Nurse Education Today (2005) 25, 140–147

Nurse
Education
Today
intl.elsevierhealth.com/journals/nedt

Experiences of online learning:

students’ perspective
Janet W.H. Sit*, Joanne W.Y. Chung, Meyrick C.M. Chow,
Thomas K.S. Wong

The Hong Kong Polytechnic University, School of Nursing, Hong Kong

Accepted 2 November 2004

KEYWORDS Summary This paper explores students’ views of an online learning initiative
Online learning; within a post-registration degree in nursing in Hong Kong. A self-administered
Teaching technology; questionnaire was used for data collection. One hundred and ninety eight stu-
Innovative teaching; dents completed the study. Online learning was seen to be convenient allowing
Student–centred students to study at their own pace and time. Students reported that online
teaching learning enabled them to hold a higher level of accountability for their own
learning and to learn independently. Not all experiences were positive. A major
hindrance to online learning was the inadequate opportunity for human inter-
action which was deemed necessary for establishing peer support and develop-
ing in-depth group discussion on subject matter. These findings provide a guide
for further development and improvement in online teaching and learning
methodologies.
c 2004 Elsevier Ltd. All rights reserved.

Introduction (Bentley et al., 2003). Facing this challenge, the

With the advancement in educational technology
and Internet access in recent years, nursing acade-
mia is searching for ways to widen nurses’ educa-
tional opportunities and to facilitate ‘on demand’
education that suits individual student’s needs
*
Corresponding author. Tel.: +852 27666549; fax: +852
23341975.
E-mail address: hsjsit@inet.polyu.edu.hk (J.W.H. Sit).
teaching team in the School of Nursing of The Hong
Kong Polytechnic University decided to experiment
with online learning in selected subjects in the
post-registration nursing baccalaureate degree
programme in 2002. This initiative required aca-
demic administrators and educators to redesign
and rethink organisational boundaries and teaching
methodologies within higher education in nursing.
This paper outlines and discusses the findings from
a descriptive survey examining students’ experi-
ences and satisfaction with an online learning
mode.

0260-6917/$ - see front matter c 2004 Elsevier Ltd. All rights reserved.

