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Distance education: a strategy for leadership development.

ACROSS THE CONTINENTS, countries are embracing distance education as a means of upgrading large cadres of nursing care providers--from aide to auxiliary, general or technical to professional, baccalaureate to master's, and master's to doctorate--in a timely manner without disrupting their usual employment. This strategy is in response to the many challenges confronting the profession of nursing in a global context. Geopolitical changes such as regionalism, decentralization, deregulation, and privatization have an impact on the delivery of health services. Relationships among the health care professions have been changed by factors such as the adoption of primary health care strategies, economics, and workforce trends and demands.

Nursing is challenged to meet evolving health care needs, while at the same time maintaining the standards and integrity of the profession. These needs arise from the requirements of society--nationally, regionally, and globally. As countries report on their nursing situation, almost invariably, the need for well-prepared nursing leaders surfaces. Therefore, it is possible to conclude that diverse countries have some needs and expectations in common when it comes to nurses, nursing, and nursing education. And, according to Smith, one must ask, "What are the societal costs of nurses who cannot meet expectations?" (1, p. 11).

As the profession moves into the 21st century, a major role transition for nursing is occurring worldwide. This transition arises from a view of the future where the nursing role will be interdependent, focused more on health care, with clearly specified independent functions and flexible boundaries. The responsibility of the nurse will change from that of solely providing care and safety for patients in an institutional setting to that of developing health prescriptions in community-based institutions as well as in tertiary care environments. In the past, the major function of the nurse has been providing patient care under the direction of the physician, controlled by institutional policies set by others. In the future, nurses will not only provide direct care but will be involved in legislation, definition of standards, and policy determination as part of an interactive, multidisciplinary team. The focus of care provided will include prevention of illness as well as health maintenance and restoration.

Leadership is described as the ability to envision and communicate a changed future and to foster a dynamic that mobilizes and catalyzes the efforts of many toward that end (2). In his global analysis of trends, Naisbitt (3) predicts that the new leadership will be younger and more female, and power will shift from the state to the individual, and the structure will be less hierarchical with more networking. Leadership in nursing must be broader than it has been traditionally, and nursing leaders must look at nursing practice in the wider sense of health care and confront issues within a political, social, policy, and economic context. Leadership development should not be limited to preparing persons for the top of an organization. Rather, it should include preparation of persons with leadership potential at all levels of the system. In the next decades, the quality of the contributions of nurses toward improving health care delivery will expand as never before. Without a commitment to leadership development by policy makers in government, education, and health care service institutions, change cannot be initiated and societal needs go unaddressed.

Distance Education as a Strategy of Nurturing Leaders One of the keys to leadership development is education. As John F. Kennedy said, "Leadership and learning are indispensable to each other." The power of specialized knowledge and the ability to communicate and translate knowledge into action is assuming increasing importance in all nations and societies. Nursing, like many other disciplines, must move from the concepts of the industrial age to the new age of information, and efforts directed toward leadership development must be responsive to the challenges of the information age. While many changes have occurred in educational frameworks worldwide, continuing adjustment is essential. For many countries, professional education and advancement for the nursing work force has been hindered by the scarcity of health manpower resources. And, this situation may be aggravated further by a lack of qualified nurse educators and infrastructure, such as basic utilities, libraries, and communication and transportation systems. To remove potential nurse leaders from an already limited labor force for the purpose of further education is almost impossible and, perhaps, immoral.

An educational model that may meet the identified need for nurse leaders is distance education. The underlying philosophy of this strategy includes the belief that when students have access to a program of planned instruction where the course materials are systematically designed and provide direction to additional resources, students can proceed in a self-directed manner and be successful in meeting the specified outcomes for each course.

Distance education has been a part of higher education for nearly half a century, beginning with the University of South Africa (UNISA) in 1951 and followed in 1969 by the Open University of the United Kingdom (British Open University). As institutions dedicated to distance education, open universities do not offer traditional, on-campus programs. Since the 1970s, the number of open universities around the world has grown to nearly 30, including Athabasca University, Canada; Indira Ghandi National Open University, India; National University of Education, Spain; University of the Air, Japan; University Established at a Distance, Costa Rica; and National Open University, Venezuela.

