E-LEARNI NG: A COMPARATI VE STUDY FOR
KNOW LEDGE APPREHENSI ON AMONG NURSES
1Yar a Padalin o2 Heloisa Helena Ciquet o Per es3
Palad in o Y, Per es HHC. E- lear n in g : a com p ar at iv e st u d y f or k n ow led g e ap p r eh en sion am on g n u r ses. Rev Lat ino- am Enfer m agem 2007 m aio- j unho; 15( 3) : 397- 403.
The end of t he t went iet h cent ury and t he beginning of t he t went y- first cent ury are m arked by t echnology revolut ion and st rat egic changes in organizat ions. St rat egies such as t he e- learning, has been used for t raining hum an r esour ces. This st udy aim ed t o com par e t he know ledge acquir ed am ong gr oups of nur ses w ho used e-lear n in g an d t h ose w h o u n der gon e a t r adit ion al classr oom t r ain in g. Th e t r u e- ex per im en t al design w as u sed followed by a quant it at ive analysis. This st udy was perform ed at t he Hospit al and Mat ernit y São Luiz. The st udy populat ion w as com posed by 60 nur ses, r andom ly assigned t o t w o gr oups, nam ed A and B. Gr oup A r eceived t he t r adit ional classr oom t r aining and gr oup B r eceiv ed t he com put er - assist ed t r aining. I n t he dat a collect ion, part icipant s filled in a quest ionnaire before and aft er t he t raining t o evaluat e t heir knowledge and t o charact erize t he populat ion. Result s show ed t her e w as an equal acquisit ion of k now ledge in bot h gr oups; confir m ing t he efficacy of bot h m et hods.
DESCRI PTORES: educat ion, dist ance; educat ion, nur sing, cont inuing; nur sing, infor m at ics
E-LEARNI NG: ESTUDI O COMPARATI VO DE LA
APREHENSI ÓN DEL CONOCI MI ENTO ENTRE ENFERMEROS
El final del siglo XX e inicio del siglo XXI se car act er izó por la r ev olución t ecnológica y los cam bios est r at égicos en las or ganizaciones, est r at egias, com o e- lear ning, v ienen siendo ut ilizadas. El obj et iv o de est e est udio fue com par ar el conocim ient o apr endido ent r e los gr upos de enfer m er os que ut ilizar on el e- lear ning y los que recibieron el ent renam ient o presencial. La m et odología cuant it at iva ut ilizada fue el m ét odo experim ent al v er d ad er o. El local d e est u d io f u e el Hosp it al y Mat er n id ad São Lu iz. La p ob lación f u e con st it u id a p or 6 0 enfer m er os, los cuales fuer on divididos de for m a r andom izada en dos gr upos, denom inados A y B. El gr upo A r ealizó el en t r en am ien t o pr esen cial y el gr u po B a t r av és del com pu t ador . En la r ecolección de dat os, los par t icipant es llenar on un cuest ionar io ant es y después del ent r enam ient o par a poder ev aluar su conocim ient o y car act er íst icas de la población. Los r esult ados m ost r ar on que hubo apr ehensión de conocim ient o por par t e de los dos gr upos, lo cual per m it ió concluir que los dos m ét odos ut ilizados son eficaces.
DESCRI PTORS: educación a dist ancia; educación cont inua en enfer m er ía; enfer m er ía; infor m át ica
E-LEARNI NG: ESTUDO COMPARATI VO DA
APREENSÃO DO CONHECI MENTO ENTRE ENFERMEI ROS
O final do século XX e com eço do século XXI caract erizam - se pela revolução t ecnológica e as m udanças est r at égicas nas or ganizações, est r at égias, com o e- lear ning, vem sendo ut ilizadas. O obj et ivo dest e est udo foi com par ar o con h ecim en t o apr een dido en t r e os gr u pos de en fer m eir os qu e u t ilizar am o e- lear n in g e os qu e r eceb er am o t r ein am en t o p r esen cial. A m et od olog ia q u an t it at iv a d a p esq u isa con st it u iu - se d e u m m ét od o experim ent al verdadeiro. O local de est udo foi o Hospit al e Mat ernidade São Luiz. A população const it uiu- se de 6 0 en f er m eir os q u e f or am d iv id id os r an d om izad am en t e em d ois g r u p os, d en om in ad os A e B. O g r u p o A realizou o t reinam ent o presencial e o grupo B, via com put ador. Na colet a de dados, os part icipant es preencheram um quest ionár io ant es e após o t r einam ent o par a av aliação do conhecim ent o e car act er ização da população. Os result ados dem onst raram que ocorreu a apreensão do conhecim ent o pelos dois grupos de form a equiparada, per m it indo concluir a eficácia dos dois m ét odos.
DESCRI TORES: educação a dist ância; educação cont inuada em enfer m agem ; infor m át ica em enfer m agem
1
St udy ext ract ed from Mast er Thesis; 2 RN, Supervisor at t he Hospit al e Mat ernit y São Luis, Mast er st udent , e- m ail: yarapadalilino@uol.com .br; 3 RN, PhD Professor Universit y of São Paulo College of Nursing, e- m ail: hhcperes@usp.br
I NTRODUCTI ON
G
l o b a l i za t i o n h a s m a d e t h e w o r l d m o r ed y n a m i c a n d h i g h l y co m p e t i t i v e . To m a n a g e a n d
oper at e t heir pr ocesses, cor por at ions call for hum an
r esou r ces w it h u p- t o- dat e abilit ies, con sider in g t h e
set t ing in which t hey t ake part . I n t hese set t ings, new
t echniques, t echnologies and knowledge are const ant ly
cr eat ed and changed. Hence, pr ofessionals face t he
need t o updat e fast er and const ant ly * .
