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2009 Team Abstracts

Auburn University

Our project implemented and evaluated the use of a mock hospital unit simulation with SimManTM and other static mannequins prior to actual human patient contact. The students involved in this project were enrolled as first semester junior level BSN students at the sister campuses of Auburn University and Auburn University Montgomery. The project evaluated the effects of this experience on changes in anxiety as well as preparedness for live human patient contact.

The use of simulated environments in education of health care professionals has grown exponentially over the last decade. This is due in large part to a vast scholarship showing the benefit of this modality to aide experiential learning, the practicing of technical skills, and more recently the teaching of important non-technical skills in communication, clinical reasoning and team management. With the emphasis placed on safety by the Quality and Safety Education for Nurses (QSEN, 2007), the Institute of Medicine (2007), and the American Association of Colleges of Nursing (AACN, 2006), nurse educators have mandates to focus on measures that increase patient safety. Our faculty incorporated the recommendations of the QSEN quality and safety initiatives into the development of a mock hospital setting implemented in the nursing skills laboratory. The primary goal for this project was to foster the development of critical thinking skills in a clinical setting with the use of simulation technology that would allow students to practice in a “low-stakes” environment.

The use of the mock hospital unit simulation began in 2007 as a pilot study (n=24) (Gore, Hunt, & Raines, 2008) with static mannequins and continued in 2008 with implementation in the entire junior nursing class. Junior baccalaureate students spent a total of 7 weeks in the simulation/skills laboratory, culminating in one 4-hr “shift” in the mock hospital unit. During the mock hospital experience students were expected to conduct both patient and environmental assessments, formulate a plan of care, administer medications, provide treatments, perform hygiene measures, and document care. Students used personal data assistants (PDAs) to obtain “textbook” information regarding diagnoses, plans of care, medications, and nursing considerations. Students implemented their plan of care according to prioritization and level of care required for each patient. Quality and safety problems that could be detected easily were introduced into each patient scenario. Based on the interventions, patient conditions changed throughout the simulation.

This project demonstrated how use of a mock hospital simulated environment resulted in many positive outcomes. The beginning nursing students showed improvement in the transition from the skills lab to the hospital setting, along with a marked decrease in anxiety levels. Student feedback indicated that the simulation experience was effective as preparation for the clinical experience. Clinical faculty remarked that students did not appear as anxious and were noticeably less hesitant to enter patient rooms and provide care during the 1st week of clinical rotations. Faculty also reported that the experience provided an ideal opportunity to assess and evaluate the critical thinking and psychomotor skills of students prior to actual patient contact. This knowledge assisted clinical faculty in patient assignment decisions at the beginning of the students’ clinical rotations. Advantages include assuring all students receive initial preparation for clinical experiences in a consistent environment, a realistic representation of the patient environment and response to nursing intervention, assuring maintenance of patient safety, the ability to allow error to escalate to their negative consequences as a teaching tool, students can receive immediate feedback on their performance and the experience fosters team building. Additionally the mock hospital simulated experience is multidimensional, engaging and fun for both students and instructors.

Plans are in place to expand this experience to further meet the needs of the student. The nursing lab has been recently remodeled with a greater hospital unit appearance. The new environment will incorporate the greater interaction and advanced clinical situations possible with the SimMan TM and PDA StatTM high-fidelity mannequins as well as the use of electronic patient records and documentation. Experiences are being developed across the curriculum at both sites.

Ball State University

Preparing Nursing Students to Practice in Informatics-Intensive Healthcare Environments with Evidence-Based Practice Database Tools for Nursing Information Literacy

Nurses practice in informatics-intensive healthcare environments. However, as Skiba, et. al, (2008) noted, there are relatively few examples of schools forming a partnership with one of their clinical agencies in the use of informatics tools to “ . . . facilitate communication among the interdisciplinary team and with patients, manage knowledge, diminish error, and support clinical decision-making.” The goal of our 2009-2014 collaborative partnership initiative with a regional healthcare agency and a healthcare vendor is to prepare students to use a comprehensive library of nursing resources (30+ evidence-based journals and monographs, patient education, clinical practice guidelines, and drug databases) and a database of nursing skills (950+ evidence-based online skills and procedures) in each clinical course; the same evidence-based practice database tools used by staff nurses to find answers to clinical questions, educate patients, and stay informed of new developments.

