Running head: SELF-DIRECTED LEARNING & NURSING

How do Operating Room Nurses Incorporate Technology in their Self-Directed

Learning?
Bassam Adlouni
#56135098
April 5th, 2013
ETEC 500

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Abstract
Learning strategies are vastly developing in the era of the digital world. The effect of
economic, cultural changes and complexity of some professions like nursing necessitates
different strategies to be implemented to meet individual learning needs. Self-directed
learning is a developing strategy which is under study and application on some students
in colleges and universities due to accessibility to information and knowledge that
became easier to attain. However, there is a dearth of researches on the concept of selfdirected learning among nurses in the operating room where high technology and critical
thinking are demanded in such complex environment. Assuming that embracing
technology by nurses in the operating room would direct nurses towards effective selflearning strategies; it would, therefore, promote their nursing skills and critical thinking.
This research proposal is an endeavour to explore the relation between the technology of
the current digital world and the self-directed learning. According to Yuan, Williams,
Fang, and Pang (2012) Self-directed learning will increase choice, confidence,
autonomy, motivation and the development of skills for lifelong learning (p. 427).
Nurses are demanded to assess their learning needs and then find suitable resources
needed to solve their daily problems.
Key words: Self-Directed Learning, Technology, Nurses, Operating Room

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How do Operating Room Nurses Incorporate Technology in their Self-Directed

Learning?
Introduction
There is a dearth of research studies about self-directed learning for nurses in the
operating room. This proposal will be a chance to explore this unvisited area and find out
how nurses in this high sophisticated and complex environment assess their educational
needs, besides the challenges they find in developing their skills and the way they follow
to meet these needs. The findings would be a chance to generalize the result for health
care workers of the closed areas in the hospital services where complex tasks are
performed, an example of these similar areas are: nurses in the intensive care unit (ICU),
coronary care units (CCU), dialysis unit, and many more. Living in a high
communication technology world will definitely open the door for creativity in
developing a core for nurses to perform better by responsible learning. The hypothesis
that I started to work on is that nurses who embrace technology in the closed area, such as
operating rooms, would use it as an effective strategy towards their self-learning goals.
This hypothesis will lead to some queries in the relation of nurses with the concept of
self-directed learning, technology, and factors encircle it. Put it all together, it will raise
the following research questions:
1 Why do nurses in the operating room need to know the concept of self-directed
2

learning?
What are the factors affecting self-directed learning for nurses in the operating

room?
Would operating room nurses in Canada incorporate technologies in their selfdirected learning?
Literature Review
Nursing profession is dynamic and developmental. It absorbs the advancement

and innovation of information and communication technologies to develop, give

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resolution, and for better nursing care. Nurses are aware of the importance of maintaining
the competency and the advancement. However, there are many factors hindering their
ability to achieve their goals such as, shortage of nurses and staff cuts off other
departments [that] negatively impact on time and money for professional development
(Ibbotson, 2006). According to Schloman, as cited by Ibbotson (2006), computer literacy
is the key to keeping information development for professionals. Due to the strong
relation between OR nursing and technology, there is a need for nurses to develop their
information because the technology dominate the OR (Bull & FitzGerald, 2006; Girard,
2007). According to Bull and FitzGerald (2006), this ongoing advancement in technology
and sophistication of equipment is rewarding and challenging. Some of the challenges
are to keep up with the advanced innovations and research findings in this specialised
area (Girard, 2005; Meyer & Writer, 1993).This will motivate nurses to seek all possible
ways to educate themselves to meet their demands. Therefore, to achieve this goal, nurses
have to attend some formal educational sessions that would add to the existing
challenges. Some of these related challenges are the busy life related to the work and
family issues (Cleary & Freeman, 2005). Cleary and Freeman contended that, education
in clinical health settings needs to be flexible, portable and accessible (p. 14).
According to Knowles, as cited by Jennings (2007) self-directed learning is a process in
which individuals take the initiative in diagnosing their learning needs, designing
learning experiences, locating resources and evaluating their learning (p. 518). Selfdirected learning, according to Jennings (2007), is associated with the development of
many skills needed for health care personnel such as critical thinking and confidence.
Self-directed learning is rooted back to the adult learning theory (andragogy)
which is developed by Malcolm Knowles on 1960 as an extension of the idea that first

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founded at the beginning of the last century (HLWIKI Canada, retrieved 2013). Knowles
used the term andragogy to describe the art and science of helping adults learn, as cited
by Hohler (2003). On 1980, the theory started to attract more debates, researches and
attractions. Knowles identified five assumptions in adult learning, self-concept,
experience, readiness, orientation, and motivation. These assumptions encircle the
maturity level of adults in attaining their learning goals. A study conducted by Bradley,
Oterholt, Herrin, Nordheim, and Bjrndal (2005) found that there were no differences
between directed and self-directed learning in evidence-based medicine suggested that
self-directed learning is an alternative to the traditional learning.
Methodology and Data Collection
Participants
Participants for this study will be nurses from the operating room representing 6
different large to mid-size hospitals located in a geographic area of the lower mainland of
British Columbia. A total of 6 nurses will be interviewed representing these different
hospitals that are part of the Fraser Health (FH) /Vancouver Coastal Health (VCH)
authorities. The selection of the sample will be randomized based on the individual
acceptance to be interviewed and the consent to be enrolled in the study dedicating their
time and effort willingly. Confidentiality will certainly be considered at all measures to
assure and maintain the anonymous status.
Instruments
This is a mixed method of action research study, qualitative and quantitative,
using both qualitative and quantitative data in one research. Also, this study will focus
more on the qualitative data, as stage one, to build on analysis and in constructing the
main themes to reach the good recommendations required to move to stage two as a
quantitative stage. The qualitative data will influx more strength and validation to the
study in understanding how nurses in the operating room would become aware of the

