Online education for Ontario's registered nurses: An examination of critical thinking

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Online Education for Ontario’s Registered Nurses: An Examination of Critical Thinking
by
Lorraine Carter
A Dissertation
Submitted to the Faculty of Graduate Studies and Research
through the Faculty of Education
In Partial Fulfillment of the Requirements for
the Degree of Doctor of Philosophy at the
University of Windsor
Windsor, Ontario, Canada
2006
©2006 Lorraine Carter

Online Education for Ontario’s Registered Nurses: An Examination of Critical Thinking
by
Lorraine Carter
APPROVED BY:
___________________________________________________
Dr. Mary-Anne Andrusyszyn, External Examiner
Faculty of Health Sciences, University of Western Ontario
___________________________________________________
Dr. Elaine Duffy, Outside Department Reader
Faculty of Nursing, University of Windsor
___________________________________________________
Dr. Jan Flewelling, First Department Reader
Faculty of Education, University of Windsor
___________________________________________________
Dr. Rosemary Young, Second Department Reader]
Faculty of Education, Brock University
___________________________________________________
Dr. Larry Morton, Advisor
Faculty of Education, University of Windsor
___________________________________________________
Dr. T. Najem, Chair of Defense
Faculty of Graduate Studies and Research, University of Windsor
2006

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ABSTRACT
The purpose of this study was to explore critical thinking dispositions in an online
nursing education context in which writing was the principal means of communication. Writing
samples generated by participants were also examined for evidence of critical thinking skill and
writing competence. A nursing education setting was selected for the study because of the
growing popularity of online nursing education.
A mixed methods design was utilized. Analyzed data included the following: scores of 84
students on a critical thinking inventory called the California Critical Thinking Inventory
(CCTDI); scores assigned to written work by student-participants; data generated by analysis of
writing samples; data generated through interviews; contributions to course bulletin boards; and
observations made by the researcher.
There were no statistically significant increases in the participants’ overall measures of
critical thinking dispositions as a function of online study. A time interaction effect suggested
that students generally show gains in a critical thinking disposition called truthseeking as a
function of university experience.
Findings related to self-confidence and writing point to differences between younger and
more experienced nursing students. In the precourse context, the more experienced nurse-
learners’ self-perceived competence in writing was lower than that of the undergraduate nursing
students. The online course experience appeared to mitigate this difference. This improvement in
self-confidence in writing did not correspond with high scores by the more experienced nurses
when their writing was assessed for evidence of critical thinking. Analysis of the writing samples
for general writing competence revealed stronger writing by the younger nursing students.
Consideration of the writing for evidence of different ways of thinking based on an adaptation of

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Johns’ (1995) ways of knowing suggested a relationship between assignment design and kinds of
thinking.
The qualitative findings suggest that working nurses choose online education generally
because of the access and flexibility it provides. Online educational settings do appear to pose
challenges for these learners including issues related to time management and navigation of the
online environment. Mixed opinions regarding the use of asynchronous bulletin boards and the
rigors of discipline-specific writing are suggestive of the challenges experienced by these
learners.

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ACKNOWLEDGEMENTS
The list of friends and colleagues who have supported me in my pursuit of this degree is
long: I can, in every way, say that this degree is a joint one. Recognizing that I cannot thank all
of these persons individually, I do wish to express my sincerest appreciation to a select few.
Very special thanks go to Dr. Larry Morton, my thesis adviser. At every point, I felt both
challenged and supported; while Dr. Morton’s standards are exacting, he simultaneously inspires
confidence and commitment. Dr. Morton’s intellect and vast experience as an educator and
researcher are gifts to the many graduate students who have worked with him.
I also wish to recognize and thank the other members of my committee: Dr. Elaine Duffy
from the Faculty of Nursing, University of Windsor; Dr. Jan Flewelling from the Faculty of
Education, University of Windsor; Dr. Rosemary Young from the Faculty of Education, Brock
University; and Dr. Mary-Anne Andrusyszyn from the School of Nursing, University of Western
Ontario. The time these very busy professionals have taken to support and assist me is an
important statement of who they are as people and educators.
Finally, there are not enough or right words to thank my immediate family: my husband
Rick and our three adult children Quinn, Kent, and Alanna. Their belief in me as I have pursued
this uniquely personal goal has gone so far beyond the call of loyalty that I am equally humbled
and overwhelmed.

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Dedication
This project is dedicated to my parents Tom and Lillian Harrington.

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TABLE OF CONTENTS
ABSTRACT...................................................................................................................................iii
ACKNOWLEDGEMENTS............................................................................................................ v
DEDICATION...............................................................................................................................vi
LIST OF TABLES.......................................................................................................................... x
LIST OF FIGURES .......................................................................................................................xi
LIST OF APPENDICES............................................................................................................... xii
CHAPTER
I INTRODUCTION .................................................................................................................... 1
Background............................................................................................................................ 1
Critical Thinking Terminology.............................................................................................. 1
Purpose of the Study.............................................................................................................. 2
The Learning Theory of Constructivism................................................................................ 3
Online Education and Constructivism: Experience to Date and Design Issues..................... 6
Constructivism and Nursing Education............................................................................... 10
A Theoretical Model for this Study..................................................................................... 12
Significance of this Study.................................................................................................... 12
II LITERATURE REVIEW ....................................................................................................... 16
Ontario-based Nursing Education: An Overview................................................................ 16
Who is Ontario’s Post-RN Nurse?....................................................................................... 17
Distance Education in the 21st Century: Context for Online Nursing Education................ 19
Instructional Design Issues in Online Nursing Education................................................... 21
Systems-oriented Instructional Design.......................................................................... 22
Time-oriented Instructional Design............................................................................... 22
Task-oriented Instructional Design................................................................................ 23
Learner-oriented Instructional Design........................................................................... 24
Relevance to Online Nursing Education........................................................................ 25
Instructional Design Solutions to Pedagogical Issues in Online Nursing Education .... 27
Technical Issues in Online Nursing Education.................................................................... 29
Human Supports in Online Nursing Education ...................................................................30
Another Position on Technology-enabled Education.......................................................... 33
Critical Thinking in the Postsecondary Educational Context: Skills, Dispositions, and
Measurement........................................................................................................................ 35
Dispositions Towards Critical Thinking or Habits of Mind................................................ 43
More about the Context of Critical Thinking and Western-based Nursing......................... 53
Critical Thinking, Discipline-specific Writing, and Interaction.......................................... 67
Reflection, Writing, and Critical Thinking in the Online Educational Setting.................... 72
Summary.............................................................................................................................. 74
Study Hypotheses................................................................................................................. 75

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III METHODS............................................................................................................................. 76
Participants........................................................................................................................... 76
Instruments........................................................................................................................... 81
Questionnaires (Quantitative Data)................................................................................ 81
Critical Thinking Scores Based on Writing Samples (Quantitative Data) ....................85
Interviews: Students and Instructors (Qualitative Data)................................................ 86
Bulletin Board Contributions: Students and Instructors (Qualitative Data).................. 88
Observations by the Researcher of the Bulletin Boards (Qualitative Data) ..................88
Data Collection Procedures.................................................................................................. 88
Data Analysis................................................................................................................. 90
IV QUANTITATIVE RESULTS ................................................................................................92
Context and Participants...................................................................................................... 92
Gender and Age .............................................................................................................92
Educational Status and Goals......................................................................................... 92
Employment Status........................................................................................................ 94
Geographical Communities ...........................................................................................94
Self-report Data Related to Online Education..................................................................... 97
Experience and Competence with Online Education and Modalities............................ 97
CCTDI Scores.................................................................................................................... 101
Age............................................................................................................................... 101
Critical Thinking Scores Based on Writing Samples ........................................................106
Further Scoring of Writing Samples.................................................................................. 111
Analysis for Writing Competence .....................................................................................111
V QUALITATIVE RESULTS ................................................................................................. 114
Ways of Knowing (Johns, 1995) in Writing Assignments................................................ 115
Student Data: Interviews and Bulletin Board Comments.................................................. 123
Why Are You Taking Your Post-RN Degree at This Time?....................................... 124
Why Are You Taking the Post-RN Program Through Laurentian University? ..........124
What Special Challenges Did You Experience Because This Was an Online Course?
...................................................................................................................................... 129
Has the Course Increased Your Dispositions Towards Critical Thinking?................. 133
Has the Bulletin Board Supported Your Learning?..................................................... 136
Tell Me About Your Experience of Academic Writing in the Course........................ 140
What Changes Would You Recommend to Online Courses Based on Your Experience
In This Course?............................................................................................................ 140
About Instructors .........................................................................................................141
Teacher Data: Interview and Bulletin Board Comments................................................... 142
Can You Tell Me a Little About Yourself as a Nurse and a Teacher?........................ 142
How Would You Describe Your Students in This Course? ........................................ 142
Do You Think the Course Helped Your Students as Critical Thinkers?..................... 143
Do You Think You Saw a Connection Between Critical Thinking and Writing in the
Course? ........................................................................................................................ 144
Tell Me About Academic Writing in the Course......................................................... 144
How Do You See the Instructor’s Role in Moderating the Bulletin Board?............... 145
What Changes Would You Make to Increase Bulletin Board Participation?.............. 149

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How Else Did You Interact With Your Students Besides the Bulletin Board?........... 150
Summary............................................................................................................................ 151
VI DISCUSSION....................................................................................................................... 154
First Hypothesis: Dispositions Towards Critical Thinking ...............................................154
Second Hypothesis: Perception of Competence in Writing............................................... 161
Third Hypothesis: Demonstration of Critical Thinking Skills through Writing................ 162
The Study and Constructivist Learning Theory................................................................. 169
Limitations of the Study..................................................................................................... 172
Implications and Applications ........................................................................................... 175
Directions for Future Research.......................................................................................... 178
Final Thoughts................................................................................................................... 180
REFERENCES ...........................................................................................................................182
VITA AUCTORIS...................................................................................................................... 258

x
LIST OF TABLES
Table 1: Understandings of Critical Thinking in the Late 20th Century....................................... 36
Table 2: Popular Standardized Tests Used to Measure Critical Thinking.................................... 39
Table 3: Seven Subscales of the California Critical Thinking Dispositions Inventory................ 45
Table 4: Studies and Articles About the Use of the CCTDI in the Health Sciences.................... 49
Table 5: General Progression of Research Project ....................................................................... 52
Table 6: Connections between Dispositions Towards Critical Thinking (CCTDI, 2001) and
Habits of Mind (Scheffer and Rubenfeld, 2000) and Assessment Strategies............................... 54
Table 7: Possible Meanings in the Event of Significant Change and No Significant Change ..... 56
Table 8: Some Definitions of Critical Thinking in Nursing......................................................... 59
Table 9: Summary of Major Contemporary Studies of Critical Thinking and Nursing............... 60
Table 10: Age Distribution Frequencies for Two Age Groups for Participants in Experimental
and Comparison Groups ...............................................................................................................93
Table 11: Educational Goals with Chi-Squared Analyses p-values Reported.............................. 95
Table 12: Geographical Communities.......................................................................................... 96
Table 13: Reported Use of Internet Technologies (Precourse)..................................................... 98
Table 14: Reported Competence with Modalities of Online Education (Pre and Post) .............100
Table 15: CCTDI Scores............................................................................................................. 103
Table 16: Means and Standard Deviations for the Pretest and Posttest Scores for CCTDI and the
Self-perceived Competencies...................................................................................................... 107
Table 17: ANOVA Results for Ratings on CCTDI and Self-perceived Competencies .............108
Table 18: Means and Standard Deviations Based on Critical Thinking Rubric......................... 110
Table 19: Means and Standard Deviations Based on Analyses of Writing Samples.................. 112
Table 20: Means and Standard Deviations Based on Ways of Thinking in Writing Samples Based
on Johns (1995) Framework ....................................................................................................... 122
Table 21: Profiles of Post-RN Students...................................................................................... 125
Table 22: Postings in Units 1 to 5............................................................................................... 132

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LIST OF FIGURES
Figure 1: An Inclusive Constructivist Theoretical Framework Coalescing From Competing
Models and Constructed Variables............................................................................................... 13
Figure 2: Self-perceived Competencies Over Time.................................................................... 102
Figure 3: Critical Thinking Over Time....................................................................................... 105
Figure 4: Two Different Interfaces for Bulletin Board Work Used in Course Taken by
Experimental Group.................................................................................................................... 137

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LIST OF APPENDICES
Appendix A: Preexperience Questionnaire................................................................................. 208
Appendix B: Postexperience Questionnaire ...............................................................................215
Appendix C: Course Outline for Post-RN Nurses Including Bulletin Board Assignments .......222
Appendix D: Assignment: Comparison Group #1...................................................................... 233
Appendix E: Assignment File: Comparison Group #2............................................................... 234
Appendix F: Holistic Critical Thinking Scoring Rubric............................................................. 238
Appendix G: Interview Sessions................................................................................................. 240
Appendix H: Letter of Information............................................................................................. 241
Appendix I: Consent to Participate in Research......................................................................... 245
Appendix J: Four Ways of Knowing (Johns, 1995) ...................................................................249
Appendix K: Information Document: Laurentian University’s BScN Program for Registered
Nurses via Distance Education, 5th Intake.................................................................................. 253

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Chapter I
Introduction
Background
Since the mid- to late-1990s, nursing in Ontario has witnessed significant growth in its
use of computers and Internet-based technologies. This growth is demonstrated in several ways
including computer use for patient charting and general data entry as well as patient and
practitioner education. Occurring over the same general time period, Ontario’s decision to
implement—beginning January 2005—a baccalaureate entrance-to-practice requirement for
nurses came into being. Because only 20% of Ontario nurses held university-level status when
the Council of University Programs in Nursing (COUPN) first made this announcement in 2000,
the need to design, develop, and deliver innovative BScN programs for post-RN nurses was a
challenge for Ontario’s schools of nursing (Council Highlights, May 2000). Distance-based
nursing programs including online educational strategies were identified as an appropriate way
of responding to this need (Council Highlights, May 2000). As critical thinking also experienced
a surge in educational attention during the same time period and is an important component of
the nursing process, the combination of critical thinking and online nursing education is the
focus of this study. The next section of this chapter outlines several important distinctions
regarding critical thinking.
Critical Thinking Terminology
While multiple definitions of the term critical thinking are found in the nursing education
literature, the following definition was used in this study: critical thinking means giving
consideration to evidence as well as relevant contextual information, theories, methods, and
criteria. The outcome of such consideration is the formation of judgements (Facione, Facione &

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Giancarlo, 2000). Simply stated, it is the process of using reason to decide what to believe and to
do (Ennis, Millman & Tomiko, 1985).
While the above definition is straightforward enough, there are important distinctions to
be made between what are called critical thinking skills and critical thinking dispositions. The
former pertain to specific thinking applications; the latter to character tendencies to think and act
critically. Because of the inherent limitations of the online learning setting to track, measure, and
validate the critical thinking skills of nurse-learners, critical thinking dispositions were selected
as the primary focus of this study although the study also included strategies that assessed for
critical thinking skill through writing. The study further considered participants’ demonstration
of writing competence.
The specific critical thinking dispositions explored in this project are based on distinct
character attributes as suggested by Facione, Giancarlo, Facione, and Gainen (1995). Sometimes
called habits of mind, they include truthseeking, openmindedness, analyticity, systematicity,
critical thinking self-confidence, inquisitiveness, and maturity in judgment.
Purpose of the Study
As previously indicated, online education in nursing is on the rise just as critical thinking
is regarded to be the foundation of the clinical reasoning process that nurses use every day. Also
found in the nursing education literature are extensive discussions of relationships involving
critical thinking, reflection, and writing. Reflection is repeatedly identified as a strategy vital to
the development of critical thinking among health care practitioners (Daroszewski, Kinser &
Lloyd, 2004; Kennison & Misselwitz, 2002; Kessler & Lund, 2004; Smith & Johnson, 2002)
while university-level, online education courses often use writing as a primary learning
methodology (Anderson, 2003; Garrison & Anderson, 2003). As a result, educational researchers
need to explore and understand the relationship between writing, critical thinking, and online

3
education. The purpose of this study then was to bring together all of these elements so that an
understanding of the online nursing education setting as a possible facilitator of critical thinking
emerged.
The Learning Theory of Constructivism
As a learning theory, constructivism has been described as an experience in which there
is, above all, an internal orientation to learning. In addition to being a pervasive learning theory
in contemporary education in general, it has assumed a primary position in describing and
explaining online education. As a result, it is presented as the theoretical framework for the
study. Before exploring this theory more fully, it is valuable to position constructivist learning
theory in juxtaposition with its two major counterparts: behaviourism and cognitivism.
In behavioural learning theory, the concern is learner performance. Based on Skinner’s
(1938) premise of operant conditioning, learning is regarded to be a conditioned response to a
stimulus. By comparison, cognitive learning theorists are interested in the changes that learners
experience in their brains. Sometimes called information processing theory, cognitivism
emphasizes complex intellectual processes such as thinking, language acquisition, and problem-
solving.
While regarded by some to be a new theory of learning, constructivism has longstanding
roots including its manifestation in what was called discovery learning. Simply put, the driving
principle of constructivism is that knowledge is individually and /or socially constructed by
learners based on their interpretations of their experiences. Given this understanding of learning,
knowledge is not that which is transmitted. Instead, as Seels says (1989), “learning occurs
because personal knowledge is constructed by an active and self regulated learner…who reflects
on theoretical explanations” (p. 11).

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As suggested, the history of constructivism is richer and longer than some know. With
roots in both philosophy and psychology (Doolittle, 1999), it has been suggested that
constructivism is, at the same time, “a theory of learning and… a theory of knowing. It is an
epistemological concept that draws from a number of fields…” (Walker & Lambert, 1995).
Historically, constructivism has been the preoccupation of many great thinkers. The fathers of
constuctivism by their chronological place in the history of constructivism include Vico (1668-
1774), Rousseau (1712-1778), Kant (1724- 1804), Hegel (1770-1831), Froebel (1782-1852),
James (1842-1910), Dewey (1859-1952), Montessori (1870-1951), Vygotsky (1896-1934),
Piaget (1896- 1980), Rogers (1902-1987), Bruner (1915- ), and von Glaserfeld (1917- ).
While each of these thinkers has made unique contributions to the evolution of the theory
of constructivism, the contributions of Piaget, Vygotsky, and von Glaserfeld stand out. Brief
discussions of the contributions of each are presented in the next few paragraphs.
Recognized for his work in what is called developmental constructivism, Piaget first
introduced the term constructivism to psychology and focused on knowing rather than being. In
Piaget’s world of cognitive constructivism, cognitive development is facilitated by providing the
learner with activities and situations that engage the learner and require adaptation. Teaching
materials should actively involve students and present challenges although they should not force
the learner to reach beyond his or her cognitive abilities.
Vygotsky, on the other hand, is remembered for his contributions to social
constructivism. According to Vygotsky, culture and context are extremely important in shaping
understanding. Vygotsky also favoured the concept of learning as a social construct enabled by
language and discourse. Social interaction is central to the learning experience and, at their most
intense, social constructivists maintain that teaching and learning are ends in themselves (Prawt

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& Floden, 1994; Henriques, 1997). Only after a new idea or theory has been negotiated through a
peer consensus process is it considered legitimate.
Glaserfeld is affiliated with another form of constructivism called radical constructivism.
At the end of the constructivism continuum, radical constructivism holds that there is no
indisputable world—no objective reality. As suggested by Jonassen (1991), “there is no single
entity or any objective entity that can be described in any objective way; rather the real world is a
product of the mind that constructs that world (p. 29). Based on this understanding of the world
and learning, the role of the teacher and the learner is affected so that every person’s
understanding of the learning experience is equally valid.
One other form of constructivism of note is critical constructivism. A product of
postmodernist thinking, this theory came of age in the 1960s when academics began to explore
new ways of thinking within the social sciences (Kincheloe & McLaren, 1994) which, for some,
led to a condemnation of the positivist conception of science and rationality (Schwandt, 1990)
and epistemological uncertainty (Kincheloe & McLaren). What this meant for teaching and
learning was recognition of different realities not only for different individuals but also within
the same individual.
In summary, according to Fosnot (1996), the principles that define constructivism to
different degrees depending on the kind of constructivism are as follows:
Learning is development. It is not the result of development: As
such, it requires invention and organization on the part of learners.
The instructor needs to encourage learners to raise questions,
generate hypotheses, and test them.
Disequilibrium facilitates learning: Contradictions and contrary perspectives
should be explored and discussed.

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Reflective abstraction is the driving force of learning: Humans seek
to organize and generalize their experiences. Reflection time
including activities such as journal writing may enable this
abstraction.
Dialogue within a community engenders further thinking: Learners
need to be provided opportunities to defend, prove, and communicate
their ideas with others. Through this kind of activity, ideas may
come to make sense to the community and, in turn, be accepted.
Learning proceeds towards the development of structures: As
learners make meaning, structural shifts may occur and important
“big ideas” emerge (Schifter & Fosnot, 1993). Typically, these
ideas are organizing principles that can be generated across
experiences and often require revisiting earlier conceptions.
Online Education and Constructivism: Experience to Date and Design Issues
With the rise of online education, constructivism has found a home unlike other
educational venues. As Ally (2004) points out, many teachers and educational researchers have
found the online classroom to be the ideal arena for exploring the assumptions and principles of
constructivism. Additionally, the online learning setting has been demonstrated to be a place
where knowledge can be constructed through interaction with other students as well as with the
instructor (Murphy & Cifuentes, 2001). It is similarly an environment where collaborative and
cooperative learning can be accomplished and where learners can use their personal cognitive
skills while learning from others (Hooper & Hannafin, 1991; Johnson & Johnson, 1996; Palloff
& Pratt, 1999). This noted, while the Internet-based learning setting can be a place where

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learners make uniquely personal learning decisions, such learning generally occurs with
guidance and input from the instructor.
Recognizing the independence that online learners often have, Internet-based education
offers unique occasions for personal reflection. As in the case of interaction, this reflection does
not simply happen; rather, it is generally prompted by embedded questions and learning activities
that the teacher has selected so that learners process information in meaningful ways.
Counterbalancing the independent reflective experience are the aforementioned opportunities to
connect with other learners and develop a sense of community. It is within this community that
learners test and confirm ideas and apply their knowledge (Ally, 2004).
Because the online educational milieu is an opportune setting for constructivist-based
learning, some educators have argued that there is an inherent contradiction in the idea of
designing for constructivist learning. As Airsian and Walsh (1997) point out, the “constructivist
model is descriptive, not prescriptive.” Similarly, it is difficult to define instructional strategies
that always support constructivism” (Miller, 2002).
While the conflict between constructivist theory and designed instructional events is
recognized on a conceptual level, the researcher proposes that learning settings that foster
constructivism do require design, albeit design towards knowledge construction in contrast with
knowledge transmission. While there is no “cookbook approach” to how to do constructivist
learning, the literature does identify “methods and strategies that are more likely than others to
foster the desired traits in students such as knowledge construction, intrinsic motivation,
independent learning, and responsibility” (Dobozy, 1999, p. 33). Interestingly, it has been noted
that even lectures which are typically associated with a transmissive model of education “can
potentially support student construction of knowledge” (Miller, 2002, p. 3). In the case of a text-

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based online course, content-oriented notes prepared by the instructor may be likened to lecture-
like experiences.
The field of constructive learning and instructional design is one that instructional
designers and content experts will likely struggle with for some time. This is due to the newness
of the field and the fact that constructivism may not be fully compatible with all aspects of the
“present systems approach to instructional design” (Mergel, 1998, p. 21). This noted, there is
important work happening such as that by Cunningham, Duffy, and Knuth (1993); Honebein
(1996); Jonassen (1991a, 1991b, 1999); Moallem, 2001); Murphy, (1997); and Wilson and Cole
(1991). Jonassen, for instance, points out that designing for constructivist learning requires
dedicated focus on the learning environment. This design emphasizes internal and social
negotiation, exploration of real-world contexts through case-based problems with the uncertainty
and complexity of real-world practice, and teacher modeling and facilitation in contrast with
teacher purveying of information. As a result, the teacher assumes the role of co-learner although
this researcher also suggests that, in his or her role as co-learner, the teacher should also be
encouraged to assume the roles of challenger and coach. Assumption of the former role by the
teacher helps guard against situations where there may be failure to examine and disassemble
positions that may be faulty in logic or based on inaccurate information. In other words, by
encouraging learners to challenge and test constructions and to abandon them when they are
found to be flawed, the instructor assists in facilitating learning characterized by academic rigor
and discipline. By comparison, the role of coach is very important in a constructivist-based
learning setting given that this kind of setting may be disorienting to the learner who is
accustomed to a more transmissive setting and who may feel uncertain about how to proceed.
For example, the constructivist-based learning situation is likely to be a less linear and more
diverse experience than other learning settings. As such, it is helpful to the learner when his or

9
her teacher provides advice about exploring the setting and acts as a guide and assistant
(Prossner & Trigwell, 1999; Marton, Hounsell & Entwistle, 1997).
Synthesizing the aforementioned ideas, Wilson (1997) suggests that, in today’s
information age where constructivism is such an important learning framework, instructional
design can be considered in the following ways:
General ID Approach: Stretch the rules; put principles before practices;
put learners and teachers above principles
Needs Assessment: Resist the temptation to be driven by easily measured
and manipulated content; ask who determines instructional needs; ask
whose needs are being served and whose needs are being neglected
Goals, Objectives, Task Analysis: Allow learning goals to emerge during
instruction; use objectives to guide design; define content in
various ways and present through cases, stories and patterns
Instructional Strategies: Support learners in pursuing their own goals;
design learning environment, not instructional events; consider
instructional strategies that provide multiple perspectives and encourage
learners to exercise responsibility
Media: Include both media literacy and media biases for consideration;
provide opportunities for learners to use media in their pursuit of
understanding
Evaluation: Critique and discuss products and performances grounded in
authentic contexts; used, where possible, informal assessment within the
learning environment

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Constructivism and Nursing Education
The combination of constructivist learning theory and nursing education is one that
merits careful consideration. Certainly there will be individuals who will suggest that nursing
education is a discipline in which learners require exposure to learning that is transmissive and
highly experiential in nature so that they acquire the scientific knowledge base that is integral to
nursing practice as well as the skills of safe and competent nursing practice. In fact, the
researcher agrees with both views. Nevertheless, she does not perceive an inherent contradiction
between constructivist learning and learning activities rooted in the theories of transmission and
experience. As noted earlier, a lecture delivered in a transmissive way can be a valuable way of
building knowledge; an experience-based learning session can also build knowledge. Thus, a
course or program rooted in constructivist learning theory need not exclude learning activities
and assignments defined by other learning theories.
At the same time, the researcher suggests that, in nursing education, a constructivist
approach will be more appropriate in some contexts rather than in others. In the determination of
which contexts are best suited for a constructivist framework, both content type as well as the
composition of the nurse-learner group itself must be considered. For instance, in this study, the
curriculum studied by the experimental group included topics such as care of healthy individuals
and families, teaching and learning with families, and the practice of reflection as an enabler of
critical thinking in nursing. The course did not focus on data-intense areas such as pharmacology
or hands-on skills. Rather, the course explored content where it is valuable for learners to
construct knowledge in individualistic ways and where there is no risk to patient care.
Considering the course at its instructional level, it included learning activities and assignments
that lent themselves easily to a constructivist model. For instance, the nurse-learners were
encouraged to complete learning activities that involved posting reflections and responses to a

11
threaded bulletin board and to learn from each other by interacting and commenting on each
other’s work. This use of writing to facilitate reflection on one’s own thinking in addition to the
thinking of others is in line with the principles of constructivist learning.
Additionally, the learners in the experimental group were post-RN nurses—that is
registered nurses who had returned to university for baccalaureate study—rather than younger
students who were studying to become nurses. As such, the principles and practices of andragogy
would have surely affected their learning experiences. Having acquired mastery of the essentials
of nursing practice in previous learning settings, these learners had unique needs based on their
more advanced life and professional stages than the undergraduate students involved in the
study. Not insignificant among these needs may have been the need to construct knowledge in
relationship with personal and professional values acquired over time.
Finally, it is important to recognize that, as Watson (1999) has suggested, there are
certain areas of nursing where multiple truths may exist. Historically, while nursing education
has been regarded to be a discipline in which individuals were trained according to externally
defined standards, nursing education is now principally positioned within universities. In
Ontario, when nursing education occurs in the community college setting, there is always a
collaborative relationship between the involved college and a university so that resulting degree
is granted by a university. While external standards will always be a central element of nursing
education, these standards co-exist with mandates that require nurse-learners to become strong
competent critical thinkers who can build their own knowledge and arrive at decisions and
actions rooted in the best of critical thinking practice. Additionally, nurse-learners need to
possess habits of mind or critical thinking dispositions that predispose them to think critically in
the first place.

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A Theoretical Model for this Study
As the previous discussion has outlined, this study uses constructivist learning as its
theoretical scaffolding. Additionally, the elements of reflection, writing, distance education,
online learning, andragogy, and critical thinking (dispositions and skills) are brought together in
the study. Learning activities grounded in transmissive and experiential learning are also
identified as possible components of a course or program that is constructive in nature. While not
a theoretical component of the study, the relationship between instructional design and
constructivist learning is a further piece of the study. Figure 1 provides a pictorial representation
of the theoretical framework that supports the study while Chapter 2—in its review of relevant
literature—offers a closer look at the various elements of the framework.
Significance of this Study
There is little question that online education has assumed a central position in university
education. While it is occurring in many disciplines and subject areas, it is extremely valuable
for nurses studying at the postcertificate level—in Ontario, those nurses pursuing BScN standing
as a result of the new baccalaureate entrance-to-practice requirement as well as other nurses who
are seeking to meet their continuing education needs. For nurses, online courses and programs
offer an accessible and flexible educational experience not always found in face-to-face and
other distance and distributed educational contexts. Access and flexibility are necessary
attributes of nursing education at the post-RN level because this learner group is generally
employed and often carries family and community responsibilities. Other benefits of online
nursing education have been identified as well: for example, today’s nurses are using
technology—and computers in particular—on a rapidly increasing basis. With unprecedented

13

14
changes in health care and rapid generation of information, the combination of nursing education
and technology is powerful.
At the same time, the investment on the part of the nurse-learner, the instructor, and the
instructional unit supporting the online experience is typically substantive. The nurse-learner
may have no previous experience with online education and may, therefore, have a steep learning
curve concerning the use of technology for educational purposes. Training in writing at the
university level and information gathering in today’s technology-mediated university libraries
and electronic databases may also be required. On a very practical front, the nurse may be
handicapped because of weak keyboarding skills. To meet these challenges, the nurse generally
requires a strong support system at home, work, and the university.
The online instructor, by comparison, may require support in adapting existing content
for a technology-based educational setting and training in appropriate use of educational
technologies and modification of teaching strategies. This type of training entails institutional
and personal commitment to faculty development as well as time and money. Furthermore, the
emerging literature regarding online education and workload indicates that workload can be very
heavy in an online course because of students’ ongoing contact with their instructors through
communication technologies and the need to put most messages into written format (Cravener,
1999; Morris, Buck-Rolland & Gagne, 2002).
These design, training, and support issues, in addition to requiring time and energy
investments by individuals, necessitate resources at the institutional level. Instructional
designers, educational technologists, multimedia experts, and technical support staff represent
some of these supports. Thus, nursing education units and other professional schools delivering
online education are faced with the challenge of weighing the access and flexibility benefits of
online education for working adult learners against the investments. Thus, if it can be shown

15
through research that the online learning setting with its emphasis on written communication can
support a learner’s experience of critical thinking, faculties and schools engaged in online
education will have acquired the important scholarly-based evidence they need to justify the
resources that online education requires. Other findings of this research may influence the
instructional design process as it is brought to online course development. Finally, the study may
make a contribution(s) to the advancement of constructivist learning theory as it is presently
being implemented in online nursing education targeting experienced nurse-learners.

16
Chapter II
Literature Review
Ontario-based Nursing Education: An Overview
More than ever before, registered nurses in Ontario are seeking baccalaureate-level
education through online distance education. This same trend is evident among nurses as they
strive to meet their continuing professional development (CPD) requirements. Two reasons for
this surge in educational activity are Ontario’s 2005 baccalaureate entry-to-practice requirement
and the circumstance that nursing is a constantly changing field.
With respect to the 2005 baccalaureate requirement, the numbers of Ontario nurses
currently seeking university-level education are substantive. For example, in Spring 2000 when
the baccalaureate requirement was first announced, only 20% of all nurses in Ontario graduated
with a baccalaureate degree while 80% graduated with a nursing diploma (Council Highlights,
May 2000). In order to compete for positions of leadership and responsibility with their younger
colleagues, many nurses who graduated before 2005 are now pursuing their degrees.
The recent increase in continuing education activity for nurses is related to the fact that
health care is a dramatically changing field in which nursing professionals have little choice but
to keep up. There are also incentives related to salary increases and promotion opportunities. The
results of this situation are apparent in the unprecedented numbers of nurses taking additional
courses, programs, certificates, and other forms of instruction (Canadian Nurses Association,
2003).
Nursing leaders offer yet another important perspective on the issue of nursing education
in Ontario today. At an international conference called Embracing the Future: Educating
Tomorrow’s Nurses (October 24-25, 2002, Toronto) hosted by the Registered Nurses of Ontario
(RNAO), some 300 nurses and nurse educators shared ideas about the role of education in the

17
future of nursing. Both keynote speakers—Dr. Afaf Meleis, Dean of Nursing at the University of
Pennsylvania and Dr. Dyanne Affonso, Dean of Nursing at the University of Toronto—spoke
strongly about addressing the current crises in nursing through education (2002). Education,
Affonso pointed out, is integral to the shift that needs to happen in nursing to lift it out of its
current dysphoria or down feeling. Also according to Affonso, nursing education is important to
the achievement of safe patient care and it must occur in “new, different, and innovative” ways
(2002).
While most registered nurses are aware of the educational opportunities available to
them, accessing them can be a complex undertaking. This situation occurs because most adult
learners—and especially nurses—juggle very busy lives. For this reason, online distance
education with its flexibility around time and place is growing rapidly in popularity among
nurses. Historically, nurses have been seen as reluctant users of computers and other
technologies (Gibson & Rose, 1986). This situation changed, however, in the late 1990s, making
the combination of Internet technology and nursing education a powerful one. A distinctly
important outcome of this phenomenon is enhanced skill with computers among nurses. This is
significant as more and more nurses are being required to use the computer in their daily clinical
practice (Bachmann & Panzarine, 1998; Billing, 1999). By contrast, whether or not Internet-
based instruction supports development of nurses’ critical thinking dispositions and skills is an
area requiring further study.
Who is Ontario’s Post-RN Nurse?
Nurses represent a unique learner group within Ontario’s working population. The
principal reason for this is that nursing continues to be a female-dominated profession with the
large majority of its membership trained by Ontario’s community college system. As women,
nurses frequently hold other fulltime roles as wives, mothers, and active community members

18
(Andrusyszyn, Cragg & Fraser, 2005; Billings & Rowles, 2001; Bonk & King, 1998; Fraser,
Cragg & Andrusyszyn, 2003). One nurse-learner taking elective credits for her post-RN degree
through distance education at Laurentian University in Sudbury, ON, describes her experience
this way: “I mean I’m still struggling with the idea of studying, of committing [the] time….it’s a
struggle” (Carter & Rukholm, 2002, p. 2).
The literature calls these challenges disincentives (Leonard, 2003). In addition to those
already noted, disincentives can include financial concerns, difficulties with academic credit
transfers, non-availability of courses in areas of personal and professional interest, inadequate
access to support services, and geographic inaccessibility (Leonard, 2003).
As complex as the life and work responsibilities of nurses are the factors that influence
the implementation of new knowledge into clinical practice. For example, nurses may not make
new knowledge a priority in clinical practice if they question that the benefits of using this
knowledge are greater than the barriers associated with its implementation (Barriball, While &
Norman, 1992). Such barriers may include resistance to change among colleagues, inappropriate
infrastructure, and inadequate resources. In addition, nurses who lack positive reinforcement for
their studies from supervisors, peers, families, and others may not share their new knowledge
with peers and/or integrate this new knowledge into clinical practice. Nurses who perceive their
new knowledge as threatening to their control of nursing practice or to their values may be
reluctant to use new knowledge (Barriball, While & Norman, 1992). In other words, the nurse-
learner needs to perceive the relevance of learning to clinical practice and experience support at
several levels. This way, the nurse is likely to feel positively about what he or she is learning and
how it connects to the nurse’s work as a caregiver. Unfortunately, these circumstances and
perceptions do not always blend.
None of this is surprising given the more general principles of adult education. For

19
instance, Knowles (1975, 1980), regarded to be the author of the term “andragogy” or adult
education, refers to adult education as a process experience rather than a content event. As a
result, adult learners tend to be proactive and exhibit the characteristics of self-responsibility and
self-direction. In general, they are problem oriented and desire information that is realistic and
applicable to their lives.
Creating a setting that facilitates this kind of educational experience in a “supportive and
caring atmosphere” (Cranton, 1994, p. 197) when distance and technology are involved is a
unique challenge. For example, distance invariably complicates the development of relationships
and the intricacies of process learning. Nursing is a specialized discipline: although process
learning and community building should, ideally, be cultivated in every nursing education
setting, nursing courses may include content that makes this difficult. Faced with the choice to
foster community or to deliver content, the nursing instructor working at a distance will likely
choose the latter—he or she needs to know that students are taking away the content they need to
practise safe patient care.
Distance Education in the 21st Century: Context for Online Nursing Education
In recent years, distance education, like nursing education, has evolved quickly.
Originally conceptualized to serve the learning needs of individuals who lived at a geographical
distance from the educational provider, Western-based distance education has progressed away
from one-way correspondence-type learning and towards interaction and communication
strategies hitherto not possible (Bates, 1995, 2000). The computer, the Internet, and technologies
such as videoconferencing and web casting are the methodologies of contemporary distance
education.
Administrators in present-day distance and continuing education units across Canada
typically report that the students enrolled in their courses include two main kinds: students from

