Evidence-Based Online Teaching Strategies

On-line education is increasing in utilization; nurses are striving to continue their education while working full-time and managing personal lives.  On-line education greatly improves rural access to education that would otherwise not be accessible.  Nursing student success and retention is a significant priority for nursing educators.  Based on the articles reviewed there appears to be two primary themes that were identified that included creating a positive and caring on-line environment and the influences of the instructor in that environment and identifying evidence-based on-line teaching and learning strategies that promote student success. The goal of this paper is to identify evidence-based on-line teaching and learning strategies that will promote quality curriculum, student retention, and student engagement to provide optimum on-line learning.  The literature review will assist educators in identifying best practices for on-line teaching and learning.  Nursing shortages along with rapid growth in on-line nursing programs, schools of nursing are being encouraged to listen and respond to the voices of their faculty transitioning from traditional educators to on-line instructors (Sword, 2012).

Background

A significant shortage in nursing continues to be an issue in healthcare.  Seasoned nurses are retiring at an increasing rate.  Nursing education is evolving to provide increased opportunities for providing nursing education for RN to BSN to MSN to PhD through on-line education.  There are multiple barriers to nursing education that include time constraints (work schedules, staffing shortages, inflexible hours, and family responsibilities) and, financial constraints (lack of tuition reimbursement, education costs, travel costs, lack of paid educational leave) (Holtslander, Racine, Furniss, Burles, & Turner, 2012).   On-line education is expanding access to learning, engaging students actively through evidence-based learning theory utilizing active learning strategies to enhance nursing (Phillips, 2005).  Nursing educators are needing to transition from traditional education to on-line teaching, and with this change comes a change in the educator role from expert to coach and facilitator.  This research is intended to identify a variety of evidence-based strategies for nursing instructors to implement within their on-line nursing courses/programs.  Teaching methods are evolving with increasing technology, and transitioning from traditional learning methods to on-line learning methods.  Curriculum development, evaluation along with data driven decision-making is important in implementing evidence-based best practice nursing education and continued contributions to the nursing body of knowledge (Wattenbarger Baker, Mitchell & Scalf (2017).

Students expect to utilize technology in every aspect of their lives.  Engaging today’s nursing students through an interactive learning environment that will not only enhance their skills, but educational technology tools convert education into a platform for enhanced interaction.  Capturing the traditional classroom and virtualizing it to transform the future of nursing education.  Educators need to embrace technology and capture the power to engage nursing students of today and the future (Salazar, 2010).

Theoretical Framework

The article review is based on the theoretical work of constructivism and building on Patricia Benner’s Novice to Expert as a framework.  Per Nursing Education Expert (n.d.), learning theories are conceptual frameworks relating how material is immersed, managed and recalled during learning.  Intellectual, emotional and ecological inspirations, past experiences impact perspective and learning transformed to understanding and advancing skills to be retained. A theoretical framework is a grouping of suppositions, ideas, and proposals that formulate the foundation for an individual’s perspective.  All the components of the framework need to piece together and be logical, have similarities, internal regularity to make sense and be reliable.  The validity of the theory is examined through research using quantitative and qualitative data (Nursing Education Expert, n.d.).  Providing instruction to adult learners becomes challenging because of generational differences.  There are a variety of learning styles and preferences that influence learning.  It is important for educators to be aware of the generational differences and adapt teaching strategies to meet a variety of learning needs.

In researching, online learning strategies, the theoretical framework that will be utilized as the foundation for this literature review engages both Patricia Benner’s novice to expert framework in coordination with social and cognitive constructivism theory.   The primary learning theory that most aligns with on-line learning is cognitive and social constructivism, fitting into Patricia Benner’s framework.

Constructivism is a paradigm for teaching and learning and is based on observation and the scientific study of how people learn.  Students are actively engaged in their own process of learning (Piaget, n.d.).  As he/she encounters something new, he/she reconciles it against previous ideas and experiences and becomes actively engaged in learning.   The educator functions more as a facilitator who coaches, mediates, prompts, facilitates, and assists students to develop and assess their understanding, and ultimately their learning.   Learning happens as a dynamic, constantly changing view of the environment and the ability to successfully expand and explore that view.   Constructivist theory emphasis is on student-centered education, and does not focus on the educator as an expert.