Our project involves the design and implementation of a tiered approach to building student skills in using clinical evidence & research, year by year, throughout the undergraduate program. Using the newly acquired evidence-based practice literature and skills databases in conjunction with our existing information literacy tools, such as CINAHL & MEDLINE, our team will work collaboratively with the faculty of each clinical course and our institutional and agency librarian partners to expand the existing series of information literacy competencies, tutorials and exercises to each clinical course of the baccalaureate curriculum (Dorner, et al., 2001). Strategies and activities used in the implementation of the evidence-based databases with students will be shared with educators and practice partners via a web interface.

Dorner, J. L., Taylor, S. E., & Hodson Carlton, K. (2001). Faculty-librarian collaboration for nursing information literacy: a tiered approach. Reference Services Review, 29(2), 132-140.

Skiba, D. J., Connors, H. R., & Jeffries, P. R. (2008). Information technologies and the transformation of nursing education. Nursing Outlook, 56, 225-230.

Berea College

Berea College is a private liberal arts institution whose mission is to serve students of the Appalachian region that demonstrate academic promise and possess limited financial resources. Students attending the College pay no tuition, participate in a nationally recognized student labor program, and provide service to both the College and surrounding community. Currently, every incoming freshman receives a laptop computer which they take with them at graduation. Over the past several years, the College has advanced its goal to maximize access to technologic resources for students, faculty, and staff. In 2006, the Department of Nursing at Berea College recognized the need to explore the use of PDAs for student’s use in the clinical setting. The purpose of this intervention was to advance the implementation of technology resources at the point of care, better prepare nursing students to manage electronic resources, and capitalize on the students’ technologic learning style. To accomplish this, nursing faculty determined which hardcopy textbooks could be substituted through adoption of nursing software specifically designed for PDAs. The PEPID-RN program was selected for this. Financial support was obtained through a technology grant from our Information System & Services Department to purchase PDAs for each incoming sophomore nursing student. The PEPID-RN software was purchased through the campus bookstore by the students. In the spring 2009, faculty administered a survey questionnaire to current junior and senior nursing students to determine the extent their PEPID-RN and PDA usage and to solicit pros/cons of usage. As a result of the survey and faculty input, a decision was made to obtain a different PDA device and software program. Faculty and students will continue to evaluate these, increase student usage of the device and software in clinical, Nursing Skills Laboratory, and classroom settings. Options for obtaining further funding to defray students’ cost will also be explored.

California State University – Sacramento

A major focus of improving health care and patient safety is the development of effective communication between health care providers (Hackbarth, McCannon, & Berwick, 2006). The education of healthcare professionals must provide the foundational skills and opportunities for repetitive practice of a variety of patient communication encounters such as report of a changing patient condition, hand off (& end-of shift) report, and clarification of treatment plan orders (Botwinick, Bisognano, & Haraden, 2006). Written and verbal communication represents a special challenge for nursing students who are English-Second-Language learners (Choi, 2005; Salamonson, et al., 2007). At Sacramento State University, 46-54% (varies each semester) of the undergraduate nursing students come from minority backgrounds, and many struggle with English language skills. Nursing faculty, committed to the success of our diverse student population, are continuing to develop and implement active learning strategies. These include the use of human patient simulation, online modules, and case study based curriculum with embedded NCLEX questions using clickers in our first semester courses. The following is a summary of technology changes we have incorporated over the last two semesters (Spring/Fall 2008).

Human Patient Simulation: Mid-fidelity (MF) and high-fidelity (HF) simulation activities replaced two traditional 3 hour power point lectures and 3 hours of clinical and allowed students to synthesizing and integrate information from a variety of nursing courses. Simulation facilitates practice of assessment, skills, and communication in a safe learning environment. Students rotate through 4 MF simulation cases where senior students (supervised by faculty) work with first year students to practice assessments, skills, the receiving and giving report. HF simulation cases focus on recognition of changing patient status, chain of command communication to charge nurse; SBAR call to physician, read back of verbal orders, call back for clarification of incorrect medication order, medication reconciliation orders. Simulation is also used frequently in the patient care assessment courses.

