Feasibility of Mobile Devices for Nursing Practice Education final

The Feasibility of Using Mobile Devices in Nursing Practice Education Richard F Kenny1 Athabasca University 2083 Valley View Drive, Courtenay, BC, Canada, V9N 8L9 rickk@athabascau.ca Caroline L Park Athabasca University 219 Academy Road, Winnipeg, MB, Canada, R3M 0E3 clpark@athabascau.ca Jocelyne M.C Van Neste-Kenny Pamela A Burton Jan Meiers North Island College jvannest@nic.bc.ca, Pam.Burton@nic.bc.ca Jan.Miers@nic.bc.ca Abstract This paper focuses on an exploratory evaluation of the use of m-learning in nursing education We report on Stage of the formative evaluation of a project to integrate mobile learning into the Bachelor of Science Nursing curriculum in a Western Canadian college program Third year nursing students and instructors used Hewlett Packard iPAQs for five weeks in a practice education course in April - May, 2007 The iPAQs provided WiFi and GPRS wireless capability and were loaded with programs such as Microsoft Office Mobile 6.0 and the 2007 Lippincott Nursing Drug Guide Our participants found the mobile devices supplied to be easy to learn and comfortable to use They felt that the devices were readily portable and the screen size sufficient for programs designed for this medium However, they nonetheless had difficulty using the wireless connectivity afforded by the devices and found that, despite an initial orientation, they did not have time to fully learn the devices in the context of a busy course We concluded that it was feasible to implement mobile devices in nursing practice education, but that further investigation is needed on the use of m-learning for communication and interactive purposes Key Words: Nursing education, practice education, mobile learning, m-learning, FRAME Model Background Keegan (2002, 2005) declares that the future of distance education is wireless and notes that there has never been a technology that has penetrated the world with the depth and rapidity of mobile telephony He claims that the challenge for distance educators is to now develop pedagogical environments for mobile devices Kukulska-Hulme and Traxler (2005) view mobile technologies as most significantly supporting learning that is more situated, experiential and contextualized within specific domains, as well as the creation and use of more up-to-date and authentic content In healthcare, the high acuity and pace of practice in institutional environments, combined with an explosion of knowledge and technology, increasingly requires practitioners to access and process clinical data efficiently by drawing on current resources to support safe care and evidence-informed practice at the point of care Moreover, the shift of client care to the community requires that the education of health care professionals take place increasingly in this more autonomous and diverse practice environment where resources are not readily accessible, where client acuity is increasing, and where more traditional methods of directly observing and working with students are not as feasible Addressing these challenges requires new approaches and tools to support the teaching and learning of health care professionals The FRAME Model In our on-going study of m-learning in nursing education (Kenny, Park, Van Neste-Kenny, Burton, & Meiers, in press), we have used the Framework for the Rational Analysis of Mobile Education model (FRAME), (Koole, 2005; in press; Koole & Ally, 2006) to guide our understanding of m-learning Koole describes m-learning as a process resulting from the convergence of mobile technologies, human learning capacities, and social interaction, from the interaction of the device, learner, and social aspects of learning The Device Aspect describes the physical, technical, and functional components of mobile devices, i.e., the medium through which mobile learners interact and which can have a significant impact on the physical and psychological comfort levels of the users The Learner Aspect refers to the individual learner’s cognitive abilities, memory, and prior knowledge, and to those situations and tasks in which a learner needs to succeed The Social Aspect refers to the processes of social interaction and cooperation Individuals must cooperate to exchange information, acquire knowledge, and sustain cultural practices The intersections between these three aspects are seen as Device Usability, Social Technology, and Interaction Learning Device Usability relates the characteristics of mobile devices to cognitive tasks and to the effective manipulation and storage of information, while Social Technology describes how mobile devices enable communication and collaboration amongst multiple individuals and systems Interaction Learning focuses on social interaction Participation in learning communities and cognitive apprenticeships Jocelyne Kenny, Pamela A Burton and Jan Meiers, North Island College, 2300 Ryan Road, Courtenay, BC, Canada, V9N 8N6 can provide socially based learning environments in which learners can acquire information and negotiate meaning All of these components then interact to define the m-learning process Mobile Learning in Nursing and Nursing Education Nurses have been using mobile devices during the past decade for many reasons These include such functions as to keep task lists, as memo