Distance Education in Nursing in Turkey Procedia - Social and Behavioral Sciences 116 ( 2014 ) 639 – 643 1877-0428 © 2013 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and/or peer-review under responsibility of Academic World Education and Research Center. doi: 10.1016/j.sbspro.2014.01.271 ScienceDirect 5th World Conference on Educational Sciences - WCES 2013 Distance Education in Nursing in Turkey Filiz Kanteka * aAssistant Professor, Akdeniz University Antalya School of Health, Antalya, 07058, Turkey Abstract Distance education is an important means for nursing knowledge to become widespread. Although distance learning is seen as a strategy for providing solutions for educational problems such as insufficiency of lecturers, an oncoming deficit for nurses, and the unavailability of continuing education of nurses; the applications concerning nurses are limited. This article presents a general overview of the distance education application in Turkey and aims at reviewing the current status concerning distance education in nursing especially, by emphasizing the significance of distance education, and to provide perspective for administrators, Corresponding Author: Filiz Kantek, Tel: +23 412747839 Email: Filiz Kantek@gmail.com Introduction Distance education is a strategy to increase access to nursing education, train nurses for practice, and prepare future nurse educators (Mancuso, 2009). Distance education is defined as the process of extending learning, or delivering instructional resource-sharing opportunities, to locations away from the classroom, building or site by using video, audio, computers, multimedia communications, or some combination of these with other traditional delivery methods (O’Neil, Fisher, & Newbold, 2009). Educators use distance education for delivering entire courses and/or educational programs worldwide, or for providing specific learning experiences for academic courses, staff development, or continuing education (Billings, 2007; Hyde & Murray, 2005). The most widely used presentation systems in distance learning are the printed materials; television broadcasting that can be received by satellite; broadcasting via microwave, or optical fibers; and other electronic methods including computer conferencing, audioconferencing and videoconferencing (Billings & Halstead, 1998; Keating, 2006). Distance education can be totally online or partially online (blended learning). In addition to this, the interaction can be synchronous (real time) or asynchronous (delayed) (O’Neil, Fisher, & Newbold, 2009; Mancuso, 2009; Kaya, 2007). Enabling individuals to access an education program, such as a university program which is distant, by overcoming the obstacles such as time and geography, to easily fulfill the vocational and individual roles in a Keywords: Distance education, nurse education, nursing, Turkey; Available online at www.sciencedirect.com © 2013 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and/or peer-review under responsibility of Academic World Education and Research Center. http://creativecommons.org/licenses/by-nc-nd/3.0/ http://creativecommons.org/licenses/by-nc-nd/3.0/ 640 Filiz Kantek / Procedia - Social and Behavioral Sciences 116 ( 2014 ) 639 – 643 flexible environment renders distant education appealing in countries where a deficit of nurses and nurse academicians is experienced (Geray, 2007; Kaya & Akçin, 2005; Talbert, 2009; Sit et al., 2005). Today, distance education is being applied successfully in nursing in graduate and postgraduate programs, and certificate programs in many countries (Billings, 2007). A 1998 survey of 365 American Association of Colleges of Nursing (AACN) member nursing institutions revealed that 187 (51%) offered distance education courses, with a total of 1682 separate course offerings from undergraduate to Ph.D. education (Potempa et al., 2001). A 2002 survey to determine the annual enrollments of 162 accredited nursing distance education programs revealed the heaviest enrollment was in bachelor of science in nursing (BSN) completion programs (90.73%) which can be registered online, followed by Master’s degrees (3.65%), associate degrees (2.29%), basic baccalaureate degrees (2.14%), continuing education courses (0.78%), licensed practical nurse transition programs (0.36%), and Ph.D. degrees (0.06%) (Hodson-Carlton et al., 2003). There are several reasons and possibilities to promote and continue to effectively utilize distance education methods and techniques in nursing education in Turkey. These are: the differences between nursing schools in terms of facilities and education opportunities, an insufficient number of lecturers, an oncoming deficit of nurses, disenabling of the continuing development of nurses by the current system, limited career opportunities for nurses (Kocaman, Sevig & Kubilay, 2008; Kocaman, 2005), and the failure in meeting the demand for higher education systems due to growth in young population (Kaya, 2007; Geray, 2007). Distance education applications in our country, especially in nursing, have a short history and limited experience. Therefore, this study aims at reviewing the current status concerning distance education in nursing especially, by emphasizing the significance of distance education, and to provide perspective for administrators, educators and researchers who would conduct