Constructivism builds upon active learning and is a teaching approach where students actively engage with the material provided through reading, writing, discussions, peer review, listening, and reflecting.  Active learning is a contrast to traditional education that relies on the instructor doing most of the talking and the students are passive learners. Student-centered approach looks at the student’s needs and learning styles and adapts the strategies to provide for a variety of student learning opportunities.  The key to active teaching strategies is to employ a variety of teaching strategies, such as group discussions, critical thinking, case studies role playing, journal writing, and group learning projects.  The advantages include improved interpersonal skills, retention of new information, and increased critical thinking skills (Center for Educational Innovation, n.d.).

Per Piaget (n.d.), as an educator he/she transform from expert to facilitator, coach and supporting the constructivism learning theory by presenting a big picture view and breaking the pieces down into a scaffolding effect.  Constructivism is a paradigm to learning and teaching and encompasses several concepts that cause the learner to construct, engage, reflect, collaborate, inquire, and evolve as they learn.    Building upon what students already know and establishing an interactive learning environment that promotes student inquiry.  Educator facilitates interactive dialogue to help students build upon their current knowledge, experience, philosophies, and values.   Various assessments can be conducted; however, the process is as important as the product.  As the student works through the materials and sources of information, inquiry, experiences build upon and change perspectives or points of view as they consume and integrate what they are learning (Piaget, n.d.).    Constructivist theorists include John Dewey, Jean Piaget, Lev Vygotsky, and Seymour Papert capturing both cognitive and social constructivism.

As cognitive and social constructivism theory builds upon what students know and experience that in turn builds upon Patricia Benner’s framework of novice to expert. Per Benner (1982), as the student enters in to the nursing field, the new nurse begins as a novice with a set of beliefs and values, but very little hands-on experience.  As the nurse continues through an orientation in an area of nursing whether it be medical/surgical, obstetrics, or public health, the nurse begins to become an advanced beginner where he/she still may need direction, support, and mentoring but the nurse will be required to pass basic competencies and begin to function more independently over six-months to two years.  As the nurse continues to develop to a point of more dynamic knowledge and competency will begin to function more independently and base their decision-making on past experiences as well as policies and procedures.  Confidence builds and the nurse will become more competent in their profession.  As the nurse becomes more proficient, he/she will take on a more holistic approach and understanding, as the nurse continues to learn and expand their experiences and rely more on abstract principles and several years of past experiences he/she will become known more as a leader within his/her profession by mentoring and leading by example will take on the role of expert.  As a nurse transfers from one area of nursing to another, he/she will carry some skills and experiences, but start the cycle of novice to expert again.  However, he/she may move through the process more rapidly, but inevitably start the learning process from the beginning and build on current competencies.  Each level represents a change in nursing skills specific to increased independence and critical thinking.   Together Benner’s framework integrates well with social and cognitive constructivism theory providing the foundation for on-line learning.

Evidence-Based On-line Learning Strategies

A literature review of peer-reviewed articles was utilized to determine evidence based best practice teaching and learning strategies for on-line education that was compiled from searches from CINAHL and Cochrane Data Base of Systematic Review.  The review identified two major themes related to on-line education that dealt with creation of an on-line learning environment and on-line teaching strategies and methodologies to engage active learning.

On-line Learning Environment

Cunningham (2015) states that education relies on the overall structures, systems, and individuals within the learning environment and the importance of providing introductory training on expectations and technology early in the educational program.  Three key concepts applicable to on-line learning emphasized motivational and committed faculty attitudes, valid and reliable assessment, importance of accommodating different learning and teaching styles.  As faculty transition from expert to facilitator and coach, students will become increasingly independent and accountable for their own learning.

Gazza & Hunker (2014), emphasized the importance of boosting student confidence by providing solid orientation to the learning management system, software and hardware requirements, computer literacy, along with simulated course work.  A solid orientation creates greater competency in on-line learning activities and provides a supportive learning environment.  Social presence of faculty was also emphasized, along with all educational staff interacting with students were emphasized to build upon attentive relationships with students.  The creation of a virtual student-only environment for social communications between students was also found to be beneficial in promoting a sense of community.  Monitoring quality of course and program improvement strategies focused on student feedback on course and program evaluation and utilizing continuous quality improvement to enhance course and program quality.

Cole & Kritzer (2009) emphasized the importance of the instructor’s commitment to course preparation, management, and student support.  Students indicated that they appreciate faculty utilizing real-life examples, providing adjustments to their learning needs, and encouragement.  The students went on to indicate they liked faculty to be effective facilitators of the course progression, concern for the students’ learning, and providing a worthwhile course that students could easily apply.  Cole & Kritzer (2009) also stressed the importance of educators being actively engaged in the learning, promoting trusting relationships, being organized but providing a flexible learning environment with firm goals and timelines.  Emphasis was placed on the creating a community environment that is structured and the consistent availability of faculty presence.

