This article discusses the benefits of using the Internet in nurse education. It notes that while the Internet provides powerful research and educational tools, nurse educators have been slow to adopt these technologies. The article highlights some key Internet technologies that can be used practically in nurse education, such as email for fast and low-cost communication, file transfers, and accessing distant databases and information services. It argues that the Internet provides benefits like improved access to information, more effective communication, and opportunities for collaborative work.

1. Article
Practical applications in nurse
education
Robert M. Ribbons
To a number of nurse educators, the Internet is a new, innovative and exciting teaching and learning
tool. Sadly, anecdotal evidence suggests that many educators remain largely unaware of these new
technologies or their potential to assist in the process of learning. Such a situation is not surprising
given the limited amount of literature detailing the use of the Internet in nurse education and a
profound lack of educational research in the area. This paper will highlight some of the benefits of
the lnternet for nursing students and educators, provide an overview of a number of Internet
technologies and suggest some practical applications of these technologies in nurse education. A
glossary of Internet terms is included.
Introduction movement from one network to another appears
'seamless' to the user. This seamless functionality
The use of computers and information
offers access to a host of information and
technologies in education has been the focus of
communication resources including ,electronic
research for more than 20 years. This research has,
mail (e-mail), discussion groups, remote
on the whole, revealed a number of benefits for
databases, file transfer applications and the much-
educators and students alike. The use of
touted World Wide Web (WWW or Web).
computers in teaching and learning has been
Increasingly, information for nurses, by nurses,
found to be as effective as conventional
can be found on the Internet (Wink 1995, Murray
methodologies (Kulik et a11980, Kulik & Kulik
1996). A number of authors have espoused the
1987, Bennett 1991), can enhance the
Internet's benefits to nurses and nursing in terms
learning/teaching environment (Ploeger 1983,
of increased access to information sources,
Newborn 1985, Wepner 1991, Procter 1992, Cohen
improved communications and collegiality
& Decanay 1994) and provide cost- and time-
(DuBois & Rizzolo 1994, Nicol11994b, c, Yensen
effective alternatives to traditional teaching
1995), and enhanced clinical practice and research
Robert M. Ribbons methods (Wittich & Schuller 1979, Kulik et a11980, (Fawcett & Buhle 1995, Thomas 1995, Yensen
RN, ICCert, BAppSc 1983). However, the recent growth in networked
(Nur), MEd (Ed
1995, Game 1996). There have also been a number
computer use, and specifically the Internet, has
Computing), Senior of papers documenting the process of ~'getting
Lecturer, Nursing not, as yet, been the subject of such research. connected' (Nicol 1994b, Thomas 1995). However,
Informatics, School The Internet has existed in a number of guises very little has been written outlining the use of
of Nursing, Monash since the mid-1960s and now effectively connects
University, these technologies in nursing education. In fact, it
McMahons Road, millions of computers worldwide. It has often
has been suggested that educators have been slow
Frankston, Victoria been referred to as a network of networks as it to adopt these technologies due to a failure to
1399, Australia. incorporates all sizes and types of networks
Tel: 61 3 99044019, understand the role and benefits of teaching
Fax:61 3 99044130, regardless of machine platform, network strategies that employ Internet techno]logies in the
E-mail: Bob.Ribbons architecture or operating system (Nicoll 1994a). classroom (Ingvarsen 1995).
@Nursing.monash. This loose connection of thousands of smaller
edu.au
networks means that boundaries between
(Requests for networks are broken down. A single command
offprints to RI~ R)
Benefits of the Internet
can take the user to a network across the street or
Manuscript
accepted: on the other side of the world. Despite a What are the benefits of using the Internet in
29 April 1997 bewildering maze of underlying technology, nurse education? Internet technology represents
© 1998 Harcourt Brace & Co. Ltd Nurse Education Today (1998) 18, 413-418 413

2. Practical applications in nurse education
perhaps the most powerful research and all are relatively easy to implement given a network
educational tool to emerge since the printing configuration, Internet access, and appropriate
press. Every day, more institutions important to software and hardware.
