INTRODUCTION

Learners who are able to reach out for help when they need it are well-positioned to translate knowledge successfully in any learning event. In online graduate study classrooms for nurses and other health-care professionals, students’ classmates can offer invaluable assistance. However, educational research examining the instructional strategies that facilitate helpful interactions among these students is limited.

This article describes the findings from a qualitative research project that investigated the help-seeking experiences of online health-care students in graduate study programs. The purpose of the study was to explore learners’ ideas about seeking help and to identify instructional strategies that respond to learners’ needs. The research was guided by the question: “Which specific strategies do these learners implement to seek help?”

The participants in the study included graduate students from a variety of different health-care disciplines. The Center for Nursing and Health Studies at Athabasca University in Athabasca, Alberta, Canada, offers a Master of Nursing (MN) as well as a Master of Health Studies (MHST). Although students in the MN program hold undergraduate degrees in nursing, those in the MHST program come from nursing, medical technology, physiotherapy, occupational health, dietetics, social work, medicine, dentistry, and other health-care disciplines. Within the MN stream, registered nurses are able to achieve an advanced nursing practice or nurse practitioner qualification. The program’s students are predominantly nurses and female, live in many different countries, are required to have practiced in their field for at least 2 years and must complete their courses in English. The non-clinical courses are offered exclusively online using a WebCT course management system.

The primary medium for communication, instruction, and assessment within the MN and MHST programs is asynchronous, text-based, threaded discussions within a WebCT environment. In most courses, cohorts of ≅ 20 students led by one instructor progress through a study guide identifying a series of readings, discussion questions, and learning activities during a 14 week timeframe. Each course has been designed to include weekly forums where students discuss the study guide and a “coffee lounge” forum for informal connections. The students are graded on their participation in the weekly discussion forums. Small group work forums, private email, and synchronous chat room discussion options are also available.

A literature review of educational research examining postsecondary students’ help-seeking behaviors reflected positive associations between help-seeking and learning successes. Karabenic’s (1998) seminal work established that seeking help within an educational event can be a valuable and strategic resource. Undergraduate learners who sought help when necessary were more actively engaged and self-regulated (Karabenick & Sharma, 1994), preregistration nurse learners who sought help tended to perform better academically (Hegge et al., 1999), and distance education learners who sought help were identified as high achievers (Taplin et al., 2001).

However, the process is seldom straightforward for learners. Seeking help from peers might not provide accurate assistance (Bailey, 1997) and seeking help from tutors might be anxiety-provoking and perceived as conveying inadequacies (Price, 2002). Feelings of indebtedness to the provider, embarrassment, and threats to self-esteem can emerge (Karabenic, 1998).

THE RESEARCH APPROACH

This project was framed from a constructivist theoretical perspective (Lincoln & Guba, 1985; Peters, 2000; Appleton & King, 2002) and a naturalistic action research design (Corey, 1949; Kemmis & McTaggart, 1988; Kemmis & McTaggart, 1990; Altrichter et al., 1993; Stringer & Genat, 2004). The data sources included a program satisfaction survey, focus groups, and 10 audiotape-recorded, transcribed interviews with graduates who attended convocation ceremonies at the Athabasca University campus in Athabasca, Alberta, Canada. The data were collected over a 2 year period to accommodate personal contact with graduates when they traveled to the university campus for their convocation ceremonies.

The content from these data sources were analyzed first independently and then collaboratively by the researchers. The transcripts were thoroughly read and reread and a systematic process of content analysis was developed (Loiselle et al., 2004) to create a categorization and coding scheme leading to themes. Trustworthiness was established through ongoing interaction and member-checking with participants to ensure authenticity.

The research approach was conceptualized from tools examining help-seeking within learning that were tested in an earlier project (Melrose S., unpubl. data, 2003). The overarching themes (Melrose et al., 2005) identified that learners sought help first by rereading directions, second by turning to classmates, and third by involving family and friends. LaVallie and Melrose (2005) expanded on the strategies involving family and friends that online graduate learners can implement to obtain the help they need and the present article expands on the strategies involving interaction with fellow students that instructors can implement to facilitate helpful student connections in online classrooms.

To ensure anonymity, pseudonyms were used when participants’ comments are reported verbatim. Full ethical approval was granted from the Athabasca University Ethics Committee and all participants gave informed consent.

