E-LEARNING: A COMPARATIVE STUDY FOR KNOWLEDGE APPREHENSION AMONG NURSES

O final do século XX e começo do século XXI caracterizam-se pela revolução tecnológica e as mudanças estratégicas nas organizações, estratégias, como e-learning, vem sendo utilizadas. O objetivo deste estudo foi comparar o conhecimento apreendido entre os grupos de enfermeiros que utilizaram o e-learning e os que receberam o treinamento presencial. A metodologia quantitativa da pesquisa constituiu-se de um método experimental verdadeiro. O local de estudo foi o Hospital e Maternidade São Luiz. A população constituiu-se de 60 enfermeiros que foram divididos randomizadamente em dois grupos, denominados A e B. O grupo A realizou o treinamento presencial e o grupo B, via computador. Na coleta de dados, os participantes preencheram um questionário antes e após o treinamento para avaliação do conhecimento e caracterização da população. Os resultados demonstraram que ocorreu a apreensão do conhecimento pelos dois grupos de forma equiparada, permitindo concluir a eficácia dos dois métodos.


INTRODUCTION
Globalization has made the world more dynamic and highly competitive.To manage and operate their processes, corporations call for human resources with up-to-date abilities, considering the setting in which they take part.In these settings, new techniques, technologies and knowledge are constantly created and changed.Hence, professionals face the need to update faster and constantly*.
Many organizations have developed a range of educational strategies to prepare employees for the new market demands.For this reason, new teaching technologies are constantly being developed, which has encouraged distance learning practices (1) .
In the corporative domain, the use of  (2) .
When planning continuing education and personnel training programs, e-learning should be adopted, aiming at the benefits of using information technology in education.
In nursing, this educational practice is more frequent abroad.The experience of a hospital in Toronto, Canada, in 1995 can be highlighted.They planned a training program for nursing personnel, both on-site and at a distance, during working hours, using the computer as the teaching mediator, based on selflearning (4) .
In Brazil, the development of technologymediated educational programs in the nursing area is linked to university research projects.Therefore, most of them tend to focus on undergraduate courses and health education for clients.This can be confirmed in studies like: an educational program in first aid (5) ; a leap into the future in medication teaching: developing a computer-assisted instructional program (6) ; developing an educational web site about the nursing intervention: tracheobronchial secretion aspiration (7) ; administering injectable intramuscular medications in the ventral-gluteal region: evaluation after training by videoconference (8); educational software about Diabetes Mellitus for health professionals: stages of creation and development (9) ; in-service nursing education delivered by videoconference (10) ; implementing a videoconference system applied to nursing research and teaching environments (11) ; educational technology: creation and evaluation of the site nursing personnel shift (12) ; nursing physical examination of full-term newborns: selfinstructional software (13) .
To reach a market advantage, in which knowledge is a powerful weapon, the São Luiz Hospital For the implementation, basic system access instructions were provided to the multipliers, who were the managers, initially.Later, the supervisors became the multipliers, and the role was passed on, successively, until instructions reached the operational level, that is, all employees, thus decentralizing the education process.These instructions comprised information like how to access the site, how to insert the functional code and create a password.From this moment, the employee would be participating in the

OBJECTIVE
To compare the group of nurses who took part in the e-learning with those who received on-site training, in terms of the knowledge they acquired.

MATERIAL AND METHOD
This present quantitative study uses a true experimental method to compare on-site and computer-mediated training programs.
The experimental research design is used in studies in which the researcher wants to test cause and effect relationships.The true experiment has three identification properties: randomization, control and manipulation (14) .
Randomly assigning individuals to groups involves their distribution to an experimental or control group, on an entirely random basis (15) .
The strength of the true experimental design is its ability to help the research and reader to control the effects of any extrinsic variables that could threaten internal validity.Those extrinsic variables can be antecedent or intervenient.The antecedent variable occurs before the study, but it may affect the dependent variable and cause results to be confusing.
Factors like age, gender, and socioeconomic conditions are likely to be important antecedent variables in the research, because they may affect the dependent variables (14) .
The experimental method was performed in the "Quality Tools" training program delivered to the According to the methodological framework, the stratified random sample requires the population to be divided into layers or subgroups.The subgroups or subsets in which the population is divided are homogeneous.An appropriate number of elements from each subgroup is selected, based on its proportion in the population (14) .
Hence, the 49 participants were randomly divided into two groups: group A (24 participants), The existence of a possible interaction effect between these factors was also evaluated.It is worth mentioning that, when the interaction effect is not significant, the main effects (that is, moment of evaluation and group) can be analyzed directly.On the other hand, if the interaction effect is significant, the behavior factor must be evaluated within the levels of the other factor (12) .The adopted level of significance was 5% (p=0.05).

