Learning: Paper or E-books?

What are the differences for reading and learning from e-books versus paper and traditional books?

Online or E-Book


  • Uses the technology available.
  • Back lit better for older eyes.
  • Ease of accessing resources.
  • Ease of storage and back-up (cloud).


  • Skepticism regarding online and digital resources.
  • Computer vision syndrome.
  • Screen related sleeplessness.
  • Multi-tasking or task switching – can humans really do this?
  • Too easy to scroll through the content and not take in the content.
  • Need to change from just an electronic copy, to an engaging resource. incorporating engagement, visuals and virtual reality.
  • Publisher restrictions impact on software to view the e-book.
  • Device related distraction (i.e. social media).

Paper & Books


  • Note taking (highlighting), breaking down larger reading into smaller ‘chunks’.
  • Flicking pages, touching the paper and focusing on difficult sections helps focus or mind on certain topics.


  • Reluctance to embrace the technology.
  • Environmental responsibility.

Personal Experience

I tried to complete a course just using e-resources and some aspects worked fantastic. All resources I saved and organised onto an ipad and laptop as back-up, then annotated onto journal e-articles.  I am not the most organised with notes and resources so this was an additional bonus. Environmentally friendly on the paper front as well. E-books were accessible and easy to read online, but difficult to take electronic notes with some software. Then when it came to writing the assignment, I found having to flick between electronic notes, articles and other resources so time-consuming and frustrating. I missed having a pile of notes and articles, flicking quickly back and forth to develop my discussion and supporting discussion. So a mixed experience, but it definitely tested my preference for paper.


Reading has plenty of beneficial aspects for mental capacity, empathy, relaxation, motivation and physical health. At present we may mix our lives with reading from phones, tablets and laptops, with a Kindle or Nook thrown in but can the hands on, dexterity aspect of settling back with a good book be beaten? Paper wins (for the moment).

Keywords: E-books,  learning,  reading,  digital literacy.


Myrberg, C. & Wiberg, N., (2015). Screen vs. paper: what is the difference for reading and learning?. Insights. 28(2), pp.49–54. DOI: http://doi.org/10.1629/uksg.236

Bushak, L. (2015) E-Books Are Damaging Your Health: Why We Should All Start Reading Paper Books Again. Medical Daily

Guo, S. (2016) Why smart kids shouldn’t use laptops in class. Wonkblog.

Virtual Reality For Learning

Levels of fidelity for simulation are part of the development phase for delivering training and education. And virtual reality (VR) has the potential to enable learning in a recreated version of our own environments, deliver high levels of fidelity (realism) and engagement. The technology and access to virtual reality resources is limited at present but has the potential to grow and become part of everyday life and learning.

From being on a roller coaster, running with dinosaurs, to outer space travel, the ability of virtual reality to create opportunity to access various environments is an exciting technology. In healthcare we could take the opportunity to develop and test a virtual hospital/ward/bedspace in the VR world, to ensure they meet the needs before the real money is spent on bricks and mortar. Procedures and guidelines can also be tested in the safe environment of the VR world.

Then education and training can be routinely delivered in the VR world. From the nursing perspective, instead of reading or watching a video about sepsis and the complex process. You can now watch the multi-system process of sepsis in virtual reality, the bodies response to foreign bacteria, and this potentially provides a clearer imagery, increased engagement and understanding for the learner.

Patients can visit the hospital, ward or theatre pre-procedure to see the actual environment in VR. They could watch the actual surgical intervention or investigation, understanding the surgery and post-operative issues. This provides more understanding, control and power to the patient.

Like any technology the accessibility and cost will be a factor of the use of VR across education in schools, higher education and the work setting.

Virtual Reality Resources 

Virtual Reality Can Change The Hospital Experience – The Medical Futurist

ER VR Trailer – Medical Training Simulation

Blended Learning

Blended learning combines face to face learning and online learning. The traditional classroom mixed with a technology based approach to learning.


