Creative educational strategies to facilitate nurses' knowledge of Aboriginal health issues

Jenni Hardy, Maria Miller, Alison Stewart and Brock Lewin
Mackillop Campus and Mercy Campus
Australian Catholic University
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The indigenous people of Australia are regarded as being disadvantaged across all social and economic indicators. The poor health status of Aboriginal people is well recognised, and that Aboriginal health is not limited to the physical wellbeing of the individual but relates to the social, emotional and cultural well being of the whole community. Nurses work with Aboriginal people in a variety of settings and are one group within the healthcare sector who can make a significant contribution to the delivery of health care. It is essential that nurses be appropriately educated to understand and have an appreciation of the culture and special needs of indigenous Australians.

Australian Catholic University, funded by the Commonwealth Department of Aboriginal and Torres Strait Islander Health and Family Services, is conducting an educational project to develop, implement and evaluate educational units on indigenous health issues. This course of study is for inclusion in undergraduate and postgraduate nursing courses. The project team members are from several locations across three states, making use of technologies such as teleconference, video conference and email to facilitate communication.

Indigenous Health course materials are being developed for traditional and flexible delivery modes. Flexible delivery modes incorporate the World Wide Web Internet and CD-ROM. FrontPage and toolbox are being used in the development of the project. Student learning is being facilitated through traditional and/or electronic teaching strategies. The learning experience involves students undertaking field placements in urban, rural or remote aboriginal communities. Pretest and posttest questionnaires and focus group interviews provide the data to measure learning outcomes and technical value of the educational strategy.

Introduction

Australian Catholic University was established in 1991 amalgamating the previous Catholic Colleges of Education in Victoria (three campuses, two in Melbourne one in Ballarat); Queensland (one campus in Brisbane); NSW (three campuses in Sydney) and ACT (one in Canberra). There are three faculties located within the university structure: Arts and Sciences, Education and Health Sciences. The Faculty of Health Sciences conducts courses in Nursing and Human Movement at campuses in Victoria, NSW and Queensland.

The university has a long association with teaching Aboriginal students and a strong commitment to the importance of studies of the country's indigenous people as part of university curricula. Current activities by the university includes a compulsory core unit in Aboriginal education for all primary education courses, which was written in collaboration with staff of the two Aboriginal support units, Weemala (Qld) and Yalbalinga (NSW) and taught across all three state and territory divisions of the university. Currently a course designed for indigenous people, (Diploma of Education) incorporates teaching strategies such as email, Internet and the World Wide Web.

In 1996 a national undergraduate Bachelor of Nursing course was commenced offering elective units in the second year of the program. One of the electives offered explores the historical, cultural and social implication of health care relevant to Aboriginal and Torres Strait Islander communities. The students study factors that contribute to current health care delivery, primary health care, health promotion, and the role of health worker in Aboriginal communities. A two-week field trip is part of the students' learning experience. In NSW the two weeks out in the field is spent in the Far North West. In the previous nursing curriculum the Queensland division offered an elective in Aboriginal Health Issues. In Victoria the students are offered a Transcultural elective which includes a visit to Koorie sites along the Murray River.

The university has identified five areas for its Aboriginal and Torres Strait Islander education strategy during the next triennium, two of which have specific relevance to this paper:

The university over the last three years has developed increasing competence and skill in presenting "state of the art" technology for educational purposes through mediums of interactive videoconferencing and multimedia education. Each campus is linked via videoconference facilities. Management of the Aboriginal and Torres Strait Islander Health Project (ATSIHP) has been facilitated using this technology.

Introduction to ATSIHP

The Faculty of Health Sciences at Australian Catholic University was successful in receiving a grant (April 1997) from the Commonwealth Department of Aboriginal and Torres Strait Islander Health and Family Services. The grant resulted from an expression of interest submission to develop, implement and evaluate educational units, on issues relating to Aboriginal Health to undergraduate and postgraduate nurses. The development of resources is based on a flexible delivery mode. Students are able to gain knowledge and understanding, as well as relevant skill acquisition through field trips and access to print multimedia and Internet resource materials.