Many or ganizat ions hav e dev eloped a r ange
of ed u cat ion al st r at eg ies t o p r ep ar e em p loy ees f or
t h e n e w m a r k e t d e m a n d s. Fo r t h i s r e a so n , n e w
t eaching t echnologies are const ant ly being developed,
w hich has encour aged dist ance lear ning pr act ices( 1).
I n t h e c o r p o r a t i v e d o m a i n , t h e u s e o f
inform at ion t echnology and com m unicat ion t o support
co n t i n u i n g p r o f e ssi o n a l d e v e l o p m e n t , p r o m o t i n g
collabor at iv e lear ning in geogr aphically apar t gr oups
has been r efer r ed t o as e- lear ning.
E- lear n in g is on e k in d of d ist an ce lear n in g
t hat pr om ot es self- lear ning, m ediat ed by educat ional
r e s o u r c e s , s y s t e m a t i c a l l y o r g a n i z e d , p r e s e n t e d
t h r ou g h d if f er en t in f or m at ion t ech n olog y su p p or t s,
eit h er isolat ed or com b in ed , an d is d on e ov er t h e
I n t e r n e t. So m e t e r m s, d e sp i t e so m e co n ce p t u a l
dif f er en ces, ar e u sed as a sy n on y m f or e- lear n in g;
for ex am ple: w eb t r aining, w eb educat ion, I nt er net
-b a s e d d i s t a n c e l e a r n i n g, e l e c t r o n i c l e a r n i n g ,
t ech n o l o g y - m ed i a t ed t ea ch i n g , co m p u t er - d i r ect ed
t each in g* * .
E- lear ning is defined as: a solit ar y/ individual
or collabor at iv e/ gr oup act iv it y inv olv ing sy nchr onous
( happening in “ r eal t im e”, w it h all par t icipant s online
at t h e sam e t i m e) o r asy n ch r o n o u s ( w i t h f l ex i b l e
choices of st udy t im e) com m unicat ion pr ocesses( 2).
E- learning addresses a broad set of processes
and applicat ions, such as w eb based and com put er
-based t eaching, using v ir t ual classr oom s and digit al
co l l a b o r a t i o n . I t a l so i n cl u d e s d e l i v e r i n g co n t e n t
t hr ough t he I nt er net , I nt r anet / Ex t r anet, audio, v ideo
and radio recordings, t hrough sat ellit e, int eract ive TV,
and CD- ROM. Thus, e- learning is int eract ive and offers
inst r uct ional flex ibilit y( 3).
To b e su cce ssf u l , p e r so n n e l t r a i n i n g a n d
dev elopm ent pr ogr am s should be planned w it h goals
t h at ar e est ablish ed accor din g t o t h e or gan izat ion ’s
h u m an r esou r ce policy, an d t ak e in t o con sider at ion
t he inst ruct ors and t rainees, as well as t he phases of
sit u at ion al diagn osis, obj ect iv es, m et h od/ st r at egies,
ev aluat ion and r esult and cost s analy sis( 2).
W h e n p l a n n i n g co n t i n u i n g e d u ca t i o n a n d
p er son n el t r ain in g p r og r am s, e- lear n in g sh ou ld b e
adopt ed, aim ing at t he benefit s of using infor m at ion
t echnology in educat ion.
I n nur sing, t his educat ional pr act ice is m or e
f r eq u en t a b r o a d . Th e ex p er i en ce o f a h o sp i t a l i n
Tor on t o, Can ada, in 1 9 9 5 can be h igh ligh t ed. Th ey
planned a t raining program for nursing personnel, bot h
on- sit e and at a dist ance, during working hours, using
t he com put er as t he t eaching m ediat or, based on
self-lear ning( 4 ).
I n Br azil, t h e d ev elop m en t of t ech n olog y
-m ediat ed edu cat ion al pr ogr a-m s in t h e n u r sin g ar ea
is lin k ed t o u n iv er sit y r esear ch pr oj ect s. Th er ef or e,
m ost of t hem t end t o focus on undergraduat e courses
and healt h educat ion for client s. This can be confirm ed
in st udies like: an educat ional program in first aid( 5);
a l e a p i n t o t h e f u t u r e i n m e d i c a t i o n t e a c h i n g :
d e v e l o p i n g a c o m p u t e r - a s s i s t e d i n s t r u c t i o n a l
program( 6); developing an educat ional w eb sit e about
t h e n u r sin g in t er v en t ion : t r ach eobr on ch ial secr et ion
aspir at ion( 7 ); adm in ist er in g in j ect able in t r am u scu lar
m edicat ions in t he v ent r al- glut eal r egion: ev aluat ion
a f t e r t r a i n i n g b y v i d e o co n f e r e n ce( 8 ) ; e d u ca t i o n a l
s o f t w a r e a b o u t D i a b e t e s Me l l i t u s f o r h e a l t h
pr ofessionals: st ages of cr eat ion and dev elopm ent( 9);
i n - s e r v i c e n u r s i n g e d u c a t i o n d e l i v e r e d b y
v ideoconfer ence( 10); im plem ent ing a v ideoconfer ence
sy st em a p p l i ed t o n u r si n g r esea r ch a n d t ea ch i n g
environm ent s( 11); educat ional t echnology: creat ion and
evaluat ion of t he sit e nursing personnel shift( 12); nursing
p h y si cal ex am i n at i o n o f f u l l t er m n ew b o r n s: sel f
-inst r uct ional soft w ar e( 13).