RESULTS AND DISCUSSION
The research data analysis, as shown in Tables 1 and 2, provides relevant information on the initial proposal.In view of the study objective, which was to compare the knowledge acquired by nurses who attended a traditional training program, i.e. onsite, with that acquired by nurses who used elearning, it should be considered that, in both methods, subjects got a higher score on the posttest, which proves that knowledge apprehension occurred in both methods.
In general, it is observed that both the onsite group and the computer-mediated group got a higher score on the post-test than on the pre-test.
This shows that the number of correct answers was, on the average, higher after the training course, regardless of the form in which it was delivered.
However, the e-learning group reached slightly higher average scores.
For this analysis, the total score of each individual was considered at the first two moments (pre and post tests) for both groups.Tables 1 and 2 present the descriptive measures of the test scores for the on-site and computer-mediated groups.It is observed that average group scores are close, with slightly higher average values in the posttest of the computer-mediated group.This shows that the e-learning strategy is just as effective as on-site learning.
Learning strategies are procedures used in the education process which can be changed to increase learning effectiveness in a specific activity or environment.This means that there are no best strategies.Rather, the strategies are adjusted to the type of activity that is meant to be learned (1) .
Data analysis shows that, in general, scores were lower in the on-site group, for both the pre-test and post-test.The statistical analysis did not give any evidence of significant differences between the average scores of the on-site and e-learning groups (p=0.072).
That is, no significant group effect was observed.
Moreover, an increase in the average score after training (p=0.002) was observed.That is, there was a significant moment of evaluation effect.Hence, it is concluded that the average score on the post-test was higher than that obtained on the pre-course; with average scores (at 95% confidence intervals) of 18.6 (17.9 to 19.3) and 17.1 (16.0 to 18.2), respectively.The statistical analysis did not indicate an interaction effect between moment of evaluation and group (p=0.682).These results show that the average test score increase for individuals who received elearning training was not significantly different from the average increase for individuals with on-site training.Since there was no interaction effect on the estimated model, the main effects could be evaluated.
The comparative results between the training programs showed that programs were effective in both forms, on-site as well as e-learning, since there was an increase in the trainees' average score in both groups, which proves that the presented contents were apprehended.
E-learning provides the opportunity for instructors or teachers to teach better, since it allows them to use a range of both technical and pedagogical teaching tools, as opposed to the old standard oneto-many presentation (16) .
Organizations have been adopting e-learning as a strategy to train and capacitate professionals, thus increasing the company's intellectual capital through knowledge management (17)(18)(19) .
Computer and communication technologies are part of the contemporary society, which pushes people into adapting and using new technologies in their personal and professional lives (20) .
Within this business context, distance learning aims to meet the need for qualified workers, and should be adopted as a new way to educate and not as a "garment" for traditional education, presenting innovative techniques, such as critical autonomy and processes mediated by synchronous and asynchronous communication (21) .

and
Maternity has invested in intellectual capital, developing human competencies related to the institution's policies regarding quality and human resources and adopting e-learning in the personnel training process.In this perspective, the Hospital implemented Phase 1 of the Education Program for Quality through the Total Quality e-learning training.The program plan started on August 25 th 2003, and counted on an education team who planned the content in three months.All operational managers contributed to create the program content.The purpose of this training program was to develop and implement an innovative e-learning Distance Learning project at the Hospital, to train all employees: directors, managers, supervisors, medical teams, outsourced employees and internal partners from other units (Itaim and Morumbi).The program should be carried out in a short period of time, and should not require employees to move from their work site, since there were not enough training rooms or funds for costs with additional rooms, equipment and instructors.The e-learning Total Quality program was implemented on November 1 st 2003, and ended in February 2004.Thus, it corresponded to a training of, approximately, two class hours, for 2500 internal employees and over 600 outsourced employees from the units Itaim and Morumbi.