While a distance education program may be described as nontraditional, not all nontraditional programs are distance education. Distance education has been broadly defined as a strategy in which the teacher or institution providing instruction is separated either in time or place, or both, from the learners (4). In an effort to clarify, distinctions among programs are made by some writers based on variables such as the use or nonuse of single, multiple, or integrated technologies, the degree of learner independence as opposed to the need for more support, or the extent of geographical separation (5-7). But distinctions may not be clear and definitions may be blurred.

The spirit and potential of distance education can best be realized by programs that are specifically designed and implemented based on the needs of the identified population of learners for whom the program is intended. The focus of the program is student learning rather than presentation of knowledge. The curriculum is competency-based, prior learning is assessed and validated, and skills to promote each student's success are developed. The role of the teacher is that of facilitator and collaborator in the learning process rather than giver of information. Services to support the educational and administrative processes are usually decentralized. These programs typically are described as correspondence, open learning/open university, semi-present, independent study/assessment, and, more recently, the electronic classroom. A common element in all these approaches to distance education is innovation in delivery of instruction and in teaching-learning methodologies, and little or no classroom time.

An institution may extend its traditional programs to an off campus location or remote site with the identical teaching-learning strategies used in course delivery on campus. These programs typically carry titles such as on-site, extension, off-campus, or outreach programs. Some of these programs may also be nontraditional by virtue of their use of different teaching-learning strategies, the addition of electronic technology, and/or modifications in the course delivery schedule. For example, there might be changes in the length of the class sessions or the interval between the class meetings to decrease travel for the teacher and/or student. Support services for students in these programs are usually centralized on the home campus. While not distance education at its fullest potential, these programs meet an educational need and are often the forerunner of an innovative distance education program.

Adult Learning Principles and Leadership Development

Though the student population may be of any age and the program of study may be for personal enrichment only or lead to a recognized certificate, a diploma, or a degree, adults at the high school or college level are most commonly the target audience. Even so, the program may or may not be based on adult learning principles as described by Knowles (8,9). This is an important distinction for a profession that is endeavoring to develop nursing leaders. Distance education programs with an adult-learner focus are uniquely suited to leadership development in nursing. The inherent nature of such a program promotes life-long learning and fosters the development of leadership skills. The central theme is that the student is an active participant rather than a passive recipient in the teaching-learning process. Other characteristics that build leaders are the emphases on thinking rather than memorizing, and collaborative work between teacher and student and student with student. The teacher role is one of facilitation--a collegial relationship that encourages self-initiated networking so that students may have access to a wide variety of learning resources.

The development of self is another important consideration for budding leaders. The process of self-development begins when the student constructs and analyzes a personal portfolio and then devises a plan for developing knowledge and skill toward achieving an individualized program of study. The development of self continues as the student self-selects learning activities, pursues complex tasks and projects as an individual or group member, and participates in measuring his or her own attainment of the learning objectives through self-evaluation. Since adult learner centered programs are competency-based, the student faces only self-competition against a pre-established set of criteria with a specified minimum acceptable performance level.

Finally, because the program capitalizes on the assets the working adult brings to the educational setting, the workplace becomes a laboratory. The student in the employee role sees the immediate application of new knowledge to real problems encountered at work or in other settings or other roles. The personal satisfaction and the external recognition that come when new knowledge is used in problem identification and problem solving through effective change agentry boosts the confidence of the individual as leadership skills evolve.

Models of Distance Learning in Nursing Today a variety of distance education programs are available to nurses in the United States, some serving a broad geographic area, others a more local community. The origin of the nursing degree program through distance education goes back more than 20 years and is linked to the generosity of the W.K. Kellogg Foundation. In 1973, a credit-by-assessment model, first for the associate degree and later the baccalaureate, began through the New York Regents External Degree through the University of the State of New York. In 1981, through the leadership of California State University, a statewide RN to BSN model, which included teacher-facilitated seminars for all courses and a credit-by-assessment option for many courses in the nursing major, was initiated. These innovative distance education programs overcame the initial skepticism and achieved accreditation by the National League for Nursing. They continue to serve as models for other states, other institutions, and other countries. The California program, now housed at California State University, Dominguez Hills (CSUDH), added a statewide distance education master's degree in 1985. And, in 1994, through the addition of electronic communications, the statewide model became a national model. Nurses who have access to a television/VCR or cablevision, plus a computer with a modern, can now enroll in CSUDH nursing courses anywhere in the United States.