pads, as calendar/date books, to access clinical reference material, for e-mail and for Internet access (Cahoon, 2002; Rosenthal, 2003; Stroud et al., 2005) Newbold (2003) lists such additional potential clinical applications as interdisciplinary consultations, electronic ordering and test results, patient histories, progress notes and assessments, references, protocols, and prescription information, while nursing instructors have used the devices to keep records of student assignments, checklists for completing physical assessments, as a source of point-of-care reference (drug software) and to document student progress on-the-spot (Lehman, 2003) Goldsworthy, Lawrence and Goodman (2006) reported that student nurses showed a significant increase in self-efficacy in their preparation for medication administration while using PDAs and Miller et al (2005) found that students utilizing PDAs had increasing numbers of questions when in the practice setting, as well as a greater recognition of the need to use current resources Other reasons why nurses recommend PDAs for use in practice include their light weight, their convenience, the decrease in medication errors they afford (as their use is safer than relying on memory), the immensity of the information they make available, and their use to explore options with clients (Davenport, 2004; Park, 2006) The Relationship between FRAME Model and Research on Mobile Learning in Nursing Research on health care professionals’ use of PDAs tends to focus on the aspect of device usability (e.g., Cahoon, 2002; Newbolt, 2003; Rosenthal, 2003) and shows that they are early adopters of PDAs as content providers Nurses use mobile devices to access content such as information on drug interactions and for such tasks as sending pharmacy and laboratory requisitions The ongoing recording of patient information is also facilitated (Cacace, Cinque, Crudele, Iannello & Venditti, 2006; Thomas, Coppola & Feldman, 2001) The social technology aspect, on the other hand, is the least explored component in the research literature Stroud, Erkel, and Smith (2005) and Park (2006) both found students mentioned email as the only interactional use of the PDAs As a result, we conclude from our review of the literature (Kenny et al., in press) that there has been little research on interactional use of PDAs by health care professionals and that the connectivity potential of mobile devices for teaching and learning has not been fully explored M-learning potentially may afford learners access to immediate and ongoing access to information, peers, and experts who can help them determine the value of information found on both the Internet and in their real-world environments (Koole & Ally, 2006) The research reported in this paper focuses on an initial, exploratory study of these possibilities within the context of nursing practice education Methodology This study was a two stage formative evaluation of the use of mobile devices in Nursing practice education Stage was a one-on-one trial designed to test the feasibility of the use of the iPAQs with nursing students before their introduction into a real life nursing class Two instructors and three volunteer students in the final year of a year Baccalaureate Nursing Program at a western Canadian community college participated in this part of the study The results of Stage are reported in Kenny et al (in press) This paper reports on the results of Stage 2, in which we conducted a field trial of mobile learning in a real life Nursing practice education course Research Setting Stage 2, then, examined the use of mobile devices in Nursing 357, a nursing practice education course held in April May, 2007 This course was five weeks in duration and was a consolidating experience held at the end of third year The class was taught by the two instructors who participated in Stage The study participants consisted of two groups: a mobile learning group of 12 students and a comparison group of students For the m-learning group, we included all three students in community placements and randomly selected the remaining nine from those students placed in two local hospitals The remaining students were asked to participate in the comparison group The m-learning group used the Hewlett-Packard iPAQ Model 6955, which is a combined pocket PC computer, mobile telephone and digital camera, and which provides both WiFi2 and GPRS3 wireless capability The participants were supplied with both those programs included with the iPAQs (Microsoft Office Mobile 6.0, Internet Explorer and Pocket MSN Messenger) and additional software, including the 2007 Lippincott's Nursing Drug Guide, and Davis’ Lab and Diagnostic Tests, the Skype audio conferencing program, and Acrobat Reader Mobile, which was loaded onto the devices in advance Evaluation Questions This stage of the study was designed to answer the following questions: Can the use of mobile devices be implemented and sustained in independent nursing practice education settings? WiFi networks are short range, high-bandwidth, networks primarily developed for data transmission and use IEEE 802.11 standards GPRS, or General Packet Radio Service, is a wide area, mobile data service available to users of Global System for Mobile Communications (GSM) and IS-136 mobile phones It provides data rates from 56 up to 