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self-directed learning in this complex digital world (Gay, Mills, & Airasian, 2011). The
first stage purpose of the qualitative study is to have a better understanding of how nurses
recognize the self-directed learning and how they would incorporate the technology in
reaching that goal. To achieve this, an interview will be arranged with these 6 nurses
individually, as I will elaborate later during the flow of this abstract. The quantitative
study which includes questionnaires will be developed and constructed by the main
themes raised from that qualitative data. Then, it will be categorized to consolidate
qualitative analyses into main analyses. To check credibility and validity, that additional
intervention of the second stage consists of sending questionnaires to the operating room
nurses of the same hospitals, under this study, asking them to answer some questions and
return it back. These questionnaires must represent the constructed themes from the
qualitative analysis of the interviews conducted on those 6 nurses. According to Gay et al.
(2011), using multiple data resource will give credibility and reliability to research under
the process of triangulation.
Design
This study is a multiple method approach. It depends on the QUAL-Quan model
or as an exploratory mixed method designs because it depends on the qualitative study to
construct the main theme for the quantitative data study that comes on a later stage of
research (Gay et al., 2011). For the qualitative study, I will randomly choose a perioperative nurse who voluntarily accepts to be interviewed. The interview should be
conducted by the same person. And the interview will be face to face, one to one. The
interview will be semi-structured form to have a kind of directing purpose towards the
main title of the study, and freedom for the interviewee to explore his/her ideas. It is
important that the same person conducts all the interviews. This is essential to reflect on

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the personal experience extracted from those interviews. In addition, authenticity it will
be more present in the study due to the construction of the themes from the same
perspective. For the quantitative study: It is going to be a survey study. I will randomly
send questionnaires based on the themes constructed from interviews to test the
connection between the qualitative and quantitative study. This connection would
determine the analyses that would lead the study to construct a generalized
recommendation with strong validity and authenticity. Using interviews and
questionnaires together is a well-known validity tool. It is used by combining the
qualitative and quantitative study like this one to discover convergences and/or
divergences of the comprehensive view of the study; in addition, there are more benefits
such as increase in the confidence of research (Thurmond, 2001). This combined method
is known as triangulation. According to Fielding (2012), this method was used early as 50
years ago as a mean for comparative research purposes and since 2000 it started to spread
sharply as an effective way for integrating the qualitative and qualitative studies.
Purpose
The purpose of this study is to gain an understanding of the concept of selfdirected learning among nurses in the peri-operative area and the relation with the
complex technology that advanced communication and learning. In addition, it will be
vital to construct a theme to test a hypothesis of whether embracing technology by nurses
in the operating room would direct nurses toward an effective self-learning strategies so it
will promote their nursing skills and critical thinking. I have chosen mixed methods for
adapting some purposes from the work of Venkatesh, Brown, and Bala, (2013)
representing the complementarity, completeness, and developmental purposes of
using the mixed method (p. 26). For the complementarity purpose, the mixed methods

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will be used in order to gain complementary views about the same phenomena or
relationships. For the completeness purpose, the aim is to make sure a complete picture
of a phenomenon is obtained (p. 26). While for the developmental one, the purpose will
be to construct themes and hypotheses in the qualitative study, and then, quantitative
study will be conducted to test the hypotheses.
Eligibility
To enroll in this study, the participants must be nurses regardless of their level of
education. They must be working in the operating room area excluding the pre-operative
or post-operative areas. My focus study will be on those nurses working in the surgery
field as scrubbing, circulating, and/or helping in anesthesia. They are often
disremembered in research studies due to some conflict about their practical role in
comparison with the traditional role of nurses in other specialities. Confidentiality will be
guaranteed and no individual nurse names will be released.
Timeline
Phase I. The interview should be conducted within the same month or 2 months at most.
This will keep the interviewer engaged and keep the ideas linked. The Analysis
should start promptly after each interview to keep the fresh ideas. The data
analysis of the 6 interviews should be done after two weeks of the last interview
to give a broader perspective to construct better themes and hypothesis.
Phase II. The questionnaires should be distributed by mail/emails.

Phase 1

Oct Nov/ 2013

6 nurses

/interviews
Survey

Construct questionnaires based on Randomly distributed

phase I findings.

Jan-Feb 2014
-

questionnaires via
mail/email to nurses in

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the OR
December is a busy month, so I prefer not to send questionnaires
Conclusion
Integrating qualitative and quantitative study is necessarily to construct a better

hypothesis and test it in a scientific model. This will give more depth and authenticity to
the findings, besides, this will give more creditability and validity. This proposal
represents a seed that should be implanted to grow up. It opens the door to a better
understanding of the professionals learning needs in this digital fast paced world and
whether it is being met, and addressing the questions about the role of technology within
the learning process.

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References
Adult learning theory (andragogy). (2013, March 19). HLWIKI Canada, . Retrieved
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directed and selfdirected learning in evidencebased medicine: A randomised
controlled trial. Medical Education, 39(10), 1027-1035.
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Venkatesh, V., Brown, S. A., & Bala, H. (2013). Bridging the qualitative-quantitative
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