Mann (2014) conducted a pilot study that identified several influencing factors in creating a caring online environment.  The study affirmed the premise that students believe an educator can create a caring on-line learning environment.  Students believe the educator’s behavior influences their success in class.  This premise of an educator creating a caring environment further expands on existing knowledge that students’ preference for instructors exhibiting caring behaviors in the online learning environment are positive faculty attributes.    The three most important characteristics of creating a caring on-line classroom environment were:  the educator’s attentiveness to clarity and organization, the educator’s rapid and comprehensive feedback to students’ course work and questions, and the educator’s show of interest in meeting the needs and expectations of individual students.  The three least important characteristics of creating a caring environment were:  the availability of scheduled weekly virtual office hours, the use of synchronous virtual sessions, i.e. chat rooms, and the educator’s online technology expertise.

Reilly, Gallagher-Lepak, & Killion (2012) looked at learner insights on sense of community in the on-line environment and found four major themes related to emotional concept of online learning: loneliness, facelessness, non-verbal interactions, apprehensions and unknowns associated with on-line learning environment.  Emotional factors were identified as a significant part of the sense of belonging among online learners.  By listening to student experiences, educators can speak to both cognitive and affective aspects of learning, providing fertility in on-line learning.  Educator recommendations involved:

1. designing course work to help students find commonalities with one another;
2. peer reviewing of student work before submission and small group collaborative projects;
3. increasing student interaction creates a more robust community;
4. engaging leaners in posting pictures of themselves, pets, utilization of emoticons, synchronous planned meetings with instructor and class participants;
5. utilizing first names and personal greetings and closures in online interactions helps build a sense of community, belonging and collaboration;
6. encouraging learners to identify their familiarity with the online learning environment and make intermittent contact with them early in the course to offer support services;
7. providing tips on living through an on-line course discussion is a strategy that encourages experienced on-line learners to share effective strategies;
8. providing clear guidelines and particulars of course content emphasized by educators in weekly announcements;
9. delivering content that is novel to the learner can support emotional concepts; and
10. role modeling values, attitudes, beliefs, and emotions that support preferred behavior (inquisitiveness and awareness) (Reilly, Gallagher-Lepak, & Killion, 2012).

Walker (2016) developed a bridging for success curriculum that showed promise for increasing students’ self-confidence and decreasing perceived stress levels.  The curriculum included six modules that included: closer look at identifying preferred learning styles, time management, study, reading and note taking skills, test taking skills, stress management and introductions to critical thinking.  Student retention was minimally changed, but student satisfaction was positive.

On-line Teaching and Learning – Design, Resources & Strategies

The second theme identified in the literature review focused on best practice strategies that accounted for course design, teaching resources, and strategies.  Although, an attempt was made to separate the strategies associated with design, teaching resources, and strategies there is a tight relationship between the three areas that build upon overall strategies.

Design

Course design that is well thought out and developed to allow for structure, but also provide an opportunity for fluid learning from a student-centered approach can be extremely beneficial and promote student learning.  Sowan & Jenkins (2013) analyzed how to apply the seven principles of effective teaching to design and deliver an effective hybrid nursing research course format.  Students reported high satisfaction with the course and obtained significantly higher scores than students who had previously taken the course in the traditional classroom format.  Students identified concerns associated with the on-line component that included working in groups and the need to read an overwhelming number of responses to discussion questions and the additional workload associated with the online component, but overall felt the course design and experience was positive.  Course design and delivery utilizing Chickering & Gamson’s (1987) seven principles of effective teaching that provides for a solid foundation. 

First, having open dialogue with the students related to pre-course discussions of the workload and course requirements being critical for students to have a successful on-line learning experience.

Second, student-faculty contact is an essential element provided early and often throughout the course.

Third, students expect prompt instructor feedback.

Fourth, cooperation and collaboration among students to alleviate feelings of isolation in on-line courses is an essential element that can impact student retention and participation.  Engaging students with knowledge on authoring and community building are vital student and instructor characteristics that promote learning.

Fifth, promotion of active learning through asynchronous discussion board exchanges are valuable, especially for students who do not speak up in class.  Active learning also provides learners an opportunity to see how others think and provides an opportunity to learn from peers.  Studies have found that on-line learning engages more students than traditional courses.  It is important to establish discussion guidelines for answering discussion board questions and for how frequently students should review and comment on other’s posts.  This can be reflected in a clearly constructed grading rubric.