114 Kbps 3 Will nursing students and instructors find the use of mobile devices to be appealing and comfortable in real life instructional settings? Is the use of mobile devices feasible and practical in nursing practice education settings? Study Design Stage was a full field trial Tessmer (1993) indicates that field trial evaluation should be conducted in actual situations that contain all of the elements of the learning environment We tested the use of the mobile devices in the actual instructional circumstances under which m-learning would be used with full adoption of this instructional approach, that is, in Nursing 357, a nursing practice education course Several forms of evaluation data were collected in Stage 2: • A pre-study demographics survey, • A post survey of student use of the mobile devices in the course, • A post survey of comparison group computer activities in the course • Semi-structured interviews with mobile learning group participant students to detail / follow up on survey results This was a purposive sample to ensure representation of different practice settings and included the three participants in community placements • Cell phone and data download statistics and cost data on faculty and mobile group device usage Analysis The pre-study demographic survey was tallied and descriptive statistics compiled The interviews were transcribed and coded using AtlasTi© software Each interview was coded by two research team members independently and then the codes were merged The codes were next discussed by the research team and consolidated codes were grouped into networks or themes Findings Evaluation Question 1: Can the use of mobile devices be implemented and sustained in independent nursing practice education settings? Prior knowledge of computing and of mobile devices The survey data and interviews revealed that most of our participants felt quite comfortable with personal computing All had owned a personal computer for at least years prior to the study and all used devices with the Microsoft Windows operating system None reported discomfort with personal computing Eight students indicated they were somewhat comfortable with computers and reported being very comfortable Their experience with m-learning, on the other hand, was limited Thirteen participants owned mobile phones and six owned a PDA or a smart phone For most of the participants, however, this was their first experience with a PDA – style pocket computer They all had used MS Windows, MSOffice, and Hotmail on desktop or laptop computers, but not on PDA style devices They were also aware that there was nursing software for PDAs, but most had not used it Despite their lack of direct experience with PDAs, all but two participants reported that they were at least somewhat comfortable with these devices This was a somewhat curious self rating since their prior experience clearly was only with mobile telephones and, to a lesser extent, digital cameras built into their mobile phones, rather than with the functions and software provided in the HP iPAQs (See Table 1) Feature None Beginner Competent Experienced Telephone 2 Photography 5 Email 3 Internet 2 Text Messaging 6 Audio Messaging 2 Word Processing Spreadsheet 10 1 Database 10 1 Nursing Software N = 15 Two participants did not complete this part of the survey Table Prior Expertise with Mobile Devices The interviews, however, revealed that this comfort was largely based on their experience with desktop computing rather than as a result of the applications on mobile devices specifically Terrie’s response exemplifies this: Well, I have a fee… being comfortable on a computer is a good start, because… to me it’s a little version of a computer, right? Especially with the Windows program and such If you’re comfortable on a computer and how to search the internet… different addresses and just how to a basic search… you would need that sort of knowledge Learning the Mobile Device Features It was not a simple task for our participants to learn all the features available on these devices The mobile devices contained a wide range of software and provided our participants with a variety of built-in features They had access to three different keyboards: a) a touch screen keyboard, b) a thumbing keyboard, and c) a near full sized, detachable, folding keyboard The devices also allowed the transcription of hand writing (using the stylus on the touch screen) to text In addition, our participants could use either WiFi hotspots or GPRS wireless connectivity to send email, browse the Internet, or use an audio conferencing program such as Pocket MSN Messenger or Skype For the study, the iPAQs were set up with local service GPRS connectivity and WiFi was available both on campus and in spots around the community (e.g., coffee shops) as well as the home networks of some participants The mobile learning group was provided with a two hour orientation to the devices at the beginning of the study They were directly introduced to a number of these features and provided with time to practice under supervision Features taught during the orientation were: a) use of both the touch and thumbing keyboards, b) cursive to text transcription, c) how to enable wireless connectivity (WiFi and GPRS) for email and Internet browsing, d) use of the nursing drug and lab values