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Blended learning brings more depth to nursing education
Hybrid education programs merge the best instructional formats
Lisette Hilton
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Blended learning that combines elements of traditional onsite learning with digital learning is gaining traction at major institutions, including the
Johns Hopkins School of Nursing
in Baltimore, Md.

Andrea Gibson, RN
Rita F. D’Aoust, ANP
Faculty have long included digital learning in traditional onsite courses. But today’s approach to blended learning uses course design strategies and technology to actively engage the learner in a mix of onsite and online education, according to Rita F. D’Aoust, PhD, ANP-BC, CNE, FAANP, FNAP, FAAN, associate dean for teaching and learning at Johns Hopkins SON in Baltimore. The school uses traditional onsite education, blended learning approaches and online courses in its nursing education programs. Blending learning has become a recognized approach to education, D’Aoust said.
Purdue University Global
uses a form of blended learning through all of its nursing programs, from its associate degree program to doctorate of nursing practice, according to Andrea Gibson, MSN, RN, director of programmatic accreditation at Purdue University Global. “It looks a little different in each of those programs simply because the degree plans and the degree requirements are different based on the level of education that the student is pursuing,” Gibson said. “In our prelicensure programs at the associate degree and baccalaureate level, the student completes didactic or theoretical learning in an online environment, then completes their clinical and laboratory experiences through faculty- and preceptor-guided clinical experiences at healthcare facilities in their local communities.” Purdue Global’s nurse practitioner program is similar in that nurses complete theoretical learning online, but the required practice experiences are completed in a one-on-one preceptor-guided experience, Gibson said. The mix can offer the best of two important worlds. Online, D’Aoust said, offers students flexibility to learn where and when it’s most convenient. While traditional in-class or onsite teaching remains critical to some aspects of nursing education. “Hybrid education is important to students’ learning outcomes and to student retention,” she said.
“I actually could interact more with the students. I had a better sense for what students were struggling with, what they were thinking, their lines of reasoning, things like that.”
— Jennifer Rogers, PhD
What does the research show?
Jennifer Rogers
Researchers comparing blended, face-to-face lecture and online versions of the human physiology course at the University of Iowa in Iowa City, found the blended format had higher student retention and less likelihood of failure, according to data presented June 20, 2018, at the American Physiological Society Institute on Teaching and Learning in Madison, Wis. Study author Jennifer Rogers, PhD, ACSM EP-C, EIM-2, associate professor of instruction, health and human physiology, at the
University of Iowa
, who has been teaching human physiology for years in the traditional large lecture hall, said about 20% to 25% of students, many of whom are pre-med and some in nursing, would either drop or fail the course. All 414 students in the study, regardless of course type, went through the same course content at the same pace. Traditional lecture students attended two 75-min in-class sessions a week and had the option of reviewing pre-recorded course content. Online students reviewed the pre-recorded lectures and engaged in asynchronous online discussion activities about every two weeks. Students in the blended section met for a 75-minute classroom session once a week to review concepts presented in the pre-recorded lectures, complete learning activities and engage in guided peer discussions. Although students from the three course types had similar cumulative exam scores, there were significant differences among learning formats in retention. “Basically only one student of about 80 dropped in the blended section,” Rogers said. “It was significantly higher for the other sections.” The researchers found more than 95% of students in the blended course earned course grades of C- or higher, compared with 82% in the large lecture sections and 81% in the online format. Students in the blended course reported less anxiety than those taking the online format. The blended course offers a bidirectional flow, fostering conversation between the instructor and students, as well as among students, according to Rogers. “We didn’t really lecture during the blended session,” she said. “The traditional lecture met twice a week for 75 minutes and it was pretty much didactic lecture. So, the face-to-face is me standing in front of the room talking to the students and allowing time if there are any questions. But there was very little interaction during that time. In the blended section, they reviewed all the material online and then when they came in for the weekly meeting it was much less structured time. If there was any formal content presentation, I tried to keep it to 10 minutes, then the students would divide into groups and there were structured activities.”
Getting students to the finish line
Jean Moore, MSN
Blended online and in-class approaches to nursing education are increasing, according to Jean Moore, DrPH, MSN, FAAN, director for the
Center for Health Workforce Studies
at the School of Public Health, State University of New York at Albany.
“For instance, UAlbany is exploring the possibility of a BSN completer program, and that is how it will operate,” she said. By law, RNs in New York have to earn a BSN within 10 years of initial licensure. So, there’s great interest in the state to create opportunities for nurses to get their bachelor’s degrees through completer programs. Offering an online component to the completer programs makes them more accessible to nurses in parts of the state with fewer established BSN programs, according to Moore. “In New York, there aren’t as many BSN programs upstate as there are downstate,” Moore said. “The question is how do you make sure you have an adequate supply of nurses upstate, particularly in rural areas? That’s where I think building relationships between associate degree programs and BSN completers that offer the blended approach just makes a whole lot of sense.”
Hope amid a faculty shortage
The blended approach to learning could help ease the faculty shortage in nursing, according to Rogers. One reason is faculty might need to be physically on campus less often. Another is job satisfaction. “What I can say as an instructor very subjectively was class time was so much more enjoyable,” Rogers said. “I actually could interact more with the students. I had a better sense for what students were struggling with, what they were thinking, their lines of reasoning, things like that.” Faculty also seem to embrace the approach as something that works. Researchers reported in the January/February 2018
Nurse Education Perspectives
that nurse faculty feel students’ learning outcomes from online and hybrid courses are comparable to face-to-face formats.
The question any blended nursing curriculum should address, D’Aoust said, is when is it important to bring nurses onsite because it’s critical to their learning? “The learning depth drives the delivery method," D’Aoust said. "The delivery isn’t what drives the learning.”
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Lisette Hilton is a freelance writer.