Online Modules and Quizzes: Didactic content from sim day lectures (respiratory and gastrointestinal abnormalities) were addressed by creating online modules with hyperlinks and embedded quizzes that allowed students to view materials multiple times and prepare for content of activities. Students receive points toward grade for completing the modules.

Case Study Based Curriculum: Cases are used in multiple courses to address the complexity of patient care, communication with family, and ethical issues. For example, patient with complex diabetic management and noncompliance with insulin regime develops GI complications, declines further treatment although family wants strict diabetic management and surgical intervention. This case used in beginning Med/Surg endocrine lecture with NCLEX questions/clickers, GI module didactic content/online quizzes, simulation activities on communication with home medication reconciliation, and Introduction to Nursing course discussion/roleplay on ethical issues with patient rights/communication with family/resources to access for conflict resolution.

Evaluation Data: A total of 80 students out of a possible 100 completed the Simulation Evaluation questionnaire which used a 1-5 Likert-type scale with (1= Strongly Disagree to 5 = Strongly Agree). Ninety-one percent (73 students) either agreed (34 students) or strongly agreed (39 students) that the MF simulation were an effective use of lecture time. An even higher percent, 94% (75 students) found the HF simulation an effective use of lecture time with 71% (57 students) giving HF a rating of five and 23% (18 students) rating it four. Ninety-six% (77 students) agreed or strongly agreed that the simulation activities better prepared them to safely care of patients in the clinical setting. Student written comments on what they liked most centered on “hands on learning” and “it was okay to make a mistake”. The most common response to the question about what they would change were “I need more time at each station.”

Botwinick, L, Bisognano, M., & Haraden, C. (2006). Leadership guide to patient safety. Institute for Healthcare Improvement Innovation Series white paper. Cambridge, MA. Retrieved October 29, 2006 from www.IHI.org.

Choi, L.(2005). Literature review: issues surrounding education of English-as-second language (ESL) nursing students. Journal of Transcultural Nursing, 16(3), 262-268.

Hackbarth, A., McCannon, J., & Berwick, D. (2006). Interpreting the “lives saved” result of the IHI’s 100,000 lives campaign. Joint Commission Benchmark, 8(5), Retrieved from www.jcaho.org

Salamonson, Y., Everett, B., Koch, J., Andrew, S., Davidson, P. (2007). English-language acculturation predicts academic performance in nursing students who speak English as a second language. Research in Nursing and Health, 31(1), 86-94.

Johns Hopkins University

Target Group and Project Timeline

The healthcare environment is changing at unprecedented rates and concomitant changes in educational delivery are required. Our nursing program’s technology point of care delivery curriculum implementation and rollout is revolutionary in the preparation of nurses into the informatics-laced world of healthcare. In June 2006, we undertook a major restructure of our Baccalaureate clinical and theoretical education that incorporates full point of care technology (Eclipsys SCM 4.5 and Knowledge- Based Charting-KBC- to support nursing documentation) in a standardized electronic health record (EHR). Since the initial inception, seven clinical and/or laboratory courses across the undergraduate baccalaureate curriculum are now actively engaged in point of care technology. Over 400 students and over 70 faculty have been actively oriented, coached and trained on Eclipsys and KBC, a curriculum tool that creates a collaborating learning community and strengthens the theory-research-practice triangle.

