Learning Nurse Newsletter - June 2012

Welcome to the June 2012 edition of the Learning Nurse Newsletter. We try to publish three times a year to keep nurses, nursing students, nursing educators and other interested parties informed about is what happening at LearningNurse.com. (For more timely updates, follow us on Twitter.)

Learning nursing today.How do Nurses Learn?

Never before in the history of mankind has so much knowledge been generated on a daily basis! Therefore, it is critical that nurses keep constantly learning to stay on top of the latest developments and skills in order to maintain their professional competence.

With so much learning to do, the challenge is to find ways to make the acquisition of knowledge and skills as efficient and effective as possible. This has become complicated in recent years by the invention and proliferation of the new information technologies such as the Internet, iPods, iPads, mobile phones, virtual worlds, avatars, gaming technology, and significant advances in e-learning tools and strategies. Information, and therefore learning opportunities, and now virtually available anytime and anyplace on the planet!

How nurses learn is not just a theoretical issue for us here at the Learning Nurse. With limited resources, we are constantly striving to develop and produce the best and most efficient learning materials possible for our global audience.

Adult learning

There has been much research over the last 50 years on how adults learn. The key factors appear to be as follows.

1.  Adults need to know why they have to learn something before they are willing to invest time and energy in learning it. A clear purpose for the learning activity is essential.

2.  Adults need to be in charge of their own learning. They want to take responsibility for what, where, when and how they study, as well as understanding the process of learning itself.

3.  Adults come from a wide variety of backgrounds and have different ranges of experience. Learning activities need to be designed to take into account, and exploit, this diversity.

4.  Adults are ready to learn when they need to apply a skill or knowledge to the real world to be able to cope effectively with real-life situations. Application to the real world is paramount for motivation, and also aids retention of knowledge and skills.

5.  Adults are task-focused and learn best in the context of using learning activities to achieve outcomes they want to accomplish.

[Source: Whitton, Nicola. Learning with Digital Games. Routledge, New York, 2010, p 36.]

Learning styles

One factor that has received a fair amount of attention in the past is the concept of preferred learning styles. This theory postulates that all adults have a preferred style / approach to learning, i.e. visual learning, auditory learning or kinesthetic / tactile learning. The visual learner needs to see the information in a visual format and learns best from written information, diagrams and pictures. The auditory learner needs to hear information and learns best from lectures, podcasts and conversations. The kinesthetic / tactile learner prefers to receive information through touch and feel, and learns best from hands-on labs and physical demonstrations and practice.

To help us understand how nurses learn, we thought it may be worthwhile to analyze the data we collected on our Preferred Learning Styles Profile, part of our Personality Diagnostics Tests. This anonymous test measures a person's preferred learning style by generating visual, auditory and tactile scores based on the answers to 45 questions. The range for each learning style score is from zero to one hundred.

Our Preferred Learning Styles data sample included the results from 367 individuals. This group consisted of 90% females and 10% males. The occupational breakdown was 20% nursing students, 25% LPNs and 33% RNs. The rest were aides, educators and other nursing and non-nursing persons. Some 54% of our respondents had worked for less than 5 years, and 21% had been nursing for more than 20 years. Most of the nurses (41%) worked in a hospital or acute care facility.

Figure 1 below shows the distribution of preferred learning styles by gender. Out of a total of 367 respondents, 57% were predominantly visual learners, 21% were tactile learners and 13% were auditory learners (the other 9% were equal combinations of two or more styles). (The 13% auditory learners might explain why only 3% responding to our LN poll indicated they would like to see more podcasts added to the website. It may also explain why very few people listen to the narration in our Right Drugs Quiz.)

Figure 1: Distribution of Preferred Learning Styles by Gender

Although the number of males in our sample is relatively small (n=32), it is interesting to note that their preferred learning styles are different from the females. Some 34% of our males were visual learners, another 34% were tactile learns and 19% were audio learners. This compares to some 60% of females who were visual learners with 19% being tactile and 12% being audio learners. We do not know whether the males were in nursing or some other profession, but the differences are interesting.

