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					"Promises, Problems and Precepts"

Karen McGregor and Elyse Pike

Karen McGregor spoke briefly about the assumptions of Universities and
colleges seem to hold regarding adult learners and computer competency

She then contrasted and compared what we found regarding a group of
College Nurses who were preparing to return to Learning via Distance
courses. The accelerated course was designed to upgrade their RN status
to BsCN status.

WE found a group who had few of the computer skills required, few
search skills and a general lack of sophistication regarding distance

The following are some of the steps we undertook to help smooth their
way into the course work.
So you have heard that we had this wonderful brave group of nurses who
were willing to take the plunge - to sacrifice their free time for the
foreseeable future. They had decided to enroll in the nursing upgrade

But they were scared.
Scared of going back to school after so many years.
Scared of the commitment of money, and time.
Scared of what this project might ask of their families.
Scared they would not have the skills as scholars to make the grade.

But very excited and willing to put out to get the degrees they felt
they needed, wanted and owed themselves.

So how could the library fit into the picture?

First a bit about my library

I have been working at Grey Bruce for 5 years.

The Health Sciences Library occupies prime territory between the
elevator bank and Tim Horton’s so everybody passes me at least once a
day. Everybody knows where the library is but no everybody uses it.

When I started here, nurses did not commonly come to the library.

Some have told me that they believed the library was for Physicians
only. I have tried to court nurses since I arrived.

The nursing collection was weeded and editions replaced and new content
added to beef it up.

Cinhal and nursing literature databases were purchased through EBSCO.

The print nursing journal selection was increased.
Nursing week was celebrated with contests and giveaways.

I became a regular presenter at nursing orientation session for new
staff and for community college students rotating through clinical

The nurses slowly became good clients. But nurses never have enough
time. They work shift. They work crazy schedules. Some nurses I
wouldn't see for weeks on end because they simply were not in the
hospital at the same time I was.

Over the years I had become aware that the majority of nurses, new
grads as well as nurses, who had been here for the long haul, did not
have good search skills. They relied too much on scanning the journal
literature I placed on the new issue shelf and too little on targeted
information seeking methods. The most common reaction I got when asking
where they had checked on the internet for information - Had they done
a CINAHL or even a Medline search search. was a blank look and then
they mumbled something about goggle.

So here was my chance to

A:    to offer support services to prospective students and perhaps
ally some fears about going back to school

B:    to offer a search methods session to our hospital nursing service
C:    to advertise the services and resources of the library

How could I not win?

So in cooperation with the Education specialist - Karen, we set out to
produce a program which would be offered to our nursing staff.

We decided to offer the session in the evening at a time convenient to
nurses coming off shift.

The core material was to be divided into 4 sessions of 2 + hours each
offered over a two week period.

Participants could attend some or all of the sessions as it fit their
time tables or their interest.

. There would be no charges for the sessions - registration was
required simply because of space limitation - we felt we could
accommodate 20 participants in our available space.

The content offered was as follows (insert copy of first flyer.)

Response was gratifying and the sessions were filled quickly and names
had to be added to a waiting list.

We started with the very basics - why do you need information, where do
you find it – I skimmed over
Books, and other printed sources

Databases   Then how does one use Pubmed? Cinhal?
What other databases does the Hospital have? How and why would nurses
use them?

Demonstrated a sample search demonstrating simple items such as the use
of limits, mesh terms, use of the related items feature, saving to
clipboard – Most of this was new to the nurses

Internet – when to use it how to use it and what to trust – going
beyond goggle.

The second session was dealing with reading and writing skills. How to
combine and transfer knowledge and research onto paper. Spelling,
grammar, punctuation, essay types, proof reading, plagiarism (Karen may
wish to come back to speak to this topic.)

The Third session was offered with the theme of Evidence based
medicine. We have a National Treasure in Grey Bruce, Dr. David
Sackett, OC, MD, FRSC, FRCP (Ottawa, London , Edinburgh) author of
“evidence based Medicine : how to practice and Teach” as well as 8
other books, 60 chapter contribution and over 300 refereed articles.
Dr. Sackett kindly consented to speak with the nurses about evidence
based practice and how they could use the principles with in their
studies and their work. (Off side. Dr. David believes libraries
should be called libraries, not knowledge hubs, info centres, learning
resources but Libraries. I am very fond of Dr. David). The session
closed with a very quick overview of some clinical evidence based
resources specific to nursing – essentially a laundry list

The fourth and last session was a wrap-up - questions from the group
and a recap of use of information resources. The Lonesome Doc process
was discussed and some of the nurses signed up for the service This was
a chance to review search and gather techniques using real life topics.

So after it was all over we needed to look at the good the bad and the

What worked well?

We had snacks - candy, soft drinks, water and coffee. Some of these
guys were coming off shift after all! And chocolate is not only a
Librarians best friend.

We asked why the participants were there and what they expected to
learn - sometimes you will be surprised at the response. Asking up
front allows you to change the planned process, if necessary, to
respond to the needs and wishes of the nurses. If anything we scaled
down the amount of information we had planned to offer.