Clinical field experience forms a valuable component of the learning process. During year one students from NSW and Victoria undertook a traditional delivery accredited unit, the major component being a field trip. Nursing students in NSW, both undergraduate and postgraduate spent between one and two weeks in one of the following areas: Bathurst, Bourke, Brewarrina, Broken Hill, Collarenebri, Goodooga, Kempsey, Lightening Ridge, Moree, Walgett, Wentworth and Wilcannia.

Graduate Diploma in Midwifery students from Victoria spent time in Alice Springs. During years two and three of the project, students from three states will participate in field trips across Australia, gaining experience and awareness of the different issues related to Aboriginal Health from within rural, remote and urban contexts, and from cultural, social and spiritual perspective.

Development

Throughout the three years, course and informational resources will be developed, implemented and evaluated. This will take the form of printed materials, web page development: the production of a CD-ROM educational package involving an extensive literature search, consultation with the relevant Aboriginal and Torres Strait Islander agencies, universities (e.g. University of Technology Sydney, Newcastle, Sydney, Southern Queensland, James Cook) and other institutions (e.g. CATSIN-Council of Aboriginal and Torres Strait Islander Nurses, Rural Health Unit Cairns).

Process

The organisational and management structure is as follows:

Significance

Nurses work with Aboriginal people in a variety of settings and are one group within the healthcare sector who can make a significant contribution to the delivery of health care. It is essential that nurses be appropriately educated to understand and have an appreciation of the culture and special needs of Indigenous Australians.

This approach is consistent with recommendations from the National Aboriginal Health Strategy (1989) and CATSIN (1997):

Tertiary institutions responsible for undergraduate and post graduate nursing courses should include the compulsory study of Aboriginal culture, history, identity, health and principles of self-determination and management into curricula

Educational issues

Flexibility in teaching is nowadays a key construct in learning (Nikolova & Collis, 1998). Flexibility calls for new roles for teachers and learners and imposes higher demands on learner's self-initiative, self motivation, and self control and is congruent with Knowles (1976) theory of adult learning where learning is achieved at greater rate when it is student centered rather than teacher centered. In addition technology is assuming an increasingly greater role in teaching and the practice of health care professionals (Greenlick,1995). In particular the use of hypermedia, the integration of hypertext (Frisse,1988) with images, video, sounds, animations, and simulations has attracted health care educators (Bergeron &Balin, 1996) mainly because of the flexibility in how content can be presented. Negroponte (1994), suggests the modular, multisensory, interruptible and inherently non-linear aspects of hypermedia suite contemporary needs (Bergeron et al 1994).

It is envisaged that by the completion of this project a series of stand-alone modules will be developed for the web for both undergraduate and postgraduate students. The concept of developing modules is consistent with providing a more flexible range of options that can be presented by a pedagogical profile (Nikolova & Collis, 1998).

The use of field placements allows the student to transfer theory preparation into clinical situations. Collins, Brown and Newman (1987) state. "Teaching methods should be designed to give students the opportunity to observe, engage in, and invent or discover expert strategies in context" (cited in Wild and Quinn, 1998).

Multidisciplinary team

Within the team a range of disciplines and expertise are represented, located across seven campus sites along the eastern seaboard, from Brisbane to Melbourne. The team consists of representatives from the Aboriginal community, educators, educational technologists, instructional designer, content experts, computer programmers and researchers. Working collaboratively with a variety of experts enhances the quality and relevance of the educational materials being produced in this multi-modal model of delivery.

Consultations with experienced academics, health professionals working in the area of Indigenous Health and Aboriginal community representatives ensures appropriate processes and procedures are undergone in gaining access to and an understanding of the Aboriginal community. This is essential in organising field placements, support and the success of the project.

