The LEONARDO-DA-VINCI pilot project ‘‘e-learning-assistant” –
Situation-based learning in nursing education
Petra Ina Pfefferle a,*, Etienne Van den Stock b
, Annette Nauerth c
, ‘‘E-learning assistant”-project group 1
a
Philipps-University of Marburg, Department of Clinical Chemistry and Molecular Diagnostics, Biomedical Research Centre, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
b
Katholieke Hogeschool St. Lieven Belgium, Campus Dirk Martens, Kwalestraat, Aalst 92-94 9320, Belgium
c
University of Applied Science Bielefeld, Department of Nursing, Am Stadtholz 24, 33069 Bielefeld, Germany
a r t i c l e i n f o
Article history:
Accepted 24 September 2009
Keywords:
LEONARDO-DA-VINCI programme
Blended learning
E-learning platform
Systemic situation-based learning approach
Web-based learning
Nursing education
s u m m a r y
E-learning will play an important role in the training portfolio of students in higher and vocational education.
Within the LEONARDO-DA-VINCI action programme transnational pilot projects were funded by
the European Union, which aimed to improve the usage and quality of e-learning tools in education and
professional training. The overall aim of the LEONARDO-DA-VINCI pilot project ‘‘e-learning-assistant”
was to create new didactical and technical e-learning tools for Europe-wide use in nursing education.
Based on a new situation-oriented learning approach, nursing teachers enrolled in the project were
instructed to adapt, develop and implement e- and blended learning units. According to the training contents
nursing modules were developed by teachers from partner institutions, implemented in the project
centers and evaluated by students. The user-package ‘‘e-learning-assistant” as a product of the project
includes two teacher training units, the authoring tool ‘‘synapse” to create situation-based e-learning
units, a student’s learning platform containing blended learning modules in nursing and an open sourced
web-based communication centre.
Ó 2009 Elsevier Ltd. All rights reserved.
Introduction
E- and blended learning units are educational programmes
based on the structured involvement of electronic media. These
form basic tools for future learning strategies not only at the university
level but also in the field of vocational training. Even
though e-learning is independent from time and place, offers flexibility
and a wide choice of programmes from an international
market, computer-based learning does not gain acceptance all over
Europe. While in some of European countries e-learning is a crucial
part of the training portfolio in higher and vocational education, in
others e-learning programmes are not well established (Marry,
2005). In a changing field of health care with new professional
challenges, IT skills are strongly needed to fulfill the requirements
of computer-based documentation and information (Scott et al.,
2008). While there is a broad range of products developed for computer-assisted
skill training of medical students (Choules, 2007),
e-contents especially tailored for the nursing education are lacking
or not accepted by nursing teachers and students. This may due to
lack of proper didactical and pedagogical approaches, user-friendly
learning platforms and adequate approaches to integrate e-learning
units in the curricula (Childs et al., 2005). Since nursing teachers
as well as students may have poor knowledge or fear the use of
new media, there seems to be a need to improve competencies in
both groups (Christian, 2003). Suitable technical equipments,
adequate e-didactical approaches adapted to the specific needs in
nursing education and IT training programmes for teachers and
students are needed to ensure a valuable implementation of
e- and blended learning programmes in nursing education
(Muirhead, 2007). Blended learning as a mixture of well-matched
e-units and face-to-face lectures (Garrison and Kanuka, 2004) are
well-suited to equip nursing students with nursing contents and
to improve computing skills.
The LEONARDO-DA-VINCI programme, funded by European Union,
aims to complement the teaching and learning methods of
people that are involved in vocational education and training in
the European Union. According to the ‘‘Strategic framework for
European co-operation in education and training, Update 2008”
0260-6917/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2009.09.014
* Corresponding author. Tel.: +49 64212866038.
E-mail addresses: pfefferl@med.uni-marburg.de (P.I. Pfefferle), annette.nauerth@
fh-bielefeld.de (A. Nauerth).