As our usual practice, we wanted to compare the preferred learning styles among different types of nurses. The results are shown in Figure 2.

The "All" category is included for comparison purposes. We only included the data from the groups had some significant numbers, i.e. student nurses (n=61), LPNs (n=77), RNs (n=102) and nurse educators (n=15). The latter sample size is small but we thought it would be interesting to compare the preferred learning styles of nurse educators to their students and practicing nurses.

Figure 2: Distribution of Preferred Learning Styles by Nurse Type

The nursing students were similar to the overall sample with 57% being visual learners, and another 20% each split between audio and tactile learners. With the Practical Nurses, some 68% were visual learners with only 8% being tactile and 10% being audio learners. The Registered Nurses were lower than LPNs in the visual learning but with a greater percentage of tactile learners. Among the nurse educators, some 73% indicated a preference for visual learning and the other 27% were mostly tactile learners. No nurse educator in our sample preferred the auditory style of learning.

Another analysis that we did was to compare the preferred learning styles to years in the work force. This is shown in Figure 3. Again, because of cell sample sizes, we selected only three categories, i.e. 5 years or less (n=158), 11 to 15 years (n=28) and 26 to 30 years (n=47).

Figure 3: Distribution of Preferred Learning Styles by Years of Work

It seems from the data that the longer you have been working, the more likely your preferred learning style is visual, and the less likely your learning style is tactile. One possible explanation is that experienced nurses know the hands-on component of their work very well, but still need to absorb new information about procedures and regulations (which is a visual / reading activity).

Finally, we compared the preferred learning styles by work location. Again due to small sample sizes, we only compared hospitals (n=126), continuing care (n=27) and home care (n=23). We included non-nurses (n=50) to see whether nurses' learning styles differ from other professionals. The results are shown in Figure 4.

Figure 4: Distribution of Preferred Learning Styles by Work Place

Continuing care nurses are more likely visual learners (70%) compared to hospital nurses (59%) and home care nurses (48%). On the other hand, home care nurses are more likely to be tactile learners (30%) than continuing are nurses (11%) and hospital nurses (21%). Those working in other non-nurse professions tend to be mostly visual learners followed by tactile learners.

In conclusion, there certainly are some differences in preferred learning styles among the different groups examined. However, we do not know whether the differences are based on the types of individuals who are drawn to these work environments, or whether the work influences the preferred learning styles of nurses over time.

Does it matter?

One observation that struck us from our analysis was that the ratings for visual, auditory and tactile were often not very far apart! This suggests that although individuals may have a preferred learning style, no one style is so dominant that most individuals can easily switch to other learning approaches.

To test this hypothesis, we calculated the average (mean) scores for the three different learning styles - visual, auditory and tactile. The results are presented in Table 1.

Table 1: Average Learning Style Scores by Groups

 All 367  70  65  61
 Female 285 70 65 61
 Male 32 64 65 56
Students 61 69 64 59
 LPN 77 73 64 65
 RN 102 69 66 60
 Educator 15 68 64 64
 5 years or less 158 69 65 60
 11 to 15 years 70 70 64 61
 26 to 30 years 73 73 64 63

N = number; AVS = average visual score; ATS = average tactile score; AAS = average auditory score.

Looking at the data, it is obvious that the differences between the styles are not very large. For example, for the overall sample, the average visual score was 70, followed by a mean score of 65 and an average score of 61. The same pattern is found when comparing the average scores across the different sub-groups. There is not a lot of variation. Looking at the individuals' scores, the same pattern is evident.

This may explain why learning style preferences are no longer discussed much in the education and training literature. In reality, human beings are adaptable and flexible when it comes to their learning. The time and effort required to customize and tailor learning resources to particular minor learning preferences is simply not worth the investment or benefits.

Maybe a better way to look at learning styles is to analyze the learning preferences profiles. This is the learning styles arranged from most preferred to least preferred. Reconfiguring our data we found the following distribution.

  • VTA    36%
  • VAT    27%
  • TVA    15%
  • ATV    8%
  • AVT    7%
  • TAV    6%

Over a third of our respondents belong to the Visual-Tactile-Auditory group of learners. The second largest profile group was the Visual-Auditory-Tactile learners. The third group was the Tactile-Visual-Auditory group at 15%.


