Introduction to the Online Nursing Education Best Practices Guide.

INTRODUCTION: As online nursing education programs continue to increase to meet the demands of the growing market, nursing faculty are challenged to develop and deliver courses based on best practice principles. The Online Nursing Education Best Practices Guide (ONE Guide) builds on and extends the nationally recognized Quality Matters® program and serves as a roadmap guiding course development and delivery. The fundamental principle for success in online teaching is instructor presence; the teacher as a facilitator of learning is illustrated throughout the guide. An Online Instructor Checklist facilitates systematic implementation of best practice principles.
METHODS: This article is based on a focused literature review and concept analysis resulting in a comprehensive guide for delivery of effective, quality nursing education through best practices in the online learning environment. A broad search of databases focused on articles during 2014 to 2019 was completed. The literature review included articles that examined over 1200 student perceptions of instructor presence in the online setting.
CONCLUSION: Nurses carry a direct responsibility for the health and well-being of patients. Nursing quality education proves fundamental to the profession's long-term outcomes. The ONE Guide and Online Instructor Checklist apply comprehensive, evidence-based teaching strategies to give a roadmap for success in the online teaching environment.

In 2010, the Institute of Medicine (IOM) evaluated health outcome data and conducted additional research in preparing its recommendation that 80% of all nurses to hold a BSN degree by 2020. The call for advancing nursing education in the report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2010), was based on both healthcare reform initiatives and needed changes to improve health outcomes in the United States. Although nurses are the single largest cohort of health-care providers, the move to baccalaureate education has lagged. In the decade since the IOM report, nurse educators have faced significant challenges in their efforts to meet this education goal. Specifically, there is a current nursing shortage, and the demand for nurses is predicted to rise 16% over the next 10 years (Bureau of Labor Statistics, 2018). In addition, the demand has increased the need for basic and advanced nursing education (American Association of Colleges of Nursing [AACN], 2019). Furthermore, while critically important to increase preparation of nurses, the average age of doctorally prepared faculty ranges from 51.2 to 62.4 years (AACN, 2019) with one-third expected to retire by 2025 (Fang & Kesten, 2017). As a result, admissions in traditional nursing programs may be limited.

In nursing, the move to online course delivery took root in the mid-1990s as evidence of its effectiveness emerged. The evidence pointed toward this choice as a viable solution to address the demand for nursing education. Online education options exploded after the IOM report. Currently, there are a reported 459 online nursing education programs offering undergraduate, masters, and doctoral degrees in the United States (SR Education Group, 2019). Given this rapid transition to online content delivery, the direct dialogue bedrock of the traditional classroom was replaced with email, message boards, instant messaging, video conferencing, and chat rooms (see Table 1). Expert nursing faculty grounded in traditional content delivery methods suddenly found themselves novice online teachers in need of a new set of best practices.

Table 1.

Instructor Interaction.

Traditional Classroom	Online Classroom
Synchronous class times.	Asynchronous class times.
Instructors take cues from student’s verbal and nonverbal interaction.	Unable to see student faces or hear tone.
Direct dialogue with students in the classroom.	Responds to students using email, message boards, instant messaging, video conferencing, chat rooms, etc.
Feedback is provided in person and/or on assignments.	Use of technology allows online instructors to provide feedback via voice recording, within the Learning Management System, via email, recorded lectures, Voice Thread, etc.
Discussions delivered in the classroom is instructor led.	Collaborative discussions in the virtual setting forces student to interact with other students and instructor. Posts may provide students to lead the discussions.
Instructors are available during lecture time and office hours.	Instructors are available to respond to student inquires within 24 hours.
Sense of community is established in the classroom as the student attends class.	Sense of community is established through online communication, engagement, and relationship building.
Instructors speak to the class in general.	Instructors communicate to students individually, engaging them by asking thought-provoking questions.

In pursuit of best practices during the transition to online teaching, the nationally recognized Quality Matters Program® (Quality Matters, 2018) was used. Quality Matters® serves as a framework for virtual course design and delivery and established standards of quality for online teaching. It is a model well developed for traditional course content in the higher education setting. However, personal experience in using the model led to the discovery of need for strategies to effectively teach the applied science of nursing. This realization stimulated a focused literature review, collaboration, and pilot testing resulting in the Online Nursing Education Best Practices Guide (ONE Guide), a unique roadmap for nursing course development and management with specific, evidence-based best practices. This article will introduce nursing faculty to the ONE Guide (see Figure 1), created to direct effective, quality nursing education in the online learning environment.

Figure 1.

Online Nursing Education Best Practices Guide (ONE Guide).