ACTION RESEARCH

Action research is a reflective, spiral process where teachers use research techniques to examine their own educational practice carefully, systematically, and with the intention of applying their findings directly to their own and other educators’ everyday practice. Linking the terms “action” and “research” highlights the essential features of this method, where researchers and participants work collaboratively to try out ideas in practice as a means of increasing knowledge about or improving the curriculum, teaching, and learning (Kemmis & McTaggart, 1988; 1990). The term “naturalistic” within this methodology reflects how projects are completed in a setting that is both natural and familiar to researchers and participants (Lincoln & Guba, 1985).

In the 1940s, the social psychologist and educator, Kurt Lewin, first applied the term “action research” to “describe work that did not separate the investigation from the action needed to solve the problem” (McFarland & Stansell, 1993;
p. 14). In the later 1940s and 1950s, the educator, Steven Corey, argued against the existing quantitative paradigm that focused on findings that could be generalized to “. . . uniformities, explanatory principles or scientific laws” (Corey, 1949; p. 63). Rather, Corey (1949; p. 63) stated:

The action researcher is interested in the improvement of the educational practices in which he [sic] is engaging. He [sic] undertakes research in order to find out how to do his job better – action research means research that affects actions.

In his view, action research was valued more for the change it can initiate in everyday practice than for a quantitative goal of generalizing the findings to a broader audience.

Today, in the educational research field, action research methods, such as collecting interview and survey data from learners who have completed an educational event and then analyzing that data through developing categories and coding processes, are well-established (Altrichter et al., 1993). Similarly, in the health-care field, practitioners are encouraged to engage in action research and the practical nature of the findings is highly regarded (Stringer & Genat 2004).

RESULTS

Strategy 1: Award marks for participation

When the continuing health-care professionals in this project identified that they were unable to help themselves and did find it necessary to reach out to others, it was their classmates they turned to first. By count, the importance of connecting with peers in the class emerged the greatest number of times during the research discussions. Opportunities for student interaction within courses were highly valued. However, despite the value associated with class discussions, unless marks were awarded for participating in them, participants also emphasized that they would be less inclined to engage with their peers. Given this finding, the importance of awarding marks for participation as a facilitation strategy for online educators becomes clear. As Jill explained:

I think you need marks for participation. People need those marks for motivation. By participating, you can really make this program significant. With kids and working full-time, it’s hard. But the marks help make the discussions part of your life. You learn so much from one another, sometimes even more than what you get from research articles and books.

In traditional learning environments, students often turn to one another to discuss a point of interest or to clarify an aspect of the educational material presented. Facilitators in a variety of learning events build on this behavior and stimulate small group conversations to promote student interactions. Adapting this established process to an online environment is also effective. In Rick’s words:

The learning is multilayered. You have the curriculum that provides the readings and some incredible perspectives. Then you have the professors’ ideas and then you have all of the students, many of whom are experts. We were beginners in some areas and interpreting differently. To have the experts saying what they thought and the novices saying how they would look at it differently, depending on previous experience, were layers that built on top of each other.

Kim commented:

I found that interacting with the other students in my class, even online, was extremely helpful for learning how to think critically. But, without the marks for participation, we wouldn’t have had that.

Strategy 2: Encourage thoughtful, well-crafted introductions

As online environments lack non-verbal and other visual communication cues, facilitating student interaction can involve strategies that encourage learners to know one another on a personal, as well as a professional level. For Mary:

Once I got started, the biggest thing that helped me initially was interacting with the other students. I found that usually there were one or two students in each class where there was a commonality. It might be stage of life, working in the same area of health care or where we lived.

Thoughtful introductions that illustrated who participants were at work, what their families looked like, and the kinds of interests they enjoyed were well-received. Including pictures of families, pets, and geographic areas were valued.

The instructors’ own thoughtful, well-crafted introductions modeled the value of pictures and anecdotal “stories.” In Anna’s view:

The most helpful thing was when professors talked a bit about themselves. I felt like I got to know the professor as a person. It made it easier for all of us to talk about ourselves when the professor did. It was like we were a group of people sitting at a big table and participating together.

By contrast, limited attention to facilitating introductions restricted student interactions. According to Keiko:

I would have liked more opportunities to dialogue with the professors. Beyond clarifying assignments, it would be nice to find out more about their area of work or what they thought, beginning to know the professor as a person. Some of those anecdotal kinds of things really make everybody feel comfortable.