20
remote and rural areas and students from the local community (B. Brockerhoff, personal
communication, May 10, 2005). This latter group includes those who may be geographically able
to come to campus but who, for other reasons including time, cannot or prefer not to do so.
Distance, therefore, is no longer something strictly physical; instead, a more appropriate
definition of distance education speaks about barriers to education including time and lifestyle as
well as distance.
To summarize, online nurse-learners—despite obstacles such as geography and time
constraints—are seeking educational opportunities related directly to their personal and
professional learning goals. In addition to baccalaureate training, these goals include
enhancement of skills; acquisition of knowledge in specialty areas; preparation for additional
certification exams; review of theories and skills in specific areas; and acquisition of knowledge
about the future of health care (Brooks, Fletcher & Wahlstedt, 1998). Among the possible
options, online nursing education stands out for its accessibility, flexibility, and diversity.
Today’s “brand” of distance education can offer nurses many unique and flexible options
that enable the following:
⋅ learner engagement and experience with high quality learning materials and activities;
examples include notes and resources prepared by a nursing content expert, course-
and discipline-specific graphics, sound and audio clips, instructor-selected web links,
interactive demos, simulations, and so forth (Bonk & King, 1998; Harasim, Hiltz,
Tele & Turoff, 1996)
⋅ different kinds and levels of interaction through synchronous and asynchronous
strategies among students; between the instructor and the student; between the
instructor and a group of students; between a member of the learning support staff
and the student; between a member of the learning support staff and a group of

21
students; between the educational interface and the student (Billings, 1999; Bonk &
King; Carter & Rukholm, 2002; Cragg, 1994a, 1994b; Harasim et al., 1996)
⋅ multimedia-based learning resources including clinical databases and simulations
reflecting real-world practice (Billings)
⋅ opportunities for self-assessment as well as formative and summative assessment
⋅ opportunities to participate in scholarly discourse (Carter & Rukholm).
Instructional Design Issues in Online Nursing Education
As suggested in Chapter I, most learning experiences are theoretically positioned within
the context of one or more learning theories. Extrapolating to the more practical front, specific
educational sessions such as courses tend to be enabled by a practice known as instructional
design: important to this study is that online education is no exception. Regarded as procedural
frameworks for the systematic production of instruction, models of instructional design, by
definition, analyze the intended audience and assist in the establishment of appropriate learning
goals and objectives. An instructional design model provides structure and meaning to a learning
problem or challenge and, ideally, facilitates valuable and effective teaching and learning.
Recognizing that the complexities of designing for constructivist learning have led to the
development of new instructional design models and acknowledging the concerns that some
educators express about constructivist-based learning and specialized subject areas such as
nursing (Chapter I), this researcher—based on her background as an instructional designer in the
nursing education field—suggests that the more traditional instructional design models still hold
a place of importance in facilitating online nursing education. Four of the more traditional
models to instructional design that hold meaning in the online nursing domain are systems-, time-
, task-, and learner-focused models. Key experts in each of these domains and how their
respective approaches to instructional design pertain to online nursing education are considered

22
in the following paragraphs.
Systems-oriented instructional design. Instructional design that is systems-oriented
includes stages or phases. For instance, the Dick and Carey (1996) design model begins by
identifying instructional goals and ends with summative evaluation. The Hannafin Peck (1987)
model is a three-phase process including a needs assessment stage, a design phase, and a
development/implementation phase. In all phases, there is a process of evaluation and revision.
The Knirk and Gustafson (1986) model also advocates a three-stage process: problem
determination, design, and development.
Although regarded to be systems-oriented, the Kemp (1994) design model takes a more
holistic approach than other systems-oriented models. Under this model, virtually all factors in
the learning environment are taken into consideration: content, learner characteristics, learning
objectives, teaching activities, resources (computers, books, etc.), support services, and
evaluation. Two additional systems-oriented models are the Gerlach and Ely (1980) Design
Model and Tripp and Bichelmeyer's (1990) Rapid Prototyping Design Model. These latter two
models tend to be used in very specific contexts: the first within the kindergarten to senior high
school levels, and the second for discrete lessons rather than entire curricula.
Time-oriented instructional design. In this category of design theory, time is the most
important component of the instructional experience. Carroll (1963), for example, proposes that
learning is a function of time and that time is a function of two variables: opportunity to learn
and perseverance. Based on Carroll’s model, Berliner’s (1979) model emphasizes the construct
of opportunity to learn and arrangement of instructional situations.
Huit (1995) proposes that instruction is about something called output: specific
measurement or measurements of learning (e.g., student achievement, social skills, cognitive
development, etc.). Huit further examines the role of context in learning, proposing that

23
environmental or situational factors such as the home and changing global conditions influence
the measurement of educational outcomes in addition to levels of input and process variables. In
Huit’s theory, input refers to the characteristics that teachers and students bring to the
teaching/learning process. The instructional process, by comparison, involves the thoughts,
feelings, commitments, and actions of teachers and students within the classroom or learning
situation, interaction patterns, and descriptions of the learning environment that result from
interaction.
Bloom’s (1976) well-known time-oriented model goes a step further and considers the
role of attitudes in the instructional process; such attitudes include attitudes towards the subject
matter, the school, and the self as a learner. Influenced by Bloom and Carroll (1963),
Harnishfeger and Wiley’s (1976) theory focuses on background characteristics, the teaching and
learning process, and outcomes. More specifically, this model suggests that learner outcomes are
directly influenced by pupil pursuits. Teacher and learner time and personal characteristics are
key elements.
Task-oriented instructional design. Bruner’s (1966) task-focused model outlines step-by-
step procedures that facilitate learning. Acknowledged as an outgrowth of cognitive development
theory, Bruner’s theory argues for three modes of representation and points out the close
relationship between cognitive development and theories of instruction.
Gagne’s (1987) three-part, task-oriented theory of instructional design sets out conditions
by which a person can intentionally arrange for the learning of specific performance outcomes.
Based on a taxonomy, or classification, of learning outcomes, Gagne’s theory proposes internal
and external conditions necessary for achieving these learning outcomes. It offers nine events of
instruction which serve as a template for developing and delivering instructional units.

24
One of the major strengths of this model is that it values front-end analysis with emphasis
on the learner. Gagne’s (1987) model has been effectively used for the development of distance
education courses and programs.
Learner-oriented instructional design. This category of conceptual models of instruction
focuses on the learner. Instructional decisions are based on individual differences among learners
(Richey, 1986). There are two main kinds of learner-focused models.
The first one is based on adult learning principles and includes Knowles’ (1978)
instructional model. The second stems from a body of research relating to interactions that occur
between particular learner characteristics and the instructional approach. Snow’s (1977) model
falls into this latter category.
Knowles’ (1978) theory of andragogy suggests the following about the design of learning
for adults:
⋅ Adults need to know why they need to learn something.
⋅ Adults need to learn experientially.
⋅ Adults approach learning as problem solving.
⋅ Adults learn best when the topic is of immediate value.
Knowles further emphasizes several characteristics of the adult learner:
⋅ As a learner becomes older, there is movement from dependency to self-
directedness. Because of this, there can be resistance when adults are put
into learning situations where they are not allowed to be self-directed.
⋅ Because adult learners value personal experiences in learning, adult
learning situations should de-emphasize traditional teaching techniques
such as lecturing and include increased use of techniques that incorporate
learners’ experiences.

25
⋅ Adults’ readiness to learn is generally dependent on their needs and the
developmental phases of the life roles they play. These roles include
worker, spouse, parent, and other.
⋅ Instruction for the adult learner should, whenever possible, focus on
problems and applications that build on a content base. For instance, the
adult learner requires opportunities to apply what he or she is learning in
specific situations.
Given this characterization of the adult learner, it follows that adult learning is best
achieved when there is mutual planning; diagnosis of learning needs; formulation of objectives
that will satisfy these needs; identification of patterns of learning experiences; and evaluation of
learning outcomes followed by additional diagnosis of learning needs (Knowles, 1978).
Additionally, adult learners need to understand the significance behind what they are learning.
Adult learning must further take into account the vast array of different experiences that every
group of adult learners brings to the learning experience and enable individual learners to gather
rather than simply receive information (Knowles, 1978, 1984).
While Knowles’ important contribution to learning theory and design pertains to
recognition of the uniqueness of the adult learning experience, Snow’s (1977) lies in recognizing
learning as a context-specific experience. Snow has suggested that data derived from continuous
monitoring of individuals in a specific learning environment is integral to the construction and
delivery of a successful learning experience. Interpretation of such data is called knowledge of
individual cognitive processes (Richey, 1986).
Relevance to online nursing education. While learner-oriented perspectives (Knowles,
1978; Snow, 1977) are most certainly in line with the instructional experiences of web-based
nursing education, components of the other model types are also relevant. For instance,

26
designing, developing, and implementing an effective online nursing education experience when
there are large geographical distances involved requires a transparent framework with stages and
steps: this way, the instructional designer, subject matter expert, instructor, and learner are as
certain as they can be that the learner takes what is needed from the experience to meet his or her
personal and professional learning goals and to practise safe patient care. Thus, online nursing
education experiences must be carefully systematized: the multifaceted, integrated, and layered
nature of nursing practice necessitates this kind of approach to instructional design. In nursing
education, there is no room for uncertainty about achievement of learning outcomes; thus, a
rubric-oriented approach and/or a systems model is valuable in determining whether or not all
requisite components of the learning experience have been planned for and delivered.
The time- and task-oriented models are equally important in the online nursing education
context. For instance, Huit’s (1995) idea of output as specific measurement or measurements of
learning is appropriate given the goals and objectives of nursing education. In order to be sure
that nursing education is in the best interests of the nurse-learner and his or her patients,
achievement of specific educational outputs is essential. Additionally, Bruner’s (1966) and
Gagne's (1987) task-oriented frameworks are valuable when reflecting on specific areas of
nursing education that necessarily include performance-based outcomes. As noted, one of the
major strengths of Gagne’s model is its front-end analysis stage with focused awareness of the
learner. Gagne’s model, therefore, has been effectively used for developing distance education
courses and programs. In nursing education situations involving working registered nurse-
learners and distance, the importance of this kind of model is clear.
Reflecting on each of these design theories, online nursing education—by nature of the
curriculum it conveys—must utilize components from each of the major approaches to
instructional design, all the while respecting the characteristics of adult learners and their diverse

27
learning styles and preferences. When this happens and there is a skilled learning facilitator, the
impact of the learning experience on the adult learner can be positive and productive.
Instructional design solutions to pedagogical issues in online nursing education. As
already discussed, crucial to the design and delivery of all Internet-based learning environments
is instructional design, a process used to plan, develop, and evaluate instruction so that it is
efficient and effective as well as congruent with the learning theory that acts as scaffolding for
the educational exchange. Like the learning it enables, instructional design is not an event but a
process which includes “analysis, design, development, implementation, and evaluation” (Carter,
Wiebe & Boissonneault, 2002).
Brought to online nursing education, instructional design excellence can facilitate
exciting and rewarding pedagogical experiences. For example, nursing education supported by
appropriate instructional design decisions can include meaningful and effective interactivity
options; students can interact with their content, one another, the instructor, and unique learning
objects. Personal learning activities and opportunities for group sharing can be facilitated
through synchronous and asynchronous applications. Online modules including short, self-
contained learning exercises can be taken on a mix-and-match basis according to interests, needs,
and time constraints. In summary, an online nursing student who is comfortable with an Internet-
based learning environment may experience as much interaction as in a face-to-face classroom.
He or she will not, however, have to contend with the disadvantages of travelling in inclement
weather and studying according to prescriptive schedules. Such interaction—when it occurs in
some quantity and is a quality experience—is indicative of constructivist learning where the
individual learner builds an understanding of content through many avenues and encounters.
experienced over time.

28
Another area where instructional design process can play a positive role in web-based
nursing education is in identifying and facilitating opportunities for reflection (Johns, 1995,
1996) and mentoring (Meleis, 2002). Reflection and mentored experiences are important
components of all courses and programs for registered nurses (E. Rukholm, personal
communication, March 10, 2004).
Today’s new web technologies provide countless opportunities to support reflective
learning, also an identified component of constructive learning. Generally, this entails a student-
centered approach where the teacher assumes the role of the facilitator while students complete
reflection-based learning activities (Maor, 2003). Although there are valuable social and support
benefits in a networked community of learners (Vygotsky, 1978), in order to ensure that these
relationships facilitate learning around targeted curriculum, extra planning and assumption of
different roles by the teacher including “pedagogical, social, managerial and technical actions”
are generally required. These actions are best accomplished when the instructor is supported by
an instructional designer or is personally skilled in instructional design for the web environment
(Maor, 129). Even what may appear to be the simplest of online reflective activities—for
instance, threaded computer conferencing—is likely to require considerable design effort and
time. The first tasks of developing a strong conference or bulletin board are selecting topics for
discussion, implementing a cohesive strategy, and establishing participation expectations. The
instructor must also assume the role of facilitating discourse. Finally, the instructor may need to
present content, diagnose misunderstandings, and conduct assessment. Attending to each of these
responsibilities is complex and time-consuming. Yet, each is necessary if the student's learning
experience is to be rich and rewarding (Rourke & Anderson, 2002).
Historically, the mentoring relationship model was conceptualized as a personal
relationship between an expert and a student or a less experienced colleague. Often occurring

29
outside the work setting and involving few or no formal reporting structures, the mentor-mentee
relationship has been reported to enable improved clinical practice, career progression, scholarly
and research-based undertakings, and personal achievements (Mills & Francis, 2005). While the
mentorship model was initially rooted in one-to-one-relationships, it has recently undergone an
evolution and now includes activities such as team mentoring, peer mentoring, and a practice
called mentoring forward (Byrne & Keefe, 2002). Interestingly, this evolution has coincided with
the emergence of a plethora of electronic strategies designed to facilitate interactions for long-
distance relationships (Byrne & Keefe). Called telementoring or e-mentoring, this practice is
now being used by nurses in educational and professional practice settings. As an example, the
Registered Nurses Association of Ontario (RNAO) Centre for Professional Nursing Excellence,
in partnership with the Ontario Telemedicine Network (OTN), recently developed a
Telementoring Resource Kit (TMentRKit) as an outcome of the Ministry of Health and Long-
Term Care funded Teleprimary Care Demonstration Project.
While the potential of e-mentoring is impressive, the process of e-mentoring often
requires the planning and support of instructional design. With effective instructional design,
today’s registered nurse-learner studying in a web-based setting can experience mentoring
through online asynchronous discussion forums, online synchronous chatting and text
messaging, discussions enabled through web cameras, private e-mail, interactive CD-ROMS,
desktop sharing applications, and desktop videoconferencing (live and archived).
Technical Issues in Online Nursing Education
It has been well documented that the technical aspects of web-based learning can be the
source of many problems and frustrations for nursing educators and their students (Billings,
Connors & Skiba, 2001; Cragg, 1994a, 1994b; Ryan, Hodson-Carlton & Ali, 1999). At the same
time, it has been suggested that learning to use technology and overcoming technical problems

30
increase a student’s proficiency with computers, a skill documented as a positive outcome by
both students and faculty (Cragg; Conry, 1998).
In an early study of graduate-level nursing students’ perceptions of traditional classroom
teaching methods versus course delivery via the Internet, Ryan, Hodson-Carlton, and Ali (1999)
found that web-based learning technologies perform several functions: first, they deliver course
content. Furthermore, they provide the added benefits of a student learning how to combine
nursing information with computer technology and improvement of technical and writing skills
(Billings & Bachmeier, 1994; Schlosser & Anderson, 1994). Another benefit of computer-based
learning may be an enhanced sense of self in the clinical setting. Madorin and Iwasiw (1999)
examined the effect of computer-assisted instruction (CAI) on baccalaureate nursing students’
sense of self-efficacy in caring for surgical patients in the clinical environment. They found that
students who had participated in computer-assisted instruction (CAI) (n=11) had higher self-
efficacy scores than those who did not (n=12). Madorin and Iwasiw (1999) also claim that the
knowledge acquisition, retention, and decision-making skills of students using computer-assisted
instruction (CAI) are equal to those of students who experience more traditional teaching and
learning strategies including lecture, role playing, and printed instruction (Cohen & Dacanay,
1994; Day & Payne, 1987; Droste-Bielak, 1986; Gaston, 1988; Hamby, 1986; Neil, 1985).
Because the benefits of Internet-based instruction are generally perceived to outweigh its
technical problems, those involved in distance education for nurses have moved quickly to
incorporate web-based strategies into their courses and modules of study. There are no signs that
this will lessen in the foreseeable future.
Human Supports in Online Nursing Education
Although distance education in its contemporary configuration (Bates, 1995, 2000) shows
enormous potential for supporting superior learning opportunities for nurses, the practical

31
experience of the nurse-learner can be quite different from the theory. For instance, appropriate
technology application continues to be a major issue in contemporary distance education. The
fact that a technology exists does not in any way suggest its suitability for education. Some
experts in the technology field such as Stoll (2002) argue that technology and education are not
an appropriate mix at all. In Stoll’s opinion, parents and educators need to think carefully about
the beneficiaries of “wired” educational experiences and whether or not computers enhance
learning in contrast with simple information gathering.
In addition to the general pedagogical and technical complications that technology-
assisted education raises, issues exist around the readiness of the learner to manage technology.
This latter problem applies especially to adult learners and, according to some experts, to women
in particular. Burge (2000) says that many female learners “don’t have the time or the inclination
to spend time trying to conquer the finer points of a software program” (p. 34). Similarly,
awareness that women’s learning needs are different from those of men and that the female need
for connectedness in contrast with special technical effects indicates a gender-based “difference
in learning style not [a] deficit in cognition” is important (Burge, 2000, p. 30). A skilled
instructional designer will acknowledge these factors and make design choices that respect the
student as a working professional who may also be a wife, mother and community member with
limited interest or skill in educational technologies.
While Internet courses can now support multimedia applications that do not require
extensive bandwidth through technologies such as caching servers and can deliver learning
experiences that are oral and synchronous in nature in contrast with experiences that are
asynchronous and text-based, it is anticipated that, for some time, many college and university
online courses will be mainly text-based. In part, this is due to the time and financial investments
that colleges and universities made in the early days of online education when the web became a

32
repository for information and language-based learning activities. Thus, until there is sufficient
organizational will to offer learners web-based education that is rich in multimedia, web-based
education is likely, in many instances, to be reading and writing intensive.
Courses that are word-based make demands on learners’ keyboarding, reading, and
writing abilities. At the same time, in the domain of the post-RN nurse, web-based courses that
are principally asynchronous and word based offer access and flexibility that other kinds of web-
based courses might not. For example, live web casting and synchronous desktop sharing
sessions would require the post-RN nurse to be present at particular times to take in lessons or
tutorials. Because of the complexity of this nurse’s personal and professional schedule, this could
be logistically difficult to do. On a different but related note, if a nurse is trying to complete
course work from the workplace, many computers in hospitals and healthcare settings do not
include sound cards. The project team for a recent stroke education and research project offered
by the West Greater Toronto Area (GTA) Stroke Network to nurses working in northeastern and
northwestern Ontario discovered that nurses wanting to access live and archived web casts
generally had to make special technical arrangements due to firewall restrictions in hospitals
(M.Wheelwright, private communication, April 10, 2006). For these reasons, Ontario’s distance-
based nurse practitioner program—a program that began in 1995 involving ten schools of
nursing from ten Ontario universities and that has experienced several iterations and utilized
various technologies—remains, in general, an asynchronous reading- and writing-based program
(Andrusynzyn, Cragg & Humbert, 2001; Humbert & Doucette, 2006).
The consequence of all these factors is that many post-RN nurse-learners will likely
require support at several levels above and beyond the general support extended by family and
work colleagues. The first of these supports relates to technical assistance. If a learner is
burdened with repeated technical difficulties, learning about nursing may be low and frustration

33
with the web experience high. A second crucial member of the support team is the learning
facilitator. Nursing educators must be knowledgeable not only in their subjects but also in
nurturing relationships and mentoring in a technologically-mediated world. They must be willing
to be “present” in their students’ online world on a regular basis and in ways that distance
facilitators in the past were not required to be. Today’s distance instructors must be on line
regularly so that ideas are challenged, reconfigured, and tried again. Such strategies necessarily
demand a rethinking of pedagogical principles and practices. Faculty, therefore, often require
training in the pedagogical possibilities and applications of educational software programs.
Other areas where support may be required for the registered nurse-learner include
academic writing and independent learning strategies. University-level writing can be a new
experience for many registered nurses; hence, writing samples and resources that diffuse anxiety
around the writing experience and encourage development of nursing-specific writing skills are
recommended. As the majority of registered nurses will have not completed university-level
studies before starting their baccalaureate studies, they will also require support in information
gathering and electronic library skills.
Another Position on Technology-enabled Education
Although there are many supporters of computer-assisted learning, there are important
criticisms of it that merit acknowledgement. These concerns cluster into two main categories:
return on investment and the learning experience itself.
In the literature, there is a voice that suggests that not all teachers and educational
administrators are convinced that the financial and training investments that this kind of teaching
and learning requires—including the purchase of equipment and software as well as the training
of faculty and sometimes students—is worth it. Peslak (2005) describes how, in many cases, the
investment in instructional technologies is high whereas the evidence of productivity in the form

34
of “better educated students” is scarce (p. 112). Similar sentiments have been expressed by
Jochems (2003), Krueger (2000), and Papanastasion (2003). For instance, Papanastasion reports
how computers are neither positive nor negative influences on student achievement in science.
Rather, the critical factor is how computers are used which depends directly on what the
involved institution is prepared to invest in faculty training. On a related note, Jochems argues
that today’s teachers are oftentimes required to be web designers if they hope to navigate the
world of online learning successfully and that this puts investment pressure on all stakeholders.
Krueger describes the negative effects of hypermodern technology on productivity and program
development. Krueger, like Peslak, suggests that there is little evidence that more or better
educational outcomes are being achieved through technology. Finally, Rodrigo (2003) suggests
that access to technology is often a problem and that this undermines the view held by many
educators that computer-based learning and other interactive communication technologies are
“catalysts for transformation” (p. 100). For some, this lack of access with its roots in
socioeconomics is indicative of an ever-growing digital divide (Attewell, 2001).
Of concern for others is the learning experience itself. In the opinion of McLester (2005),
computers tend to be found in poor city inner schools; by contrast, the best jobs and places in
college classes go to students who have been fully teacher taught. Specific to online education is
the observation that many students do not know how to approach online resources in a blended
learning experience so as to maximize the experience. As a result, the authenticity and active
learning components of online case-based learning may be diminished (Ellis, 2005). Another
reservation expressed about online learning is that it may erode the learner’s ability to experience
narrative (Gordon, 2005; Johnstone, 1991). Other dissenters suggest that Internet-based
education fosters student isolation and that, while it may support the development of intellectual
skills, it hampers interpersonal skills (Dede, 1991).

35
Critical Thinking in the Postsecondary Educational Context: Skills, Dispositions, and
Measurement
During the last century, critical thinking became an area of special educational interest,
tracing directly to the work of philosopher John Dewey who wrote on the centrality of critical
thinking in the educational experience (Dewey, 1933). Going back further, critical thinking can
be traced to the Greek philosophers including Socrates, Plato, and Aristotle. Socrates, for
instance, embraced the questioning critical attitude (Furedy & Furedy, 1985); Plato maintained
that education should encourage students to question, examine, and reflect on ideas and values
(Aune, 1967); and Aristotle pointed out the relationship between thinking and the intellect
(Oswold, 1962).
Much more recently, in the mid- to late-twentieth century, the concept and practices of
critical thinking emerged in the work of, among others, Kitchener and King (1990), Paul (1993),
Perry (1970), and Sternberg (1985). Because of a distinct surge of interest in critical thinking in
the 1980s, that decade saw gravitation toward the idea that, at the heart of education, lie the
processes of inquiry, learning, and thinking rather than mere accumulation of skills and
information. By the decade’s end, at least in the Western educational world, the movement to
infuse both public school and postsecondary school curricula with critical thinking (CT) content
and activities had gained remarkable momentum.
Just as the interest in critical thinking grew rapidly in the latter part of the twentieth
century, so too did the confusion regarding what critical thinking means. Key points related to
some dominant understandings of critical thinking of contemporary time are identified in Table 1.
While all of the different understandings of critical thinking are important in contemporary
times, most relevant to this study are the understandings offered by the American Philosophical.

36
Table 1
Understandings of Critical Thinking in the Late 20th Century
Understanding Source
deciding what to believe or do based on reasonable,
reflective thinking
Ennis, Millman & Tomiko, 1985
critical thinking…being appropriately moved by reasons
and…to generate and seek out good reasons
Siegel, 1988
to think critically is to examine assumptions, beliefs,
propositions and the meanings and uses of words,
statements, and arguments
Bandman & Bandman, 1988
reflective thinking Brookfield, 1987; Mezirow, 1981,
1990; Watson & Glasner, 1980
a productive and positive intellectual activity…a
process…varies according to context
Brookfield, 1987
a process of purposeful, self regulatory judgment, which
results in interpretation, analysis, evaluation, and
inference, as well as explanation of the evidential,
conceptual, methodological, criteriological contextual
considerations upon which that judgment is based
American Philosophical
Association (APA), 1990
Note: From “Teaching and measuring critical thinking,” by S. Staib, 2003, Journal of Nursing
Education, 42(11), p. 502.

37
Regarding the former view of critical thinking, in 1987 through a Delphi project
involving a group of American and Canadian scholars, the American Philosophical Association
(APA) brought together 36 cross-disciplinary theoreticians from throughout North America to
develop a conceptual definition of the ideal critical thinker. Based on the project’s results, the
ideal critical thinker is inquisitive; informed; trustful of reason; open-minded; flexible, fair-
minded in evaluation; honest in facing personal biases; prudent in making judgments; willing to
reconsider; clear about issues; orderly in complex matters; diligent in seeking relevant
information; reasonable in the selection of criteria; focused in inquiry; and persistent in seeking
results which are as precise as the subject and the circumstances of inquiry permit (Facione,
Facione & Giancarlo, 2000).
By comparison, those who maintain that critical thinking involves reflection suggest that
the critical thinker is one who possesses the ability to handle change; to rethink habits; to
participate in self-examination of behaviours and ways of thinking; to create alternatives; to
think things through; to do strategic planning and goal setting; to demonstrate specific
intellectual and personal traits; and to reflect on the consequences of decisions (Brookfield,
1987; Merriam & Caffarella, 1999; Paul, 1993).
As a nonlinear, recursive cognitive process involving interpretation, inference,
explanation, evaluation, and self-regulation (APA, 1990), critical thinking frequently occurs in a
unique contextual situation. An important means, therefore, of measuring a person’s skill as a
critical thinker is the context-based test (Norris & Ennis, 1989; Pascarella & Terenzini, 1991;
Pendarvis, 1996). Unfortunately, a major confounding variable with this kind of test is that the
testee’s score is likely to be affected by prior knowledge of the discipline or a specific
application. Validation of the testee’s critical thinking skills can be problematic: for instance, in
the case of nursing, a context-specific measure of a nurse’s critical thinking skills could only be

38
validated by direct observation of the nurse in practice. Thus, while context-based tests of critical
thinking exist, they are generally expensive to develop and problematic to validate.
At the same time, there are a variety of standardized instruments available on the market
dedicated to the measurement of critical thinking in a more generalized way. Some of the more
popular of these tests with relevant commentary as they pertain to assessment for critical
thinking in nursing are noted in Table 2. While the tests noted in Table 2 depend largely on
multiple-choice test items, many critical thinking experts argue that multiple-choice items are not
always the most appropriate way to measure critical thinking skills. Some qualitative means of
assessing critical thinking include asking a learner to analyze a situation (Oermann, Truesdell &
Ziolkowski, 2000); evaluating student-prepared portfolios, reflective journals (Ibarreta &
McLeod, 2004); evaluating learning exercises based on narrative pedagogies (Ironside, 2003);
and so forth. While all of these qualitative techniques have a place in nursing education,
reflective journals and learning activities built on narrative pedagogies are especially relevant to
this study.
Repeatedly, the nursing education literature describes the use of reflective journals and
narrative pedagogy as ways of developing personal and professional confidence and awareness
as a clinician. This should not be surprising given the prominence that reflective practice holds in
the field in general (Daroszewski, Kinser & Lloyd, 2004; Kennison & Misselwitz, 2002; Kessler
& Lund, 2004).
Journaling by nurse-learners can take several forms: for instance, it can involve an
intimate relationship with an expert nurse such as occurs when journal entries are submitted for
instructor feedback. It can also involve a collaborative relationship with peers: for instance, one
student shares a significant experience with classmates who then assist the presenting student in
making connections and identifying salient points. In both cases, reflective writing offers nurses

39
Table 2
Popular Standardized Tests Used to Measure Critical Thinking
Test Comment
Watson-Glaser Critical Thinking Appraisal
(WGCTA)
one of the most widely used standardized tests;
an 80-item, self-administered test; for pre
and postadministration; includes problems
and arguments similar to those found in
nursing situations; possible test bias; lack
of cross-validation studies
California Critical Thinking Skills Test
(CCTST)
frequently used by schools of nursing although
does not contain discipline-specific
content; assesses, via 34 multiple-choice
items, the skills of analysis, inference, and
evaluation; is an outcome of the 1987
Delphi project; some indications of
cultural bias
Ennis-Weir Critical Thinking Essay Test uses written essays to evaluate argument;
generally not used in nursing or nursing
education situations

40
Test Comment
Collegiate Assessment of Academic
Proficiency (CAAP)
Focuses on five areas: reading, writing,
mathematics, science reasoning, and
critical thinking; uses multiple-choice
questions that respond to short essays;
limited to ability to analyse, clarify,
evaluate, and extend argument
Minnesota Test of Critical Thinking builds on the APA definition and measures
critical thinking skills and dispositions; has
been suggested that it will benefit from
further testing and revision
National League for Nursing (NLN)
Critical Thinking in Clinical Nursing Practice
Recently developed as a response to the claim
that existing tools are not specific to the
context of nursing; are plans to use this
test in conjunction with other tests to
measure the critical thinking of graduating
students
Indirect Measures of Critical Thinking
evaluates nursing knowledge, comprehension,
application, and analysis
Note: From “Teaching and measuring critical thinking,” by S. Staib, 2003, Journal of Nursing
Education, 42(11), pp. 504-506.

41
opportunity “to reflect on their practice, explore reactions, discover relationships, and connect
meanings to past experiences” (Kennison & Misselwitz, 2002, p. 239). Burrows (1995) suggests
that reflective writing provides students the occasion to describe significant events as they
understood them, explore their affective responses to these experiences, and answer three
questions: What have I learned from this experience?; How would I behave given a similar
situation?; In what ways do nursing and related theories explain the situation? As a kind of
dialogue, this experience, according to Burrows, can elicit candid self-evaluation in addition to
strategies for self-correction and future action. Written reflective exercises with appropriate
structuring and feedback have also been reported to enhance critical thinking skills (Brown &
Sorrell, 1993; Ibarreta, 2004; Kennison & Misselwitz; Sedlak, 1997). According to Sedlak,
“reflections prompted students to think critically about their experiences and facilitated self-
directed learning as students developed skills as professionals” (p. 16). Both critical thinking and
self-directed learning as identified by Sedlak (1997) are elements in the adult education
literature.
Narrative pedagogies align closely with the technique of reflective writing. Ironside
(2003) points out that it is vital to redirect nursing education units from the quest of finding
effective strategies for teaching critical thinking to consideration of the underlying assumptions
that inform and characterize teaching and learning strategies. This new focus will, in turn,
influence students’ thinking experiences. In order to make this shift, Ironside (2003) argues that
teachers and students should be encouraged to engage in “converging conversations wherein
many perspectives can be considered” (p. 510). Such convergence as it requires questioning,
perspectival openness, uncertainty, and fallibility can be effectively facilitated in the online
learning setting where the voices and narratives of learners and their mentors can come together
through the written word.

42
In the context of the post-RN nurse, the opportunity to grow as a reflective clinician and a
writer in nursing through web-based educational settings is important. As the literature suggests,
there is a demonstrated connection between reflection and clinical decision making
(Daroszewski, Kinser & Lloyd, 2004; Kennison & Misselwitz, 2002; Kessler & Lund, 2004) and
between reflection and writing (Brown & Sorrell, 1993; Ibarreta, 2004; Kennison & Misselwitz;
Sedlak, 1997). Additionally, although there may be a perception among non-nurses that nurses
do not do a great deal of writing, this is untrue. Nursing involves the use of many kinds of
written communication: reports, articles, policies, procedures, patient case notes, charts, and so
forth. Thinking more broadly, nursing is a field that requires nurses to use their communication
skills, written and oral, “to promote consistent quality care, maintain continuity of care, to
demonstrate critical thinking that accompanies the use of nursing process, to establish
accountability for care, and to develop nurse-patient and nurse-colleague relationships” (Poirrier,
2000, 3-4).
Baccalaureate-educated nurses have other reasons for pursuing excellence in written
communication. According to the web site of the Canadian Nurses Association, today’s nurse is
required to provide evidence-based practice and integrate findings into practice as well as be a
team player, “working with other health professionals including dieticians, midwives,
occupational therapists, pharmacists, physicians, physiotherapists, and speech therapists” (2003).
As a result of these requirements, superior written and oral communication skills are more
important in nursing than ever before. Finally, because baccalaureate nurses may assume
positions as administrators, managers, educators, and researchers and/or pursue graduate-level
studies, competence in writing is essential (Spears, 1996).

43
Dispositions Towards Critical Thinking or Habits of Mind
The literature on critical thinking dispositions wears several guises: for example, some
educators and researchers use the term “mindfulness” while others refer to a “critical spirit.”
Regardless of the vocabulary used, the literature tends to suggest agreement on the idea that
critical thinking dispositions are innate traits, not to be confused with critical thinking skills. A
second key point made in the literature is that, while there is disagreement on whether or not
critical thinking dispositions should be taught, there is consensus that critical thinking
dispositions can often be nurtured or cultivated. This claim, in turn, leads to the question of how
such dispositions can be measured.
In addition to providing the basis for the development of the California Critical Thinking
Skills Test (CCTST), the 1987 Delphi project led to the development of the California Critical
Thinking Disposition Inventory (CCTDI), a test that measures seven discrete critical thinking
dispositions. According to Facione, Facione and Giancarlo (1998), a disposition towards critical
thinking is a dimension of personality or characteristic that indicates the likelihood that a person
will approach problem framing and solving using reasoning. Thus, a person’s overall disposition
towards critical thinking is a person’s consistent internal motivation to embrace problems and
make decisions by using thinking (Facione et al.).
The reasons for measuring a person’s dispositions towards critical thinking are several:
first, a relationship between critical thinking disposition and critical thinking skill has been
demonstrated (McCarthy, Schuster, Zehr & McDougal, 1999). In practical terms, this means that,
if an instructor and his or her student know something about the student’s innate dispositions
towards critical thinking, then the challenges of the instructional situation may be better managed
than they might otherwise be. Knowledge about dispositions towards critical thinking, therefore,
may increase the chance of an effective educational exchange.

44
A second reason for measuring the learner’s dispositions towards critical thinking is that
there is evidence to support the claim that, if a person is disposed to a particular critical thinking
element, he or she will be motivated to cultivate this element (Bartlett & Cox, 2000; Facione et
al., 1998). As already suggested, the position that critical thinking dispositions are innate does
not mean that they cannot be enhanced or nurtured. To the contrary, knowing about natural
strengths and weaknesses may stimulate a person to take proactive measures to develop the
former and compensate for the latter.
Finally, it has been suggested that, without positive critical thinking dispositions, critical
thinking applications may be substandard (Profetto-McGrath, 2003a). Hence, in the educational
setting, it is important to gather information about learners’ critical thinking dispositions so that
learners and their teachers can take steps to enhance the learning experience based on that
knowledge. From the instructor’s perspective, this awareness may assist him or her in
determining appropriate educational interventions.
As already noted, the California Critical Thinking Disposition Inventory (CCTDI) was an
outcome of the 1987 Delphi project. Its focus is measurement of a person’s innate dispositions
towards critical thinking applications. Specifically, the CCTDI includes 75 Likert scale items
designed to reflect seven discrete critical thinking dispositions: these dispositions are
truthseeking, openmindedness, analyticity, systematicity, critical thinking confidence,
inquisitiveness, and maturity (Table 3).
As a response to the 1987 Delphi study, Scheffer and Rubenfeld (2000) replicated the
original APA study attempting to find consensus about the meaning of critical thinking for
nursing. Their work led to the following description of the ideal nurse-critical thinker:
Critical thinkers in nursing exhibit these habits of mind: confidence, contextual
perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition,

45
Table 3
Seven Subscales of the California Critical Thinking Dispositions Inventory
Disposition Description
Truthseeking Measures intellectual honesty, the courageous desire for best knowledge
in any situation, the inclination to ask challenging questions and to
follow the reasons and evidence wherever they lead.
Openmindedness Measures tolerance for new ideas and divergent views.
Analyticity Measures alertness to potential difficulties and being alert to the need to
intervene by the use of reason and evidence to solve problems.
Systematicity Measures the inclination to be organized, including focus, diligence and
perseverance.
Critical thinking
confidence
Measures trust in one’s own reasoning and ability to guide others to
make rational decisions.
Inquisitiveness Measures intellectual curiosity and intention to learn things even if their
immediate application is not apparent.
Maturity Measures judiciousness which inclines one to see the complexity in
problems and to desire prudent decision-making, even in uncertain
conditions.
Note: From California Critical Thinking Disposition Inventory (pp. 2-3), by P.A. Facione, N.C.
Facione, and C. Giancarlo, 2001, Millbrae, CA: California Academic Press.

