Introduction

This article describes findings from a qualitative research project that investigated the experiences, reflections and feelings of online health care students during times in their graduate study program where they sought or attempted to seek help. While the main purpose of the project was to explore learners’ ideas about seeking help, a secondary purpose was to begin to consider instructional strategies that respond to learner needs.  The research was guided by three questions. First, do online health care graduate study learners believe they need help? Second, what specific strategies do these learners implement to seek help? Third, what kinds of problems occur throughout the help-seeking process? Preliminary findings from the project were reported at the Tenth Annual NAWeb Web-based Teaching and Learning Conference ( Melrose, 2004).

Participants in the study were graduates of either the Master of Nursing (MN) or Master of Health Studies (MHST) programs offered through the Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta, Canada (http://www.athabascau.ca/cnhs/index.php). While students enrolled in the MN program hold undergraduate degrees in nursing, those in the MHST program come from nursing, physiotherapy, occupational health, dietetics, medicine and other health care disciplines. Both male and female students are enrolled in graduate study programs at the Centre and are required to have practiced in their field for at least two years. Graduates of the 2003 and 2004 classes were predominantly women and lived all across Canada as well as in a variety of other countries.

Course work in the MN and MHST programs is completed exclusively online using a WebCT course management system. Therefore, Convocation ceremonies at the Athabasca University campus are the first opportunity for students in these programs to meet their classmates and instructors. Graduates and faculty congregate in the nearby city of Edmonton, Alberta, Canada for several days before the formal ceremonies and most of the data for the present research was gathered during this time in June 2003 and June 2004.

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 approximately 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 time frame. Each course has been designed to include weekly forums where students discuss the study guide and a “coffee room” forum for informal connections. Students are graded on their participation in the weekly discussion forums. In-course e-mail, private small group work forums and synchronous chat room discussion options are also available.

Literature Review

A literature review revealed that over the past decade educational researchers have come to recognize how the process of seeking help within an educational event can be a valuable and strategic resource for learners (Karabenick, 1998). Rather than simply reflecting student dependency or an immediate need to execute a task, the ability to reach out to others to ask for help when it is necessary is an adaptive learning strategy. Considerable research has been undertaken to investigate help-seeking behaviour among students in both elementary/middle/high schools as well as undergraduate university settings. There is a “gap,” however, in our understanding of how graduate learners seek help within their learning experience.

Traditionally, the process of seeking help from others was considered somewhat of a dependent behaviour. Bornstein‘s (1992) review of literature from the field of psychology noted that individuals diagnosed with a dependent personality disorder tend to seek help from others more to fulfill a need for support and nurture than for specific responses to an expressed concern. However, within the field of educational psychology, research distinguishing the process of seeking help within educational events from problematic dependent behaviour began to emerge during the 1980s.

DePaulo, Nadler and Fisher (1983) published an important edited series of research studies that examined how learners seek help and this collection laid a foundation for further study. Nelson-Le Gall’s (1981) seminal work examining children’s learning was significant in identifying that the ability to seek help is an important developmental skill. Focusing on motives rather than actions, she distinguished between executive and instrumental motivation. Executive help-seeking involved asking others for help simply  to complete or execute a task. By contrast, instrumental help-seeking involved only enough assistance from others to master the ability to complete a task independently. Although this research was implemented with children, the distinction between executive and instrumental is important in understanding motivation among adult learners, such as graduate students, as well.

Other conceptual approaches from the field of educational research also emphasized how the ability to seek help is a valuable learning strategy. For example, Ames (1983) presented the idea of seeking help within learning as a strategic achievement behaviour. And, Karabenick’s (1998) edited series summarized how the work of Newman (1991, 1994), Schunk and Zimmerman (1994), and Zimmerman and Martinez-Pons (1986) led   to the comprehensive explanation that “adaptive help-seeking is a strategy of self regulated learners who efficiently seek necessary assistance in response to perceived lack of comprehension” (p. 2).