studies in this topic. First, information is given on distance education applications in Turkey; later distance education applications in nursing are surveyed and suggestions are made. Distance education applications in Turkey Although the concept of distance education in Turkey was brought into agenda in a meeting in which the problems of education had been discussed in 1927, the first application of distance education was performed by private educational institutions (namely FONO and Limasollu Naci for teaching English) in the early 1950s (Kaya, 2007; Geray, 2007). The first correspondence course was started within higher education by the Institute of Banking and Commerce, in the year 1954, Law Faculty of Ankara University. Ministry of Education developed the mail education in 1961 at first, and then started primary and secondary school, and high school distance learning programs over radio, television and internet (Kaya, 2007; Geray, 2007; Çakır & Oguz, 2010). In higher education though, the Higher Education Board assigned the mission of distance education to Anadolu University grounding on the Higher Education Fundamental Law in 1981. Anadolu University Open Education Faculty began with two programs; one in Economics and one in Business Administration, which was supported by Radio and Television Institution of Turkey made its channels eligible to use. In due course, the Open Education Faculty developed associate degrees, bachelor’s degrees and vocational programs in Education Sciences, Health Sciences, Continuing Education and Informatics in order to meet the needs of the growing and developing Turkish society (Kaya, 2007; Anadolu Üniversitesi, 2011). After the Internet was formed in 1993 in Turkey, a new dimension has been brought to distance education. While distance education is done with both printed materials and via broadcasting, education programs that can be given through internet as synchronic and asynchronous have been included to them (Geray, 2007; Çakır & Oguz, 2010). Most of the universities in Turkey started and still continue associate, bachelor’s, master’s degrees and Ph.D. programs based on the internet, via either synchronous or a synchronous communication systems with distance learning centers within an institute or a vocational school of higher education (Kaya, 2007; Anadolu Üniversitesi, 2011). These programs generally include the social and education sciences areas such as Computer Education and Technology Instruction, Pre-School Teaching, Philosophy, Sociology, Human Resources Management, Marketing, Finance, Business, and Econometrics (Geray, 2007; Senyuva, 2007). 641 Filiz Kantek / Procedia - Social and Behavioral Sciences 116 ( 2014 ) 639 – 643 Although the distance learning applications in Turkey exhibit a rapid increase, it is difficult to say that this increase is at the desired level (Kaya, 2007). Particularly, the applications for applied programs in engineering, medicine, and nursing need to be improved. Distance Education Applications in Nursing The first distance education program in nursing in Turkey, the Nursing Associate Degree Program, started in the 1991-1992 academic year with the cooperation of Ministry of Health, Istanbul University Florence Nightingale School of Nursing and Anadolu University Faculty of Open Education. The main purpose of these programs was to reduce the constraints on higher education and to provide the working with an opening to level up their education. Only the applicants who had high-school nursing education were admitted to the program. This program was very similar to the nursing associate programs started in 1985. The education period of this program comprised of four academic semesters and the total period was two years. The education was conducted via printed material and television programs. 47.442 nurses, as of 1997-1998 academic year, registered in these programs and 32.626 of them graduated the programs (Kaya & Akçin, 2005; Senyuva, 2007). Nursing Associate Degree Programs stopped admitting students in 1996, with the decision of carrying nursing education to bachelor’s degree. After this period, Turkish Nurses Association was faced with the demands of the nurses with associate degree for topping up their education via open nursing bachelor’s degree completion. Thereupon, Turkish Nurses Association, in order to meet this demand, initiated the studies for a completion program, in cooperation with Anadolu University, conferring on the opinions of the nursing schools. As the association was about to complete its studies, Ministry of Health made a protocol on nursing bachelor’s degree completion program with Atatürk University in 2009. According to the protocol, Atatürk University distance education center would perform the completion training of the graduates of Nursing and Health Officer associate departments/programs working in public or private institutions for a two-year period starting from 2009-2010 academic year (atauzem.atauni.edu.tr/UserFiles/file/ sss_080210.pdf.; Sağlık Bakanlığı 2009). The program started accepting students in September 2009. The lectures in the program are done over the internet; the following of the lessons is not dependent on any time limitation, and any printed material is not given to the students. The visa examinations are performed online over the internet, but the final and repeat examinations are done in person (atauzem.atauni.edu.tr/UserFiles/file/sss_080210.pdf). 