46
openmindedness, perseverance, and reflection (Scheffer & Rubenfeld, 2000, p. 7).
A key difference between the original APA definition and its focus on seven dispositions
and the Scheffer and Rubenfeld (2000) definition is that the latter identifies ten different habits
of mind rather than seven. This difference noted, there is solid correspondence between the
Facione et al. (1998) list and seven of the ten attributes on the Scheffer and Rubenfeld list. Two
of the three additional attributes—creativity and intuition—fall into the affective domain, an area
not specifically referred to by the APA definition. The last habit of mind is reflection. While the
researcher does not dispute that an effective nurse is likely to be intuitive and creative in her
work, it is suggested that these characteristics which are challenging to measure in any context
are very difficult to assess in nursing. Thus, while the Scheffer and Rubenfeld study is an
important one, it has its limitations, and, to date, no tool has been developed to test the ten habits
of mind identified in it.
A second noteworthy point regarding the two studies is that, in Scheffer and Rubenfeld
(2000), reflection is cited as a discrete habit of mind indicative of critical thinking in nursing.
There is no question that being reflective is a highly desirable characteristic in a nurse; at the
same time, within the critical thinking literature, reflection is frequently regarded to be a tool
and/or supporting structure (Ford & Profetto-McGrath, 1994; Schon, 1983; Shor & Friere, 1987).
According to Duchscher (2003), reflection is that which goes “beneath the superficial structure
of the situation to reveal the underlying assumption that constrains action” (p. 24) while,
according to Johns (1995, 1996), structured or guided reflection is a tool that can enable critical
thinking.
It is acknowledged then that the CCTDI does not investigate creativity, intuition, and
reflection in particular ways. Regardless, the CCTDI was selected as an appropriate tool for this
research project. Most importantly, this is because, as previously noted, there is no tool like the

47
CCTDI to measure Scheffer and Rubenfeld’s (2000) ten habits of mind. Additionally, the
researcher chose to use the CCTDI in combination with other data collecting strategies in order
to compensate for any shortcomings it might have. Scoring and analysis of writing samples is
one such strategy and has precedent in the nursing education literature (Andrusyszyn & Davie,
1997).
Another reason for using the CCTDI for this project is that it focuses on dispositions that
are highly valued in a wide variety of leadership positions and occupational fields. For example,
some nurses returning to study at the baccalaureate level may choose to continue their studies at
the graduate level; graduate programs in nursing and the health sciences are springing up quickly
at Ontario universities. The critical thinking dispositions articulated by Facione et al. (1998) will
clearly be an advantage to these nurses and others who work in administrative and leadership
roles. Finally, by using a tool that assesses critical thinking from a more general perspective in
contrast with a tool based on the Scheffer and Rubenfeld (2000) definition, there are potential
benefits for all universities that support online learning. For instance, the lessons learned from
this project may have some applicability to other disciplines and professional schools within the
university community at large.
While some nursing educators and researchers may have reservations about the CCTDI
because it does not measure all the personal characteristics for nursing-specific critical thinking
identified by some nursing theorists (Stone et al., 2001), there is much support for using the
CCTDI in health education contexts. For example, the CCTDI is presently being used throughout
the health education fields. In Canada, for instance, Profetto-McGrath (1998) used both the
CCTST and the CCTDI with a group of baccalaureate nurses as part of her doctoral study with
the University of Alberta. She reported that participants scored highest on the critical thinking
disposition of inquisitiveness and lowest on truthseeking. This finding is important as it suggests

48
how baccalaureate nurse-learners may or may not critique the information they receive for its
relative truth.
The CCTDI is also being used by the health sciences faculties at the University of
Western Ontario and McMaster University. Based on their work with physiotherapy students,
Bartlett and Cox (2000, 2002) from the University of Western Ontario reported that
physiotherapy students scored highest on openmindedness and inquisitiveness, and lowest on
truthseeking and critical thinking self-confidence. Based on these findings, the researchers
suggested that the curriculum of the university’s physiotherapy program appears to focus on the
enhancement of certain dispositions, perhaps to the detriment of others. This point was further
made in a telephone conversation that this researcher had with Dr. Bartlett in July, 2004. During
this conversation, Dr. Bartlett revealed that the physiotherapy program at the University of
Western Ontario continues to use the CCTDI, and that she believes that it is a very useful tool,
particularly for what it suggests about learners and truthseeking. The reason that truthseeking is
so important to educators and researchers in the health sciences, Dr. Bartlett indicated, is that
truthseeking is the basis of evidence-based practice. Other benefits of using the CCTDI with
learners studying in the health sciences include its possible role in career counselling, curriculum
reform, and interdisciplinary education (Bartlett & Cox, 2000, 2002). Additional work in the
health sciences where there is use of the CCTDI is described in Table 4.
Because of the complexity of the previous discussion, it is timely to step back and re-visit
the general purpose of this research project, clarify certain relationships, and declare its
theoretical framework As an overarching goal, the researcher is interested in understanding
possible connections among critical thinking dispositions and skills; writing; and the online
educational setting. The strategies proposed to explore these areas of interest and possible
meanings are presented in Table 5. In addition, since there are differences between the

49
Table 4
Studies and Articles About the Use of the CCTDI in the Health Sciences
Author/Researcher/Title Observation
Facione, N.C., & Facione P.A. (1997).
Critical thinking assessment in
nursing education programs: An
aggregate data analysis. Millbrae,
CA: California Academic Press.
Examined CT dispositions among 145 predominantly
undergraduate samples at 50 programs of nursing
education programs throughout the United States
(n=7, 926).
Significant relationships revealed between two
measures of critical thinking (the CCTST and the
CCTDI) and a wide variety of academic
achievement indicators.
Modest cross-sectional increases and longitudinal
gains demonstrated in critical thinking skills and
habits of mind. Strength in scores tended to occur
in programs where nursing faculty reported being
engaged in discussions about critical thinking.
Disposition scores were higher for BScN stream
students than for generic (college level) students.
This discrepancy raised concerns about curriculum
for students studying in generic programs. This
study is the largest aggregation of CT skills and
dispositions test data to date.

50
Author/Researcher/Title Observation
Colucciello, M.L. (1999). Relationships
between critical thinking dispositions
and learning styles. Journal of
Professional Nursing, 15, 294-301.
Examined relationship between CT dispositions and
learning styles of baccalaureate nursing students.
Used the CTTDI and Kolb’s Learning Style
Inventory. Relationships were demonstrated
between specific CT dispositions and learning
modes.
Leaver-Dunn, D., Harrelson, G.L., &
Malissa, M., & Wyatt, T. (2002).
Critical thinking predisposition
among undergraduate athletic
training students. Journal of Athletic
Training, 37(4), 47-151.
Used the CCTDI to assess 91 students in
undergraduate athletic training education
programs for tendency to think critically.
Participants showed a general but weak trend
towards CT. The study suggests that classroom
and clinical instructors need to assess and
possibly change teaching methods to better
facilitate CT by students.
Profetto-McGrath, J., Hesketch, K.L.,
Lang, S., & Estabrooks, C.A. (2003).
A study of critical thinking and
research utilization among nurses.
Western Journal of Nursing
Research, 25(3), 322-227.
Investigated relationship between CT disposition
scores and research utilization habits. Results
found positive correlation between CT
disposition score and overall research utilization.

51
Author/Researcher/Title Observation
Rapps, J., Riegel, B., & Glasser, D.
(2001). Testing a predictive model of
what makes a critical thinker.
Western Journal of Nursing
Research, 23(6), 610-626.
Examined if knowledge base, CT skills, CT
dispositions, and experience predict the cognitive
development of nurses. The three levels of
cognitive development studied were dualism,
relativism, and commitment. CT dispositions
contributed to all three levels of cognitive
development.
Ip, W.Y., Lee D.T., Lee, I.F, Chau, J.P.
Wootton, Y.S., Chang, A.M. (2000).
Disposition towards critical thinking:
A study of Chinese undergraduate
nursing students. Journal of
Advanced Nursing, 32, 84-90.
Examined dispositions among 122 Chinese
baccalaureate nursing students. Showed a
negative disposition among the majority of the
sub-scales.
Also revealed a significant relationship between CT
dispositions and grade point average.
Implications for nursing education, curriculum,
and research delineated.

52
Table 5
General Progression of Research Project
Pre Experience Post Data
1. CCTDI Online, distance-based,
university-level course
with reflective writing
1. CCTDI 1. CCTDI scores
2. Demographic
data and self-
perceptions
related to
online
learning
2. Participants’
perceptions
2. Scores given to
bulletin board
postings; writing
analyzed for
strengths,
weaknesses, and
themes
3. Interviews 3. Interview data
4. Researcher’s
observations of
bulletin board
activity
4. Researcher’s
observations of
bulletin board
activity

53
dispositions of the APA definition which is used in this study and the ten habits of mind for
nurses suggested by Scheffer and Rubenfeld (2000), a comparison of similarities and differences
and an itemization of how each disposition will be examined in found in Table 6.
Finally, acknowledging theory as that which assists the researcher in deciding what he or
she will observe and keeps the researcher on track, the reseacher has chosen constructivist
learning as the theoretical architecture of the study. By comparison, the context of the study is an
online learning setting where specialized content is involved. Considering the study at yet
another level, it brings together a variety of elements indicative of constructive learning
including reflection through writing (Brown & Sorrell, 1993; Ibarreta, 2004; Kennison &
Misselwitz; Sedlak, 1997); andragogy (Knowles 1975, 1980), and critical thinking (Brookfield,
1987; Mezirow, 1981, 1990; Watson & Glasner, 1980; APA, 1990). In summary then, the study
is—as a consideration of online learning as a subset of distance learning—knowledge-,
community-, and learner-centered (Anderson, 2004). Possible meanings based on anticipated
findings are found in Table 7.
More about the Context of Critical Thinking and Western-based Nursing
Situating the principles and practices of contemporary critical thinking within Western
nursing education requires consideration of what has been described as a major paradigm shift.
Watson (1999), in her seminal work on paradigms and worldviews in nursing, points out how
nursing during the twentieth century was shaped largely by themes and concepts including
objectivity, rationality, technology, and positivist reasoning. Because of these themes and
concepts, nurses tended to be trained rather than educated; in addition, the profession of nursing
was seen principally as a subset of medicine rather than as a discipline or profession in itself.

54
Table 6
Connections between Dispositions Towards Critical Thinking (CCTDI, 2001) and Habits of
Mind (Scheffer and Rubenfeld, 2000) and Assessment Strategies
CCTDI (2001) Scheffer and Rubenfeld (2000) Assessment strategy
Truthseeking Perseverance
Flexibility
CCTDI
Reflective writing
Openminded-
ness
Openmindedness CCTDI
Reflective writing
Analyticity
Intellectual integrity CCTDI
Reflective writing
Systematicity
Intellectual integrity CCTDI
Reflective writing
Critical
thinking
confidence
Confidence CCTDI
Reflective writing
Maturity Contextual perspective CCTDI
Reflective writing
Inquisitiveness
N/A
Creativity
Openmindedness
CCTDI
Reflective writing

55
CCTDI (2001) Scheffer and Rubenfeld (2000) Assessment strategy
N/A Intuition Reflective writing
N/A Reflection For the purposes of this project, reflection
is understood to be a foundation for
and a tool of critical thinking.
Additionally, reflective writing is
understood to be a cognitive and
affective (creative, intuitive)
experience. It is an action in contrast
with a disposition.

56
Table 7
Possible Meanings in the Event of Significant Change and No Significant Change
Significant change in one or more dispositions:
Possibilities
No significant change: Possibilities
…online nursing courses that use reflective
writing as a central communication and
learning technique can facilitate positive
changes in nurse-learners’ dispositions
towards critical thinking…
…the curriculum and/or instructional design of
an online course do/does not influence the
development of dispositions towards
critical thinking…
…the sample group―because of its area of
study―is more open to changes in
dispositions towards critical thinking than
other learners…
…changes in critical thinking dispositions take
longer to occur than a four-month
period…
…collaborative thinking and writing in the
“semi-public” forum of an Internet-based
course raise the “critical thinking bar”…
…more supports for and models of reflective
writing and critical thinking through
writing are required to support growth in
critical thinking dispositions…

57
In contrast, when Watson (1999) speaks of contemporary or postmodern nursing, she sees
it as embracing multiple truths, nonlinearity of thinking and acting, and a sense of human caring.
Following from this idea that postmodern nursing has entered “an historical period of
transitions” (Watson, 1999, p. 5), it is logical that contemporary nursing education is in a state of
radical change. Muff (in Watson, 1999) emphasizes how, in the past, nursing education was
physically removed from mainstream education by social institutional forces. This led to nursing
education patterns with specific models, theories, and language that contributed to nurses’
alienation from coworkers. As suggested earlier, contemporary nursing education for registered
nurses in the province of Ontario, as well as most other provinces in Canada and states in the
United States, involves a university degree, thereby placing nursing education within a setting
that, by its nature, demands critical thinking of learners.
Central to understanding early twenty-first century nursing and nursing education in
Canada and the United States is the definition and social policy statement about nursing first put
forward by the American Nurses’ Association in 1995. Attesting to the changing nature of
nursing and its continuous experience of redefinition, the ANA definition, in an important
postscript, sets out four features as essential components of contemporary nursing:
Since 1980, nursing philosophy and practice have been influenced by a greater
elaboration of the science of caring and its integration with the traditional knowledge
base for diagnosis and treatment of human responses to health and illness. As such,
definitions of nursing more frequently acknowledge four essential features of
contemporary nursing practice:
⋅ attention to the full range of human experiences and responses to health and
illness without restriction to a problem-focused orientation.
⋅ integration of objective data with knowledge gained to form an understanding

58
of the patient’s or group’s subjective experience.
⋅ application of scientific knowledge to the processes of diagnosis and
treatment.
⋅ provision of a caring relationship that facilitates health and healing.
(American Nurses Association, 1995, as found in Watson, 1999)
Because of these changes within clinical nursing practice and nursing education and the
very high pace of contemporary nursing practice due to cutbacks, shortages, and technology, it
follows that nurses must possess dispositions that enable them to think critically and efficiently.
Thus, in nursing today, critical thinking dispositions and skills are essential work strategies and
transferable skills.
While the connection between the state of present-day nursing and the need for nurses to
be competent critical thinkers is straightforward enough, the specific literature on critical
thinking and nursing is, at best, complex. Table 8 points out some of the inconsistent and
conflicting opinions about critical thinking and nursing found in the literature. Despite these
varied understandings, nursing- and health education-oriented researchers have conducted a
variety of studies that examine critical thinking and nursing. Table 9 presents the highlights of
some of these studies.
Review of the information presented in Table 9 reveals that the majority of these studies
have used qualitative methods. On one hand, this could suggest that, for many nursing educators
and researchers, critical thinking is a largely qualitative occurrence. At the same time, it is
suggested that the results of the qualitative methods described in Table 9 demand careful scrutiny
because of the heavy reliance on self-judgment and self-report. Thus, a fair conclusion might be
that assessment of critical thinking is a complex activity and should ideally include quantitative
and qualitative methods.

59
Table 8
Some Definitions of Critical Thinking in Nursing
Definition Source
a skill applied to nursing process Case, 1994; Jones & Brown, 1991
a variant of the scientific method used in clinical practice Shenk Pless & Clayton, 1993
contextual formal reasoning undertaken with critical inquiry Schumacher & Severson, 1996
a free, rational, and autonomous mind Jones & Brown, 1991; Paul, 1993
Note: From “Critical thinking: perceptions of newly graduated female baccalaureate nurses,” by
J.E. Duchscher, 2003, Journal of Nursing Education, 42(1), pp. 15-25.

60
Table 9
Summary of Major Contemporary Studies of Critical Thinking and Nursing
Author and method Goal Evaluation and results
Baker, C.R. (1996).
Reflective learning: A
teaching strategy for
critical thinking.
Journal of Nursing
Education, 35, 19-22.
To help students identify
their own cognitive and
affective behaviour
during nursing practice.
________
Bell, M.L., Heye, M.L.,
Campion, L., &
Hendricks, P.B.,
(2002). Evaluation of a
process-focused
learning strategy to
promote critical
thinking. Journal of
Nursing Education, 41,
175-177.
To teach students how to
conduct in-depth
analyses of clinical
incidents that caused
them to use critical
thinking.
Anecdotal. Students appeared to
strengthen theoretical and
experiential knowledge.
Callister, L.C. (1996).
Maternal interviews: A
teaching strategy
To foster critical thinking
in the cognitive and
affective domains.
Anecdotal. Student and faculty
reported an increase in critical
thinking.

61
fostering critical
thinking. Journal of
Nursing Education, 35,
29-30.
Daley, B.J., Shaw, C.R.,
Balistrieri, T.,
Glasenapp, K., &
Piacentine, L. (1999).
Using concept maps: A
strategy to teach and
evaluate critical
thinking. Journal of
Nursing Education, 38,
42-47.
To increase critical thinking
by helping students
identify and draw
relationships between
concepts.
Evaluated knowledge acquired
during the semester. Statistical
comparison of first concept
map to third concept map.
Statistically significant
difference between the first and
third maps was found. Students
like the method but thought it
was time consuming. Faculty
thought the maps demonstrated
students’ knowledge.
Eerden, K.V. (2001). Using
critical thinking
vignettes to evaluate
student learning.
Nursing and Health
Care Perspectives, 22,
231-234.
To teach critical thinking
skills in a controlled
laboratory environment
that stimulates the
complexity of clinical
nursing situations.
Anecdotal. Favourable faculty
response.

62
Jenkins, P., & Turick-
Gibson, T. (1999). An
exercise in critical
thinking using role
playing. Nurse
Educator, 24(6), 11-14.
To increase students’
awareness of the effects
of disease on the life of
someone living with
the disease.
Anecdotal. Students’ journals
showed critical thinking
through problem solving during
their experiences.
Jones, D.C., & Sheridan,
M.E. (1999). A case
study approach:
Developing critical
thinking skills in
novice pediatric nurses.
The Journal of
Continuing Education
in Nursing, 30, 75-78.
To provide novice nurses
with a chance to make
decisions, apply
knowledge, and
examine beliefs in a
safe setting.
Anecdotal.
Krejci, J.W. (1997).
Imagery: Stimulating
critical thinking by
exploring mental
models. Journal of
Nursing Education, 36,
482-484.
To stimulate students to
think about the images
that appear in response
to terms common to
nursing.
Anecdotal. Positive feedback from
students.

63
Mottola, C.A., & Murphy,
P. (2001). Antidote
dilemma-an activity to
promote critical
thinking. The Journal
of Continuing
Education in Nursing,
32, 161-164.
To teach students how to
“practise thinking,”
then think about and
evaluate the thinking
process.
Critical thinking was measured
using two parts of the NLN
Psychiatric Nursing
Examination. Knowledge was
measured using two other parts
of NLN Examination and the
Mosby Assess Test. Authors
believed that thinking about
factors students had not
considered in their solutions to
the dilemma was valuable in
teaching critical thinking.
Perciful, E.G., & Nester,
P.A. (1996). The effect
of an innovative
clinical teaching
method on nursing
students’ knowledge
and critical thinking
skills. Journal of
Nursing Education, 35,
23-28.
To determine the effect on
students’ knowledge
and critical thinking of
CAI vs. clinical
experience.
WGCTA scores. CAI students
scored higher on the NLN
Examination (i.e., critical
thinking). No statistically
significant difference in
knowledge was found between
the groups.

64
Rossignol, M. (1997).
Relationship between
selected discourse
strategies and student
critical thinking.
Journal of Nursing
Education, 36, 467-
475.
To compare effectiveness
of five strategies:
teacher high-level
questions, teacher
elaboration of student
ideas, teacher probing
questions, student
participation, and
student-to-student
participation.
Inconsistent, small positive
relationship was found between
high-level teaching questions
and critical thinking. Large
inverse relationship was found
between student participation
and critical thinking.
Russaw, E.H. (1997). The
personally perceived
problem technique:
Enhancing clinical
instruction. Nurse
Education, 22(4), 36-
43.
Students identify personal
learning needs, work
through these needs,
and identify future
improvements.
CCTST
Saucier, B.L., Stevens,
K.R., & Williams, G.B.
(2000). Critical
thinking outcomes of
computer-assisted
To compare the effect of
CAI and written case
study strategies on
critical thinking
abilities of nurse
Anecdotal. No significant increase
in critical thinking occurred
using either method.

65
instruction versus
written nursing process.
Nursing and Health
Care Perspectives, 21,
240-246.
practitioner students.
Schumacher, J., &
Severson, A. (1996).
Building bridges for
future practice: An
innovative approach to
foster critical thinking.
Journal of Nursing
Education, 35, 31-33.
To facilitate continuing
development of critical
thinking by nurses and
create a dialogue
among various levels of
nurses and students.
Nurses and students reported a
“therapeutic” effect.
Sorrell, J.M., Brown, H.N.,
Silva, M.C., &
Kohlenberg, E.M.
(1997). Use of writing
portfolios for
interdisciplinary
assessment of critical
thinking outcomes of
nursing students.
________ Students completed a questionnaire
at the end of the course.

66
Nursing Forum, 32(4),
12-24.
Todd, N.A. (1998). Using
e-mail in an
undergraduate nursing
course to increase
critical thinking skills.
Computers in Nursing,
16, 115-118.
To increase student
participation in
learning and student-
teacher interaction.
Most students responded that they
felt the exercises using e-mail
were useful and improved their
critical thinking. Recommended
for future use.
Note: CAI = computer-assisted instruction; CCTST = California Critical Thinking Skills Test;
NLN = National League for Nursing; WGCTA = Watson-Glaser Critical Thinking Appraisal.

67
The intent of this research study then is in line with the interests of other nursing
researchers and educators as they seek to learn more about nurse-learners as critical thinkers. As
previously noted, it would be a practical choice to use a quantitative tool based directly on the
work of Scheffer and Rubenfeld (2000); however, presently, no such instrument exists. Hence,
the decision was made to assess a group of nurse-learners by using the CCDTI as well as through
other carefully chosen quantitative and qualitative methods.
Critical Thinking, Discipline-specific Writing, and Interaction
As discussed, critical thinking and nursing education have become an especially powerful
combination during the last twenty years as nursing has moved from a medically-based to a more
holistically-based model of practice and education (Johns, 1995). In practical terms, this shift has
required nurses to think more critically about their nursing care plans, attitudes, and actions so
that they are, to the best of their abilities, responding to the needs of the whole patient.
A further factor influencing schools of nursing education to make critical thinking
through reflection an integral part of the curriculum is that competent nursing practice requires
much more than content knowledge in clinical practice (Cody, 2002). According to Ironside
(2003), such practice requires “ongoing and interactive understanding of both the context of care
and patients’ experiences of wellness and illness” (p. 510). Additionally, just as information is
increasing at an alarmingly rapid rate, so too has the amount of content that needs to be covered
by nursing curricula. The result of this is something called the “additive curriculum” (Ironside,
2004, p. 509)—an unwieldy experience for educators and students.
These factors and others have led schools of nursing throughout North America to
dedicate time and resources to the development of learning opportunities and settings which—in
addition to “covering content”—nurture students’ growth as thinkers (Ironside, 2004).
Accomplishment of this goal, according to Johns (1995), requires conscious and organized

68
reflection practised in nurses’ formal courses. It is, according to Johns, shortsighted to think that
nurses will be able to teach themselves these skills within the fast-paced context of contemporary
health care. Powell (1989) similarly points out that nursing education experiences must enable
nurses to be proficient thinkers, and that nurses cannot realistically be expected to learn new and
complex ways of thinking on their own without formal instruction and opportunities to practise
these ways of thinking in safe settings.
Two techniques documented in the literature to facilitate critical thinking and in keeping
with Brookfield’s (1987) androgogical principles based on the specific ways adults learn are
interactive learning and reflection. Since as far back as Dewey (1916), interaction with other
learners has been regarded to be a key element in the decisions that educators make about
incorporating technology into an educational experience. Some educators argue that such
interaction not only supports but actually defines the educational experience (Anderson, 2003).
In nursing education, interactive learning is an integral part of the learning experience
and parallels the clinical setting where a team of health care professionals work together. Hence,
the nursing education literature recommends instructional activities and experiences such as
questioning, small group learning, role playing, debate, case studies, journals, simulations,
problem solving, and writing assignments (Abegglen, 1997; Elliott, 1996; Whiteside, 1997). Of
the approaches noted, the three most frequently recommended are small group activities, role
playing, and journals (Simpson & Courtney, 2002).
In similar fashion, the nursing education literature is rich in recommendations about the
use of reflective writing as means of enhancing critical thinking or “thinking aloud on paper”
(Ibarreta & McLeod, 2004). At times, reflective writing can be an individual activity such as
journal writing (Daroszewski et al., 2004; Duchscher, 2003). At other times, it can include
activities such as sharing ideas and resources with others. Other forms of reflective written

69
activity include written assignments with instructor and peer feedback (Tsui, 1999) and group
work in which learning teams follow a pattern such as “think/pair/share” (Lauder & James,
2001).
Integration of these kinds of activities into the nursing education setting represents an
effort to insure that learners will experience what Schon (1983, 1987) called reflection-in-action
and reflection-on-action. Sometimes referred to as “thinking on our feet,” reflection-in-action is
about looking at one’s experiences, connecting with feelings, and examining theories in
situations of practical application. The outcome of this reflection is often a new understanding
that informs actions in the present. More specifically:
the practitioner allows himself to experience surprise, puzzlement, or confusion in
a situation which he finds uncertain or unique. He reflects on the phenomenon
before him, and on the prior understandings which have been implicit in his
behaviour. He carries out an experiment which serves to generate both a new
understanding of the phenomenon and a change in the situation. (Schon, 1983,
p. 68)
By comparison, when the learner considers his or her actions after an event, Schon calls
this reflection-on-action. It is through these two kinds of reflection that nurses and other
professionals become stronger critical thinkers in their daily practices.
As discussed, Internet-based education offers several synchronous and asynchronous
ways for the exchange of ideas and facilitation of interactive learning. In this study with its focus
on writing in a shared public space where there is natural potential for interaction, it is important
to note that the researcher is also interested in the potential of this setting for enabling students’
growth as discipline-specific writers. By definition, an effective discipline-specific writer is a
person who is able to express ideas effectively within a particular discourse community—in this

70
research project, the community of baccalaureate prepared nurses. Generally, discipline-specific
writing involves patterns of thinking congruent with the area of study and demonstrated
competence in using relevant literature and writing conventions. In nursing and health fields in
general, writing conventions are set by the American Psychological Association (APA). When a
person can write confidently and competently according to the standards of his or her discipline,
this generally means that the person can demonstrate knowledge not only with words and the
thinking patterns that characterize the community but also that he or she will be accepted into the
discourse community.
The research into the benefits of “teaching” discipline-specific writing divides into three
major perspectives. The first includes those who maintain that discipline-specific writing
conventions should be taught (Elbow, 1991), while the second includes those who believe that
students may be denied authentic voice if they are required to use writing conventions taught to
them in formal and quasi-formal ways. Finally, there is a third group of writing theorists and
instructors who maintain that competence as a discipline-specific writer occurs most efficiently
when formal instruction, writing opportunities, and a supportive environment come together.
On the subject of how students learn to do discipline-specific writing best, Colomb
(1988), like Elbow (1991), suggests that students need models and sample texts in addition to
many and diverse occasions to practise their writing: they need, in other words, clear directions
and assistance in their quest to become effective discipline-specific writers. Freedman (1993),
however, suggests that explicit teaching of writing conventions is much less important than the
instructor’s role in “setting up facilitative environments” (p. 237). Freedman further states that
students need considerable reading experience “in the discourse of the discipline, along with
attention to their anxiety level, motivation, and intention” (p. 238). The third position on
discipline-specific writing is held largely by those who work side by side with students in

71
classrooms and writing clinics in colleges and universities across North America. In these
settings, the student is provided tools and explanations and then “the process of understanding”
is turned over to the student (Harris, 1986, p. 121). In the context of discipline-specific writing,
this means that the student is provided with the resources he or she will need to navigate the
writing challenges of the subject; then, the student needs many opportunities to practise writing
in the discipline and receive constructive feedback.
Whether one supports the idea of directed teaching or the facilitative writing environment
approach or the blended perspective, the online learning milieu is emerging as a valuable setting
for cultivating learners’ growth as discipline-specific writers. Each theoretical position, with
certain supports, can be actualized in an Internet-based learning environment. The online
environment—through e-mail, asynchronous discussion boards, synchronous chat, and other
writing-based tools—offers countless opportunities for instruction, feedback, support, and
practice. Some of the ways by which discipline-specific writing can occur in an online nursing
education setting are presented below:
⋅ Weekly written submissions to the instructor’s online dropbox: According to
Bilinski (2002), this strategy, called “the mentored journal,” can be highly effective
in enhancing the process of critical thinking among nursing students.
⋅ Directed asynchronous journaling using an online discussion board: Daroszewski et
al. (2004) used this strategy with a group of advanced practice nurses and reported
that all participants described this experience of shared journaling as “highly
effective and valuable” (p. 178).
⋅ Asynchronous discussion of a complex case study using an Internet classroom
assistant (ICA) conferencing forum: Malloy and De Natale (2001) used this
approach to bring together nursing students from two different universities. The

72
students reported that the experience increased their comfort with computer
applications, and they expressed appreciation for exposure to a case they might not
otherwise experience. Faculty identified cross-disciplinary sharing of ideas as a
positive outcome of this kind of discussion forum.
⋅ Web-based discussion groups within a large lecture setting: Participation and
interaction were identified by Harden (2003) as the main benefits of online
discussion groups used with a class of 117 nursing students.
⋅ A blend of reflective journals submitted online to the instructor and online clinical
case studies revealed in a progressive fashion: According to DeBourgh (2001),
these strategies can enable nursing students to experience communication,
collaboration, coaching, and “cognitive apprenticeship” within clinical nursing
courses, thereby supporting the transition from student to novice nurse.
Reflection, Writing, and Critical Thinking in the Online Educational Setting
As previously suggested, the relationship between critical thinking and reflection is a
unique one. While some educators and philosophers claim that reflection is a characteristic or
trait of the critical thinker, the position adopted in this study is that the proficient critical thinker
is skilled in the technique of reflection while reflection itself is a heuristic tool that fosters critical
thinking (Kessler & Lund, 2004). Additionally, reflective learning is an experience that is both
cognitive and affective in nature: “reflective learning is the process of internally examining an
issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self,
and which results in a changed conceptual framework” (Kessler & Lund, p. 22). Or, as Boud,
Keogh, and Walker suggest (1985), reflective learning is a combination of intellectual and
affective activities whereby individuals explore experiences to come to new understandings.

73
While reflective journal writing and other writing-based activities have long been valued
by educators—Bilinski (2002) claims that the “writing to learn paradigm” with its emphasis on
“personal transformation” is a valuable tool in fostering critical thought and concept
clarification―the potential of the web in supporting reflection through writing has only recently
emerged in the literature. Still, the early findings are impressive. In the case of nursing
education, Kessler and Lund (2004) describe how online reflective journaling accomplished
through e-mail and electronic drop boxes embedded in courses can enable valuable feedback
from the nursing instructor and serve as a record of learning outcomes achieved across the
curriculum over time. It can also provide opportunities for a nurse-learner to reflect on clinical
practice experiences and develop new insights and understandings. Nursing students themselves
report how online journaling facilitates self-directed learning and critical thinking (Ibarreta &
McLeod, 2004).
While the earliest e-writing strategies tended to focus on writing submitted to a faculty
member for feedback, there is growing interest in the community of thinking and writing that can
occur within the context of a managed asynchronous bulletin or discussion board. Bilinski (2002)
points out that writing, when it is shared, brings together experiences, feelings, implications, and
connections. In former configurations of the distance education experience, these kinds of
mentoring and feedback occurred solely via the relationship between an instructor and an
individual student; the electronic bulletin board, by contrast, can support a different kind of
mentoring, not the least important being mentoring by peers. When this occurs, “support, vision,
and challenge” become possible (Bilinski). Different nurse-educators also report how online
discussion groups can foster understanding of content and support active learning (Harden,
2003). Some of the benefits affiliated with online reflective writing are the following:
⋅ encouragement of participants to see and understand others’ points of view

74
⋅ challenging of participants to include references to relevant literature as supports
for positions and claims
⋅ use of comments made by others to gauge personal thinking
⋅ decreases in test anxiety and increases in general thoughtfulness
⋅ multiple responses (Harden)
A further benefit of online reflective writing among nurse-learners is that it can be an
exemplification of the collaboration that is the hallmark of successful practice in contemporary
health care (DeBourgh, 2001). Finally, and important to this project, is the claim that the peer
support, sharing, clarification of ideas, and opportunities to practise professional communication
that electronic discussion boards can provide assists learners in performing better on critical
thinking tests than other learners (DeBourgh).
Summary
This literature review has demonstrated the following:
⋅ online distance education is a popular option among Ontario nurses seeking
baccalaureate and continuing professional development opportunities
⋅ the learning needs of registered nurses relate to issues of gender
⋅ online education can facilitate reflection, interaction, and discipline-specific writing,
all of which may contribute to the development of critical thinking
⋅ online learning has been criticized for its costs and returns and the learning
experience it offers students
⋅ critical thinking has been an area of growing interest among North American
educators since the 1980s; it is studied largely from two perspectives: dispositions
and skills
⋅ critical thinking is regarded as an important learning outcome of nursing curricula

75
across North America
⋅ reflection is a tool that may foster critical thinking
⋅ Internet-based nursing education may hold potential as an enhancer of learners’
critical thinking dispositions and skills when reflective writing is a key component of
the learning experience
Study Hypotheses
Based on this literature review, the hypotheses explored in this study are as follows:
1. online nursing courses that include asynchronous reflective writing activities
enhance the learner’s dispositions towards critical thinking,
2. online courses that include asynchronous reflective writing activities increase
the learner’s perception of competence as a writer, and
3. online courses that include asynchronous reflective writing activities
facilitate demonstration of critical thinking skills through writing.
These hypotheses will be considered within the context of a constructivist learning setting. It is
further anticipated that the study may make a contribution to the advancement of constructivist
learning theory when learning settings include special components such as physical distance
and/or older learners. Reflections offered by the post-RN students and their instructors during
interviews, bulletin board contributions, and the researcher’s observations will be considered for
possible inference of such advancement.

76
Chapter III
Methods
Participants
The participants in the study included 34 post-RN nurse-participants, 28 undergraduate
nursing students, and 22 undergraduate sociology students. The following paragraphs describe
the participants and provide relevant contextual information about their respective learning
settings and levels of participation.
The 34 participants in the experimental group were registered nurses enrolled in a
baccalaureate-level online course as part of a post-RN degree program in its fifth offering at
Laurentian University in Sudbury, ON. Laurentian University is a mid-sized university in
northeastern Ontario with several health education programs including nursing, midwifery, social
work, and medicine. Laurentian has a centralized unit for continuing and distance education
called the Centre for Continuing Education.
The post-RN course targeted by the study is called Nursing Healthy Individuals and
Families. In this combined theory and practice course, there is a focus on the nursing process,
group dynamics, teaching and learning, critical thinking and reflective practice, family
assessment, growth and development, and therapeutic communication. Students support their
learning by practice-based work in the community.
Post-RN nurses can take Nursing Healthy Individuals and Families at different points in
the program, and it is possible to have students who are early in the program taking the course
with others who are finishing the program. In other words, nurses who have no university
education and who trained to become nurses directly out of high school may be studying with
nurses who are near completion of their degrees.