We used humor – My Sheriff’s badge and cowboy hat were used as props to
reinforce the idea that the internet, like the Wild West has no
supervision and buyer beware.

What didn’t work well
By the end of the two weeks of evening sessions, everybody was tired.
The nurses were tired after their day and the instructors - Karen and
I, who taught at night after a full working day. Any one who works as
a solo, in any job, appreciates that taking lieu time is a rather
illusive concept.

Unfortunately the session on Evidence based medicine was not as
successful as we had hoped. Although Dr. Sackett is a powerful and
engaging speaker, the nurses felt the topic was not of particular
relevance to them at this time as an aid to learning. We dropped this
session when the course was offered a second time - reducing the
sessions to three instead of four.

Finally -- Technology will always find a way to hang you and the use of
laptops and data projectors is always fraught with problems. Moral of
the story – always have overheads ready to back you up.

What we could have done to improve this course offering

What would have worked better?

Offering the course in a computer lab and allowing hands on would have
been helpful. Learning always improves when visual and auditory
learning is enhanced by activity.

At the time we offer this course, two universities were offering the
possibility of nursing upgrade programs. Many of the Nurses had
applied to both programs and none had confirmation of acceptance.
One school later withdrew when they did not receive enough applicants
to fill their course requirements.

It would have been useful if we could have been able to target
searching behaviors to the resources specifically offered by a single
school. Access to a pass word for the library for purposes of
demonstration of library site navigation and of specific resources
would have helped those who were accepted.   Once classes started I was
able to “borrow” a student number, and using the library was then able
to give a much more focused session on mining resources - demonstrating
not in the abstract but in real time.

Did we make a difference?
Each group was asked to fill in an evaluation form at the end of the
night. The responses to the session were very favourable.

Based, we believe on word of mouth, the number of people on the waiting
list increased. There were sufficient number s to justify offering the
course a second time.

Various people stopped us in the halls afterward and commented that
having a bit more understanding of the system and its expectations had
allayed their fears and validated their decision to return to school.
I like to think we made a difference.

What the library did to continue support for returning learners.

The literature is bloated with papers outlining the advantages and
problems with the whole distance education thing. I won’t single out
any particular one at this time its easy enough to check for your self.
Looking at the demographics for this groups of students,
I wonder however if the nurses at my hospital fall a bit outside the
norm for distance education. I believe that the educational institutes
have to consider this when formulating course materials, rules and

The group we had did not group up with computers at home or at school.
They are older, almost every one over 29 – some are grandmothers.

They are not computer illiterate, but tend to use computers at work in
very focused situations - grasp or other work load measurement tools,
medication or test ordering, charting, pay role or scheduling.

Staff are NOT encouraged to surf or "play with computers".

They are often unaware of the potential offered by computers databases
and the internet.

They are often “afraid they will do something to break it" – technology

At home the equipment is often a single outdated family computer and
they compete with the kids for time.

Rural and small town connections are often land lines not high speed
and this equates to slow download times, frequent cutoffs and
frustrating service.

Universities – being urban based often don’t seem to consider these
factors when setting course requirements.

So what can we do to help support users and returning student?

Offer instruction in databases and web-sites of value for the subject

Offer help in setting evaluation criteria.

Help dispel the myth that it’s all on the internet and but I’m pretty
stupid because I can’t find it.

Help dispel the myth its all on the internet -- period.   And even if it
was -- it’s not all true.

Provide access to high speed lines or networked computers for easier
Offer after hours access to accommodate those on shift and students
involved in group work. Any idea how hard it is to get 5 nurses
together. Shifts, families, distance, and life - a central place to
work and spread out is very useful.

Provide printers and scanners and help them work them.

Give them access to a photocopier

If possible get access to the institution library as the user/student
would see it. Work it out yourself - set yourself an assignment - try
to try to negotiate the easiest path to the information you would need.
Show your students that path.   The nurses are here to learn nursing
skills --- they need to know computer skills -- enough to get them
through but have no need for expert knowledge.

Ask your IT department to provide cheat sheets on purchasing computers
– desk top vs. lap top, computer specs to look for. The cost of a new
computer on top of the cost of books, tuition and potential lost wages
during the time of study can be frightening. They want to be assured
they are purchasing the best machine for the purpose. Help then
purchase machinery if possible - see if your hospital has deals with
suppliers to offer discounts – - we have a deal with Dell

Source textbooks for better prices. I was able to knock about 150 $ of
the total textbook list price by using Login and other suppliers rather
than the university book store.

Be prepared to proof read, offer search advice, offer print resources,
order interlibrary loans and ill materials to support course projects.

Remind them that distance e-learning does not all have to be done on
the internet.

Advertise that you, (the library) is open for business and follow
though on it. Talk to your nurses – Ask them what they need. Get it.
Once Nurses become used to seeing the library as a home base which
supports their learning, as their library, they will continue to use
its services and support you.

All this is time consuming at the front end. But these are the nurses
you will be having as your care givers down the line and you deserve
the best. And with your help -- they will be the best. Elyse Pike
Health Sciences Librarian Grey Bruce Health Services 1800 8th St. E
Owen Sound Ontario Canada N4K 6M9

519-376-2121 ext 2043

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