Sixth, in technology-mediated education communicating time on task special reminders about course deadlines to monitor students’ progress and deter procrastination.

Seventh, identifies the important factor of respecting diverse talents and multiple ways of learning, and keeping in mind knowledge construction is an individual process with students’ abilities and learning styles, perceptions, and expectations differ, and need to be taken into consideration when designing a web-based course.

Resources

Technology is a significant factor in daily life and bringing technology into education as a tool to increase knowledge and skills around technology as well as the specific topic of the applicable course is a win win for the student.  Education resources vary as much as the strategies to actively engage students, but technology is a major factor in today’s education design and educational resources.  Salazar (2010) states students expect to use technology in all aspects of their life.  Providing an interactive learning environment promotes the utilization of technology that enhances students’ technology skills.  Educational technology tools convert the on-line learning environment into interactive learning.  Virtual classrooms are the future of education.  Technology is the key to engaging and stimulating today’s students.  It is important to distribute information on how to access the course on-line in an efficient and timely manner.  The instructor must develop the course with a structured online platform to provide organization and be intuitive for students to locate basic information, i.e. Brightspace, Blackboard, Angel, Moodle, Sakai, or WebCT often referred to as either Course Management Technology (CMT) or Learning Management Tool (LMT).  Incorporating Video Lecture Capture Technology (VLCT), Wiki (collaborative software) and podcasting in to the curriculum provides extensive opportunities to engage students with actively preparing presentations to their peers, instructor or student providing feedback, preparing lectures for inverted classrooms, and providing endless opportunities for utilization.

Wong (2011) conducted an experimental study to utilize online community learning collaborative using Video Interactions for Training and Learning (VITAL) an internet-based collaborative software that features a private workspace so that student groups can work privately until ready to share.  Peers cannot view others works until they have submitted their own work, to help preserve the originality of intellectual work.  On-line learning tools and applications are evolving and expanding rapidly.  On-line learning interprofessional collaboratives has the potential to improve relationships as well as improve decision-making abilities, and promote teamwork, sharing and participation.

Guarino, et al. (2014), conducted an online survey and concluded that the internet was identified as being as important as the materials and guidance provided during lectures and note taking.  Students are increasingly utilizing smartphones and tablets to instantly obtain information and scientific data, however, there was a preference for personal computers over portable internet devices.  Textbooks continue to be the foundation for learning, followed by lecture materials, and then acknowledgement of the internet as well as other multimedia materials as useful resources.

Strategies

The literature review identified a multitude of teaching and learning strategies that are present throughout this document, however, an attempt was made to highlight the most commonly utilized best practice teaching and learning strategies within one section.  Cunningham (2015) identified teaching strategies that helped students transition into practice that apply to online learning that included:  role playing, reflective journaling, problem-based learning, needs assessments, and student contracts, and alignment of curriculum with practice.   Cole & Kritzer (2009) identified individual and group discussion boards, scaffolding projects with each component receiving instructor feedback, inverted classroom that takes teaching methods done inside and outside the classroom setting, modules based on major themes and objectives, assigned readings, slide presentations, discussion questions, and interactive activities.  Faculty providing community building activities such as “getting to know you” discussion boards, weekly informational or motivational messages synchronous office hours, and accessibility via e-mail and/or phone.  Salazar (2010) indicated the need for instructors to introduce themselves early and establish an on-line presence by engaging students early in the class to utilize educational tools and introduce themselves to create an on-line community environment.  Educators need to maintain consistent contact with students regarding process, graded assessments, and student ideas and provide timely feedback and provide a strong orientation, maintaining a single point of contact, and frequent instructor feedback.