77
The programs offered by Laurentian University School of Nursing including the post-RN
program are committed to “the scientific component of the practice of Nursing [that] involves
abstract and logical thinking skills and the generation and utilization of research findings,
knowledge and experience” (Laurentian University School of Nursing Student Manual, 2006).
According to the Director of the School of Nursing at the time of this study, the School’s nine
articulated goals are “conceptual and broad-based in nature” and are “inclusive of critical
thinking and reflection. We include these concepts within the delivery of all programs” (S.
Mossey, personal communication, April 5, 2006).
The particular version of Nursing Healthy Individuals and Families examined in the study
was the first offering of the Web Course Tools (WebCT) version of the course. Laurentian’s
Centre for Continuing Education, a teaching and learning unit with a strong history in distance
and continuing education, provided instructional design expertise as well as administrative and
technical support for students and instructors during the course. Content expertise and the faculty
members who mentored the students in the course came from the School of Nursing.
Because of the enrolment in the course (n=130) at the time of the study, the course was
offered as three sections, each section with its own instructor. All instructors are highly
experienced female faculty members in their mid-careers. Two instructors are part-time
instructors while the third is a full-time faculty member. This course was the first distance-based
teaching experience of any kind for the full-time faculty member. Of the two part-time
instructors, one had taught two print-based distance courses supported by teleconferences and
one Internet-based course while the other had not taught any distance courses before.
As noted, of the 130 nurses enrolled in the course, 34 agreed to participate in the study.
This low participation rate may be due to several factors including the complex and stressful
lives of working nurses (McVicar, 2003; Stordeur, D'Hoore & Vandenberghe, 2001). This point

78
will be discussed in detail in Chapters V and VI. Most notable in the literature pertaining to the
complexity of nurses’ lives is the issue of workplace stress and constant change. As well, not
unlike rural nursing research which has been described as a research field with challenges related
to recruitment of research participants (Cudney, Craig, Nichols & Weinert, 2004), this research
project involved a distance component that included northern and remote regions. The
multifaceted design of the research study with before and after components, an intervention, and
several data collecting strategies is another factor that may have affected participation.
Additional factors suggested to have been influences are that some of the nurses were new to
university and/or online learning and that the survey was delivered to the post-RN nurses as a
web-based survey. While web-based surveys offer many advantages to researchers when face-to-
face interaction with potential participants is not possible, the literature suggests that response
rates to web-based surveys are not always as high as other kinds of surveys (Dillman, Tortora, &
Bowker, 1998a, 1998b; Duffy, 2002; Sitzia & Wood, 1998). Although the benefits of web-based
surveys for the researcher are self-evident, there are mixed findings about response rates.
In light of these considerations, while a higher participation rate was desired, the
researcher was satisfied that the response rate was workable. This view was supported by
Irmajean Bajnok, Director for the Centre of Professional Nursing Excellence through the
Registered Nurses Association of Ontario (personal communication, April 21, 2006). Her
observation was that the response rate for this study “is very respectable” particularly because it
involved “a longer term commitment” (personal communication, April 21, 2006).
It was important for the researcher to maintain a focus on students from the same
university given the diversity of educational philosophies and approaches that different
universities hold regarding online courses. She, therefore, approached the Director of Nursing at
Laurentian University to discuss appropriate comparison groups. During the term targeted by the

79
study, there were no other post-RN courses being offered on line. In turn, the researcher and the
Director discussed other undergraduate courses wherein faculty would be amenable to
participation of their students in a research study. After consideration of two possibilities based
on the recommendation of the Director, the researcher decided to approach the instructors of a
course called Nursing Research I. While the content of this course did not match that of Nursing
Healthy Individuals and Families, the researcher determined that the juxtaposition of the two
groups would yield valuable findings about the critical thinking experiences of different types of
nurse-learners enrolled in the same school. Additionally, the researcher chose to regard the
different groups involved in the study to be comparison groups rather than control groups.
As noted, the principal comparison group included Laurentian University undergraduate
nursing students taking a term-length, university-level face-to-face (on-campus) course called
Nursing Research I. This group, in contrast with the post-RN learners, did not experience the
intervention of online delivery. Rather, the class met with their instructors—one male and one
female—from the School of Nursing once a week for three hours. Additionally, while the content
of this course was different from that taken by the post-RN group, it also emphasized critical
thinking: the focus of the course is that students are challenged to transform personal
inquisitiveness into posing, exploring, and answering researchable questions. Using both
qualitative and quantitative research methods, students are required to examine the research
process critically.
Recognizing the obvious age differences between the post-RN and undergraduate nursing
students, the researcher did not regard this to be problematic: as a whole, the critical thinking
dispositions literature does not suggest that there are significant differences related to
dispositional scores and age (Claytor, 1997; Clizzizza, 1970; Facione et al., 1995; Feely, 1975;
Rudd, Baker et al., 2000). Similar observations need to be made about the two nursing groups

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with respect to writing. While the older group had more life and clinical experiences to describe
in their writing, many of them had been away from formal writing for some time. The younger
group, on the other hand, may have had less to write about; however, they had the advantage of
uninterrupted writing experience.
The researcher recognizes that the differences between the two nursing groups were
genuine and, hence, acknowledges the possible impact of confounding variables. This noted,
sensitivity to research design issues was demonstrated in the decision to use a pre and postdesign
whereby each participant acted as his or her own control. The researcher also deliberately chose
to include a second comparison group.
The second comparison group was composed of undergraduate students taking a term-
length, university-level online (WebCT) course in sociology called The Sociology of
Adolescence. In this sociology course, students examine the social factors which affect the
behaviour and development of adolescents. The sociology course, like the course taken by the
post-RN nurses, was designed by the Centre for Continuing Education while subject matter
expertise was provided by the involved department, Laurentian University’s Department of
Sociology. As an experienced distance education teacher, the female instructor is a full-time
member of the Department of Sociology.
In summary, the comparison group included 50 students: 28 undergraduate nursing
students and 22 undergraduate sociology students. With the 34 post-RN nurse-participants, this
led to a total of 84 student participants in the study. It is interesting to note that the participation
rates for the comparison groups were higher than for the experimental group. In the case of the
undergraduate nursing students, 60% of students in the class agreed to participate while 50% of
the sociology students participated in the study. It is suggested that these higher participation

81
rates in relation to the lower participation rate by the post-RN nurses (26%) may point to the
situational uniqueness of the post-RN learners.
All instructors were invited to participate in whatever parts of the project they wished.
The two part-time instructors of the post-RN nurses participated in interviews.
Instruments
The study was conceptualized as a mixed methods, quasi-experimental (before and after)
design with quantitative and qualitative components (Creswell, 2003). Data were generated in
five ways: two questionnaires completed in pre and postcourse contexts, writing samples
completed near the end of the term, bulletin board contributions, and observations made by the
researcher of the bulletin boards as they evolved.
Questionnaires (quantitative data). The researcher purchased the right to use the
California Critical Thinking Disposition Inventory—henceforth called the CCTDI (Facione et
al., 1998)—as the core component of both questionnaires (Appendices A and B). A number of
additional questions designed by the researcher related to the project’s focus were included in
each survey.
The CCTDI is a validated 75-item attitudinal measure that uses a six-point forced-choice
Likert scale ranging from 1 (strongly agree) to 6 (strongly disagree) to generate a profile of a
person’s overall disposition towards critical thinking. Seven specific sub-scales are also assessed:
they are truthseeking (T), openmindedness (O), analyticity (A), systematicity (S), critical
thinking self-confidence (C), inquisitiveness (I), and maturity of judgment (M).
Because of the forced-choice nature of the scale and the item format, scores for the seven
sub-scale scores range from 10 up to 60. Each CCTDI item targets one of the seven sub-scales,
and each scale score is derived from the set of items that targets the scale. Persons with a

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negative disposition earn 1, 2, or 3 points per item while persons with a positive disposition earn
4, 5, or 6 points.
Each of the seven sub-scales ranges from 10 up to 60. The recommended positive cut
score for each scale is 40; any score below 40 is considered weak at best since scoring below 40
requires scoring some items negatively. The suggested targeted score is 50. Persons who score
above 50 on a scale are strong in that dispositional aspect. Scores from 31 to 39 are regarded to
indicate ambivalence towards the disposition; that is there is no clear expression of either a
positive or a negative disposition. Persons who score below 30 on a scale are negatively disposed
in the identified disposition.
Overall scores are based on the sum of the seven separate scores and range from 70 up to
420; a score of 280 is regarded to be the cut-off indicator of overall deficiency in disposition.
Scores from 211 to 279 fall into the ambivalent range while scores below 210 indicate a
significant opposition toward critical thinking. At the other end, scores from 281 to 349 indicate
an increasingly positive overall disposition while an overall score of 350 or greater is a general
indication of “across the board” strength in disposition towards critical thinking.
In interpreting scores, it should not be presumed that a person who scores well on a
particular sub-scale can be predicted to score well across all seven sub-scales. Rather, it is
suggested that persons often show significant strength in some areas and significant weakness in
others. Because of this, it is recommended that evaluation of the sub-scales may be more
meaningful than analysis of a total score which may obscure important differences across the
sub-scales (Facione et al., 1998). Additionally, plotting a person’s CT dispositions across the
seven sub-scales and providing the necessary information to interpret them is a suggested way of
identifying stronger and weaker areas.

83
Cronbach’s alpha internal reliability indices of the seven scales range from .71 to .80 and
have been consistently replicated: truthseeking .71, openmindedness .73, analyticity .72,
systematicity .74, critical thinking confidence .78, inquisitiveness .80, and maturity of judgment
.75 (Facione et al., 1998). The alpha reliability for the overall instrument, measuring overall
disposition towards CT, is reported to be .91.
Any validity issues concerning the CCTDI should be considered in light of the
development process for the tool and the developers’ use of factor analytic methods to determine
which items would comprise the final form of the test. An outcome of a two-year Delphi project
on critical thinking representing the views of Canadian and American theoreticians from
different disciplines, the CCTDI experienced several iterations before assuming its final form.
Originally, 250 item prompts were developed and then screened by post-secondary educators for
ambiguity and interpretation flaws. The resulting 150 items were piloted with students at three
universities in Canada, California, and the mid-western United States. As a result of the pilot, 75
items were selected for the final form of the test based on internal consistency and ability to
discriminate between respondents. To minimize the likelihood of socially desirable responses,
the scale items are interspersed throughout the test and the names of the seven subscales are not
revealed on the test.
As noted, in this research project, the CCTDI was the principal component of each
survey. However, a number of project-specific questions were added to each survey. In the
presurvey, questions were posed about age, gender, employment status, educational goals, prior
experience with online learning, expectations regarding support, level of perceived competence
in areas frequently required in online learning, understanding of the term “critical thinking,” and
understanding of the relationship between critical thinking and character. In the post-survey,
questions were posed about changes in educational goals, use of course supports, technical

84
problems during the course, level of perceived competence in areas frequently required in online
learning, the course’s effect on critical thinking skills and dispositions, and recommendations for
improvement.
All questions were based on study of the literature and the researcher’s previous
participation in three government-funded nursing education research projects. These projects
included two Office of Learning Technologies (OLT) projects funded by Human Resources
Development Canada and an Ontario Ministry of Health and Long-term Care project. Called
Cardiac Care on the Web (2000), Nursing Health Assessment on the Web (2002), and Stroke
Best Practices for Nurses: A Technology-enabled Education and Research Project (2006)
respectively, these projects examined the experiences of working nurse-learners in distance
education contexts. Additionally, the Nursing Health Assessment on the Web and Stroke Best
Practices for Nurses: A Technology-enabled Education and Research projects explored nurses’
development as critical thinkers. Building on the findings of these projects, the questions for the
present study were reviewed for clarity of expression by a Laurentian University researcher.
In both instances, the surveys were organized such that the CCTDI was completed first.
This was to ensure freshness of response on the part of the participant to the critical thinking
items.

85
Critical thinking scores based on writing samples (quantitative data). The second source
of data came from written assignments completed near the end of the course by participants from
all three courses (Appendices C, D, E). In each instance, there was a focus on critical thinking in
the assignment as suggested in the description of the assignment for the post-RN nurses and
through communications with the other involved instructors (P. Bailey, private communication,
January 10, 2005; K. Tilleczek, private communication, January 10, 2005).
Each sample was scored by two different graders from Laurentian University. The
scorers had similar backgrounds in the teaching and assessment of writing; each teaches in the
Department of English at Laurentian University and has more than 20 years of teaching
experience in writing. In all instances, the scores were based on a four-point rubric called the
Holistic Critical Thinking Scoring Rubric where 4 is high and 1 is low (Facione & Facione,
1992) (Appendix F). A score of 4 means that the writer consistently does all or almost all of the
following: accurately interprets evidence, statements, graphics, questions, etc.; identifies the
salient arguments (reasons and claims) pro and con; thoughtfully analyses and evaluates major
alternative points of view; draws warranted, judicious, non-fallacious conclusions; justifies key
results and procedures; explains assumptions and reasons; and follows where evidence and
reasons lead. A score of 1 means that the writer consistently does all or almost all of the
following: offers biased interpretations of evidence, statements, graphics, questions, information,
or the points of view of others; fails to identify or hastily dismisses strong, relevant counter-
arguments; ignores or superficially evaluates obvious alternative points of view; argues using
fallacious or irrelevant reasons, and unwarranted claims; does not justify results or procedures,
nor explain reasons; maintains or defends views based on self-interest or preconceptions; and
exhibits close-mindedness or hostility to reason (Facione & Facione).

86
While there are other rubrics available for assessment of critical thinking, the researcher
chose this one for two reasons. The first reason is that it is based on the critical thinking work of
the authors of the CCTDI (Facione & Facione, 1992). Given the different understandings of
critical thinking in the literature, it was decided that this was an appropriate choice. As well, the
graders had had experience with a comparable four-point scoring grid based on their
participation in the Writing across the Curriculum (WAC) program at Laurentian University.
As previously noted, this activity was conducted by two independent raters: the
researcher and a university instructor with similar credentials and educational experience. The
researcher took one hour with the second rater to familiarize her with the rubric and the
assignments. Correlation of the scores provided by the two raters was conducted to determine
inter-rater reliability.
Interviews: Students and instructors (qualitative data). Interviews with single students
and pairs of students were conducted with 14 participants from the experimental group
(Appendix G). Originally, the researcher had planned to conduct focus groups. However, due to
the number of participants and their differing availabilities, interviews were conducted. Because
these participants were working nurses, times were organized based on the nurses’ schedules and
ranged from 8 am to 8 pm ET. Sessions lasted approximately one hour and occurred via bridged
teleconferences at no cost to the participants. Telephone sessions were necessary since
participants lived across the province. The sessions were conducted shortly after completion of
the course so as not to lose the opportunity to connect with the participants given their busy
personal and professional lives and the fact that many of them lived at a distance from Sudbury.
The researcher facilitated the sessions working from a predetermined set of questions
while a research assistant listened and made extensive notes. The sessions were not taped due to
the fact that, at the time of the interviews, the conferencing system available to the researcher

87
was experiencing technical difficulties. The main problem was that one speaker would talk over
another and, as a result, good quality audiotapes were not possible. It was, therefore, decided that
the strategy of a research assistant dedicated solely to listening and taking notes was appropriate.
Effort was made to elicit responses from all participants to all questions.
During the sessions, a number of open-ended questions were posed. The nature of the
questions derived from review of the relevant literature, themes emerging from a preliminary
analysis of the quantitative data, and observations made by the researcher as the course unfolded.
The researcher had been granted permission by the instructors to observe the contributions made
to the course bulletin boards over the term. Students were advised by the instructors of the
researcher’s observer role by postings made to the bulletin boards. Questions explored the
participants’ reasons for taking the post-RN degree program at this time, the decision to study at
Laurentian University, the challenges of online courses, whether or not the course enhanced their
disposition towards critical thinking, bulletin board participation, academic writing in the course,
and changes they would recommend to the course. Unsolicited comments about their instructors
were also captured in the sessions.
The choice to include student-based sessions in the project was not only to generate
additional data to complement and perhaps support the data provided in the questionnaires. In
addition, it was important to the researcher to provide participants the opportunity to have a
strong voice in the project. This is in line with the fact that, in educational research, student voice
is increasingly recognized for its importance (Erikson & Schultz, 1992; Levin, 1995; Rudduck,
1996).
Two instructors for the experimental group (Appendix G) agreed to be interviewed. The
interview was conducted in the same way as the student interviews: open-ended questions were
presented for feedback. The questions were based on review of the relevant literature, themes

88
emerging from a preliminary analysis of the quantitative data, and observations made by the
researcher as the course unfolded. The specific areas explored included relevant educational and
nursing background, their sense of the students, possible impact of the course on the students as
critical thinkers, academic writing, bulletin board work, and interacting with students.
Bulletin board contributions: Students and instructors (qualitative data). The final source
of data was the bulletin board as it was used by the post-RN nurses. For both students and
instructors, it was a repository of data that complemented and often elaborated points raised in
the interviews.
As noted earlier, the course was divided into three sections, each with its own instructor
and bulletin board. This situation provided the researcher the opportunity to observe contrary
approaches to management of an electronic bulletin board and interactions with students in the
same course. Studying bulletin board contributions was appropriate because of the project’s
focus on a possible relationship between writing and critical thinking in online course
environments. By approaching her topic from different perspectives through “juxtaposing
analysis of different data types and methods” (Morse & Richards, 2002), the researcher was able
to triangulate the data collection process.
Observations by the researcher of the bulletin boards (qualitative data). Because the
researcher was given permission by the course instructors to observe the postings as they were
made during the course, comprehensive notes pertaining to the evolution of the three boards
were compiled. Similarities and differences regarding the organization and navigational
functionality of the three boards were identified.
Data Collection Procedures
Greater emphasis was placed on quantitative data collection and analysis (Creswell,
2003). Quantitative data were collected first followed by the qualitative components. Because of

89
this approach, the results of the project are presented in two chapters, progressing from
quantitative results (Chapter IV) to qualitative findings (Chapter V).
The quantitative data were gathered by means of the two questionnaires. Except by the
participants in face-to-face nursing course, these questionnaires were completed on line. A web
link with an explanatory note was provided to the participants via their respective bulletin
boards. This link took the participants directly to the survey which took approximately 15-20
minutes to complete. The decision to use a web-based tool was logical since these participants
were enrolled in web-based courses. The first survey was available to students during the first
two weeks of the term while the second survey was available beginning the second last week of
the term.
All students in the two WebCT courses received a letter of information (Appendix H)
about the project and a consent form (Appendix I) through regular Canada Post mail. Signed
consent forms were returned in postage-paid envelopes to the researcher. As required, ethics
approval for the project had been procured through the Research Ethics Boards (REB) at
Laurentian University and the University of Windsor.
In the case of the participants in the face-to-face, undergraduate nursing course, the
researcher made a classroom visit in the first week of classes to invite participation, collect
signed consent forms, and administer a hard copy (print) version of the same presurvey. A
second visit was made in the second last week of classes to distribute the second survey. The
instructors were not present on either occasion in order to minimize the situation that students
might feel pressured to participate. It was also anticipated that, in not having the instructors
present, students might be more honest in their comments than otherwise.

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As previously indicated, the interviews occurred after all quantitative data had been
collected. Of the total number of participants in the experimental group, 41.2% volunteered to
take part in interviews. These sessions occurred as planned.
Regarding the interview with the two instructors, written permission was sought of the
instructors to use their comments in the project. This session unfolded as planned.
Two further important components of the project were the bulletin board contributions
and the writing samples. In many instances, the bulletin board data elaborated the quantitative
results and ideas presented in the interviews. As indicated, the researcher observed the
contributions as they were made and examined them at the conclusion of the course in hard copy.
The writing samples were voluntarily provided by participants who understood that this written
work would be analyzed. Of the 84 participants in the project, 58 contributed writing samples.
The project’s mixed methods design brought the benefits of different types of data
collection to the project. Through the quantitative methods, differences in critical thinking
dispositions before and after the course were identified. The qualitative data helped discover,
describe, and, in some cases, explain the participants’ actual experiences related to critical
thinking in an online course setting and the online nursing education culture.
Data analysis. Descriptive statistics were prepared based on the data offered by the
participants in the surveys. Data pertaining to gender, age, educational status and goals,
employment status, geographical communities, and prior experience with online education
comprised these statistics.
Analysis of participants’ self-perceptions of competence in skill areas generally required
in university-level online courses—use of the computer, use of the Internet, keyboarding skills,
and university-level writing—was conducted. Based on these data, a three-way ANOVA with
Group, Scale, and Time as the independent variables was also performed.

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The primary statistical analysis used for the quantitative data based on participants’
completion of the CCTDI was a 3 x 7 x 2 three-way ANOVA with repeated measures on the last
two variables. The independent variables were Group (experimental, comparison #1, comparison
#2); Scale (truthseeking, openmindedness, analyticity, systematicity, critical thinking self-
confidence, inquisitiveness, and maturity in judgment); and Time (pretest, posttest).
A one-way ANOVA was computed for the writing scores for the three groups. As
indicated, the scores were generated for written assignments completed near the end of the
course. They were based on a rubric ranging from 1(low) to 4 (high). For this statistical work as
well as all other statistics generated for the project, an alpha level of 0.05 was selected for
statistical significance.
Based on strategies from focused ethnography, the qualitative data generated by the
interviews, the bulletin board contributions, and the researcher’s observations became the basis
of detailed descriptions that represent the participants as working nurse-learners sharing the same
online course experience. Using Nudist as well as hand coding techniques, the researcher
organized the qualitative data based on the bulletin board and her personal observations of the
bulletin board into themes based on the topics explored in the interviews. The resulting data
groups were then analyzed for what Wolcott (1994) calls patterned regularities. These patterned
regularities are offered as findings that build on the quantitative data.
The following two chapters present the results of the study and reflect the design of the
project, progressing from quantitative findings (Chapter IV) to qualitative findings (Chapter V).

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Chapter IV
Quantitative Results
Context and Participants
Quantitative results are based on the contributions of 84 participants who completed the
pre and postsurveys: 34 in the experimental group (online course, post-RN nursing students); 28
in comparison group #1 (face-to-face course with optional online bulletin board, undergraduate
nursing students); 22 in comparison group #2 (online course, undergraduate sociology students).
Demographic data, self-report data related to online education, the participants’ CCTDI scores,
and scores assigned to writing samples from all groups are presented.
Gender and age. By gender, the experimental group was exclusively female. With the
exception of a single male in comparison group #1, the two comparison groups were also female.
When age was configured in terms of two categories, it was apparent (Table 10) that the
experimental group was made up of a larger portion of older students, χ2(2) = 21.73, p < .001.
Educational status and goals. Asked about their highest level of education as they started
the course, 4.5% of respondents in the experimental group indicated that Grade 12 was their
highest level of education while 9.1% reported that Grade 13 was their highest level. The
participants who reported no postsecondary education were the more experienced participants
who had “trained” to become nurses within the hospital training programs that dominated
nursing education before nursing became a discipline of study offered by community colleges
and universities. All participants in the two comparison groups reported university education to
be their highest level of education. This is not surprising since, in both groups, the participants
were enrolled in upper-year university courses.

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Table 10
Age Distribution Frequencies for Two Age Groups for Participants in Experimental and
Comparison Groups
Age categories Experimental Comparison
#1
Comparison
#2
20-35 12 25 17
36+ 21 3 4

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Table 11 presents the participants’ educational goals. Participants were invited to choose
as many items as applied from six choices. As the table reveals, the goal of career advancement
was the only goal different at a statistically significant level.
Employment status. When asked about employment status, 67.6 % of participants in the
experimental group indicated that they were working full-time while 29.4% reported working
part-time. Some of the more specialized kinds of nursing the post-RN nurses reported working in
include public health, clinical education, community health, and management.
In comparison group #1, 48.1% reported working part-time; 44.4% not working at all;
and 7.5% full-time. These nurse-learners in contrast with the nurses in the post-RN program are
undergraduate students with fewer financial, family, and community obligations. In comparison
group #2, 35.0% indicated that they were working full-time; 53.0% part-time; 12.0% not at all.
The kinds of work the participants reported varied from the retail and service industries to
counselling, teaching, management, and social service.
Geographical communities. The geographical communities of the nurses from the
experimental group and comparison group #2 are found in Table 12. All participants in
comparison group #1 were living in the Sudbury region at the time of the study. This is
appropriate since this course was a traditional, face-to-face course delivered on the university
campus.
As Table 12 reveals, 14.7% of participants in the experimental group and 54.4 % of
participants in comparison group #2 were from Sudbury, suggesting that online courses are being
taken not solely by those who live at geographic distance from a university.

95
Table 11
Educational Goals with Chi-Squared Analyses p-values Reported
Goal Experimental
(n=34)
Comparison
#1 (n=28)
Comparison #2
(n=22)
p
University degree 90.6 % 96.4 % 100.0 % .28
University credits 9.4 % 21.4 % 28.6 % .19
Continuing education 59.4 % 32.1 % 33.3% .06
Career advancement 62.5 % 28.6 % 2.5 % .03
Personal growth 71.9 % 60.7 % 57.1 % .49
Other 3.1% 7.4% 0.0% .40

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Table 12
Geographical Communities
Region Experimental
(n=34)
Comparison #2
(n=22)
Greater Region of Sudbury 14.7% 54.4%
Northeastern Ontario
(excluding Sudbury)
32.4% 22.7%
Northwestern Ontario 0.0% 0.0%
Central Ontario 0.0% 4.5%
Greater Toronto Area 14.7% 0.0%
Southwestern Ontario 23.5% 4.5%
Eastern Ontario
(Ottawa Valley Area)
2.9% 9.1%
Other 2.9% 4.5%

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While the focus of the study was the respondent group, the researcher did try to develop a
demographic profile of the nurses who chose not to participate in the study. She contacted the
Centre for Continuing Education and the School of Nursing and asked about acquiring
demographic data for the non-participating nurses. The Centre for Continuing Education was
unable to provide any information. The School of Nursing through the post-RN Coordinator,
however, provided the researcher with information about gender and the home communities of
the nurses. Regarding gender, all non-participating nurses were female. Additionally, when the
nurses’ home communities were organized by area (Greater Region of Sudbury, Northeastern
Ontario, Northwestern Ontario, and so forth), the breakdown of regions matched those noted in
Table 12. No additional data were available regarding the non-respondents.
Self-report Data Related to Online Education
Experience and competence with online education and modalities. Asked if they had ever
taken an online course or a course with online components such as an Internet-based
communication tool before this study, 65.8% of respondents in the experimental group said they
had. By comparison, 85.7% and 17.2% in comparison group #1 and comparison group #2
reported they had. The high percentage of undergraduate nurses who responded that they had
previously taken an online course/course with online components may be a reflection of the
School of Nursing’s commitment to incorporate online components into all courses and
programs. As a result, it is not surprising that, by the third year of the undergraduate program,
students have acquired some experience with online education.
Table 13 displays participants’ reported prior experience with Internet-based
communication tools. While there was an absence of an effect noted for e-mail, group
differences for chat and bulletin board were found to be significant. It is suggested that these
differences may be related to greater experience with these tools by younger participants.

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Table 13
Reported Use of Internet Technologies (Precourse)
Tool Experimental
(n=34)
Comparison
#1 (n=28)
Comparison
#2 (n=22)
p
Email 93.8% 96.4% 100.0% .50
Chat 56.3% 85.2% 81.0% .03
Bulletin Board 64.5% 92.9% 33.3% .00

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In the precourse period, participants in all three groups were asked about their self-
perceptions of competence in four skill areas generally required in university-level online
courses: use of the computer, use of the Internet, keyboarding skills, and university-level writing.
For each variable, a one-way ANOVA was conducted. As Table 14 indicates, the only variable
that showed a statistically significant difference was writing. The experimental group reported
significantly poorer scores for writing than both comparison groups (p < .01). In the postcourse
context, participants in comparison group #1 were not asked to complete the ratings. Their
course was not an online course but a face-to-face course with an optional course web site which
was rarely used by the students.
A MANOVA was computed for the four self-perceived competencies with group
(experimental, comparison group #1, comparison group #2) as the independent variable. There
was a main effect for group, F(8, 152) = 2.9, p < .01, which the subsequent univariate analyses
revealed to be due to writing, F(2, 78) = 9.03, p < .001. The posthoc analyses showed that the
experimental group was significantly poorer than both comparison groups on the writing
measure (p < .01).
To examine change over time, a 2 x 4 x 2, three-way ANOVA was run with Group
(experimental group, comparison group # 2), Scale (computer, Internet, keyboarding, and
writing), and Time (pretest, posttest) as the independent variables. Comparison group #1 was not
included as no posttest data were available. The main effects for time, F(1,51) = 4.99, p < .05
(higher performance on the posttest), scale, F(3, 49) = 28.13, p < .001 (lower performance on
writing), and group, F(1, 51) 9.4, p < .01 (lower performance by the experimental group) were
qualified by a three-way interaction effect for the tests of within subjects effects, F(3, 153) =
3.42, p < .025. The posthoc analyses showed the interaction effect was due to a posttest increase
for the experimental group only, and only in the area of writing, t(31) = 3.55, p = .001. The large

100
SD
Table 14
Reported Competence with Modalities of Online Education (Pre and Post)
n M
Area of se
com
lf-perceive
petency
Group
re P Post Pre t
Experimental 32 34 3.81 3.82 .69 .80
d
P Post re Pos
Comp. #1 28 -- 3.96 -- 1.00 --
Computer
Comp. #2 21 22 4.29 4.32 1.06 .72
imental 4.00 4.03 .80
4. -- .77
Internet
p. #2 4. 4.45 1.00
Experimental 32 34 4.06 4.06 .88 1.13
Comp. #1 28 -- 4.29 -- .94 --
Keyboarding
Comp. #2 21 22 4.67 4.73 .80 .77
Experimental 32 34 2.69 3.24 1.35 1.02
p. #1 3. -- .83
University-level
writing
3. 3.73 .58
Exper 32 34 .94
Comp. #1 28 -- 18 --
Com 21 22 24 .67
Com 28 -- 64 --
Comp. #2 21 22 67 .55

101
difference in writing between the two groups at pret s seen in re 2. It ramatically
mitigated at posttest, apparently as a function of the course experience.
CCTDI Scores
Participants’ completion of the CCTDI in the pre and postcourse settings generated two
sets of scores for each participant. Each set of scores included an aggregate score and seven
discrete scores for the seven critical thinking dispositions: truthseeking, openmindedness,
analyticity, systematicity, critical thinking self-confidence, inquisitiveness, and maturity. These
scores are summarized in Table 15.
A three-way (3 x 7 x 2) ANOVA was run on the data using Group (experimental group,
comparison group #1, comparison group #2), Scale (truthseeking, openmindedness, analyticity,
systematicity, critical thinking self-confidence, inquisitiveness, maturity), and Time (pretest,
posttest) as the independent variables, with Scale and Time treated as repeated measures. There
was a main effect for group, F(2, 81) = 2.28, p = .05, and the posthoc tests indicated that this was
due to a difference between the two comparison groups (comparison group #1 M = 294.84, SD =
21.87; comparison group #2 M = 312.59, SD = 40.05, p < .05). Group did not interact with scale
or time (p > .1). The main effect for scale, F(6, 76) = 60.12, p < .001, is qualified by a scale by
time interaction effect, F(6, 76) = 2.91, p < .025. The interaction effect is due to greater scores
on truthseeking at posttest, t(83) = 1.98, p = .05, as may be seen in Figure 3. It seems that
students generally show gains in truthseeking as a function of their university experience.
Age. Regarding age (younger, older), there was a clear imbalance. There were more older
students (36+ years of age) in the experimental group (21 vs. 7) and more younger students (<36
years of age) in the comparison group (42 vs. 12), χ2 (1) = 21.36, p< .001. However, preliminary
est i Figu was d

102

Table 15
CCTDI Scores
M SD
Variables Group
Pre Post Pre Post
Experimental 36.85 38.53 5.93 6.95
Comp. #1 36.25 36.71 5.60
Truthseeking
Comp. #2 38.55 39.55 8.43
Experimental 42.35 43.09 4.56
Comp. #1 42.14 43.11 6.25
Openmindedness
5.56
7.91
4.63
6.45
Comp. #2 45.23 45.82 6.65 7.64
Experimental 45.41 44.56 4.59 5.02
Comp. #1 42.25 41.68 5.28 5.33
Analyticity
Comp. #2 43.41 42.77 8.00 7.58
Experimental 42.15 42.97 7.63 8.07
Comp. #1 39.21 41.36 5.83 5.59
Systematicity
Comp. #2 43.45 43.18 7.86 7.08
Critical thinking self-confidence Experimental 45.29 44.15 7.01 6.14
103

104
Comp. #1 42.82 42.46 6.90 6.66
Comp. #2 46.95 46.91 8.04 8.77
Experimental 49.53 49.21 4.89 6.82
Comp. #1 47.82 47.79 5.12 5.75
Inquisitiveness
#2 7.96
ental 6.3 7.50
. #1 4.9 5.15
Maturity
#2 7.8 9.23
Comp. 51.82 49.32 5.17
Experim 43.56 44.59 9
Comp 43.21 42.86 5
Comp. 44.73 43.50 3

105

106
inking
g at the
< .05. All
ed to
ic
analyses indicated that there were no differences on the pretest and posttest total critical th
scores nor on the self-perceived competencies (Table 16), with the exception of writin
pretest level where the older students were showing less confidence, F(1,78) = 5.05, p
other comparisons were non-significant (Table 17). The age effect for writing is clearly link
the number of older students in the experimental group who were returning to the academ
environment with depressed writing confidence. This was evident in the previous analyses
(Figure 2). This age effect is reported here as an addendum that assists in understanding the
effects noted. The self-perceived reduced competence in writing for the experimental group
students is tied to the age of these returning students.
Critical Thinking Scores Based on Writing Samples
Writing samples were voluntarily provided by participants with representation from
course. For each course, the writing sample was based on the same assignment comple
each
ted near
the end of the course. While the assignments varied in length and topic because of the different
course content areas, according to all involved instructors, each assignment involved application
of critical thinking.
As outlined in Chapter III, each sample was scored twice by the researcher and a second
researcher with comparable experience as an instructor of writing at Laurentian University. A
four-point critical thinking rubric for the scoring of writing for demonstration of critical thinking
(4 being strong and 1 being weak) was used by each scorer (Appendix F).
The scores provided by the second rater were used for analysis because of the possibility
of an expectancy effect on the part of the researcher for the participants in the experimental
group to do well. A one-way ANOVA based on these scores was computed for the writing
results for the three groups (experimental group, comparison group #1, comparison group #2),
and there was a main effect, F(2, 54) = 3.99, p < .025. The posthoc analysis showed the

107
Table 16
Means and Standard Deviations for the Pretest and Posttest Scores for CCTDI and the Self-
Perceived Competencies
n M SD
Scale Age
Pre Post Pre Post Pre Post
20-35 54 54 300.87 299.59 31.72 34.66
Total CCTDI
36+ 28 28 309.96 313.25 22.27 2
20-35 53 29 4.09 4.03 .99 Perception of competence:
computer 36+ 27
9.89
.94
25 3.78 4.00 .75 .65
29 4.21 4.14 .86 .99
36+ 27 25 2.89 3.40 1.25 .96
20-35 53 Perception of competence:
Internet 36+ 27 25 3.96 4.28 .81 .74
20-35 53 29 4.38 4.31 .90 1.11Perception of competence:
keyboarding 36+ 27 25 4.15 4.40 .91 1.00
20-35 53 29 3.47 3.45 1.01 .87 Perception of competence:
writing

108
df F P
Table 17
ANOVA Results for Ratings on CCTDI and Self-perceived Competencies
Pre Post Pre Post Pre Post
Total CCTDI 1, 80 1, 80 .82 3.13 .368 .080
Perception of c etence: computer 1, 78 1, 52 2.14 .02 .147 .878
Perception of c 78 1 1.50 .22 .558
Perception of competence: keyboarding 1, 78 1, 52 1.15 .10 .287 .757
ion of competence: writing 1, 78 1, 52 5.05 .04 .027 .847
omp
ompetence: Internet 1, , 52 .35 5
Percept
Note: The values noted in Table 17 are based on separate one-way ANOVAs for pre and post
scores.

109
group ceived htly high atings (M4, SD = 0.66) than the
ental group (M = 2.47, SD = 0.51), p < .01. There were no differences with respect to
comparison group #2 (M = 2.63, SD = 0.52) which may be related to the smaller sample size for
this group (n = 8). It would appear that comparison group #1 showed greater proficiency in
critical thinking as demonstrated in writing than the experimental group and comparison group
#2.
The difference between the experimental group and comparison group #1 is interesting
(Table 18). In the case of the experimental group, some participants had been away from writing
for some time and may have been experiencing academic writing at university for the first time.
In comparison group #1, the students had been exposed to writing at university for more than
two years.
Given the problem with interrater reliability between the two sets of scores (.553), the
reader is advised to be extremely cautious in considering these results. As an outcome of this
concern, the researcher decided to conduct further analysis of the writing samples. First, she had
the writing samples scored a third and fourth time by two other raters with backgrounds similar
to those of the first and second raters; next, she analyzed the writing samples using a framework
that tracked elements suggested by composition experts to be components of writing
competence; finally, she conducted a thematic analysis of the samples based on findings related
to the CCTDI scores and in particular the disposition called truthseeking.
In these next two sections, the findings related to the additional scoring activity and the
writing competence framework are described. Findings based on the thematic analyses are
described in Chapter V.
comparison
experim
#1 re slig er r = 2.9

110
Scorer 2 n M SD
Table 18
Means and Standard Deviations Based on Critical Thinking Rubric
Experimental
Comp. #1
Comp
Total
32
18
58
2.47
2.94
2.63
.5
.66
.52
.
. #2 8 2.63
1
59

111
Further Scoring of Writing Samples
The interrater reliability problem was not addressed through additional scoring with
reliability co-efficients of .085 and .229 for the third and fourth raters respectively. This suggests
that subjective judgements of written texts by even experienced scorers are generally unreliable.
It should be noted that, in this study, the researcher had trained the scorers before the scoring
occurred and that each rater was provided copies of the assignments and the scoring rubric.
Analysis for Writing Competence
Each writing sample was examined for five variables: spelling, word choice, grammar,
vocabulary, and sentence length. Values for spelling, word choice, and grammar were generated
by a count of the number of errors found in each writing sample. Vocabulary was assessed as the
number of words eight letters in length or longer. Mean sentence length was determined by
counting the number of words in sentences. Indices were used to comparison for quantity of
writing as the samples varied in length with some participants writing less than 500-word
assignments. The index was obtained when the measure of interest was multiplied by 100 and
divided by the sample size.
Errors related to run-on sentences, comma splices, and sentence fragments were
categorized as grammatical errors. Punctuation was not considered to be a separate variable since
errors related to terminal punctuation (periods, semi-colons, and colons) were accounted for in
the grammar category. Errors in comma usage were not recorded in that there is considerable
discretion in how writers use the comma; additionally, errors in comma usage are not typically
regarded to be serious writing problems.
For the five variables, a one-way ANOVA was conducted for each index (Table 19).
There were no statistically significant differences among groups for spelling (F (2, 54) = .21, p =
.812); word choice (F (2, 54) = 2.62, p = .082); or sentence length (F (2, 55) = 0.95, p = .393).

