Nurse Education Today (1992) 1% 182-191 0 Longman Group UK Ltd 1992

Reflections of a distance education facilitator

Brenda Harrison

After nearly a year of preparation, ‘Therapeutic Communication’, the first nursing unit in our new Bachelor of Nursing degree was taught for the first time in 1988. The unit has developed and grown since this time, with both educational and financial factors determining such things as design of student materials and assessment mode. The geographically scattered - and often isolated - students are formally recognised for their individuality and their personal and professional life experiences, and given choices within the unit of what they want to learn and how they will present this material, through introduction of a learning contract as part of the unit assessment.

Difficulties encountered by these students in maintaining their self-esteem when moving from the demanding and complex world of clinical nursing to the arena of tertiary study are discussed. The provision of speedy, comprehensive feedback with general as well as specific guidance with essay writing and referencing, focuses on the process skills many nurses lack as they enter this unit. The applicability of therapeutic communication to clinical practice and the diversity of projects undertaken by students within the limits of the unit demonstrate its appeal to a wide range of registered nurses. Some of the often ignored or minimised factors that differentiate external study from on-campus work are highlighted for both students and unit facilitator, and the creation of an in-house booklet to assist students in developing their skills in external study is outlined.

INTRODUCTION

For many Registered Nurses (RNs) the current trend is to obtain a tertiary qualification - sometimes referred to as the ‘academic epi- demic’ in nursing. The phasing out of hospital- based nursing education programmes by the mid-1990s was a goal set by Australian nurses

Brenda Harrison RMN SRN

over 20 ago (Wilkinson 1988, p 76) and in 1984 was confirmed as policy by then Federal

of Health (Australia 1984, As a consequence, the basic in this country is taught mainly in

to either or degree qualifica- (as well as for state nursing regist-

are endeavouring to and gain advanced to augment and complement and thus advance

two campuses in State of for RNs, one the the Bachelor

NUKSE EDu!(:A-rIoN lWI)AY 183

of Nursing (BN) course by external studies

(distance education). One of the first units

offered in this programme at the Warrnambool

campus is a one-semester unit entitled ‘Thera- peutic Communication’. This article is focused on the preparation and teaching of this unit.

PROGRAMME PLANNING AND DESIGN

The written materials for this unit were origin- ally prepared in collaboration with the nursing

school at Gippsland University College, Monash University where Therapeutic Communication

was taught in a similar BN programme.

There is a range of options recommended for presentation of student materials/resources for

external students, such as a combination of

mandatory or optional residential schools, tele- conferencing, use of regional resource centres

and print and multi media learning materials. Many variations have been used in tertiary

nursing education programmes world wide (e.g. Armenaki 1990; Atkinson 1988; Hart 1989; Osborne lYS7; Kobinson 1986; Kobinson 1988).

The mode of presentation chosen for this unit

was based on an evolving understanding of which approaches have been of consistent value to students undertaking external studies. Deci-

sion making also took into account departmental

budgetary restraints and the back-up available from the faculty and external studies teams on

campus. There was also consideration for students not having to purchase or access specialist equipment (e.g. computer or video machine) in their home environment at extra cost or possible inconvenience, together with the often limited resources available to students in

isolated areas. The unit offered is based around a print-pack-

age consisting of a study guide and booklet of readings, plus a prescribed text. A recom-

mended (but not mandatory) residential school forms a part of the introduction to the unit, with on-going telephone tutoring and supportive counselling throughout the semester to provide support to individual students. Preparation for this single semester unit began almost a year

before the unit was offered, and with Sparkes’