nurses are offering access to computerized
databases via the Internet. The ability to remotely
E-mail
access these resources multiplies the benefits of
such access. More importantly, access to this E-mail is the world's fastest growing form of
information can be achieved in a time- and cost- communication (Ebbs & Horey 1995). E-mail is a
effective manner. This equates to enhanced access little like sending a letter and a little like making a
to rapidly changing information, cost- and time- phone call, but quite unlike either. E-mail is
effective communications, the promise of undoubtedly a time- and cost-effective form of
collaborative intra- and international ventures as communication. By way of example, the author
well as the possible use of innovative teaching recently had to send a manuscript to the USA. It
and learning strategies such as distance took 11 days to arrive by airmail at a cost of
education and 'virtual classrooms'. $US6.30. Had the manuscript been sent via e-mail
Specifically, access to the Internet provides to the same destination, it would probably have
nurse students and educators with a host of arrived within a minute or so and all for the cost
benefits including the ability to: of a local telephone call. Is it any wonder that
surface mail is now being nicknamed 'snail mail'?
• Exchange e-mail messages (not just locally, but
Its ease of use ensures an improvement in the
internationally)
level of communication among colleagues and
• Transfer computer data, text and graphic files
students. Students are able to make appointments,
• Connect directly to and use distant information
address questions regarding course information,
services / databases
check on academic performance or apply for
• Participate in, and obtain information from,
assignment extensions directly to their educator
special interest group mailing lists
without having to see the educator in person. This
• Obtain electronic journals such as the Online
improves time management, as students do not
Journal of Knowledge Synthesis in Nursing and the
have to waste time looking for the educator and
Australia ElectronicJournal of Nursing Education.
the educator can deal with requests at a time most
All this equates to instant access to a rapidly suited to his or her schedule. Student e-mail
changing and expanding sphere of nursing and accounts can also be used to facilitate group work
health care information. and distribute lecture notes and tutorial
information. In the not too distant future, audio
Practical applications of the and video will be a regular function of standard
e-mail services.
Internet
The integration of Internet technologies into the
Internet mailing lists
curriculum is a daunting task. The success of
implementing such technologies will rely on them Many readers may already be aware of the special
becoming ubiquitous: a seamless integration of interest group mailing lists or listservers
these technologies into existing nursing curricula. (NRSINGED, NURSENET and NRSING-L for
This task requires enormous commitment from example). There is an increasing number of these
nursing faculties in the form of sizeable investments listservers, covering an enormous range of nursing
in capital equipment, technical support and interests and include nursing research and clinical
educational technology know-how. The process practice, school nursing, i.v. therap3~ home care and
demands cultural and structural change and must hospice nursing, nurse practitioners, to name but a
occur if nurse educators are going to adequately few. The user subscribes to the group by sending
prepare graduates to work in an increasingly an e-mail to a listserver. The listserver is simply a
technological health care arena. The following computer that holds a list of all members of the
represent a number of practical applications of group. Whenever one posts an e-mail to the list, the
Internet technology that may be used to facilitate listserver accepts the message and then sends a
such preparation. From a technological viewpoint, copy of the posting to every member of the group.
414 Nurse Education Today (1998)18, 413~418 © 1 9 9 8 Harcourt Brace & Co. Ltd

3. Practical applications in nurse education
These mailing lists give the user direct access to to be addressed in the near future. Specific
hundreds of like-minded clinicians and academics nursing-related newsgroups can be found at
throughout the world, m a n y of w h o m are at the sci.med.nursing, a general forum for all nursing
forefront of research in their chosen fields. This issues, and alt.npractitioners for nurse
characteristic makes listservers invaluable for practitioners.
postgraduate students and academics wishing to
keep up with issues that concern nurses in their
File transfer protocol
particular specialties or to access information that
would have been impossible to obtain using File transfer protocol (FTP) allows the user to
conventional methods. access and transfer files between two computers,
Nurse educators should encourage students to FTP allows access to computers where y o u have
join a list of their interest. In fact, there is a no account. This is done b y using an ' a n o n y m o u s '
listser~er designed specifically to provide an account. There are a n u m b e r of FTP specific
electronic forum for nursing students (Snurse-L). software available but the easiest form of access is
Lists of Iistservers can be found on the Web. One simply via a Web browser such as Netscape or
such site, The Directory of Scholarly and Mosaic. Typically, a directory called ' p u b ' is where
Professional E-Conferences, can be found at software and utilities can be found. In terms of
h t t p : / / n 2 h 2 . c o m / K O V A C S / W h e n used in a practical application, there are a n u m b e r of
course addressing professional issues, listservers nursing FTP sites where staff and students can
can be used to facilitate and reinforce the concept download software, search for information (text,
of the 'global nursing village'. graphics) that can enhance research or teaching
and obtain technical support.
