Bernard et al. (2009) conducted a meta-analysis on three different types of distance learning (e-learning) and analyzed 74 studies for:

1. Student–student interaction

2. Student–teacher interaction

Student–content interaction
The authors gained some insights as they reviewed the literature to include the problem of comparing distance education to classroom instruction. Such comparisons take away from a deeper assessment of what is useful for just improving distance education alone. They determined that classroom instruction best practices do not translate well to distance learning best practices, and this comparison between distance and in-seat education has been the focus of most distance learning research.

In addition, the authors found that there are examples of distance education that are better than and worse than classroom instruction methods for increasing student achievement. The two distance educational strategies included in the analysis were asynchronous (mostly correspondence and online) and synchronous (mostly teleconferencing and satellite based). The authors found asynchronous was more often superior to classroom instruction in terms of achievement and student attitudes about the course. However, asynchronous distance education has more challenges with course completion. This certainly would suggest the need for additional research on what constitutes quality achievement for e-learning courses. In my own experience, I also see higher grades for e-learning courses versus classroom instruction, but I believe there is a serious shortcoming in how we assess learning for e-learning courses as well as compare the two methods related to long-term knowledge retention.

From an affective experience perspective, Bernard et al. (2009) found studies that support the need for student–student interaction and student– teacher synchronous or a blended distance educational experience in order to have positive affective student experiences. The authors believe there is a social presence and personal satisfaction that is derived from these live connections. The overall study results suggest that student–teacher interactions “are less effective, possibly more difficult to implement consistently, or provide less added value than student–student or student–content interactions” (p. 1259). The second result “suggests that increasing the strength of interaction treatments affects achievement” in a positive way (p. 1260). This seems to be true for any form of distance education. This would also be supported by theories on relational-centered or learner-centered teaching as being valuable to improve student achievement.

The third result of this affective distance education study “suggests that stronger student–content interaction treatments provide achievement advantages over weaker student–content interaction treatments” (Bernard et al., 2009, p. 1260). This may seem obvious and brings up the question why the authors even examined this issue. The fourth result suggests “the combination of student–student plus student–teacher [interactions] was not significant” (p. 1261) for improving student achievement. This seems to be borne out by the next result, as it invalidates our preconceived notions regarding better distance education using combined methods. The fifth question was to assess the difference between the asynchronous and synchronous versus mixed forms of distance education. The idea of mixing methods has been seen as more
effective by Bernard et al., but this was not validated by the data analysis. There does not seem to be any advantage in mixing methods. Their study does not offer much insight into how an affective experience might be created during distance education, but the potential is there for synchronous methods that experiment with strategies for improving the relationship between the students or between the student and the instructor.

Imagine a teaching method that shows some humanism during the interactions, an open dialogue asking for critical reflection on issues of power, or preconceived assumptions versus posttreatment assumptions. This study does help clarify that quality teaching needs to be present either in distance education or classroom instruction. Both are at risk for lacking in affective pedagogy and potentially having teachers who would be labeled as traditional or surface teachers.

Shen, Wang, and Shen (2009) studied how to improve e-learning using emotion feedback to correct the misperceptions of the e-learning content. They believed e-learning should generate positive learning achievements and also improve student engagement in the learning process if the content could have an immediate correction based on the instructor knowing the emotions being generated by the student. These authors were interested in determining if adding an emotional content feedback correction would improve learner outcomes. There are a few significant issues that present themselves in this study. The first is the technique of measuring affective–biological (emotion) data (e.g., heart rate, skin conduction, electroencephalography [EEG], and blood pressure using finger electrodes). The more serious question is their use of one subject being tested over a week and collecting 43,200 data points. Certainly such an approach risks generalizability, but probably it gives the reader some idea of the effect of the process for this one student. The most common emotion during the experiment was confusion that was quickly turned into engagement when the e-learning module operators were able to see the emotional response of the student. The emotional correction method was 91% more effective in promoting learning than the method of not providing corrections for emotional responses. However, it is hard to imagine how this can be effectively conducted on more than one subject and then compare the findings. This was such an extensive study on an N = 1 that it seems impossible to conduct these measurements on a substantially larger number of subjects.

Assessing a student's emotional response to some learning event may seem to be impractical. However, this may be what is happening when excellent teachers intuitively assess for emotions such as frustration or confusion in a classroom, and then make corrections in the moment or for the next session for improved learning. It would be ideal to say that affective teachers are those who have their emotional antennae out in order to catch the collective emotion of the class and then make subtle changes that are smooth, nonshaming, and offer clarification to what is being discussed. Maybe the clarification comes in the form of a personal experience that represents the issues using
thick description and storytelling—two very useful affective strategies. This would be much more difficult to assess in a typical e-learning or distance education process. It might be something for future assessments of students' emotional tone to have a skin conductor attached to every computer used for an online class. The instructor could receive a collective stress response graph as the discussion continued and then could make emotional corrections online— or maybe even in the classroom. However, it is likely we will continue to make these adjustments this intuitively, especially with emotionally intelligent literate faculty looking for signals that suggest something is wrong.

Impact on Affective Teaching in Nursing From e-Learning Research

So what can we take away from the e-learning research outlined above with regard to nursing education? Nursing education continues to grow additional distance learning methods that are synchronous and asynchronous. The studies discussed suggest we have more to learn about what has been working and what makes no difference or detracts from e-learning. Researchers have found teaching practices that are better than and worse than e-learning methods. The information presented may also advise us on some of the best ways to mix our teaching methods without trying to move to higher levels of synchronous teaching in nursing. There are students who do better on their own and in their own time frame using asynchronous methods but we don't know if we are assessing long-term learning using any of these methods.

There have been studies conducted on the use of emotion as a corrective feedback method, and we learned about measuring emotional responses in students. I believe there is potential in these studies for nursing, but more than likely, nursing education will remain relatively intuitive in such feedback for some time to come.

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