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“It helped us understand the future trend of using technology in nursing practices and we acquired new information. Using PDAs is convenient for keeping records of nursing processes.” The nurses envied students’ access to PDAs and expressed the desire to use PDAs in their future practice. The findings correspond to Farrell’s (2008) study in which the nurses encouraged students to use the PDA for accessing information in real time. Farrell also pointed out that some students in her study thought using PDAs in front of patients seemed rude. Our observation showed that the concern was not necessary. We found patients’ initial reaction to the PDAs was often that of curiosity towards the use of this technological device. Patients quickly got used to the students’ use of PDAs, eventually viewing them as almost routine tools of the clinical staff. Students had expressed few non-technical concerns about using PDAs in the clinical site. One concern which was voiced by almost every student was fear of losing their PDA in the hospital. PDAs were loaned to students for the three-week practicum period. They were reminded that the device was expensive and had to be well taken care. Due to its pocket-small size, students thought it would be easy to lose or to be stolen. Students felt a little insecure about carrying such an expensive technologically advanced device around the hospital throughout the practicum. Conclusions In the instructor’s final comments (expressed in the questionnaire), she wished that “one day all the clinical sites will become wirelessly connected.” The instructor stated that the handheld environment was a great “breakthrough” in what had been years of difficulties in conducting effective clinical practicum. The wireless handheld environment not only provided students with tools for taking notes, recording information, and accessing resources but also facilitated their collaboration with peers and improved interactions with the instructor. Ultimately, the PDAs acted as cognitive scaffolding tools to support student learning in the clinical site. Our findings were different from Garrett and Jacksons’ (2006) study, in which they found the PDAs mainly used as electronic reference tools, rather than data recording and communication devices. We believe the differences were mainly due to the design of the PDA-based tools, which did not closely integrate into the learning activities. Our implementation was a more integrative one where we incorporated several key clinical learning instruments into the PDA system. We have addressed the utilization of handheld devices in terms of pedagogical underpinnings by building the learning environment based on collaborative, contextual, and constructivist principles (as indicated in Patten, Sánchez, & Tangney, 2006). Our findings showed that the wireless handheld environment in a clinical nursing practicum was both technologically appropriate and pedagogically sound. As we have discussed, there were limitations in our present approach such as sluggishness of the Internet access in the clinical site, short battery life of the PDAs, constraints on the PDA software (i.e., PicoMap), limited PDAadapted web resources, and students’ confusion about the interface of PDAs with their previous PC using experience. However, the limitations were far overshadowed by the potential benefits. Slowness or inconvenience of hospital network access was mainly due to older network infrastructures which could be easily remedied. Issues such as short battery life could be resolved with newer model PDAs. We believe that some of the limitations and confusion about PDA based systems could be resolved with additional training. Some of the hardware and software problems would be alleviated by the maturation of future mobile technologies. PDAs have the potential of revolutionizing and transforming the way clinical practicum is conducted in nursing training settings. Finally, the results of the present study were primarily based on qualitative data collected from small number of participants, future study may want to recruit more participants and implement an experimental design to explore the effectiveness of the handheld learning environment from quantitative aspects. References Andreasen, N. C. (1983). The Scale for the Assessment of Negative Symptoms (SANS), IA: University of Iowa. Andreasen, N. C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS), IA: University of Iowa. Billings, D. M. (2005). Guest editorial: From teaching to learning in a mobile, wireless world. Journal of Nursing Education, 44 (8), 343. Clifford, C. (1992). The role of nurse teacher. Nurse Education Today, 12, 340-349. Criswell, D. F., & Parchman, M. L. (2002). Handheld computer use in U.S. family practice residency programs. Journal of the American Medical Informatics Association, 9 (1), 80-86. 203
Faruque, F., Hewlett, P. O., Wyatt, S., Wilson, K., Lofton, S., Frate, D., & Gunn, D. (2005). Geospatial information technology: an adjunct to service-based outreach and education. Journal of Nursing Education, 43 (2), 88-91. Farrell, M. L. (2008). Use of mobile handheld computers in clinical nursing education. Journal of Nursing Education, 47 (1), 13-19. Fowler, D. L., Hogle, N. J., Martini, F., & Roh, M. S. (2002). The use of personal digital assistant for wireless entry of data into a database via the Internet. Surgical Endoscopy, 16, 221-223. Garrett, B. M., & Jackson, C. (2006). A mobile clinical e-portfolio for nursing and medical students, using wireless personal digital assistants (PDAs). Nurse Education Today, 26 (8), 647-654. Greenfield, S. (2007). Medication error reduction and the use of PDA technology. Journal of Nursing Education, 46 (3), 127-131. Guerrero, L. A., Ochoa, S. F., & Pino, J. A. (2006). Selecting computing devices to support mobile collaboration. Group Decision and Negotiation, 15, 243–271. Hewison, A., & Wildman, S. (1996). The theory-practice gap in nursing: a new dimension. Journal of Advanced Nursing, 24, 754-761. Huffstutler, S., Wyatt, T. H., & Wright, C. P. (2002). The use of handheld technology in nursing education. Nurse Educator, 27 (6), 271-275. Jeffries, P. R. (2005). Guest editorial: <strong>Technology</strong> trends in nursing education: next steps. Journal of Nursing Education, 44 (1), 3-4. Koeniger-Donohue, R. (2008). Handheld computers in nursing education: A PDA pilot project. Journal of Nursing Education, 47 (2), 74-77. Lai, C.