Communication in this project with the diversity of personnel and locations is being achieved in part through face to face interview and discussions, but the major component is via video conferencing technology. This method has proved to be both an efficient and economical communication tools. Other methods include electronic communication through email and Lotus notes. More recently a Newsletter and web information page has been developed and maintained to invite comments and contributions from external sources.

Development of traditional unit

Currently the elective is being administered in traditional mode using print materials, face to face classes and fieldtrips to rural, remote and urban locations. Objectives of the unit include the following: The students attend workshops, tutorial and discussion groups including the use of videoconference.

Representatives from CATSIN are reviewing the unit for undergraduates. An External Advisory Committee will review the final modules, elective unit, website and CD-ROM.

Website development

Website development remains in the planning stage. The development of the website is co-ordinated by the Project Administering Officer under the guidance of an internal advisory committee. The committee comprises of representatives with content, technical, and educational expertise. Software being used is as follows: A computer, printer and scanner have been allocated for dedicated project use. Consultation and sharing of resources with other institutions and universities (Rural Health Unit in Cairns and University of Newcastle) have been a priority by project team members. It is envisaged the course material presented on the website, will provide a core component (Module) for all undergraduate and postgraduate nursing students studying at ACU and be available to other interested institutions and universities. A modular format provides an opportunity for different delivery approaches.

An essential component from a project management perspective is clearly defining:

One model under consideration has three phases: phase one consists of information sharing through chat and discussion rooms (based on the approach used by Joy Doherty, a social studies lecturer at McAuley Campus, ACU). The material is written so students explore their perceptions and knowledge of Aboriginal and Torres Strait Islander history, culture, health status and health delivery systems. Phase two encourages students to participate interactively with Aboriginal and Torres Strait Islander communities, an approach which uses a combination of multimedia resources, videoconference, workshops and visits. Phase three involves the students in activities to investigate ways of providing effective health care delivery to Aboriginal and Torres Strait Islanders.

Development of CD-ROM

The instructional design of the CD-ROM is based upon Laurillard's Conversational Model (1993). The computer as the facilitator is in dialogue with the learner, allowing the learner to make hypotheses and draw conclusions from material presented. The rationale for using Laurillard's Model being a student centered approach has been found to be an effective method of enabling adult learners to acquire knowledge, understanding and psychomotor skills (Knowles, 1978).

The context of the CD-ROM is divided into five sections: rural, remote and urban indigenous settings, additional resources and user notes. The Laurillard Framework forms the basis for the rural, remote and urban setting. Additional resources is linked to the Website and form a live data base, User navigation through the package is tracked and they can write to learning notes or download materials to the notes for review at a later date.

Development of the program has commenced with identification of the context or the setting of the learning experience. After several discussions with the team it was decided to base the program around the student's field experiences, this also reflected the community setting approach used by Peterson (1996) in a CD-ROM about the Biripi indigenous community of NSW. Concept mapping was used to explore the proposed content for the program.

Following identification of the settings the next step involved developing a pen and paper educational design based upon Laurillard's framework. Once this was evaluated a computer programmer was engaged to develop the Framework on disk. Toolbox Producer is the authoring system utilised for this task. Content related to the remote area section of the project will be added and formative evaluation will occur with both experts and student. Modifications made and then the modified Laurillard Framework will be replicated for the urban and rural communities.

Screen design

The team has a preference for a simple uncluttered screen. Graphic buttons located on the top right hand side of every screen represent the menu. Help messages and instructions are found in a dialogue box at the bottom of each screen. An Australian Indigenous artist is preparing artwork that will be incorporated into the program as wallpaper. The font selected for the written word is Arial and all commands and help message is written in Arial italic.

Field placements

During 1997, 20 undergraduate students participated in a two week field trip to rural and remote regions of Far West northern NSW. Teaching and learning strategies included a self-directed learning package completed before a full day pre-departure workshop; comprising guest speaker presentations, group discussions, and video and panel presentation via videoconference. 11 midwifery postgraduate students from Victoria spent seven days in Alice Springs engaging in activities at the following places: Fieldtrips for 1998 will extend to 30 undergraduate students from the ACU campus in Brisbane travelling to 17 venues and 20 undergraduate students from campuses in Victoria to Alice Springs.

