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) 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
G
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up
w
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in
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(co
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Fa
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Lo
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kil
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up
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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