The effects of two types of graphic advance organizers on academic achievement and attitudes toward computer-assisted instruction (CAI) of nursing students who used a computer-interactive videodisk (IAV) clinical simulation program were examined. Two graphic organizers were developed to present guidance to the students on either the clinical content of the IAV program or the structure of the IAV system used to present the clinical content.

One-hundred twenty-eight senior nursing students were randomly assigned to four treatment groups, receiving: (1) structure guidance only, (2) content guidance only, (3) structure and content guidance combined, and (4) no guidance. Achievement was measured through a post-test. Pre- and post-treatment attitudes toward CAI as a creative, functional and comfortable medium were measured.

The results, evaluated through one-way ANOVAs and orthogonal comparisons, clearly demonstrated that neither the type of guidance, nor the presence or absence of guidance, had any significant effect on achievement or on attitude toward CAI as a creative medium. However, groups receiving any type of guidance had significantly more positive changes in overall attitude and in attitude toward CAI as functional and comfortable than did the no guidance group.

Qualitative data from focus groups and program usage data forms further supported the importance of guidance. Students clearly expressed frustration in managing the IAV program and indicated a need for additional guidance, including assistance in using the organizers effectively. Although students were slightly positive toward the structure organizer, the attitudes toward the graphic organizers as designed were generally not positive enough to support their further use.

The findings of this study indicate that future research should emphasize open-ended qualitative studies designed to evaluate students during their interaction with IAV programs and to obtain their perceptions of problems and guidance needed. From this data more effective guidance materials should be developed and tested.