Technology and How it is Used

Care was taken during integration of point of care technology into the curriculum to reflect the faculty’s belief that nursing education is most effective when it builds upon itself and advances from simple to complex. In the first lab course, students are directed toward the utilization of the computerized documentation process and the importance of timing and accuracy of that documentation of psychomotor skills such as vital signs, dressing changes, and medication administration. Students in their health assessment class enter physical assessment findings of one another collected during clinical labs into the EHR and also register a “patient” presented in standardized patient case scenarios led by the faculty. Using “answer keys” designed for easy use, faculty checks all students’ documentation. Thus assessments of ailing patients with symptoms presented are documented. A graded final assessment includes pre-setting the human patient simulator (HPS) with vital signs, various heart, pulmonary, and gastrointestinal findings; students are graded (again with a provided “answer key”) on the accuracy of the findings they documented in the EHR. Integration of computerized charting with a HPS experience adds fidelity to the simulation experience. Second semester clinical courses required the development of elaborately designed structured notes and total health assessments. The data collected on real patients assigned in clinical practice (without any identifying information) is then entered and used to create a care plan using the KBC component of the system. KBC directs students to utilize best practice guidelines as nursing interventions. Graphically depicted comprehensive outlines and “User Guides” have been constructed for students and faculty and are placed on the relevant course web site. The EHR and HPS have also been incorporated into non-clinical courses. An integrated pathophysiology and pharmacology experience was designed where students assessed, researched and evaluated a patient’s progress through four snapshots of a cardiovascular event using data sets in Eclipsys and a corresponding assessment experience with a HPS. Skills acquired through the exercise included team building and advanced critical thinking. The senior semesters offer a variety of simulation experiences involving EHR and HPS. A scenario of respiratory and cardiac distress using the infant HPS requires accurate assessment, treatment by a team of students, and documentation into the EHR via a Computer on Wheels. A group debriefing follows. The immediate feedback demonstrates the impact of nursing interventions and allows collaborative tracking of documentation accuracy. Additionally, in senior level a work task list of four complex patients in the Eclipsys EHR system was designed to guide students as they review, design, and coordinate daily activities for safe and efficient interdisciplinary patient care. The experience fosters the students’ decision making skills, leadership behaviors, and the delegation of tasks.

Impact and Benefit of the Technology

Integration of various technologies in the curriculum provides multiple opportunities for active learning and mastering of informatics skills required of new nursing graduates as well as faculty. Students can establish a portfolio of EHR documentation reflecting their progressive learning, and offer it as evidence of their informatics knowledge and skills with future employers. A core group of faculty comprise the “Eclipsys team”; their involvement was paramount to the success of technology-curriculum integration. The team supports faculty to become newly enabled by technology through the open exchange of insights, ideas, and frustrations regarding EHR and HPS. Team actions included: promoting faculty “buy in” through assisting with “brain storming” regarding how to incorporate the technology within course content; provide dry runs of technology experiences before going live with clinical courses; frequent emails and meetings with faculty to determine how the project is proceeding; creating well crafted instructional aids for faculty and students (such as “How TO” instructional aids designed for each course, CD ROMs, online videos, and Powerpoints with streaming audio); and supporting faculty and students when problems occur.

These actions were crucial in fashioning an integrated technology community within the curriculum, advancing the curriculum to provide informatics competency, and providing numerous opportunities for students to develop critical thinking, problem solving and team building skills.

Moorpark College

Hybrid Courses Using Wimba Technology

In understanding the changing dynamic of education in nursing and in looking at our student population we as a nursing faculty felt that the traditional lecture format was not conducive to student learning today. Our non-traditional student body was made up of younger digital natives and older digital immigrants that use all the modern technology available today, i.e. IPods, laptops, text messaging, Podcasts, etc. Understanding this and wanting to keep our student engaged in learning it was our decision as a faculty to hybrid our core nursing classes (NS1, 2, 3, and 4 which represents the 4 semesters in our ADN program) by instituting Wimba technology to record our course lectures. The nursing program has used the Wimba Classroom program through WebCT to integrate a live, virtual classroom into its course delivery. The virtual whiteboard enables presentations and computer tablets to be used to lead a class, with an audio function enabling peer discussion and questioning. The instructor’s digital tablet allows for drawing on the whiteboard. Participants may also interact with the presentation and draw on the whiteboard. For students without the ability to call-in to the class session, there is a textchat function available.