112
Table 19
Means and Standard Deviations Based on Analyses of Writing Samples
Index Group
n M SD
Spelling Experimental 32 .29 .509
Comparison #1 18 .30 .248
Word Choice Experimental
Comparison #1
Comparison #2
32
18
8
.66
.97
.54
.486
.653
.218
Comparison #2 8 .19 .109
Grammar Experimental
Comparison #1
Comparison #2
32
18
8
1.40
.67
1.04
1.030
.467
.481
Sentence Length
Experimental
Comparison #1
Comparison #2
32
18
8
3.79
4.09
4.07
.828
.705
.926
Vocabulary Experimental
Comparison #1
32
18
19.45
24.74
6.309
3.640
Comparison #2 8 14.38 2.399

113
ere were significant group differences for grammatical errors (F(2, 54) = 4.22, p =
matical errors revealed that
th enta ou d a greater number of grammatical errors. Posttests for
vocabulary showed lower vocabulary scores by the experimental group in relation to comparison
than participants in comparison group #2 for
vocabulary com mparison group #2 for vocabulary may have been
due to the nature of the assignm autobiographical and, hence, might have led to
simp they might make otherwise.
Th
.020) and vocabulary (F (2, 55) = 12.09, p = .000). Posttests for gram
e experim l gr p ha made
group #1. The experimental group did score higher
plexity. The lower scores of co
ent which was
ler vocabulary choices by the students than

114
Chapter V
e
iting samples were volunteered by student-
particip
ing
e
researcher presented a set of standard questions and prompted for
elabora ho did
d of the course.
Qualitative Results
The results reported in this chapter are based on thematic analysis of the writing samples
from participating students and the interviews. Illustrative comments taken from bulletin board
activity are also included. Taken together, these data elaborate and complement the quantitativ
findings.
As previously noted in Chapter IV, wr
ants from across the participant group. In addition to being studied for components
related to writing competence (Chapter IV), the samples were coded for demonstration of Johns’
(1995) four ways of knowing. The decision to code the writing samples for the ways of knowing
was based on quantitative findings related to an interaction effect involving the critical think
disposition called truthseeking.
Regarding the interviews, they were conducted via conference calls at no cost to th
participants and times convenient to the participants from 8 am to 8 pm ET. Sessions lasted
approximately one hour. The
tion when relevant. Notes were taken by the researcher and a research assistant w
not participate verbally in the conferences. Two instructors and 14 nurse-participants from the
post-RN group participated in the sessions.
The comments included from the bulletin board are offered as elaborations of points
made in the interviews. It is acknowledged that the researcher observed the bulletin boards as
they evolved and examined them at the en

115
nowing (Johns, 1995) in Writing Assignments
ays of knowing was due
to an interaction effect for truthseeking as a function of university experience. As Johns’ ways of
knowing pertain specifically to nurses and were part of the curriculum covered by the course
taken b -RN nur ork wa approp tool for a ing the writing
samples submitted by the ts. Alth h the stu s in com n group #2 were
not nurses, the framework was appropriate for them considering the personal and reflective
nature of their writing assignm has used Johns previously in work with two
research teams from Laurentian University’s School of Nursing and has been the primary author
for two peer reviewed articles as a result of this work (Carter, Rukholm, Viverais-Dresler,
Bakke n, 2006; olm, 2002).
In this project, as in the previously noted jects, Jo (1995) “knowing” and
“ways of knowing” (Appendix J) were changed to “thinking” and “kinds of thinking.” While
there are distinctions between opriate to have made this
modification for two reasons. The first pertains to the finding that the disposition of truthseeking
was an area of growth related to university experience. Truthseeking as defined by Facione and
Facione is about “ s, and ng] hone d object out pursuing
inquiry another w ive proc such as thinking is. H it follows that
analysis of the writing samples would involve consideration of different kinds of thinking.
Secondly, when Johns’ four categories are broken down as questions as they are in Appendix J,
they become a kind of scaffolding to identify four kinds of thinking.
The four different kinds of thinking are called aesthetic, personal, ethical, and empirical.
Aesthe involv the se e nurse cts on what he or she is trying to
achieve and the course of action taken. Personal thinking focuses on the nurse’s feelings. Ethical
Ways of K
The decision to code the writing assignments for Johns’ (1995) w
y the post ses, the framew s an riate nalyz
nursing studen oug dent pariso
ent. The researcher
r & Sheeha Carter & Rukh
pro hns’ terms
knowing and thinking, it is appr
(2000)
”; stated
asking question [bei st an ive ab
ay, it is an act ess ence,
tic thinking es challenges to lf: th refle

116
thinkin ith the iss nce betw . It is
about responding to questions such as the following: “How did my actions match with my
beliefs?” and “What factors made me act in ways that do not fit with my values?” Finally, in
empirical thinking, the nurse reflects on how nursing knowledge informs practice.
In order to analyze for the four categories, the researcher read all samples twice to gather
a gen he assi equent dividu nment read, and discrete
ideas were coded as responding to the questions noted in Appendix J. Where there was
ambiguity, sections were re-read until the researcher was confident in her final decision. Based
on the theme coding exercise, the following section explains what each assignment tended to
demonstrate about the different ways of thinking and provides a detailed discussion of one
student assignment for each different assignment. The discussion progresses from the written
work completed by the post-RN learners in the experimental group to the work done by
participants in each of the comparison groups.
The assignment completed by the post-RN nurses (Appendix C) was constructed around
a case study with a family focus. Thinking as a community nurse, the nurse-writer was asked to
demonstrate critical thinking by responding in narrative form to four questions. The second of
two formal or graded postings—each was worth 10% of the student’s final standing in the
course—, the posting was evaluated on the basis of content as well as inclusion of references to
evidence-based practice literature.
The questions that comprised the core of the assignment are as follows: What actual data
or information do I have about this case? What other data do I need to better understand this
situation? What are my provisional hypotheses (problem or need statements)? What learning
issues have I identified in this case? While no length requirement was stipulated, the postings
tended to range from 500 to 800 words in length.
g deals w ue of congrue een the nurse’s actions and value system
eral sense of t gnments. Subs ly, in al assig s were

117
e case
t a dominant
form of thinking in this assignment, personal thinking was minimally evident. Personal thinking
tended to occur when the writer described how she felt about the situation. This kind of thinking
is revealed in the following passage:
This student chose to complete a case study about a woman with two small
children at home: a child of 28 months and a new baby of three months. At home on
maternity leave, this new mother is having trouble managing the routines of a young
family; she also feels that her husband is becoming impatient with the situation.
The evidence of Johns’ different ways of thinking in the student’s analysis of
the case was ranked as follows: 26 examples of empirical thinking, 12 examples of
aesthetic thinking, 5 examples of personal thinking, and 1 example of ethical
thinking.
As illustrations of empirical thinking, the student offered two main kinds of
statements: the first pertained to what she knew about the family based on the case,
“With regard to marital status, we are told that Carol is married to Ron who works
full-time hours from 6-8pm nightly.” A second form of empirical thinking occurred
The way of thinking demonstrated most frequently in this assignment was what Johns
(1995) calls empirical. For example, in every case (n = 32), the student began with an iteration of
what was empirically known about the family and the family’s life situation based on th
study description. There was also some demonstration of aesthetic thinking; that is thinking that
explores questions such as what was I trying to achieve and why did I respond as I did. This kind
of thinking tended to occur in statements wherein the writer reflected on her role as a care
provider for the family. At times, this self-assessment was visible in the words the writer used
while, on other occasions, it was more subtle and found in the tone of the text. No

118
when the writer connected her ideas to relevant nursing-based literature, “‘Most
depressed post-partum women have self-est
temperament. An infant such as Sophie who is irritable and demands more from a
fatigued mother who has limited support from a significant other can experience an
increase in depressive symptoms’” (Allender & Spradely, 2001).
The assignment also showed, at different points, the writer to be engaged in
what Johns (1995) refers to as aesthetic and personal thinking. Instances of the former
occurred near the beginning and middle of the assignment when the writer was
discerning what she needed to know about this family in order to assist it, “It is not
mentioned that Ron is the father of both children but I will assume he is.” Although
the writer’s assumption may be incorrect, the passage does demonstrate awareness of
a need to gather further information. Additionally, the writer is self-aware of the act
of making assumptions.
Evidence of personal thinking tended to occur near the end of the assignment
when the writer described her thinking process, “By analyzing this scenario, I chose
to seek more information and apply some logical reasoning by utilizing literature of
child/family development.”
The assignment included one instance of ethical thinking. In this statement, a
situation of incongruence at the level of personal belief is presented, “Some of my
beliefs were inconsistent with the factual information making this a learning
experience for me.”
eem which is reinforced by the infant’s
The assignment completed by participants in comparison group #1 (Appendix D)
involved preparation of a critical literature review based on a nursing topic of the writer’s choice.

119
to prepare an assignment that showed
astery
ns
the context
of their
Like the post-RN nurses, these nurse-students were asked
m of English composition and APA writing conventions. The length requirement was eight
to ten pages.
Because of the design and criteria of this assignment, the way of thinking demonstrated
almost exclusively was empirical. Although the assignment description did not specify that
expression of personal ideas or experiences was unacceptable, this appeared to be the students’
understanding: there was almost no evidence of the other ways of thinking suggested by Joh
(1995).
This student explored the topic of palliative care. Her assignment used
headings typically associated with a literature review: introduction, description of the
literature, summary, limitations, and conclusion.
While a reader would not expect demonstration of the four ways of thinking in
the body of an assignment such as this, he or she might expect some form of thinking
other than empirical thinking in the sections called limitations and conclusion. This,
however, was not the case in this student’s work; rather, like the earlier parts of the
assignment, these sections were characterized by straightforward statements of fact
unchallenged by the writer. Thus, in its entirety, the assignment moved back and forth
between empirical statements such as “[t]he most common limitation encountered by
the researcher in this review was sample size” and “[b]oth White et al (2004) and
Hopkinson and Hallet (2001) believed that their samples were too small for the
findings to be generalized and that the findings should only be applied to
sample.”
In this student’s assignment, 46 examples of empirical thinking were

120
identified. There is no evidence of the other ways of thinking.
The assignment completed by comparison group #2 participants (Appendix E) included
many examples of empirical thinking; in addition though, it also tended to include examples of
aesthetic and personal thinking and, on a limited number of occasions, ethical thinking. It is
suggested that this diversity was due not only to the topic but also to the point of view that the
students were encouraged to assume. In this autobiographically-based assignment, students were
asked to reflect on their adolescence and how various experiences in it signaled or affected the
young person’s emerging adulthood. If a student did not wish to prepare an autobiography, he or
she was welcome to write a biography based on the life of a real or fictional individual. Students
were further asked to connect their observations to the theories they were studying in the course.
Like the assignment for the first comparison group, this assignment was to be between eight and
ten pages.
ents of empirical thinking offered in relation to
ersonal, and ethical thinking. The
This student chose not to use her own voice and, instead, she wrote a
biography.
Called “Hailey’s Story,” the text recounted the life story of a young woman
growing up in the 1980s in a small northern Ontario community.
While there were clear mom
Hailey—“Her family did not have that much money simply because her father was
the only parent able to work and provide for his family” and “Arnett stated that
‘autonomy is to learn to be independent and self-sufficient, to think for themselves
and be responsible for their own behaviour (Arnett, 2003)”—there were also many
moments of thinking that demonstrated aesthetic, p

121
as
following statement is provided as evidence of aesthetic thinking, “Hailey herself
struggled daily with both of these [identity exploration and instability]. She had an
insatiable need to please others, a need to explore new relationships, a dedication to
her family’s expectations, and a need to find her own place within the world.” As this
passage reveals, the author is very aware of what Hailey was trying to achieve in her
adolescent years.
As noted, the assignment also demonstrated personal and ethical thinking.
“She often felt that her parents just wouldn’t understand” is one example of several
cases of personal thinking found in the assignment. The statement “[t]he level of care
needed by Hailey’s mother was sometimes more than she could handle and conflict
would arise” suggests ethical thinking.
The four kinds of thinking found in this student’s assignment can be ranked
follows: 18 examples of empirical thinking, 8 examples of aesthetic thinking, 12
examples of personal thinking, and 6 examples of ethical thinking
The previous discussion has highlighted the design and general criteria associa
the three different assignments. It has, in addition, offered commentary based on the
student from each participant group. Because it is also important to consider th
all particip
ted with
work of one
e performance of
ants in demonstrating the four different kinds of thinking, Table 20 presents the more
general
rison group
al. It is
noted
earlier in this chapter, the assignment completed by this group was a reflective autobiographical
findings of the coding exercise.
The analysis presented in Table 20 reveals that students in the second compa
displayed greater variety in their kinds of thinking as well as more thinking in gener
suggested that this was due to the general topic and the criteria of the assignment. As

122
ed on Johns
Table 20
Means and Standard Deviations Based on Ways of Thinking in Writing Samples Bas
(1995) Framework
Way of thinking Group n M SD
Empirical Experimental
Comparison #2
32
8
22.91
42.50
8.058
1.512
Comparison #1 18 .61 1.037
Ethical Experimental
parison #1
32
18
.44
.00
.716
.000
Comparison #1 18 36.00 6.417
Personal Experimental
Comparison #1
Comparison #2
32
18
8
.56
.00
14.38
1.190
.000
6.610
Aesthetic Experimental 32 6.47 3.951
Comparison #2 8 18.25 5.092
Com
Comparison #2 8 3.63 1.847

123
eems reasonable to suggest that, when a person is writing about him- or herself,
the wri
cal
foster thinking that Johns (1995) calls aesthestic and personal. Finally, it seems
reasona e might be
th this life
all the writing assignments commented that,
in her o
upport for
stering of
to be paid to
rent ways of
ng, it may
r written
vious studies in online nursing education the researcher has participated in,
and her prior to full
analyses of the quantitative data. This was necessary because many of the potential participants
assignment wherein the student was asked to recount pivotal adolescent events that may have
contributed to the student’s emerging adulthood and to connect these ideas to theories studied in
the course. It s
ter has an “easy-to-access” repository of empirical data: no one can know the empirical
events of a person’s life better than the person him- or herself. In the assignment, this empiri
data was then supplemented by connections made to course readings and lecture notes. The
requirement that the writer was asked to reflect on these important life events would quite
naturally
ble to suggest that, when a writer reflects on his or her adolescence, ther
instances of ethical thinking given the turbulence and conflict frequently associated wi
stage. As an aside, one of the scorers who had read
pinion, this was the most interesting and stimulating of the three assignments.
Extrapolating, the coding for different kinds of thinking exercise may provide s
the idea that written assignments can elicit different kinds of thinking. Therefore, if fo
particular kinds of thinking is a valued educational goal, specific attention may need
assignment design. Additionally, if it is important for nurse-learners to practise diffe
thinking in the safety of a learning setting rather than in today’s fast-paced clinical setti
be especially important for instructors to take time and care in the development of thei
assignments.
Student Data: Interviews and Bulletin Board Comments
The ideas explored in the group sessions built on the themes explored in the
questionnaires, pre
experience as an online instructor and student. The sessions occurred

124
us group sessions as soon as the
course was completed might have meant losing the opportunity to do so. Table 21 provides
background on the student-participants (Table 21).
Why are you taking your post-RN degree at this time? Asked why they were pursuing a
nursing degree at this time, three cited personal learning (Students A, C, L). It is interesting that
the three participants who cited personal learning were among the oldest in the sample. Four
participants spoke about a degree as being pivotal to achievement of a professional goal
(Students A, E, I, J). All participants spoke about the need for nurses to continue to study
(Students A-N).
Why are you taking the post-RN program through Laurentian University? Of the 14
participants, seven commented on the program’s accessibility and flexibility. Called the “pay
off” of online learning (Student A), the participants indicated that accessibility and flexibility are
necessary for a variety of reasons including schedules with shifts and part-time commitments.
Four students spoke about the challenges of balancing work, study, and family responsibilities.
In one ealed that she
e able to study except for Internet-based education (Student L). In a second case, a
new mo p” (Student
were distance education students; not to have conducted the foc
instance, a mother of ten children due to a blended family situation rev
would not b
ther on maternity leave spoke of “stealing study time when the baby is aslee
I).

125
ude toward
course
Table 21
Profiles of Post-RN Students
Student Age Area of nursing
practice
Geographic
community
Previous online
experience
General attit
this online
Student A 49 Neonatalogy GTA Yes (1 course) Very Positive
Studen sitive
e
Yes (3 courses) Positive
Studen ork; not
gh time for
interaction
42 Haemodialysis S. Ontario No Overwhelmed at
Ontario Yes (4 courses) Positive
for
ed
t B 46 ET S. Ontario Yes (1 course) Po
Student C 47 Emergency;
oncology
N. Ontario Yes (5 courses) Very Positiv
Student D 34 Emergency N. Ontario
t E 46 ______ N. Ontario No Too much w
enou
Student F
beginning; need the
flexibility of online
course
Student G 39 Cardiac N.
Rehabilitation
Student H 35 Community
Health
N. Ontario No Several suggestions
improvement; ne

126
Age Area of nursing Geographic Previous online General attitude toward
Student
practice community experience this online course
flexibility of online
course
Student I 37 Medical- N. Ontario Yes (3 courses) Positive
Student J __ ______ N. Ontario No Positive
Student K 36 Case Manager S. Ontario No Quality good; too much
content; overwhelming
at times
Student L 46 Psychiatry N. Ontario Yes (8 courses) Very Positive
Student M 36 ______ ______ Yes (3 courses) Negative
Student N 50 Em S. Ontario No Positive
Surgical
ergency

127
The following excerpts bulletin board refle e complexity of the life of the
post-RN nurse-learner.
Hello Fellow Nurses and a Happy New Year to Everyone:
My name is…and thanks to my good friend…(who is also taking this course), I have
finally figured out how to work the WebCT Bulletin Board.
I am happily married and have 2 boys, 13 and 12, a dog and 2 budgies. This coming
ear is going to be both exciting and challenging, and I look forward to getting to know
everybody. It is nice to go through this with the support of other fellow nurses as I have not
been in School since 1982.
I got my nursing diploma from…in 1982. I started off my career working for an
agency in…but it was mainly psych nursing and there were there were no full time jobs at
that time so I applied everywhere in Canada and Europe. I got accepted at a hospital in
Switzerland and had a great experience working on a med-surg floor and traveling across
Europe. I came back to Canada and there still were no jobs, so I applied with the Army and
the Government. The Government offered me a job in…and I was stationed there for 2 yrs as
a med-surg-er-mat-ob-delivery nurse. I also did outpost nursing in the Northern Communities
at that time, and that is where I met my husband who was flying bush planes throughout
Northern Ontario.
We then moved from there to…for one year, where I worked on a med-surg floor and
in the emergency dept. Due to my husband's job with the airlines, we had to relocate to…in
1989, and ever since, I have been working at…. I worked there full time in the ICU for 8
years and I have been in the Emergency Dept since 1997. Presently I work casual in the ER
and PACU, and also work part time at…. In the past, I have had to put my career on hold and
taken from the ct th
y

128
and
ost of you, trying to balance full-time work and family and now schooling is
the grindstone even in the deep
freeze
work less hours to help balance home life, because my husband is an airline pilot and is away
a lot. We have decided that now is a good time in our lives for me to go back to school and
advance in my career as a nurse. I would like to focus more on leadership and management
now, therefore looking forward to completing the Post-RN program to compliment all my
other achievements and certifications.
These are exciting times for nursing, and it is time for us all to make a difference and
to bring all our previous experiences forward to help the upcoming generation. I must admit I
am a little nervous about going back to school, but with the support on line and of family
friends, I can do this.
Looking forward to this journey with all of you.
Regards,
Student N
******
Hello to all:
I wonder if I am the last person to introduce myself. My name is…and I have been an
RN for over 17 years. My experience has been varied from rehab to step-down, adult
surgical, ICU and now presently in the ER for 8 years. I have a casual position at…as the
intravenous instructor.
Like m
overwhelming. I am finding it difficult to get my nose to
that we are now experiencing.
I have two children 12 and 14 and tend to be a taxi driver for the most part.
Student D

129
in
in much closer physical proximity to other
r
nder,
plex
appear that flexibility in the delivery of courses and programs is a significant
conside
(E,
they were not always sure where to find and post materials, “I put my responses to the unit
one topics in the main section. Sorry” (Student E). These ideas are further suggested in the
following passages.
Being geographically close to a university did not appear to be the only factor in
choosing to study at that university. For example, several of the focus group participants live
southwestern Ontario. Despite the fact that they live
universities, these nurses have chosen Laurentian University in northeastern Ontario to take thei
studies. Repeatedly, the researcher heard that the flexibility of the Laurentian program was an
important factor in choosing the program. In the words of Student B, Laurentian University’s
School of Nursing is “right on track with its commitment to students regardless of age, ge
and social class who cannot attend traditional classes.” While choosing a university is a com
decision, it would
ration of the post-RN nurse-learner.
What special challenges did you experience because this was an online course? Three
challenges were repeatedly cited by the participants. The first included navigating an online
course with no previous experience. The second was starting the course late; the third was
keeping up with postings and other online activity.
Six participants reported that they had no previous experience with online education
F, H, J, K, N). According to Students F and K, this caused them to feel overwhelmed especially
at the beginning of the course. Another comment shared by participants about navigation was
that

130
Hi…
I wasn't quite sure where to post this message. Several other individuals in my group
u ve e c h
visits because of not receiving any comments at only after she p
ou e b eed to it
Could you please confirm that our email is working with ….?
Thank you.
*****
I apologize. I think being new in this system, I got confused with the email. I was
posting on the bulletin board under…name. Because her name is listed on the bulletin board,
ha is wh ould Looking k at previo
bulletin board…clearly requested that we email her from the email section.
Sorry for the confusion.
Student H
nder…ha not y t received feedback for our obje
from…. She posted th
tives. A few of us ave had to cancel
rovided
feedback, w ld w e able to proc our vis
Student H
I assumed t t this ere we w correspond. bac us postings on the
About starting the course late, the students suggested two general re
first being personal (“My daughter and I have just returned from Cuba which is w
I am a single mother of a wonderful little girl that will turn eight tomorrow,” Student M); the
second relating to the university’s tardiness in getting information about the course to them. In
one case, the student reported that she did not realize that the course was an online course until
ft e c ted
asons for this: the
hy I am late….
two weeks a er th ourse had star (Student F).

131
Well, I am another one of those signing in late. This is my first course online and I
didn't realize until tonight that it was mandatory to go online. I was really overwhelmed with
this course, didn't know which direction to go in! Thanks for calling me and helping m
I am really nervous about this course, especially with this late start!
Student F
e out!
Keeping up with postings was cited as a problem by several participants and reflected by
t nu er of p s the c essed. In three sections of the course, the
bulletin board forum
became progressively less active as the course unfolded. Table 22 shows how the postings for
Instructor A’s section dropped from 72 (32.0% of total optional postings) in Unit 1 to 12 (5.3%
of total optional postings) in Unit 5. Similar patterns occurred in the course sections moderated
rs nd C drop .6 9.8% to 2.1% respectively.
oc roup ts said e ab allenges o arning
although one student expressed strong displeasure with the course. In addition to identifying her
need to study within a face-to-face class context where she would be “able to put faces to
names,” she felt that the online nature of the course meant “too much information at once”
(Student M). Because she had started late, she “didn’t want to post.” She found the posting to be
“tough and tedious with too much analysis of one moment.” As a result, she said she decided to
simply “pop out a pass [standing for the course].”
he reduced mb ostings a ourse progr all
s where students posted answers to optional (ungraded) learning activities
by Instructo B a as postings ped from 37 % to 6.7% and 2
All f us g participan they wer le to meet the ch f online le

132
Table 22
Postings in Units 1 to 5
Unit number Instructor A Instructor B Instructor C
n=225 n=178 n=94
Unit 1 72 (32.0%) 67 (37.6%) 28 (29.8%)
Unit 2 73 (32.4%) 53 (29.8%) 25 (26.6%)
Unit 3 29 (12.9%) 31 (17.4%) 16 (17.0%)
Unit 4 39 (17.4%) 15 (8.5%) 23 (24.5%)
Unit 5 12 (5.3%) 12 (6.7%) 2 (2.1%)

133
I
zed that the course and the online aspect of the course
was cle
course was set up to enhance the learner's dispositions toward critical
thinkin so.
*****
I think the bulletin board is an excellent tool. This is my first online course, so I don't
a basis to go on. I did appreciate, however, the questioning of my views by the
profess
Has the course increased your dispositions towards critical thinking? All participants
including Student M reported that the course had favourably impacted their critical thinking
dispositions. Examples of student responses to this question are presented below.
I strongly believe that this type of course is an excellent format for critical thinking.
was initially intimidated, but soon reali
ar, easily accessible and provided excellent links to interesting sites.
Student B
*****
I think that this
g. The readings were extremely effective in doing
Student D
have much of
or on the bulletin board. It only happened the one time, but it forced me to defend my
position while acknowledging another's.
Student J
The participants offered recommendations for how the course might be adapted to fu
enhance critical thinking. Student A commented that “problem-based learning involving t
application of different principles or m
rther
he
odels to a practical (often real life) setting is an important
learnin ase studies
re a lot of personal opinions, past experiences, etc.” while Student H described the
portance of “more open discussion and finding a way of ‘sharing’ that is not direct copying of
g tool for me.” Student C suggested that “assignment content might include c
which requi
im

134
ialogue
y
ontent with its emphasis on Johns’ ways of
ns
the fact that when she started the course she
he
udent A describes the impact of the course and its focus on reflection on
her in detail.
I just wanted to share with you my news. I have accepted a new position as a Clinical
Leader…. This has been a huge decision for me as I have been in the NICU environment for
the work of others…the number of students could also be lower to facilitate more open d
with each one.”
In summary, the majority of the nurses prefaced their comments about critical thinking b
pointing out that they practise critical thinking in the clinical setting—“As an ET nurse, I am
always thinking critically (Student B); “Nurses are always thinking critically” (Student D).
Seven of them went on to add that the course had been an excellent reminder of the role of
critical thinking in practice; for example, two students stated that the course renewed their
awareness that critical thinking is a “touchstone” in clinical practice (Students A, B). According
to Student A, critical thinking is how “we grow as learners” and “critical thinkers are not easily
swayed.” Student C talked about the course c
thinking in nursing as “helpful in defining issues that nurses have long since struggled
with…such as caring.”
A self-reported example of possible impact on a student’s critical thinking dispositio
was suggested by Student A. Student A talked about
found herself asking “why am I doing this?” Describing herself as a nurse who was “struggling
at bedside after a very trying year,” she “did not know if [she] wanted to carry on with [her
degree]” at the beginning of the course. As the course unfolded, she found her “confidence
returning through the reflective thinking activities of the course,” the theme of caring which
“struck a chord,” and the instructor’s “ability to connect [which] came across the wire.” In t
following passage, St

135
rs. People have been encouraging me to pursue leadership roles for some time, my
confide
ling wounded…. Caring was such a
touchy uch to that unit.
flection piece of this course helped me make the decision to pursue other
pportunities and not let fear paralyze me. As I examined my clinical experiences,
I realized I could support nurses by providing a ractice environment, I had returned
to scho s
al issues stay
the sam drain with disappointment, I felt it returning as excitement
ok to this new adventure.
“Creativity in caring cannot be something that is taught, but it certainly can be
facilitated” (Richards, 2002, p. 32). An important question for me as I reflected on my 29
year practice was whether or not the current climate or professional practice encourages
creativity to thrive, encouraging nurses to feel enabled to respond to need in ways that
transcend the mechanics of routine care (Richards, 2002). As I enter this new career phase
into management, I can only leave behind my clinical practice believing I can support nurses
in developing quality practice environment, hoping they can experience the rewards I have
had over the years. I will remember this course as part of a turning point in my life and have
26 yea
nce causing me reluctance. This Jan. a temporary role for CL came available for the
NICU…. Between the 2 exams I was writing, Chem and Women’s Health, I did poorly on
the interview and was not successful. I had previously done the role and had received great
reviews…. To say the least, I started this course fee
subject for me…. I was not feeling cared for… I had given so m
The re
leadership o
quality p
ol to grow… [My teacher’s] teaching style of personally acknowledging everyone’
contributions has been a great morale booster for me…did a lot to help me recover from my
disappointment and helped me feel able to pursue this other job interview. The sharing and
postings helped me to realize the diversity in nursing, to realize that the centr
e. Just as I felt me energy
builds as I lo

136
to believe in a power that places tools where they are needed. Everything happens for a
reason.
Has the bulletin board supported your learning? Because of the study’s focus on the role
n an asynchronous discussion forum, the students were asked about the use of the
ulletin board in supporting learning. The students’ responses reflected mixed opinions.
d
of writing i
b
Before sharing these opinions, it is important to remind the reader that although all
students were enrolled in the same course, there were three sections of the course with bulletin
boards organized and moderated by three teachers. Although each board included forums for
assignments and the learning activities of each unit, beyond this, the look and feel of each boar
was unique. Figure 4 shows the different organizational systems used by two instructors. In the

137
Figure 4. Two Different Interfaces for Bulletin Board Work Used in Course Taken by
Experimental Group.

138
first, th
udent in the
course
uld use personal
anted to tell a story about my father. I could not have done this live without becoming
teary.” A second student who said she read the postings stated that she might have been
intimid ,
e been intimidated in a classroom”
. While Student A expressed positive views about the bulletin board, she noted that
the posting experience can be “wounding” and that learners need to be prepared to take “risks.”
A fourt rse
as that, except for the “required” or “for marks”
uations in which all students participated, posting was carried out by a small core
group of students. Student B commented, “I'm not sure how to fix the problem of one person
always answering the questions before everybody else. This isn't a rude thing. For me, there just
seems no impetus to respond to an activity that somebody else has already answered all the
questions for. I don't mind responding to the response, but not to reiterate what someone else has
said.” About this same idea, Student L offered the following remarks:
ere are 18 forums grouped in subsets. In the second, there are 32 forums that do not
follow an apparent system of organization.
Four students spoke very positively about the bulletin board. Student L, a st
section with the less cluttered bulletin board (see Figure 4), indicated that she found
posting to be a “liberating experience,” explaining that the anonymity of the board prevents a
person from becoming too emotional, “I like the fact that in this course we co
stories. I w
most of
ated expressing her views in a classroom. She was not intimidated on the bulletin board
“There was so much experience in our group that I would hav
(Student G)
h participant (Student C) stated that the communication tools of this WebCT-based cou
made the course a “much better experience than the old print courses.”
Three main concerns were expressed regarding the bulletin board. The first complaint—
recounted by (Students A, B, E, F, K)—w
posting sit

139
ve never received any feedback from other students. This present professor
has bee
e
s
Students need to provide more feedback to each other—I have posted many
comments and ha
n excellent in that she responds to all comments posted. This is my last course prior to
graduation so I have much experience with WebCT—and this professor has been outstanding
with how she has responded to all our postings. It is interesting to note that the course I took
in…, the feedback from other students was outstanding. Everyone would respond back and
give some ideas about things that were written. Is it the type of student taking the course, th
workload of the course...that helps determine the amount of feedback that you receive? These
are all interesting questions??? In regards to critical thinking...when I posted and ask for
other students’ feedback...it is this feedback that encourages my critical thinking and open
up my world views....
Two students (Students L, M) commented that the board was ineffectively organized; as
stated earlier, each teacher organized her own board and there was no standardized
organizational framework across the three sections. In the case of Student L, her bulletin board
was the cluttered board presented in Figure 4. In the opinion of Student M, her board was “weak
and poorly organized”; she “would have preferred a board that moved on more quickly.”
Six students (B, D, E, F, K, M) pointed out that the bulletin board included too much to
absorb and that they went to the board only to deposit their required (“for marks”) postings
and/or when they had a problem they could not solve alone. In the opinion of these students, the
bulletin board was more of a place to go to drop off assignments and resolve problems than a
place to
enough time and feeling overwhelmed especially near the beginning of the course. This feeling
experience learning. Of the six students who expressed this idea, four of them had no
previous experience with online education; these same six students spoke about not having

140
in
re
I find
).
ts
ents D,
F). Thi post-
e
ic
s say
ent
he different expectations of instructors, a two-page style
guide w hen there
nted that
e in
this
ited
from either an Internet-based chat room where the instructor could hold office hours or from a
of being overwhelmed did not appear to be tied to the organizational interface of the bullet
board as each of these students was enrolled in the section with the less cluttered board (Figu
4). One student commented, “We need far less e-mails and reading from the bulletin board.
it hard to keep track of it all that way and there has been well over 300 postings” (Student F
Tell me about your experience of academic writing in the course. Two participan
indicated that academic writing at university was a brand new experience for them (Stud
s situation occurred because the course included students at different points in the
RN program. Student D went further to say that “this course was the first time I have ever
written a formal paper. We didn’t do any formal writing in college.”
The other students expressed that they felt comfortable with the writing required in th
course although there were concerns expressed about the APA style conventions expected in
their graded postings. Students A and B commented on the inconsistency across the academ
community in its demand for the use of these conventions, “I am frustrated that our teacher
they are marking our APA style but then they all seem to be using different guidelines” (Stud
A); “With APA being so daunting and t
ould be a good idea” (Student B). Student L remarked, “It is really frustrating w
is so much importance placed on it but we are not taught it. APA is a difficult skill to learn
alone.” While two students thought that they might have benefited from the services of
Laurentian University’s writing assistance program (Students D, B), it was also comme
such supports are valuable only if there is a quick turnaround time, “I don’t have enough tim
my schedule to wait one or two days for feedback” (Student B).
What changes would you recommend to online courses based on your experience in
course? Several participants (Students B, C, D, E, J, M) indicated that they would have benef

141
r in it
en time for questions or concerns. It could also be a great way to interact with other
learners. I don't feel this should be mandatory (because different people have different schedules
and may not be able to chat a specific time) but certainly it should be an option.” Two students
recommended providing grades for general bulletin board participation (Student G, E), “By
giving marks for participation, students would have to do critical thinking and maybe they would
end up enjoying it” (Student G).
As noted in the students’ responses to the question “Do You Think the Course Has
Increased Your Dispositions Towards the Practice of Critical Thinking?”, students had a number
of suggestions regarding how the course might be modified to further enhance critical thinking.
The recurring suggestions suggested more problem-based learning, case studies, opportunities to
draw on personal clinical experiences, and more dialogue in contrast with straightforward
answering of questions where there might be the inclination to repeat others’ ideas.
About instructors. Although not formally queried about their instructors, four students
from the same course section volunteered strongly positive comments about their instructor.
Student A spoke about her teacher’s “wonderful presence on the board.” This same student
continued to say that, while she found that assignments were slow to be returned by this teacher,
she preferred the “caring feedback the teacher provided over a fast turnaround in marks”
(Student A). Two other students in a second section spoke favourably about their teacher. No
comments were offered by students about the third instructor. While the first instructor was
commended for her extraordinary presence on the board in both qualitative and quantitative
ways, the second instructor was recognized for the clarity and helpfulness of her messages.
teleconference. Student B commented, “Definitely a chat room, maybe with the instructo
for a giv

142
experienced part-tim e teachers, they
may have more tim ember might have.
Instructor A, in addition
education completed through distan
on experience at the
Both instructors spoke about the
age and experience spread among their students from new graduates to highly experienced
ce.”
Teacher Data: Interview and Bulletin Board Comments
Two of the three course instructors agreed to be interviewed. Each is a highly
e nursing instructor. Both instructors stated that, as part-tim
e to dedicate to an online course than a full-time faculty m
Can you tell me a little about yourself as a nurse and a teacher?
to her background in nursing education, spoke about her Master of Education degree in adult
ce education. As a graduate of Laurentian University’s
School of Nursing, Instructor B has over 15 years of nursing educati
community college and university levels.
How would you describe your students in this course?
nurses. According to Instructor B, “the different levels of experience in nursing were very
evident. Also for some students, this was their last course and this meant that they had covered
some of the content before.”
Instructor A worked with students principally from southwestern Ontario. A comment
she offered about this group was that many of them had been referred to the Laurentian program
through colleagues and peers who had taken the program previously. While Instructor B’s
students drew principally from northeastern Ontario, her group also included learners from the
Greater Toronto Area (GTA) and Hamilton, “I had a number of students from Chinese and
Russian backgrounds. They would call me regularly and were very concerned about the writing
they had to do in the course.” By comparison, the students from northern Ontario tended to be
more technically savvy and to have more support networks than other students, “My students
from North Bay, Sudbury, and Sault Ste. Marie were familiar with the ‘distance ed’ experien

143
ed every week.
nt
nd perhaps too difficult.”
Accord
ad
ile, someone raised a
clinical issue out of the blue. Near the end of the course, someone started a new thread about
something going on at work. The dialogue that happened in that thread was very rich.”
The exceptions were a student from a small northern community who had ongoing technical
difficulties and another student who telephon
Do you think the course helped your students as critical thinkers? Critical thinking—
while expected in all aspects of the course—was targeted in two “required” or “for marks”
postings made by each student. Students were asked to complete these bulletins at the mid-poi
and towards the end of the course.
The first assignment asked the student to reflect on a clinical practice event from the
student’s work experience. In the second assignment, the students were provided with a clinical
case and asked to analyze the case. The headings used in this assignment were actual data, data
needed, provisional diagnosis, learning issues, and critical thinking. The two assignments were
called Posting #1 and Posting #2 (Appendix C).
Regarding the first assignment, Instructor A commented, “My students just didn’t get it.”
While the reflection and thinking components of the assignment “resonated with some,”
Instructor A felt that the description of the assignment was “too wordy a
ing to Instructor A, this led to “situations where there was straightforward repeating of
information….They simply fed back information and did little reflecting on their personal
experiences.” Instructor B stated that, in her opinion, the students had done good work. She h
posted hints about how to approach the assignment and felt that the use of a real personal
experience in nursing was a strong point of the assignment. She added that the “bulletin board
postings that demonstrated the greatest critical thinking were those in which students spoke
about their own lived experiences and showed valuing of their clinical experiences. This
happened not so much in the assignments but when, every once in a wh

144
d
end
usy.
?
can’t
ad some very strong participants who contributed regularly and acted as
role models for the others but I also had some outstanding work from students who were hardly
ever on line.” Instructor B mentioned one student who had many technical problems and
accessed the bulletin board only occasionally yet her work was exceptional.
Tell me about academic writing in the course. Instructor B spoke about the writing needs
of a group of her students who were from the Toronto area and who contended with situations of
English as a second language, “My students from the Toronto area called a lot. They were very
concerned about the writing required in the course.” Although these students required much
support, all of them successfully completed their work and experienced “great growth as writers”
(Instructor B).
Regarding the students’ expertise with the discipline-specific writing conventions (APA),
both instructors indicated that the students’ skill in this area depended largely on where they
were in the post-RN program, “Students new to the program had much more to learn than those
About the second assignment, both instructors felt that students had performe
satisfactorily. However, Instructor A commented that, since this assignment was due near the
of the course, students did not have enough time to do reflection and critical thinking in a
meaningful way, “In the overall, there were too many assignments and the assignments need to
be re-worked. It was extreme for everyone.” Instructor B agreed that “the students were too b
They really had no time for reflection. We have to remember that these students have lives.”
Do you think you saw a connection between critical thinking and writing in the course
Asked if they perceived a positive connection between writing and enhanced critical
thinking, both instructors were reluctant to support this view. Instructor A commented, “I
really say. Some of them are comfortable with writing. Others prefer reading over writing.”
Instructor B added, “I h

145
near the end of the program. If this was the last course for a student, APA was old hat. In all,
students did improve a lot” (Instructor B).
Instructor A called herself a “stickler” for APA who encourages her students to rely on
the APA manual, “I tell them to get the manual and to flag it. I really push my students. Some of
them really take this on.” Instructor B commented, “I don’t take marks off. I do encourage them
to keep at it. I also give them samples. I don’t find the manual to be very helpful.”
Both instructors commented that some students demonstrated growth in their expertise of
evidence-based writing. These students progressed from “I believe” type statements to
statements supported by relevant references to the nursing literature, “The students who
demonstrated evidence-based writing were the graduating participants. They had met some of the
content before and had learned APA over the program” (Instructor B).
How do you see the instructor’s role in moderating the bulletin board? Asked to describe
the instructor’s role in moderating the bulletin board, each spoke about the challenge of “how to
create dialogue” (Instructors A, B). At the same time, they presented somewhat contrary
positions regarding how they approach this task.
Instructor A spoke of making a conscious decision not to participate on the board
regularly. Instead, she read everything and stepped in only when asked or if there was a problem
requiring her expertise. She did, however, summarize comments shared on the board at the end
each week and at other key points in the course. In the following excerpt, Instructor A describes
her approach to the bulletin board to her students:
Hello everyone:
We are moving along and some of you have organized your visits. Excellent!
You'll notice that I don't make many comments on the bulletin board. Your thoughts

146
and comments are the true meat of the discussion and provide the varied perspectives
that make the course interesting and thought provoking. I try to put out questions that I
hope will facilitate the critical reflection that takes us to a deeper understanding of our
motives and values. I do read each posting. The more postings the better the dialogue
but realistically you can be selective about the questions you answer.
I have posted under assignment one a few helpful hints. Make sure you read it.
Instructor B described herself as a participant, “This was the only course I was
facilitating. I very much enjoyed it. I saw myself as a participant.” This excerpt taken from
Instructor B’s very first posting on the board emphasizes this idea, “The greatest gift of teaching
is the opportunity to meet and study with such a dynamic and caring group of people like
yourselves.” Near the end of the course, Instructor B posted the following statement:
It has been a privilege to have the chance to study with you over the past few months.
It has been a very enriching experience sharing your wealth of experiential knowledge and
outstanding insight into the concepts of caring, healing, health promotion, the therapeutic
relationship, reflective practice, the family, teaching/learning and critical thinking and the
nursing process. You are all outstanding role models for the utmost level of care and have
truly shown me the path to the aesthetic way of knowing in nursing.
While the instructors saw their roles differently, both offered their students many notes of
clarification and encouragement as well as resources and samples.