While the studies noted above have focused on younger children, the view that undergraduate learners who seek instrumental assistance when necessary are more  actively engaged and self-regulating has also become accepted (Karabenick & Sharma, 1994). Karabenick and Knapp (1991) identified that college students who use a variety of cognitive, metacognitive and self-regulating strategies will also seek help more  frequently. In the field of library sciences, Bailey (1997) examined the extent of help undergraduate students needed when researching papers and from whom they sought assistance. Findings suggested that learners who sought assistance from peers did not always receive accurate help (Bailey, 1997). In the field of undergraduate (pre- registration) nurse education programs, only one study mentioned help-seeking. In  relation to hardiness, social support and academic performance, Hegge, Melcher and Williams (1999) asserted that nursing students who sought help tended to perform better academically.

In the field of distance education, Price (2002) disseminated findings from a five-year doctoral research project that examined help-seeking among distance learners in an undergraduate (post-registration) nurse education program. His findings emphasized the emotional challenges involved with seeking help, in particular because the role of university tutor or teacher is very different from school teacher or college nurse education teacher, making the transition to university education difficult for nurses. Price (2002) identified that the role of an academic tutor aids learning by promoting individual thought rather than offering definitively correct answers and that this can pose problems for students who want to get the best help from their tutor, yet are anxious that what they say or do might seem inadequate or stupid.

Also in the field of distance education, Taplin, Yum, Jegede, Fan and Chan (2001) compared the help-seeking strategies of undergraduate students identified as high achievers with those identified as low achievers in an attempt to uncover insights about successful help-seeking strategies that could be used by distance education students. Here, findings revealed a tendency for more of the high achieving students, particularly the women, to seek help for personal difficulties related to their courses such as test anxiety, self-motivation and finding time to study. Sources of help included family and friends, fellow students and tutors. Taplin et al. also observed that the group in which the fewest students sought help was the high-achieving men.

Deterrents to seeking help have also been examined and Karabenick (1998) noted that they included indebtedness to the provider, individualistic and cultural norms, embarrassment, self-esteem threat and characteristics of the source of assistance, such as the degree of formality. Taplin et al. (2001) also discussed the source of assistance and identified that, within a distance education environment, the main reason for not seeking help was that access to a tutor or suitable knowledgeable person was difficult.

The Research Approach

This project was framed from a constructivist theoretical perspective (Peters, 2000) and a naturalistic action research design (Altrichter, Posch, & Somekh, 1993; Corey, 1949; Kemmis & McTaggart, 1990; Stringer & Genet, 2004). Data sources included one  question on a program satisfaction questionnaire, focus groups and ten audio tape- recorded transcribed interviews with graduates who attended Convocation ceremonies at the Athabasca University campus in Athabasca, Alberta, Canada in June 2003 and June 2004. Content from these data sources were analyzed first independently and then collaboratively by the researchers. The transcripts were thoroughly read and re-read and a systematic process of content analysis was developed (Loiselle, Profetto-McGrath, Polit, & Beck, 2004) to create the categorization and coding scheme that led to the themes. To ensure inter-coder reliability, once the broad conceptual categories of the four themes  were decided, the researchers independently colour coded each section of data and filed it according to theme. During the process of exchanging files, modifications were made and agreement reached. The research approach was conceptualized from tools examining help-seeking within learning that were tested in an earlier project (Shapiro, Kappelman, Melrose, & Tse, 2003). Pseudonyms were used when participants’ comments are reported verbatim. Investigator triangulation promoted thematic validity. Trustworthiness was established through ongoing interaction and member checking with participants to ensure authenticity. Full ethical approval was granted from the Athabasca University Ethics Committee. Funding for the project was provided by the Mission Critical Research Fund  at Athabasca University.

The following question was included on the graduate satisfaction questionnaire and provided the structure for discussion in both the focus groups and the individual audio tape-recorded transcribed interviews:

Seeking help with learning can be difficult for online students at the graduate level.

Please describe an incident when, even though you read the study guide, that you did not understand all the instructions and did not know what to do. As the course progressed,  and other students began to work—what did you do? What kind of help did you need and who did you seek it from? What happened? Do you think other people in the class would do the same thing? Are there “unwritten rules” for getting help as an online graduate student? If you would be willing to describe your experience in more detail, please e-mail Sherri Melrose (sherrim@athabascau.ca).

The following four themes emerged from analyzing the data and represent key findings. The first theme was that self-help included reflection and re-reading directions available within the course. The second theme was that a primary source of help was other students in the class. The third theme was that involving family, friends and co-workers provided important educational support. The fourth theme was that instructors’ first message, involvement in weekly discussions and anecdotal comments were highly valued.