1
Belgium: Linda Nabintu, (HEMES Haute Ecole, now Helmo Haute Ecole, Liége),
Patrick Janssens (Katholieke Hogeschool St. Lieven, Campus Dirk Martens, Aalst);
Czech Republic: Renata Halmo (Univerzita Palackého, Olomouc); Finland: Sari
Mettiainen, Päivi Salokangas (Pirkanmaan Polytechnic-University of Applied Sciences,
Tampere); Poland: Tomasz Cuber, Edyta Religan (Akademia Medyczna, Lublin);
Latvia: Inese Ozolina, Kristine Pfafrote (LM Medicinas Profesionalas Izglitibas Centrs,
Riga) Germany: Heike Bentlage (Kolping Werk-Pflegeschule Gütersloh, Germany);
Sibylle Esser (Deutsches Rotes Kreuz-Pflegeschule Braunschweig); Maja Cuber,
Michaela Ewers (Pflegeschule-Johanneswerk, Bielefeld), Antares Reisky (VirtualArt
Consulting, Bielefeld and Xaton Ldt, Birmingham, Great Britain) Christiane Freese,
Susanne Jaeger, Elisabeth Buesch and Gunnar Geuter (University of Applied Science,
Bielefeld).
Nurse Education Today 30 (2010) 411–419
Contents lists available at ScienceDirect
Nurse Education Today
journal homepage: www.elsevier.com/nedt
(EU, 2008), the LEONARDO-DA-VINCI programme should contribute
to the harmonisation of education systems of EU member
states based on comparable qualifications. From 2003 to 2006
the programme focused on new applications in e-learning (EU,
2003). Transnational partnerships were invited to submit proposals
for pilot projects that promised new e-products and tools to improve
vocational education in the EU member states. This was the
starting point for the LEONARDO-DA-VINCI pilot project ‘‘e-learning-assistant”
addressing blended learning in nursing education.
Aims of the project
The overall aim of the project was to create new didactical and
technical e-learning tools and learning materials to improve media
competencies of teachers and students and to facilitate the application
of a web-based learning in nursing education.
In particular, the project had the following objectives:
1. Teachers working in nursing education should be able to adapt,
implement, create and evaluate blended- and e-learning materials
without advanced knowledge in computer programming.
2. A web-based user-package should be developed that provides a
compact set of components that are necessary to implement
blended learning in educational settings of nursing. A transnationally
applicable user-package in computer-based learning
that should be suitable for beginners as well as for advanced
persons.
3. In addition to these tools for teachers to develop and implement
e-learning units the user-package should include a learning
platform for students where these e-learning units could be
accessed.
Structure of the project
Project group
The LEONARDO-project brought together a skilled team of
teachers in nursing education from Belgium, the Czech Republic,
Germany, Finland and Latvia and Poland as well as two IT companies
based in Germany and Great Britain.
The project was co-ordinated at the University of Applied Sciences
at Bielefeld, Germany. This centre was involved in a forerunner
project aimed to modularise nursing education (Knigge-Demal
and Nauerth, 2003) and is therefore experienced in the field of elearning
and modularisation. To promote entrepreneurship and
improve exchange of experiences between companies and educational
institutions LEONARDO-DA-VINCI project partnerships are
obliged to involve small and middle enterprises (SME) (EU,
2005). Therefore two IT companies from Germany and Great Britain,
skilled in technical development of IT based educational tools
were responsible for technical development. Other partners were
from different public and non-profit educational settings, such as
nursing schools, universities and higher education centres for nursing.
IT companies were funded by the EU following agreement to
the rules of dissemination ensuring open access of the project
products via the internet.
Work packages and project organisation
Based on a route chart, featuring milestones to characterize
sub-goals, tasks were assigned to the partners by the co-ordination
centre (Fig. 1).
The co-ordination centre was responsible for the overall management
of the project, including communication, arrangement
of workshops, budget administration, documentation and the process
evaluation of the project. Additionally, the co-ordination centre
was responsible for the development in of the e-didactical
approach, the development of teacher training units in e-learning
and the construction and validation of evaluation tools.
Templates were created by the IT enterprises to build up e-tools
for e-unit development and learning platforms containing e-units
and evaluation tools. Additionally, the companies provided technical
tools for the internet presence and the intranet.