Brief Review of ONE Guide

The ONE Guide is a comprehensive evidence based quality assurance tool for online nursing education at all levels. Three domains of course development are addressed by the ONE GUIDE: (a) course presentation, (b) instructor presence, and (c) assessment and measurement. Each domain, considered a pillar of success, proves essential for ensuring online classroom quality (Quality Matters, 2018). Specific, evidence-based strategies are the building blocks of each pillar. The second domain, instructor presence, emphasizes the instructor as a facilitator and permeates each of the other domains, such that incomplete or ineffective development of any one strategy diminishes the total course quality. Our assumption is that untested course delivery strategies increase the likelihood of negative outcomes in student satisfaction and/or student performance. As a result, we believe that each strategy of the guide is equally important to course delivery success.

Course Presentation

Course presentation criteria provide a structure to design, develop, or build out a new or existing course. A well-prepared course presentation will aid the learner in understanding the purpose of the course and define expectations (Kuo et al., 2014).

To enhance the learning environment, content needs to be clear, organized, and easily accessible (Kuo et al., 2014). There are 13 strategies essential for effective course presentation: (a) syllabus, (b) organization, (c) structure, (d) netiquette, (e) course calendar, (f) clear guidelines, (g) learning materials, (h) course objectives, (i) learning objectives, (j) course introduction, (k) course instructions, (l) instructor introduction, and (m) navigation instructions. Within these components, information should be presented in a format that is clear and easy to understand (Kuo et al., 2014) from the student’s perspective. Using technology in creative ways can facilitate online engagement, such as using a video introduction to establish instructor presence while acquainting each student with the instructor (Martin et al., 2018). For example, an orientation video can be used to provide the overview of course expectations, demonstrate how to navigate through the course, and the syllabus and course calendar (Martin et al., 2018). This step is critical for student success in the online learning environment (Smidt et al., 2017) and minimizes confusion and frustration (Trammell & LaForge, 2017).

Expectations of netiquette should be addressed and emphasized in the orientation as well to promote online civility (Quality Matters, 2018). Most importantly, the instructor should provide a careful quality review of all learning materials before launching an online course; this ensures that materials are current and appropriate for diverse learning styles (Chen et al., 2018).

Instructor Presence

Instructor presence is the pivotal component of the ONE Guide. Although expectations of presence prove challenging for online education, using evidence-based strategies to assume the role of facilitator and remain active in the course are fundamental to student learning (Martin et al., 2018). Eleven parts make up the instructor presence component: (a) availability, (b) contact information, (c) office hours, (d) approachability, (e) friendliness, (f) response within 24 hours, (g) individualized feedback, (h) weekly announcements, (i) presence on discussion board, (j) response to all first posts, and (k) engagement, involvement, and support. Instructor presence in an online course is related directly to student satisfaction (Howell et al., 2016; Kuo et al., 2014; Martin et al., 2018). Instructor presence encourages student engagement and personal connection, so daily instructor presence is optimal. To make instructor presence meaningful, attention should be paid to being approachable and encouraging (Price et al., 2016).

The Quality Matters Standard 5.3 provides general guidance regarding timeliness of faculty responses and feedback indicating that the plan be stated. In contrast, the ONE Guide sets the expectation that faculty responses to questions should be within 24 hours and no later than 48 hours (Howell et al., 2016; Martin et al., 2018). In addition, feedback on assignments should be provided within seven days (Martin et al., 2018; Smidt et al., 2017). Attention to timely feedback supports student learning and more importantly, fosters student satisfaction (Price et al., 2016).

Best evidence indicates that it is important for the online learner to have several ways to contact the instructor including email, video chat, telephone, or web conferencing (Martin et al., 2018). Instructors also should state clear office hours and availability times (Quality Matters, 2018) and create an environment that is comfortable for students to contact them (Sebastianelli et al., 2015). A positive, encouraging environment impacts learner motivation directly (Kuo et al., 2014).

Instructor presence also involves instructor participation, which can be accomplished in several, equally important ways. Questions should be responded to within 24 hours, and assignments should be graded in a timely manner (Poll et al., 2014; Quality Matters, 2018). Feedback should be relevant and should include guidance; these practices enhance the learning experience (Poll et al., 2014). Feedback on all assignments for each student is important to learning. Price et al. (2016) advise that attention should be paid to providing appropriate constructive feedback and promoting diverse thinking; learning occurs through debate of ideas and developing a defense for one’s position. Interaction on the class discussion board is equally important; making it personalized assures students that their instructor is actively engaged (Smidt et al., 2017). Class discussions that are personal and collaborative contribute to a student-centered environment and create a sense of community (Poll et al., 2014). As such, instructors should respond to the initial post of each student to establish their presence early in the course (Quality Matters, 2018); doing so should be done using the student’s name (Martin et al., 2018). Students having a sense of instructor engagement are supported further by weekly announcements (Dodson, 2017).