To r e a c h a m a r k e t a d v a n t a g e , i n w h i c h
knowledge is a powerful weapon, t he São Luiz Hospit al
an d Mat er n i t y h as i n v est ed i n i n t el l ect u al cap i t al ,
d e v e l o p i n g h u m a n c o m p e t e n c i e s r e l a t e d t o t h e
i n st i t u t i o n ’s p o l i ci es r eg ar d i n g q u al i t y an d h u m an
r esou r ces an d adopt in g e- lear n in g in t h e per son n el
t r ain in g pr ocess.
I n t his perspect ive, t he Hospit al im plem ent ed
Phase 1 of t he Educat ion Program for Qualit y t hrough
t he Tot al Qualit y e- learning t raining. The program plan
st a r t ed o n Au g u st 2 5t h 2 0 0 3 , a n d co u n t ed o n a n
ed u cat ion t eam w h o p lan n ed t h e con t en t in t h r ee
m o n t h s. Al l o p e r a t i o n a l m a n a g e r s co n t r i b u t e d t o
cr eat e t he pr ogr am cont ent .
The pur pose of t his t r aining pr ogr am w as t o
d e v e l o p a n d i m p l e m e n t a n i n n o v a t i v e e - l e a r n i n g
Dist ance Learning pr oj ect at t he Hospit al, t o t r ain all
em ployees: direct ors, m anagers, supervisors, m edical
t eam s, ou t sou r ced em ploy ees an d in t er n al par t n er s
fr om ot her unit s ( I t aim and Mor um bi) . The pr ogr am
should be car r ied out in a shor t per iod of t im e, and
should not require em ployees t o m ove from t heir work
sit e, since t her e w er e not enough t r aining r oom s or
funds for cost s wit h addit ional room s, equipm ent and
in st r u ct or s.
Th e e- l ear n i n g To t al Qu al i t y p r o g r am w as
im p lem en t ed on Nov em b er 1st 2 0 0 3 , an d en d ed in
February 2004. Thus, it corresponded t o a t raining of,
ap p r ox i m at el y, t w o cl ass h o u r s, f o r 2 5 0 0 i n t er n al
em ployees and over 600 out sour ced em ployees fr om
t he unit s I t aim and Morum bi.
For t he im plem ent at ion, basic syst em access
inst ruct ions were provided t o t he m ult ipliers, who were
t he m anagers, init ially. Lat er, t he supervisors becam e
t h e m u l t i p l i e r s , a n d t h e r o l e w a s p a s s e d o n ,
successively, unt il inst ruct ions reached t he operat ional
lev el, t hat is, all em ploy ees, t hus decent r alizing t he
e d u ca t i o n p r o ce ss. Th e se i n st r u ct i o n s co m p r i se d
inform at ion like how t o access t he sit e, how t o insert
t he funct ional code and creat e a password. From t his
m om ent , t he em ploy ee w ould be par t icipat ing in t he
e- lear n in g t r ain in g pr ogr am .
For t his t raining program , a deskt op com put er
w as av ailable in each sect or of t he nur sing unit s, in
t he cont inuing educat ion sect or, nursing m anagem ent
and e- lear ning r oom .
I nit ially, t he e- learning program was posit ively
ev alu at ed as a lear n in g t ool, m eet in g all t h e n eeds
and goals of t he Hospit al program . Hence, t he Hospit al
in v est ed in Ph ase 2 of t h e Ed u cat ion Pr og r am f or
Qualit y, nam ed “ Qualit y Tools”. This phase had t he sam e
prem ises, principles, obj ect ives, and infrast ruct ure as
p r e v i o u s l y d e t e r m i n e d , a n d w a s d i r e c t e d t o a l l
m anagers, supervisors, em ployees, and leaders of t he
several areas in t he I t aim and Morum bi unit s.
The São Luiz Hospit al and Mat ernit y Program
for Qu alit y Ph ase 2 - Qu alit y Tools is su bdiv ided in
t h r ee m odu les: m odu le 1 con sist ed of t h e pr ogr am
p r esen t at i on , i n t r od u ct i on , i n st r u ct i on s on h ow t o
n av igat e, an d a r ev iew of t h e f ir st e- lear n in g Tot al
Qualit y t raining program ; m odule 2 was com posed of
t he m odule pr esent at ion, PMQ cor por at e st r uct ur e of
t he Pr ogr am for Qualit y ( PMQ) , PMQ pr inciples, and
a c t i v i t i e s ; m o d u l e 3 , c o m p o s e d o f t h e m o d u l e
present at ion, Qualit y Tools, process m odel 1, process
m odel 2, act ivit y flow chart , check- list , brainst orm ing,
Par et o char t , fiv e “ S” pr ogr am , act iv it ies, cause and
effect char t , 5W2H t ool, and conclusion.
Th e p r o g r a m i s h o st e d o n t h e Ho sp i t a l ’ s
int ranet, wit h access lim it ed t o em ployees, who receive
a login and password from t he inst it ut ion. Hence, t he
m o m e n t w a s i d e a l t o p e r f o r m t h i s r e s e a r c h ,
evaluat ing t he know ledge lear ned by t he nur ses w ho
used t he “ Qualit y Tools” e- lear ning pr ogram , t hr ough
an ex per im ent al st udy.