147
ave put
struc
5
hey
sights, and resources as you work through the
units in
Clarification
Based on some of your questions about assignment #1, the course professors h
together some ideas that we hope will clarify any questions you have.
It is attached as a word file.
In tor A
*****
The bulletin board postings are submitted for marking. These are described on page
of the assignment file. Any other bulletin board postings that you make are not marked. T
are intended to promote sharing of ideas, in
the book. Every unit has questions that are asked to be answered but they are not
marked. The only bulletin board postings that are marked are the ones on page 5 in the
assignment file:
Posting #1: Reflective Practice
Posting #2: Critical Thinking
Hope this makes it a bit clearer. I will be here today so please call if I can be of
further help.
Take care.
Instructor B

148
examine our progress and make plans to
move f
Encouragement
Hello Everyone:
The marks are posted. I will hopefully mark all the bulletin board postings in the next
few days…and then it is a wrap. You have done amazing things and I have learned a lot from
your submissions.
Instructor A
*****
Hi Everyone:
Your interactions and reflections on the bulletin board illustrate that you are a gifted
group of nurses!! It is a privilege to have the chance to study with you. As we move to the
end of the third week of the course, it is helpful to
orward into our theoretical applications and professional growth.
Unit Two provides a vital link…
Instructor B
*****
Thank you for sharing this very touching reflection that speaks volumes to the
potential for a high level of human connectedness in the therapeutic relationship. You have
demonstrated an outstanding sensitivity to the needs of this family, your empathy was
accompanied by warmth and genuineness and your true caring and concern for what the
client/family was experiencing shone…. Thanks so much for sharing this reflection. This
woman was very fortunate to have you as her husband’s nurse. You have touched her life
forever.
Instructor B

149
Hi Eve
Resources and Samples
For some of you accessing articles online may be a new experience. In order to find
the article we discussed in the first helpful hints, we have put together a few more tips.
See attached.
Instructor A
*****
ryone
I hope you are all well. I met with your teachers from the other two sections of NURS
2276 and we developed some helpful hints for this assignment. We will work toward a more
thorough application of the Ways of Knowing in the Bulletin Board Posting assignment.
Please let me know if you have any more questions. Take care.
Helpful Hints for Assignment #1
1. Plan time accordingly, the assignment is due….
Instructor B
What changes would you make to increase bulletin board participation? Asked about
changes they would make to increase participation on the bulletin board, both instructors
suggested that providing a participation grade might be a way to increase participation. Each
instructor stated that she would consider doing this in subsequent offerings of the course.
Instructor B volunteered her recollection of an online course in which she had been a student and
15% of students’ final standing was based on participation, “In this course, there was less to read
and there was group work. Each group had a position paper and three questions to explore. The
questions really got me engaged.” Instructor A volunteered that she had taught an online course

150
s
sted that
are
d taught previously
, “All
end them in all courses.”
rse,
don’t think teleconferences would be
neces hard to organize and that the nurses don’t need one more thing they ‘have
to do.’”
a
way f
with a nursing issues focus and that, in her opinion, this kind of content generated robust
discussion.
How else did you interact with your students besides the bulletin board? Both instructor
suggested that the course included much teacher-to-student interaction that went unseen;
Instructor B said, “I did lots of telephone work. I probably talked to 30% of my students over the
course.”
In many cases, the phone calls were an important means of providing reassurance.
Instructor A talked about checking on her students’ “emotional state.” It was also sugge
some students benefited from these calls because they are auditory learners, “Just as there
individual learning styles in the classroom, the same applies in online learning” (Instructor A).
Instructor A volunteered that, during the online course that she ha
(noted at What Changes Would You Make to Increase Bulletin Board Participation?), she had
received very few phone calls, “I had hardly any calls in the Issues and Directions course I taught
last spring.” Her explanation of this was that this course had included a weekly work plan
students benefit from work plans. I would recomm
Asked whether or not teleconferencing might be an appropriate addition to the cou
Instructor B said, “Any support network that fosters a sense of community and sharing about the
course would be a valuable addition to the course.” Instructor A recommended reducing the
course load in contrast with the idea of adding required teleconferences, “If we reduce the
number of assignments and re-work them a little, I
sary. They are so
Asked about the option of synchronous chat, the instructors stated that this might be
or students to connect with each other and establish informal support networks, “Chats

151
migh
requi
Summ
of the relationship
between the ly
demonstrate. Because of the role that writing plays in online education, this area merits serious
study.
ram,
e-to-
ances, the
flexibility of
responses were mixed; some spoke very positively while others did not comment. Organization
of the b
with serious concerns
expressed by those who were new to writing in nursing at university. Students varied in their
opinions about the emphasis on APA writing conventions in the course and how writing supports
might be useful for them. As for suggestions for improving the course, the dominant suggestion
was to include alternate ways for the nurses to connect such as a chat room or teleconference
t help students connect with each other but I would not want to see them be a course
rement” (Instructor A).
ary
The coding for Johns’ (1995) ways of thinking led to an appreciation
design of writing assignments and the kinds of thinking that students will typical
Although the students reported a variety of reasons for taking a post-RN degree prog
all spoke about the need for nurses to pursue additional education. It is suggested that this may
be an outcome of the changes presently occurring in healthcare as well as the baccalaureat
practice requirement. As for why the nurses chose to study at Laurentian, in many inst
online learning was cited as a variable (Appendix K).
Navigating an online course with limited experience, starting the course late, and keeping
up with postings were cited by the participants as their main problems. While the nurses had no
quantitative measure of whether or not the course had positively impacted their disposition
towards critical thinking at the time of the focus group sessions, they all reported that the course
had done so. Regarding the role of the bulletin board in enhancing their learning, students’
oard was described to be problematic by some of the participants.
Their experiences of academic writing were similarly mixed

152
might offer. Problem-based learning, cas earning activities that draw on personal
and cli
up who spoke very
warmly about one of the instructors. She was recognized for her extraordinary commitment to
dback and her interest in her students.
The instructors expressed enormous respect on the part of the teachers for their students
and rec er
f the
Toronto
e into the course with challenges related to language and, in turn, academic
extremely hard and made impressive gains over the duration of
ng that
e first “for grades” bulletin board posting. Both felt that better critical thinking was
demonstrated in the second bulletin board posting. Ambivalence was evident when they were
perceived a connection between writing and enhanced critical thinking; it was
suggested that reading may be just as important as writing in the enablement of critical thinking.
The instructors described somewhat different expectations regarding the use of APA
conventions in the course, one offering a greater number of samples to her students and the other
encouraging students to rely almost exclusively on the APA manual. The instructors further
described contrary manners of moderating a bulletin board: in one instance, the instructor saw
herself as a co-learner; in the other, the instructor saw the board as a place for her students to
e studies, and l
nical experience were recommended as ways of fostering critical thinking.
Although not asked about their instructors, there was a core gro
providing fee
ognition of the complexity of their lives. The instructors further impressed the research
with their extensive backgrounds as nursing and adult educators.
Some patterns seemed evident to the instructors based on geographical groupings o
students. In particular, northern learners were described as possibly more familiar and
comfortable with distance education strategies than others. Some students in the Greater
Area (GTA) cam
writing. These students worked
the course.
The instructors expressed different viewpoints about the quality of critical thinki
occurred in th
asked if they

153
exchange ideas with a limited personal acher. As for ways to increase bulletin
board participation, awarding grades and modifying certain components of the content and
learnin
tside of the WebCT course. Most notable were the number of personal calls
students. Teleconferences were recognized as a possible way by which students
might feel more connected but were recognized as logistically complex to organize and often
im orking nurses. Online chatting might be a way to reduce isolation but was not
seen as
presence by the te
g activities were recommended.
Finally, each instructor commented on the additional support and interacting with
students they did ou
each had with
practical for w
valuable as a way of delivering course content.

154
The hypotheses explored in this study are the following:
1. online nursing courses that include asynchronous reflective writing activities enhance the
learner’s dispositions toward critical thinking,
2. online courses that include asynchronous reflective writing activities increase the learner’s
perception of competence as a writer, and
3. online courses that include asynchronous reflective writing activities facilitate demonstration
of critical thinking skills through writing.
In this chapter, findings related to each hypothesis and relevant emerging findings and areas of
interest are discussed. The study’s contribution to constructivist learning theory will also be
highlighted.
First Hypothesis: Dispositions Towards Critical Thinking
The study did not reveal statistically significant increases in the participants’ measures of
critical thinking dispositions as a function of online involvement. As a result, the first hypothesis
not supported.
Chapter VI
Discussion
is
For those who work as educators in fields where certain critical thinking dispositions are
valued, this is important. The healthcare profession is one such discipline (Bartlett & Cox, 2000,
2002; Profetto-McGrath, 2003a, 2003b). Because this study reveals that critical thinking
dispositions do not generally change according to age, life experience, and learning format, there
is a need for research into the design and evaluation of learning activities and assignments as
well as content presentation if cultivating critical thinking dispositions through education is a
desired goal. This research would impact not only those interested in specific critical thinking
dispositions but also those who maintain, that, without positive critical thinking dispositions in

155
sted that, although cultivation of critical thinking dispositions may not be an easy
ning
t Canadian universities continues to climb, educators need to better understand how
assignm
to chan
, 2005; Sedlak,
1997);
this
s tends
critical thinking skills can be fostered and demonstrated through writing as well as how
to desig
general, critical thinking applications may be substandard (Profetto-McGrath, 2003a). It is
further sugge
goal to achieve, this does not mean that it is not worth pursuing.
Another area for research involves the adaptation of assignments used in other lear
contexts for the online setting. For example, as the number of online learning courses taken by
students a
ents typically used in the face-to-face classroom require modification in order to
maximize the potential of the web experience. On a similar note, the strengths and limitations of
text-based assignments in web-based settings likewise require study.
A further outcome for educators based on the finding that dispositions tend to be resistant
ge might be a greater focus on critical thinking skills in contrast with critical thinking
dispositions. Although difficulty was encountered in measuring critical thinking as displayed in
writing, there is a rich body of literature that supports the claim that critical thinking applications
can be demonstrated in writing (Brown & Sorrell, 1993; Burrows, 1995; Garrison & Anderson,
2003; Ibarreta, 2004; Ironside, 2003; Kennison & Misselwitz, 2002; McLean
as well, as later discussion in this chapter suggests, it was found that that different kinds
of thinking can be elicited through writing. In the case of online education, the decision to focus
on critical thinking skills rather than critical thinking dispositions could require collaboration
among the different members of the learning team. As suggested in the literature search for
project, at the present time, online education as delivered by most colleges and universitie
to be heavily text-based. Research needs to continue so that educators have a good understanding
of which
n written assignments that encourage development of specifically-identified critical
thinking skills. Additionally, subject matter experts may want to explore with instructional

156
effectiveness in enhancing critical thinking skills. In other words,
e is a need for further research into writing-based assignments for the online
educati
blended with written assignments support development of critical thinking skills is
another
, others have found a
relation
tting
nd
cal experiences
(Lundy he
ing
designers, educational technologists, and educational researchers alternate kinds of online
learning experiences and their
just as ther
onal environment and how they may foster specific critical thinking skills, there is a need
for research into the critical thinking potential of other web-based learning options including
multimedia applications and web streaming. How multimedia-rich learning opportunities when
they are
area for study.
An interesting observation related to assignment design was offered by a post-RN nurse
in one of the interviews. This nurse suggested that more case studies might have been a way of
encouraging critical thinking skills in the course. While some studies claim that critical thinking
skill is not related to gender (Baxter-Magolda, 1992; Claytor, 1997)
ship between gender and critical thinking based on the idea that women have different
ways of knowing than men (Belenky, Clinchy, Goldberger & Taurule, 1986; Miller, Finley &
McKinley, 1990; Rudd et al., 2000; Walsh, 1996; Wilson, 1989). Therefore, in a learning se
where critical thinking skill is valued, the issue of gender may also need to be considered. For
instance, it has been suggested that, because women are more culturally socialized to build a
maintain relationships through co-operation, they tend to apply critical thinking in scenario- and
case-based learning situations and activities that draw on personal and clini
et al., 2002). Extrapolating, in learning situations such as nursing education where t
majority of participants are female, attention may need to be paid by content experts and learn
designers to preparing these kinds of learning activities.
Additional observations made about the development of critical thinking skill in an online
course were offered by the two instructors of the post-RN nurses in their interview. The

157
ritical
thinkin n
described how a student who had made
minima
ills were enhanced more
through
a result,
ting or the act of reading postings or some blend of the two that whets the critical
thinkin
est
conside
s,
instructors commented on the idea that, in the course, both writing and reading in contrast with
just writing might have contributed to any growth the students experienced in their c
g skills. They further commented on how personal learning style likely affects how a
individual student responds to a learning activity designed to elicit critical thinking skill. As
possible support for these ideas, one of the instructors
l contributions to the bulletin board did extremely well in the course. While the student
had been able to read postings, she had had technical difficulties whenever she tried to make a
posting. The suggestion was that this student’s critical thinking sk
reading than through writing. While the researcher accepts that the student may have
been learning effectively, her ideas were not being shared with others in the course. As
she would not have gained from her peers’ critique of her ideas. Nor would she have contributed
to the learning of her colleagues.
Considering all these ideas, the researcher has been challenged to consider whether it is
the act of pos
g appetite in an online course where words are extremely important. At the same time, it
is suggested that, in each scenario, writing is a pivotal element: the learner is either doing writing
or interacting with the writing of others. Building on this idea, it is suggested that there is work
to be done to understand which activity—reading or writing—and which blends of the two b
support critical thinking skills when there is specialized subject matter and unique learning style
rations. While the researcher is primarily interested in writing as it occurs in the
postsecondary educational setting, she would suggest that there has been excellent work done in
this area by reading and writing experts who have focused on younger learners and that there
may be valuable opportunities to build on this work (Atwell, 1998, 1991; Calkins, 1994; Grave
1983, 1994).

158
is a
volving the online learning setting, learning styles,
reading idence
here critical thinking skills are
utilized and possibly enhanced.
The finding that there was an increase in the truthseeking disposition corresponding with
university experience across all three participant groups may be related to what some North
American educational researchers are saying about twenty-first century university learners. Adult
learners have long been classified as being approximately 25 or older and have been described as
possessing unique characteristics (Knowles, 1978; Snow, 1977). There is growing evidence that
the characteristics and motivations historically associated with adult learners apply to the
majority of students pursuing twenty-first century higher education (Bash, 2003). According to
Bash (2003), many younger university students are “exhibiting behaviours and characteristics
previously attributed to their older classmates” (p. 39): these attributes include internal
motivation, awareness of social role, use of life experience in learning, a sense of immediacy,
problem-centeredness in learning, and self-direction (Knowles, 1980, 1984). If one accepts this
idea that that postsecondary institutions are witnessing a “new 18- to 22-year old student” (Bash,
2003, p. 57) and the fact that more mid-career professionals are seeking postsecondary
educational opportunities, it is not surprising that, in this study, truthseeking in comparison with
While there is research happening in the area of learning styles and distance-based online
education settings (James & Gardner, 1995; Neuhauser, 2002), it is recommended that there
need for research into the relationship in
and writing, and critical thinking skills. Regarding reading and writing, there is ev
that the online reading experience is different from that which occurs in other learning settings;
the ways by which writing can occur on line are numerous and, in several instances, have been
identified as specific to the online milieu. The more that researchers can discover about these
activities and their connections to critical thinking skills, the better able course designers and
subject matter experts will be to offer learning experiences w

159
the other dispositions emerged as the CCT ow the greatest increase over time. The
rationale suggested here is rooted in the pri ractices of andragogy.
s learners with high
ng
ition of truthseeking as offered by Facione
ts the disposition of being eager to seek the
reconceived opinions. The truth-seeker would
elphi
change is warranted,” “reasonableness in selecting and applying criteria” and
es and/or the generation of meaning, it seems reasonable that online learners—
like the
cipline,
ld
DI scale to sh
nciples and p
Adult learners have typically been described in the literature a
motivation and strong sense of purpose; they are learners who are often dedicated to discoveri
truth as it applies to their life circumstances. The defin
and Facione (2000) and as measured by the CCTDI is offered here:
The truthseeking scale (the T-Scale) targe
truth, courageous about asking questions, and honest and objective about pursuing inquiry even
if the findings do not support one’s interests or p
rather pursue the truth than win the argument. This scale refines, focuses, and extends the D
characteristics “willingness to reconsider and revise one’s views where honest reflection
suggests that
“flexibility in considering alternatives and opinions.” (p. 2)
Additionally, if asynchronous bulletin boards are places where learners not only share
ideas but also receive constructive feedback from peers and instructors that may assist in the
refinement of issu
ir peers in face-to-face learning classrooms—would demonstrate increases in their
truthseeking scores. It is also interesting that the truthseeking gains were reflected across all
three groups in the study, perhaps suggesting that postsecondary learners regardless of dis
age, and learning format are truthseekers. A further observation about the truthseeking scores is
that, although truthseeking in the pre and postcontexts generated the lowest scores, it also
witnessed the greatest gains. Therefore, if modern universities value truthseeking as a goal for
their learners, this is a positive finding. Additionally, those who work in the adult education fie

160
is regarded to be the basis of
evidenc
and
information they receive
for its r
s
ed
and with learners who carry additional family and work responsibilities may be take some
assurance that these learners are also making progress in truthseeking.
As a critical thinking disposition, truthseeking—because it
e-based practice—is of particular interest in the healthcare professions and, therefore, to
those who educate health care professionals. For example, in doctoral work conducted by
Profetto-McGrath (1998), it was discovered that a group of baccalaureate nurses at the
University of Alberta scored highest on the critical thinking disposition of inquisitiveness
lowest on truthseeking as per the CCTDI. Based on this finding, Profetto-McGrath (1998)
suggested that baccalaureate nurse-learners may not always critique the
elative truth. Similarly, in research conducted with physiotherapy students, Bartlett and
Cox (2000, 2002) from the University of Western Ontario reported that physiotherapy student
scored highest on openmindedness and inquisitiveness, and lowest on truthseeking and critical
thinking self-confidence. Based on these findings, the researchers suggested that the university’s
physiotherapy curriculum required review to determine if it emphasized one disposition over
others. Given the quasi-experimental design of this study, it is suggested that contemporary
university students including nursing education students of different ages who are studying in
different ways do make gains in the truthseeking area. If this gain is not rapid or substantive
enough based on the demands of the discipline, university educators may wish to complement
this natural evolution over time with educational occasions that target development of this
disposition.
In summary, although the hypothesis that online nursing courses that include
asynchronous reflective writing activities enhance the learner’s dispositions towards critical
thinking cannot be supported by this study, it is suggested that important insights have been
generated for instructors and those who work in course development units. It is also suggest

161
the
s
s
hesis was that online courses that include asynchronous reflective
writing
e-
is
e.
84; Prajares, 1996; Schunk, 1991), it is
suggest
icate
that the finding of sustained scores is more advantageous than had there been a decrease in
scores; for those who might question the impact of online courses on learners’ attitudes, this
finding suggests that the influence of the online educational experience on dispositions i
comparable to that of other learning experiences. Stated another way, online learners are on par
with their peers in terms of disposition development. Finally, exploration of this hypothesis ha
revealed a trend related to truthseeking among university students.
Second Hypothesis: Perception of Competence in Writing
The second hypot
activities increase the learner’s perception of competence as a writer. Based on the self-
report data gathered from the participants before and after the course, this hypothesis is
supported. Improvement was reported by all participants with the most dramatic gain occurring
among the participants in the experimental group composed of the more experienced nurs
learners. There was strong evidence that the course had mitigated the anxieties of these learners
about writing and had increased their confidence as university-level writers.
By contrast, when the instructors were asked about the post-RN nurse-learners’
development as writers, they reported no remarkable growth over the course. In light of this, it
recommended that the participants were either eager to report what they thought was the
expected or socially desirable answer (Issac & Michael, 1997) or that they were experiencing an
increase in personal confidence which might eventually lead to a measurable positive chang
Based on the researcher’s extensive experience as a writing instructor at Laurentian University
and the literature related to self-efficacy and performance as found in the educational psychology
and composition fields (Meier, McCarthy & Schmeck, 19
ed that increased personal confidence and belief in a positive change may precede
demonstration of the change. In the case of this study, the course requirement to commun

162
e
e
;
a et
hile to note some of the benefits frequently cited regarding
text-ba
s
,
ctivities
almost exclusively through writing and to complete a number of written learning activities and
assignments, the culture of a supportive learning environment of other adult learners, and th
support of caring instructors may have been the “right climate” for facilitating an increase in th
learners’ confidence as writers.
Other possible factors that might have influenced participants to report increased
confidence as writers have been suggested in the literature regarding online courses. This
literature describes both negative and positive aspects of writing in online courses (Bullen, 1998
Burt et al., 1994; Garrison & Anderson, 2003; Gunawardena, Lowe & Anderson, 1997; Har
al., 2000; Kanuka & Anderson, 1998; McKenzie & Murphy, 2000). If the post-RN learners in
this study had had an overall positive learning experience as indicated by the interview data, it
seems reasonable to suggest that they might also report an increase in confidence in writing.
Given this possibility, it is worthw
sed online courses: opportunities for equitable participation based on the non-linear and
time-independent nature of discussion boards; more time to reflect and craft thoughtful message
than may occur in face-to-face settings; access to social supports and networks of other adult
learners; and access to multiple perspectives and an audience that acts as a sounding board for
ideas (Blanchette, 2001; Carter & Rukholm, 2002; Davis & Brewer, 1997; Garrison & Anderson
2003; Harasim et al., 1995; Meyer, 2003).
Third Hypothesis: Demonstration of Critical Thinking Skills through Writing
The hypothesis that online courses that include asynchronous reflective writing a
facilitate demonstration of critical thinking skills through writing could neither be supported nor
rejected based on the study. Despite the best efforts of the researcher and three other writing
experts from Laurentian University to assess for demonstration of critical thinking through

163
writing
g
be
st is
to be affected by prior knowledge of the discipline. In the case
of nurs
an
to
,
rs
xts.
n
via a holistic scoring activity (Facione & Facione, 1992), no conclusions could be drawn
because of interrater reliability problems.
Although there are likely many reasons for the problems encountered with the scorin
activity, two stand out: the first pertains to the challenges of measuring critical thinking skill; the
second to the issue of assessing writing. As discussed earlier in the literature review for this
study, assessment of critical thinking skills has been an area of longstanding debate among
educators and assessment experts. For example, the context-based test is regarded by some to
the most appropriate measure of critical thinking skill (Norris & Ennis, 1989; Pascarella &
Terenzini, 1991; Pendarvis, 1996). Unfortunately, a confounding variable with this kind of te
that the test taker’s score is likely
ing, the only way of validating that a nurse who takes a context-based test can apply
critical thinking in practice would be to follow the nurse in the clinical setting; clearly this is
expensive and impractical way of validating the critical thinking of nurses. If, on the other hand,
one maintains, as does this researcher, that writing has some “inherent…advantages over speech
when engaged in critical discourse and reflection” and that writing can be both “a process and
product of rigorous critical thinking” (Garrison & Anderson, 2003, p. 26), it is appropriate
want to assess for evidence of critical thinking in writing. However, as experienced in this study
this is no easy undertaking. Still, it is suggested that it is important for researchers and educato
to continue to seek ways to identify critical thinking skills in text-based e-learning conte
The scoring of writing is likewise an area that has historically challenged writing
instructors and those who teach in content areas where demonstration of acquired knowledge and
skills relies heavily on writing (Barnet, Berman, Burto, Cain & Stubbs, 2000; Kirszner &
Mandell, 2001; Schoonen, 2005; Troyka, 2004). The hypothesis of a possible connectio
between online reflective writing and critical thinking skills, therefore, brought together three

164
e writing
sample
s task. As an English
te
in the literature review
as
a
f
extremely complex areas: evaluation, critical thinking skills, and writing. Capturing the
complexity of this situation, one of the scorers described her experience of rating th
s in the following passage:
Thank you for inviting me to read these papers; it was a fascinating and
challenging task. I hope the following comments may be helpful.
I encountered a number of difficulties in completing thi
acher, it was difficult for me to separate good critical thinking and the ability to
convey those thoughts in clear, effective English. Although language and thought are
closely interrelated on second reading of some papers, I decided to change the
evaluation from 3 to 4 or 2 to 3 because I felt that on the initial reading I had been
negatively influenced by poor writing.
In addition, I found that the very varied nature of the assignments made it
difficult to apply the rubric consistently. For example,
signment, there was little scope for students to express their own ideas or use their
own experiences. Therefore, I awarded level 4 to those students who seemed to have
been able to organize their material in ways that demonstrated interesting connections
and who appeared to have most effectively synthesized the information obtained from
variety of sources.
In contrast, the autobiographies relied so heavily on personal experience that
another series of issues arose. In some cases, I evaluated work as level 3 because it
seemed to lack the necessary depth of explanation, the analysis of alternative points o
view and a judicious drawing of conclusions; however, I wonder whether in some cases
the very personal nature of the material made this difficult. Perhaps older students are

165
vercome stressful
an
e
s
more able to demonstrate these traits when contemplating their own adolescence from
the relative safety of distance and the security gained from having o
d in some cases traumatic experiences.
The case studies presented their own challenges; students often claimed to have
demonstrated certain critical thinking skills which I could find little evidence of in th
scripts. In some cases, students appeared to be well versed in the requirements of
critical thinking but less able to demonstrate their application of them. Further, my own
ability to identify connections not made and questions not asked and alternative point
of view in the autobiography and case study assignments may have influenced my
grading.
I hope these reflections are useful. Thank you again for allowing me to
participate in this process.
Two outcomes resulted from the scoring experience. The first was renewed respect by the
researcher for the intricacies of assessment of critical thinking skill as demonstrated in writing.
The researcher would like to suggest that, as Hara, Bonk, and Angeli (2000) point out, “there is a
pressing need to consider the dynamics of online discussion and how it facilitates students’
cognitive and metacognitive development” (p. 125); however, measurement of critical thinking
skill is a complex task since there is no “generally accepted model to evaluate critical thinking”
(McLean, 2005, p. 2). Hence, there is a certain dilemma: while it would be the researcher’s
recommendation to use only psychometrically-sound instruments in all future research work
related to critical thinking, when the thinking is embedded in writing, there will always be some
element of subjectivity.

166
ng competence revealed that
ence did not coincide with
demons ose
roup
t
ajority of
compar c writing
r
The second outcome of the holistic scoring work was the decision to study the
participants’ writing in two additional ways—to study the writing samples for general writing
competence by tracking writing errors and to examine them for themes related to ways of
thinking based on Johns’ (1995) ways of thinking framework. The findings related to each
strategy are discussed in the following paragraphs.
The decision to analyze the writing samples for general writi
the post-RN nurses’ perceptions of increased writing confid
trated strength in writing. As pointed out in Chapter IV, of all the writing samples, th
by the post-RN nurses showed significant weakness in grammar relative to the two comparison
groups, and significant weakness in vocabulary complexity relative to first comparison g
composed of the younger nurse-learners. From the researcher’s perspective, this was not difficul
to understand: all of the undergraduate nursing students had experienced at least 2.5 years of
university before the study. By contrast, for some of the post-RN nurses, this was their first
university course. Additionally, unlike the majority of post-RN learners, the m
ison group participants had not experienced major interruptions in their academi
experiences having recently progressed from high school to university. These points noted, the
post-RN nurses had more life and clinical experiences to draw on in their writing.
Based on the finding of weakness in the written work of the post-RN nurses, it is the
recommendation of the researcher that universities develop special measures to provide older
adult learners such as the post-RN group represents with supports and resources to enhance thei
writing. Anticipating that the post-RN nurses would welcome the idea of writing supports, the
researcher discussed this idea with the nurses. Although the nurses saw value in writing supports,
they were strongly vocal that such supports would have to accommodate their lives. For

167
re encouraged to utilize. There is no cost to participate in the
program e
and
e
en
activities and assignments require specific
ication is the
primary
g
lays
a triple role. The first is that of learning designer. Sometimes the faculty member will be
example, if a writing support program was offered by the university but required advanced
planning in order to access it, the nurses would likely not use it.
In the case of Laurentian University, it offers a Writing Assistance Program that all
Laurentian University students a
. The program offers limited services in the evening and no weekend services. Th
program will receive written work from distance learners as emailed attachments and faxes
return the submissions with commentary in one to two days. Several participants commented
that, because of the turnaround time involved in accessing Laurentian’s Writing Assistance
Program, they did not use it. As the Laurentian program presently stands then, it is not
adequately serving the writing needs of this student population, and the University may wish to
consider making modifications to the hours and format of the program. A second
recommendation is that resources and services and, in particular, writing supports be integrated
as much as possible into the online course experience itself.
The final way by which the writing samples were analyzed involved coding for evidence
of Johns’ (1995) four ways of thinking: empirical, aesthetic, personal, and ethical. Although th
findings are based on a small sample, it is suggested that a connection was demonstrated betwe
the kinds of thinking by students and assignment design. Thus, if cultivation of different kinds of
thinking is an important learning objective,
developmental attention; additionally, in online courses where written commun
learning tool, course designers and content experts need to build on the strengths and
limitations of written assignments as they can occur in an online educational milieu.
This last recommendation leads to a further finding based on the study—albeit a findin
not directly related to the study hypotheses: that is how, in online education, the instructor p

168
onsible for the entire course experience. Either way,
the onl
,
r
.
ith
y
over an in the
r
at
supported by a team of experts who assist in the planning and execution of an online course; in
other instances, the faculty member is resp
ine instructor will need to utilize principles from one or all of the major schools of
instructional design and in the tradition of their champions—systems (Dick & Carey, 1996;
Tripp & Bichelmeyer, 1990), time (Berliner, 1979; Bloom, 1976), task (Bruner, 1966; Gagne
1987), learner (Knowles, 1978; Snow, 1977). Ideally, the instructor will make choices that
enable an effective constructivist-based learning experience.
The second role the instructor plays is that of teacher. While this is a self-evident
statement of fact, the role of teacher in the online educational setting is one that may not be fully
understood; yet, according to the participants in this study, the teacher plays a pivotal role that
students appreciate a great deal. For instance, the gratitude that several students expressed fo
their instructors during prompted the researcher to reflect seriously on the role of instructors in
online courses. Compared to the tasks typically performed in a face-to face classroom, the tasks
that an effective online instructor performs may not be as clear cut. As Easton (2003) notes, “the
role of the online distance learning (ODL) instructor is ambiguous and often ill defined” (p. 95)
Consider, for example, how, in the presurvey the post-RN nurses indicated greatest comfort w
e-mail as a communication tool. Does this mean that an instructor should choose to use e-mail
over bulletin board as a primary communication and learning tool? Both instructors spoke about
the time they spent on the telephone with their students. Because students prefer one technolog
other, does this mean that this technology should be the principal technology used
learning experience? If a faculty member does a great deal of private e-mail and telephone work
with students, there are workload implications to consider and loss of interaction with othe
students. If Biggs’ (1996) observation is right that “good dialogue elicits those activities th
shape, elaborate and deepen understanding,” then failure to provide students with this kind of

169
also
a
the instructor to deviate from the course framework and
specified tec
pace of the bulletin
board, there or of
disco also
provi
enthu lvement
requi ot an
easy eral, do more postings by the instructor suggest a
more effectiv y, the
stude ings made—
felt e ical
tips a r
who line
cours
area t nvestigation so that the learning experience is effective for students
and managea a
(And
Pauls
The S
dialogue represents a shortcoming in the learning experience; however, as this study has
pointed out, the online instructor working with older adult learners will, in all likelihood, face
variety of problems that may incline
hnologies from time to time.
Furthermore, when an instructor places emphasis on the shared s
are other variables to consider since, in this context, the instructor is a facilitat
urse. In the case of this study, one instructor’s commitment to be a co-learner who
ded content expertise, encouragement, learning supports, and discourse facilitation was
siastically recognized by her students. Still, the time and effort this kind of invo
res are substantive. How much instructor presence on a bulletin board is enough is n
question to answer. For example, in gen
e teacher and better learning on the part of students? In the case of this stud
nts of the most active instructor—most active as defined by the number of post
xtremely positively about her. Her students expressed appreciation for her many pract
nd messages of encouragement. By contrast, there was ambivalence about the instructo
was least present on the board. These points noted, is robust instructor presence in an on
e integral to the achievement of course goals and objectives? It is suggested that this is an
hat requires further i
ble for teachers. Although there is good theoretical work happening in this are
erson, Rourke, Garrison & Archer, 2001; Anderson, Varnhagen & Campbell, 1998;
on, 1995), there is more to do to assist faculty on the practical front.
tudy and Constructivist Learning Theory
As Chapter I outlines, the principles of constructivist learning theory are

170
distin
natur
wher t easily measured and may not be the same for
each learner”
milie rst
relate ialized
curric
the
post- boards,
this s ests that additional elements may need to be considered relative to constructivist
learning theo d their
instru e post-RN nurses in this study. It is recommended that, when
physical distance is part of the experience, the selected constructivist design model that drives
the learning experience—for example, Jonassen (1991a, 1991b) or Wilson (1997)—may require
incorporation of components from instructional theories that are systems-, time, -task, and
learner-oriented as well as elements from transmissive and experiential learning theories. In
other words, from a theory perspective, the constructivist learning theory can include facets of
different instructional design theories and different learning theories.
Consider how in the case of the post-RN nurses care was taken by the Laurentian School
of Nursing and Centre for Continuing Education to deliver a course that encouraged
constructivist learning while it also provided an organized, task-based educational experience.
This approach was respectful of the additional learning that distance-based online education
exacts from a newcomer to the online learning setting. Because this learner has no face-to-face
opportunities to clarify concepts, ask questions, and so forth, it can be extremely challenging to
ct from those of behaviourism and cognitivism. While the former tend to be objective in
e, constructivism, on the other hand, promotes “a more open-ended learning experience
e the methods and results of learning are no
(Mergel, 1998, pp. 20-21). As a result, designing instruction in a constructivist
u is at best a complex undertaking. This dilemma as well as two additional ones—the fi
d to distance-based online settings and the second to situations where there is spec
ulum such as occurs in nursing education—were central in this study.
Based on the researcher’s observations throughout the study, the comments shared by
RN participants and instructors in the interviews, and their contributions to bulletin
tudy sugg
ry when the learners are at genuine physical distance from each other an
ctor; this was the case for th

171
be enro
need
eir courses and programs (Bash, 2003). As a
result, i
ence is
he
se
ge. If he or
she bel y
cific
curriculum to be covered as well as the learner group itself. In this study, there was a natural fit
lled in an online course that lacks a degree of systematicity. Similarly, although
andragogy suggests that, adult learners require opportunities to create meaning based on their
personal and professional lives and, therefore, may be especially receptive to constructivist
learning, the administrators and staff who work with adult learners speak loudly about their
to experience clarity and straightforwardedness in th
ncorporation of elements from schools of instructional design that may appear to be at
odds with constructivist learning into the design of a constructive-based learning experi
recommended. As noted, this circumstance is very important when the educational experience
includes the elements of geographical distance, the Internet, and older learners.
Another possible addition to constructivist learning theory emerging from the study is t
idea that teachers and designers should not feel compelled to exclude learning activities and
assignments that are transmissive or experiential in nature in a course that builds on a
constructivist framework. Rather, consider how there may be an instance in designing a cour
when a lecture is the most appropriate way to present certain curriculum. Because lectures are
typically associated with transmissive learning, should this prompt the teacher to exclude them?
In fact, this researcher would recommend that teachers and designers always reflect on whether
or not a specific learning strategy is likely to contribute to construction of knowled
ieves that the strategy will, then the strategy should be included regardless of the theor
body from which it derives.
The study has also argued that constructivist learning theory can hold a valid place in
subject areas where there is specialty content—for example, nursing education. This stated, not
all facets of nursing education are well suited for constructivist learning. In other words, the
decision to use one learning theory over another in nursing education depends on the spe