(1984, p 219) estimate that it takes 50--100 hours

to prepare each hour of distance learning text,

this was not a moment too soon. The main preparatory work for the writers

was compiling the material for. and actually

writing, the package students would be using at home. With support and guidance in instructio-

nal design from the external studies staff at the Warrnambool campus, an interactional study

guide was prepared. By using this study guide, students are encouraged to discover new mater- ial and to update/refine current knowledge related to communication in clinical nursing

through exercises, direction to readings and completing review questions. This was to give

students maximum flexibility in pacing learning to suit individual situations, a factor considered

important for adult learners, especiallv in exter-

nal studies (Mast & Van Atta 1986). A major feature of the work is acknowledging

that students are practising KNs with both life and professional experiences to use as resources

for learning (Du Gas 8c Casey 1989, p 31). Attempts are made to ensure the print materials

are ‘user friendly’ and additional features, e.g. use of cartoons, use of white space. division of

the study guide into discrete sections. were used

to ensure this. An integral part of the unit design is the

assessment planned for students. Lt became an

important factor that, although written assign- ments are set, a specified quantity of written

material (i.e. a pre-determined aggregate number of words) does not have to be submitted

to gain a satisfactory grade in the unit. but that the quality of work produced is the central

factor. There is no examination set for the unit, but three pieces of written work are required

and a pass grade necessary in each piece for students to satisfactorily complete the Itnit.

The pieces of work students are asked to complete consist of:

1. presentation of a contract specifying self- identified learning needs in therapeutic communication in the nursing context and an indication of work to be undertaken to help meet those needs;

184

2.

3.

NURSE EDUCATION TODAY

evidence of completion of the contract as written;

completion of an essay chosen from 5 given topics related to the unit objectives.

With these decisions made regarding assess-

ment, the first section of the study guide was written with the focus on basic communication theory with nursing applications. This is an effective unit introduction ensuring all students

have a basic theoretical understanding of com-

munication. The second part of the study guide is centred around the uses of communication

therapeutically in nursing practice involving specific techniques, such as therapeutic touch,

humour therapy, conflict resolution, and peer

review (see Table I).

Advice received from the campus external studies staff suggested that inclusion of a text-

book as a focus for development of materials for this unit could be useful to students as it was

anticipated many would live in areas where academic libraries and bookshops are not

commonly encountered. Many nursing com-

munication texts were assessed for suitability

and ultimately rejected in favour of a general technical and further education text without

specific reference to nursing, yet well structured, clearly written and relevant for nurses (Tolmie &

Tolmie 1980). Throughout the study guide,

students are referred to specific readings from this text and also to a selection ofjournal articles

and other readings to help relate the theory of the unit to nursing practice. The collection of journal and other readings are provided for students as an integral part of their study-

package.

RN STUDENTS

Offering a BN programme by external studies serves the needs of many KNs who are unable to

attend on-campus programmes due to pro- fessional and personal commitments and geo- graphical location. Northcote (1975) uses

Blainey’s (1966) phrase ‘the tyranny of distance’ in referring to the provision of any public service

in Australia - and education falls into this category. The Deakin University BN courses

Table 1 Content outline for the unit therapeutic communication

Par-t A - Communication concepts

Topic 1: Communication as behaviour and interaction Communication, behaviours and perception; feedback and participation; empathy, sympathy and rapport; non-verbal communication; communication climate; listening and responding; assertiveness

Topic 2: Verbal communication Levels and types of language; saying what we mean; revealing our biases; tech talk

Topic 3: Written communication Grammar; planning; clear thinking and argument; specific written documents - reports, memoranda, letters

Topic 4: Organisation and communication Communication models; communication in organisations - formal lines of communication, informal lines of communication, the individual communicating in an organisation

Part I3 - Using communication skills holistically

Topic 5: Holistic care Holism

Topic 6: Therapeutic use of self Introduction; relaxation; meditation; visualisationlimagery

Topic 7: Complementary therapies Introduction; touch; massage; reflexology; music therapy; humour therapy; crisis management

Topic 8: Self recognition and personal growth Introduction; self limits and growth; role functions; conflict resolution

Topic 9: Professional dialogue Nursing communications; health team communication; written communications - nursing reports, professional writing for nurses; speaking to colleagues; formal meetings; peer review; communication for change

have attracted students from all Australian states

and territories - including some students who

reside over 3000 km from the college campus,

and some in remote locations with the nearest post office being over an hour’s drive away. The largest number of students come from metropo- litan and country Victoria and South Australia - although distances of over 1OOOkm separate

students in this group. Registered nurses who reside near a college offering on-campus courses are still often unable to attend classes due to

work or other commitments, and external study

provides a viable option that many choose to

take. Working part-time or full-time and under-

taking tertiary studies is a challenge a lot of

people would find difficult but many nurses accept this challenge (Peeling 1990).