-Y., & Wu, C.-C. (2006). Using handhelds in a Jigsaw cooperative learning environment. Journal of Computer Assisted Learning, 22 (4), 284-297. Landers, M. G. (2000). The theory-practice gap in nursing: the role of the nurse teacher. Journal of Advanced Nursing, 32 (6), 1550-1556. Lee, D. T. F. (1996). The clinical role of the nurse teacher: a review of the dispute. Journal of Advanced Nursing, 23, 1127-1134. Lehman, K. (2003). Clinical nursing instructors’ use of handheld computers for student recordkeeping and evaluation. Journal of Nursing Education, 42 (1), 41-42. McCaugherty, D. (1991). The theory-practice gap in nurse education: its causes and possible solutions. Findings from an action research study. Journal of Advanced Nursing, 16, 1055-1061. Miller, J., Shaw-Kokot, J. R., Arnold, M. S., Boggin, T., Crowell, K. E., Allegri, F., Blue J. H., & Berrier, S. B. (2005). A study of personal digital assistants to enhance undergraduate clinical nursing education. Journal of Nursing Education, 44 (1), 19-26. Ndiwane, A. (2005). Teaching with the nightingale tracker technology in community-based nursing education: a pilot study. Journal of Nursing Education, 44 (1), 40-42. Patten, B., Sánchez, I. A., & Tangney, B. (2006). Designing collaborative, constructionist and contextual applications for handheld devices. Computers and Education, 46 (3), 294-308. Rempher, K. J., Lasome, C. E. M., & Lasome, T. J. (2003). Leveraging Palm technology in the advanced practice nursing environment. AACN Clinical Issues, 14 (3), 363-370. Ruland, C. M. (2002). Handheld technology to improve patient care: evaluating a support system for preferencebased care planning at the bedside. Journal of the American Medical Informatics Association, 9 (1), 192-201. Stroud, S. D., Erkel, E. A., & Smith, C. A. (2005). The use of personal digital assistants by nurse practitioner students and faculty. Journal of the American Academy of Nurse Practitioners, 17 (2), 69-75. Tooey, M. J., & Mayo, A. (2003). Handheld technologies in a clinical setting: state of the technology and resources. AACN Clinical Issues, 14 (3), 342-349. White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvy, R. (2005). Infusing PDA technology into nursing education. Nurse Educator, 30 (4), 150-154. 204
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April 2009 Volume 12 Number 2
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Abstracting and Indexing Educationa
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Engaging students in multimedia-med
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this study discusses computer-based
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Sampling for preliminary study One
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Part 2 Pearson correlation .349** 1
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Figure 1. Box and whisker plot of t
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characteristics and learning styles
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However, critical reflection and in
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novels, so they collected any relat
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1. Theories of teaching: Comments m
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grammatical errors and basic writin
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Ho, B., & Richards, J. C. (1993). R
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Hwang, K.-A., & Yang, C.-H. (2009).
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e deduced from the Affective Domain
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Detection procedure Figure 1 shows
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avoided. Image processing is perfor
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falling asleep) as defined in this
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classmates or left their seats duri
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help teachers to recognize the lear
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Hsieh, P.-H., & Dwyer, F. (2009). T
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significant comprehension effects o
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Treatment 3 (keyword group): Studen
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Criteria of achievement measures Th
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esults. A correlational analysis de
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A 2 x 1 ANOVA analyzed the effect o
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References Aragon, S. R. (2004). In
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Raphael, T. (1982). Improving quest
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educing maintenance costs. The cont
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Synchronization functions According
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inconsistency) and navigate directl
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the suitability of the instructiona
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Design of manipulation process The
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Table 1: Comparative analysis of au
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the convenience of mobile-based ass
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According to evaluation result, the
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Tan, O. S., Parsons, R. D., Hinson,
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At a deeper level, though, there wa
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theoretical assumptions. Two theore
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The students were not going to have
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slightly different. The group who c
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every item, not giving any result.