The faculty were trained on the technology by the college’s experts, and issued digital tablets and headsets. Within 1 semester, each course integrated the technology by holding live office hours or recording lectures or workshops. Students have benefited by being able to access the recordings multiple times to enhance their comprehension of the topics. During our classroom meetings most instructors have used this time to present case scenarios using CLICKER technology.

A typical adult medical/surgical lecture would include two (1) hour online lectures that the student listens to prior to attending the live classroom session. The lectures would cover pathophysiology of the disease that is being studied, risk factors and key points including prevalence of the disease, clinical manifestations, diagnostic procedures, assessment, nursing diagnosis, interventions, evaluation of outcomes, and complications. Throughout our content we have threads of cultural, spirituality, nutrition, and meeting the needs of the older adult. During the live on-campus meeting a case study would be presented using PowerPoint and CLICKER technology. The case would be unfolding as a real scenario would incorporate the assessment, lab results, medications, and the patient progress through the continuum of care. After the case scenario the instructor may have a pair or group activity to further engage the students in the lab interpretations of the case or the medication key points.

The technology also enabled nursing lecture to be held on a day when the campus was closed due to nearby wildfires. The didactic classes were held live, with all participants in off-campus locations. The session was archived, enabling students that were evacuated from their homes to view the lecture at a later time.

Each semester we are adding more and more lectures to our hybrid courses. We are also incorporating Medication Calculation workshops in Wimba using the Graphfire tablets to show the math. This has been a new adventure for some of us and a lot of fun too. So far, our class evaluations have shown good results. We are continuing to fine-tune our courses and our students are guiding the changes we are making.

Rush University

Maternity nursing is an essential component of pre-licensure nursing education (American Association of Colleges of Nursing, 2008). For Rush University’s Advanced Generalist Master’s in Nursing program, changes in the women’s health course presented unique challenges and opportunities. These challenges included a reduction in clinical and classroom hours, earlier placement of the course in the curriculum, and the addition of women’s health content. The faculty for this course needed to employ a variety of innovative pedagogies and use all available resources to ensure the provision of safe, competent, knowledgeable students. With nearly one million dollars in high and low fidelity simulation models, the Rush University Simulation Lab (RUSL) is a significant resource for students and faculty. However, the lab is currently under-utilized. This is unfortunate since modern students expect a learning environment that is creative, engaging, and employs the latest technologies (Larson, 2008). To address the need for an innovative women’s health curriculum, expanded clinical experiences, and better stewardship of RUSL, faculty of the Women’s Health course piloted a perinatal assessment simulation experience as well as a labor support workshop for students in the fall of 2008. Both components were very well received with students reporting “more confidence with assessment skills”, and “decreased anxiety” during their first clinical day. Many also found the review of didactic information (e.g., fetal monitoring, newborn assessment) beneficial during test-taking.

In the current course, using a case study approach, students rotate through four assessment stations – antepartum, intrapartum, newborn, and postpartum. The focus of the antepartum assessment station is determining estimated due dates, fundal heights, and practicing Leopold’s maneuvers on a pregnancy simulation model. Students in the intrapartum assessment station will interpret a “fetal” monitor tracing that is streaming across the computer monitor and respond to abnormal findings by repositioning the model, applying oxygen, or other indicated nursing actions. In the newborn assessment and care station, students will need to assign an appropriate Apgar score to a newborn model based on the case scenario and demonstrate a physical assessment. The fourth station utilizes the obstetric simulator, Noelle. At this station, students go through the steps of a postpartum assessment and are asked to demonstrate various breastfeeding positions using Noelle. Each station, 30 minutes in length, is staffed by a faculty member who provides the patient history, demonstrates skills, and asks clinically related questions.

To complement this simulation experience, a two-hour labor support workshop is also offered. This “world’s largest childbirth class” gives students the opportunity to practice a variety of positions and pain management techniques used by laboring women. By practicing labor support skills, students are reminded of the importance of incorporating “human technology” into the care they provide and that the most sensitive and reliable assessment tools are their hands and their heads.

