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July 15, 2015

Is Open Online Learning Appropriate for Health Students Learning Person-Centered Practice?

Is Open Online Learning Appropriate for Health Students Learning Person-Centered Practice?

Sue Koch

Thompson Rivers University

EDDL 5151

Abstract Hypothesis

Is an online open learning system appropriate for healthcare students who will be

carrying out person-centered practice instead of the traditional face-to-face approach that

has been followed by most universities in the past? Can both online open and traditional methods of instruction exist and complement each other well in healthcare education? I think they are both needed to balance recent developments in simulated (SIM) learning and changes in attitude and compassion. This paper will examine the pros and cons of online open learning for healthcare students with the focus of person-centered practice.

Keywords: health, person-centered, online learning, open learning, SIM, health students

Definition of Open Learning

Open learning is defined in “as a system of further education on a flexible part-time basis”. ( Bates states “open education can also be described as education that is free for all; gives open access to courses or programs that are for credit or not for formal credit; or open/online textbooks that are free of charge.” (Bates, 2015) This would mean that many more people would have entrée to educational opportunities they would previously not have had the opportunity to access. Bates goes on to say that merit-based admittance to universities has been the norm for a long time and high academic standards have been the standard (Bates, 2015).

I have found that high academic standards do not necessarily create a worthy, dedicated health care student. I have often seen people more interested in high marks than person-centred caregiving or actual emphasis on curiosity, communication and learning to provide care using best-practice to their clients. In this instance, I believe traditional instruction or a blended learning environment with both online and face-to-face instruction may be a better fit to modify attitudes toward seniors and others in need of care. Learning how to communicate effectively with patients, families and others is problematic if it is not practiced in person with actual individuals.

Highly competent, compassionate people are needed in healthcare as many experienced healthcare personnel will be retiring. I am in favour of open access and open textbooks to decrease costs to students and increase accessibility to education for all but I am concerned that open learning may not be as focused as it needs to be in the area of providing competent, compassionate care for seniors and other vulnerable people. Leow & Neo (2014) cite Manson (2007) who states” a well-planned learning environment can enhance the quality of learning and encourage students to demonstrate their understanding in the learning activities, so students are given more choices to determine their learning experience.

Does this mean that students who experience simulated experience of person-centred practice will be able to demonstrate that ability in real-life situations? I am skeptical that simulated learning can produce the desired effect in this area. Changes in the emotional or affective domain in healthcare are the most difficult to achieve. Our own prejudices and beliefs may hinder those necessary changes.

A small example is in the language that is used for seniors in care facilities who are some of our most vulnerable individuals. We may think we are approaching them with a respectful, compassionate manner and helping maintain their dignity but we use words like ‘feed’ for assisting with meals; ‘diapers’ as opposed to incontinent pads and so on. I think this is demeaning and many people are not aware they are continuing this disrespectful manner.

Person-Centered Practice

The Victorian government health information found at describes person-centered practice as:

  • “Responsive to individual differences, cultural diversity and preferences of the people receiving care.
  • Easy to navigate.
  • Provided in the most favourable environment.”(

This, to me, describes person-centered practice in healthcare very well. The idea is to treat patients as individuals with unique, individual needs based on their health and past history. We do not just care for people lying in hospital beds but for individuals with children, grandchildren, wishes, preferences and so on.

Wenda (2012) speaks of necessary changes in values. He states “students, including nursing students, learn values from a conscious effort resulting from the teaching of values and/or transmission via the hidden curriculum. The conscious effort to teach values occurs within the affective domain of learning. The affective domain includes the teaching of attitudes, beliefs, and feelings (Neumann & Forsythe, 2008 citing Billings & Halstead, 2009)”. This is when a blended format would work well for teaching of attitudinal change. Again, many younger students are focused on their own needs rather than that of others. Online learning for the technical and procedural components of healthcare works well but the face-to-face portion is also needed even with the caring curriculum described by Ramirez (2009).