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edited and presented to the class u
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Figure 10. Screen captures from the
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Some of the concerns that emerge fr
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Ajayi, L. (2009). An Exploration of
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As a result of the confluence of di
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peers (Schellens et al. 2005). Sche
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The integration of discussion board
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ecause the technology allowed the p
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The pre-service teachers perceived
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Furthermore, the study demonstrated
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Schellens, T., van Keer, H., & Valc
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McKean, 2003). Instructors will see
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program at The Ohio State Universit
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Knowledge and skills of developing
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their monthly reflections or assign
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Bull, K., Montgomery, D., Overton,
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frustrating the student). ITSs make
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• Link removal - advanced student
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Expert Module Expert Module’s mai
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Based on the questionnaire results
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students were told that their perfo
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thirds of the interviewed students
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Throughout the semester, students i
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human teacher or question developer
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To test the learning effectiveness
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APPENDIX A Computer Science and Sof
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Thus, the use of computers changes
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Specifically, two objectives were p
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Nonetheless, both teachers assign a
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48% 35% 53% similar similar 69% 42%
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Table 4: Students’ attitudes Stat
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activities. Specifically, the histo
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Huang, Y.-M., Huang, T.-C., Wang, K
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• Could recommended learning sequ
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Analysis of sequences prediction me
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Figure 4. The sorting of learning s
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Page 159 and 160: Learning sequence recommendation sy
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Page 163 and 164: The potential for LSRS to promote l
Page 165 and 166: They pointed out that LSRS helped t
Page 167 and 168: Cover, T. M., & Thomas, J. A. (1991
Page 169 and 170: Related Efforts An Internet forum i
Page 171 and 172: with handheld devices and they were
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Page 179 and 180: With novel technological support, m
Page 181 and 182: Shen, L., Wang, M., & Shen, R. (200
Page 183 and 184: as an ‘affective loop’, which r
Page 185 and 186: Figure 2 is an example of two-dimen
Page 187 and 188: preference was gathered through dat
Page 189 and 190: compute the heart rate (HR) as a fu
Page 191 and 192: sessions. Of all the 18 learning se
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Page 195 and 196: Wu, C.-C., & Lai, C.Y. (2009). Wire
Page 197 and 198: The wireless handheld learning envi
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Page 201 and 202: Nursing dictionary We constructed a
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Page 207: questionnaire. We do not consider t
Page 211 and 212: etween a user and the system. Addit
Page 213 and 214: Figure 2. A concept map representin
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Page 223 and 224: The PADS sometimes assigned very di
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Page 227 and 228: Hwang, W.-Y., Hsu, J.-L., Tretiakov
Page 229 and 230: listed these functions as allowing
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Page 233 and 234: Research Tools Web-based learning e
Page 235 and 236: Table 1. Operational definitions of
Page 237 and 238: action, interaction, and outeractio
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Page 241 and 242: Table 6 shows the learners’ prefe
Page 243 and 244: Bell, P., & Winn, W. (2000). Distri
Page 245 and 246: Askar, P., & Altun, A. (2009). CogS
Page 247 and 248: elations, interactions and activiti
Page 249 and 250: Figure 3. A comparison of knowledge
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Page 253 and 254: Figure 7. Visual Representation of
Page 255 and 256: Step 5: Use Boolean to combine the
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Neo, M., & Neo, T.-K. (2009). Engag
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• Conversation and collaboration
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IMAGE 2 2. Problem identification I
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Methodology At the end of the proje
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presentation skills (m = 3.72), and
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6. Can’t be denying that, sometim
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Lambert, N. M., & McCombs, B. J. (1
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not detected in a previous study, t
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et al. (2001) studied the learning
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all the students. At the midpoint o
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The observed pairs were aware of be
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Table 2 shows the results from a mo
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Table 5: The distribution of time (
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As discussed in the section on prev
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McDowell, C., Werner, L., Bullock,
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Comprehension monitoring is the awa
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or roles in a context, such as “I
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Correlation coefficient was also co
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(a) Text 1 (b) Text 2 (c) Text 3 (d
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Table 3 shows that the average read
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Figure 10. Trace results of the les
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monitor their reading process and h
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Conn, S. R., Roberts, R. L., & Powe
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The technology-mediated groups, wit
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hybrid model of supervision was pos
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Our research indicates that the hyb
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Janoff, D. S., & Schoenholtz-Read,
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goal of using storyboards. But, thi
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In general, learning activities nee
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Furthermore, free subjects, such as
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Storyboarding Roots and related wor
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Referees, on the other hand, may wa
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Symbols Interpretation Defines a un
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Figure 4. Top-level storyboard for
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may take subjects such as practical
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network security information envir
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The concrete procedure and interact
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(e.g., for graduation) using such i
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Thus, academic education modeling b
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Feyer, T., Kao, O., Schewe, K.-D.,
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Richards, G. (2009). Book review: T
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expands the child’s proximal envi
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Chapter 6 exemplifies the activitie
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