doi:10.1016/j.nedt.2004.11.004
Experiences of online learning: students’ perspective
Literature review
The application of information technology in edu-
cation has a varied nomenclature, for example on-
line learning, e-learning, Web-based learning,
distance learning and cyber learning. It can also
mean a variety of delivery formats including self-
instructional packages, Web-based subjects, two-
way audio or video conferencing (Zalon, 2000).
Although there may be differences in the level of
application by different institutions, it is commonly
agreed that the use of technology in education
does not merely refer to disseminating lecture
information and content through the Internet.
The underlying philosophy of adult education still
applies (Chapman, 2000).
Online learning overcomes drawbacks that are
inherent in traditional classroom teaching, espe-
cially its lack of flexibility in the use of resources,
including space and time scheduling (Rosenlund
and Damark-Bembenek, 1999). The advantages dis-
cussed in the literature of using computer-assisted
tools include its convenience in providing access to
information, its flexibility in adapting to the educa-
tional needs of student and its cost-effectiveness in
opening educational opportunities to large num-
bers of students (Olinda et al., 2001; Herrin,
2001; Ribbons, 1998; Soon et al., 2000; Cuellar,
2002). Rosenlund and Damark-Bembenek (1999)
further identified that use of information technol-
ogy in education offers new opportunities to pro-
vide interactive learning experiences (Rosenlund
and Damark-Bembenek, 1999).
Nonetheless, despite some studies documenting
advantages in online learning, others provide a dif-
ferent view. The key factor for the effectiveness
of computer-assisted learning is the accessibility
and affordability of up-to-date computer hardware
and software as well as the speed and stability of
Internet access (Cragg et al., 2003; Atack and Ran-
kin, 2002; Billings et al., 2001; Scollin, 2001). A
number of authors identified that computer profi-
ciency and technical support are important for
effective online learning. For beginners, it has
been reported that confronting computer technol-
ogy was more stressful and consumed more time
than the actual learning activities at the beginning
of a course (Atack, 2003; Atack and Rankin, 2002;
Billings et al., 2001; Scollin, 2001). In addition,
feeling isolated and missing social contact have
been reported in studies of computer-assisted
learning. Particularly, the absence of non-verbal
cues in solely Web-based learning left students
feeling they have been communicating largely
with a machine rather than other human beings
141
(Atack and Rankin, 2002; Billings et al., 2001;
Andrusyszyn et al., 1999; Bullen, 1998). Cragg
et al. (2003) in a study examining continuing edu-
cation for nurses in China found that the lack of
culturally and linguistically appropriate Internet
learning materials (the majority being from a Wes-
tern perspective and written in English) hindered
nurse learners’ ability to transfer contextual
learning into practice.
When compared with traditional teaching meth-
ods, online learning is relatively new and has not
endured the same scrutiny as classroom teaching
(Ryan et al., 1999; Kenny, 2002; Atack and Rankin,
2002; Kozlowski, 2002; Henderson et al., 2002). As
the online learning marketplace expands, there is a
timely need for evaluating its outcomes and effects
on teaching and learning. One of the processes for
establishing quality outcome is benchmarking: ‘a
process improvement technique that provides fac-
tual data that allows institutions to compare per-
formance on specific variables in order to achieve
best-of performance’ (Billings et al., 2001, p. 41).
A literature review found that the Flashlight Pro-
gram provided a framework and Current Student
Inventory (CSI) tool kit for assessing students’
views of technology-based teaching and learning
as well as for benchmarking good practices in edu-
cational uses of technology (American Association
of Higher Education, 2004). Billings et al. (2001)
highlighted key elements in the CSI which included
students’ perception of specific outcomes that are
enabled by the technology-based teaching and
learning method (for example, access to learning,
convenience, connectedness, preparing learners
for problem-solving, development of knowledge
and skills required for practice, satisfaction with
the teaching); educational practices used to facili-
tate learning (for example, taking responsibility in
learning, respect for diversity, collaboration and
interaction among peers, student–teacher interac-
tion and feedback); and use of technology to facil-
itate learning.
Since students’ learning can be influenced by
their satisfaction with their learning experience
(Espeland and Indrehus, 2003; Ramsden, 1991), it
is important to consider the students’ viewpoint
on this new teaching and learning method. There-
fore, this study aimed to examine the online learn-
ing experience from the students’ perspective. To
address the study aim, four research questions
were formulated:
 What is the students’ level of satisfaction with
online learning?
 With what aspects in online learning do students
feel satisfied?
142
 What aspects in online learning do students per-
ceive to be barriers to their study?
 What are the factors affecting students’ satis-
faction with online learning?
The learning environment
In this study, the online learning environment,
using WebCT, includes a subject homepage where
subject lecturer/subject designer can locate
point-and-click navigation buttons (icons) linking
to Web pages. A subject homepage can have as
many or as few navigation buttons linking to Web
pages as the online teaching development team
and the subject lecturer deem necessary. Common
features include a subject introduction, syllabus,
learning modules and content, calendar of learning
events and assessment schedule, assignment guide
and submission box, communication box which in-
cludes bulletin board, e-mails and chats, e-learning
resources as well as online evaluation survey and
feedback. Interactive online learning material
was developed so as to enhance the students’
engagement in learning activities, foster students’
ability to set their own schedule, to complete tasks
or assignments at their own pace as well as to facil-
itate students’ monitoring their own learning pro-
gress. In addition, interaction and communication
between teacher and students as well as among
fellow students were enhanced through the use of
online forums, private e-mail and synchronous chat
sessions. Evaluations from teaching and learning
perspectives were conducted through electronic
subject administration features including students’
progress tracking, record of date and time of
assignment submission and completion of online
quizzes for progress monitoring and quality
improvement.
Method
Design and sample
A survey was used to examine students’ experi-
ences in online learning within a part-time
post-registration baccalaureate nursing degree
programme. A questionnaire was considered to
be the method of choice so that all students had
the opportunity to participate in the survey. To
address the shortcomings of forced choice ques-
tions, the questionnaire was supplemented with
J.W.H. Sit et al.
3 open-ended questions, to provide clarification
of respondents’ perception of benefits and hin-
drances to the use of an online learning method.
This helped understand better the quantitative re-
sults (Scollin, 2001; Clinton et al., 1998). The de-
sign of the questionnaire was influenced by the
evaluation framework of the Flashlight Program
(Billings et al., 2001). Hence, the questionnaire fo-
cused on the students’ experiences in a technol-
ogy-enhanced teaching and learning process.
Permission was granted by the Flashlight Program
to use the evaluation framework. Ethical consider-
ations were reviewed by the School of Nursing
which gave permission to proceed with the study.
According to the ethical protocol, all students and
subject lecturers concerned were fully informed
about this study as part of the online learning
evaluation project, as well as the study aim and
process. Students were informed that participa-
tion was voluntary and it was stressed that all per-
sonal data would be handled confidentially.
Students’ identities were not revealed by the
questionnaire. The studied group was confined to
current students enrolled as part-time second year
or above students. Full-time students and visiting
students were excluded.
Instrument
The questionnaire consisted of 3 parts: demo-
graphic background, self-reported online learning
experience, and open-ended questions. The self-
reported online learning experience comprised
27 items. For each of the items, students were
asked to provide a response on a 4 point Likert
scale ranging from ‘strongly disagree’ to ‘strongly
agree’. The development of the online learning
experience questionnaire was based on the evalu-
ation framework of the Current Student Inventory
(CSI), of the Flashlight Program, and on the preli-
minary findings of a focus group interview on
exploring students’ experiences in online learning.
A preliminary questionnaire was evaluated by the
Education Development Centre for its relevancy
in the local context. The final questionnaire
examined 6 aspects of the online learning experi-
ence: (1) access of information and learning mate-
rials; (2) flexibility and convenience; (3)
opportunity for interacting with peers; (4) oppor-
tunity for interacting with teachers; (5) the value
of supplementary face-to-face resource sessions
and (6) overall satisfaction with online learning.
Content validity, internal consistency and test–
retest reliability was assessed prior to the data
collection.
Experiences of online learning: students’ perspective 143

