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Nurse Education in Practice 11 (2011) 124e130

Contents lists avai

Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Using problem-based learning in web-based components of nurse education

Tonia R. Crawford*

Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia

a r t i c l e i n f o

Article history:Accepted 17 October 2010

Keywords:Problem-based learningOnline educationE-learningWeb-based nurse education

* Tel.: þ61 2 9487 9608; fax: þ61 2 9487 9625.E-mail address: tonia.Crawford@avondale.edu.au.

1471-5953/$ e see front matter � 2010 Elsevier Ltd.doi:10.1016/j.nepr.2010.10.010

a b s t r a c t

Problem-based learning (PBL) is a student-centred method of teaching, and is initiated by introducinga clinical problem through which learning is fostered by active inquisition (Tavakol and Reicherter, 2003).Using this teaching and learning strategy for web-based environments is examined from the literaturefor potential implementation in a Bachelor of Nursing program.

In view of the evidence, students accessing online nursing subjects would seem to benefit from web-based PBL as it provides flexibility, opportunities for discussion and co-participation, encourages studentautonomy, and allows construction of meaning as the problems mirror the real world. PBL also promotescritical thinking and transfer of theory to practice. It is recommended that some components of practice-based subjects such as Clinical Practice or Community Health Nursing, could be implemented onlineusing a PBL format, which should also include a discussion forum to enable group work for problem-solving activities, and tutor facilitation.

� 2010 Elsevier Ltd. All rights reserved.

Introduction

As technology has evolved, web-based learning has gainedpopularity with students, and increasingly, higher educationinstitutions have recognized the benefits of utilizing this tech-nology as a strategy to enhance student recruitment and retention(Parker et al., 2005); to remain relevant, convenient, flexible andaccessible (Care and Scanlan, 2000); and to promote autonomouslifelong learners (Howatson-Jones, 2004). According to O’Neil andFisher (2008), the changing profile of nursing students anddemands of the healthcare environment have prompted schools ofnursing to deliver or support education using informationtechnology.

Problem-based learning (PBL) is a student-centred method ofteaching, and is initiated by a clinical problem aimed to fosterlearning through active inquisition, and to encourage students totake the major responsibility for their own learning (Tavakol andReicherter, 2003). Web-based PBL can develop self-directedlearning and problem-solving skills using real life problems, whileaddressing some of the time, travel and access constraints forstudents. Consequently web-based PBL is of particular interest forthe development of online interaction/communication in anAustralian Bachelor of Nursing (BN) program as the course isoperated over two campuses and students can attend from a widegeographical area. While there has been much written on the

All rights reserved.

strengths and limitations of PBL, this paper will describeweb-basedlearning and PBL before reviewing the literature on web-based PBLfor nurse education.

Web-based learning

Online education is seen to create access to learning (Pawan,2003) as it is independent of geographic and temporal bound-aries, and increases learner control allowing for greater flexibilityand autonomy. It also provides ready access to resources, allowingfor interaction and communication with other students andeducators via email and synchronous or asynchronous discussionforums (Prows et al., 2004). Synchronous methods includediscussions, virtual classrooms or video-conferencing whereinteractions occur in real time and need to be pre-planned. Asyn-chronous activities such as use of websites, problem-solvingscenarios, and online discussions are self-directed and allow forgreater choice of process, pace and location (Larsen et al., cited inHowatson-Jones, 2004). Increased demand for distance educationhas prompted nursing faculties to implement information andtechnological approaches to provide education opportunities thatcater for the diversity of learners needs (Udod and Care, 2002).

Problem-based learning

PBLwas introduced in the 1970s in health profession curricula atMcMaster University in Canada, and has been used in variousgraduate and undergraduate settings such as engineering, business,

Table 1Review of primary research on web-based PBL.

Authors Description Results Limitations Reason for inclusion

Edwards et al.,1999

Canadian study used pre andpost-course questionnaires tocompare learning satisfactionbetween nursing students whoattended the PBL course face-to-face (control group), andthose who received the coursevia teleconferencing

� A small percentage of students finding theadjustment to PBL difficult

� The item receiving the highest satisfaction ratingwas ‘group functioning as a PBL team’, with similarsatisfaction ratings for the course betweenface-to-face and distance students.