The Center for International Nursing Education at CSUDH is currently serving as a resource to existing and emerging distance education projects that have been funded by the W.K. Kellogg Foundation in Latin America and Africa. In the southern part of the African continent, two countries are reaching out to nurses through distance education (9). Botswana implemented a program in 1994 to upgrade enrolled nurses (similar to the LVN/LPN) to the registered nurse level (10). The existing RN curriculum was updated by one group, while a core planning committee gathered information about distance education, prepared proposals, and secured the necessary approvals before proceeding with materials development. The result was a distance education RN program for enrolled nurses that recognizes prior learning and expects the same student outcome competencies as the revised generic RN program.

The Republic of South Africa is home to the world's oldest open university, UNISA, which serves students not only on the African continent but throughout the world, using a correspondence model with strong library and tutor support. Nurses can pursue a bachelors degree, a master's degree, or a doctorate at a distance.

This year a cadre of 10-15 key black nursing leaders from Botswana, Zimbabwe, Swaziland, and South Africa will begin an innovative nursing doctorate through UNISA. In addition to the research emphasis offered in the curriculum by correspondence, a series of colloquia will be conducted focusing on advanced leadership concepts and the role of the nurse leader in primary health care.

On the South American continent a variety of distance education programs is encountered. Consultants found that in Latin America, the term distance education often meant that students would never come on a campus or interact directly with a teacher. The term "semi-presencial" was coined to distinguish distance education in nursing from those that use solely a correspondence or independent study model.

In the Cono Sur region of South America, nursing schools in Uruguay, Argentina, and Chile have initiated distance education programs. The University of the Republic in Montevideo has experience with a BSN completion program. Argentina's nurses can pursue the professional degree (BSN) through the Federal University of Rosario. Through the Catholic University in Santiago, Chile, nurses from service can develop their knowledge of leadership and primary health care through a distance education certificate program. The latter two universities are also pursuing institutional authorization for a master's degree "semi-presencial" program. The need is great, as the entire Cono Sur area of the continent is unserved at the graduate level.

Nurses in Cali, Colombia and nearby cities have had an exceptional opportunity. During the early 1980s, the entire population of nurses there who desired upgrading earned the bachelors degree in nursing through a distance education program offered by the School of Nursing at the University of the Valley. As the demand for that program was met, a distance education master's degree program was implemented and is actually more popular than the on-campus program. Future plans include the possibility of extending the program to nurses in neighboring areas of Colombia and Ecuador.

At the University of Zulia in Maracaibo, Venezuela, the School of Nursing implemented a distance education program to upgrade technical nurses to the bachelor's level. While nursing faculty developed the learning materials, students from the School of Education, under the guidance of their professors, participated in the instructional design process. Classes are admitted each semester so that students do not have to wait the traditional year if something inhibits their progress during the term. Nearly 600 nurses are taking advantage of the program since its inception in 1993.

Brazil has two key endeavors under way in distance education, but the audiences are very different (1). Approximately 60 percent of Brazil's nurses are attendants and about half of them have completed less than eight years of formal education. The Federal University of Minas Gerais, Belo Horizonte is providing leadership to respond to the government mandate that attendants be upgraded to the auxiliary level, which requires an eighth grade education. Since the work force cannot be depleted, nurse educators, public school educators, and the various health and education authorities are working together in planning and implementing a distance education program to meet this pressing need.

In the southern part of Brazil, the School of Nursing at the Federal University of Santa Catarina in Florianopolis has a unique project involving six universities and the states of Rio Grande do Sul, Parana, and Santa Catarina. It is offering its master's courses on the campuses of the other universities to help build capacity, and will then serve as a resource when the other schools are ready to offer their own master's programs. The multi-university project has subsequently added a new component--specialization through distance education. In Latin America, specialization occurs only at the postbasic level, but the credential, emphasizing clinical expertise rather than research, is distinct from the master's degree.