Data collection procedure Around 96% of the respondents used electronic

Data collection was conducted in mid-February
2003 after the completion of the academic semes-
ter. All eligible students were invited by correspon-
dence to participate in the survey. Since students
might take more than one online subjects in a
semester, they were requested to return the ques-
tionnaire for each subject they had attended. Of a
total of 400 students 198 returned the completed
questionnaires, giving a response rate of 49.5%.
Data analysis
In the analysis of the online learning experience
data, reverse coding was performed on the nega-
tive statements. Descriptive statistics were drawn
up for the demographic characteristics, the
respondents’ online learning experience and their
overall satisfaction. The relationship between
overall satisfaction and online learning experience
was examined with a backward stepwise logistic
regression model. The criteria for removal were
based on a ‘change-in-estimate’ where the F-to-re-
move was set at 0.5. The presence of near collin-
earities were examined by the condition number
of 30 or more as indicating moderate to severe col-
linearity. All of the analyses were completed using
the Statistical Package for Social Sciences, version
10.0 (SPSS Inc., Chicago, IL). Written responses
from the open-ended questions were assessed using
content analysis. The written statements were
read, coded and categorised by drawing out seg-
ments, phrases and words. They were analysed
for recurring regularities (Polit and Hungler,
1999). Patterns that emerged were analysed and
refined to form common themes, which subse-
quently demonstrated 87% convergence by a 3-per-
son face validity panel.
communication means (e.g. forum, e-mail, chat
room, ICQ-instant messaging). Broadband connec-
tions were used by 76.8% of the respondents.
To reflect the content of the questionnaire and
students’ opinion in the open-ended questions,
our findings are presented within the following cat-
egories: overall satisfaction; the online learning
experience and factors affecting students’ satis-
faction with online learning.
Overall satisfaction
The overall satisfaction rate of 56.7% where
respondents reported that they were either satis-
fied or very satisfied with the online learning expe-
rience is given in Table 1. When analysing the
different aspects of online learning experience in
the questionnaire, it was found that ‘convenience
in studying’ was rated somewhat higher than the
other aspects such as the opportunity to interact
with classmates (Table 2).
Online learning experience
Students were asked to rate elements in their on-
line learning experience that they considered facil-
itative to their learning. More than 80% of the
respondents agreed that through online learning,
they learnt to take responsibility for their own
study; they were able to work through the subject
Table 1 Overall satisfaction with online learning
(N = 305)
Level of satisfaction Frequency Percentage
Very dissatisfied 37 12
Dissatisfied 95 30.8
Satisfied 161 52.3
Very satisfied 12 3.9