172
xt of
. The appropriateness of this fit
was str
ve
to
to
tance-
ories and
As
describ
between curriculum that examined topics such as critical thinking and reflection in the conte
nursing health individuals and families and constructivist learning
engthened by the circumstance that the post-RN nurse-learners were already nurses in
contrast with being undergraduate nurse-learners. It is possible that the post-RN nurses may ha
been more receptive to a constructivist learning setting since adult learners have been noted
value making connections as form of learning.
Given the above discussion, the study has recommended several ideas for possible
incorporation within constructivist learning theory. In particular, these contributions pertain
the implementation of constructivist learning theory in a specific learning setting—a dis
based online setting wherein there are older learners studying a particular kind of content—and
the relationship that needs to remain open and fluid between different learning the
instructional models.
Limitations of the Study
The first and most outstanding limitation of the study is its small sample size. Based on
this, it is not possible to generalize findings to all post-RN Ontario nurses taking online courses.
The study does provide a picture of the culture of critical thinking—including dispositions and
skills—in the context of an online course taken by a cohort of post-RN nurses studying at a mid-
sized northern Ontario university.
Regarding the issue of sample size, while every researcher desires an adequate sample
size, in this study there was a conscious decision to work strictly with participants in online
courses developed and offered by the same institution, namely, Laurentian University.
ed earlier in this document, for an educational research study, there are confounding
differences between institutions and their approaches to online learning (Ko & Rossen, 2004):
for example, many institutions use the commercially available WebCT platform; others

173
at
ersity
curate
ific
Desire2Learn, BlackBoard, Angel, and so forth; still others use institutionally-developed
software programs and open source applications. Likewise, the term “online learning” is used
broadly and can refer to courses that are fully and partially Internet-based and to courses th
include a variety of web-based multimedia components. A further variable when one thinks
about online education at different universities pertains to instructional design and course
development processes. The fact that this project focused on students from Laurentian Univ
somewhat addressed these areas of variability.
Noted too as a limitation are the comparison groups. In order to achieve a more ac
picture of the Ontario post-RN nurse as a learner and critical thinker, more closely matched
comparison groups are recommended. Such matching might have occurred had the researcher
used comparison groups from other post-RN programs at other Ontario universities.
Other limitations of the study pertain to the data collection methods, the four-point
writing rubric, and the professional experiences of the researcher herself. These factors will be
discussed in turn. Each was a contributing and limiting factor in the study.
Regarding the use of surveys, it is important to recognize the limitations of surveys: they
do not, for example, provide the researcher an opportunity to ask additional follow-up questions.
The researcher is unable to seek clarification, and participants are typically unable to share
insights beyond what the survey items address. Non-responses are a further limitation of survey
strategies (Gray & Guppy, 1994).
A further possible criticism might relate to the researcher’s choice to use the CCTDI in
contrast with some other standardized measure. The CCTDI is a tool that considers critical
thinking dispositions in general in contrast with critical thinking dispositions within the spec
scope of nursing. Although this concern is respectfully acknowledged, the study was foremost
about online learners who are registered nurses and require strong critical thinking dispositions

174
e
is the possibility that the supporters of online learning
would
s
s.
e
kind of
with better
ion, reliability, and validity.
ewise require
consideration. As a person in her forties with a busy personal and professional life, the researcher
and skills in contrast with being a study dedicated exclusively to nurse-learners as critical
thinkers.
Returning to the idea of participation rate, the participation of the post-RN nurses in th
interviews was strong (41.2%). Still, there
have been inclined to participate over other nurse-learners.
Because the interview sessions were not audiotaped, it was not always possible to capture
extended statements made by the participants. Still, the researcher maintains that all quotation
are accurate. Therefore, while all quotations used in Chapter V are presented verbatim, those
included from the interviews are not as long as those selections derived from the bulletin board
The researcher also conferred with the silent research assistant to check the accuracy of the
quotations she reported in her findings. Although participation in the interviews was high,
participants may have been weary of the research process by the time the interviews were
conducted. These sessions were conducted at the end of the course and represented one of
several data collecting strategies. While effort was taken to keep the session to one hour in
length, it is understandable that the participants may have been tired of the research experience
by this time. The possible impact of subject fatigue, in combination with the complex lives of
working nurses needs to be recognized.
As the researcher has already documented, the use of a four-point rubric to assess for
evidence of critical thinking in writing was problematic and appeared to have contributed to th
interrater reliability problem. It is strongly recommended that researchers conducting this
analysis carefully consider the various instruments available and select one
psychometric properties related to scales, precis
The persona and the professional experiences of the researcher herself lik

175
ills
d
e also meant that
the
g
hat critical
may have been positively biased towards the registered nurses, wanting them to experience
positive growth in their critical thinking dispositions and demonstration of critical thinking sk
through writing. At the career level, the researcher works with registered nurses on a daily basis
and regularly sees the demands in their work lives. The researcher’s interests are further relate
to this project in that she has extensive experience in online and distance education as an
instructional designer and instructor of writing at Laurentian University. While these
circumstances have made the project personally rich and insightful, they hav
extra effort was required to ensure objectivity regarding the data. For example, she solicited the
assistance of other scorers when working with the writing samples.
The participant-observer role held by the researcher in relation to the three bulletin
boards needs to be noted in this discussion of limitations. As Anderson and Kanuka (2003)
suggest, the “e-Researcher is both a participant and a researcher of the environment in which the
research occurs” (p. 5). One of the benefits of this approach is that “new social phenomena can
be explored in virtual groups, distributed or online discussion groups, and online collaboration
(Galagher et al, 1998; Hinds & Kiesler, 2002). In this study then, as the researcher watched
bulletin boards unfold, she may have been influenced to formulate views about online learnin
settings, critical thinking, and writing before other data were analyzed.
Implications and Applications
This study makes valuable contributions to the research on critical thinking dispositions
and skills in online education. Based on rejection of the first hypothesis, the finding t
thinking dispositions are not positively influenced by online courses that use reflective writing
activities may prompt educators to choose certain components related to critical thinking for
special development to the exclusion of others. For example, if the educator knows that it is
difficult to influence a critical thinking attitude, he or she may choose to focus more on teaching

176
n the
r
ing awareness
rts. This
a
e
critical thinking. To the former, the study has made the
of
s
e
a critical thinking skill than on preparing an activity that targets attitude development. O
other hand, if a particular critical thinking disposition is essential to the discipline, the instructo
knows, from the outset, that he or she may need assistance from an educational expert in
designing assignments and activities. The instructor may also decide to modify his or her general
teaching style.
The support generated for the second hypothesis regarding perception of writing
competence—coupled with the posthoc findings related to the third hypothesis that focused on
demonstration of critical thinking though writing—makes an important contribution to the field
of andragogy. While practitioners in the adult education field have had longstand
of adult learners’ challenges as they balance school, home life, career, family, and community,
this study has made clear that, when these learners take online university courses that are
reading- and writing-intensive, they require user-friendly, easy-to-access writing suppo
way, the increased confidence that may be reported by an adult learner who has taken an online
course may be complemented with increased competence as a writer. It is suggested that this is
win-win situation: increased confidence and competence in writing may lead the student to take
additional courses and to grow as a thinker, student, writer, and person.
Findings based on the second and third hypotheses make contributions to the literature
dedicated to instructional design and online courses as well as the more general body of literatur
that examines assessment and
contribution that course assignments may elicit different kinds of thinking and that these kinds
thinking depend largely on the design of the assignment. The study has pointed out that writing
supports for older adult learners taking online courses need to be designed to maximize acces
and flexibility. Because of the writing-intensive nature of many university online courses, ther
may be interdisciplinary opportunities for collaboration among those who work in the

177
rses are here to stay, critical thinking researchers
se as
s
g for ways to enhance what appears to be a natural
ity students. The insights shared by the post-RN participants
about i
cores and establish personal improvement goals. As an
aside, o
oss
se who
educational technology area, those who work in disciplines wherein writing and thinking are
valued in discrete ways, and those who hold content expertise in areas being adapted for online
delivery.
As for the study’s contribution to the literature that considers assessment of critical
thinking, the study has emphasized how there is a distinct need for a tool that assesses critical
thinking skill in writing. If text-based online cou
will want to strategize on the development of a tool that is valid, reliable, and practical to u
quickly as possible.
There were a number of other findings generated by the study that may fuel discussion
and other research in the critical thinking field. For instance, the finding that there was growth
over time in truthseeking is an information point that adminstrators and faculty at universitie
may wish to explore, possibly lookin
evolutionary process among univers
nstructors in online courses likewise provides fodder for research.
Other important implications of this study pertain to the participants themselves. As all
participants received their entry and exit scores for the CCTDI, they have new personal
information. As a result, it is anticipated that the participants will consider those areas in which
they achieved stronger and weaker s
ne of the instructors involved this project told the researcher how interested her students
had been when they received their CCTDI scores.
On another note, because online nursing education programs show no signs of
disappearing—a number of online Master’s programs in nursing have recently sprung up acr
the country while online education continues to be a popular mode of delivery for post-RN
learning and other continuing education programs for nurses—, it is incumbent upon tho

178
e and
,
&
they need. Because of the identified connection
betwee
to
ng
Directi
general, there are
many o
s
itionally, as the use of web casting, web conferencing, and
videoco
e
plan and design online programs for working nurses to be diligent in the choices they mak
supports they extend to these learners. While all adult learners have complications in their lives
nurses are experiencing unprecedented levels of workplace stress (Farrington, 1997; Gillespie
Melby, 2003) coupled with encouragement to continue to study. Therefore, effort needs to be
made to design and implement flexible programs and learning supports that meet nurses’
specialized learning needs. Based on the comments of the post-RN nurses, asynchronous online
courses seem to offer the access and flexibility
n critical thinking and clinical decision making in the practice setting (Daroszewski,
Kinser & Lloyd, 2004; Kennison & Misselwitz, 2002; Kessler & Lund, 2004), it is essential
learn as much as possible about how these kinds of courses can support learners’ critical thinki
dispositions and skills.
ons for Future Research
Because of the proliferation of online courses in nursing and other disciplines around the
world and the role that critical thinking plays in post-secondary education in
pportunities for research in this area.
Specific to this project, replication of the research design with larger groups of post-RN
nurses and with post-RN nurses studying at other universities and in other geographical area
beyond Ontario is suggested. Replication of the study with comparison groups that are better
matched is also recommended. Add
nferencing as teaching and learning methodologies increases, study of critical thinking
dispositions and skills in these learning contexts is appropriate. It might also be valuable to
compare the CCTDI scores of different groups of older working learners who are taking online
courses: for example, by comparing the scores of nurses and teachers, valuable insights might b
generated into how to tailor learning strategies to specific learner groups. Research is further

179
ip
ersonal learning style and technology-enabled education is an area suggested for
further
ecific disciplines. Findings in
this are
gies
t
anges in this study were not demonstrated to be
statistic k
re as
s, are university
student
suggested in online workplace training and critical thinking. As noted earlier, the relationsh
between p
study.
Research is recommended into the relationship between writing confidence and writing
performance among adult learners in general and adults studying sp
a could then be used to inform choices that faculty members and program development
units make to support learners who are taking writing-intensive courses. On a related note, there
is work to be done to identify the role that reading plays in online courses and how to maximize
growth in critical thinking skills through learning strategies that involve both reading and
writing.
Research into adequate levels and kinds of support for adult learners is strongly
recommended, as is research into adequate levels of support for faculty members teaching
technology-based courses. In learning situations where there are new and different technolo
involved, research is always necessary to identify the supports that instructors require so tha
they can concentrate on their subject matter and their students in contrast with the intricacies of
new educational technologies.
While the overall dispositional ch
ally significant, it is nevertheless suggested that the study does point to a need for wor
in the area of university-level education and critical thinking dispositions. Work is especially
recommended in the areas of truthseeking and inquisitiveness, the dispositions at the low and
high ends of the measurement spectrum. Some questions that emerged from this study a
follows: based on the evidence that the learners scored highest on inquisitivenes
s at the baccalaureate level motivated most by a sense of inquisitiveness? Does
truthseeking become an important personal goal only after the disposition of inquisitiveness has

180
oted
arch
of
context of postmodern
nursing ing
e online educational
arning as enabled in this learning setting that promises to be an
integra
been appeased or is there a complementary relationship between them? Would the patterns n
in the study sustain over months and years? What are the differences between the critical
thinking dispositions of undergraduate and graduate-level students? What is the effect of
educational technologies on these dispositions?
In the context of nursing education, there may be a special need to do focused rese
into truthseeking. Dr. Ellen Rukholm, former chair of Laurentian University’s School
Nursing, remarked on the low scores of the nursing students in truthseeking in this study. She
pointed out that some nursing curricula suggest that, in nursing, there are many truths (personal
communication, October 12, 2005). While this may be the case in the
, if the idea of many truths curbs students’ truthseeking dispositions, schools of nurs
may wish to examine this issue in some depth.
From the perspective of learning theory, this study points to the need for aggressive
research into both the general role and practical design implications of constructivist learning in
distance-based online education as well as in specific subject areas when they are presented in
the online setting.. On a more focused basis, researchers must explore the nature and meaning of
interactive learning in the online educational setting, the unique role of the teacher, how
meaningful collaborative learning can be facilitated, learner control in th
process, and transformational le
l part of twenty-first century education (Ally, 2004).
Final Thoughts
Online courses as offered by the professional schools of Canadian universities are in a
strong growth situation. While the reasons for this growth are many, based on this study, one
reason that stands out is that online education provides busy professionals the access and
flexibility they require to meet their learning goals while balancing work and personal

181
eal with online education, adult education, writing, critical thinking, instructional
design, r work
ions of
responsibilities. Recognizing this, it is important that the universities and other learning
institutions that develop and deliver these programs know how they can most effectively support
and encourage these learners as thinkers and writers.
Given its focus and the hypotheses examined, this study has made a contribution to the
literatures that d
and various combinations thereof. This study has also revealed that there is furthe
to be done if postsecondary educators wish to understand more deeply the critical thinking
dispositions that most strongly motivate university students. If educators know more about these
dispositions as possible learning motivators, curriculum reform and instructional design may
facilitate achievement of learning that is personally meaningful and in line with professional
competencies more effectively. Finally, the study includes recommendations for modificat
constructivist learning theory in specific contexts.

182
tario Education, 36, 452-458.
Affons f
ndations of educational theory for online learning. In Terry Anderson and
a
n, Post-
t of expert consensus
n pre-
sca_univ/theory_and_practice/index.html
Anders and
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208
Appendix A: Preexperience Questionnaire
Part A
¾ The California Critical Thinking Dispositions Inventory
DIRECTIONS
• Enter your name and research ID code where indicated.
• Indicate how much you agree or disagree with each numbered statement by choosing the
EXAMPLE A: The best things in life are free.
who
STRONGLY DISAGREES with EXAMPLE A and LESS
Agree strongly…………………………………Disagree Strongly
Eg. A ○ ○ ○ ○ ○ ●
Eg. B ○ ●○ ○ ○ ○
• response on the answer grid in the place with the corresponding number.
• After you have responded to the 75 statements, fill in the information items at the end of
_____________________________
Enter your research ID code: ____ ____ ____ ____
1. Considering all the alternatives is a luxury I can’t afford.
2. Studying new things all my life would be wonderful.
3. The best argument for an idea is how you feel about it at the moment.
4. My trouble is that I’m easily distracted.
appropriate place on the answer grid.
• Read the two examples before you begin the survey.
EXAMPLE B: I’m always doing more than my share of the work.
The figure below shows the responses of someone
STRONGLY AGREES with EXAMPLE B.
Begin with statement number 1 and continue through to number 75. Indicate your
the survey.

209
Appendix A Con’t
It’s never easy to decide between competing points of views.
It bothers me wh
5.
6. en people rely on weak arguments to defend good ideas.
8.
9. us the question before I attempt to answer it.
11.
12. avour and one against, I’d go with the four.
14.
16.
18.
20. titled to your opinion if you are obviously mistaken.
22.
24. to right and wrong.
26.
7. The truth always depends on your point of view.
It concerns me that I might have biases of which I’m not aware.
I always foc
10. I’m proud that I can think with great precision.
We can never really learn the truth about most things.
If there are four reasons in f
13. Men and women are equally logical.
Advice is worth exactly what you pay for it.
15. Most college courses are uninteresting and not worth taking.
Tests that require thinking, not just memorization, are better for me.
17. I can talk about my problems for hours and hours without solving anything.
Others admire my intellectual curiosity and inquisitiveness.
19. Even if the evidence is against me, I’ll hold firm to my beliefs.
You are not en
21. I pretend to be logical, but I’m not.
It’s easy for me to organize my thoughts.
23. Everyone always argues from their own self interest, including me.
Open-mindedness has limits when it comes
25. It’s important to me to keep careful records of my personal finances.
When faced with a big decision, I first seek all the information I can.
27. My peers call on me to make judgments because I decide things fairly.

210
Appendix A Con’t
29.
30. rstand what other people think about things.
32.
34. e waste time.
36. f us always trying to understand theirs.
38. ng to disagree with another’s opinion.
40. lf on coming up with creative alternatives.
42. r people’s arguments.
44.
46. ish reasonable standards to apply to decisions.
48.
50. ort my views, not facts that disagree.
28. Being open-minded means you don’t know what’s true and what’s not.
Banks should make checking accounts a lot easier to understand.
It’s important to me to unde
31. I must have grounds for all my beliefs.
Reading is something I avoid, if possible.
33. People say I rush into decisions too quickly.
Required subjects in colleg
35. When I have to deal with something really complex, it’s panic time.
Foreigners should study our culture instead o
37. People think I procrastinate about making decisions.
People need reasons if they are goi
39. Being impartial is impossible when I’m discussing my own opinions.
I pride myse
41. Frankly, I am trying to be less judgmental.
Frequently I find myself evaluating othe
43. I believe what I want to believe.
It’s just not that important to keep trying to solve difficult problems.
45. I shouldn’t be forced to defend my own opinions.
Others look to me to establ
47. I look forward to learning challenging things.
It makes a lot of sense to study what foreigners think.
49. Being inquisitive is one of my strong points.
I look for facts that supp

211
Appendix A Con’t
Complex problems are fun to try to figure out.
I take pride in my ability to und
51.
52. erstand the opinions of others.
54.
56. to keep working on a problem when the going gets tough.
58. al topics depends a lot on who I talk to last.
61.
62. too frightening to ask.
64.
65. ything you can, you never know when it could come in handy.
67.
69. de when the problem is solved.
71.
73. e entitled to their opinions, but I don’t need to hear them.
53. Analogies are about as useful as a sailboat on a freeway.
You could describe me as logical.
55. I really enjoy trying to figure out how things work.
Others look to me
57. Getting a clear idea about the problem at hand is the first priority.
My opinion about controversi
59. No matter what the topic, I am eager to know more about it.
60. There is no way to know whether one solution is better than another.
The best way to solve problems is to ask someone else for the answers.
Many questions are just
63. I’m known for approaching complex problems in an orderly way.
Being open-minded about different world views is less important than people think.
Learn ever
66. Life has taught me not to be too logical.
Things are as they appear to be.
68. If I have to work on a problem, I can put other things out of my mind.
Others look to me to deci
70. I know what I think, so why should I pretend to ponder my choices?
Powerful people determine the right answer.
72. It’s impossible to know what standards to apply to most questions.
Others ar

212
Appendix A Con’t
I’m good at developing orderly plans to addr
74. ess complex problems.
76.
© 199
75. To get people to agree with me I would give any reason that worked.
Please respond to these final items in the places provided on this page.
2; Peter A. Facione, Noreen C. Facione, and The California Academic Press; Millbrae,
California. All rights reserved.
Preque
___________________________________________________________________________
A Critical Look at Critical Thinking in Online Courses Taken by
Nurses Pursuing BScN Standing
optional.
Age in years _____
Gender  M  F
Employment status  full-time  part-time  not employed
If you are employed, briefly describe your work.
. What are your educational goals at the present time? Check off all relevant items.
 university degree
 personal growth
 professional development
 other: specify _____________________________________________
Indicate number of years of completed university-level education at this
stionnaire: Part B
¾ Relevant Demographic and Profile as an Online Learner
1. Demographic information: Please note that disclosure of this information is entirely
2
 university credits
 continuing education
 career advancement
time_____

213
Appendix A Con’t
3. Have you taken an online course or a course with online components before?
Yes____ If you have checked Yes, how many? ____
f the following are you currently enrolled in?
NURS 3216 ____
5. In the space provided below, describe your expectations for technical support (assistance
ed off at Question #4.
6. ectations for your instructor(s) during the
course you checked off at Question #4.
7. Have you used the following Internet technologies before this course?
Email
Chat _____ _____
Bulletin Board/ _____ _____
Discussion Board _____ _____
8. On a scale ranging from 1 to 5 (1 being low, 5 being high), how do you rate your present
a) use of the computer 1 2 3 4 5
the Internet 1 2 3 4 5
c) keyboarding 1 2 3 4 5
d) university-level writing 1 2 3 4 5
9. In the space provided below, describe what the term critical thinking means to you.
No ____
4. Which o
NURS 2276 ____
SOCI 2007 ____
with using the computer) during the course you check
In the space provided below, describe your exp
Yes No
_____ _____
competence in the noted areas?
b) use of

214
Appendix A Con’t
10. Do you think that your character or personality assists you in d oing critical thinking?
Please explain your response.
OCIPATION IN THIS RESEARCH
PROJECT.
NCE AGAIN, THANK YOU FOR YOUR PARTI
PLEASE SUBMIT BY CLICKING HERE.

215
Appendix B: Postexperience Questionnaire
ere indicated.
ith each numbered statement by choosing the
appropriate place on the answer grid.
• Read the two examples before you begin the survey.
EXAMPLE A: The best things in life are free.
EXAMPLE B: I’m always doing more than my share of the work.
The answer sheet shows the responses of someone who
and LESS
STRONGLY AGREES with EXAMPLE B.
gly
○ ○ ○
• Begin with statement number 1 and continue through to number 75. Indicate your
place with the corresponding number.
items at the end of
the survey.
________
Enter your research ID code: ____ ____ ____ ____
1. Considering all the alternatives is a luxury I can’t afford.
2. Studying new things all my life would be wonderful.
3. The best argument for an idea is how you feel about it at the moment.
Postquestionnaire: Part A
¾The California Critical Thinking Dispositions Inventory
DIRECTIONS
•Put your name and research ID code wh
•Indicate how much you agree or disagree w
STRONGLY DISAGREES with EXAMPLE A
Agree strongly…………………………………Disagree Stron
Eg. A ○ ○ ○ ○ ○ ●
Eg. B ○ ●○
response on the answer grid in the
•After you have responded to the 75 statements, fill in the information
_____________________

216
Appendix B Con’t
4. My trouble is that I’m easily distracted.
5. It’s never easy to decide between competing points of views.
6. It bothers me when people rely on weak arguments to defend good ideas.
point of view.
not aware.
9. I always focus the question before I attempt to answer it.
h the four.
orth taking.
e.
ld firm to my beliefs.
ion if you are obviously mistaken.
right and wrong.
.
.
7. The truth always depends on your
8. It concerns me that I might have biases of which I’m
10. I’m proud that I can think with great precision.
11. We can never really learn the truth about most things.
12. If there are four reasons in favour and one against, I’d go wit
13. Men and women are equally logical.
14. Advice is worth exactly what you pay for it.
15. Most college courses are uninteresting and not w
16. Tests that require thinking, not just memorization, are better for m
17. I can talk about my problems for hours and hours without solving anything.
18. Others admire my intellectual curiosity and inquisitiveness.
19. Even if the evidence is against me, I’ll ho
20. You are not entitled to your opin
21. I pretend to be logical, but I’m not.
22. It’s easy for me to organize my thoughts.
23. Everyone always argues from their own self interest, including me.
24. Open-mindedness has limits when it comes to
25. It’s important to me to keep careful records of my personal finances
26. When faced with a big decision, I first seek all the information I can

217
Appendix B Con’t
27. My peers call on me to make judgments because I decide things fairly.
t.
all my beliefs.
32. Reading is something I avoid, if possible.
nto decisions too quickly.
34.
35. When I have to deal with something really complex, it’s panic time.
36. Foreigners should study o ing to understand theirs.
8. People need reasons if they are going to disagree with another’s opinion.
39. eing impartial is impossible when I’m discussing my own opinions.
40. pride myself on coming up with creative alternatives.
1. Frankly, I am trying to be less judgmental.
42. requently I find myself evaluating other people’s arguments.
3. I believe what I want to believe.
44. to keep trying to solve difficult problems.
45. oul d my own opinions.
46. h reasonable standards to apply to decisions.
47. look forward to learning challenging things.
48. tudy what foreigners think.
49. Being inquisitive is one of my strong points.
28. Being open-minded means you don’t know what’s true and what’s no
29. Banks should make checking accounts a lot easier to understand.
30. It’s important to me to understand what other people think about things.
31. I must have grounds for
33. People say I rush i
Required subjects in college waste time.
ur culture instead of us always try
37. People think I procrastinate about making decisions.
3
B
I
4
F
4
It’s just not that important
I sh dn’t be forced to defen
Others look to me to establis
I
It makes a lot of sense to s

218
Appendix B Con’t
50. I look for facts that support my views, not facts that disagree.
1. Complex problems are fu
2. I take pride in my ability to understand the opinions of others.
bout as useful as a sailboat on a freeway.
4. You could describe m g al.
5. I really enjoy trying to figure out how things work.
56.
8. My opinion about controversial topics depends a lot on who I talk to last.
9. No matter what the topic, I am eager to know more about it.
60. another.
61. answers.
62.
63. orderly way.
4. Being open-minded about different world views is less important than people think.
65. ever know when it could come in handy.
66. gical.
67.
68. hav lem, I can put other things ou
69. problem is solved
1. Powerful people determine the right answer.
2. It’s impossible to know what standards to apply to most questions.
5 n to try to figure out.
5
53. Analogies are a
5 e as lo ic
5
Others look to me to keep working on a problem when the going gets tough.
57. Getting a clear idea about the problem at hand is the first priority.
5
5
There is no way to know whether one solution is better than
The best way to solve problems is to ask someone else for the
Many questions are just too frightening to ask.
I’m known for approaching complex problems in an
6
Learn everything you can, you n
Life has taught me not to be too lo
Things are as they appear to be.
If I e to work on a prob t of my mind.
Others look to me to decide when the .
70. I know what I think, so why should I pretend to ponder my choices?
7
7

219
Appendix B Con’t
73. Others are entitled to their opinions, but I don’t need to hear them.
74. I’m good at developing orderly plans to address complex problems.
75.
© 1992; Peter A. Facione, emic Press; Millbrae,
California. All rights reserved.
To get people to agree with me I would give any reason that worked.
Noreen C. Facione, and The California Acad
Postquestionnaire: Part B
¾ Your Profile as a Learner
______________________________________________________________________________
A Critical Look at Critical Thinking in Online Courses Taken by
Nurses Pursuing BScN Standing
Postquestionnaire: Part B
2. Now that you have completed your course, have your educational goals changed?
Yes  No 
If your goals have changed, please explain. If your goals have not changed, go ahead to
Question #2.
2. Assuming that you used the technical supports available to you for this course, were they
effective?
Yes  No  N/A 
Explain your answer.
3. Please describe any technical problems/difficulties you experienced. If you did not
experience technical difficulties of any kind, proceed to Question #4. If you did
experience difficulties, explain how you managed them.

220
Appendix B Con’t
4. On a scale ranging from 1 to 5 (one being low, 5 being high), how do you rate your
present competence in the noted areas?
a) use of the computer 1 2 3 4 5
b) use of the Internet 1 2 3 4 5
c) keyboarding 1 2 3 4 5
1 2 3 4 5
5. flects your perception of the
effectiveness of each item or person in assisting you as a critical thinker in your course. 1
eans you found the item or
person to be minimally effective.
a) email 1 2 3 4 5
b) 3 4 5
c) other learners 1 2 3 4 5
d) t 4 5
e) the course content 1 2 3 4 5
f) the assignments 1 2 3 4 5
g) other components of the course (please specify) 1 2 3 4 5
6. rds the practice
of critical thinking?
Yes ____
No ____
7. Because of the course, do you believe you are doing higher level critical thinking in your
No ____
d) university-level writing
Using the scale below, choose the number that best re
means you found the item or person to be very effective; 5 m
bulletin board/discussion board 1 2
he instructor(s) 1 2 3
Do you think this course has enhanced or increased your dispositions towa
work setting than before the course?
Yes ____
N/A ____

221
Appendix B Con’t
8. In your opinion, how might online courses and course with online components be
designed and delivered so that they enhance a learner’s dispositions towards critical
ONCE AGAIN, THANK YOU FOR YOUR PARTICIPATION IN THIS RESEARCH
PLEASE SUBMIT BY CLICKING HERE.
thinking?
PROJECT.

222
Appendix C: Course Outline for P ding Bulletin Board Assignments
ost-RN Nurses Inclu
AND FAMILIES
ASSIGNMENT VALUE DUE DATE
NURS 2276
NURSING HEALTHY INDIVIDUALS
ASSIGNMENT SCHEDULE
C
4 Family Visits:
Teaching Session
l
________
LINICAL PRACTICE
Assessment and Pass/Fai
THEORY
Analysis of a 20% February 11, 2005
Helping Relationship
Family Assessment: 30% March 11, 2005
Application of a Model
Family Teaching 30% March 25, 2005
Two Bulletin Board Postings:
1. Reflective Practice
2.
10% each for a total of
Critical Thinking 20%

223
Appendix C Con’t
S
ily as Pass/Fail based on your
objectives for the visits, the actual visits, and how they were conducted.
Working with a “healthy” family in the community, you are required to demonstrate the ability
interview.
d functioning through family
interviews.
- analyze the data to identify family strengths and limitations.
The Process:
1. Obtain the agreement of the family (of at least two members and preferably three) to make
fo it in the role of a
student―that you will not provide service. Assure them of confidentiality and ensure that
th r first visit. Submit
this as an appendix of the Family Assessment Assignment.
2. Give the name, address, and telephone number of the family to your clinical advisor.
3. The home visits should be approximately an hour long.
4. Before making your first visit, plan your family assessment guidelines, referring to the unit
on ll
various sections to focus on during the interview.
5. Develop written objectives for each of your visits. Use the guidelines to decide the areas to
fo
G to your assigned advisor for reviewing and feedback.
Make sure you have the feedback prior to attending the proposed visit.
Confidentiality is of utmost importance. Do not use family names when discussing the family.
y of the data; instead, use
initials and pseudonyms.
Faculty Advisor Role
In the first weeks of the course, each of you will be assigned a Faculty Advisor with whom you
visits.
CLINICAL PRACTICE ― FAMILY VISIT
Fam visits are part of your clinical work and will be graded
to:
-analyze communication skills used in the second
-acquire data about family structure, development, an
ur visits. Be sure that the family understands that you will vis
e Letter of Consent (sample follows) is signed at the beginning of you
Family Assessment. You will want to make a few notes to yourself to help you reca
cus on.
6. ive your objectives for each visit
Do not write identifying information (name, address, etc.) with an
will work to organize and manage your clinical practice, namely, the family

224
Appendix C Con’t
problems in
assignment completion, and sorting through the expectations of the course.
The Faculty Advisor will:
- review the student’s objectives with him/her prior to each visit
- assist the student with reviewing and sorting through data collection and setting priorities
- discuss with the student the appropriateness of the wellness topic for the teaching visit
- review the teaching plan with the student
- monitor the family situation to ensure student’s interventions remain focused on health-
Family Visits
Their role is to act as support when you are writing objectives, dealing with
for family learning
related needs
Grading of Clinical Practice:
Pass/Fail

225
Appendix C Con’t
ear ______________________________
hank you for agreeing to have a student visit your family. The student who will be visiting you
is a Re ng on her Bachelor
Laurentian University.
he student ______________________ will contact you by telephone to arrange a time that is
convenient for both of you for the visit. The student will make
e approximately one hour in length. In order to assist the student in evaluating his/her ability to
its.
Only th
in any
he purpose of this learning experience is to help the student further develop skills in
sessing a “healthy” family in a hom
Thank rogram. I
do not hesitate to contact me by phoning ________________________.
Sincere
Course fess
SAMPLE OF LETTER SENT TO FAMILY
D
T
gistered Nurse who is currently worki of Science in Nursing with
T
four home visits. These visits will
b
conduct an interview in the home with a family, it is necessary to audio-tape one of the vis
e student and the course professor will listen to the tape. Your name will not be included
written communication. Confidentiality will be maintained.
T
communicating with and as e setting.
you again for contributing to our educational p f you have any questions, please
ly,
Pro or

226
Appendix C Con’t
We agree to have ______________________________________ visit with our family on four
occasions for the purpose of obtaining information for a family assessment. We understand that
one interview will be audio-taped. We understand that the material will be kept confidential and
will rd,
the tape will be erased.
SIGNATURES
All Adults: ____________________________________________
____________________________________________
____________________________________________
____________________________________________
Student: ____________________________________________
Date: ____________________________________________
CONSENT FOR FAMILY INTERVIEW
be used by the student and course Professor for educational purposes only. After it is hea

227
Appendix C Con’t
AS #1
The purpose of this assignment is for you to dem nstrate understanding of intentional caring
abilities as expressed within a therapeutic relatio ship. The learner is expected to demonstrate
this through an audio-tape of the
Select a five minute excerpt of the audio-tape that you will evaluate using Johns’ model. Provide
a written transcript, which is to be handed in ndix to the assig ss the
congruency between your intention and what happened on the tape. Considering that nursing is a
profession based on Standards of Competency an self-regulation. As such, this assignment
provides you with an opportunity to demonstrate your image of nursing.
Length of pa maximum, not including appendix. Cite all references using APA, 5th
The aud it is handed in.
Ma
ened (6 marks)
Describe from your point of view what transpired.
Include all the factors contributing to the experience and the context of the situation.
Perception (10 marks)
SIGNMENT
Analysis of a Helping Relationship
o
n
second Family Visit.
as an appe nment. Discu
d
per: 4 pages
edition.
iotape must be submitted with the paper when
rking Scheme
Description of What Happ
In your efforts to demonstrate your plan of inter-relational care, comment on your thinking
process.
What were your actions to support such ideas?
What were the consequences of your actions for yourself? the client? the family?
How did you know the client’s/family’s perception?
Influencing Factors (6 marks)
What ways of knowing guided your thinking in the situation?
What is unique to this situation with respect to the context?
Alternative Perspectives (12 marks)
Considering this experience, what knowledge have you gained from the use of both therapeutic
and non-therapeutic communication?
What would you have done differently? Be specific.
Praxis (6 marks)
How has this experience changed your ways of knowing?
How will it change your nursing practice? Total: 40 (1/2=20%)

228
Appendix C Con’t
ASSIGNMENT #2
elect a family assessment model or framework to complete an assessment of the family.
er should include the following:
Fra w
Family Assessment – Application of a Model
S
This paper is a report and analysis of the data collected during the first two family visits. Your
pap
me ork
1. the
fam ature to support your framework.
10 marks
ata Collection
A framework or model of the structural, developmental, and functional components of
ily. Use liter
D
. Raw data collected. Identify categories where more data are needed and indicate the specific
d
20 marks
Anal
2
ata needed (raw data should be included as an appendix).
ysis
. Analysis and synthesis of the data to identify:
amarks
b) Family strengths 15 marks
c 10 marks
TOTAL 60
m
and i
3
) The family’s developmental stage based on theory and supported by data 5
) Actual, potential, possible diagnoses
De onstration of critical thinking and use of the nursing literature to support decision-making
nterventions will be considered in the evaluation of this assignment.
Page Length: Maximum 10 pages, typed, double-spaced. Cite all references using APA, 5th
edition.

229
Appendix C Con’t
Family Teaching Assignment
ased on the priority diagnosis determined by your family assessment (Assignment #2), you are
require will occur on the third
fam y visit.
The fou include evaluation of the teaching and closure of the therapeutic
relationship.
This assignment is designed to allow you to demonstrate achievement of the objectives of the
uni n
Usi t
Learner Objectives Teaching Strategies Rationale and Theory Evaluation
ASSIGNMENT #3
B
d to prepare and initiate a teaching session with the family. This
il
rth family visit will
t o teaching and learning.
ng he following sample as a guide, create an outline for your assignment:
1. Make sure that objectives are measurable and relate to the identified learning need via the
priority diagnosis.
2. Outline your teaching strategies (teacher and learner activities) for each of your objectives.
3. Support your choices with teaching and learning principles and evidence from the
literature. Include an outline of the content to be taught.
4. Outline your proposed method of evaluating the teaching and learning process. Include any
evaluation tools or questions you may use at the final visit with the family.
Marking Scheme
Identification of learning needs and objectives 10 marks
Identification of teacher and learner activities 20 marks
Use of theory and evidence-based practice 20 marks
Evaluation of the teaching process 10 marks
TOTAL MARKS 60
Page Length: Maximum 10 pages, typed, double-spaced not including appendices. Cite all
references using APA, 5th edition.