Theme One: Self-help Included Reflection and Re-reading Directions Available Within the Course

Without exception, participants in this project all commented on how they spent considerable time reading and re-reading course materials before reaching out beyond themselves for help. When a publication or direction for an assignment did not make sense, participants discussed how leaving the course, reflecting on the matter and then returning to it at a later time seemed effective.

It is not unexpected that professional adult learners who have experienced previous academic success and who have actively practiced in a health care discipline might implement a self-help learning process of reading, reflecting and re-reading. In fact, seeking help independently and from written resources provided within the course was sufficient for many students. One questionnaire response stated simply: “I never experience this problem.” Within the focus groups, participants frequently commented on how their professional responsibilities equipped them to “figure things out on our own.”

From the student perspective, a key problem with this process of independent help   seeking emerged in terms of allocating the time needed for reading material several times and on different occasions. In addition to their graduate courses, most students continued to manage their full time employment and family responsibilities. Establishing dedicated study times of “four or five hours each week for the study guide and several days for each of the assignments” was considered a norm. For some students, taking time away from employment was possible. As Sandy explained:

As I got closer to finishing my degree, I reduced my full time employment which made a significant difference. Then—I could take a full day that would be my paper writing day, reading day, research day. I would still have two nights a week to do the discussion groups. But, taking that one full day a week to do all the other work really made a difference.

However, for students, it was the amount of time needed for reflection and the difficulty in planning for this kind of time that was particularly frustrating. For example, as one participant stated:

I didn’t like to have to go back and re-read too many things. In some cases—a research study for example—it is expected. But—re-reading directions and information that just isn’t clear is a waste of my time—which I don’t have enough of anyway!

Implications for instructing online graduate courses become apparent as we consider how learners can be expected to first apply self-help strategies such as re-reading and  reflecting that they may already have in place. For example, responding to student questions with suggestions to read or re-read course material is not likely to be construed as helpful. As Marilyn emphasized:

To receive a message (from an instructor) that says just go back and read it—it’s in your guidelines—go back and read it—because I already would have done that! If I was still questioning what I read then I need somebody to turn the light on because obviously I haven’t got it. There is an assumption—because I myself would never ask unless I’ve studied it and made my own interpretation. And, if I’m still not clear, that’s when I would go to the instructor. So, I always do my homework first and try to figure it out. If I’m not clear, it is because I really do have a need for some explanation.

On the other hand, instructor responses that acknowledged both the expected amount of time spent on course requirements as well as the unexpected time spent reflecting were considered helpful. Students appreciated recognition that the additional time they spent reflecting and thinking about their learning was worthwhile. Similarly, any invitations to discuss time management, self-help strategies and reflective musings within the course were welcomed. And, students clearly expressed the importance they placed on clear, concise directions and messages that required only one reading.

Theme Two: A Primary Source of Help was Other Students in the Class

When participants in this study 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, students emphasized the importance of connecting with peers in the class the greatest number of times during the research discussions.

Private e-mail was used most frequently to initiate discussions. In many instances,  students would pick up on a colleague’s posting in a public discussion forum and add a personally relevant point by private e-mail. Initially, the connections could be sparked by commonalities such as working in the same area of health care, living near to one another or experiencing similar life stage issues. From these initial social conversations, more in- depth communication emerged and “life-long friendships” developed. Participants in this study all described how they established at least one or two of these friendships in most   of their classes. And, as the relationships between and among learners did develop into friendships, students felt comfortable in asking one another for help when they needed it.

Content of the private e-mail discussions ranged from simple tips for navigating the technical environment of the WebCT course management system to more complicated concepts such as strategies for academic writing. “Gossip” related to individual instructor expectations, specific challenges within particular courses and support for “outspoken or negative feedback” from instructors and peers.

Public forum discussions and the coffee rooms were also used to forge help-seeking and help-giving connections among students. As Gerri explained, “For me, it was most  helpful in the big group because if I was having a problem, out of 20 or so other folks, somebody else probably wondered too.” When asked if the anonymity of working online rather than face-to-face lessened the risks often associated with asking for help, participants in one focus group discussed how health care professionals “seldom have the luxury of not asking when we don’t know something.”