Findings

From the 198 student respondents, 305 question- Table 2 Aspects of satisfaction (N = 305)
naires were received. This is because each student Aspects Satisfaction
could take more than one subject during a semes-
Mean SD
ter. The average number of subjects taken by the
students was 1.5 (SD = 0.51). All respondents were Convenience in studying 2.97 0.58
Access of information and 2.85 0.49
participating as full-time registered nurses at the
learning material
time of the study period. Around 81% worked shift
Opportunities to interact with 2.62 0.51
hours. The average travelling time for attending teachers
class in campus was around 1.5 h (SD = 0.54). More Opportunities to interact with 2.35 0.48
than half (55.1%) of the respondents reported classmates
themselves to be familiar with using a computer.
144 J.W.H. Sit et al.

Table 3 Top five elements on that students considered facilitate to their learning (N = 305)
Elements in the learning process Percentage
I was encouraged to take responsibility for my own learning 84.1
I was able to work through the subject material at my own pace 81.2
It was easy to navigate the subject learning material 80.9
The face-to-face resource sessions were valuable when supplemented with online learning 79.9
Electronic communication with the subject lecturer was useful 79.2

material at their own pace and it was easy for them
to navigate the subject learning material. Table 3
lists the top five elements of online learning expe-
riences that students considered being facilitative
to their learning. However, there were several ele-
ments in online learning mode that respondents
identified as hindrance to their learning (Table 4).
The main issue was the human contact element,
in particular, the inadequate opportunity to estab-
lish peer support and to sustain discussion dialogue
with peers and teachers.
Findings from the questionnaire were further
elaborated in the supplemented open-ended ques-
tions. From the 198 respondents, 878 narrative
comments were received. Among these, 413 com-
mented on the benefits of online learning (47%)
and 292 commented on learning hindrances with
online learning (33.3%). Around 160 comments
(19%) addressed suggestions for future improve-
ment. The most frequently identified benefit of on-
line learning was its flexibility in the learning
process, i.e. allowing students to study according
to their own pace and time (165 comments, 40%).
Online learning was time saving (145 comments,
35%), in particular, saving the travelling time to at-
tend classes as well as the waiting time between
classes as a result of a scattered timetable. About
30% of the respondents commented that online
learning reduced competing demands from work
and study. Their views are exemplified by the fol-
lowing verbatim:
‘I like online learning. This is because I do not have
to request a ‘duty-off’ from my workplace for
attending class. It is very difficult to apply for study
day as our wards are short of manpower
nowadays.’
‘Juggling between study and work commitments
divides me into two parts. Evening class does not
solve the problem as most of us are on shift duty.
I believe online learning is beneficial to shift work-
ers. Now I don’t have to worry about meeting the
minimal class attendance requirement.’
Similar to the findings from the questionnaire
portion of the study, the most frequently identified
learning hindrance with the online learning mode
was the inadequate opportunity for human contact
and interaction (105 comments, 36%). Student
comments included:
‘Sometimes it is boring to study on my own. It
seems that I am talking to the computer. This feel-
ing is particularly strong when I am struggling with
difficult tasks. I felt lonely and not sure if I was on
the right track.’
‘I wanted so much to see the faces of the ‘names’
seen in the online discussion forum. I felt good
when I met them in the classroom tutorial because
I could see and talk to the real persons.’
The length of the online learning material was
another hindrance reported by the respondents
(67 comments, 23%).
‘There was too much information and too many
hyperlinks. Sometimes I was lost and wondered if
I needed to study them all in detail.’
‘Despite the website design being interactive, the
learning material was too rich for me to grasp the
key points and main foci of the modules. It was
good that I attended the face-to-face tutorial. It
was good that I talked directly with the lecturer.
Things have been much clearer since then.’