Joint teachers working in the partner institutions were responsible
for the development, implementation and evaluation of
blended learning nursing modules in their institutes based on the
techniques provided by the ‘‘e-learning-assistant”.
Working process
Starting with the conceptual and technical development for
core facilities of the ‘‘e-learning-assistant”, the co-ordinators laid
foundations for the subsequent training of teachers in e-learning.
Based on a situation-based learning approach, two teacher training
units have been created to promote e-learning competencies in
teachers.
The first unit addressed strategies on how to implement
blended learning modules within the setting of nursing education.
In the next phase teachers should act as learners within the project
applying the freshly acquired knowledge to adapt and implement
blended- and e-learning units. Based on these experiences the second
unit aims to train teachers in the development of blended
learning nursing modules. Subsequent to the application of these
materials in student courses the products have been evaluated to
elucidate benefits and deficits (Fig. 2).
To acquaint joint teachers with the underlying principals of
blended- and e-learning, the teacher training modules were also
constructed as blended learning units: the e-learning units were
provided online by the ‘‘e-learning-assistant” and completed by
workshops conducted in the co-ordination centre. Thereby teachers
were enabled to acquire their own experiences in a ‘‘learning
by doing” process guided by the co-ordinators acting as tutors on
the whole process (Fig. 1).
Evaluation of the process and the products
LEONARDO-DA-VINCI pilot projects are obliged to evaluate the
project and document and control the work progress. According to
the parameters given by the programme guidelines evaluation of
the working progress and the project products should include all
persons that were involved in the project activities.
Fig. 1. Work packages of the partner within the project.
412 P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419
The initial idea to evaluate the process and outcomes of the project
was grounded on the approach of Donabedian (1980), who
established evaluation as a tool in the quality management of nursing.
Donabedian aimed to show that evaluated processes are in line
with predefined goals. According to Donabedian three dimensions
supposed to be affected by the project were evaluated in the partner
institutions using standardized questionnaires:
 Technical and structural conditions in the partner setting
To survey preconditions and special requirements the joint
teachers from the partner institutions were asked to fill in a
baseline needs assessment. Alterations within the term of the
project were assessed by follow-up survey in the last project
phase. The questionnaire included items concerning technical
equipment, technical staff, technical organisation and management,
implementation of e- and blended learning and further
training of teachers in IT applications.
 Motivational attitudes, experiences and competencies in e-learning
in the teachers group
In order to document and control the project motivational
parameters, expected benefits and tutorial challenges initiated
by the project were assessed by the joint teacher group, which
constantly assessed project issues. Evaluation sheets were provided
on the initial and the final workshop held in the co-ordination
centre.
 Effects of the project products in students
To determine how students were benefited by participation in a
blended learning module, students in the partner institutions
were surveyed after completion. The questionnaire contained
items concerning experience with the IT media, motivational
attitudes regarding e-learning and an overall assessment of the
blended learning module.
Based on a pre-testing the student instrument was optimised by
using item and factor analysis and controlled for validity and reliability.
Scales were accepted when reaching a Cronsbach a > 0.75.
Statistical analyses were carried out by using SPSS 12.1 software
package.
Results and products
The following products were developed by the project team
within the two years of term.
1. An e-didactical situation-based learning approach
 To embed contents and tools into a practically relevant professional
background.
 To tailor self-learning units suitable to the level of knowledge
and experience of the learner.
2. The teachers training modules containing the blended learning
lectures I and II.
3. The authoring tool ‘‘synapse”: an icon-based online tool that
guide teachers in creating e-units according to the situationbased
learning approach. Comparable to Xerte, an online
authoring tool developed at the University of Nottingham to
create interactive learning materials, ‘‘synapse” enables authors
to compose contents by using a word/html-editor, to embed
presentations and videos. According to the situation-based
learning approach, the tool helps authors to link the so composed
scenes in branched ways. Furthermore, ‘‘synapse”
includes instruments that allow the development of structured
and standardized online assessment sheets according to the
student’s level of education.