software, and e) use of text and audio messaging (e.g., Skype) Any further instruction after the orientation was done on individual request to the instructors No technical support was provided by the community college In fact, our interviewees indicated that they felt no need for technical support beyond that provided by the instructors nor had they required more training Instead, they would refer to the user manual provided or would figure out how to use the application on their own A comment from May exemplified this attitude: ‘Mmmm Well the orientation session was really helpful Uh… in learning how to use it That basically answered pretty much all of my questions on… on learning to use the device Other things… I didn’t really encounter too many problems Other things I just kind of figured out from trial and error…’ Table reports the mobile group participants’ views from the post survey on the ease of learning the various mobile applications Curiously, while participants largely reported that the mobile applications were easy to learn, this viewpoint was not necessarily based on their direct experience with the mobile applications beyond the orientation as the usage data showed that participants engaged in minimal use of GPRS connectivity to download data Only two of the twelve mobile group members downloaded more than 10 MB of data over the five weeks The rest used MB or less and most (eight students) did not use this feature at all This would imply that they did not use the devices to access the Internet or send email while they were in their practice experiences since neither hospital and none of the other placements were they were assigned had WiFi hotspots One hospital did have WiFi in the cafeteria, but not on the wards GPRS connectivity, therefore, would have been the most likely way for them to use these applications in practice Application Very Difficult Difficult Relatively easy Easy Telephone 0 Email 5 Browsing Internet 0 6 Text messaging Pseudonyms are used in place of participants’ actual names 5 Audio messaging 4 Pocket Word 1 Pocket Excel 4 Drug software 0 Lab software Total 44 46 Table Ease or difficulty in learning the mobile applications When asked in the interviews about how well they learned to use the mobile devices, participants raised two main concerns that explained why at least some of the participants may not have learned to use them well First, most students found that, because of the intensity of the one month practice experience, they lacked sufficient time to focus on learning the devices and, therefore, tended to not use them as much as they might otherwise have done It was a voluntary, not required, learning activity Joan explained this issue: ‘I thought it was really very neat and I I feel a little bit bad that only in the last couple of weeks just started getting in to it more I think I was really quite overwhelmed with everything else getting started and it was really busy where I was, so I wasn’t utilizing it as much, so I had um… not remembered everything that I had sort of learned, so it took a little bit more to start learning things But the last couple of weeks I really started using it a lot more and started to enjoy… and not feel afraid of it.’ The second issue was that the students did not own the devices They felt less inclined as a result to invest time in learning to use them and also were afraid to damage what they viewed as expensive devices Joan also noted that: ‘I think a longer period of time would have lended itself well… just to the fact that you needed that… okay, like putting everything into the calendar, for instance Right, well you spend this time loading it all in and it’s only for this amount of time and as it was, you know, our time was very, very limited, short with things You know, in terms of assignments and clinical and doing extra things and ’ Evaluation Question 2: Will nursing students and instructors find the use of mobile devices to be appealing and comfortable in real life instructional settings? Ease of Use Despite the apparent complexity of the devices, especially the number of features to learn, our participants uniformly claimed that these devices were easy to learn and easy to master overall In addition to the orientation, our respondents found that they only required a few hours learning on their own afterwards to become comfortable with the use of the iPAQs In the post survey, when asked to indicate how long it took them to learn various applications, nearly 78% of all responses from mobile group participants were that it that it took then one hour or less Of the various programs on the iPAQs, our participants found the Nursing software to be most user-friendly and reported this to be the software they used most in the trial They also found Pocket Word simple to use since it was a reduced version of the desktop computer version When asked which programs she found easiest to use, Alice commented: Alice: ‘Both Drug guide, the drug manual and the… um, procedures…’ Interviewer: ‘Mmhmm.’ Alice: ‘…the procedures And the Microsoft Word was actually really easy to create a Word document And I’m technologically challenged, so if I can it, anyone can it! ’ Portability One of the most pervasive arguments for mobile learning is the perceived ready portability of mobile devices Our participants generally agreed that the iPAQs were portable, but they tended to find it somewhat heavy for carrying attached to their uniforms Joan’s comment is representative of how the devices were carried: ‘It was fairly portable I mean, because I had my big bag with me and it also fit in my purse too, so I could actually take it with the… uh… if I was leaving the office and I didn’t take my big school bag I could pop it in my purse or take it with me when we were going to see clients or clipped on too… most of my of my clothing it clipped on okay, but if I was wearing a skirt that was a little bit thinner and it would pull it down a little bit right? I would feel uncomfortable wearing it, it was better when I had jeans on Like, something that was a little bit more heavier weight to it’ Size of the screen Kukulska-Hulme and Traxler (2005) considered that mobile technologies might be most useful to support learning that is more situated However, this implies that users can comfortably and effectively use their mobile devices for the specific task at hand When asked about the screen size of the devices, our respondents had varying opinions, but tended to point out that it was too small for many tasks they needed to carry out They found it acceptable for purposes such as consulting the drug reference program, but not for browsing web sites or reading or creating word processing documents where they found themselves having to scroll both vertically and horizontally through the document Alice, for example, commented: ‘Um… I found that it was great, like as far as looking up, um, the drugs or the procedures or IV… procedures or what not But um, for Word documents, I found, without the keyboard, the screen… it was very difficult with the small screen to type an actual full Word document’ Barriers to use As was the case in Stage 1, the feature that posed the most difficulty for participants was wireless connectivity Despite orientation to this feature, few of our participants were able to make the GPRS data connection work when using the devices on their own and they were also unable to use wireless connectivity in the hospital Local hospitals in our region still tend not to allow the use of wireless devices on the wards for fear of causing medical equipment to malfunction and, therefore, neither supply WIFI connectivity nor allow the use of GPRS devices a the bedside Terrie commented on the inconvenience and her resultant choice not to use her mobile device connectivity in practice: Terrie: ‘I couldn’t have the Internet on in my practice for some reason… I just left it off because I didn’t know what the issues were… with that, and I… and I couldn’t access I tried to get on to it at the [local area] hospital, I couldn’t get internet on the… what’s it? Hi-Fi?’ Interviewer: ‘Wi-Fi’ Terrie: ‘Wi-Fi, yeah I couldn’t pick it up on my… well on my floor I could in the cafeteria, but… so I didn’t really use internet up there a lot’ During Stage trials, the instructors and research team discovered one other barrier that promised to seriously impact Stage of our study, but were unable to remedy the problem in time Participants were not able to use the iPAQs to access the WebCT course website that was the main vehicle for communications and for sharing of resources in the nursing practice course The issue appeared to be with Java scripting and, at the time of writing, the problem still has not yet been resolved, which will necessitate a switch to the Moodle LMS, which can be accessed by mobile devices This highlights the need for the use of learning management systems and web sites that have been designed specifically for mobile use (e.g., Google Mobile) Joan’s comment highlighted the problem: ‘And I guess it would have made it better had we been able to access WebCT, because that’s where I was sending all my documents from home, right?’ Evaluation Question 3: Is the use of mobile devices feasible and practical in nursing practice education settings? Our participants expressed mixed feelings about whether or not they found the use of these mobile devices in this specific practice experience to be useful This course was of short duration (five weeks) and the students were quite busy Table reports the mobile group post survey responses pertaining to the usefulness of the mobile applications in their practice experiences and shows that students were nearly evenly split in their assessment The applications rated most useful were, in descending order, the Nursing programs (drug reference and lab values), the mobile telephone and Pocket MSWord (tied for second), email (third) and browsing the Internet (fourth) Application Useless Telephone Email Rarely Useful Sometimes Useful Frequently Useful 5 Browsing Internet Text messaging 3 Audio messaging Pocket Word 3 Pocket Excel 2 Nursing software Total 29 22 21 23 Table Usefulness for completing course learning activities When asked about their specific use of the mobile applications, eight mobile group participants indicated that they used the Nursing programs at the bedside to verify information at least five times and seven of them used these programs more than ten times during their practice experience However, only two participants reported using this information for patient teaching and only one did so more than five times The participants also indicated in the