230
Appendix C Con’t
ASSIGNMENT #4
stings: one each on Reflective Practice and
ritical Thinking.
nce-
.
e a reflective bulletin. This
hould be from a clinical experience you have had relating to the concept (e.g., an experience in
efer to the marking scheme on the following page in order to guide your writing for this piece.
The student will complete two Bulletin Board po
C
Postings will be evaluated on the basis of their content as well as references to nursing evide
based practice literature
Be sure to type For Marks in the subject line to indicate that this is your Assignment #4 to be
marked.
Posting #1 – Reflective Practice
Referring to the course concepts in the syllabus, select one and writ
s
which you feel caring was demonstrated).
R

231
Appendix C Con’t
B eulletin Board Posting #1: Reflective Practic
ASSESSMENT OF CONTENT MARKING SCHEME
1.0 Description of Experience
1.1 Phenomenon: Describe and define the main concept
found in your journals
1.2 Causal: What
essential factors contributed to your
rowth within this concept?
t: What are the significant background factors
your growth within this concept?
ith this concept?
___________
7
g
1.3 Contex
to
1.4 Clarifying: What are the clarifying processes that
relate to your growth w
2.0 Reflectio
ying to achieve?
2.2 Why
s of my actions for:
m
the client/family/others?
for the people I work with?
appening?
2.5 How did the client/family/others perceive it?
___________
8
n
2.1 What was I tr
did I intervene as I did?
2.3 What were the consequence
yself?
2.4 How did I perceive this experience when it was
h
2.6 How did I know the others’ perception(s)?
3.0 Influencing Factors
3.1 What internal factors influenced my decision making
related to the concept?
3.2 What external factors influenced my decision making?
3.3 What sources of knowledge did/should have
influenced my decision making?
___________
5
4.0 Dealing with the Situation
4.1 Could I have dealt better with the situation?
4.2 What other choices did I have?
4.3 What would be the consequences of these choices?
___________
3
5.0 Learning
5.1 How do I now perceive this experience?
5.2 How have I made sense of this experience in light of
past experiences and future experiences?
5.3 How has this experience changed my ways of
knowing?
(DEFINE AND USE ALL 4 WAYS OF KNOWING: personal,
empirical, aesthetic, and ethical)
HOW DOES THIS AFFECT ME AS A NURSE?
___________
7
TOTAL GRADE – to be divided by 3 for 10% /30

232
Appendix C Con’t
Bulletin Board Posting #2: Critical Thinking
After reading the case study th of critical thinking in
answering the provided questions. This is to be done in a narrative fashion, not in point form.
. What actual data or information do I have about this case? 5 marks
TOTAL 20 marks
CASE STUDY: ily
home visitation of
lients after early discharge from the hospital. Your identified clients for this morning’s visits are
ennifer and her newborn son, Carl. You will be visiting the family twice, today for the two-day
nd again a week from today.
waitress at a local restaurant. Her primary language is English. She smokes a half a pack
ay.
as
en giving her what she wants – apple juice. Melissa is in the 80th percentile for height
or her age group.
nd works in construction. It is November,
and he will be laid off soon for the winter. He has a grade 12 education and his primary
side town. The family pets are a
d Mustang.
in the first trimester of her pregnancy. She missed five
identified medical problems during
regnancy include anaemia and insufficient weight gain. Total weight gain for this pregnancy
nnifer’s labour was 18 hours long and was uncomplicated. She suffered a third
at follows, demonstrate your process
Marking Scheme
1
2. What other data do I need to better understand this situation? 5 marks
3. What are my provisional hypotheses (problem or need statements)? 5 marks
4. What learning issues have I identified in this case (i.e., may have 5 marks
to review in the professional literature).
Postpartum/Infant/Toddler/Generative Fam
You are a community health nurse whose job duties include postpartum
c
J
postpartum visit, a
Family Information:
- Jennifer: 19 years old, P2G2. She did not complete highschool. Jennifer is employed as a
of cigarettes a d
- Melissa: 18 months old and has become a fussy eater lately, refusing milk. Jennifer h
be
and is in the 50th percentile for weight f
- Carl: 2 days old, weighs 6 lbs.; he is on formula.
- Joe: Jennifer’s boyfriend. He is 19 years old a
language is French.
- The family live in a two bedroom mobile home just out
Siamese cat and a Husky dog. They drive a 1984 For
Medical Information:
Jennifer began receiving prenatal care
appointments because she had no transportation. Her
p
was 17 pounds. Je
degree laceration during parturition.

233
Appendix D: A ison Group #1
ssignment: Compar
Prepare a seven to eight doublespaced typed page critical literature review on a nursing-related
topic of your choice. In your assignment, group similarly-focussed articles together. Be sure to
identify gaps and limitatio
ns in the studies.
Standard use of English and APA citing and referencing practices are required.

234
Appendix E: Ass arison Group #2
ignment File: Comp
General Instructions for Assignment
There are two online quizzes, five assignment, and a final exam for
SOCI 2007EL 12. Before doing anything else, quickly look over this handout, noting certain
nline quizzes are multiple choice format. Quiz 1 covers Modules One and Two and
Quiz 2 covers Modules Three and Four. Each quiz has sixty items from the Arnett text.
day
ailability. Pay close attention to the Assignment Schedule for the dates of
availability for each quiz. You are allowed one attempt (lasting four hours) for each quiz.
ted an assignment, prepare an assignment cover sheet and make a
copy of your work for yourself. Make a final check that everything is complete and in
in one of the large,
preaddressed envelopes provided in your course package and mail the envelope.
* When the assignment is returned, give some thought to the comments and contact your
course supervisor if you have any questions.
Bulletin Board Postings
d for posting questions and
The final exam is based on Modules One through Four.
* , you will have
their importance for sociology of youth. The essays are longer versions of short answers.
require defining and often comparing/contrasting the main reading from the
, conclusions, and a body with sound arguments
ll the
by
s
Bulletin Board postings, one
points:
* The o
Each online quiz is available for a limited time only, ending at 11:55 p.m. on the last
of av
* When you have comple
order. Make sure that the assignment sheet is on top. Put everything
* You must post answers for Learning Activities 1.3, 2.1, 3.2, 3.8, and 4.4.
Throughout the course, feel free to use the Bulletin Boar
*
comments.
General Information on the Final Exam
*
The exam consists of short-answer and essay questions. In each case
choices. The short-answer questions ask you to define certain concepts/people and state
They also
course. They should have introductions
and reference to course material. You can prepare for the final exam by reading a
l the ad itional readings, the Schissel reader, and
material in the online course materia , d
completing all Learning Activities.
* The Learning Activities will function as sources of exam questions.

235
Appendix E Con’t
Assignment 1
Term Paper: Critical Biography
rough the readings for the course, keep in mind that you are required to write
critical biography of an adolescent or an autobiography of your own adolescence. This can be
begin writing early in the course as your developing biography or
utobiography is related to course content.
ical biography consists of telling the story of an adolescent. This process includes
lacing your adolescent in historical and cultural contexts. You may write about yourself as an
a fictional character. Your
haracter may be from any epoch of history, the present, or the future. Placed in a setting and
d
r. The course will help you define how your character
lates to family, peers, media, and historical time.
Your character must assume an identity. The readings will help you understand adolescence as a
time in the life journey during which gender, ethnic, and developmental issues help forge
identity. Given the identity that your character is striving toward, he or she should attempt to
adapt to social-contextual challenges and move into adulthood. Present or outline this process in
your document. Address the problems and challenges that typically face young people.
Keep in mind that the elements of a simple narrative are as follows:
setting context and social world
plot trajectories, pathways
characters individual identities and social relationships
problems and resolutions challenges and solutions encountered by the characters
Your critical biography is to be no more than eight pages, typed and double spaced. Use the
course readings to give credence to both your character and story. Reference and refer to at least
As you progress th
a
about you (auto-biographical) or an imaginary/someone else (biography). It is strongly
recommended that you
a
Your crit
p
adolescent or about someone else you know. Or, you may create
c
specific cultural context, the adolescent in your assignment should meet the challenges an
opportunities defined by his or her setting and cultural context. Think about social class issues
and social policy that affects your characte
re
one of the readings from each module in this assignment. Reference all sources by including a
reference list on a separate sheet at the end of your paper. See the referencing guidelines below.
How to Reference Materials for the Critical Biography (and in Sociology more generally)
1. Include author's last name and year of publication (e.g., Smith, 1987).
2. Include page number when directly quoting an author (e.g., Smith, 1987, p. 125).

236
Appendix E Con’t
3. a) Always include a reference when you are citing factual information or ideas
presented in readings. If you do not credit your sources, you are committing the
a
references to elevant literature,
last names(s) of author(s) and year of publication for sources which lend
4.
cademic offence of plagiarism.
b) Always support arguments you are making with
i.e., cite
r
support to your argument.
Include only the author's last name and year of publica
necessary for a direct quotati
tion (a page number, however, is
on) when citing references in the body of your essay. Other
nitial, title, editor(s), issue number,
in your references section at the end
information such as author's given name or first i
publisher, etc., should be included of your essay.
5. es. Be consistent and use one style only, preferably the
A style).
6. this style, when you cite two or more authors who have said
thors, in alphabetical order, in one set of brackets
and s ., (Jones, 1987; Smith, 1986; Towne, 1985).
eviously suggested, list all references in a separate section at the end of your essay.
nce. When you are citing a source which
ple, if the source you read was
finding by Brown, you should use one of the following methods
984) has cited the findings of Brown's (1978) s elinquency
ited by Smith (1984), has suggested that ....
in Smith, 1984).
7. itle of the text, in your essay. For
, think about a text in which each chapter is written by a different author. In the
er author. In your references section at the end
accordin ast names.
e following example:
Dreidger, L. (1986). Ethnic and minority relations. In R. Hagedorn (Ed.),
and Winston Ltd.
Avoid using two referencing styl
one which is used in the text (AP
To be consistent with
essentially the same thing, enclose all au
eparate with semi-colons; e.g
7. As pr
Also, be sure to clarify the source of each refere
you have not directly read, make this clear. For exam
Smith, who cited a
a) Smith (1 tudy on male d
indicating .......
b) Brown (1978), as c
c) Brown (1978), has stated that .....(cited
Always cite the chapter author, not the editor(s) or t
example
body of your essay, you must cite the chapt
of the essay, list your sources in alphabetical order,
Then, include the editor's name(s) in this list as indicated in th
g to authors' l
Sociology (pp. 273-303). Toronto: Holt, Rinehart

237
Appendix E Con’t
9. The first time you hors include all authors'
names. Thereafter, you may use the name of the first author listed and "et al." For
er, you
to authors made within the body of the essay are part of the sentence
structure. Therefore, do not place a period before and after the reference but rather only
l cla s and al attainment
cite a reading which has more than two aut
example, the first time you would cite (Jones, Moore & Smith, 1987). Thereaft
would cite (Jones et al., 1987). If there are only two authors, always cite both names.
10. References
after the reference, e.g., The relationship between socia s education
has been clearly documented (Smith, 1986).

238
Ap ic
pendix F: Holistic Critical Thinking Scoring Rubr
Holistic Critical Thinking Scoring Rubric
4 Consistently does all or almost all of the llowing:
Accurately interprets evidence, statements, graphics, questions, etc.
Identifies the salient arguments (reasons and claims) pro and con.
Thoughtfully analyses and evaluates major alternative points of view.
Draws warranted, judicious, non-fallacious conclusions.
Justifies key results and procedures, explains assumptions and reasons.
Fair-mindedly follows where evidence and reasons lead.
fo
3 Does most or many of the following:
Accurately interprets evidence, statements, graphics, questions, etc.
Identifies relevant arguments (reasons and claims) pro and con.
Offers analyses and evaluations of obvious alternative points of view.
Draws warranted, non-fallacious conclusions.
Justifies some results or procedures, explains reasons.
Fair-mindedly follows where evidence and reasons lead.
2 Does most or many of the following:
Misinterprets evidence, statements, graphics, questions, etc.
Fails to identify strong, relevant counter-arguments.
Ignores or superficially evaluates obvious alternative points of view.
Draws unwarranted or fallacious conclusions.
Justifies few results or procedures, seldom explains reasons.
Regardless of the evidence or reasons, maintains or defends views
based on self-interest or preconceptions.
1 Consistently does all or almost all of the following:
Offers biased interpretations of evidence, statements, graphics,
questions, information, or the points of view of others.
Fails to identify or hastily dismisses strong, relevant counter-arguments.
Ignores or superficially evaluates obvious alternative points of view.
Argues using fallacious or irrelevant reasons, and unwarranted claims.
Does not justify results or procedures, nor explain reasons.
Regardless of the evidence or reasons, maintains or defends views
based on self-interest or preconceptions.

239
Exhibi
ne, and The California Academic Press. Millbrae,
CA. All rights reserved.
ts close-mindedness or hostility to reason.
© 1992. P.A. Facione, N.C. Facio

240
Appendix G: Interview Sessions
Questions for Students
Why are you taking your post-RN degree at this time?
Why are you taking the post-RN program through Laurentian University?
What special challenges did you experience because this was an online course?
uestions for Instructors
Do you think the course has increased your dispositions towards the practice of critical thinking?
What are your thoughts about the bulletin board and how it supported your learning?
Tell me about your experience of academic writing in the course.
What changes would you recommend to online courses based on your experience in this course?
Q
o you think the course helped your students as critical thinkers?
o you think you saw a connection between critical thinking and writing in the course?
Tell me m
How do you see the instructor’s role
Can you tell me a little about yourself as a nurse and a teacher?
How would you describe your students in this course?
D
D
about acade ic writing in the course.
in moderating the bulletin board?
What changes would you make to increase bulletin board participation?
Aside from the bulletin board, did you interact with your students in any other way?

241
Appendix H: Letter of Information
LETTER OF INFORMATION
You ar
of Edu
searcher’s doctoral thesis in educational studies.
If you h search project, please contact Lorraine Carter
t lcarter@northnetwork.com or 705-688-0378, ext. 2235 or her thesis supervisor, Dr. Larry
PURPO
a centra
informa
level le the
onnection between nursing practice and critical thinking.
PROCEDURE
If you v nte
• mple ugh the Internet); each
questionnaire will take approximately twenty (20) minutes of your time. The first survey
st).
• organiz
• rovide the researcher with access to your written work for the course including all
ulletin board postings and the final written assignment.
Title of Study: A Critical Look at Critical Thinking in Online Nursing Education
e invited to participate in a research study conducted by Lorraine Carter from the Faculty
cation at the University of Windsor. The findings of this study will be used in the
re
ave any questions or concerns about this re
a
Morton, at morton@uwindsor.ca or 519-253-3000, ext. 3835.
SE OF THE STUDY
The purpose of this study is to determine the effect an online learning setting that uses writing as
l learning methodology has on learners’ dispositions towards critical thinking. While this
tion will be valuable in the design and development of online courses for all university-
arners, it is especially important for those involved in online nursing education given
c
S
olu er to participate in this study, you will be asked to do following:
Co te two questionnaires provided to you on line (thro
will occur at the beginning of the course and the second near the end of the course. If, for
some personal reason, you would prefer to receive print copies of these questionnaires
and to return them via regular mail, please contact the researcher at 705-688-1519, ext
2235 or email at lcarter@northnetwork.com. Be sure to provide a detailed message
explaining where your questionnaires should be sent via the regular mail (Canada Po
Consider participating in a focus group session or interview. The session would
ed by the researcher and at no cost to you.
P
b

242
Appendix H Con’t
TIAL RISKS AND DISCOMFORTS
re no known and/or anticipated risks inherent in this study. The researcher is not in any
POTEN
There a
ay involved in the delivery of your course not does she have access to your grades.
POTEN
There a ional benefits associated with participating
this study. They include the following:
• ecause, at the end of the study, you will receive information about your personal
dispositions towards critical thinking, you will have new understanding of your possible
strengths and weaknesses in this area. In turn, you may choose to focus on stengthening
certain dispositions and/or compensating for others.
• Acquisition of the above information is helpful in career planning.
It is also suggested that, as a student who is required to read scholarly research and possibly do
research of your own, you will learn about the research process as it occurs in a university
setting.
Speaking more generally, the findings of this study will help universities to design and develop
online courses that enhance the critical thinking dispositions of the students who take them.
PAYMENT FOR PARTICIPATION
There are no costs or payments associated with this project.
CONFIDENTIALITY
Any information that is obtained in connection with this study and that can be identified with you
will remain confidential. Such information will be disclosed only with your permission.
The following steps will be taken to ensure confidentiality:
9 If you decide to participate, you will be assigned an ID number to be used on both of
your surveys.
9 Identifying information will be removed from your written work. Your written work will
be assigned the same research ID number as used for the two surveys.
9 If you choose to participate in an interview or focus group session, you have the right to
w
TIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
re a number of potential personal and profess
in
B

243
Appendix H Con’t
hear the resulting tape before it is analyzed by the researcher. The only person who will
have access to the not be provided to your
instructor(s). The ta uccessfully completed her
thesis defence.
9 The only purposes for which the above data will be used are educational: specifically,
and related peer-reviewed scholarly
ARTI IPAT
imilar , if yo
onseq nces you do not wish to
nswer and still remain in the study.
EDB TUDY TO THE SUBJECTS
rward you a
This
ateria will b
ou may withdraw your consent at any time and discontinue participation without penalty.
ics clearance through the University of Windsor
arch subject, contact:
916
a
indso
tape will be the researcher; access will
pe will be erased after the researcher has s
this includes the researcher’s doctoral thesis work
articles.
C I
P ON AND WITHDRAWAL
It is entirely your personal decision to participate in this study or not.
time without
S ly u volunteer to be in this study, you may withdraw at any
ue of any kind. You may also refuse to answer any questions
c
a
E ACK OF THE RESULTS OF THIS S
F
to fo
After successful completion of her thesis defense, the researcher will be happy
copy of your personal data as well as an executive summary of the project as a whole.
m l e mailed to you at no cost.
RIGHTS OF RESEARCH SUBJECTS
Y
iewed and received eth
This study has been rev
Research Ethics Board. If you have questions regarding your rights as a rese
Research Ethics Coordinator Telephone: 519-253-3000, ext. 3
lbunn@uwindsor.c
University of Windsor E-mail:
W r, Ontario
N9B 3P4

244
Appendix H Con’t
TURE OF RESEARCH S
SIGNA UBJECT
I understand the information provided for the stu A Critical Look at Critical Thinking in
Online Nursing Education as described herein. My questions have been answered to my
satisfaction and I agree to participate in this study. I have been given a copy of this form.
____________________________
Name of Subject (please print)
____________________________ __________________
Signature of Subject Date
SIGNATURE OF INVESTIGATOR
These are the terms under which I will conduct research.
_____________________________________ ____________________
Signature of Investigator Date
dy

245
Appen search
dix I: Consent to Participate in Re
Faculty
f Education at the University of Windsor. The findings of this study will be used in the
t lcarter@northnetwork.com or 705-688-0378, ext. 2235 or her thesis supervisor, Dr. Larry
sor.ca or 519-253-3000, ext. 3835.
t an online learning setting that uses
writing as a central learning methodology has on learners’ dispositions towards critical thinking.
ent of online courses for all
university-level learners, it is especially important for those involved in online nursing education
owing:
gh the Internet); each
rvey
urse. If, for
some personal reason, you would prefer to receive print copies of these questionnaires
and to return them via regular mail, please contact the researcher at 705-688-1519, ext
2235 or email at lcarter@northnetwork.com. Be sure to provide a detailed message
explaining where your questionnaires should be sent via the regular mail (Canada Post).
• Consider participating in a focus group session or interview. The session would
organized by the researcher and at no cost to you.
• Provide the researcher with access to your written work for the course including all
bulletin board postings and the final written assignment.
CONSENT TO PARTICIPATE IN RESEARCH
Title of Study: A Critical Look at Critical Thinking in Online Nursing Education
You are invited to participate in a research study conducted by Lorraine Carter from the
o
researcher’s doctoral thesis in educational studies.
If you have any questions or concerns about this research project, please contact Lorraine Carter
a
Morton, at morton@uwind
PURPOSE OF THE STUDY
The purpose of this study is to learn about the effect tha
While this information will be valuable in the design and developm
given the connection between nursing practice and critical thinking.
PROCEDURES
If you volunteer to participate in this study, you will be asked to do foll
• Complete two questionnaires provided to you online (throu
questionnaire will take approximately twenty (20) minutes of your time. The first su
will occur at the beginning of the course and the second near the end of the co

Appendix I Con’t
POTENTIAL RISKS AND DISCOMFORTS
There are no known and/or anticipa The researcher is not in any
way involved in the delivery of your course access to your grades.
POTENTIAL BENEFITS TO SU Y
participating
this study. They include the following:
ll have new understanding of your possible
strengths and weaknesses in this area. In turn, you may choose to focus on stengthening
r planning.
udent who is required to read scholarly research and possibly do
search of your own, you will learn about the research process as it occurs in a university
d
PARTICIPATION
ted risks inherent in this study.
not does she have
BJECTS AND/OR TO SOCIET
There are a number of potential personal and professional benefits associated with
in
• Because, at the end of the study, you will receive information about your personal
dispositions towards critical thinking, you wi
certain dispositions and/or compensating for others.
• Acquisition of the above information is helpful in caree
It is also suggested that, as a st
re
setting.
Speaking more generally, the findings of this study will help colleges and universities design an
develop online courses that enhance the critical thinking dispositions of the students who take
them.
PAYMENT FOR
There are no costs or payments associated with this project.
246

247
Appendix I Con’t
LITY
ny information that is obtained in connection with this study and that can be identified with you
he following steps will be taken to ensure confidentiality:
9 If you decide to participate, you will be assigned an ID number to be used on both of
oved from your written work. Your written work will
be assigned the same research ID number as used for the two surveys.
ight to
.
sfully completed her thesis defence.
9 The only purposes for which the above data will be used are educational: specifically,
er reviewed scholarly
rticles.
is entirely your personal decision to participate in this study or not.
onsequences of any kind. You may also refuse to answer any questions you do not wish to
E SUBJECTS
tion of her thesis defense, the researcher will be happy to forward you a
opy of your personal data as well as an executive summary of the project as a whole. This
IGHTS OF RESEARCH SUBJECTS
ou may withdraw your consent at any time and discontinue participation without penalty. This
stu
Research Ethics Board. If you have questions regarding your rights as a research subject, contact:
Research Ethics Coordinator Telephone: 519-253-3000, ext. 3916
University of Windsor E-mail: lbunn@uwindsor.ca
Windsor, Ontario N9B 3P4
CONFIDENTIA
A
will remain confidential. Such information will be disclosed only with your permission.
T
your surveys.
9 Identifying information will be rem
9 If you choose to participate in an interview or focus group session, you have the r
view the tape before it is analyzed by the researcher. The only person who will have
access to the tape will be the researcher; access will not be provided to your instructor(s)
The tape will be erased after the researcher has succes
this includes the researcher’s doctoral thesis work and related pe
a
PARTICIPATION AND WITHDRAWAL
It
Similarly, if you volunteer to partake in this study, you may withdraw at any time without
c
answer and still remain in the study.
FEEDBACK OF THE RESULTS OF THIS STUDY TO TH
After successful comple
c
material will be mailed to you at no cost.
R
Y
dy has been reviewed and received ethics clearance through the University of Windsor

248
Appendix I Con’t
SIGNA
I under
Online Nursing Education as described herein. My questions have been answered to my
sati
____________________________
________
IGNATURE OF INVESTIGATOR
hese are the terms under which I will conduct research.
Signature of Investigator Date
TURE OF RESEARCH SUBJECT
stand and the information provided for the study A Critical Look at Critical Thinking in
sfaction and I agree to participate in this study. I have been given a copy of this form.
Name of Subject (please print)
____________________________ __________
Signature of Subject Date
S
T
_____________________________________ ____________________

249
Appendix J: Fo (Johns, 1995)
ur Ways of Knowing
Aesthetics
⋅ What was I trying to achieve?
⋅ Why did I respond as I did?
⋅ How did I know this?
⋅ What were the consequences of that
for the patient? Others? Myself?
⋅ How was this person(s) feeling?
Personal
⋅ How did I feel in this situation?
⋅ What internal factors were
influencing me?
Ethics
belie
⋅ Wha
⋅ How did my actions match with my
fs?
t factors made me act in an
incongruent way?
Empirics
⋅ How knowledge did or should have
informed me?
Johns, C. (1995). Framing learning though reflection within Carper’s fundamental ways of
knowing in nursing. Advanced Nursing Practice, 22, 226-234.

Appendix J Con’t
Below are elaborations of the four ways ight occur in a nursing
education context:
Aesthetic Knowing
Aesthetic knowi eflection on what the
nd of
with
lso showing it!)” suggests self-analysis as the nurse reflects on
g
any of our paranoid patients as they didn’t trust the ‘device’ we were sticking
ly in the context
t n
proved
I alread
much i
eling ptoms, although not causing any
imm nual
of knowing as they m
ng often involves challenges to the self as well as r
person is trying to achieve and why she or he responded in a particular way. This ki
thinking also tends to focus on the feelings of others and the experience of consequence.
A statement such as “I am much more comfortable discussing these things issues
strangers than I am with a good friend…When I got to this section with my volunteer, I could
feel my words were not coming as easily as they had been and my tongue was tripping on itself
(I am certain my cheeks were a
why she responded as she did. Other examples of aesthetic thinking include statements dealin
with consequence: this sense of consequence often related both to the patient and the nurse,“We
did try tympanic ones (thermometers) for a few months but we found they increased the amount
of suspicion for m
in their ear.” On the other hand, the following statement places the nurse square
of he ursing situation:“Completing a comprehensive health history on my willing volunteer
to be a very valuable and interesting experience. It not only reinforced some of the skills
y use, but refreshed other areas that I may not have had the opportunity to utilize very
n my current practice.”
Aesthetic knowing is also said to involve consideration of how the other person is
. This is reflected by statements such as “These symfe
ediate distress to Mr. B. , have caused him enough concern to talk about them at this an
250

251
Appendix J Con’t
assessment which leads me to believe that he is worried.”
Personal Knowing
While similar to aesthetic knowing with a focus on feeling, personal knowing is almost
always about the self and is often an attempt to answer questions such as “How did I feel in this
om e tential
for per
nowing
rofessional and his or her personal value system. It is about wrestling with questions such as
How did my actions match with my beliefs?” and “What factors made me act in ways that do
ot fit with my values?” An example of this kind of thinking is evident in the following
statement:
One of the challenges that an interviewer may encounter is when the patient
describes something in their life that conflicts with your own values or
morals…such as teen pregnancy, abortions, sexual orientation, use of cigarettes,
alcohol or street drugs, a person’s choice to refuse blood transfusions.
situation?” and “What internal factors influenced my behaviour?” For example, the following
c m nt is clearly about one nurse’s sense of self in relation to a clinical situation with po
sonal embarrassment:
I thought that I had gotten over feeling embarrassed about asking personal
questions…I really felt this was the most difficult part of the interviewing process
for me and my discomfort probably made it harder on the volunteer as well.
thical K
E
Ethical knowing deals with the issue of congruence between a nurse’s actions as a
p
“
n

252
Appendix J Con’t
A second example of a nurse in a situation involving ethical knowing is described below:
act
personal values and practices require special th
pers
Empiri
inform ed) practice.
“Do you think this is ethical practice (kissing foreheads to assess temperature) or it is violating
patients’ rights? I have been doing this for 35 years and have never been denied a forehead; in
f most patients give me a beautiful smile and a thank you.” In this passage, one nurse’s
inking about given the ethical rights of another
within the context of a professional relationship.
on
cal Knowing
In a situation of empirical knowing, the nurse considers how nursing knowledge
ed (or should have inform

253
Appendix K: Information Document: sity’s BScN Program for Registered
Laurentian Univer
Nurses via Distance Education, 5th Intake
THE NURSING PROGRAM
ing to
dmitted to the program in 1975. Students may study on a full-time or part-time basis.
DISTANCE EDUCATION
January 1987, the BScN program for registered nurses became available on a part-time basis
anded
om Barrie, Orillia, North Bay, Timmins and Sault Ste. Marie to include students in Oshawa,
, Simcoe,
irkland Lake/Englehart/Haileybury, Attawapiskat, and Sudbury.
LUM FOR REGISTERED NURSES
ciences, Social Sciences, and Nursing.
ursing is studied in increasing intensity throughout the program. In the courses NURS 2276,
their nursing process, interpersonal, and physical examination skills that are required to assess
individ 316 introduces students to Epidem tics.
NURS 3317 explores major contemporary issues affecting nursing and health care. The four
4000 level nursing courses provide opportunities for the student to pursue individual clinical
interests, to test nursing theory, to apply aspects of the research process, and to function in a
leadership role in a chosen clinical field.
ADMISSION REQUIREMENT
Registered nurses are required to submit their current Certificate of Registration from the
College of Nurses of Ontario or be eligible for registration with the College of Nurses of Ontario.
PROGRAM OF STUDY
Required Non-Nursing Courses
The School of Nursing opened in 1967 and admitted students to a four-year program lead
the degree of Bachelor of Science in Nursing (BScN). Registered nurse students were first
a
In
through Distance Education at five sites. As the demand increased, the number of sites exp
fr
Owen Sound, St. Catharines, Toronto, Muskoka/Parry Sound, Kitchener/Guelph
K
THE CURRICU
The curriculum combines courses from the Humanities, S
N
NURS 2286, and NURS 2296, the emphasis is on health and normality. Students further develop
uals and families. NURS 3 iology and Biostatis
*CHMI 2220 E - Clinical Chemistry
BIOL 2110 E - Medical Microbiology
*Students who do not have grade 13 Chemistry, or equivalent, or who took grade 13 Chemistry
or equivalent over 5 years ago, are required to take CHMI 1401, CHMI 1031, or to consult with
the Chemistry Department before taking the required Chemistry courses.
NOTE: CHMI 1041 or CHMI 1031, if taken, may be used as an elective.

254
Appendix K Con’t
Electives
12 credits of ele
Nursing Courses
ctives
Nursing 2276 E – Nursing Healthy Individual
*** Nursing 2286 E – Nursing Health Assessm
*** Nursing 2296 E – Community Health Nursing
*** Nursing 3316 E – Epidemiology and Bios is
*** Nursing 3317 E – Issues and Directions in u
Nursing 4005 E – Theoretical Basis for Nursing Practice
Nursing 4015 E – Nursing Research
Nursing 4025 E – Critical Analysis of a Nursing Field
Nursing 4035 – Leadership Skills in Nu n
Tot er of credits in the prog m
*** A student may apply to challenge NURS 2286, 2296, 3316 and 3317 if they are able to
demonstrate appropriate educational and experiential background.
COURSE DES R
Individuals and Families
ourse content includes the nursing process, group dynamics, teaching and learning, family
e
community with individuals. This course is open to Post R.N. students only. (lec 2, tut 2) cr 3
NURS 2286 E Nursing Health Assessment
ourse content includes the physical and psychological assessment of the individual. Skill
evelopment in the area of interviewing and history taking are learned. Students practice in the
boratory setting. Prerequisite: NURS 2276. This course is open to Post R.N. students only. (lec
, lab 2) cr 3
NURS 2296 E Community Health Nursing
Course content includes concepts of health behaviour, health promotion, illness prevention,
community health nursing and community organization. Students work with families and groups
in the community. Prerequisite: NURS 2276. Corequisite: NURS 2286. This course is open to
Post R.N. students only. (lec 2, tut 2, total clin 24) cr 3
NURS 3316 E Epidemiology and Biostatistics
Introduction to Epidemiology and Biostatistics including basic study designs, measurements and
sources and data. Issues in methodology include sources of variation, common biases,
s and Families
ent
tat tics
N rsing and Health Care
E rsi g Practice
al n mbu ra : 63
C IPTIONS
NURS 2276 E Nursing Healthy
C
assessment, growth and development and therapeutic communication. Students practice in th
C
d
la
2

255
Appendix K Con’t
compli e
introduced and applied to nursing
in Nursing and Health Care
ploration and critical analysis of major contemporary issues affecting nursing
tem. Included in the analysis will be: exploration of historical background,
governm
approa
the
frameworks. Students practice in a selected cl
framew
A combined theory and practice course. The focus is on the analysis of a nursing setting. Course
management, adult education and program implementation. Students practice in a selected
rship principles and develop nursing skills required to function in
that area. Prerequisite
124) cr
Prerequisites: CHMI 1041, CHMI 1031, OAC or equivalent. (lec 3, lab/tut 3) cr 6
ance, contamination, cointervention and reproductibility. Methods of analyzing data ar
and health care. (lec 3) cr 3
NURS 3317 E Issues and Directions
This course is an ex
and the health care sys
ent documents and briefs, current research and ethical and legal implications of various
ches to these issues. (lec 3) cr 3
NURS 4005 E Theoretical Basis for Nursing Practice
A combined theory and practice course. Students examine a number of conceptual/theoretical
nursing frameworks. The course focuses on identifying appropriate criteria for evaluating
inical setting and apply and analyze various
orks while developing nursing skills required to function in that area. Prerequisites:
NURS 2276, 2296. This course is given in one term. (lec 3, total clin 108) cr 6
NURS 4015 E Nursing Research
The students will develop an understanding of the purpose of research for nursing practice.
Students will examine the two major research paradigms and the components of the research
process. They will develop skills in the critical appraisal of nursing research. These skills will
assist them in their role as research consumers and enhance their evidence-based practice.
Students will practice in a selected clinical setting, demonstrating research-mindedness while
developing nursing skills to function in that area. Prerequisite: NURS 3316. This course is given
in one term. (lec 3, total clin 108) cr 6
NURS 4025 E Critical Analysis of a Nursing Field
content includes organizational structure/systems analysis, change and decision making theory
and skill development in communication and colleague relationship. Students practice in a
selected clinical setting and identify organizational concepts and develop nursing skills required
to function in that area. Prerequisites: NURS 2276, 2296. This course is given in one term. (lec 3,
total clin 108) cr 6
NURS 4035 E Leadership Skills in Nursing Practice
A combined theory and practice course. The focus is on leadership as a situation-specific
process. Course content includes theories of leadership, administration, quality assurance/risk
clinical setting and apply leade
s: NURS 2276, 2296. This course is given in one term. (lec 2, total clin
6
CHMI 2220 E Clinical Chemistry
A course designed for students in Nursing to provide an understanding of the relationship
between disease, the underlying biochemical causes and the methodology for diagnosis.

256
Appendix K Con’t
edical
immunology, and a survey of infectious diseases that emphasizes causative
otherapy, and prevention. Exceptionally, students in the three-year or
four-year program
permis
an, Italian, Latin, Linguistics, Music, Native Studies,
phy, Religious Studies, Russian, Spanish, Theatre Arts, Women’s
- Social Sciences:
- Sciences:
Studies, Engineering, Geology, Mathematics, Physics.
- Professional Schools: Commerce, Education, Nursing, Physical Education, Social Work,
BScN education and to promote a lifelong learning process. To this end, the School employs
earning
and ongoing professional development. The School invites students to participate in PLA at
o the BScN program or prior to completing 15 credits. Prior learning is evaluated
against established BScN course outcomes so that credit(s) can be awarded for equivalency. The
percentage of and
the student’s portfolio. In accordance with university policy, a student must complete a minimum
of 30 credits in
The PLA proc
comprehensive dossier encompassing a student’s achievements, reflections, and critical thinking
in view of pre ms,
courses taken, work experience, volunteer work, and other life experiences. The School of
Nursing has specific guidelines for the portfolio content.
BIOL 2210 E Medical Microbiology
This course consists of an introduction of microorganisms, the principles of m
microbiology, basic
agent, symptoms, chem
in Biology may take this course for Biology credit, but only if they have prior
sion of the Department. (lec 3, lab 3) cr 6
ELECTIVES
To meet our program requirements, electives may be chosen from the following groups:
- Humanities: Canadian Studies, Classics, English, Film Studies, Folklore, Français,
French, Greek, Germ
Philoso
Studies.
Anthropology, Cooperative Studies, Gerontology, Economics, Geography,
History, Law and Justice, Political Science, Psychology, Sociology.
Astronomy, Biology, Chemistry, Computer Science, Environmental
Sports Administration, Translators.
PRIOR LEARNING ASSESSMENT POLICY
A goal of Laurentian University’s School of Nursing, English Division is to facilitate access to
Prior Learning Assessment (PLA), an evaluative method for assessing a student’s prior l
admission t
credit granted toward the BScN degree is a function of the program applied to
order to obtain a degree from Laurentian.
ess necessitates the student to prepare and submit a portfolio. A portfolio is a
viously acquired knowledge and skills. It can also include challenge exa

257
Appendix K Con’t
CREDIT BY CHALLENGE
Challenge in a given course is an opportunity for the registered nurse to demonstrate the ability
to meet the objectives without actually taking the course. Credit in the course is earned by
successful challenge. If the challenge is unsuccessful, the student must register for the course.
ADVANCED STANDING FOR REGISTERED NURSES
Students who have completed approved Health Assessment courses in their diploma program
within the last five years and who have attained a minimum G.P.A. of 2.5 on these courses will
be given advanced standing in NURS 2286 – Nursing Heal
th Assessment.
ccessfully completed the Introduction to Nursing Management: Distance
ster University will be given advanced
standing in NURS 4025. Only student
eligible
OHA Applied Management Skill Development –
ity to challenge NURS 4025 after completion of the
re-requisite courses.
AN Certification – 3 credits will be granted for a current CAN Certificate.
TIME LIMIT
Students must complete the nursing
Students who have su
Education program sponsored by CAN/CHA or McMa
s who have completed this course in 1982 or thereafter are
.
Students who have successfully completed the
Series 1 and 2 can be considered for eligibil
p
C
courses in eight calendar years from the beginning of the
first nursing course at Laurentian University.

258
Lorraine Carter was born in North Bay, ON. She completed an Honours BA and MA in
English language and literature through the University of Western Ontario in 1979 and 1980
pecializations in English and music.
From 1982 to 1988, Lorraine taught at Marymount College in Sudbury, ON, teaching
aine
as also worked in Laurentian University’s Centre for Continuing Education as an instructional
designer and project manager. While her work in continuing education has involved working
VITA AUCTORIS
respectively. In 1981, Lorraine completed her BEd at the University of Toronto with
s
intermediate and senior English. In 1988, Lorraine became a faculty member in Laurentian
University’s Department of English where she continues to teach on a sessional basis. Lorr
h
with faculty on projects from all disciplines, she has particular expertise in online education for
nurses. Presently, Lorraine is the Education Manager, Educational Events and Academic
Partnerships for the Ontario Telemedicine Network (OTN).