OBJECTI VE
To com p ar e t h e g r ou p of n u r ses w h o t ook
part in t he e- learning wit h t hose who received on- sit e
t r aining, in t er m s of t he k now ledge t hey acquir ed.
MATERI AL AND METHOD
Th is pr esen t qu an t it at iv e st u dy u ses a t r u e
e x p e r i m e n t a l m e t h o d t o c o m p a r e o n - s i t e a n d
com pu t er - m ediat ed t r ain in g pr ogr am s.
The ex per im ent al r esear ch design is used in
st udies in w hich t he r esear cher w ant s t o t est cause
and effect relat ionships. The t rue experim ent has t hree
iden t ificat ion pr oper t ies: r an dom izat ion , con t r ol an d
m anipulat ion( 14).
Ra n d o m l y a ssi g n i n g i n d i v i d u a l s t o g r o u p s
involves t heir dist ribut ion t o an experim ent al or cont rol
gr oup, on an ent ir ely r andom basis( 15).
The st rengt h of t he t rue experim ent al design
is it s abilit y t o help t he research and reader t o cont rol
t he effect s of any ext rinsic variables t hat could t hreat en
i n t er n al v al i d i t y. Th o se ex t r i n si c v ar i ab l es can b e
ant ecedent or int er v enient . The ant ecedent v ar iable
o c c u r s b e f o r e t h e s t u d y, b u t i t m a y a f f e c t t h e
dependent variable and cause result s t o be confusing.
Fact or s like age, gender, and socioeconom ic
co n d i t i o n s a r e l i k e l y t o b e i m p o r t a n t a n t e ce d e n t
v ar iables in t h e r esear ch , becau se t h ey m ay af f ect
t he dependent v ar iables( 14).
The ex per im ent al m et hod w as per for m ed in
night shift nur ses. The cont r ol gr oup w as com posed
of t r ainees w ho at t ended on- sit e t r aining, w hile t he
ex per im en t al gr ou p com pr ised t h ose w h o t ook par t
in t he e- learning program . The nurses were random ly
assi g n ed t o t h e g r o u p s. Ho w ev er, t h e an t eced en t
v ar iables w er e t r eat ed because of t heir pot ent ial t o
affect or confound t he r esear ch r esult s.
The st udy was perform ed at t he I t aim unit of
t he Sao Luiz Hospit al and Mat ernit y, w hich is a large
scale pr iv at e hospit al, w it h 397 beds, locat ed in t he
cit y of Sao Paulo.
Th e n u r sin g m an ag em en t is d ir ect ly lin k ed
t o t he Adm inist r at iv e Boar d, w hich offer s aut onom y
and power of decision t o t he nursing t eam . The nursing
st af f is com p osed of 8 3 6 n u r sin g em p loy ees: on e
Nu r si n g Ma n a g er, f i v e Nu r si n g Su p er v i so r s, ei g h t
Heads of closed unit s, 142 head nurses, seven t rainee
n u r ses, 1 6 5 n u r si n g t ech n i ci a n s a n d 5 0 8 n u r si n g
au x iliar ies.
The populat ion w as com posed of 6 0 nur ses
fr om t he night shift , fr om t he I t aim unit , r egar dless
of t heir j ob posit ion. The following were excluded from
t he st udy: t he nurse- researcher who works in t he night
sh if t as a su p er v isor an d m u lt ip lier of all t r ain in g
p r o g r a m s i n h e r sh i f t , n u r se s o n v a ca t i o n o r o n
m edical leave, and nurses w ho t ook part in only one
o f t h e r e s e a r c h p h a s e s . Th e r e f o r e , t h e s t u d y
populat ion included 49 nurses who volunt arily agreed
t o par t icipat e in t he st udy and signed t he I nfor m ed
Con sen t For m .
Th is popu lat ion w as con sider ed st at ist ically
significant for t he pr esent st udy obj ect iv es, since it
com p r ised all n ig h t sh if t n u r ses an d p r esen t ed t h e
charact erist ics inherent t o t hat shift , m ainly regarding
w or k hour s and changes in w or k er s’ biological clock .
Tw o quest ionnair es w er e used t o collect t he
dat a: one for populat ion char act er izat ion, w hich w as
creat ed by t he researcher, and t he ot her nam ed Pre/
Post - t est about Qualit y Tools, w hich w as cr eat ed by
t he Educat ion Team responsible for developing t he
e-l ea r n i n g t r a i n i n g p r o g r a m . Th e p r e a n d p o st - t est
qu est ion n air e w as adm in ist er ed in t h e ex per im en t al
as w ell as t h e con t r ol g r ou p b ef or e an d af t er t h e
t r ain in g pr ogr am s, in or der t o ev alu at e t h e n u r ses’
knowledge apprehension. Thus, t his second inst rum ent
was used as a way t o check t he ext ent t o which nurses
lear ned t he fact s, pr inciples and m et hods included in
t he t raining pr ogram about Qualit y Tools.
Th is r esear ch pr oj ect w as appr ov ed by t h e
Resear ch Et h ics Com m it t ee of t h e in st it u t ion w h er e
t h e st u d y t ook p l ace. Al l et h i cal r eg u l at i on s w er e
com plied w it h, and anony m it y and secr ecy of t hose
in v olv ed w er e gu ar an t eed.