Newsgroups
Internet video
Newsgroups work by having posted messages
available for public consumption, like putting a This technology provides the user with the ability
message on a notice board. The most common to send and receive audio and video via the
newsgroup network is Usenet. The estimated Internet. It involves the use of a small video
n u m b e r of active newsgroups varies widely from camera (the size of a tennis ball) motu~ted on a
around 15 000 to 50 000 (Northwestern University computer, a video and sound blaster card and the
1997, Virtual Interactive Center 1997). Internet video software such as CU-SeeMe. The
Newsgroups can also be set up to run specifically person on the other end needs the same sebup. A
on a local area network, acting very m u c h like an small w i n d o w on the screen runs the video image
electronic bulletin board. When used on a local of the person y o u are talking to and the sound
area network, such a configuration could be used card carries the audio signal. Although still in its
to facilitate an electronic tutorial or virtual infancy, this technology effectively provides
classroom. Members of the tutorial need not all online video conferencing for not much more than
meet in one place at the same time. Timetabling the cost of a local telephone call. This technology
and room allocation could be used in a more will be able to greatly enhance communication
dynamic way. Capital intensive resources such as with colleagues, researchers and students, as it is
tutorial rooms might be used more effectively for able to convey m a n y of the subtle nuances of
other purposes. conventional one-on-one communication: a
Electronic tutorials could be an effective characteristic sadly lacking in e-mall
method of sharing information and m a y facilitate communication. Internet video technology also
critical thinking and questioning, particularly by holds great promise in the development of cheap,
students who are usually reluctant to contribute in effective distance education.
traditional tutorial settings. Even these 'quiet'
students would be free to ask questions in a safe,
World Wide Web
supportive environment. Student newsgroups are
student-focused but can be moderated (vetted) by The Web represents the graphical part of the
facilitators. Giveff the increasing cost of education, Internet, incorporating text, full colour graphics,
the advantages of this form of education will need sound and video. The Web is based on a
© 1998 Harcourt Brace & Co. Ltd Nurse Education Today(1998) 18, 413-418 415

4. Practical applications in nurse education
mechanism called hypertext, which acts to 'link' these situations to reinforce the need for students
pages together. By selecting a highlighted word or to develop effective search skills and critical
section of a Web page, the user is able to jump to analysis of information.
another page that m a y be on the same computer
or on a computer on another continent. The Web
has been designed to sit on top of other Internet
Conclusion
applications such as FTP, e-mail, Gopher and What impact will developments in Internet
Telnet, providing access to a variety of technologies have on nurses and nurse
information using a piece of software known as a education? Where will the so-called 'information
browser. The browser is configured in such a w a y superhighway' lead nursing? It is impossible to
as to be able to display on screen the native Web say. It is fair to say that these technologies will
' p r o g r a m ' language HyperText Markup Language change forever the w a y we communicate, do
(HTML). business, research, teach and learn. Increasingly,
Given the open nature of the Web, students are students exposed to the Internet at home and at
also free to publish material on it. This can be school will enter college or university education
done in a number of ways. Depending on confident and comfortable with the technology.
university or school policies, students might be This trend will increase over the next 2-5 years
permitted to establish their own homepages, or and present a serious challenge to nurse
information generated from class projects or educators who are not conversant with the
presentations might be converted to HTML and technology.
linked to a school or course homepage. Provided In order to help students to navigate the
the quality content can be ensured, this represents information highways, nurse educators need to be
a cost- and time-effective w a y of increasing the able to recognize trends in this rapidly changing
number of nursing specific Websites. Students environment. They will also need to be ready to
might also be charged with the responsibility of implement revolutionary educational changes.
maintaining or updating specific homepages. These changes will require a collaborative
One recent variation of this technology is that relationship between nurse educators, technical
of Intranets. Intranets work in essentially the specialists, students and the technology itself. A
same w a y as the Internet, but the information great deal of educational research in the area is
carried on them is only available to users within a called for as little, if any, has been conducted thus
local area network (LAN). Rather titan publish far.
information and make it available to the world, However, as educators, we cannot afford to
the technology can be used to publish documents wait if we are to harness the enormous potential
for in-house consumption only. Course outlines that Internet technologies hold for teaching and
and material, school information, evaluations, learning. The use of these technologies should be
application forms and the like can all be carried implemented at all levels of the curricula as a
on the LAN with substantial savings in both clinical, educational and research tool. The
ecological and financial terms. The technology can Internet is certainly not a panacea for the m a n y
also be used by educators and students alike for educational ills we face but it can contribute to a
presenting lectures, course seminars and richer, more dynamic learning environment.
workshops.