Hampton, Pearce, & Moser (2017) conducted a study that looked to better understand student preferred teaching and learning methods for on-line courses across multiple generations.  The study found the most favorite/preferred and most engaging/effective methods involved on-line discussion boards, case studies, assigned journal article reading, internet searches, videos or power point presentations with no voice over, or adobe connect synchronous education sessions, and e-mail and dialogue with instructors.  Other teaching and learning methods included in the study also looked at synchronous chat rooms, Wikis, group problem-solving exercises, group collaborative projects, quizzes/tests/examinations, simulation, and on-line games.  On-line programs provide convenience and flexibility, students in nursing programs are primarily representative of three generations (Millennial, Generation X, and Baby Boomers), students like balance of both passive and active learning strategies.  Evans, Suzuki, Begg, & Lam (2008), found that problem-based learning worked well with the number of participants greater than 16.  Teaching and learning strategies need to be mindful of class or group size, some strategies are more effective based on group size and should be considered when identifying strategies.  Phillips (2005) identified a variety of on-line active learning strategies that involved feedback to the learner from peers and instructor in most cases.  On-line learning strategies identified included:  student assessment surveys, online test/quizzes, reflective journals and essays, video clips, asynchronous and synchronous on-line discussions, interactive online games, reading from hyperlinks, case studies, role playing, debates with assigned roles, study and support groups, group projects, individual projects, online presentations, electronic portfolio submissions, writing case studies, care plan submissions, virtual social spaces, problem-solving assignments, online community building projects, and peer review projects.

Weed, Spurlock, and Forehand (2014), focused their literature review on on-line discussions found that careful preparation and organization of on-line discussion questions promote a positive learning environment for students.  Discussions can create a shared sense of community and provide students with equal opportunities to participate in the discussions.   The challenges involve students feeling like they are under constant surveillance and postings are permanent and cannot be deleted or changed.  Students are open to criticism, but may provoke a sense of vulnerability and technology can pose challenges with navigation and technical support.  It is important to establish guidelines for discussion posts related to size of groups, grading rubrics, number of posts, and length of posts.  Phillippi, Schorn, & Moore-Davis (2015), looked at APGAR scoring rubrics for on-line discussions and identified grading criteria:  application (includes and applies relevant course concepts or materials correctly), professionalism (responds to peers, relates the discussion to relevant course concepts and provides substantive feedback), group work (contributes to the group task – responds to a minimum of two other peers per question), analysis (analyzes the application of knowledge with changing conditions and conflicting resources), rationale (provides references to support position as applicable, utilizes APA style).  The rubric should be adjustable and reflective of the competencies and philosophy of a variety of nursing specialties, and overall scoring is helpful for both students and faculty.

The literature review indicated the importance of developing critical thinking skills and how these skills might be enhanced.  Novotyny (2016) looked at the importance of expanding student opportunities to further develop critical thinking skills essential for advanced nursing roles.  The study looked at complimentary strategies to enhance critical thinking skills through on-line discussions.  Strategies that were identified to promote critical thinking skills included:

1. instructor facilitation in first discussion;
2. instructor discussion feedback throughout term;
3. discussion rubric that identified discussion parameters;
4. self-reflection about own discussion posts;
5. video presentations:  development of analytical skills and thinking critically about professional issues;
6. peer responses to discussions;
7. video presentation defining critical thinking.

Critical thinking skills in on-line discussions improved considerably with the utilization of several educational strategies as noted above and involved substantial student and faculty effort.  It was also noted that recognizing the elements of our thinking enhances critical thinking skills such as: purpose in reasoning, question we are trying to resolve, what assumptions are we imposing, perspectives we are considering, facts we are utilizing, conceptions with which we describe our rational, explanations of how we make sense of information, and inferences we pull from our reasoning.  Integrating critical thinking strategies is an essential element of on-line nursing education course.

Discussions

On-line nursing education continues to evolve and increase in popularity and carry many benefits of increasing access to education that otherwise may not be accessible.  Emphasis is placed on providing a quality education that engage students in active learning opportunities, create positive learning environments and highlight characteristics that promote student success.  For the purposes of this article on-line education is based primarily on constructivism learning theory, keeping Benner’s novice to expert as a reference point of nursing progression.  Teaching methods are evolving with increasing use of technology and student’s use of technology exists in every aspect of their life including education.  Technology supports and provides educators the opportunity to engage today’s nursing students with an emphasis on student-centered education through the educator facilitating the learning process.  The literature review identified two major themes related to on-line nursing education that included creating a positive, caring, community-based learning environment and evidence-based teaching and learning methods to engage active learning.

The course design involves web-based platforms and applications that provide structure, communication, and assessment.   It is important to assess student familiarity with technology and on-line learning tools and ensure a solid orientation to the technology utilized, providing a primary contact person, and frequent educator feedback from start to finish.  Critical thinking skills are essential for progression in the nursing profession.  A student introductory course that helped support success included bridging for success curriculum that looked at identifying preferred learning styles, test taking skills, stress management, and an introduction to critical thinking.