Some of the RN students who enrol in the BN

course are adamant in their belief that they do not need to be taught about communication and

are scornful of a unit entitled ‘Therapeutic Communication’ as they have been, ‘doing the job for years and therefore can communicate

well’. Other beginning students are baffled by

the need to study communication at all as they cannot see the importance of it. Yet another

group of students are of the opinion the unit would be ‘a breeze’ as they know all about

communication anyway. Notwithstanding these perceptions, Therapeutic Communication is introduced to students as an opportunity to learn how to communicate beneficially with

patients/clients and colleagues by design rather than potluck, and, surprisingly, most students take this as a challenge, irrespective of previous

attitudes and assumptions. Many nurses have a remarkable ability to exert

their authority with each other (and patients) most effectively, but, when removed from the familiarity of a nursing practice situation, self-

esteem and realistic recognition of abilities often become distorted. Entering tertiary education is, for many nurses, an emancipatory experience whilst for others it causes more than a little unease. For some it reinforces their poor image of self coping if challenges seem overwhelming in the initial stages. Of the nurses beginning university studies, the majority have the ability to achieve success at this level. But when entering

this environment for the first time, a number of

students do not have the basic process skills

required to organise, plan and prepare work to

an ‘acceptable’ academic standard. Many students have never encountered the

concept of academic referencing, let alone differentiating between using the Harvard referencing system or a referencing system using footnotes. Some RNs have little idea of producing a logical argument on paper, the

meaning of plagiarism, writing an introduction,

conclusion or abstract for a work or. for some

others, the fine points of spelling, grammar and

sentence construction. Critiquing a nursing research article or deciding what they want to

learn are activities often not previously encountered or actively considered by a KN

beginning tertiary studies. Taking into account the complex decisions

and activities nurses carry out as a routine part of

nursing practice, the number of RNs over-

whelmed when starting tertiary studies may seen surprising. However, this does not mean that nurses should be excluded from tertiary study,

but suggests that, if students do not possess the appropriate process skills to cope with their

study situation, these skills need to be learned at

the beginning of a course and extended pro- gressively as the course continues. ~rhe oppor-

tunity for students to do this is vital as it then avoids the unacceptable situation of students failing courses because unrealistic expectations

are made of them.

’ . because of the explosion in professional

information and knowledge in recent years,

the written word is increasingly being used as a means of communicating with others . Although medicine is the best known example, nursing is fast catching up as it develops its

own expertise and experience of written information exchange . .’ (Cormack 1984, p 2)

Specifically, referencing and all the associated activities, e.g. finding, reading and selecting relevant works, producing bibliographies, reference lists and annotated bibliographies and avoiding plagiarism, are some of the activities

186 NURSE EDUCATION TODAY

that seem to cause the highest anxiety for many RN students.

SUBJECT PRESENTATION

As well as focusing on therapeutic communica- tion, this unit is designed to assist students in developing many of the skills they will find useful in tertiary study by offering support in learning and assignment preparation and encouraging creative thought. Using a learning contract as a form of assessment is also an integral part of skills-teaching. Giving students speedy and comprehensive feedback on work submitted is another planned part of the teaching process.

At the on-campus residential school before the beginning of the semester, students have an opportunity to meet and discuss studies with fellow students and teaching staff and also get a brief introduction to the organisation and workings of the university, faculty, library and other student services. There is time to deal with any unresolved administrative problems, meet the student counsellors and generally identify with being university students - all recognised as important supportive features of a distance education programme (Robinson 1981; Sia- ciwena 1983). For teaching staff based on-cam- pus, this is an opportunity to develop a rapport with students - an important part in beginning an educational relationship with students that can be of assistance when attempting to facilitate learning.