Difficulties in finding appropriate information Glossary
on the Web have recently been elucidated (Nicoll
Anonymous FTP: A File Transfer Protocol that allows
1994a). The anarchic nature of the Web and the
retrieval of files from public sites.
sheer volume of information it contains can pose
Archie: A network tool that searches anonymous FTP sites
significant hurdles for the novice. The advent of for files.
Web search engines has, in some respects,
BITNET: 'Because It's Time Network', a collective of
exacerbated rather than solved the problems of academic networks.
information retrieval. All too often, one is Browser: Client software that allows you to access the World
confronted with m a n y thousands of documents Wide Web.
resulting from a single search query, the bulk of Client: A program that can request services from another
which will be useless. Nurse educators can use computer called a server.
416 Nurse Education Today (1998)18,413-418 ©1998 HarcourtBrace& Co. Ltd

5. Practical applications in nurse education
Disk Operating System (DOS): A program that controls It is a little like holding a telephone conversation but
the operation of the computer. It uses a command line instead of talking, the parties type their responses.
interface, the basis of which is often called the DOS Internet service provider (ISP): An individual or
Prompt. organization who, for a regular fee, will offer connections to
Domain name: A unique address of a computer on the the Internet accessed by dialling up the provider via a
Internet. It is made up of a number of subdomain names telephone line (a dial-up account).
that are Used to group computers together. For example, all Intranets: A network using the same protocols as the
computers in educational institutions will have an .edu in Internet and requiring the same Web browser software.
their domain name, while all commercial sites will have However data carried on an Intranet is only available to the
.corn as the domain. All Australian sites are grouped under users within a Local Area Network (LAN).
.au while all sites in the UK are characterized by .uk. It is
interesting to note that sites in the USA do not have a IP: See Internet Protocol.
geographical domain name. IRC: See Internet Relay Chat.
DOS: See Disk Operating System. ISDN: See Integrated Services Digital Network.
Download: A computer process whereby a file from a ISP: See Internet Service Provider.
remote host computer is transferred to your computer over Java: Developed by Java Microsystems, Java is
a network link. programming language, similar to C++ and used
E-mail: An electronic message that is transferred over a specifically for the production of W W W applets. Applets
computer network to other computers. are small executable Web applications.
File TranSfer Protocol (FTP): An Internet standard for Kbps: Abbreviation for describing the speed of data
transferring files. transmission in thousands of bits per second (kilobits per
second).
FTP: See File Transfer Protocol.
LAN: See Local Area Network.
Home page: The initial page for an individual or
organization on the WWW. The term also relates to the Listservers: See Mailing lists.
hypertext page first loaded by a Web client. Local area network: A localized network of computers
Host: A computer that is directly connected to a network located in the same building or within a limited
and provides services to many users. A host computer will geographical area. See WAN.
run server software as a means of interacting with a Login: The act of connecting to a host computer. The
number of clients. process usually requires the user to type in a ]ogin name
HTML: See Hypertext Markup Language. (username) and a password.
HTTP: See Hypertext Transport Protocol. MacWeb: Graphic User Interface client software developed
by EINET, for Macintosh users.
Hyperlink: Relationship between two objects on the Web.
Mailing lists: A list of individual subscriber's E-mail
Hypermedia: Multimedia hypertext.
addresses. These are used by a mail server which
Hypertext: Text that contains pointers to other text. automatically receives, copies and distributes an E-mail
Hypertext M a r k u p Language (HTML): Standard language message to every member of the mailing list.
of the WWW. Modem: This device is used to transfer digital signals from
Hypertext Transport Protocol (HTTP): Standard protocol a computer into analogue signals that can then be
of the WWW. transmitted over a standard telephone line. This process is
Information superhighway: An amalgam of computer, called MOdulation. Analogue signals are DEModulated
television and telecommunications technologies that will back into digital signals.
provide high-speed data transmission to a large portion of Mosaic: Graphic User Interface client software developed
the population cheaply and efficiently. Once implemented, by NCSA. For both Windows and Mac.
the information superhighway promises to deliver a wide
Netscape: Graphic User Interface client software for
range of 'infotainmenff services such as online shopping,
Windows PC platform.
banking, movies, music, games and general and specific
information facilities. Newsgroups: A collection of electronic messages relating to a
specific topic or group of topics mostly on the Usenet. Usenet
Integrated services digital network (ISDN): A digital
topics are arranged into a hierarchical naming system.
network Capable of delivering two medium-width digital
channels and one narrow data channel. The bandwidth Point to point protocol (PPP): A type of Internet Protocol
rating is at least 64 Kbps. often used for serial Internet connection.