interviews that they found the drug reference and lab values software the most useful application When asked how she might use mobile devices in her overall Nursing education, Alice commented: ‘Um… well for anything that I’ve just mentioned, for… looking up… Um the biggest thing for any student, I would say, is looking up medications that you’re unfamiliar with Looking at the weights for, um, complex procedures like blood transfusions, that’s right at your finger tips and it’s accurate and up to date Um, plasma transfusions, um, like compatibility of IV fluids and stuff, um…’ This response highlights the fact that nine of the twelve mobile group members were in hospital placements, while only three were in community placements Those students in the hospitals would have been much more likely to have to given medications on a daily basis and, therefore, more inclined to verify drug information Nurses’ use of PDAs to reference content, however, is already well established in the research as discussed above Our team was most interested in the use of mobile devices to foster more active communications between the students and their instructors when out in the field as well as to improve communication among students We thought that nursing students would feel more need for communication when were out in community placements such as clinics and even patients’ homes, than when in hospitals When asked if they used the mobile devices for communicating with instructors or fellow students, our participants indicated that, for the most part, they did not (See Table 4) The figures in parentheses in Table show the responses of the three students in community placements Only one of the three actively used the phone and text messaging to communicate with fellow students, which would imply that these students did not need to communicate any more regularly than students in hospital placements In their interviews, these participants reaffirmed that they did not feel the need for frequent communication, but the reason surprised our instructors and highlighted a problem with these placements Students in the community placements tended to be placed in passive, observational roles, rather than to be engaged in direct nursing care themselves As a result, they were not involved in making decisions about the care of patients and, therefore, felt no need to seek the support and advice of their instructors or fellow students A comment by Joan highlights this circumstance: ‘I’m sure… I mean I can totally see in the hospital how it would be really very valuable having that right beside you at the bedside I mean I guess I don’t see it as valuable because I didn’t need to access information right on the spot and use it when I was in clients’ home when we went on home visits and stuff like that Because the information that they give people, it’s all in pre-packaged, kind of a package that we give people for home visits, for baby visits and stuff And anything that we’re needing to record there, it has their preset type of sheet that they have ‘ Never 1- times - times 5- times > 10 times Communicating with other students Telephone (1) (1) (1) Email (2) (1) 1 Text messaging (1) (2) 1 Audio messaging 12 (3) 0 0 Total 33 Percentage 68.8 16.7 0.0 6.3 8.3 Communicating with instructors Telephone (2) 1 (1) Email (1) (1) (1) Text messaging (1) (1) 1 (1) Audio messaging 12 (3) 0 0 Total 22 17 2 Percentage 45.8 35.4 10.4 4.2 4.2 Table Usefulness for completing course learning activities Conclusions In past work (Kenny et al., in press), we have pointed out that nursing care is moving to the community where client complexity and acuity is increasing and where up-to-date information at the point-of-care is critically needed to support practice As a result, the delivery of nursing education requires physical mobility throughout the community and does not lend itself to more traditional direct teaching supervision models The purpose of Stage of this study was to test the use of m-learning to support teaching and learning interactions in this context, that is, in a real life nursing education class The answers to our evaluation questions tended to confirm what we had learned in Stage We asked if m-learning can be implemented and sustained in independent nursing practice education settings This question is closely related to the second evaluation question concerning the appeal and comfortable use of mobile devices by nursing students and instructors and to the issue of ease of use The results again show that our participants believed that the use of mobile devices in practice education is both possible and desirable They uniformly reported they were comfortable with personal computing in general and with mobile devices specifically Despite having to learn a number of features to use the iPAQs effectively, they reported them to be easy to learn and master overall Our participants particularly found the nursing software (drug reference and lab values) and familiar programs such as Pocket Word simple to learn and to use at the point of care They also found the devices to be readily portable and the screen sufficiently large for many uses However, despite direct teaching and practice of the feature during the orientation, few of our students were able to make effective use of the GPRS data connectivity when using the devices