There are a variety of teaching and learning resources that can be engaged in on-line nursing education and these are continually evolving; the internet was identified as being as important as materials and guidance provided through lecture and note taking.  Textbooks continue to be the foundation, but multimedia materials were also among the resources identified.  The seven principles of effective teaching emphasized pre-course discussions on workload and course requirements, student-faculty contact, prompt instructor feedback, community building, active learning, establish a timeline for progression, and last but certainly not least is respect for diverse talents and multiple ways of learning.

Teaching strategies were varied and looked to engage cross generational learners through a variety of interactive learning styles and methods, that strived to engage critical thinking skills to enhance professional development.  The methods that were discussed more prominently were:  community building activities, role playing, reflective journaling, problem-based learning, needs assessments, student contracts, modules based on major themes, assigned readings, power-point  presentations, on-line discussion forums, case studies, assigned journal article  readings, internet searches, synchronous chat rooms, Wikis, group problem-solving exercises, group collaborative projects, quizzes/tests/examinations, simulations, on-line presentations, portfolio submissions, peer review projects, and on-line games.  Students identified with both passive and active learning strategies.  Discussion questions were the most prominent strategy identified, and because discussion posts were such a significant strategy a review of an APGAR scoring rubric for on-line discussion posts was appropriate to review.  The importance of integration of critical thinking skills within the discussion posts was also assimilated into the content of this literature review.  Although a rubric for on-line discussion posts was discussed, it is important to lay out and formulate a rubric scoring grid for all graded assignments.  This provides a helpful tool for both the students and instructor.  An article review looked at complimentary strategies to enhance critical thinking skills through on-line discussions and laid out seven strategies that support critical thinking.  Although a strong literature review was conducted, it in no way captured all the strategies and methods that could be implied in an on-line nursing program or course, but certainly provides a baseline to start from.  It was also identified that there were limitations in the literature review based on long-term studies on utilizing on-line strategies and student success rates.  Many of the studies include within this literature review involved only short-term one course studies or looked at two different student groups.  A more extensive study encompassing a larger group of students and consistent evaluation over a longer period would be beneficial.

Recommendations for Practice

Nursing faculty characteristics can create a caring, personalized and supportive community-based learning environment through attentiveness to clarity and organization, rapid and comprehensive feedback to students’ course work and questions, and by showing a sincere interest in meeting the needs and expectations of individual students.  Nursing faculty need to provide for an introductory student orientation to technology and applicable learning tools that will be utilized in the course/program early on or prior to the course/program starting.  This will require appropriate follow-up and support from the faculty to student.  It is essential to implement strategies that promote critical thinking skills and bridging for success curriculum and assessing for student technology learning needs to promote student success.

The aim of on-line learning is to appeal to multiple generations of learners’ styles and needs with the primary focus of student-centered education.   Student-centered education requires utilization of a variety of evidence-based active learning strategies that have been shown to be successful in engaging students.  As nursing faculty strive to increase student critical thinking skills, faculty needs to not be afraid of trying something new whether it be a new teaching method, new resource or new technology.  Nursing faculty can be engaged in assessing students’ reaction to new teaching methods, new resources, or new technology by conducting pre- and post-course evaluations that will help build faculty toolboxes for student success.  The changing role of the nursing faculty member from expert to coach and facilitator provides for a more active responsibility for the student to actively engage in their education experience.  Educator affect is conveyed through the on-line environment and exhibits role modeling values, beliefs, and emotions and can support preferred behaviors such as inquisitiveness and awareness within the student.  Educator presence and commitment is essential for on-line student engagement.  Educators need to have a respect for diverse talents and multiple ways of learning as knowledge construction is an individual process and educators need to make accommodations for diversity when designing on-line courses.

Conclusion

Nurse shortages continue to be a challenge in healthcare and the need to provide educational opportunities to those wanting to continue their education and increasing access to students in rural communities.  There is an increasing need to provide online asynchronous education that provides for increased access, flexibility, and potentially remove some financial barriers to continuing education (Holtslander, et al., 2012).  Further continued research is needed to provide clarifying information about what on-line teaching methodologies help RN-BSN and graduate programs across various generations learn in the most effective way, these strategies and methodologies continue to evolve along with advances in technology.

Additional studies and literature reviews need to be done to continually assess and make modifications to current teaching and learning methods, additionally longer term studies would be beneficial to determine best practice strategies and student long-term success.  This article review is considered a baseline for new educators considering on-line teaching strategies.  Education methodologies and technologies continue to evolve and course and program evaluation from both faculty and students will continue to provide additional evidence of the best educational and learning strategies to employ.

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