An introduction to the principles of adult learning and formally giving students ‘permis- sion’ to make their own decisions about what, when and how they learn, are integral parts of the teaching of this unit. These are accompanied by information on unit objectives, content and limits of study within the unit. Students are encouraged to formulate their own balance between unit limitations and learning freedom so that they can successfully complete the unit/ course requirements whilst surviving and enjoying the rest of their lives.

Students are also encouraged to contact the college during the semester if they have any

queries or problems regarding study. A 24-hour external study centre answer-phone operates or students may ring the unit facilitator directly during working hours to discuss an assignment or negotiate their learning contract. It is not uncommon to have messages or calls from a dozen or more students in any one day and the interactions that follow are usually telephone tutoring sessions - or face-to-face consultations if the students live close and visit the campus - and are tailored to the needs of individual students. Some students are initially tentative about ‘phoning - especially those unable to attend the residential school-but follow-up calls are common and the work received reflects students’ understanding of specific topics discussed during these interactions. The tele- phone enables some of the students unable to attend residential schools to develop at least some sense of identity with the campus through personal contact which they say is valuable to them. The students’ repeated use of this service, and their positive response to it, supports Flinck’s (1978) conclusions regarding the value of telephone teaching to support written dis- tance education materials.

Comprehensive and speedy feedback on ass- ignment work undertaken by students is a vital part of this unit. For many students the essay they complete for Therapeutic Communication is the first ‘academic’ piece of work they have attempted. Specifically, feedback is centred on highlighting good points in the work and pointing out any problem areas in content, context, sequencing and construction, use of language, referencing or presentation. Although students’ attention is drawn to careful reading of essay questions, some students still mis-read questions and present work only loosely related to the topic. Others become mesmerised by a seemingly unattainable word limit and, whilst staying well within the bounds of the topic, produce copious work with little content depth. Any submission of a standard deemed potentially ‘borderline’ or unsatis- factory is double-marked and feedback to the student reflects the input of at least two markers.

Students are given careful feedback on their referencing, and direction to help them improve

NURSE EDU(:A-l-IO& 1‘OI)Ak’ 187

both the quality and presentation of their work.

The perennial queries regarding what to

reference and what is original thought are

usually dealt with on an individual basis in an attempt to help students achieve a meaningful understanding of this concept if they have a

particular problem. Plagiarism is always discussed openly and is clearly outlined in mater-

ials received by all external students - but some

students still trespass into forbidden territory.

With new students this is not treated as an irrevocable transgression but is penalised in

marking. As with Carmack’s (1984) findings,

experience with this unit indicates that plagia- rism is usually due to students’ lack of skills and

knowledge in writing assignments rather than dishonesty.

ADULT LEARNING

Students enrolled in the Therapeutic Communi-

cation unit are all RNs with a variety of life and

professional experiences. They come to this unit with differing behaviours, skills, abilities and perceptions regarding communication in their nursing practice and probably different expecta- tions about what they can get from studying this unit. Therefore it is unrealistic to expect all students will exit from the unit with identical

behaviours, skills, abilities and perceptions.

These features are characteristic of any group of adults and provide the rationale for adoption of

teaching methods tailored to meet the varied needs of adult learners practised in the prepar-

ation and facilitation of this unit (Kidd 1959; Knowles 1978). Although areas of anticipated learning are outlined for students in the form of objectives, it is assumed that many students will be able to achieve some of these objectives on

entry to the unit, but it is also planned that each student will be able to gain and grow in a unique way from undertaking the unit.

The style of the study guide - acknowledging already learned and experienced material and building from there - encourages students to make their own decisions about the pace and quantity of their own learning and is based on

the adult learning principles espoused by Know-

les (1980). Many of the exercises in the study guide encourage students to reflect on their own nursing practice and select from these experi- ences ones that inform on Therapeutic Com- munication. This is a formal way of using the experiences of the students to help individualise the unit for them, and is consistent with the

principles of experiential learning (Burnard

1987). The inclusion of the learning contract in this

unit is another way of introducing adult learning

principles to the students. As part ol‘ their proposal, students set themselves an airn, and

process objectives to achieve their aim, and identify the work to be submitted for evaluation, the criteria for evaluation and the waiting for

various parts of the work to be completed. If, when a contract is presented, the topic is

not related to therapeutic communication or

there is another problem with it, the student is contacted and encouraged to negotiate what it is

they wish to do within the unit limits.