The online environment can be synchronous or asynchronous (which can be perfect for the adult learner and in particular the nurse working shifts). High quality online learning environments provide interactions and engagement with knowledge, learning resources, teachers and peers.

The online learning can provide a ‘flipped classroom’ approach to really enhance the face to face time.

Add a discussion forum for learners to engage, question, discuss and share resources in the online platform as this can create a learning community. To build confidence set some basic netiquette rules and as the facilitator judge when discussion can be developed or when to sit back and allow the discussion to take the learning into new areas.

When to use?

Consider how education is delivered. Decide what is the best approach to deliver, face to face, fully online or blended learning.

Consider Your Learners

  • Relies on self-directed learners.
  • Are they comfortable with the technology being utilised?
  • E-learning approach can be new for some learners and they may resist and disengage.
  • Does it meet their learning needs?

The technology approach for online education will commonly utilise a learning management system. Take a look at this critique of LMS by Leigh Blackall.

Remember to consider your change management strategy as you develop and change the delivery of education, as this may really challenge the traditionalists (students and educators). In nursing there are so many skills and specialities to learn that delivering one standardised educational approach may not be the most effective approach to delivering education.


Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every day. International Society for Technology in Education.

Bower, M., Kenney, J., Dalgarno, B., Lee, M. J., & Kennedy, G. E. (2013). Blended synchronous learning: Patterns and principles for simultaneously engaging co-located and distributed learners. In Electric dreams. Proceedings of the 30th ASCILITE Conference (pp. 92-102).

Bradshaw, M., & Lowenstein, A. (2013). Innovative teaching strategies in nursing and related health professions. Jones & Bartlett Publishers. [sample here]

Garrison, D. R., & Kanuka, H. (2004). Blended learning: Uncovering its transformative potential in higher education. The internet and higher education, 7(2), 95-105.

Tucker, B. (2012). The flipped classroom. Education next, 12(1).

Innovation in Health: The Edge

Change in health can be slow and frustrating, especially as we stand in such a technological advanced era. The governance aspects of individualism matching national health systems and standardisation may often seem worlds apart. The vast number of specialties within health also challenge how to scale online communities to meet everyone’s need. So innovation to improve communication, access to health records and services are major factors. How to connect and engage across formal and informal health resources so patients are themselves experts and are empowered is an essential aspect of future transformation and innovation.

The Edge

About: “Think, Connect, Share, Change:  a free social platform committed to finding, sharing, curating and creating the boldest and most innovative new ideas in health & care”.


  • Healthy communities
  • Health innovation
  • Transformation
  • Collaboration

Social Media: 

They also have a ” School for Health and Care Radicals

Importantly The Edge is to think differently about how effective change practice can lead to better outcomes for patients.

The work they create is under creative commons licence which is also another great sharing aspect they have embraced.

Massive Open Online Course (MOOC)

MOOC stands for Massive Open Online Course and are part of the e-learning educational approach.

MOOC poster mathplourde

Nurses and nurse educators are likely to have experienced some form of learning management system such as Blackboard, Canvas, Moodle or Desire2Learn in the workplace or higher education setting. Learning management systems range from systems for managing workplace training to educational online or blended/hybrid higher education courses. Courses may have varied in cost, accessibility and number of participants.

A MOOC uses a platform to encourage knowledge in the sharing or “the network” rather than an oracle or sage on the stage approach where one person is the fountain of knowledge. A MOOC therefore allows collaboration and contribution from all and provides “connectivism” (Downes, 2016). Use of free web based systems allows massive scalability rather than using one server and opens up participation. 

xMOOC is instructor led, videos and have discussion forums for sharing ideas and discuss learning. Although learning can be at the individual’s own pace, there is still assessment to measure learning. xMOOC therefore follow a constructivist approach to education (Downes, 2016). Examples of xMOOC’s providers are Coursera, Linda, Khan Academy, Udacity and edX.