A final example is one from Mexico. The Autonomous University of Nuevo Leon (AUNL), Monterrey, in collaboration with CSUDH created an innovative faculty development program that arose out of three identified needs: the increase in Mexico's elderly population, a lack of faculty expertise in advanced gerontology nursing, and a curiosity about creative teaching-learning methods and distance education. Mexican faculty members were able to pursue graduate level courses through a distance learning methodology and earn an AUNL certificate in gerontology nursing. New ways of teaching and learning were conveyed experientially along with new knowledge and skill in advanced gerontology nursing. The AUNL master's program was subsequently extended to the Yucatan and the future goal is to develop and implement an ongoing distance education master's program for nurses in the entire region.

Future View The demand for nurses educated at the baccalaureate level and beyond continues to grow. Developed countries need to accelerate their efforts and developing countries need to be encouraged and supported as nursing in countries at all levels of development and experience with distance education endeavor to respond to current and anticipated societal needs. To capitalize on the accomplishments to date and to maximize the potential of distance education for leadership development, the following actions are recommended as next steps:

1. form a network of leaders in nursing distance education for the purpose of exchanging information, materials, and strategies, and to serve as a resource to others aspiring to use this strategy;

2. incorporate adult learning principles into any program that proposes to foster leadership development in nursing;

3. include in the curricula--

* learning activities that require convergent and divergent thinking, decision making, problem solving, collective action, group process, and

* content in health care economies, information management, communication processes, management of human resources, systems management, cost effectiveness strategies, and program evaluation;

4. conduct formative and summative evaluations of distance education programs constructed to support leadership development, including examination of inputs, processes, and outcomes.

Historically, nurses do not have a tradition of representing themselves in a unified manner to the health care community or to the society they serve. The distance education models described in this paper demonstrate that nursing leaders around the world have been able to overcome the technical, structural, and attitudinal obstacles typically encountered when alternatives to firmly entrenched academic traditions are proposed. Through their efforts, more highly qualified nurses and nursing leaders will be available to address current and future societal needs for improved health care.


(1.) Smith, G. (1992), Outlook for nursing: Health programming for the '90s. In Reunion Desarrollo de Enfermeria de Latino America, Minas Gerais, Brazil: Escola de Enfermagen da UFMG Programa Desenvolvimento de Enfermagem.

(2.) Salmon, M., & Vanderbush, P. (1990). Leadership and change in public and community health nursing today. In J. McCIoskey & H. Grace, Current issues in nursing (pp. 187-193). St. Louis, MO: Mosby.

(3.) Naisbitt, J. (1994). Global paradox. New York: Avon Books.

(4.) Moore, M. G. ( 1987, September). University distance education of adults, Tech Trends, 13-18.

(5.) Faibisoff, S. G., &Willis, D.J. (1987). Distance education: Definition and overview. Journal of Education for Library and Information Science, 2 7, 223-232.

(6.) Romiszowski, A. (1993). Telecommunications and distance education. Syracuse, NY: Syracuse University.

(7.) Scales, L. (1983, November).A typology applied to distance education in British Columbia. Lifelong Learning, 14, 26.

(8.) Knowles, M. S. (1975). Self directed learning. A guide for learners and teachers. Englewood Cliffs, NJ: Cambridge Adult Education.

(9.) Knowles, M. (1980). The modern practice of adult education: From pedagogy to andragogy (Rev. ed.). Chicago: Association Press/Follett.

(10.) Mmtli, K., & Mossieman, D. (1994, January). A model of distance education for nurses: The Botswana experience. Paper presented at the W.K. Kellogg Foundation Sixth Southern African Nursing Networking Conference, Victoria Falls, Zimbabwe.

COMMENTARY by Gloria Goldman

Judith Lewis and Marlene Farrell focused on the global need for well-prepared leaders to meet evolving health care needs while maintaining professional standards during a major role transition for nursing. The changing responsibilities of the nurse of the future will only be met if leadership in nursing becomes broader and nurse leaders develop their practice within a wider view of health care. The authors called for leadership preparation at all levels of the system so that nursing could reach its potential to expand the quality of the profession's contributions to improving health care delivery in the 21st century.