What conclusions have we reached from this mini-research study? Most learners are flexible and adaptable when it comes to a preferred learning style. If there is a slight preference, our data shows that over half of our learners are visual learners, followed by tactile learners.

Auditory learners are a small minority. This suggests to us that developing strictly auditory learning materials is not an effective use of our resources since these learners only account for about 13%. Strictly audio materials such as podcasts, audio lessons for iPods, and narrated quizzes are now a low priority.

On the other hand, e-learning materials that contain words, pictures, images, photographs, diagrams, charts and animation - features that appeal to visual learners - will continue to be a high priority. To accommodate the tactile learners - who enjoy using computers - we now strive to build as much interaction as possible into our learning materials.

Visual learners benefit from flashcards when studying. This may explain the high use of, and interest in, our nursing learning games. Tactile learners have trouble staying still or in one place for a long time. Our tactile learners would therefore benefit from our learning materials becoming available on mobile devices such as laptops, iPads and smart phones. Developing learning materials with these considerations in mind will benefit most of nurses that use our Learning Nurse website.

After all this analysis and introspection, we conclude that developing quality e-learning materials according to the current best practices and strategies will easily meet the needs of most of our learners - regardless of their preferred learning style!

Learning Nurse Users

Analyzing the Learning Nurse website statistics from January 1 to June 30, 2012 shows the following:

  • 85,400 unique visitors (IPs), almost as much as all of 2011
  • 140,400 visits with 1.76 million page views and 180 GB of traffic
  • 24 hour traffic (many from night shifts) with Monday, Tuesday and Wednesday being the busiest days
  • Over 20,800 visits were 30 minutes or longer.

The geographical locations of Learning Nurse visitors were as follows:

  • 44% from the United States
  • 12% from the Australia
  • 9% from Great Britain and 9% from Canada
  • 3% from the Philippines, 3% from India, 3% from Malaysia and 2% from New Zealand
  • The rest of the traffic came from 40 other countries - United Arab Emirates, China, Columbia, Cypress, Egypt, Ireland, Israel, Iran, Jamaica, Japan, Korea, Kuwait, Pakistan, Portugal, Saudi Arabia, Singapore, etc.

The Learning Nurse website has a loyal following with a high rate of repeat visits. This is demonstrated by:

  • Some 74% of visitors come directly from a bookmark or URL entry
  • 20% come to the website from a search engine - Google, Bing and Yahoo; "learningnurse" and "nursing quiz(zes)" are the most common search terms with Learning Nurse being listed at the top of these search engines
  • Only 5% of traffic comes from links on other websites with Facebook being the top referrer
  • Over 85% of visitors bookmarked the website in 2012.

Despite the fact that our visitors are increasing every month, we are still a long way away from reaching the approximately 6 million English speaking nurses on this planet.

New, Improved and Planned

Since the January 2012 Newsletter, we have made many additions and updates to the Learning Nurse website. These include:

  • Added 7 new quizzes on clinical microbiology
  • Added 13 new quizzes on diseases and disorders of body systems
  • Added a Nursing Practice III quiz
  • Added a Drug Classifications quiz
  • Added 3 quizzes on medical charting including computer and legal aspects
  • Updated Medication Abbreviations quiz to include those abbreviations no longer in use.

Some 26 new / updated quizzes with 2,230 questions have been added to our Test and Quiz section. The total number of nursing quizzes is now 160 with 11,140 questions.

Other significant additions to our learning resources include:

  • New advanced competency self-assessment tools - 215 self-assessment forms covering over 3,200 nursing competencies
  • A new section - Nursing Educational Games - with 33 fun games for learning vocabulary and concepts
  • We updated our statistics on the number of nurses world wide.

We still have 4 quizzes on pain management that we need to finish. Our other priority is to continue to develop innovative nursing computer games and simulations. These seem to be popular and high on our visiting nurses' wish list.

Quiz Results

We now have 160 nursing quizzes with 11,140 questions. However, from our poll at our Test and Quiz Center, nurses say they want even more quizzes!