For participants in the present research, the social conversations that emerged from thoughtful, well-crafted introductions led to more in-depth communication. Rather than distracting the students, sharing anecdotal information within the online classroom helped to create a climate of safety and decreased anxiety, and encouraged a willingness to risk asking for help from peers when it was necessary.

Strategy 3: Create a coffee lounge, private email, and small group forums within the course environment

In addition to the comprehensive content knowledge that continuing health-care learners expect in educational events, opportunities to translate knowledge in personally meaningful ways are also required. In online classrooms, creating areas where learners are invited to interact, such as a coffee lounge, small group forums, and private email are helpful.

Given that most online learning environments provide a permanent record of all interactions, this strategy begins to address Bailey’s (1997) finding that seeking help from peers might not provide accurate assistance. With access to the coffee lounge and small group forums themselves, instructors can identify and intervene if participants inadvertently offer inaccurate direction or responses.

Furthermore, creating these areas can indicate that helpseeking and help-offering behaviors among learners are expected. In turn, these expectations serve to lessen the barriers to seeking help, such as feeling anxious and inadequate (Price, 2002) or embarrassed and threatened (Karabenic, 1998).

For some, the inherent anonymity of online learning made areas for student interactions particularly appealing. Zabida felt that:

. . . being online means there is less risk of looking stupid in front of your classmates because they really can’t see you, so it was, for me anyway, not too intimidating to ask a classmate something. I could ask in the coffee room or the small group forum. If I really didn’t want anyone to know what I didn’t know, I could use the private email.

Karen added:

You can always ask your colleague a stupid question and no one will laugh at you on the Web. If you really don’t understand, somebody can tell you and help you learn. With the anonymity of your computer, you can ask the questions that people wouldn’t ask if they were in a public classroom.

Although chat rooms are available in the WebCT courses at Athabasca University, some students expressed a difficulty in accessing them. For other students, however, the chat rooms were well-used and provided learners with another venue for interaction. Recognizing that learners find these areas useful and then including them in the initial design of an online course is a simple but important facilitation strategy that readily promotes student interaction.

Strategy 4: Identify non-contributing students

When given the opportunity to share their reflections on how online instructors can best facilitate helpful interactions among learners, the participants in this study repeatedly described instances where some students did not “do their share.” Although responding to colleagues’ help-seeking was consistently seen as “a compliment to be asked” rather than a burden, these health-care professionals also clearly resented “carrying” others who did not contribute.

Summarizing the importance of instructional intervention when a learner is not contributing to a group task, Mai-Ling stated:

There is a fine line between helping and doing work for someone. My approach, when someone in the group is going to get the same mark, but they haven’t done the work, is to email the instructor privately. I won’t hold back because I want the project done well. But, at the same time, you really need the instructor to get in touch and say something. You need to have some discretion and not air these things in public, but it is really important for the instructor to step in and act.

Just as in traditional classroom learning activities when students’ contributions are unequal, the early identification of the issue is essential in online classrooms as well.

DISCUSSION

The aforementioned four instructional strategies, developed from discussions with clinicians who successfully completed their graduate degrees exclusively through a WebCT online course management system, begin to illustrate the kind of facilitation approaches that these groups of learners appreciate. Given these findings, the implications for online healthcare educators include ensuring that opportunities for students to connect with one another are readily available. Clearly, awarding marks for participation establishes this activity as a priority. Also, encouraging and modeling introductions that include pictures and descriptions of workplaces and homes help create a safe climate. In addition, creating a coffee lounge, small group forums, and private email are simple design elements that provide the virtual space needed for student interaction. Finally, intervening immediately when a student is not contributing strengthens group processes.

CONCLUSION

This article presented findings from a naturalistic action research study that explored strategies to facilitate helpseeking through student interactions online. In contrast to other studies that explored learners’ help-seeking experiences, this project extends existing understanding by presenting specific strategies unique to educators working with health-care professionals.

Connecting with colleagues can enhance the process of translating knowledge from theory to clinical practice. Participation marks, well-crafted introductions, comfortable virtual spaces, and instructional intervention when learners are not contributing are examples of facilitation strategies that health-care professionals value. As educational events for nurses and other health-care professionals move to online environments, creating intentional strategies to facilitate student interactions is both a challenge and an opportunity for the field.

ACKNOWLEDGMENTS

Funding for this research was provided by the Mission Critical Research Fund, Athabasca University, Athabasca, Alberta, Canada.

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