Earning marks for weekly participation in academic forum discussions was consistently identified as a critical factor for choosing to create meaningful postings. Without the opportunity to earn marks for their participation—students in the present study repeatedly stated that they would not take the time to contribute.

It is important to note how the student-to-student exchanges continued even after the courses ended. Participants commented on how they intended to remain in touch and to continue sharing academic information. As Carol explained: “Both the gossip-talk and   the academic talk was really important for me to learn to think critically again. It was my friends in the classes that really got me through.”

Where problems occurred within the help-seeking experiences among students was when contributions to graded group projects were perceived as unequal. Here, while the process of actively and explicitly seeking help was clearly acceptable, a process of passively or implicitly seeking help was more controversial. In some of the research discussions, the definition of help-seeking was extended to include seeking help implicitly through passive behaviours such as not attending planned group chat sessions, late or very limited submissions to group papers and other examples of “not doing their share.”

Participants in the present research study were fairly equally divided between positive   and negative experiences with assignments requiring group work. For the most part, students did not view helping others as a burden. However, resentment towards  “carrying” others when earning a group grade and “doing all the work when some  students don’t do much—but still get the mark” was apparent. Comments such as “there   is a fine line between offering help and doing work for others” illustrated how an element of reciprocity may be an implicit expectation or unwritten rule among graduate learners online, particularly where marks and grades are at stake. In Kelly’s words:

Maybe there could be recognition by instructors that peer support does occur, and that we encourage it, we support it, but—there are limits to the extent that students can actually render that support. Time is an issue; we are all busy, working, kids, trying to get our own assignments done. We want to help people—yes for sure. But, you can’t do the work for them. Sometimes it is important to understand that there may have to be some extra help beyond just other students if there tends to be a lot of need for support.

Given these findings, implications for instructing online graduate students include ensuring that opportunities for students to connect with one another in a class are readily available. Design elements within the course such as private e-mail and coffee room forums are useful. Clearly, awarding marks for participation in academic forum discussions establishes this activity as a priority. Further, the importance of encouraging each student to post a thoughtful well-crafted introduction should not be underestimated. Inviting students to include pictures and brief descriptions of their workplaces and homes establishes communication that can extend social conversations into academic dialogue. And, it is critical for instructors to recognize that learners generally willing to offer help  do resent situations where non-contributing members of group projects receive marks.

Theme Three: Involving Family, Friends and Co- workers Provided Important Educational Support

Throughout the research discussions, participants often commented on the important support they received from family, friends and co-workers during their program. While specific course related help-seeking questions were most likely posed to classmates and instructors, seeking help for “bouncing ideas around,” and sharing exciting new learning “discoveries” were often discussed in person with the individuals closest to the students in their daily lives.

Extending learning beyond the virtual classroom and into everyday conversation added a practical dimension to graduate students’ online experience that otherwise might have been missed for them. For example, Jan described how she created a “tutorial group” at her workplace:

I really did find that, based on the online sort of program, that I did need that kind of personal face-to-face talking it through context. So, one of the things I found really  helpful was to find people within my work area that would follow me through each  course. Because as much as you can express yourself online—it is still—sort of—you know you don’t actually get the time to work it through and discuss it and get more understanding. I really did use my colleagues at work a lot, almost as my tutorial group.

Similarly, Kathy commented on how she sought feedback on assignments before submitting them:

Because of the distance learning situation, one of the things that I did was to seek help  from a number of my colleagues. I had several colleagues who had completed a master’s degree, not from Athabasca, but from other universities, and so at times I did actually begin my work and then ask them to look it over and give me some advice. It would not be the same as submitting the whole thing for a mark; it would be more asking them what direction I should proceed and if I was—in their opinion—following what I should be in terms of the outline and the instructions given in the course.

Problems associated with the strategy of seeking help from family, friends and co-workers included having few contacts to turn to and contacts who had limited understanding and familiarity with course expectations. In some cases, students’ contacts were not supportive of their scholarly endeavours and questioned why they were “doing this.” Also, one student discussed how she was not working in a health care environment during her program and did at times feel “alienated” when she “didn’t have those  constant cues around me.”