� Tutor feedback to distance students is inherentlymore difficult than inface-to-face situations

Only 9 of the 30 students were from distantsites with the distance students togetherphysically as a group, with the facilitator ata distant location, rather than each individualbeing linked via electronic means

Conclusions add to the evidence ofother studies

Oliver andOmari, 1999

Australian study in whichonline PBL was employed witha group of on-campusundergraduate students toexplore the practical issues andresponses of the learners

� Found PBL cognitively demanding, which tendedto lessen enthusiasm for participation

� Web-based PBL strategies provideconsiderable scope for developinginformation literacy, metacognition and self-regulating skills, important for lifelong learning

� Problem-based activities contributed substantiallyto learning, and that the environment wasenjoyable and stimulating

� Using collaborative groups in the problem-solvingprocess allowed students to choose the extent towhich they participated, with large discrepanciesin effort among students

� Students valued the input of the teacher

Only 57 participantsThe authors did not identify what theundergraduate degree program wasAction research was carried out with datagathered at several stages consequently theresults could change over time

Despite not being a nursing study, andparticipants being on-campus, theconclusions are useful in informingdecision-making about designingonline PBL

Cooke andMoyle, 2002

Australian study of 100 studentevaluations of PBL(face-to-face) in anundergraduate-nursing degree

� PBL strategies encouraged students to take controlof their own learning by promoting involvement,self-direction and identification of learning needs.

� PBL promoted critical thinking skills, as they wereable to problem-solve insituations that replicated clinicalsituations in nursing practice

� They were expected to synthesize various aspectsof knowledge, make clinicaldecisions based on their learning, and providerationales for their clinical reasoning

� The teacher’s role in PBL was moreinteractive and responsive, and helped them todevelop critical thinking skills by questioning andchallenging students

� PBL assisted the theory to practice transfer asstudents reported that their learning waspurposeful and relevant to their practice as futurenurses

� Group contribution and participation wasrewarding, discussions creative, and studentslearnt effective group-processing skills

On-campus, PBL was not online, with the studyextending over a 4-week period.No discussion regarding measures taken toensure trustworthiness of the data.

Higher number of respondents givesresults that are more indicative ofstudents generally, and provides usefulinformation that nurse educators canuse in designing innovative teachingprograms

(continued on next page)

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Table 1 (continued )

Authors Description Results Limitations Reason for inclusion

Dennis, 2003 A comparison between onlineversus face-to-face grouplearning. Post-test only controlgroup to investigate the effectsof earning conditions onlearning outcomes andprocesses in a US physicaltherapy program.

� Computer-mediated communication in PBLresulted in significantly longertime-on-task as face-to-face groups, and thattechnological problems played a role in thepercentage of off-task time for online PBLstudents. Despite this, there was no difference inlearning outcomes between the two groups

� The use of a chat room for PBL tutorials proved tobe as effective for learning as face-to-face formats,but that the process was less efficient

� Recommended cautious implementation of onlinePBL due to greater time needed for similaroutcomes

Study size was small (17 in each group)Not a nursing programThe online component minor as the study wasconducted using two scenarios/problems withface-to-face laboratory session.

Study used a medical/surgicalcomponent of an allied healthprogram, and investigated PBLin an online format.

Valaitis et al.,2005

Canadian study of 22 nursingstudents’ perceptions of PBLover a 4e6 week period

� Online learning increased flexibility, by allowingstudents to learn at their own pace, and ina manner that suited their learning style, time andlocation

� Students valued taking a more active role with thePBL format

� Used a ‘real’ client to promote authentic learning� Web-based PBL offers opportunities forinterdisciplinary learning through onlinecommunication

� Students initially had difficultysetting learning objectives, and group decision-making was difficult

� Asynchronous discussion threads confusing forsome students to follow

� Preliminary communications weremonologues rather than discussions as studentswere reluctant to reply critically to peer’smessages

� Students clearly valued tutor guidance, wantingdirection with teacher expectations, andguidelines for online contributions

Cohort is small and extends over a short periodof time, using students who are actually on-ampus, who met face to face in concurrent PBLclasses

The results and recommendations forcarefully planned training sessions fortutors and students, and a period ofadaptation to onlinePBL are a useful guide.A number of techniques used toincrease the trustworthiness of thefindings.