The underlying goal is to better prepare nursing students to provide safe and competent patient care. This learning experience will also provide an opportunity to practicecommunication, work as a team member, use critical thinking, and increase self-confidence. We plan to collect and analyze quantitative and qualitative data from students and faculty involved in the experience. The findings of this project will be disseminated in presentations and a publication. We hope to confirm the importance of incorporating simulation technology into nursing education.

References
American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate
Education for Professional Nursing Practice. Washington, DC. Author.

Larson, J. (Spring, 2008). Innovations in Curriculum. Teleconference, Rush University College of Nursing.

University of Massachusetts Worcester

Cultural Competency Toolkit with OSCE Technological Platform: Educating Students for the Community

Introduction

The University of Massachusetts, Worcester (UMW) Graduate School of Nursing (GSN) uses the Objective Structured Clinical Examination (OSCE: Objective Standardized Clinical Examination) in the professional pre-licensure courses (health assessment), advanced practice core courses (advanced health assessment), and nurse practitioner specialty courses. This program is integrated with the technological innovations in Simulation Center, Vista 4 Blackboard, Adobe Presenter, Wikispace, and MP3 in delivery of didactic material to the students. The GSN prepares professional nurses and advanced practice nurses through the Graduate Entry Pathway, Traditional Master’s Pathway, and the Doctor of Nursing Practice Program. The GSN is the only publicly-supported academic health center for the state with a GEP/MS/DNP/Ph.D. programs.

Now we have embarked on developing a technologically driven, culturally sensitive OSCE as an educational program on cultural competency. This effort is one component of the Cultural Competency Toolkit that we are developing for our students as part of the pre-licensure Capstone. The program will address the cultural and linguistically appropriate concerns in educating nurses on how to evaluate patients from the Latino and African American communities. In the Worcester area, Latino speakers are the second most numerous linguistic groups after English speaking Caucasian and African Americans. Both the Latino and African American ethnic groups total 22% of the population (Mass DPH, 2008).

Background

The Graduate School of Nursing prepares advanced practice nurses to meet the objectives of the American Association of Colleges of Nursing (AACN), Baccalaureate and Master’s and the National Organization of Nurse Practitioner’s Faculties (NONPF) competencies for Master’s and DNP programs. Further, the GSN integrates didactic and clinical experiences to facilitate holistic assessment and the development of cultural competencies incorporating the genetics content in the curricula. All of these are enhanced through interdisciplinary and collaborative learning experiences. The Standardized Patient Program is used for the development and evaluation of physical examination skills in advanced health assessment as a part of the pre-licensure Capstone. This program is also used in the advanced practice nursing clinical specialty course for the Objective Standardized Clinical Evaluation (OSCE) of student competency through patient scenarios. The OSCE program at the UMASS Worcester provides multicultural/ multilingual simulations.

Project Health assessment cultural competency- Phase One

The GSN is committed to developing and enhancing the knowledge of students and faculty in cultural competency with the use of available technological innovations, educational opportunities, and experiential learning and community outreach. Therefore, we will produce a technologically driven cultural assessment learning module that reflects the increasing diversity of the City of Worcester (Mass DPH, 2008). Our team will introduce health assessment simulation in the Graduate Entry Pathway, Year 1 curriculum. This will also include culturally sensitive didactic program as a preparatory step for phase II. We will also use technology to deliver this program via on-line modules in Vista Blackboard.

Project OSCE– Phase Two

Reference Video: Cultural Competency Toolkit video: We will record a reference video of an OSCE with a nurse competent in Spanish cultures and an African American nurse. Although the assessment will be conducted in English, we will use a protocol that is culturally appropriate to the Spanish and African-American communities for this purpose, in order to address culturally specific issues of concern. The video will be edited and produced at the GSN. We will use the video as a teaching tool for GSN students as part of the pre-licensure Capstone. Teaching tool for students: This will be done in two steps. The first step will involve screening of the Reference Video produced as part of the Cultural Competency Toolkit with OSCE. The second step will require the students to perform an OSCE with a culturally appropriate patient. This will be followed by a discussion with the faculty and fellow students about various facets of cultural diversity, and points of concern. These students will then perform their own OSCE with either a Hispanic or African-American standardized patient which will be videotaped. The students will be provided a link to observe the video through the Standardized Patient Program at UMW. The students will write a journal and critique their performance (see flow chart). The students will thus be well versed with the nuances of approaching patients in the community.