As of this writing, over 228,000 Learning Nurse quizzes (with over 5.7 million questions) have been completed and recorded. Between 200 to 500 quizzes are now done every 24 hours! The quiz results are tracked on the website in real time, both in a searchable query table, and in a series of statistical reports for each quiz. Here is a summary analysis of the quiz results to date.

The 15 most popular quizzes were: (N)
  • Anatomy Terminology I (18,089)
  • Anatomy Terminology II (8,156)
  • Disease Terminology I (7,886)
  • Medical Terminology I (7,183)
  • Anatomy and Physiology (6,161)
  • Safe Medication Principles (5,406)
  • Cardiovascular System (5,090)
  • Endocrine System (4,362)
  • Word Roots ((4,232)
  • High Blood Pressure (4,090)
  • Disease Terminology II (4,002)
  • Cardiology Terms (3,860)
  • Blood Components (3,817)
  • Tablet Dosage Calculations (3,793)
  • Diabetes I (3,605)
The 10 least completed quizzes were: (N)
  • Antiviral Drugs (25)
  • Antifungal Drugs (34)
  • Protozoa (55)
  • Herb-Drug Interactions (64)
  • Helminths (70) 
  • Phobias (104)
  • Immune Disorders (105)
  • Rectal Disorders (106)
  • Integumentary Disorders (109)
  • Viruses (113).

The complete list of the Learning Nurse quiz results sorted by descending frequency can be seen here.

Average scores were computed for all of the completed Learning Nurse quizzes.

The 20 highest scoring quizzes were: (average percent)

  • Medication Abbreviations (90%)
  • Fluid Dosage Calculations (89%)
  • Injection Dosage Calculations (89%)
  • Tablet Dosage Calculations (88%)
  • Intravenous Flow Rates (86%)
  • Managing Patient Rage (84%)
  • Cardiology Terms (83%)
  • Metric Conversion (83%)
  • Drug Classifications (82%)
  • Nervous System Terminology (80%)
  • Legal Risks (79%)
  • Safe Medication Principles (II) (79%)
  • Musculoskeletal System Terminology (78%)
  • Respiratory System Terminology (78%)
  • Digestive System Terminology (77%)
  • Anatomy Terminology II (76%)
  • Antidotes (76%)
  • Reproductive System Terminology (76%)
  • Urinary System Terminology (76%)
  • Endocrine System Terminology (75%)
The 15 quizzes with the lowest average scores were:
  • Antiviral Drugs (43%)
  • Cancer Risks (44%)
  • Nutritional Disorders (45%)
  • Dangerous Drug Combinations (45%)
  • Antibacterial Drugs (46%)
  • Diarrhea (47%)
  • Diagnostic Tests (I (47%)
  • Viruses (49%)
  • Substance Misuse (49%)
  • Skin Disorders (49%)
  • Mental Status (49%)
  • Herb-Drug Interactions (49%)
  • Antifungal Drugs (49%)
  • Phobias (50%)
  • Helminths (50%).

The complete list of the Learning Nurse quiz results sorted by descending average scores is available here.

About Learning Nurse

The Learning Nurse Resource Network (LearningNurse.com) was created by Steppingstones Partnership, Inc. and went online in April 2008. The purpose of this nursing professional development resource is to make available free, informal, accessible and convenient learning opportunities for nurses. Because of the shortage of nurses in many facilities, it is very difficult to get away for traditional courses and workshops. This is particularly true in smaller and rural areas where it nearly impossible to obtain leave and funding to attend professional development events.

Although the Learning Nurse was originally designed for all levels of practicing nurses, it has become popular with nursing students, graduate students and nurses returning from leaves. Many of the visiting nurses take time during breaks in their night shift to review and refresh their nursing knowledge and skills using our quizzes and e-learning modules.

That's it for now. If you have any questions, comments or suggestions, please let me know. Thanks for your continuing interest and support.

Best regards,

Russ Sawchuk
Webmaster and Editor

Note: Permission is granted to reprint all or part of the information in this newsletter provided that the source - LearningNurse.com - is credited.


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