Research

The research project aims to evaluate the effectiveness of an educational experience for undergraduate and postgraduate nursing students pertaining to Aboriginal and Torres Strait Islander health (ATSIH), and to determine if exposure to Aboriginal culture enhances students attitudes and awareness of Aboriginal and Torres Strait Islander people. The research also aims to identify if undertaking the ATSIH unit facilitates student learning and to determine if students, by undertaking the unit are influenced to work with ATSIH services. Preliminary research findings suggest there is a change in both knowledge of and attitude to Indigenous Australians and associated health issues in those groups undertaking the course of study.

Methodology and data collection tool

All students entering second semester of year two of an undergraduate (BN) program in years 1997 (NSW only), 1998 and 1999 are invited to participate in a survey. Students undertaking the elective form the experimental group; those students not undertaking the elective will form the control group. The questionnaire and focus group interviews (from the experimental group only) are administered pre- and post-field trip. SPSS and NUDIST are the computer data analysis programs used in this project.

Many of the questionnaire items included in the tool have been taken from previous studies measuring learning outcomes following cultural awareness sessions. Postgraduate students involved in the elective piloted the questionnaire and focus group interview schedule. Following this pilot the tool has been modified to improve validity.

Summary

The project is being developed in consultation with a variety of individuals and organisations. We believe a quality product can be produced if interested individuals and experts work collaboratively, with each contributing their special expertise. To date this has been a positive experience for the team with group cohesion being enhanced by electronic communication. Learning materials and field placements are proving to effective and appropriate to the learning needs of both undergraduate and postgraduate students.

References

Bergeron, B. P. and Balin, M. T. (1996). Collaborative hypermedia development: Considerations for academic publishing. Journal of Educational Multimedia and Hypermedia, 5(2), 101-112.

Collins, A., Brown, J. S. and Newman (1998). In Wild, M. and Quinn, C. (eds), Implications of educational theory for the design of instructional multimedia. British Journal of Educational Technology, 29(1), 73-81.

Doherty, J. (1997). Teaching for tolerance: The hope for reconciliation in Australia. In Ballantyne, R., Bain, J. and Packer, J. (eds), Reflecting on University Teaching: Academics' Stories, 151-160. Canberra: Australian Government Publishing Service.

Frisse, M. (1998). From text to hypertext. Byte, 13(10), 247-253

Greenlick, M. (1995). Educating physicians for the twenty-first century. Academic Medicine, 70(3), 179-185.

Knowles, M. (1978). The adult learner: A neglected species. Houston: Gulf Publishing Co.

Laurillard, D. (1993). Rethinking university teaching: A framework for effective use of educational technology. London: Routledge.

Negroponte, N (1994). Being digital. Random House Audio Publishing.

Nikolova, I. and Collis, B. (1998). Flexible learning and design of instruction. British Journal of Educational Technology, 29(1), 59-72.

Authors: Mrs J Hardy (Project Leader), Mrs M Miller, Australian Catholic University, Mackillop Campus, 40 Edward Street, North Sydney NSW 2060

Ms Alison Stewart, Mr Brock Lewin, Australian Catholic University, Mercy Campus, 412 Mount Alexander Road, Ascot Vale VIC 3032.

j.hardy@mackillop.acu.edu.au
m.miller@mercy.acu.edu.au
a.stewart@mercy.acu.edu.au
b.lewin@mackillop.acu.edu.au

Please cite as: Hardy, J., Miller, M., Stewart, A. and Lewin, B. (1998). Creative educational strategies to facilitate nurses' knowledge of Aboriginal health issues. In C. McBeath and R. Atkinson (Eds), Planning for Progress, Partnership and Profit. Proceedings EdTech'98. Perth: Australian Society for Educational Technology. http://www.aset.org.au/confs/edtech98/pubs/articles/hardy.html

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