Af t er t h e n u r ses sp o n t an eo u sl y ag r eed t o
part icipat e in t he research by signing t he consent t erm ,
t h e q u e st i o n n a i r e w a s h a n d e d o u t . Th u s, i t w a s
p ossib le t o ch ar act er ize t h e n u r se g r ou p ’s p r of ile,
obt ain in g t h e v ar iables of age, t im e of w or k at t h e
h osp it al, t im e an d d eg r ee of ed u cat ion , com p u t er
k n ow ledge, an d par t icipat ion in com pu t er - m ediat ed
cou r ses.
Th e s e v a r i a b l e s w e r e c l a s s i f i e d a s
an t eced en t , w h i ch co u l d i n f l u en ce o r co n f u se t h e
research result s if t hey were not previously cont rolled.
Ther efor e, t he populat ion w as st r at ified accor ding t o
t h e s e a n t e c e d e n t v a r i a b l e s , t h u s f o r m i n g
hom ogeneous subgr oups. Aft er t his st r at ificat ion, t he
subgroups were random ly dist ribut ed, form ing groups
A and B. This avoided any confusion regarding st udy
r esu lt s.
Accor ding t o t he m et hodological fr am ew or k ,
t he st r at ified r andom sam ple r equir es t he populat ion
t o be divided int o layers or subgroups. The subgroups
o r su b set s i n w h i ch t h e p o p u l at i o n i s d i v i d ed ar e
h om og en eou s. An ap p r op r iat e n u m b er of elem en t s
f r o m e a c h s u b g r o u p i s s e l e c t e d , b a s e d o n i t s
pr opor t ion in t he populat ion( 14).
Hen ce, t h e 4 9 p ar t icip an t s w er e r an d om ly
div ided in t o t w o gr ou ps: gr ou p A ( 2 4 par t icipan t s) ,
which at t ended t he on- sit e t raining program ; and group
B ( 2 5 p ar t icip an t s) , w h ich t ook p ar t in e- lear n in g
t r ain in g.
Th e on - sit e t rain in g abou t Qu alit y Tools for
g r o u p A w a s d e l i v e r e d b y t h e r e se a r ch e r t o t w o
groups: night shift one ( even) and night shift t wo ( odd) .
The t wo- hour course was held at t he Hospit al’s t raining
room , which is locat ed out side t he com plex, at 2 AM.
The sam e cont ent w as t aught on- sit e and in
e-lear ning t r aining, using pow er point pr esent at ions.
Th e p ost - t est w as ad m in ist er ed sh or t ly af t er each
t raining, using an inst rum ent ident ical t o t he pre- t est ,
in which part icipant s inform ed what t hey had learned
in t he on- sit e t raining.
Th e e- lear n in g t rain in g abou t Qu alit y Tools
deliv er ed t o gr ou p B w as also don e in t w o gr ou ps:
night shift one ( even) and night shift t wo ( odd) . The
post - t est in st r u m en t w as adm in ist er ed sh or t ly aft er
t he end of each t r aining cour se.
Th e e - l e a r n i n g t r a i n i n g co u r se s co u l d b e
t h e m o m e n t t h e p a r t i c i p a n t c h o s e t o b e m o s t
conv en ien t . How ev er, t o assu r e t h at t h er e w er e n o
int erferences from a t hird part y, during t he course as
w e l l a s o n t h e t e st s, t h r e e n u r si n g m a n a g e m e n t
r oom s, w it h f ou r com pu t er s each , w er e select ed in
four night shift s, where t he t raining courses could be
perform ed. The nurses com plet ed t he t raining course
in about for t y m inut es, w it h no int er fer ence.
Dat a w er e an aly zed descr ipt iv ely, based on
t h e r e su l t s p r e se n t e d i n ch a r t s a n d t a b l e s w i t h
descr ipt iv e m easur em ent s ( m ean, m edian, st andar d
dev iat ion, m ax im um and m inim um v alues) .
Th e av er age scor es in t h e dif f er en t gr ou ps
and m om ent s of ev aluat ion w er e com par ed, using a
v ar ian ce an aly sis m odel ( ANOVA) w it h t w o f act or s:
m om ent of evaluat ion ( Pre- course or Post - course) and
g r o u p ( o n - si t e o r I n t er n et ) , co n si d er i n g r ep eat ed
m easu r em en t s in t h e m om en t of ev alu at ion f act or.
The exist ence of a possible int eract ion effect bet ween
t h e s e f a c t o r s w a s a l s o e v a l u a t e d . I t i s w o r t h
m en t ion in g t h at , w h en t h e in t er act ion ef f ect is n ot
si g n i f i ca n t , t h e m a i n ef f ect s ( t h a t i s, m o m en t o f
ev alu at ion an d gr ou p) can be an aly zed dir ect ly. On
t he ot her hand, if t he int eract ion effect is significant ,
t he behavior fact or m ust be evaluat ed wit hin t he levels
of t he ot her fact or( 12). The adopt ed level of significance
w as 5% ( p= 0.05) .
RESULTS AND DI SCUSSI ON
Th e r e se a r ch d a t a a n a l y si s, a s sh o w n i n
Tables 1 and 2, pr ov ides r elevant infor m at ion on t he
init ial pr oposal. I n v iew of t he st udy obj ect iv e, w hich
w as t o com par e t h e k n ow ledge acqu ir ed by n u r ses
w ho at t ended a t r adit ional t r aining pr ogr am , i.e.
on-si t e , w i t h t h a t a cq u i r e d b y n u r se s w h o u se d e
-l e a r n i n g, i t s h o u l d b e c o n s i d e r e d t h a t , i n b o t h
m et h ods, su bj ect s got a h igh er scor e on t h e post
-t e s-t , w h i ch p r o v e s -t h a -t k n o w l e d g e a p p r e h e n si o n
occu r r ed in bot h m et h ods.