4. The student’s learning platform: a virtual working area comparable
to the ILIAS platform which offers communication- and
management tools as well as virtual class rooms and providing
Fig. 2. Working process of the project.
Fig. 3. Interdependencies in decision-making in the nursing process according to Bronfenbrenner (1994) and Kaiser (1985).
P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419 413
e-lectures developed within the project for nursing students at
different grades of education.
The situation-based learning approach as a basis for e-learning units
in blended learning modules
In 1988 Hundenborn and Knigge-Demal created a new didactical
learning approach that aimed to synthesize two essential features
of nursing education: the transfer of knowledge close to
the daily practice of nursing and of principles in decision-making
within a systemic network as described by King (1981). Additionally,
this approach should include further pedagogical aspects:
 The process of transfer should be facilitated by a high concordance
between the typical professional and the learning
situations.
 The illustration of complex professional processes in decisionmaking
for students on different levels of education should be
improved.
 The degree of complexity should be adaptable by varying the
number of interdependencies.
To fulfill these criteria Hundenborn and Knigge-Demal first
modelled a situation-based matrix by merging the situation-based
learning approach of Kaiser (1985) with the eco-systemic model of
the human development and behaviour according to Bronfenbrenner
(1994). In a second step this matrix was adapted to the professional
field of nursing (Fig. 3). Kaiser’s approach displays
professional actors and their pattern of action in interdependency
to their professional environment. This includes daily tasks and
needs, monetary environment, technical equipment and legal and
social requirements. Exemplified on typical professional processes
Kaiser summed up these constellations as situations.
The eco-systemic model describes human processes of action as
a result of impacts and interdependencies allocated on different
levels of the social community. By bringing these models together
Hundenborn and Knigge-Demal created a matrix structure that
mirrors impacts and interdependencies influencing professional
situations and processes.
In the preceeding LEONARDO-DA-VINCI-EU-pilot project ‘‘Modularisation
of the Nursing Education” conducted by Knigge-Demal
and Nauerth (2003), the matrix was successfully utilised as a scaffold
to build up learning units that mirrors situations often met in
the daily routine of nursing.
The situation-based matrix as a tool to develop e-learning units
The structure
As described above the matrix offers a high degree of flexibility
to teachers in composing learning situations that reflect professional
conditions adequate to the student’s level of education. In
return, the mosaic structure of a situation is broken down into
scenes which represent relevant parts of the nursing process. By
assembling the so created scenes to a situation the teacher is capable
to determine the learning contents. The reticular structure of
the matrix allows scenes to be linked linearly (e.g. to describe a
chronology) but also to compose multiple ways of solution by creating
hubs. This option illustrates that the nursing process is
mostly non linear but eclectic and coincident. Ascertained that
all scenes are involved into the sequence the student is capable
to select a learning pathway self-dependently (Fig. 4).
The practice
In practice, a complex exemplary case as used in problem-based
learning serves as the starting point for the construction of learning
situations. Since typical problem-based cases are focused on
the description and solving of a main problem, this method mostly
could not provide insights in systemic dimensions of professional
patterns of action. The situation-based learning approach addresses
additional aspects embedded in the constitutional, institutional
and social context leading to a sequence of new scenes. By
using the situation-based matrix an exemplary case describing a
health problem or a reason for intervention can be transferred into
a situation. The sequence of linked scenes reflects the underlying
process of decision-making and action. The character and content
of the scenes are determined by factors resulting from the constitutional,
institutional and social context affecting the nursing process.
The narratively linked scenes should enable the students to
stepwise and self-dependent elucidation of cross-linked implications
and deductive reasoning shaping the nursing process. In this
way the situation-based matrix is a useful tool to develop structured
e-learning units.
Depending on the knowledge of students and the respective
learning content the complexity of the situation can be designed
dynamically. The integration of further impact factors such as additional
actors or process parameters enables the teacher to vary the
level of complexity. By adding further actors e.g. therapists or
Fig. 4. Situation-based matrix of nursing interdependencies. Starting points; end point.
414 P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419
social workers to the matrix, the student gains insight into the perception
of additional persons involved as well as into interdisciplinary
thinking and networking.