Implications for instructors related to the important help that family, friends and co- workers can provide include creating opportunities for students to transfer their learning   to their day-to-day life situations whenever possible. Constructing activities that direct students to present assignments in their workplace and then discuss any responses in class can be effective. Suggesting that forming out-of-course educational support groups may also be useful for some students can be a useful teaching prompt.

Theme Four: Instructors First Message, Involvement in Weekly Discussions and Anecdotal Comments Were Highly Valued

When given the opportunity to share their ideas about and activities related to help- seeking, participants in this study repeatedly identified how dialogue with their  instructors was deeply meaningful to them. In particular, memories of instructors’ first or introductory message, involvement in weekly discussions and anecdotal comments stood out for students.

The “tone” of the messages and “how quickly” instructors responded were identified as indicators of “whether or not you would get any help.” This finding is consistent with Ekong (2004) and Kearns, Shoaf and Summey (2004). Although isolated incidents of “profs who didn’t get back to you for several days” were mentioned, for the most part, students spoke with great admiration about how their instructors “did everything they could” to clarify, explain and offer help with course requirements.

Looking through the students’ eyes, it was the first message from their instructor that often set a “tone” of engagement and encouragement. “Friendliness” was valued over “a lot of directions.” And again, the importance of an introductory message that shared conversational information about home, work and personal as well as professional interests contributed to creating a climate where learners felt “comfortable enough to ask for help” when they needed it.

Participating in and facilitating rather than “just saying something was right or wrong” during weekly discussions also contributed to a safe and comfortable climate within classes. Knowing that their instructor was present, would add comments and could be “counted on to re-direct when we needed it” was reassuring. As Lesley mentioned:

I think honestly the thing I found most helpful and enjoyed the most were the classes  where the professor participated in the postings. I had a few where the professor would sort of post one at the beginning of the week and then that was it. And, I had some where the professor would join every discussion. I found that the most helpful. I felt like I got to know the person a little bit and almost like we were a group of people sitting around a  big table and participating together.

And, anecdotal comments that welcomed learners to “begin to know the professor as a person—not just their work experience” were valued. In addition to creating a warm and inviting climate, seemingly anecdotal comments became very helpful when it came to modeling tasks that might be new to students. “I really liked hearing about the prof’s experiences—especially when things didn’t go perfectly for them. I learned a lot from those examples.” Often, students viewed the light-hearted comments instructors interjected about their lives and experiences as invitations to share aspects of their own lives.

Relationships with instructors became critically important in one key area of help- seeking—that of students not knowing or not believing that help was needed, when in fact, it was. Several participants in this study identified times where they did not know they needed help, but received an assignment back that identified problems with their work. In these instances, where professional individuals did not seek help, and yet found themselves in the position of being required to receive it, emotional connectedness  clearly strengthened the exchange.

A striking feature of the devastation graduate students in this study experienced when they received low marks emerged time and again during the private interviews. Two participants came close to tears as they shared instances when they had not earned high marks. In one situation, Jill “lost” 10 marks on a 25 mark assignment. She spoke about her initial response as “a hesitation to ask for help. Everybody else seems to get it—am I that dumb or whatever?” She continued:

I think when I realized that I did not have the concepts down well was when my  assignment came back and my mark wasn’t what I wanted it to be—but the professor was extremely good. What I did was put together an explanation of what I thought the  concepts were and asked her to review them and explain to me where I was off base. She did that and after that my marks were OK, so I was happy again [laughing as she wiped her eye].

In another instance, Chris, who had mentioned earlier in the interview that she “would have liked to have had more opportunity to have a dialogue with the professor,” did not express a sense of closure with a low mark in one of her classes. She described resolving the situation, “…just get it done—get it over with. After the course I can practice.” Chris commented quite emphatically that the experience left her feeling “self-defeated” and, unlike Jill, she did not choose to seek further help from her instructor once she received the feedback. Chris made a point of mentioning several times that she had achieved success in other courses and “hadn’t needed much help.”

Implications for instructors related to the value graduate students place on their first message, involvement in weekly discussions and anecdotal comments can be far-reaching. Sharing ideas, personal experiences and problem solving strategies can enhance the learning climate and provide useful role modeling. An engaging learning environment and an approachable instructor can make the often difficult task of seeking help easier during times when learners know they need help as well as during those times when they did not know or believe they needed help.