13.000 medical staff registered in this bachelor’s degree completion program in 2009 (http://www.memurlar.net/haber/174093). This completion program caused reactions and raised an issue among nurse academicians, bachelor’s degree graduate nurses, graduate program students and especially Turkish Nurses Association. The first one of their concerns was that this completion program, prepared by a university without adequate experience in distance education and without any preparation process, would weaken nursing education. The main reason for this concern was the Ministry providing a quick and easy way for obtaining a nurse diploma, without considering any agreement with the nursing professionals. This would both reduce the quality of the nurses and reduce the motivation of the students in the traditional education system (http://www.saglikmemurlari.com). In the meantime, other concerns included academic dishonesty, the lack of face-to-face interaction, and the time and effort involved in distance education. Despite all criticism, concerns and issues, it is a fact that the distance education programs draw intense interest among nurses working in public and private institutions, and make a positive contribution to the nurses and nursing profession. This program has enabled the rapid rise in the of education level of nurses by offering them the opportunity of having associate and bachelor’s degree diplomas (Kaya & Akçin, 2005; Senyuva, 2007; Dal & Kitis, 2008). Further to this, due to the determination of the education levels of nurses as “bachelor’s degree” in the Nursing Law amended in 2007, and the requirement of having at least a bachelor’s degree in nursing for the Nurse Administration positions (http://www.mevzuat.adalet.gov.tr/html/976.html; http://www.mevzuatlar.com/sy/resmiGazete/rga/10/03/080310001.htm.), the program enabled nurses who completed this program to improve their status. Nurses, working in the public institutions have got the chance of 642 Filiz Kantek / Procedia - Social and Behavioral Sciences 116 ( 2014 ) 639 – 643 advancements in grades and of earning a retirement pension of a better level, and they earned an increase in their supplementary payments such as floating capital. In addition, internet acquaintance of the nurses has increased. This program gave the nurses a chance to learn again, whose education lives had ended years ago. Lessons Learned It can be said that the limited number of applications in nursing caused negative thoughts to arise about distance education among a large number of nurses (especially the bachelor’s degree graduate nurses) and nurse academicians. Probably, the biggest mistake made in distance education in nursing is starting with programs that provide advantage to some certain group. If distance education in nursing was to be applied in courses/certificate programs or traditional education lectures, a negative opinion of this kind would not have occurred. Because, when the arguments of the nurse academicians in Turkey were examined in detail, it can be said that they are of one mind, as are their colleagues in other countries (Mancuso, 2009; Cheryl, Fisher, & Newbold, 2009), on distance education having certain advantageous aspects such as the opportunity to reach remote students, the intellectual challenge and the opportunity to develop new ideas, the opportunity to work with more motivated students, release time, financial reward, opportunities for research, motivation to use technology, the opportunity for recognition, the opportunity to utilize support services, reduced travel, an increased course quality, and increased flexibility. While the experiences are of great importance for the future success of distance learning in nursing in Turkey, the scarcity of distance learning programs and their being uncommon are the problems to be solved. In overcoming these problems, reinforcement of lecturers in distance learning can be an important strategy. Within the scope of these, the strategy applications below can be proposed: 1- Organizing courses/certificate programs on subjects such as planning, organizing and evaluating courses in distance learning, providing feedback, and using technology may provide a preparation to distance education for lecturers. 2- Organizing seminars, workshops, conferences and symposiums about distance education may increase lecturers’ knowledge and willingness. 3- Lecturers who are willing and volunteering distance education may form a network and thus speed up their own learning and may decrease their concerns. 4- Selecting distance education as a thesis topic in graduate programs may increase the awareness of the future lecturers about distance education. 5- Providing funds and support by their institutions may increase the motivation of the lecturers who are conducting or willing to conduct studies on distance education. 