The topics chosen by students for their con- tract work are rich in their diversity and rele-

vance to therapeutic communication (see Table 2). The different interests, work experiences and skills levels of the students are clearly shown with their choices and the work ultimately pre-

sented. Students are encouraged to tailor their work to their particular nursing practice needs,

and this has been attractive to many students who were anxious to fit their learning directly

into and around their current work situation.

For a unit facilitator who espouses the prin-

ciples of adult education but has, in fact, been practising within a fairly didactic teaching model

with expectations of students that. are fairly rigid, teaching this unit is more demanding than

anticipated. Moving from ‘permitting’ students to make decisions about learning to truly encouraging students to direct their own learn-

ing is exhausting, with temporarv regressions to more traditional teacher/pupii interactions. These occur from time to time with students who are assertive about their own abilities and input but where material presented-both written and verbal - does not support this.

The difficulties encountered by students in

188 NURSE EDUCATION TODAY

Table 2 Selection of learning contract topics

Information booklets and patient education leaflets and pamphlets on various treatments, disorders and procedures, e.g. hysterectomy, hypertension, post-MI rehabilitation, breast feeding, chemotherapy, hip-replacement surgery, for children going to OR, various testing procedures.

Information booklets for relatives and carers related to nursing homes, palliative care units, intensive care units, communication with intubated patients, detoxification units.

Local resource material for aged care services, new mothers, telephone counsellors.

Grief, death and dying related to the terminally ill, relatives and carers, parents of stillborn babes, nurses’ coping, services of chaplains.

Teaching, e.g. safety in the home, self-health programmes, advocacy, use of equipment, colleagues about AIDS, adolescents about sexuality, stress management and reduction.

Learning and applying new skills, e.g. massage, massage with babies, relaxation, guided imagery for children, conflict resolution, assertion, coping with aggression.

Preparation and presentation of staff appraisal, recruitment and orientation programmes.

getting a balance between the limitations of the unit and freedom to direct their own learning are similar and no less difficult for the facilitator. The question arises: where is the line drawn between the student who has put a lot of effort into his work and shown remarkable improve- ment, to the decision about academic ‘acceptabi- lity’ of the work in question? It is envisaged this question will never be answered totally to the satisfaction of all students and academics but, as in many such situations, discretionary decisions are made. In this unit an independent moder- ator (another member of faculty teaching staff familiar with the content but not involved in the routine teaching/assessing the unit) is consulted, and works with the facilitator to assist in resolving such situations, hoping to arrive at a decision that encourages student growth and maintains unit (and course) integrity and credibility.

Encouraging students to contact the unit facil- itator with any queries and to negotiate the learning contract causes a degree of frustration. ‘Chasing’ a student for work or reminding a student of ‘teacher-expectations’ - something

often done informally or unwittingly (merely by having some form of visual contact) with on- campus students-is not possible with this group of external students unless formal contact is made. Using the principles of adults being responsible for their own learning, individuals

are only contacted to respond or reply to a specific student-initiated query, unless a particu- lar problem (academic or administrative) is caused by, or precipitated by, the university. Some students find this difficult to come to terms with initially. ‘You could have told me’, or ‘If you’d give me some warning’, or ‘How was I expected to know?’ are typical responses of students if they receive some sort of penalty for a less than perfect or punctual assignment that they feel could have been minimised by a friendly call or reminder from the teaching staff. Concise and relevant information is provided at the beginning of the semester and unit criteria are cited in responses to student queries, but this is not deemed to be a satisfactory response by all students. Several intimate that teaching staff failing to contact them amounts to staff not caring.