on their own It is likely that a more thorough orientation and more practice of these features would be needed before students will feel comfortable with the interactional uses of mobile devices This failure to fully learn and use the devices is likely also related to the pilot nature of the experience Even though they thought the iPAQs did not take long to learn, when faced with an intensive, one-month, practice experience, the students found that they did not have sufficient time to focus on learning the devices and, therefore, tended to not use them fully in their learning It was a voluntary, not required, learning activity, and, therefore, overall, not a full test of m-learning in this context This concern was compounded by the fact that the devices did not belong to the students nor did they have them for an extended period of time It is doubtful, therefore, that they wished to devote the time and energy into fully integrating them into their learning Finally, we wished to determine if m-learning was useful in nursing practice education settings Our results appear to indicate that m-learning is useful in this context, at least to a degree Our participants referred to the Nursing software as the most useful feature of the mobile devices for their nursing practice experiences They found the devices convenient for immediate reference and easy to access when needed They also thought that the devices were sufficiently portable for use in practice, although a bit heavy to carry in a nursing uniform They judged screen size to be suitable for programs, like the nursing software, designed for mobile use, but not for such purposes as browsing a full web site on the Internet or creating a full word processing document However, our participants did not find the mobile devices useful for communication purposes despite including a mobile phone They encountered a hospital culture and policies that precluded the use of wireless devices in those settings and had difficulty with connectivity in any case The most serious impediment was the inability to use the iPAQs to access the course website This was the main vehicle for both accessing course documents and for posting messages to the instructors and other students It will be necessary to resolve this problem if m-learning is to be effectively implemented in future in this or related practice education courses In conclusion, Stage of our study confirmed that the use of m-learning, at least with mobile devices providing the breadth of features afforded by the HP iPAQ, is feasible in actual nursing practice education settings At a minimum, mobile devices have the potential to be very effective in allowing students and instructors ready access to resources at the point-of-care We have not yet been able to determine if the interactive and communication uses of mobile devices are can be used in this setting This needs to be more thoroughly investigated in future investigations Future Research The voluntary nature of the learning activity in this pilot study highlights the need for a more extensive trial of mlearning in which the use of mobile devices is an integral part of the course The authors are now planning a study of Mlearning in a Nursing practice education course to be offered over a thirteen week period in the winter, 2009, semester Instructors and students will first be oriented to the devices and asked to practice the specific features of the devices around campus and the community for two months (November – December, 2008) before the course begins The use of the mobile devices in the course will be compulsory in order to support the learning of nursing technology learning skills specified among the Nursing program learning outcomes Students will be asked to search for information through the use of reference software on the mobile devices and on the Internet and to communicate with faculty and other students through email, web-based discussions and voice over internet protocol (VOIP) audio technology In addition, while we continue to believe that mobile technology can facilitate learning in this context by assisting instructor – student and student – student communication, we feel that we need stronger theoretical support for this conviction This has led us to consider the application of the Community of Inquiry (COI) model (Garrison, Anderson, & Archer, 2001) to m-learning in this context, to how improved communication might help to build and maintain learning community by increasing learners’ cognitive presence and teaching presence We also believe that the COI and FRAME (Koole, 2006; in press) models have considerable overlap, with the latter likely describing a subset of the former specific to m-learning, and intend to investigate further this relationship References Cacace, F., Cinque, M., Crudele, M., Iannello, G., & Venditti, M (2004) The impact of innovation in medical and nursing training: A hospital information system for students accessible through mobile devices Proceedings of mLearn 2004, the 3rd World Conference on Mobile Learning Rome, Italy Cahoon, J (2002, April) Handhelds in health care: Benefits of content at the point of care Advances in Clinical Knowledge 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Is the use of mobile devices feasible and practical in nursing practice education settings?