The Pros of Open Online Learning in Healthcare

Leow & Neo (2014) cite Shank (2005) and Asthana(2009) when they state “In recent years, multimedia has introduced the pedagogical strength in facilitating student learning and supplementing learning with liveliness as it adds richness and meaning to the information presentation with the use of more than one medium (Shank, 2005; Asthana, 2009)”. A multimedia approach to presenting a person-centered way of providing care may be more effective if it is delivered in a blended format. The students can practice their person-centered approach in a reality based setting. The experience of facing patients and their families is entirely different from the simulated format. The mental script that one develops prior to meeting with people does not always go according to plan. There can be many more emotions and ‘family interactions’ whether positive or negative involved in reality.

Ramirez (2009) states ” A caring curriculum was implemented into a rural public high school nursing assistant program in an effort to increase the caring behaviors of students as well as improve student resident interactions. Interactions and behaviors with long-term care residents were observed to be caring and nurturing as nursing assistant students performed nursing skills such as feeding, bathing, repositioning and transfers.” (pg. 3)

In this particular instance the setting for learning caring behaviours was a classroom, so face-to-face and a clinical setting with patients and occasionally family members. The instructor/nurse modeled the caring behaviour and the students basically copied it. If a nursing or other healthcare curriculum can impart a holistic caring viewpoint to caregiving, it should not matter if the program is delivered online but it is difficult to see if the affect or attitude of the learner is changed to a person-centered one.

Cons to Open Online Learning in Healthcare

Ramirez ( 2009) takes Gramling & Nugent into account who state “Living in this advanced technological environment where patient related skills and tasks are often rushed, has perhaps devalued caring behaviors and has required that nurse educators teach and incorporate concepts in health care and caring into nursing curriculums” (Gramling and Nugent, 1998). Curriculums evolve frequently, almost yearly, and although papers are written and research is conducted, the actuality of direct interaction with patients and families is always unscripted. I believe it is necessary for face-to-face connections are the key to good, compassionate healthcare practice.

At Kwantlen Polytechnic University (KPU), we use simulators (SIMS) which are quite advanced. They can be programmed for various scenarios to allow students to experience emergency situations and everyday occurrences in a safe place without putting patients at risk. The program we use is and I have included a page called Tips and Tricks in Appendix B. It is copyrighted so I wanted only to show what the program is and give a sample of questions that could be asked to a ‘patient’. Any scenario can be demonstrated but this only teaches the physical, analytical and problem-solving skills. With all the procedural abilities SIMS have they do not teach compassion and empathy. That is much simpler to teach and model in a face-to-face setting.

Pedagogical Use of Open Online Learning in Healthcare

Hutchins & Finney (2015) agree with Galvin & Todres (2013) who said:

“Technology is used to connect learners to humanising practices through engagement facilitated by rich, multimedia enabling technologies. What is unique about this blended learning approach is that it is informed and underpinned by a lifeworld-led humanising with distinct kinds of evidence; conventional evidence, technical knowledge or knowledge for the ‘head’ in the form of qualitative and quantitative research papers and policy and practice guidelines and protocols, together with evidence of people’s experiences of a situation or condition, knowledge for the ‘heart’, represented through stories, narratives, poetry and drama, and philosophy in which students are encouraged to gain personal insights that come from imagining ‘what it is like’ for the person experiencing human services, to make connections to their own personal and professional experiences, knowledge for the ‘hand’, and to integrate understandings about these different kinds of complex knowledge, the head, heart and hand to inform and guide their practice (Galvin & Todres 2013).”

I think this quotation agrees with my view that blended learning is the ideal method of instruction for healthcare students to learn the mind-set of person-centered practice. Various approaches to learning are needed to change the focus some students in healthcare have from a personal focus to a focus on others; our patients require ‘personal care and maintenance of dignity and personhood.’

Caring Behaviour Modeled by Health Care Educators

Melrose & Bergeron (2006) describe the need of students for closeness and a sense of community. This is called immediacy.

“Immediacy is defined as an affective expression of emotional attachment or closeness to another person and was originally developed by social psychologist Albert Mehrabian in the 1960s (Mehrabian, 1967; 1971; Wiener and Mehrabian, 1968)…expressions of immediacy include both verbal and nonverbal behavioral cues. A “we” or “our” statement communicates immediacy while a “you” or “your” statement does not. Subtle variations in language indicate different degrees of separation or non-identity of speakers from the object of their communication.”