McLinden et al.,2006

Phase 2 of a pilot studyconcerned with thedevelopment and evaluation ofonline resources using PBL foruse with postgraduate teachers.

� High degree of apprehension among students atthe start of the program (76%), with initialhesitation about participating in online groupwork

� Fast pace of synchronous chat rooms intimidatingdespite having completed induction activities

� Asynchronous discussions enabled students totake time to think about their responses

� Almost two-thirds of participants reported tech-nical difficulties in access the program during thefirst scenario, having to contact technical supportfor guidance (40%)

� Use of technology must be informed by soundpedagogical principles, andstructured support must be provided during theearly stages of the program to maximize learnerengagement

Small cohort of non-nursing participants withsome face-to-face components e.g. residentialschool

Majority of the course was online, ascompared to studies where the onlinecomponent was a very small part of thecourse.These results could therefore be moregeneralizable, and used to inform thedevelopment of online components ofa nursing program.

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educational psychology and administration and K-12 educationwith extensive support from literature (Hmelo-Silver, 2004;Williams and Beattie, 2008). According to Tavakol and Reicherter(2003), PBL was developed to address the perceived lack ofproblem-solving skills required by medical students, and has beenadopted in combinationwith traditional methods in many medical,nursing and allied health curricula.

PBL is an approach in which students work in small, collabora-tive groups to solve a series of problems that are presented in thecontext in which the students are likely to encounter. Real clinicalsituations are used to promote clinical reasoning responses instudents as they learnwhat they need to know to address the clientproblems in the same way they would as practitioners, thus inte-grating theory and practice (Cooke and Moyle, 2002). In thisprocess, the student gains knowledge, and acquires problem-solving and self-directed learning skills (Wilkie, 2000; Rideout andCarpio, 2001), an important aspect of adult learning as adults havea self-concept of being responsible for their own decisions, andneed to be seen by and treated as being capable of self direction(Knowles et al., 2005). According to Azer (2008, p. 5) the primarygoals of PBL in health related programmes are claimed to ‘fosterclinical reasoning, problem-solving skills, self-directed learning,communication skills and deep understanding of concepts andprinciples in the curriculum’. The sharing of knowledge to solveproblems (case scenarios) that are real life in context, encouragescritical thinking and engagement. Students are encouraged tomakedecisions about their learning focus, needs and resources (Hmelo-Silver, 2004; Oliver and Omari, 1999; Valaitis et al., 2005); andpresent and discuss new information at their next session, reflecton the outcomes and make modifications. Students can apply theirknowledge to the problem in a practical way, for example, devel-oping a plan of care (Pawan, 2003; Valaitis et al., 2005). With thislearning strategy, the teacher is a facilitator rather than an infor-mation provider (Azer, 2008). The 4-stage cycle of learning theory,developed by Kolb (1984), supports this process, arguing thatstudents learn best when they are active, take responsibility fortheir learning, and are able to apply it to their own context. Kolb(1984) outlined adaptive learning modes as concrete experience,reflective observation, abstract conceptualization and activeexperimentation, suggesting that learning was a process whereknowledge was created through the transformation of experience,which could be facilitated through the PBL process.

Web-based PBL

PBL is recognized as an alternative to traditional lecture-labo-ratory approaches in health profession programs, and can be easilyadapted to online environments to meet the increasingly diverseneeds of students (Dennis, 2003). Further, Edwards et al. (1999)argue that the interactive nature of PBL also provides for directinvolvement that web-based education may lack. By having PBL inweb-based units, students will be taking an active role in solvingproblems that mirror real life scenarios through the use of casestudies, and utilising an online discussion forum to discusshypotheses and solutions. This approach encourages self-directionin learning.

