strength:
1. In total, the
program does prepare graduates for practice
Areas for
Improvement:
1. Students’
feeling of being overwhelmed at the outset of the program
2. Perceived
disorganization within the program
3. A possible over-reliance
on self-directed, problem-based learning (PBL)
4. Insufficient
individualized feedback about exam results
5. Lack of
apparent links between the Pathophysiology, Advanced Health Assessment and Diagnosis,
and Therapeutics courses
Recommendations
1. Provide
potential applicants with an accurate picture of the workload (readings,
studying, online activities, and class attendance) of the program. They might
be told, for example, the average number of hours per week they could expect to
devote to each course;
2. Ensure that
all pertinent program materials and information are accessible in a timely
manner, possibly by producing
3. course packages
with all necessary materials; Provide
guidance to faculty in assisting students when self-direction, PBL is
ineffective and frustrating;
4. Develop means
to provide students with individualized feedback about their examinations;
5. Provide added laboratory
practice with OSCEs to expand critical thinking, and provide concrete
suggestions about preparation for the OSCEs beyond memorization;
6. Strengthen the
links between the Pathophysiology, Advanced Health Assessment and Diagnosis,
and Therapeutics courses. One idea might
be to ensure that the topics and readings of these three courses are mapped and
sequenced each week, so that the flow between the courses and required thinking
processes is related and smoother.
About the Authors: E. Staples RN, DNP is Assistant Professor of Nursing at the University of Regina,
Regina, SK, Canada. Contact Dr. Staples at eric.staples@uregina.ca; Ray, S.L., RN, PhD is Associate Professor/Associate
Scientist Arthur Labatt Family School of Nursing Western University, Faculty of
Health Sciences London, ON, Canada. Contact Dr. Ray at slray@uwo.ca;
Iwasiw, C., RN, EdD Professor Arthur Labatt Family School
of Nursing Western University, Faculty of Health Sciences London, ON, Canada.
Contact Dr. Iwasiw at ciwasiw@uwo.ca
Key Words: nurse practitioner education, curriculum evaluation,
qualitative methodology, blogging
References
Ali-Hasan, N.
F., & Adamic. L. A. (2007).
Expressing social relationships on the blog through links and comments.
Retrieved April 4, 2009 from http://www.icwsm.org/papers/2--Ali-Hasan--Adamic.pdf.
Andrusyszyn, M.A., van Soeren, M., Laschinger, H., Goldenberg, D.,
& Di Censo, A. & the Nurse Practitioner Evaluation Group. (1999). Evaluation of Distance
Education Delivery Methods for a Primary Care Nurse Practitioner Program. Journal of
Distance Education, 14(1), 14-33.
Caty, S., Michel, I., Pong, R., &
Stewart, D., (2000). The 1996-1997 cohort of graduates of the transition phase
of the NP education program: their views and career activities. Centre for
Rural and Northern Health Research (unpublished).
Caty, S., Michel, I., Pong, R., &
Stewart, D. (2001a). The 2000 cohort of graduates of the transition phase of
the NP education program: their experiences, views and career plans. Centre for
Rural and Northern Health Research (unpublished).
Caty, S., Michel, I., Pong, R., &
Stewart, D. (2001b). “ profile of the 2001 cohort of applicants to the
Ontario primary health care NP education program. Centre for Rural and Northern Health Research
(unpublished).
Caty, S., Michel, I., Wong, R.W., & Stewart, D.
(2002). A profile of the 1999-2001 students of the primary health care nurse
practitioner education program: A summary report. Centre for Rural &
Northern Health Research (unpublished).
Chen, H-T. (2005). Practical
program evaluation. Thousand Oaks, CA: Sage.
Iwasiw,
C., Goldenberg, D., & Andrusyszyn, M.A. (2009). Curriculum development in nursing education. Sudbury, MA: Jones and
Bartlett Publishers.Jacobs, P.M., & Koehn, M.L. (2004). Curriculum
evaluation: Who, when, why, how? Nursing Education Perspectives, 25(1), 30–35.
Macdonald, C., & Ounis,
I. (2006). The TREC Blogs06 Collectio :
Creating and analysing a blog test collection.
Retrieved Apr 4, 2009 from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.101.1540&rep=rep1&type=pdf
Martindale, T., &
Wiley, D. A.(2005) Using weblogs in scholarship and teaching. TechTrends, 49(2), 55- 61.
Oermann,
M. H., & Gaberson, K. B. (2006). Evaluation and testing in nursing
education (2nd ed.). New York: Springer Publishing Company.
Pachler,
N., & Daly, C. (2009). Narrative
and learning with Web 2.0 technologies: Towards a research agenda. Journal of Computer Assisted Learning, 25 (1), 6-18.
Rather, M.L. (1992). Nursing as a way of thinking:
Heideggerian hermeneutical analysis of the lived experience of the returning
RN. Research in Nursing & Health, 15, 47-56.
Sauter,
M. K., Johnson, D. R., & Nightingale Gillespie, N. (2009). Educational
program evaluation. In D.M. Billings & J.A. Halstead (Eds.), Teaching in nursing. A guide for faculty
(3rd ed.). (pp. 467–515). St. Louis: Saunders Elsevier.
Silva, L.,
Goel, L., & Mousavidin, E. (2008). Exploring
the dynamics of blog communities: The case of MetaFilter. Info Systems
Journal, 19, 55-81.
Van
Manen, M. (1998). Researching lived
experience. (3rded.). London, ON: The Althouse Press.
Todoroki, S., Konishi, T., & Inoue, S. (2006). Blog-based
research notebook: Personal informatics workbench for high-throughput
experimentation. Applied Surface Science, 252, 2640–2645.
Wasko, M.
M. & Faraj, S. (2000) It is what one does: Why people participate and help
others in electronic communities of practice. Journal of Strategic
Information Systems, 9,
155–173.
Wasko, M.
M. & Faraj, S. (2005) Why should I share? Examining social capital and
knowledge contribution in electronic networks of practice. MIS Quarterly,
29, 35–57.