Assessment and Measurement

Assessment and measurement are the final component of the ONE Guide. This domain explicates strategies in assessing and measuring student progress and comprises 11 parts: (a) grading policy, (b) descriptive rubrics, (c) available rubrics, (d) clear assignments, (e) stated deadlines, (f) consistent grading, (g) timely grading, (h) personalized feedback, (i) detailed grading policy, (j) tracking learning progress, and (k) measuring learning objectives. Instructor presence is important for this domain as well.

A clear grading policy is fundamental to the assessment and measurement domain. A grading system including a clear grading policy helps students understand the evaluation system and should be made easily accessible online (Quality Matters, 2018). To give students a way to track their progress, the grading policy should specify deadlines (Quality Matters, 2018). It is further important to give a clear picture of assignment expectations and how student learning is to be evaluated (Howell et al., 2016; Sebastianelli et al., 2015). The grading policy should be provided in the course syllabus for ease of access (Jaggars & Xu, 2016).

Instructors also should make clear, descriptive rubrics available to the students. Such rubrics detail specific expectations through the grading criteria to measure learning objectives and performance (Jaggars & Xu, 2016). This practice reduces student confusion as well as the number of email and phone questions (Trammell & LaForge, 2017). However, learners should receive personalized feedback from the instructor based on the grading criteria (Quality Matters, 2018). Care should be taken to assure consistency in grading over time and between students (Howell et al., 2016).

Instructor Checklist

To give instructors a way to facilitate ONE Guide implementation, the Online Instructor Checklist was developed (Figure 2). The checklist contains eight sections listing elements essential to the model: (a) course introduction, (b) course delivery, (c) availability, (d) approachability, (e) discussion board interaction, (f) announcements, (g) feedback and grading, and (i) email interaction. To use the checklist, instructors answer “yes” or “no” to simple statements. Responses in the “no” column encourage the instructor to add materials or tasks that will uphold best practices. Established best practices for online education help instructors improve teaching (Price et al., 2016).

Figure 2.

Online Nursing Education Best Practices Guide (ONE Guide) Instructor Checklist.

Communication is foundational to all effective teaching. In the teaching-learning process, messages must be clearly transmitted, received by the learner, and translated into meaningful information. In the absence of face-to-face dynamics, attention to communication is perhaps the most significant aspect of quality online teaching. To address this critical component, the GUARD system of email communication is recommended. GUARD stands for greet, understand, answer, reassure, and dedication. Greet points to the need to address each student personally. Understand represents acknowledgment of student concerns. Answer reminds the instructor to supply the student with information and resources that answer the question. Reassure is a reminder to encourage the student. Dedication prompts reassurance of the student by the instructor offering availability and support. After the email is composed, the instructor should read it aloud and eliminate any phrasing that may be perceived as condescending.

When communicating with students via email, instructors should create a feeling of connectedness to reduce the sense of perceived distance (Martin, et al., 2018). A personalized quick response helps build a sense of belonging (Poll et al., 2014) and reduces the feeling of isolation (Martin et al., 2018). In the email response, the instructor should include a personalized greeting and acknowledge the student’s need or purpose for asking the question. Answering the question in a noncondescending manner makes the student feel encouraged and welcomed (Dickinson, 2017). For example, students often ask the instructor when assignments are due. Instead of a short answer, “it’s in the syllabus,” following the GUARD principle guides the instructor to answer the question without belittling the student. For example: Hi Lindsey, Thank you for your email. I understand it is hard at times to find the information you are looking for. No worries, I am here to help. The ethics paper is due by Sunday at midnight. A list of assignments and due dates are noted in the course calendar and syllabus, and are located on the left side of the navigation screen. I hope this answers your question. If you need additional information, please let me know. Take care.

Conclusion

Early evidence of the ease of use and effectiveness of the ONE Guide was demonstrated in the rapid and massive shift to remote instruction across academic settings and levels as a result of the COVID-19 global pandemic. Because the preponderance of nursing faculty and programs were ill prepared for the transition, ONE Guide was distributed to many schools of nursing throughout the state of Texas to facilitate course development and implementation of effective online teaching strategies. Preliminary feedback indicates the guide provided a valuable resource for faculty during the rapid transition. Additional evaluation will follow.

The social responsibility of professional nursing carries an imperative of excellence in nursing education whether the delivery is traditional or online. Given a looming nursing shortage, projections of increased demand for nurses in the next 10 to 15 years, and demand for baccalaureate prepared nurses, it is anticipated that the demand for online nursing education will continue if not increase. However, as a newer program delivery modality, educators must use best evidence to assure quality in online programming. The ONE Guide and its companion, the Online Instructor Checklist, were developed to address this need. Together, these comprehensive, evidence-based tools provide a roadmap for online teaching.