Self-directed, active learning where the teacher is a facilitatorwho allows students to construct new knowledge while promotinginterpersonal communication is necessary in the e-learning envi-ronment using PBL. This process uses constructivist (Bruner, 1966)and humanistic learning principles (Rogers, 1983; Magnussen,2008) as these skills develop metacognitive abilities, which alsoassist nurses to make a better transition to clinical settings (Peters,2000).

Literature review

A search of PBL approaches in online education over the last 10years was conducted using the online databases ERIC, Cinahl, andMedline. Keywords used in the search included ‘problem-basedlearning’, ‘problem-based scenario’, ‘online education’, ‘web-basededucation’, ‘e-learning’, ‘nurse education’, case-based learning’, and‘independent learning’. Criteria for inclusionwere English languagepublications from 1997 to 2008 discussing PBL and web-basededucation for nurses. Therewas a significant amount of informationon PBL generally (441), however, a paucity of articles combiningPBL and web-based nursing education was revealed. There wereonly six primary research articles and four reviews/reports dis-cussing web-based PBL in nurse education (Table 1). Many of thestudies were conducted in the general education context and werenot transferable to this situation, therefore excluded. Allied healtheducation was included due to similarities in training and workenvironments. Themes that emerged include: increased flexibility,motivation and autonomy; improved critical thinking; technical/time issues; group work; and the role of the facilitator.

Increased flexibility, motivation and student autonomy

A Canadian study of 22 nursing students’ perceptions of PBLover a four to 6-week period (Valaitis et al., 2005) reported thatonline learning increased flexibility, by allowing students to learnat their own pace, and in a manner that suited their learning style,time and location. The respondents also reported that asynchro-nous communication between students, used with web-based PBL,provided them with more time for reflection, consequently allow-ing for much more in-depth discussion on the problem they wereworking on. The majority of students, who expressed favourableopinions regarding this aspect of web-based PBL, recognized thevalue of taking a more active role with the PBL format (Valaitiset al., 2005).

This study was relevant as it involved students from nursing,midwifery and a graduate neonatal program using web-based PBL.Individual’s weekly reflections throughout the experience, andsemi-structured focus group interviews related to online PBLenvironment would have provided a wealth of data, however, thecohort was small and the study extended over a short period oftime as part of the face-to-face programwhich included concurrentPBL classes, consequently the strength of the evidence is reduced.However, the authors described a number of techniques used toincrease the trustworthiness of the findings, such as checking withthe focus groups for transcription errors, similarities and differ-ences in coding between researchers were compared and dis-cussed, constant comparison of the main themes, and triangulationof individual reflections and focus group interviews. Further to this,the results and recommendations indicated that carefully plannedtraining sessions for tutors and students, and a period of adaptationto online PBL provided a useful guide to developing web-basednursing programmes.

An Australian study of 100 student evaluations of a 4-week trialof face-to-face PBL in a ‘traditional’ nursing degree (Cooke andMoyle, 2002) supported the findings of Valaitis et al. (2005) withmany respondents reporting that PBL strategies encouraged themto take control of their own learning by promoting involvement,self-direction and identification of learning needs. This suggestedstudents weremoremotivated and responsible towards this type oflearning. However in this study, students were on-campus with thestudy extending over a 4-week period, and PBL was not online.Despite this, the number of respondents gave results that weremore indicative of nursing students generally, and provided useful

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information nurse educators can use in designing innovativeteaching programmes.

Critical thinking

Critical thinking in nursing is important as it enables students tosolve clinical problems and provide rationales for their clinicalreasoning and decision making, with the ability to transferreasoning strategies to new problems (Hmelo-Silver, 2004; Cookeand Moyle, 2002). Students in Cooke and Moyle’s (2002) studyreported that PBL promoted critical thinking skills, as they wereable to problem-solve in situations that replicated clinical situa-tions in real life nursing practice. Student nurses were expected toanalyse and synthesize various aspects of knowledge, make clinicaldecisions based on their learning, and provide rationales for theirclinical reasoning. The teacher’s role in PBL was more interactiveand responsive, and helped them to develop critical thinking skillsby questioning and challenging students. This process assisted thetransfer of theory to practice as students reported their learningwas purposeful and relevant to their real life practice as futurenurses. Valaitis et al. (2005) used a ‘real’ client to promote authenticlearning, and students gained new perspectives about the day-to-day struggles from the client. The authors found that web-basedPBL offered tremendous opportunities for interdisciplinary learningthrough the use of online communication. Students perceived thatthe various problem-based activities contributed substantially totheir learning, and that the environment was enjoyable and stim-ulating (Oliver and Omari, 1999).