E
-learning: a comparative study... Paladino Y, Peres HHC.night shift nurses.The control group was composed of trainees who attended on-site training, while the experimental group comprised those who took part in the e-learning program.The nurses were randomly assigned to the groups.However, the antecedent variables were treated because of their potential to affect or confound the research results.The study was performed at the Itaim unit of the Sao Luiz Hospital and Maternity, which is a large scale private hospital, with 397 beds, located in the city of Sao Paulo.The nursing management is directly linked to the Administrative Board, which offers autonomy and power of decision to the nursing team.The nursing staff is composed of 836 nursing employees: one Nursing Manager, five Nursing Supervisors, eight Heads of closed units, 142 head nurses, seven trainee nurses, 165 nursing technicians and 508 nursing auxiliaries.The population was composed of 60 nurses from the night shift, from the Itaim unit, regardless of their job position.The following were excluded from the study: the nurse-researcher who works in the night shift as a supervisor and multiplier of all training programs in her shift, nurses on vacation or on medical leave, and nurses who took part in only one of the research phases.Therefore, the study population included 49 nurses who voluntarily agreed to participate in the study and signed the Informed Consent Form.This population was considered statistically significant for the present study objectives, since it comprised all night shift nurses and presented the characteristics inherent to that shift, mainly regarding work hours and changes in workers' biological clock.Two questionnaires were used to collect the data: one for population characterization, which was created by the researcher, and the other named Pre/ Post-test about Quality Tools, which was created by the Education Team responsible for developing the elearning training program.The pre and post-test questionnaire was administered in the experimental as well as the control group before and after the training programs, in order to evaluate the nurses' knowledge apprehension.Thus, this second instrument was used as a way to check the extent to which nurses learned the facts, principles and methods included in the training program about Quality Tools.This research project was approved by the Research Ethics Committee of the institution where the study took place.All ethical regulations were complied with, and anonymity and secrecy of those involved were guaranteed.After the nurses spontaneously agreed to participate in the research by signing the consent term, the questionnaire was handed out.Thus, it was possible to characterize the nurse group's profile, obtaining the variables of age, time of work at the hospital, time and degree of education, computer knowledge, and participation in computer-mediated courses.These variables were classified as antecedent, which could influence or confuse the research results if they were not previously controlled.Therefore, the population was stratified according to these antecedent variables, thus forming homogeneous subgroups.After this stratification, the subgroups were randomly distributed, forming groups A and B. This avoided any confusion regarding study results.
attended the on-site training program; and group B (25 participants), which took part in e-learning training.The on-site training about Quality Tools for group A was delivered by the researcher to two groups: night shift one (even) and night shift two (odd).The two-hour course was held at the Hospital's training room, which is located outside the complex, at 2 AM.The same content was taught on-site and in e-learning training, using power point presentations.The post-test was administered shortly after each training, using an instrument identical to the pre-test, in which participants informed what they had learned in the on-site training.The e-learning training about Quality Tools delivered to group B was also done in two groups: night shift one (even) and night shift two (odd).The post-test instrument was administered shortly after the end of each training course.The e-learning training courses could be performed using the computers in the sectors and at E-learning: a comparative study... Paladino Y, Peres HHC. the moment the participant chose to be most convenient.However, to assure that there were no interferences from a third party, during the course as well as on the tests, three nursing management rooms, with four computers each, were selected in four night shifts, where the training courses could be performed.The nurses completed the training course in about forty minutes, with no interference.Data were analyzed descriptively, based on the results presented in charts and tables with descriptive measurements (mean, median, standard deviation, maximum and minimum values).The average scores in the different groups and moments of evaluation were compared, using a variance analysis model (ANOVA) with two factors: moment of evaluation (Pre-course or Post-course) and group (on-site or Internet), considering repeated measurements in the moment of evaluation factor.

Table 1 -
Total number of correct answers of the on-

Table 2 -
Total number of correct answers of the

Table 3 -
Descriptive measures for score increase according to training group, Sao Paulo, 2006