Being used to on-campus study and having informal contact with teaching staff, even with- out specific discussion about unit material, it can be distressing for a student undertaking distance education by necessity rather than choice to be cut-off from this contact. However, other students relish the opportunity to self-determine their studies without the possibly perceived stresses of close or informal encounters with teaching staff and, for others, external study provides an opportunity to undertake study that would otherwise be a geographical and logistical impossibility.

A personal frustration in facilitating this dis- tance education unit is the lack or loss of contact with participant students during the semester who ljust fade away’, not to be heard of again- or until the major crisis they are involved in has subsided. Having begun to develop a rapport with students either on-campus or by telephone, then neither seeing nor hearing from these students again can be a concern, with the unit

facilitator often engaging in repeated self-analy- sis to determine whether any interactional

MXSE EDUCAl‘IOh l‘ODA\’ 189

changes could have influenced the situation to

assist these particular students. Students who do

contact the unit facilitator to inform about a

decision to withdraw from the unit (or course) or to discuss a particular situation are given rel- evant academic counselling or referred to the

campus student counselling service. Students are supported and all students are assured that

whatever decision they make regarding study

load/continuance is the right decision for them.

STUDENT FEEDBACK

With return of their final assignment, students enrolled in this unit each year are asked to complete a questionnaire providing both the

unit facilitator and external studies staff with

information to direct future developments and glean new ideas and perspectives for present-

ation and teaching of this unit.

In reflecting on the unit, many students say that they felt ‘uneasy’ beginning studies and had

a lack of confidence in their abilities to success- fully complete the unit. Paucity of basic study skills has been identified by many students as

problematic and this unit is seen as providing an opportunity for personal development in this

area. Feedback from students indicates the unit has

provided them with sufficient challenge and new material that is relevant to their nursing practice

to stimulate both learning and interest. The material chosen for study in the learning con-

tract is repeatedly cited by students in their evaluations as valuable in nursing practice. Many say that the learning contract has reinforced the practical nature of this unit for them. A number of students who have worked through the study guide say the readings provided are a valuable resource, and the textbook prescribed is assessed

as being relevant. Respondents say they have begun to realise that much of their previous professional communication was either disor- ganised or relied on assumptions rather than being based on theory and design. Many say they feel more confident and willing to be more assertive in their professional communication after completing this unit.

Although, on reflection, many of the students

acknowledge the learning contract as being a valuable experience in learning and growth, it is

not popular with all students. There are expres- sions of frustration and dissatisfaction that subject matter is not given for the assignment

and that students are expected to choose this for themselves. Also, without a word limit, some

students say they find planning and preparing their evidence difficult - and that work they set

themselves was difficult to produce in some instances. However, these comments are in con-

trast to those from other students who are pleased to have the opportunity to undertake or pursue a project that is exciting, relevant to their

nursing practice and often something that would otherwise never be attempted.

‘STUDYING EXTERNALLY FOR REGISTERED NURSES’

The first year this unit (and the BN degree) was offered (1988) was particularly exhausting for

the unit facilitator due to the repeated number of enquiries about assignment writing and presentation, referencing, finding resources and

learning contracts. A decision was made to prepare material for student purchase (at mini-

mal costs) that contained information on all of

these topics - and others frequently encountered by external students. An in-house

booklet ‘Studying Externally for Registered

Nurses’ (Harrison 1989) was prepared for newly enrolled students. Also, students were encou-

raged to use one of the many comprehensive genera1 books on study skills and assignment writing readily available (e.g. Anderson, Dur- ston & Poole 1989; Clanchy & Ballard 198’7; (3-r 1988), but many said they felt the in-house booklet more relevant to their study and also

more useful. Students suggest that having clear and concise

guidelines using examples from the nursing context to highlight particular points are positive

features of this booklet. Students who began studies before the booklet was written and pur- chased it in second or subsequent years of study, say they wished they had been able to access it

190 NURSE EDUCATION TODAY

previously, asserting its continued usefulness to them, answering unformed queries and clarify- ing areas of uncertainty.

It is not an aim that this booklet be considered a definitive piece of work for nurses entering tertiary study, but it does achieve the objective of providing students with both useful and practi- cal information related to nurses, nursing and tertiary study that each student can afford to purchase and use as a personal reference in their own study area.