In contrast to these positive findings, Oliver and Omari (1999)also reported that some students found this type of activitycognitively demanding, which tended to lessen enthusiasm forparticipation. Generally, however, responses regarding the devel-opment of personal skills suggested that web-based PBL strategiesprovided considerable scope for developing information literacy,metacognition and self-regulating skills, which were critical forlifelong learning (Oliver and Omari, 1999). In this study, online PBLwas used in a core unit of an unspecified undergraduate programwith a group of 57 on-campus students to explore the practicalissues and responses of the learners. Action research was carriedout during implementation of the courses, with data gathered atseveral stages from questionnaires and interviews, consequentlythe results could change over time. Despite not being a nursingstudy, and participants being on-campus, the conclusions wereuseful in informing decision-making about designing online PBL asit highlighted the importance of ongoing input of the teacher toprovide adequate access and open lines of communication for thestudents.

Technical/time issues

Although a number of studies have identified positive aspects ofonline PBL, there have been challenges noted, and one major issueidentified was the time needed to adjust to online PBL with theoften associated frustrations of slow content downloads, timestressors, time zones and technical difficulties (Valaitis et al., 2005).A comparison between online versus face-to-face group learning(Dennis, 2003), found that computer-mediated communication inPBL resulted in significantly longer time-on-task as face-to-facegroups, and that technological problems played a role in thepercentage of off-task time for online PBL students. Despite this,there were no differences in learning outcomes between the twogroups. Dennis (2003) concluded that the use of a chat room for PBLtutorials proved to be as effective for learning as face-to-faceformats, but that the process was less efficient, and recommended

cautious implementation of online PBL due to greater time neededfor similar outcomes.

Dennis (2003) used a post-test only control group to comparethe outcomes of PBL between synchronous online groups and face-to-face tutorial groups in a medical/surgical component of a USphysical therapy program. Statistical analysis was used to investi-gate the hypothesis that the final course grade would be nodifferent between groups. Thirty-four participants were drawnfrom second year students, and seventeen randomly assigned toeither a computer-mediated PBL group or a face-to-face PBL group(control). The number of participants was small and the onlinecomponent minor as the study was conducted using two scenarios/problems in a Women’s Health component of a medical/surgicalconditions coursewith a face-to-face laboratory session. The resultswere obtained from one test consisting of 30 multiple-choicequestions and two case-based short answer questions, reducing thegeneralizability of the results. While it was not a nursing program,it was useful as the medical/surgical component of an allied healthprogram would have some similarities to nursing programs, andwhile limited, it investigated PBL in an online format.

McLinden et al. (2006) reported on phase two of a pilot studyconcernedwith the development and evaluation of online resourcesusing PBL in one unit of a distance education postgraduate teach-ing program. Participants (34) were allocated to one of six onlinePBL tutorial groups, which were required to submit a groupassignment with individual contributions. On completion of twocase scenarios, an anonymous questionnaire (using a 4-point Likertscale) was used to collect feedback regarding participation of theonline PBL component, and information related to the design andrelevance of the two case scenarios. The authors found a highdegreeof apprehension among students at the start of the program (76%),with initial hesitation about participating in online group work andfinding the fast pace of synchronous chat rooms intimidating,despite having completed induction activities. Asynchronousdiscussions however, enabled students to take time to think abouttheir responses. Almost two-thirds of participants reported tech-nical difficulties in accessing the program during the first scenario,with 40% of that group having to contact technical support forguidance. These findings suggested that use of technology mustbe informed by sound pedagogical principles, and that structuredsupport be provided during the early stages of the programto maximize learner engagement. This study had a small numberof participants, and involved teachers with some face-to-facecomponents such as residential school and study days. However,the majority of the course was online, strengthening the resultsregarding the use of PBL in an online environment, as compared tostudies where the online component was a very small part of a face-to-face course. These results could therefore be more generalizable,and used to inform the development of online components ofa nursing program.