6- Cooperation of schools/lecturers who are interested in distance learning with the schools/lecturers who are experienced in this subject may be facilitative in increasing their success. Conclusion Distance education as a means of disseminating nursing knowledge should be strengthened in nursing education in Turkey. The distance learning applications intended at fulfilling the needs of nurses should be continued, avoiding the previous mistakes. Monitoring the recent rapid developments in distance learning applications in Turkey will make a significant contribution to distance education in nursing. In addition, conducting studies on nurses’ knowledge about distance learning, the readiness levels of academician nurses, and on determining the obstacles before the distance education may provide an important data source for monitoring the success and quality of distance learning in nursing in Turkey. References Adalet Bakanlığı. (February 2, 2011). Hemşirelik Kanunu (Nursing Law). Retrieved from http://www.mevzuat.adalet.gov.tr/html/976.html. Accessed February 2, 2011. 643 Filiz Kantek / Procedia - Social and Behavioral Sciences 116 ( 2014 ) 639 – 643 Anadolu Üniversitesi. (2011). Tanıtım (Introducing). Retrieved from http://www.anadolu.edu.tr/aos/aos_tanitim/aos.aspx. Accessed January 25, 2011. Atatürk Üniversitesi Uzaktan Eğitim Merkezi. (January 25, 2010). Sık Sorulan Sorular (Frequently Asked Questions). Retrieved from atauzem.atauni.edu.tr/UserFiles/file/sss_080210.pdf. Accessed January 25, 2010. Bilings, D.M., & Halstead J.A. (1998). Teaching in Nursing: A Guide For Faculty. Pennsylvania, W.B. Saunders Company, 331-345. Billings, D.M. (2007). Distance Education in Nursing: 25 Years and Going Strong CIN: Computers, Informatics. Nursing, 25(3), 121-123. Çakır, O., & Oguz, E. (2010). Situations of Distance Education Institutions in Turkey. Procedia Social and Behavioral Sciences, 9, 1722–1730. Cheryl, A.O., Fisher, C.A., & Newbold, SK. (2009). Developing Online Learning Environments in Nursing Education. New York, Springer, 35- 97. Dal, U., & Kitis, Y. (2008). The Historical Development and Current Status Of Nursing in Turkey. Online Journal of Issues Nursing, 13(2). Available at http://www.nursingworld.org/. Accessed January 25, 2011. Geray, C. (2007). Distance Education in Turkey. International Journal of Educational Policies, 1(1), 33-62. Hodson-Carlton, K.E., Siktberg, L.L., Flowers, J., & Scheibel, P. (2003). Overview of distance education in nursing: Where are we now and where are we going?. Annual Review of Nursing Education, New York: Springer, 165–189. Hyde, A., & Murray, M. (2005). Nurses’ Experiences of Distance Education Programmes. Journal of Advanced Nursing, 49(1), 87–95. Kaya, H., & Akçin, E. (2005). Uzaktan Eğitim ve Hemşirelik Eğitimi (Distance Education and Nursing Education). Hastane Yönetimi (Hospital Management), Ocak-Şubat-Mart, 43-47. Kaya, Z. (2007). Uzaktan Eğitim (Distance Education). Değişim Çağında Yüksek Öğretim, Global Trendler-Pradigmal Yönelimler (in: Higher Education in an Era of Change, Global Trends-Pradigmal Directions). Birleşik Matbaacılık, İzmir. Keating, S.B. (2006). Curriculum Development and Evaluation in Nursing. Philadephia, Lippincott Williams & Wilkins, 351-373. Kocaman, G. (2005). Türkiye’de Hemşirelik Eğitim Sorunları ve Çözüm Arayışları (Turkish Nursing Education Problems and Search for Solutions). Odak Ofset. Ankara. Kocaman, G., Sevig, U., & Kubilay, G. (2008). Türkiye'de Hemşirelik Eğitimi ve İnsangücü Planlaması: Mevcut Durum ve 2013 Yılı Vizyonu (Nursing Education and Manpower Planning in Turkey: Current Status and Vision of 2013). Tıp-Sağlık Bilimleri Eğitim Konseyi Türkiye’de Tıp-Sağlık Bilimleri Alanında Eğitim ve İnsangücü Planlaması Hemşirelik Çalışma Grubu Raporu (Nursing Education and Manpower Planning Working Group Report), Ankara. Mancuso, J.M. (2009). Perceptions of Distance Education among Nursing Faculty Members in North America. Nursing and Health Sciences, 11(2), 194–205. Memurlar Net (January 25, 2011). Atatürk Üniversitesi Hemşirelik Lisans Tamamlama Programına Son Kez Öğrenci Alınacak (Atatürk University Nursing Degree Completion Program Will Be the Last Time Student). Retrieved from http://www.memurlar.net/haber/174093/. Accessed January 25, 2011. O'Neil, C.A., Fisher, C.A., & Newbold, S.K. (2004). Developing online learning environment in nursing education. Best Practices for Nurse Educators. New York: Springer, 1-57. Potempa, K., Stanley, J., Davis, B., Miller, K.L., Hassett, M.R.,& Pepicello, S. (2001). Survey of Distance Technology Use in AACN Member Schools. Journal of Professional Nursing, 17, 7–13. Sağlık Bakanlığı. (2009). Sağlık Bakanlığı 05.08.2009 Tarihli Lisans Tamamlama Programı Genelgesi (Degree Completion Program Circular of the Ministry of Health dated 05.08.2009). Ankara. Sağlık Bakanlığı. (2010). Hemşirelik Yönetmeliği. (Nursing Regulation). Retrieved from http://www.mevzuatlar.com/sy/resmiGazete/rga/10/03/080310001.htm. Accessed February 2, 2011. Senyuva, E.A. (2007). Hemşirelik Eğitiminde WEB Tabanlı Uzaktan Eğitim Uygulaması: Hasta Eğitimi Ders Örneği (Implementation of Web- Based Distance Education in Nursing Education: A Sample Lesson in Patient Education). Istanbul Üniversitesi Sağlık Bilimleri Enstitüsü Doktora Tezi (PhD Thesis), Istanbul. Sit, J.W.H., Chung J. W.Y., Chow M.C.M., & Wong, T.K.S. (2005). Experiences of Online Learning: Students’ Perspective. Nurse Education Today, 25, 140–147. Talbert, J.J. (2009). Distance Education: One Solution to the Nursing Shortage?. Clinical Journal of Oncology Nursing, 13 (3), 269-270. THD Başkanının Lisans Tamamlama Hakkındaki Görüşleri (THD Chairman's Views on The Degree Completion). Available at http://www.saglikmemurlari.com. Accessed January 25, 2011.