Table 4 Most frequently identified learning hindrance with the online learning mode (N = 305)
Learning hindrance Percentage
Inadequate opportunity to study with other classmates 70.2
Not confident enough to handle difficult task with online learning mode 68.5
Difficult to apply concepts taught in the subject 67.9
Inadequate opportunity to discuss with teachers 64
Inadequate opportunity to establish peer support 63.3
Experiences of online learning: students’ perspective
Students’ suggestions for future improvement
mainly concerned two aspects: first to build infra-
structure in the online learning design to facilitate
peer support and second, to strengthen the face-
to-face resource sessions so that dialogues among
fellow students and teachers could be consistently
sustained. This was considered important in pro-
viding opportunity to debate and clarify complex
issues or concepts relating to subject matter. In
addition, about 30% of the respondents com-
mented that the first face-to-face meeting be-
tween lecturer and the students on the first
week of a semester was very important and sug-
gested to keep such practice. It helped students
gain a thorough understanding about the subject
requirement so that they could plan their study
accordingly.
Factors affecting students’ satisfaction with
online learning
Backward stepwise logistic regression was per-
formed to examine the relationship between over-
all satisfaction and elements in online learning
experience. Table 5 shows that seven variables ex-
plained 54% of the variance in the overall satisfac-
tion with online learning. They were, convenience
in being able to study at their own time
(Wald = 9.371, p = 0.002); gaining confidence to
tackle difficult tasks (Wald = 8.657, p = 0.003);
understanding concepts taught in the subjects
(Wald 8.890, p = 0.003); taking up responsibility
for their own learning (Wald 7.047, p = 0.008).
The interactivity of the online learning material
(Wald = 6.743, p = 0.009); supplementary face-to-
face tutorial (Wald = 5.345, p = 0.021) and the
use of a technology (e.g. video clips, animated
graphics, etc) to facilitate learning (Wald = 4.458,
p = 0.035) were also found to correlate with the
respondents’ overall satisfaction with online
learning.
Table 5 Factors affecting students’ satisfaction with online learning
Variables
Convenience
Confidence to tackle difficult tasks
Able to understand the concept taught in the subject
Taking up responsibility for own learning
The interactivity of the online learning material
Supplementary face-to-face tutorial
Use of technology in developing learning package
95% CI = 95% confidence interval.
145
Discussion
Students’ overall satisfaction with online learning
was found to be slightly positive in this study. Sim-
ilar to findings in other studies, the most frequently
reported satisfying aspect of online learning was its
flexibility in learning, where students were able to
study at their own pace and at the time convenient
to them (Heidari and Galvin, 2002; Bentley et al.,
2003; Rouse, 2000; Kozlowski, 2002). Students’ re-
sponses also reflected satisfaction with the struc-
ture, delivery and content of the online subjects.
Based on the findings in this study, the benefits
and barriers of online learning mode are discussed
in three aspects: the student-centred online learn-
ing environment; the facilitation of independent
learning and human interaction in online learning.
Student centred online learning
environment
In online learning, lectures are replaced by learning
materials on the Internet. As a delivery and re-
source tool, the Internet provides unique opportu-
nities to shift away from traditional classroom
teaching to provide ‘on demand’ education at the
convenience of the students. This is particularly
important in post-registration nursing education
because the focus shifts from ‘teaching’ to ‘learn-
ing’. The former is a teacher-centred approach,
emphasising information giving, instructing and
lecturing. The latter is a student-centred approach
in which the goal is to help students learn to orga-
nise and sift through information and use critical
thinking to solve problems (Kozlowski, 2002). The
online learning subjects examined in this study
were developed through a team effort with faculty,
technical support, and instructional designers col-
laborating to create a student-centred learning
environment. In this study, most students were sat-
isfied with the interactivity and the ability to direct
B Wald p 95% CI
0.84 9.371 0.002 1.35–3.98
0.85 8.657 0.003 1.33–4.15
0.75 8.890 0.003 1.29–3.46
0.72 7.047 0.008 1.2–3.47
0.75 6.743 0.009 1.2–3.75
0.58 5.345 0.021 1.09–2.94
0.51 4.458 0.035 1.03–2.68
146
their own learning pace. A majority of students
appreciated the animated graphics which helped
them understand subject contents.
Independent learning
This study identified that the benefits of online
learning extended beyond the flexibility for obtain-
ing education: the process of learning empowered
students to be accountable for their own study. Stu-
dents reported they were encouraged to take and
gradually became capable in taking responsibility
