Nursing students and nurses live at distances from educational institutions offering primary and continuous nursing education. As the teacher and student are not in the same classroom, distance education mainly focuses on designing instruction in a way that transcends the class with the learner expected to assume additional responsibility for learning. This includes supporting meaningful interaction that allows for overcoming the separation barrier between the teacher and student. One of the most essential methods of overcoming the teacher-student separation is through the use of information technology including the internet and computing capacity. However, the use of technology is limited by access to computing resources and inadequate knowledge and skills among nurses and nursing students.
Technology Related Issues
Distance education learning occurs either in real time or in delayed time. In real time or synchronous distance education, the teacher and the student participate in the educational experience at the same time even when separated by distance (Wilson & Pretorius, 2017) . This method involves the use of live interactive television and online computer charts using such modes of education as video conferencing. On the other hand, delayed time or asynchronous distance learning allows for the difference in timing of participation between the teacher and students. It includes such methods as independent study modules, computer conferencing, videotapes and email sharing. Depending on the synchrony of the media, the course delivery and interaction between teacher and student is determined (Wilson & Pretorius, 2017) . While the modes of the communication differ, their reliance on computing and information technology including student’s skills is high. Consequently, the lack of these factors would be a significant issue to distance education learning.
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Several studies have indicated the lack of computer and IT infrastructure access as a significant drawback to distance education. The inadequate access to IT infrastructure is especially problematic in rural areas and healthcare facilities located in remote areas. Among the most essential missing IT infrastructure is the internet connection. Internet connectivity is of importance to material sharing and interaction between teachers and students in remote locations. The importance of the internet is mainly seen in real time distance education. Students need to interact with their teachers each time they log in. According to Günay & Kılınç (2018) insufficient computer resources, lack of personal computing devices, and slow internet speed are the primary barriers to distant learning. However, with the high cost of acquiring internet, some students do not access educational material. Moreover, most healthcare organizations do not have dedicated internet and computing services to support distance learning education.
Recommendations
Healthcare organizations have not embraced distance education learning enough to make efforts for enhancing the concept. In most healthcare organizations, continuous nursing education is the responsibility of the nurse. The nurse must create time and acquire the resources necessary for constant education. Without the internet and other IT infrastructure, the nurses struggle to achieve the expected outcome of continuous education (Günay & Kılınç, 2018) . This does not provide for flexibility in conducting distance learning. Without dedicated infrastructure such as computers and internet to promote distance education learning through the nurses rely on unreliable means such as personal computers and phones which may have dire consequences on the quality of learning that takes place.
There are also several studies that have shown the inadequacy in technology skills among nurses as a significant impediment to distance education among nurses. In a study on the presence of basic computing skills among nurses, Jamshidi et al., (2016) found out that despite the presence of many applications for IT skills in the nursing professionals, there is still a large gap that impacts their ability for distance education learning. Lack of computer skills is especially a problem among elderly nurses. The age of nurses was positively related to inadequacy skills and knowledge in technology and confidence in using computers (Munro et al., 2018) . While this study looked at the general use of computers among nurses, it also relates to their confidence in using technological means of continuous learning.
The issue of technology that includes a lack of skills and IT infrastructure affects the distance education learning among nurses. Consequently, efforts should be made to solve this issue especially concerning the ability to increase the quality of services offered by healthcare organizations. Organization based interventions are the most appropriate in responding to both inadequacies in IT skills and unavailability of IT infrastructure. The chief agent of change in this process is the organization's management and those in charge of nursing education. Several steps should be taken to respond to technical issues affecting distance education learning.
Incorporation of IT Skills in Healthcare Based Continuous Medical Education
Most organizations have continuous education sessions where healthcare workers are familiarized with emerging issues and methods in taking of patients. Most organizations concentrate efforts to critical nursing that enhance the relationship between the nurses and patients and the consequent improvement of care (Munro et al., 2018) . However, seeing that technology affects every aspect of our lives in society today, IT skills should be incorporated in the continuous education sessions. Analytical skills that are necessary for interaction with education material should be included in hospital-based continuous education sessions. These include such issues as video conferencing, email conferencing and e-learning. Also, general information technology knowledge should be offered to nurses who have trouble with technology. As research shows, age is positively correlated with inadequacy in IT skills among nurses (Günay & Kılınç, 2018) . Consequently, the provision of IT skills should have a strong focus on elderly nurses and provide the necessary skills for interacting with computers. Through the provision of IT training, the nurses will have a greater ability to engage in distance education through e-learning.
Create distant learning Infrastructure at the hospital
Distant learning is an important part of nursing care as it involves the improvement of skills for nurses which translates into the quality of care and improved hospital efficiency. Healthcare organizations should, therefore, create programs and allocate resources to this vital part of the healthcare system (Sarre et al., 2018) . In the digital world, the most appropriate resources that an organization should provide are computing and IT infrastructure. These include computers and the internet that would enable nurses and nursing students to interact with their teachers effectively. An organization with proper IT infrastructure encourages employees to study and use them hence acquiring the necessary skills (Munro et al., 2018) . By providing nurses with a proper internet connection and working computing resources dedicated to distance education, an organization encourages its nurses and nursing students to acquire the necessary skills for the improvement of patient care.
Conclusion
With distance learning being highly dependent on information technology, IT skills among nurses and the presence of computing resources are a necessity. However, in the most healthcare organization, there are issues with IT capabilities that act as barriers to distance learning among nurses and nursing students. The IT issues which revolve around lack of IT skills among nurses and IT infrastructure is mainly seen among the elderly nurses and in rural based hospital. To overcome the challenge, there is a need for inclusion of IT skills in continuous nursing educations and provision of the necessary resources to nurses to promote e-learning.
References
Günay, U., & Kılınç, G. (2018). The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: A qualitative study. Nurse education today , 65 , 81-86.
Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Najafi Kalyani, M. (2016). The challenges of nursing students in the clinical learning environment: A qualitative study. The Scientific World Journal , 2016 .
Munro, V., Morello, A., Oster, C., Redmond, C., Vnuk, A., Lennon, S., & Lawn, S. (2018). E-learning for self-management support: introducing blended learning for graduate students–a cohort study. BMC medical education , 18 (1), 219.
Sarre, S., Maben, J., Aldus, C., Schneider, J., Wharrad, H., Nicholson, C., & Arthur, A. (2018). The challenges of training, support, and assessment of healthcare support workers: A qualitative study of experiences in three English acute hospitals. International journal of nursing studies , 79 , 145-153.
Wilson, G., & Pretorius, R. W. (2017). Utilizing work-integrated learning to enhance student participation and engagement in sustainability issues in open and distance learning. In Handbook of theory and practice of sustainable development in higher education (pp. 245-257). Springer, Cham.