Phase III, Project Evaluation & outcome measures:

The students will participate in a pre- & post- intervention Cultural Competence instrument on-line, using Blackboard Vista platform.UMW implemented password protected Vista 4 Blackboard in January 2008. This platform is routinely used to post course syllabi, course materials including PowerPoint presentations, web links, assignments and assessments. Since the students will have gone through the culturally appropriate training, on-line modules such as journaling and threaded discussion will be used to evaluate student attitudinal change regarding socioeconomic, racial, cultural differences that students observe in community clinics.

Conclusion

Thus, at the GSN we are well placed with our facilities and history to apply technological innovations in producing a culturally sensitive educational tool for students and the community at large. This program will enhance the knowledge and skills of our students as they practice in culturally diverse health settings in the Greater Worcester Community and Massachusetts. Attainment of these skills will be measured by formative and summative evaluations.

Source: Massachusetts Department of Public Health. Massachusetts Community Health Information
Profile: Kids Count Profile for Worcester; 2008.

University of Miami

The Use of a Web Portal (NVCR) as a Innovative Tool Used for the Enhancement of Teaching Distance Education in Nursing Programs

A lack of computer literacy on distance learning and on-line education at the University of Miami School of Nursing and Health Studies fueled the school to designate a faculty member as their distance learning coordinator. The experience of a previously developed hybrid course revealed a need to integrate instructional technology among faculty as a means to prepare faculty to teach nursing students of the future. This need fostered the development of a web- based site dedicated to faculty at the school devoted to literacy in educational technology. The Nursing Virtual Classroom Resource site, (NVCR) was developed using Blackboard ® as the platform modem. NVCR provides orientation for faculty as well as to maintain and update information on technological resources available to nursing faculty.

NVCR site evolved from efforts of the school’s IT, distance education coordinator, librarian and university’s Blackboard ® department. The IT department formulated easy instructional maps for Blackboard ® on how to organize courses on-line, and trouble shoot using the discussion board within NVCR. The nursing librarian assisted with searches, populated the NVCR virtual library, and provided directions on how to upload external links. An independent graphic website designer added navigation expertise and visual aesthetics.

The different navigational and highlights of the site plan were divided into six sections; Distance Learning, Computer Requirements, Department Resources, Organizing Courses, Discussion Board, and Announcements. The Distance Learning section includes an introduction, welcome podcast, glossary, state and national regulations and guidelines, and articles related to distance learning. The Computer Requirement section covers computer resources for faculty and student computer needs. Department Resources highlights several university resources available to help with distance learning education. The Organizing Course section provides step- by- step instructions on populating the Blackboard system for distance learning. Workshops have been introduced to advocate NVCR and to promote usage of distance education. Future plans are to provide hands- on workshop on SoftChalk Lesson Builder™ software with assistance from the Professional Development Department at the university.

The NVCR at the UMSON-HS was used for the integration of distance learning within a traditional RN-BSN nursing program. All teaching materials were held on line with asynchronous communication to facilitate the working professional. The faculty served as change agents using Bandura’s Social Cognitive Theory of Learning on role -modeling and Self-Efficacy/comfort. Faculty increased their level of comfort or Self-Efficacy from assistance of the change agents who served as role models. The NVCR platform served as an innovative means to elicit faculty involvement with programs such as the Wiki ™ and DimDim© Webcasting for use with the master’s Nursing Education Program. Another innovative teaching strategy was the use of high-fidelity simulators, task-trainers and computer-assisted programs to enhance assessment and critical thinking of students. Students identified in a pilot study that the innovative strategies helped them achieve more comfort/Self-efficacy. The use of NVCR is a useful tool for distance education, online learning, and access to promote innovative educational experiences for faculty.