for their own learning. The online learning environ-
ment together with the Internet as a resource tool
provided an opportunity for them to develop skills
and confidence in handling difficult tasks and prob-
lem-solving. As reflected from students’ responses,
their satisfaction was not only with the convenience
in accessing learning material, but also with the
structure, delivery, and feedback from teachers
throughout the online learning process. Unlike tra-
ditional classroom teaching, online learning pro-
vided a facilitative environment where students
could engage in learning. It allowed students’ re-
peated exposure to the learning activities at their
own pace and to the level and depth that suited
their needs. The learning material, study guide, dis-
cussion forum and online quiz also facilitated and
helped students to engage in their study and
empowered them to tackle difficult learning tasks.
The enhancement of independent learning skills is
especially relevant to post-registration nursing stu-
dents since they are practising in a potentially
unpredictable setting that demands independent
thinking and problem solving.
Human interaction
Aspects of human interaction, particularly interac-
tion with fellow students, and the opportunity to
establish peer support were found to be the learn-
ing hindrances with the online learning mode. De-
spite the availability of an online discussion
forum, e-mail and chat room in lieu of in-person
meetings, narrative comments from the students
expressed a sense of loneliness. Students preferred
to physically meet with their study group mates in-
stead of solely using the online communication
functions. Students’ positive comments on the
face-to-face resource sessions further affirmed
the value of on-campus meetings supplementing
an online communication channel. Apart from an
opportunity for group discussion to clarify difficult
learning issues, on-campus meetings can also fos-
ter a sense of classroom community among stu-
J.W.H. Sit et al.
dents and lecturer (Bentley et al., 2003; Espeland
and Indrehus, 2003). Based on the findings from
this study, it is suggested that innovation and cre-
ativity are needed in enhancing human–machine
interface communication to facilitate peer interac-
tion, support and socialisation in the online learn-
ing process (Bentley et al., 2003; Espeland and
Indrehus, 2003; Kozlowski, 2002). Further, to im-
prove socialisation and support among peers and
teachers, a blended approach including online
learning and supplementary on-site classroom
meetings could also be considered.
Limitations
When interpreting the results of this study, it is
important to note that a high proportion of stu-
dents had broadband Internet access which might
have provided a speedier and more stable learning
environment. Comparison with other studies must
take this issue into consideration.
The online teaching team was fully informed
about the evaluation project. The awareness of
the current study as one of the elements in the
evaluation of the online learning project may have
influenced teaching practice. The Hawthorne ef-
fect on teachers might have subsequently affected
students’ learning experience (Atack and Rankin,
2002).
Conclusion
Online learning can be a satisfactory experience for
nurses who are shift workers or with competing de-
mands from family, work and professional develop-
ment to access continuing education. Nonetheless,
we must accept the fact that technology alone
does not automatically improve the learning pro-
cess. In order to be successful, the focus must be
on teaching and learning, not merely the techno-
logical issue. Advance preparation, continuous sup-
port and feedback as well as providing a facilitative
learning environment throughout the study process
all need to be considered. A major challenge in
adopting the online learning mode is to enhance
human interaction so as to provide a facilitative
environment for establishing peer support, devel-
oping academic dialogue and socialization. By
acknowledging the challenges, nurse educators
and students can work together to build an
infrastructure in online environment to facilitate
learning. Evaluation on longitudinal basis as
well as benchmarking good practice among nursing
Experiences of online learning: students’ perspective
students in different programmes would shed more
light on the value of online learning as a teaching
methodology for nursing education.
Acknowledgements
The authors wish to thank all the research team
members who contributed their efforts in data col-
lection: Mr. Chan Hok Lun, Ms. Chan Po Yan, Ms.
Choi Ching Yee, Mr. Lee Wai Shun, Ms. Tong Tsui
Mei, Ms. Wong Wai Man, and Ms. Yip Sau Kuen.
The authors also gratefully acknowledge the Flash-
light Program in granting permission to use their
evaluation framework. Special thanks to Dr. Jose-
phine Csete and Mrs. Paula Hodgson for reviewing
the questionnaire as well as Mr. Ian Dunn for English
proof-reading on the manuscript. Most importantly,
the study would not have been possible without the
participation of the students in this study.
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