Group work

Conflicting results were returned about the use of groupwork inPBL. Oliver and Omari (1999) report that using collaborative groupsin the problem-solving process allowed students to choose theextent to which they participated, resulting in large discrepanciesin effort among students. However, Cooke and Moyle (2002) statedthat respondents reported group contribution and participationrewarding, discussions creative, and effective group-processingskills were learnt.

Edwards et al. (1999) found that, despite a small percentage ofstudents finding the adjustment to a new approach such as PBLdifficult, the item receiving the highest satisfaction rating was‘group functioning as a PBL team’, with similar satisfaction ratings

T.R. Crawford / Nurse Education in Practice 11 (2011) 124e130 129

for the course between face-to-face and distance students. ThisCanadian study used pre- and post-course questionnaires tocompare learning satisfaction between nursing students whoattended the PBL course face-to-face (control group), and thosewho received the course via teleconferencing in two terms ofa ‘traditional’ nursing program. From the 51 students whocompleted the initial set of questionnaires, 30 students and sixtutors completed the second questionnaire yielding a post-courseresponse rate of 58.8% for students, and 100% for tutors, howeverthe sample size for this study was the number of problem-solvinggroups rather than the number of students, and hence the samplesize for a number of comparisons was small. The post-courseresponse rate from students was low and only nine of the 30students were from remote/distance sites as opposed to being ‘on-campus’. Furthermore, the distance students in this research weretogether physically as a group, with only the facilitator linked viateleconferencing, rather than each individual being linked viaelectronic means, thus allowing students to be engaged in activeface-to-face group process. This reduced the strength and utility ofthe evidence, however the conclusions added to the evidence ofother studies.

Valaitis et al. (2005) reported that students initially had diffi-culty setting learning objectives, and group decision-making wasdifficult with asynchronous discussion, with some students findingdiscussion threads confusing. In addition, preliminary communi-cations were monologues rather than discussions as students werereluctant to reply critically to peer’s messages.

Beadle and Santy (2008) described the delivery of an onlineundergraduate-nursingmodule in theUK, using a PBL approach thatwas previously delivered face-to-face as part of a classroom-basedpreregistration program. They found from student evaluations thatwhile PBL was useful in making links between theory and practice,therewere difficult groupdynamicswith some students ‘not pullingtheir weight’, along with logistical difficulties when delivering PBLface-to-face to large numbers, thus making it unpopular with thestudents. This improved significantlywith theuse of online sessions,with the discussion groups useful in enhancing student learning andengaging them in discussion, consequently this lead to studentsreporting they felt more comfortable participating online. Theauthors claimed web-based PBL was a useful method for varyingdelivery approaches in teaching healthcare students about practice,and the theory that underpinned it.

The role of the facilitator

The importance of the role of the facilitator was a recurringtheme. Valaitis et al. (2005) found that students clearly valued tutorguidance, wanting direction with teacher expectations, and guide-lines for online contributions. According to Oliver andOmari (1999),students continually reminded them that they valued the input ofthe teacher. Edwards et al. (1999) found that tutor feedback todistance students was inherently more difficult than in face-to-facesituations due to the reliance on written communication. Theysuggested providing an opportunity to meet the tutor might over-come this problem. Assigning a group member to the role of groupfacilitator may also be a useful adjunct to the distance tutor.

Discussion

In view of the evidence, students accessing units in a Bachelor ofNursing program could benefit fromweb-based PBL. Not only doesit provide a social learning environment with opportunities fordiscussion and co-participation, encouraging student autonomyand construction of meaning with real world problems consistentwith PBL approaches generally, but according to Valaitis et al.