The situation-based matrix as a template for the authoring tool
‘‘synapse’’
Technical templates rebuilding the matrix structure were constructed
by the IT companies. The authoring tool ‘‘synapse” serves
an instrument that enables teachers to transfer matrix-based concepts
into an e-learning unit without any sophisticated knowledge
in computer programming. The platform helps the teacher to construct
multiple pathways, to import and integrate developed
scenes, to add figures or tables, to determine hubs and to link
the scenes without leaving open ends. Additionally, ‘‘synapse”
facilitates the integration of assessment sheets. ‘‘Synapse” is directly
linked to the students learning platform to transfer freshly
developed e-learning units automatically. This allows the modification
of contents and lay-outs online.
The situation-based e-learning units are ideally suitable as
working materials supplying self-guided phases in blended learning
modules. By altering with face-to-face-phases these units could
be used as examples of learning contents that have been previously
taught in the classroom.
Teacher training units
The ‘‘e-learning-assistant” aims to provide all tools that are necessary
to use e- and blended learning in the daily teaching without
assuming any special knowledge and experiences in e-learning. To
equip teachers with the basic competencies in dealing with elearning
units and in composing such units the user-package offers
two programmes:
 ‘‘How to implement e- and blended learning in the daily
teaching”.
 ‘‘How to compose and develop e- and blended learning units”.
The online situation-based training units were created by the
project co-ordinators using the authoring tool ‘‘synapse”. For this
purpose, the situation-based learning approach was transferred
from the field of nursing to the classroom by placing the actors
and the setting into an educational environment.
In the first training unit teachers become acquainted with typical
problems arising in the implementation process of e- and
blended learning. By accompanying a fictional teacher on the
way to implement e-learning the participant gains insights in the
technical conditions to be installed and in the concerns of colleagues
and students regarding the application of new media.
Additionally, the module emphasises the training in tutorial competencies
that are necessary to assist students in e-learning.
In the second teacher training the participant joins the fictive
teacher in creating a blended learning module based on situations.
The participant must handle ‘‘synapse” in order to design a matrixbased
storyboard of situations. The teacher learns how to link the
scenes by maintaining the narrative flux and how to integrate
situations within a blended learning unit. Additionally, this unit
addresses the adjustment between face-to-face- and self-learning
online phases (Fig. 5). In a terminal workshop teachers learned
how to compile teacher’s and student’s manuals.
Blended learning nursing modules developed within the project – the
student modules
In the preceding LEONARDO-DA-VINCI-EU-pilot project ‘‘Modularisation
of Nursing Education” six nursing modules were developed
to teach students in blended learning manner. By using the
tools of the ‘‘e-learning-assistant” each project partner adapted
one of these modules according to the national requirements in
nursing education. In a trial of the adapted module, participating
students were invited to evaluate the units (see evaluation).
The materials developed by the partners included a curriculum,
a working plan, online-units and working materials provided in
teacher’s and a student’s manuals that were created in different
European languages. The following modules are available:
The nursing process
 Introduction to the nursing process and nursing diagnoses.
 Nursing assessment in persons with dementia.
 Basics of trans-cultural nursing.
 Nursing of persons with dysfunctions of the musculoskeletal
system.
Fig. 5. Construction of a blended learning module including situation-based learning units.
P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419 415
Wound care management:
 Wound care assessment.
 Stoma and Tracheostoma.
 Nursing of patients with Ileostomia according to the Orem Nursing
process.
Special nursing interventions:
 Infection control and practical aseptic interventions.
 Cardiopulmonal reanimation – live-saving interventions in diabetic
patientsCounselling and communication.
 Health education in nursing.
 Counselling of patients and their families.
The student’s platform
The student’s platform includes a learning section and a communication
area. The learning section offers manuals and onlineunits
to supply the self-learning phases within blended learning
modules. The platform administration is organized by an administration
tool authorising the access of students, learning groups,
teachers and authors.
The communication platform includes options to create blackboards,
newsletters, chat-rooms and discussion boards to ensure
a time- and location-independent tutoring of students.