Connectivist MOOC (cMOOC) is networked learning where learning and sharing occur. The traditional approach of teacher is removed and everyone becomes a collaborator and any teachers become facilitators of learning. The idea of the cMOOC aims to mirror the web, the openness, accessibility, flexibility and how we as individuals currently interact, communicate and collaborate on the web, especially social media platforms. Social learning theory relates to the connectivism approach (Downes, 2016).

MOOC design by Stephen Downes
MOOC design by Stephen Downes

Some Stats & The Future for MOOCs

Although the numbers enrolling may be in impressive, those actually finishing the course may be below 7% (Parr, 2013).

Although MOOC’s are impacting on Universities, and some prominent ones at that. The predicted impact of MOOC’s to transform education has not quite occurred at the levels expected, yet (Bothwell & Havergal, 2016).

What is a MOOC?

Anant Agarwal: Why massively open online courses (still) matter



Downes, S. (2016) Knowledge, Learning, Community 

Bothwell, E. & Havergal, C. (2016) Moocs Can Transform Education- but not yet. Times Higher Education.

Parr, C. (2013) Mooc Completion ‘Rates Below 7%’. Times Higher Education.

Wikipedia (2016) Massive Open Online Course.


QR Codes In The Classroom

I recently came across a group of education developers using Quick Response (QR) codes in a higher education setting, creating an interactive environment. Having never used these in teaching before, I was motivated to look into this further and share my learning experience. So this post is in itself a work in progress as we learn how to incorporate QR codes into a learning or work environment. It would be great if anyone has any recommendations or advice, so please add a comment at the bottom of the page. As we create more codes we will also post them into the blog. The videos below provide a fantastic introduction to QR codes.

The magic of QR codes in the classroom – Karen Mensing (Ted-Ed)

Using QR Codes in the Classroom

How To Create A QR Code – Instructions 101

QR Code Generators

QR Code Scanners

Just access your app store for your mobile device (Android, iPhone, Windows) and there should be plenty of free resources.

QR Code: First Attempt 

qrcode.35591936 (1)

Ideas For Using QR Codes

  • Embed into presentations and resources for easy access.
  • Create a problem solving “scavenger hunt” case study.
  • Education: scan the QR code to reveal a task and create team work together to get the task complete, using communication, collaboration and critical thinking.
  • Get staff to use and create QR codes to develop their IT skills.
  • Place QR codes around your unit informing staff of updates.
  • Link to access or helpful resources (create information hot spots in the environment).
  • Makes learning more creative and interactive (could be a fad but its something different to add).
  • Link to a YouTube playlist.
  • They are typically free to create, so give it a go.

Gaming: A Solitary Existence?

If we think of gaming for education purposes we think of World of Warcraft or a recreation of a hospital setting and the ability to interact and train in a safe environment. The learner can be immersed in this experience, and with virtual reality increasing in its development the potential is fast approaching for mainstream education opportunities.

Here it is….. the but. Is this method of training too isolated? If we think back to childhood games (maybe go back a generation or so, depending on your age) and the level of team play and interaction that was involved. Today the experience can be recreated but in a potentially isolating setting, and with a loss of real human interaction and managing the relationships that occur in day-to-day life could be missing in gaming. People are just unpredictable and the question is: how is this unpredictability recreated in a gaming situation for healthcare professionals?

“There is no right decision in life, because every decision we make is new and unpredictable.”  by M.F. Moonzajer

This need to network and connect for deeper learning must not be forgot in the advance of technology. Tacking in technology to a learning program will likely be a novelty, it needs to be embedded into the pedagogy.

“We’re stupid in dozens and dozens of ways. But human minds are plug-and-play devices; they’re not meant to be used alone. They’re meant to be used in networks” James Gee (Arizona State University). Games allow us to do that – they allow us to use what Gee calls “collective intelligence.” Collectively, we’re not so stupid.”

Keywords: Gaming, gamification, play, learning, networking, human mind