Internet: Contraction of 'international networks'. An PPP: See Point to point protocol.
international collection of networks running TCP/IP. Protocol: The rules that two computers must follow to
Internet protocol (IP): Stores data in packets that carry the exchange messages.
address of the computer for which the data are destined. Serial: A means of computer communication in which
Internet relay chat (IRC): A form of communication in digital data are sent one bit at a time, one after the other,
which the user types comments to other users in real time. over a serial line.
©1998 Harcourt Brace & Co. Ltd Nurse Education Today (1998)18, 413~18 417

6. Practical applications in nurse education
Serial line intemet protocol (SLIP): A protocol used to Fawcett J, Buhle E L 1995 Using the Internet for data
connect a single host to an IP network using a serial collection: an innovative electronic strategy. Computers
connection such as a telephone line. in Nursing 13:273-279
Server: A program that provides a service to a client. Game C 1996 Nursing-related information and data: what
is the role of computers in nursing practice? Collegian 3:
Shockwave: Developed by Macromedia, this application 20-22
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over the WWW.
7:40-42
SLIP: See Serial line internet protocol. Kulik J A, Kulik C C, Cohen P A 1980 Effectiveness of
SMTP: Simple mail transfer protocol. computer-based college teaching: a meta-analysis of
findings. Review of Educational Research 50:525-544
TCP: See Transmission control protocol.
Kulik J A, Bagert R L, Williams G W 1983 Effects of
TCP/IP: See Transmission control protocol/internet protocol. computer-based teaching on secondary school students.
TELNET: Internet standard protocol for remote terminal J Ed Psych 75:19-26
connection. Kulik J A, Kulik C C 1987 Review of recent research
Transmission control protocol (TCP): The network literature on computer-based instruction.
protocol used by host computers on the Internet that Contemporary Educational Psychology 12:222-230
ensures correct transmission of data. Murray P J 1996 Click here - and be disappointed?
Evaluating web sites. Computers in Nursing 14:
Transmission control protocoFInternet protocol (TCP/IP): 260-261
In combination, these protocols provide the method by Newbern V B 1985 Computer literacy in nursing education:
which computers communicate over the Internet. TCP/IP an overview. Nursing Clinics of North America 20:
directs Internet traffic through the Internet. 549-556
Uniform resource locator (URL): A standardized syntax Nicoll L H 1994a An introduction to the Internet, part I:
used by the Internet to describe the location and method of hisfor~ structure, and access. Journal of Nursing
accessing Internet resources. Each URL is a unique address Administration 24:9-11
and consists of a number of elements: the type of service, Nicoll L H 1994b An introduction to the Internet, part Ih
the domain name of the host, the port address, and the addresses and resources. Journal of Nursing
pathname of the file. Administration 24(5): 11-13, 59
URL: See Uniform resource locator. Nicoll L H 1994c An introduction to the Internet, part III:
the Internet and other online services. Journal of
Usenet: See Newsgroups.
Nursing Administration 24(7/8): 15-17
WAIS: Wide area information server. Northwestern University 1997 'NU Frequently Asked
WAN: See Wide Area Network. News Questions'. Northwestern University frequently
asked news questions.
Wide Area Network: A network of computers not located
http: //grumpy.nsg.nwu.edu/news/nufaq.html
in the same geographically limited area. A network that
(2 April)
extends beyond the local computer network, essentially
Ploeger F D 1983 The effectiveness of microcomputers in
consisting of a network of networks. See LAN.
education. ERIC document ED 246 876. Southwest
World Wide Web: A graphical system for storing, retrieving Educational Development Lab, Austin, TX
and presenting information stored on computers connected Procter P 1992 Nurses, computes and information
to the Internet. technology. Chapman & Hall, London
WWW: See World Wide Web. Thomas R 1995 Nursing on the net. Australian Nursing
Journal 3:18-21
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