Evaluation of the project
The following data display the feed-back given by the teachers
(n = 35) involved in the project for the internal project evaluation.
127 students joining the blended learning module were enrolled to
evaluate effects of the blended learning approach.
Preconditions of the joint partners
The basic needs assessment was carried out by teachers of the
partner institutes. The majority of the involved teachers (89%) reported
to have experiences with computer- and web-based working.
Forty-five percent stated to have experiences with e-learning,
while none of them stated to have knowledge in situation-based
learning our similar learning approaches. Ninety-five percent of
the teachers indicated to be acquainted with e-communication.
The data displayed a major demand of training in e-didactics, in
the implementation and the development of e-learning units
(Fig. 6).
Improvement of e-learning competencies in teachers
A follow-up survey conducted in the teachers group emphasised
effects of the project process on technical and contextual
skills. Data showed an improvement of all of the surveyed competencies.
As shown in Fig. 7 the effects could be observed in e-tutoring,
in situation-based teaching as well as in the development and
implementation of e-learning units.
Evaluation of the teacher training I and II and the implementation
process
The teacher training programme achieved a high acceptance
among the teachers (Fig. 8). Most of the teachers reported to work
on the online-units frequently (89%) and 75% stated to accomplish
the exercises set on the end of the scenes. Seventy-eight percent
assessed the situations as entertaining and instructive. The workshops
were assessed to be helpful in building up a collaborative
atmosphere between the partners (93%). Furthermore the teachers
considered the workshops to be essential in the consolidation of
knowledge and skills mediated by the online-units.
The majority (70%) remarked that the situation-based learning
approach is a useful and manageable tool in the development of
e-learning units. Ninety-one percent of the participants reported
that their knowledge of how to deal with e-learning materials
was improved by working on the teachers training units.
Eighty-three percent of the teachers reported to manage the
development or adaption of the chosen module as successful. The
German teachers stated to have more problems in the construction
of the module and in compiling the materials than the other
partners.
Fig. 6. Needs assessment in teachers of the partner institutions. Demands of e-learning competencies at the starting point of the project (in % of the participating teachers
n = 35).
416 P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419
Evaluation and effects of the blended learning nursing modules in
students
A change of attitudes concerning e-learning after accomplishment
of a blended learning was observed (Fig. 9). German students
assessed the performance of the nursing module, the e-tutoring
and the learning success to be less effective than students from
other partner institutions. Students from Belgium, Finland and
the Czech Republic reported to reach a higher learning success
compared to traditional learning, while German students reported
the opposite (data not shown).
Discussion
The LEONARDO-DA-VINCI programme was designed to innovate
and improve education all over Europe by supporting transnational
Fig. 7. Changes in e-learning competencies of joint teachers in term of the project = kick-off meeting; = final workshop. 1 = Excellent; 2 = good;
3 = satisfactory; 4 = poor; and 5 = inadequate.
Fig. 8. Evaluation of the teacher training I and II given by the participating teachers. = Teacher training I; = teacher training II. 1 = Excellent; 2 = good;
3 = satisfactory; 4 = poor; and 5 = inadequate.
P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419 417
co-operation projects in the field of vocational training. The collaboration
between private and public partners is one of the hallmarks
of EU-funded research programmes and pursues two goals: on one
the hand, the European Union aimes to support SMEs to gain reputation
as technological experts to establish their competencies on
the commercial market. On the other, public and non-profit institutions
of education should be enabled to translate didactical and
pedagogical ideas into learning applications. In this sense the pilot
project ‘‘e-learning-assistant” successfully accomplished these
aims by providing a new user-friendly tool kit. Another goal of
EU educational programmes is the harmonisation of educational
contents towards a joint strategy in professional education.