If instructors model this behaviour, there is a greater chance that students will begin to demonstrate that behaviour to others, especially their patients. This is a difficult concept to master in an online open learning format. I believe learners need to experience the application of person-centered practice in order to have an effective understanding of ‘what it looks and feels like.’


Teaching health care students to behave in a caring person-centred manner in their practice with patients and families is more effective when presented in a blended learning format. Instructors modeling caring behaviour and demonstrating person-centered practice will provide the best learning outcome.


Bates, T. (2015, February). What do we mean by open in education. Retrieved June 11, 2015, from

Beard, A. (2013, September). Education: An open or closed system? Retrieved from

Dr. Draper, J. &. (2013, March). The importance of person-centred approaches to nursing care. Retrieved June 28, 2015, from OpenLearn homepage The home of free learning:

Hutchins, M. &. (2015). the flipped classroom, disruptive pedagogies,enabling technology and wicked problems: Responding to the ‘bomb in the basement’. Electronic Journal of e-learning, 13(2). Retrieved July 04, 2015, from Electronic Journal of e-Learning Volume 13 Issue 2 2015.

Leow, F. N. (2014, April). INTERACTIVE MULTIMEDIA LEARNING: INNOVATING CLASSROOM EDUCATION IN A MALAYSIAN UNIVERSITY. TOJET: The Turkish Online Journal of Educational Technology, 13(2). Retrieved June 27, 2015, from

Melrose, S. &. (2006, June). Online graduate study of health care learners’ perceptions of instructional immediacy. International Review of Research in Open and Distance Learning, 7(1). Retrieved June 27, 2015, from http://EJ806008.pdf

Ramirez, B. (2009). Design and implementation of a caring curriculum in nursing education. Brownsville, Texas, USA: The University of Texas at Brownsville and Texas Southmost College . Retrieved July 7, 2015, from

Ulrich, B. &. (2013). Mastering Simulation : A Handbook for Success. Sigma Theta Tau International. Retrieved June 13, 2015, from

Wenda, S. (2012, 03 13). Nurse educators’ lived experiences with values changes in baccalaureate nursing education. Retrieved 07 08, 2015, from ERIC .

Appendix A

Gagne’s Instructional Event

Internal Mental Process

1. Gaining Attention Activate the stimuli receptors
2. Informing Learners of Objectives Create level of learning expectation
3. Stimulating Recall of Prior Learning Retrieve and activate working memory
4. Presenting Content Perceive, recognize content and pattern
5. Providing Learner Guidance Rehearse and encode the knowledge to memory
6. Eliciting Performance Retrieve, respond and enhance encoding by responding to questions
7. Providing Feedback Reinforce and assess the learning performance
8. Assessing Performance Reinforce the content as the evaluation
9. Enhancing Retention & Transfer Retrieve and generalize the learned skill to the situation or case

Association of Gagne’s events and internal mental process (Gagne, Wager, Golas & Keller, 2005).

Appendix B


Please visit for Learner Support contact means and hours should you have any questions or technical issues.


Each assignment represents one piece of Tina’s comprehensive assessment within the same 8am hour exam. By breaking Tina’s assessment into individual assignments, you are able to apply your knowledge and practice your skills to understand each system in greater depth.


Tina can understand a vast amount of questions but context can confuse her. Ask questions that avoid the use of unclear pronouns, like “it” or “she”.

Does it hurt when you put pressure on it?

Can you put pressure on your foot?


If you ask Tina a compound question, she may respond to only one part of the question. Instead, ask multiple simple questions.

Do you take drugs or alcohol?

Do you take drugs?

Do you drink alcohol?


Tina does not have a working memory. This means Tina doesn’t recall the subject or context of your last question. For best results ask a question that would be answerable by a person if it were asked on its own without referring to the previous sentence for context.

Do you have any other hobbies?

What are your hobbies?

What are your symptoms?

What are your allergy symptoms?


Please note that documenting findings does not unlock the finding in your exam report. Only asking or examining your patient directly will do that. You can document the findings you elicit in the Electronic Health Record.

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