I n gener al, it is obser v ed t hat bot h t he
on-sit e gr ou p an d t h e com pu t er - m ediat ed gr ou p got a
h igh er scor e on t h e post - t est t h an on t h e pr e- t est .
This show s t hat t he num ber of cor r ect answ er s w as,
o n t h e av er ag e, h i g h er af t er t h e t r ai n i n g co u r se,
r eg ar d l ess o f t h e f o r m i n w h i ch i t w as d el i v er ed .
However, t he e- learning group reached slight ly higher
av er ag e scor es.
Fo r t h i s a n a l y si s, t h e t o t a l sco r e o f ea ch
in div idu al w as con sider ed at t h e fir st t w o m om en t s
( pre and post t est s) for bot h groups. Tables 1 and 2
pr esent t he descr ipt iv e m easur es of t he t est scor es
for t he on- sit e and com put er - m ediat ed gr oups.
Table 1 - Tot al num ber of correct answers of t he
on-sit e g r ou p ( N= 2 5 ) on t h e p r e an d p ost - t est s, Sao
Paulo, 2006
t n e m o m t n e m s s e s s
A MeanMedianStandard n o it a i v e
d MinimumMaximum
t s e t -e r p s r e w s n a t c e r r o c l a t o
T 16.4 19.0 4.5 6.0 21
t s e t -t s o p s r e w s n a t c e r r o c l a t o
T 17.8 19.0 3.2 11 22
Tab l e 2 - To t al n u m b er o f co r r ect an sw er s o f t h e
com put er m ediat ed group ( N= 24) on t he pre and post
-t es-t s, Sao Paulo, 2006
t n e m o m t n e m s s e s s
A MeanMedianStandard n o it a i v e
d MinimumMaximum
t s e t -e r p s r e w s n a t c e r r o c l a t o
T 17.7 19.0 3.1 9.0 21.0 t s e t -t s o p s r e w s n a t c e r r o c l a t o
T 19.4 20.0 1.7 16 22
I t is observed t hat average group scores are
close, wit h slight ly higher average values in t he post
-t es-t of -t he com pu-t er- m edia-t ed group. This shows -t ha-t
t he e- lear ning st r at egy is j ust as effect ive as on- sit e
lear n in g .
Lear n in g st r at egies ar e pr ocedu r es u sed in
t h e e d u ca t i o n p r o ce ss w h i ch ca n b e ch a n g e d t o
in cr ease lear n in g ef f ect iv en ess in a specif ic act iv it y
or en v ir on m en t . Th is m ean s t h at t h er e ar e n o best
st rat egies. Rat her, t he st rat egies ar e adj ust ed t o t he
t ype of act ivit y t hat is m eant t o be learned( 1).
Dat a analy sis show s t hat , in gener al, scor es
were lower in t he on- sit e group, for bot h t he pre- t est
and post - t est . The st at ist ical analysis did not give any
evidence of significant differences bet ween t he average
scores of t he on- sit e and e- learning groups ( p= 0.072) .
Th at is, n o sig n if ican t g r ou p ef f ect w as ob ser v ed .
Mo r eo v e r, a n i n cr ea se i n t h e a v er a g e sco r e a f t er
t raining ( p= 0.002) was observed. That is, t here was a
significant m om ent of ev aluat ion effect . Hence, it is
concluded t hat t he average score on t he post - t est was
h ig h er t h an t h at ob t ain ed on t h e p r e- cou r se; w it h
average scores ( at 95% confidence int ervals) of 18.6
( 17.9 t o 19.3) and 17.1 ( 16.0 t o 18.2) , respect ively.
Tab le 3 sh ow s t h e in cr ease in scor es af t er
t raining, obt ained by calculat ing t he difference ( post
-t es-t score - pre- -t es-t score) for each individual in -t he
Tab le 3 - Descr ip t iv e m easu r es f or scor e in cr ease
accor ding t o t r aining gr oup, Sao Paulo, 2006
FI NAL CONSI DERATI ONS
I t is observed t hat t he average score in bot h
g r ou p s, A an d B, in cr eased b et w een t h e f ir st t w o
m om ent s of pr e and post - t est . I n t he on- sit e gr oup,
t h e av er ag e in cr eased f r om 1 6 . 4 t o 1 7 . 8 , an d t h e
st andard deviat ion decreased from 4.5 t o 3.2. I n t he
e- learning group, t he average also increased from 17.7
t o 19.4, and t he st andard deviat ion was reduced from
3.1 t o 1.7. Dat a analysis shows t hat t here was sim ilar
k n ow ledge appr eh en sion by bot h gr ou ps of n u r ses,
t hus confirm ing t he effect iveness of bot h m et hods.
Re s e a r c h d a t a s h o w s t h a t k n o w l e d g e
appr ehension occur s r egar dless of t he st r at egy used
in t he t r aining pr ogr am , eit her on sit e or com put er
-m ediat ed. How ev er, it is in f er r ed t h at e- lear n in g is
e f f e ct i v e a n d e f f i ci e n t , si n ce i t co m b i n e s se v e r a l
adv ant ages r egar ding flex ibilit y and t im e and cost
-ef f ect i v en ess, w h i ch i s n o t o b t a i n ed w i t h o n - si t e
t raining, due t o it s lim it at ions.
