ORIGINAL RESEARCH Nursing and healthcare students��� experiences and use of e-learning in higher education Pam Moule, Rod Ward & Lesley Lockyer Accepted for publication 6 August 2010 Correspondence to P. Moule: e-mail: pam.moule@uwe.ac.uk Pam Moule EdD RNT RN Reader in Nursing and Learning Technologies Faculty of Health and Life Sciences, University of the West of England, Bristol, UK Rod Ward MA Ed RNT RN Senior Lecturer Faculty of Health and Life Sciences, University of the West of England, Bristol, UK Lesley Lockyer PhD BSc(Hons) RN Director of Market Intelligence Faculty of Health and Life Sciences, University of the West of England, Bristol, UK MOULE P., WARD R. & LOCKYER L. (2010) MOULE P., WARD R. & LOCKYER L. (2010) Nursing and healthcare students��� experiences and use of e-learning in higher education. Journal of Advanced Nursing 66(12), 2785���2795. doi: 10.1111/j.1365-2648.2010.05453.x Abstract Aim. This paper presents research on nursing and healthcare students��� experiences and use of e-learning. Background. The inception of e-learning in higher education is supported by a policy background and technological developments, yet little is known of student experience and use in the United Kingdom. Methods. Conducted in 2007 and 2008, this study employed a mixed methods approach. An initial quantitative questionnaire was completed by 25 Higher Edu- cation Institutions and nine case study sites were visited. In the sites 41 students took part in focus groups and 35 staff were interviewed. Findings. Twenty-four Higher Education Institutions used a virtual learning environment and all respondents used e-learning to enable access to course materials and web-based learning resources. Three main themes were identified from student interviews, ���Pedagogic use��� ���Factors inhibiting use��� and ���Facilitating factors to engagement���. Student���s main engagement with e-learning was at an instructivist level and as a support to existing face-to-face modes of delivery. Student use of Web 2.0 was limited, although a number were using social software at home. Limited computer access, computing skills, technical issues and poor peer commitment affected use. Motivation and relevance to the course and practice, in addition to an appreciation of the potential for student-centred and flexible learning, facilitated use. Conclusion. There is scope to broaden the use of e-learning that would engage students in the social construction of knowledge. In addition, experiences of e-learning use could be improved if factors adversely affecting engagement were addressed. Keywords: e-learning, health care, higher education, nursing, student engagement, student experiences, technology-enhanced learning �� 2010 The Authors Journal of Advanced Nursing �� 2010 Blackwell Publishing Ltd 2785 JAN JOURNAL OF ADVANCED NURSING

Introduction Government policies expounding the benefits of e-learning use internationally (Dearing 1997, Department for Education and Employment (DfEE) 1998, Pittinsky 2002, Department for Education and Employment (DfEE) 2003) have influenced educational developments in Higher Education Institutions (HEIs). Notably in the United Kingdom (UK), the Higher Education Funding Council for England (Hefce) has produced a revised approach to its original strategy for e-learning that focuses on enhancing teaching, learning and assessment through the use of technology (Hefce 2009). E-learning, defined here as ���any learning that uses infor- mation and communication technologies��� (Hefce 2005, p. 5), is viewed as one way to support the development of healthcare professionals (Department for Education and Skills (DfES) 2003). The flexibility and accessibility of such modes of delivery are seen internationally as offering oppor- tunities to meet key education agendas including lifelong learning and widening participation (Department of Health (DH) 1998, 2000, 2001, DfEE 2003, Bates 2001). Given this policy background it is unsurprising that claims are made relating to the increasing use of technology to support pedagogy (Adams 2004). However, whilst e-learning may be shaping the landscape of nursing and healthcare education (Glen & Cox 2006) there is limited appreciation of the real impact of key government policies and we do not fully understand the student experience and use of e-learning (Moule 2007). This paper presents aspects of research commissioned by the Higher Education Academy, Health Sciences and Practice Subject Centre (HEA HS&P), conducted between January 2007 and December 2008. The research explored student experiences and use of learning opportunities mediated through technology in HEIs in the UK. The study included an initial survey phase, followed by case studies that included staff and student interviews. Data relating to student use and experiences of e-learning is presented here. Background Technology-enhanced learning in nursing and healthcare education spans instructivist to constructivist approaches, as set out in the E-learning ladder (Figure 1 Moule 2007). Instructivist learning theory, is a teacher���centred model of learning that suggests knowledge exists independently of the learner, and is transferred by the teacher, to the student, who is viewed as a passive recipient. Constructivist theory is student, rather than teacher focused. The student con- structs new knowledge through analysis of information and reference to experience and understanding. The ladder base identifies e-learning applications that give access to instructional material through to supporting constructivist approaches to learning. Opportunities for social learning and Constructivist learning Social networking for Eduction e.g. Twitter, Facebook Wikkis Virtual ���chat��� classroom Blogs, E-mail discussions, Discussion board Video conferencing, Synchronous transmission Interactive learning media e.g. CD-ROM Group working (composition) Facilitation Longevity of engagement ICT access IT Skills Technical support Information gathering e.g. databases, course notes Instructivist learning Figure 1 E-learning ladder. Adapted from Moule (2007). P. Moule et al. �� 2010 The Authors 2786 Journal of Advanced Nursing �� 2010 Blackwell Publishing Ltd