(2005), resources available in the online environment werehighly valued. Online instruction is a viable instructional method,and has been used with success in a number of situations (Valaitiset al., 2005; Oliver and Omari, 1999; Cooke and Moyle, 2002). Web-based PBL has the potential to enhance student recruitment andretention (Parker et al., 2005) due to increased flexibility, assistingunits to remain relevant and accessible (Care and Scanlan, 2000), asstudents will be able to access information and group discussionanywhere. According to Magnussen (2008), the success of a web-based program requires thoughtful planning, a committed faculty,and investment in technical support and equipment in an effort toreduce technical difficulties. With sound planning, the benefits ofproviding quality, accessible and convenient education areworth tothe investment.

In order to reduce the limitations of web-based PBL (such asapprehension and time taken to adjust to the PBL style of learningwith group work), the course should include an orientation anda period of adaptation to the PBL, along with a technologicalinduction to the online environment (Valaitis et al., 2005; Beadleand Santy, 2008). The program should include training for thetutors, and tutors should be encouraged to make regular contribu-tions to the discussion forums to encourage collaboration andexploration, aswell as learningof cognitive skills forproblemsolving(Tavakol and Reicherter, 2003).

To implement a web-based programme a number of measuresare recommended. Firstly, the teacher would need to be responsiveto student contributions but also to make regular contributions tothe discussion forum, both in the formof simple acknowledgementsor requests for further information (Brookfield, 2006). Brookfield(2006) recommends that instructors need to be present andparticipate even more in an online discussion than face to face toenhance their social presence and keep the discussion focused onthe topic by inserting questions and comments, and giving timelyfeedback. Secondly, requesting all participants begin their remarksby commenting on the previous participant’s observations, usingthese as a springboard for their ownencourageswider participation,and preventing a few people dominating the discussion (Brookfield,2006). Asynchronous communication is recommended for studentcontributions as the fastmoving nature and fragmented discussionsof synchronous chat rooms can intimidate some students. Asyn-chronous discussions can take place over several days and providetime for students to think about their responses (McLinden et al.,2006), which is useful for international or travelling students.Thirdly, assigning students to small groups helps manage multiplepostings andpromotes interaction. Finally, the course shouldbewellorganised so that the students clearly understand from the begin-ning what the expectations are for the class, marking criteria forparticipation and group work, what the ground rules for participa-tion, and can clearly see how the interaction is linked to the contentmodules of the class (Brookfield, 2006).

Web-based PBL could be implemented in a Clinical Practice orCommunity Nursing subjects with the uploading of case studies invarious contexts with various clinical problems (which could alsobe case studies for assignment questions). Students work inassigned groups to discuss the case and what they need to researchin online discussion forums, then present their findings and discussvarious management options and hypothesize about possibleoutcomes/complications. If group assignments are produced asa result, marks could be assigned to individual’s participation to thegroup and individual’s section of the assignment. The instructorwould monitor the group discussion and participate with questionsand comments to promote interaction and focus on the topic. Price(2000) recommended PBL for a skills development componentwithin the curriculum,while cautioning against its broad use acrossthe whole nurse education program.

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Conclusion

It is proposed that some components of the Bachelor of Nursingprograms, for example, the practice-based subjects such as ClinicalPractice or Community Health Nursing, be implemented onlineusing a PBL format prior to or after students going on clinicalplacement as these experiences enhance critical thinking and self-directed learning (Kolb, 1984). Web-based units should includea discussion forum that enables group work for problem-solvingactivities, with tutor facilitation. In order to reduce some of thechallenges of web-based PBL, an initial period of adaptation, withcarefully planned training sessions for students and tutors in PBLprocesses, technological aspects and defined expectations is rec-ommended (Valaitis et al., 2005; Beadle and Santy, 2008; Price,2000). Providing access to teachers along adequate lines ofcommunication (Oliver and Omari, 1999) should be encouragedthroughout the implementation of the program. Students andteachers should be given the opportunity to provide feedback atregular intervals throughout the program, as further research willneed to be undertaken regarding the effectiveness, efficiency andsustainability of web-based PBL in this program and setting.

Acknowledgements

I would like to thank my colleagues, Athena Sheehan and AlisonSmedley for their constructive feedback and support during thewriting of this paper.

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