Hence, it is underst ood t hat e- learning provides
t he individual wit h a m ore individualized st udy, adj ust ed
t o t he t rainee’s rhyt hm , t hus providing t im e flexibilit y
a n d o v e r co m i n g g e o g r a p h i ca l b a r r i e r s, si n ce t h e
st u den t ch ooses w h en an d w h er e t r ain in g w ill t ak e
place. E- leaning in nur sing pr ovides opt im izat ion and
f lex ib ilit y of t h e t im e sp en t in t r ain in g cou r ses. I n
addit ion, it em phasizes t he im port ance of im plem ent ing
new t ools in nursing educat ion, which should fit each
i n d i v i d u a l ’ s l ea r n i n g d y n a m i cs a n d b e a f a st a n d
efficient way t o t rain and capacit at e professionals.
Hence, it is concluded that adopting e- learning
in the continuing education process in nursing represents
a st r on g im pact on t h e im pr ov em en t of k n ow ledge
m anagem ent , care qualit y and client sat isfact ion.
I n t h is per spect iv e, it is con sider ed t h at
e-lear ning allow s for changes in educat ional par adigm s
and behaviors, t hus creat ing a new cult ure regarding
l ea r n i n g a n d t h e i m p l em en t a t i o n o f t ech n o l o g i ca l
adv ancem ent s in nur sing educat ion.
n a e
M Median dSetavniadtaiornd MinimumMaximum
) 5 2 = n ( l a it n e s e r
P 1.3 1.0 3.8 -7.0 9.0
) 4 2 = n ( g n i n r a e l
-E 1.7 1.0 2.8 -3.0 7.0
Th e st at ist ical an aly sis d id n ot in d icat e an
int er act ion effect bet w een m om ent of ev aluat ion and
group ( p= 0.682) . These result s show t hat t he average
t est scor e in cr ease f or in d iv id u als w h o r eceiv ed
e-lear ning t r aining w as not significant ly differ ent fr om
t h e a v e r a g e i n cr e a se f o r i n d i v i d u a l s w i t h o n - si t e
t raining. Since t here was no int eract ion effect on t he
est im at ed m odel, t he m ain effect s could be evaluat ed.
The com parat ive result s bet ween t he t raining
program s showed t hat program s were effect ive in bot h
for m s, on- sit e as w ell as e- lear ning, since t her e w as
an in cr ease in t h e t r ain ees’ av er ag e scor e in b ot h
groups, which proves t hat t he present ed cont ent s were
ap p r eh en d ed .
E- l e a r n i n g p r o v i d e s t h e o p p o r t u n i t y f o r
inst ruct ors or t eachers t o t each bet t er, since it allows
t hem t o use a range of bot h t echnical and pedagogical
t eaching t ools, as opposed t o t he old st andar d
one-t o- m any pr esenone-t aone-t ion( 16).
Or ganizat ions hav e been adopt ing e- lear ning
as a st r at egy t o t r ain an d capacit at e pr of ession als,
t h u s i n cr easi n g t h e co m p an y ’s i n t el l ect u al cap i t al
t hr ough k now ledge m anagem ent( 17- 19).
Com p u t er an d com m u n icat ion t ech n olog ies
ar e par t of t he cont em por ar y societ y, w hich pushes
people int o adapt in g and using new t echnologies in
t heir per sonal and pr ofessional liv es( 20).
Wit hin t his business cont ext , dist ance learning
aim s t o m eet t h e n eed f or q u alif ied w or k er s, an d
should be adopt ed as a new way t o educat e and not
as a “ gar m ent ” for t r adit ional educat ion, pr esent ing
innov at iv e t echniques, such as cr it ical aut onom y and
p r o c e s s e s m e d i a t e d b y s y n c h r o n o u s a n d
asy n ch r on ou s com m u n icat ion( 2 1 ).
REFERENCES
1. Zerbini T, Carvalho RS, Abbad G da. Treinam ento a distância via internet: construção e validação de escala de estratégias de aprendizagem . I n: Anais do 29º Encontro da Associação Nacional de Pr ogr am as de Pós- Gr adu ação em Adm in ist r ação; 2 0 0 5 . set em bro 17- 21; Brasília [ CD- ROM] . Brasília: ENAMPAD; 2005. 2.Romiszowski A. O futuro de e-learning como inovação educacional: fatores influenciando o sucesso ou fracasso de projetos. Rev Bras Aprendizagem Aberta Distância [ periódico on line ] . 2003. [ acesso 2004 jul 10] . Disponível em: http: / / www.abed.org.br
3. Allen M W. Dow n w it h boring e- Learning. [ Ent revist a a Ryam Ellis] . Lear ning Cir cuit s Edit or [ on line] 2004. [ acesso 2004 ago 3] . Disponível em : ht t p: / / w w w .learningcircuit s.org/ 2004/ j u l 2 0 0 4 / allen . h t m
4. Mur phy F, Kar m ali K, McFar lane G, August in K. Educat ion s t r a t e g y f o r i m p l e m e n t a t i o n o f c o m p u t e r i z e d n u r s i n g d ocu m en t at ion . Med in f o. 1 9 9 5 ; 8 : 1 3 9 0 - 3 .
6 . Ca ssi a n i SHB. Um sa l t o p a r a o f u t u r o n o e n si n o d a ad m in ist r ação d e m ed icam en t os; d esen v olv im en t o d e u m pr ogr am a inst r ucional aux iliado pelo com put ador [ t ese liv r e-d ocên cia] . Rib eir ão Pr et o ( SP) : Escola e-d e En f er m ag em e-d e Ribeir ão Pr et o, Univ er sidade de São Paulo; 1998.