Education is a major key to leadership development, and this education must be appropriate to move nursing from models suited to the industrial age to those compatible with the information age in which we now live. However, educating nurse leaders in sufficient numbers is constrained by a variety of factors, the most serious of which is the current shortage of nurses worldwide. As nurses are more desperately needed at the bedside, it becomes more difficult to justify removing them for the purpose of obtaining further education. Distance learning is providing a solution to this dilemma.

Since this article appeared in 1995, opportunities for obtaining education in nursing via distance methodologies have expanded rapidly throughout the world. This is particularly significant today, as the need for nurses prepared to serve in leadership roles at all levels has never been greater. Well-crafted and executed distance courses and programs make it possible to provide the knowledge and skills necessary for the leadership development that is so crucial to the delivery of quality global health care.

The demand for nurses educated at the baccalaureate level and beyond continues to grow as the shortage of registered nurses in this country and others worsens. Distance learning may provide the best opportunity for increasing the percentage of RNs prepared at the associate and diploma levels who continue their education to higher levels. Indeed, the heaviest enrollments in online nursing education programs by far are in RN-BSN completion programs (1).

Distance learning options for leadership development of practicing nurses make it possible for those nurses to stay in the workplace while pursuing additional education, preventing loss of nursing workforce hours. As we know, many students pursuing additional education are women who balance full-time employment and parenting with school. Working RN students value individualized, flexibly scheduled, independent and interactive learning opportunities that can be facilitated using distance technologies (2).

One might assume that positive experiences with online BSN completion programs will encourage many of these nurses to pursue master's and doctoral degrees via distance learning as well. Increasing opportunities for graduate study is especially critical during this time of a serious and burgeoning global nurse educator shortage. With few available graduate programs with an emphasis on preparing nurse educators, more talented nurses with an interest in becoming faculty are pursuing existing distance learning options. Perhaps direct experience with online learning will lead the next generation of nurse educators to prefer to teach using new technologies, creating more capacity for nursing education programs to expand their reach.

Distance learning technologies are changing the roles of the faculty, permitting them to function as learning facilitators from anywhere, geographically. As we struggle with the shortage of nurse educators, we will see more faculty and practice experts teaching for more than one school, perhaps in more than one country. Significant investment in faculty development is needed if teaching/learning techniques appropriate to distance technologies are to be more widely used. The growing body of research on distance learning points to the need for specific faculty competencies and delineates the impact of distance learning on faculty roles (3).

National benchmarks for best practices in distance education are supported by research evidence (4). Ethical issues such as academic honesty and faculty ownership are being systematically addressed (5). As newer technologies evolve, best practices are widely shared, and ethical frameworks are fully utilized, distance learning will fulfill its promise as a strong force for change in nursing education and leadership development.


(1.) Ryan, M., Hodson Carlton, K., & Ali, N. (2005). A model for faculty teaching online: Confirmation of a dimensional matrix. Journal of Nursing Education, 44(8) 357-365.

(2.) Lashley, M. (2004).Teaching health assessment in the virtual classroom. Journal of Nursing Education, 44(8), 348-350.

(3.) Ryan, M., Hodson Carlton, K., & Ali, N. (2004). Reflections on the role of faculty in distance learning and changing pedagogies. Nursing Education Perspectives, 25(2), 73-80.

(4.) Billings, D., Connors, H., & Skiba, D. (2001). Benchmarking best practices in web-based courses in nursing. Journal of Nursing Education, 39, 60-67.

(5.) Fulton, J, & Kellinger, K. (2004).An ethics framework for nursing education on the internet. Nursing Education Perspectives, 25(2), 62-66.

Gloria Goldman, PhD, RN, chair of the Nursing Department, Sinclair Community College, Dayton, Ohio, is a member of the Nursing Education Perspectives Editorial Board.

Judith M. Lewis, EdD, RN, a professor at California State University, Dominguez Hills, was director of the school's Center for International Nursing Education when this article was written. Marlene Farrell, MS, RN, was academic coordinator.
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Author:Lewis, Judith M.; Farrell, Marlene
Publication:Nursing Education Perspectives
Date:Nov 1, 2005
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