Discussion

The aforementioned four themes, developed from discussions with students who successfully completed their graduate degrees exclusively through a WebCT online  course management system, begin to illustrate the experience of help-seeking among this group of learners. Listening attentively as students discussed their experiences revealed useful ways of looking at whether online graduate learners believed they needed help, the strategies they implemented, the problems they encountered, the “unwritten rules” and   the preferred instructor responses. Some learners did not believe they needed help and others did not know they needed help until they received assignments back from their instructors.

Specific strategies students implemented, included extensive reading and reflection and turning to fellow students, family/friends/co-workers and instructors. The motivation guiding these strategies was consistent with Nelson-Le Gall’s (1981) definition of instrumental help-seeking directed towards independent mastery of a task and not towards dependent behaviour or a wish to have the task done for them (executive help- seeking). The behaviours were consistent with Karabenick’s (1998) explanation that seeking help efficiently and when it is necessary is an adaptive and self-regulating   learning tool. The characteristic that academically strong students willingly reach out for help reflected in this study is also consistent with both Hegge, Melcher and Williams (1999) findings with undergraduate nursing students in a traditional classroom setting and Taplin et al. (2001) findings with undergraduate students in a distance education setting. And, the strategies themselves were not significantly different from those identified in research examining elementary/middle/high school and undergraduate learners.

However, some of the difficulties that this group of professional graduate level learners experienced in their process of help-seeking are unique. Self-help strategies, such as reading and reflecting can be expected to be highly developed. Therefore, questions and requests are not likely to be posed casually. Time is stretched to the extent that the intense commitment required in graduate course work may necessitate decreasing or actually leaving employment. Time management skills have been carefully developed to target priorities and eliminate activities not directly identified with earning marks, such as participation in forum discussions. So, unless marks are appropriated for discussions, in spite of the positive comments participants in this study used to describe the friendships they made in classes, graduate learners may not identify the activity as a priority. While a willingness to respond to others’ needs for help clearly exists, there is an “unwritten rule” suggesting an expectation of reciprocity and equal participation within group projects when marks are involved. Family, friends and co-workers, known to be an important educational support, may be neither available nor supportive. And, perhaps most  important of all, it was the personal connections with classmates and instructors that established the foundation for efficient help-seeking for these students.

The present investigation suggests expanding our ideas about facilitating learning with online graduate learners to include acknowledging the activities they may already be engaged in to seek help. In turn, this acknowledgment can guide us toward a deeper understanding of how best to respond and offer what further help may be needed. Knowing how much online graduate learners value a safe and welcoming climate within their classes leads us to look for ways to create warm and inviting virtual spaces. The importance of establishing and maintaining an engaging learning climate within online nurse education is consistently emphasized in the literature ( Billings, Conners, & Skiba, 2001; Boyle & Wambach, 2001; Diekelmann & Gunn, 2004; Frith & Kee, 2003; Mills, Fisher, & Stair, 2001; Wills, Stommel, & Simmons, 2001). Affirmations of the value of instructors’ first message, involvement in weekly discussions and anecdotal comments encourage us to pay careful attention to these activities.

Clearly, implications for future research include involving a larger sample of participants from different universities. And, while the reflections that program graduates in this study shared during their Convocation ceremonies were in depth, it would also be useful to examine these experiences at different times. The researchers were left wondering about how help-seeking experiences at the beginning of a program might be different than those articulated upon graduation.

Conclusion

This article presented findings from a naturalistic action research study that explored online graduate students’ ideas about and activities related to seeking help within a  WebCT course management system. In contrast to other studies that explored the experiences of students in schools or undergraduate programs, this projects extends existing understanding of what it was like for professional health care workers to reach  out for help when they needed it during their masters program by identifying four overarching themes. This research found that students’ self-help included reflection and re-reading, that their primary source of help was other students in the class, that involving family, friends and co-workers provided important educational support and that instructors’ first message, involvement in weekly discussions and anecdotal comments were highly valued. The article calls for the creation of more opportunities to understand how students seek help and continued attention to constructing teaching strategies that respond to and collaborate with students in innovative and genuinely helpful ways.

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