7. Mar in HF, Diogo RC, Car m agnani MI . Desenv olv im ent o do w eb si t e ed u caci o n al so b r e i n t er v en ção d e en f er m ag em : a sp i r a çã o d e secr eçõ es t r a q u eo b r ô n q u i ca s. I n : An a i s 8 º Encont ro de enferm agem e Tecnologia - ENFTEC: Enferm agem n o Sécu lo XXI : r ef lex ões e v isões; 2 0 0 2 . abr il 2 2 - 5 ; São Paulo [ CD- ROM] . São Paulo: Cent ro de Est udos 8 de Agost o; 2 0 0 2 .
8 . Go d o y S, N o g u e i r a MS, H a y a s h i d a M, Me n d e s I AC. A d m i n i s t r a ç ã o i n t r a m u s c u l a r n a r e g i ã o v e n t r o g l ú t e a : av aliação após t r einam ent o por v ideoconfer ência. Rev ist a da Rede de Enfer m agem do Nor dest e 2 0 0 3 , 4 ( 1 ) : 8 6 - 9 2 . 9. Duran ECM, Cocco MI M. Soft ware educat ivo sobre diabet es m ellit us para profissionais de saúde: et apas de elaboração e d e s e n v o l v i m e n t o . Re v La t i n o - a m En f e r m a g e m 2 0 0 3 ; 1 1 ( 1 ) : 1 0 4 - 7 .
10. Godoy S, Mendes I AC, Hy ashida M, Nogueir a MS, Alv es L M M . I n - s e r v i c e n u r s i n g e d u c a t i o n d e l i v e r e d b y v i d eo co n f er en ce. Jo u r n al an d Tel ecar e 2 0 0 4 ; 1 0 ( 5 ) : 3 0 3 -3 0 5 .
11. Seixas CA, Mendes I AC, godoy S, Cost a AL. I m plant ação d e si st em a d e v i d eocon f er ên ci a ap l i cad o à am b i en t es d e pesquisa e de ensino de enfer m agem . Rev ist a Br asileir a de En f er m ag em 2 0 0 4 set em b r o- ou t u b r o; 5 7 ( 5 ) : 6 2 0 - 4 . 1 2 . Ju l i a n i CMCM. Te cn o l o g i a e d u ca ci o n a l : p r o d u çã o e v a l i d a ç ã o d o s i t e e s c a l a d e p e s s o a l d e e n f e r m a g e m [ d i sse r t a çã o ] . Sã o Pa u l o ( SP) : Esco l a d e En f e r m a g e m , Un iv er sidade de São Pau lo; 2 0 0 3 .
13. Fernandes MG. O exam e físico de enferm agem do recém -n ascid o a t er m o: sof t w ar e au t o- i-n st r u cio-n al [ d isser t ação] . São Pau lo ( SP) : Escola Pau list a de Medicin a, Un iv er sidade Feder al de São Paulo; 2004.
14. Lobiondo- Wood G, Har ber j J. Pesquisa em enfer m agem : m ét odo e avaliação crít ica e ut ilização. 4ª ed. Rio de Janeiro: Gu an abar a Koogan ; 2 0 0 1 .
15. Winer BJ, Brow n DR, Michels K M. St at ist ical principles in ex per im ent al design. New Yor k : McGr aw - Hill; 1 9 9 9 . 16. Lee S, Groves P, St ephens C. I nt ernet t eaching: exist ing t ools e pr oj ect s for on- line t eaching [ on line] .1996. [ acesso 2006 j ul 1] . Disponível em : ht t p: / / info.ox.ac.uk/ j t ap/ report s/ t each i n g
17.Shinyashiki GT, Trevizan MA, Mendes I AC. Sobre a criação e a gest ão do conhecim ent o or ganizacional. Rev Lat ino- am En f er m ag em 2 0 0 3 j u lh o- ag ost o; 1 1 ( 3 ) : 4 9 9 - 5 0 6 .
1 8 . Men des I AC. Apr en dizagem or gan izacion al e gest ão do conhecim ent o: um desafio a ser enfr ent asdo. Rer Lat ino- am En f er m agem 2 0 0 3 m aio- j u n h o; 1 1 ( 3 ) : 2 6 9 .
1 9 . S e i x a s CA , Me n d e s I A C. E- l e a r n i n g e Ed u c a ç ã o a Dist ância: guia pr át ico par a im plant ação e uso de sist em as aber t os. São Pau lo: At las, 2 0 0 6 .
20. Peres HHC. O ser docent e frent e ao m undo da inform át ica: um olhar na perspect iva da fenom enologia social [ t ese] . São Pau lo ( SP) : Escola d e En f er m ag em , Un iv er sid ad e d e São Pau lo; 2 0 0 1 .
2 1 . Co st a G, Na sci m e n t o L. Ed u ca çã o e t r e i n a m e n t o a d i s t â n c i a m e d i a d o s p o r c o m p u t a d o r : e m b u s c a d a a p r e n d i z a g e m s i g n i f i c a t i v a . Re v N o v a s Te c n o l o g i a s n a Ed u c a ç ã o : I I I c i c l o d e p a l e s t r a s n o v a s t e c n o l o g i a s n a educação [ per iódico on line] . 2004; 2( 1) : 2- 8. [ acesso 2004 ag o 3 ] . Disp on ív el em : h t t p : / / w w w . cin t ed . u f r g s. b r / r en ot e/ m ar 2 0 0 4 / in d ex . h t m l