FUTURE DIRECTIONS

This unit has been included in the BN pro- gramme for the past 3 years, and is currently being taught in this programme as well as being offered pro tern as part of a preliminary study programme for RNs entering tertiary study for the first time wishing to undertake a Graduate Diploma in nursing. The design and content of the unit are seen as relevant to nurses with a wide variety of professional and study experiences, and as suitable for nurses approaching tertiary studies for the first time who may need to develop study skills, essay writing skills and self-confidence in studying.

The text originally chosen for this unit (Tolmie & Tolmie 1980) became unavailable in 1989 so a new text was introduced (Vallence & McWilliam 1987). This is another technical and further education text that is clearly written, entertainingly presented and relevant to nurses - although not directed to health care prac- titioners specifically. The unit has been com- pletely revised to direct students to the valuable readings and exercises contained in the new text.

Before the unit was presented in 1991, a minor rewrite was required. This is in line with the campus external studies policy which sug- gests 3 years to be sufficient time to receive feedback from students and unit facilitator(s) to indicate any minor adaptations needed to improve the unit offering. Also this allows for inclusion of current material and/or readings,

and adaptation of material to reflect current trends and recent events in the context of the

unit. As nursing is in a constant state of develop- ment and change, updating external studies units is seen as being of vital importance. For this unit, changes were made to the second part of the study guide, including more materials on the non-invasive therapies nurses can develop as a result of awareness and increase in communica- tion skills.

Teleconferencing with students in different locations has, to date, been logistically impossible without ready access to a teleconferencing bridge, but many students say they enjoy the individual contact with the unit facilitator - although the time-saving potential of teleconfer- encing as well as its potential liaison function for students is recognised. The cost of returning

student telephone calls if the unit facilitator is unavailable to answer a direct call is a noticeable budgetary factor, but deemed to be viable when other means of communication are so limited for some students. Students are encouraged to con- tact the unit facilitator and telephone teaching will continue as a planned part of this unit. Satellite and solar telephone networks and radiophones prove useful for students in iso- lated areas contacting the unit facilitator, and all but a very few isolated students are able to make direct contact using one of these systems. Use of electronic communications - fax machines and computerised electronic mail - may affect com- munication with students undertaking this unit in the future, but are onlyjust emerging as viable options for some of the more isolated students.

CONCLUSION

The ‘Therapeutic Communication’ unit is deemed to be a successful offering within the Bachelor of Nursing course with a total of 325 students successfully completing the l-semester unit over the past 3 years. Over 125 students enrolled for 199 1. The effects of the unit are being felt in various nursing practice settings throughout the country, with nurses practising newly learned skills and patients, clients, staff, relatives and other visitors being the recipients of teaching programmes and literature developed by RNs as part of their studies.

NLJKSE EDC(:A-I-ION TODA1' 191

Challenges in adult learning and adult Harrisoin B I989 Studying externally for Registered

teaching have been created by this unit and serve Nurses. Deakin University, Warrnambool, Australia

as emancipatory pathways to learning and Hart C 1985 College-based education. The Australian

Nurses lournal 15.4: 46-48

communicating in nursing practice and edu- Kidd J R i973 How adults learn. Association Press, New

cation.

Acknowledgements

York Knowles M S 1978 The adult learner - a neglected

snecies. 2nd ed. Gulf. Houston. Texas Knowles M S 1980 The modern practice of adult

education: from pedagogy to andragogy. 2nd ed.

I should like to thank my colleagues Bernadette Keane Association Press; Chicago ”

and Jenny Brooker for their generous time and support Mast M E, Van Atta J 1986 Applying adult learning

whilst preparing this article, and Stuart Hosking and the principles in instructional module design. Nurse

staff from the Institute of Distance Education, Deakin Educator I 1, I: 35-39

University, Warrnambool, for their support whilst writing Northcote P 1975 Open tertiary education in Australia

_ and facilitating this unit.

a viewpoint. Teaching at a Distance 4: 2 l-30 Orr F 1988 How to pass exams. (George Allen & Unwin,

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