Depending on the member state nursing education in Europe is
allocated on different levels of education: in Poland and other
Eastern European countries nursing education is allocated at the
university level, in Belgium and Finland nursing students are
educated at centers and schools of higher education. Germany like
some other EU member states has embedded nursing schools in
the vocational training system. The partnership represents these
different educational systems in nursing. The contents of the
‘‘e-learning-assistant” are applicable all over Europe independent
from the different levels of education. This was achieved by adjusting
the contents on the professional qualifications to be initiated
by learning content. Free access to the tool kit and the leaning
contents as well as the open source character of the ‘‘e-learningassistant”
that allows adaptations to national conditions may also
support the transnational usage of project product.
The project brought together a team of highly motivated teachers.
Though each partner institution was successful in developing a
blended learning module of nursing, teachers from Germany reported
to have more problems to integrate the additional tasks of
the project into their daily agenda. This might be due to substantial
differences between the partners with regard to the knowledge
and the management of virtual media. These differences might
not only to be explained by impacts coming from the micro- and
meso level, e. g. specific conditions of the school, fears of contact
to computers or motivational differences of several teachers. National
differences in the structure of the education systems and
the type of setting might also have an impact. Nursing teachers
working in an academic environment might have better access to
the objectives of the project compared to partners coming from a
vocational school. Since evaluation was implemented as an internal
documentation tool and limited to the group of joint teachers
the data may serve as first hints on chances and deficits of the project
products. A widespread usage of the package by nursing teachers
that intent to implement blended learning modules is
necessary to yield valid data.
This was also true for the evaluation of the student’s modules by
students of the partner institutions. Data may be biased by the fact
that all students surveyed are enrolled at the partner institutions.
Students that attended the blended learning modules reported they
enjoyed the narrative and well scripted online-scenarios but failed
to achieve more knowledge than in classroom lessons. This notion
might assume that an intensive tutoring via e-mail and online-discussion
is necessary to gain benefits from this approach (Salmon,
2005). Working with online-scenarios does not implicate that
teachers are released from any tutoring (Creedy and Hand, 1994).
On the contrary, carefully scripted narrative scenarios allow to picture
professional situations very close to reality and, as a consequence,
elicit a number of questions to be discussed in onlinediscussion
boards or chats and in the face-to-face lessons as well
(Fox and MacKeogh, 2003). As shown for the problem-based learning
strategy these discussions are essential to induce self-learning
processes in students. Tutoring should aim at the initiation of these
Fig. 9. Changing of e-learning attitudes in teachers and students before and after participation in a nursing module. = Students before module implementation;
= students after module implementation; = teachers before module implementation; = teachers after module implementation. 1 = I totally agree;
2 = I agree; 3 = I partially agree; 4 = I disagree; and 5 = I totally disagree.
418 P.I. Pfefferle et al. / Nurse Education Today 30 (2010) 411–419
processes that include the elucidation of the central problems pictured
in the scenario and the identification of gaps in knowledge.
Furthermore an adequate tutoring should enable students to develop
self-directed strategies about how to fill these gaps and to maintain
these strategies in a lifelong learning process (Milligan, 1999).
The situation-based learning approach, developed to structure
nursing modules and to picture processes of decision-making in
the daily work of a nurse, was shown to be a solid didactical fundament
for the construction of e-learning units. The modules based
on this approach may help to illustrate and to transfer the complex
network structure of the nursing process to students by giving insights
in daily situations as they occur in the routine of nursing.
The pilot project of European networking has paid off for all of
the participants in several aspects: by learning to think outside the
own box new perspectives were achieved to strike new paths of
teaching and learning. The partnership between nursing teachers
from Western and Eastern Europe brought together different traditions,
views and learning cultures.
In conclusion, the co-operation within the partnership elucidates
a high demand to break the mould for e-learning in nursing
education.
More information and open access by registration to the ‘‘elearning-assistant”
is available on http://elearn.pflegemodule.de.
Acknowledgements
This project was supported by the EuropeanUnion, LEONARDODA-VINCI
programme from 2004 to 2006. Grant D/04/B/F/PP-146
172 ‘‘Schulung von Lehrkräften im Gesundheitsbereich zum Einsatz
und zur Entwicklung von e-learning-Materialien”. Acronym:
‘‘e-learning-assistant”.
We thank Dr. Leigh Matthew Marsh for the critical review of the
manuscript.
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