University of North Carolina – Chapel Hill

The University of North Carolina at Chapel Hill School of Nursing offers a curriculum leading to the degree of Master of Science in Nursing (MSN). The curriculum consists of four components, the professional core, the research core, the clinical core, and the advanced nursing practice specialty courses. In 2005, in response to the increasing number of MSN programs in North Carolina and elsewhere providing master’s coursework via distance learning technologies, the Masters Executive Committee developed a vision statement about distance learning. Our commitment is to provide quality educational experiences that foster intellectual curiosity, integrity, and professional expertise. Further, we would like to assure that our faculty have appropriate and convenient educational programs so they can increase the flexibility and accessibility of our programs to learners across the state.

Since 2005, the Faculty in the School of Nursing have worked to provide distance-learning options for our students within a limited infrastructure for distance modalities. We continue to explore new and creative methods to employ distance technologies in spite of limited resources. The members of the proposed project team have all found ways to introduce distance education technologies into the specific courses that they teach.

We would like to highlight VoiceThread as one successful technology that we have utilized to further the use of distance technologies in the MSN program. VoiceThread is an online media album where the user can upload essentially any type of media (images, documents, and videos). It allows users to view and interact with digital media in 5 innovative ways. It is collaborative and allows for comments by using voice (microphone or telephone), text, audio file, or video. Voice thread also allows participants to doodle or draw on top of the media as they record their comments.

As of 2008, VoiceThread has partnered with the University of North Carolina at Chapel Hill in creating a secure collaborative portal for students, faculty, and staff using VoiceThread’s Custom School Integration services. Unlike technologies such as Adobe Breeze, VoiceThread is a Web 2.0 application and no software is required. With the Internet as the platform, Web 2.0 represents the logical evolution of web based services. VoiceThread is support by the UNC ITS Teaching and Learning Division.

Members of the team have extensive experience in using VoiceThread for communicating with master’s students and providing online modules and lectures that engage students to be active learners. The technology was first piloted in the School of Nursing in the Family Nurse Practitioner course: N827 Child Health in Primary Care. VoiceThread was used to orient students to the course and course xpectations and to replace four face to face lectures. VoiceThread was also used to present practice quiz questions that students could take and then receive the instructor’s answers with voice rationales. Content was delivered in 20-30 minute modules that students could view as often as desired. For most modules, instructors used the ‘moderation mode’ so that only the instructor could see students’ comments, questions, or responses to specific prompts. Student responses to and evaluation of VoiceThread were extremely positive. Students commented that it was cool and fun. They especially liked that it required no special software and allowed them time away from campus while still allowing them to interact with the content. They felt engaged and were still able to master the content.

University of Oklahoma

College of Nursing faculty and staff have implemented an open-source clinical information system (CIS), OpenVista, as a platform for nursing students’ acquisition of healthcare informatics competencies. Healthcare facilities of the twenty-first century are increasingly adopting technology to manage information. Providing experiential learning activities to facilitate nursing students’ development of informatics competencies necessary for practice in these technology rich environments is a timely challenge. The project, funded by a grant from HRSA/BHPr/DON/NEPR, is the first academic application of an open-source production-grade clinical information system in the US. The overall goal of the grant is to use the clinical information system to integrate informatics competencies in the baccalaureate nursing curriculum via learning activities in the clinical courses. Data sets used in the student learning activities will be based on simulated and/or deidentified patient data. The open-source CIS is a less expensive alternative to using proprietary clinical information systems in an academic setting. As the community of users grows, other users can have the benefit of improvements including forms and templates developed as a result of the community’s efforts.

The electronic medical record system (EMRS), Vista, was developed initially in the 1980s for use in the VA Medical Center. Subsequent versions of Vista are currently in use by VAMC, Indian Health Service facilities, and Tribal health facilities. Medsphere Systems Corporation developed enhancements to Vista and markets their version, OpenVista, to non-government hospitals and healthcare facilities that seek an alternative to the more expensive proprietary health information solutions.

The College has contracted with Medsphere for installation, training, and support services for the academic use of OpenVista. Medsphere technical staff configured and installed the OpenVista CIS on a College server. Medsphere nurses and technical staff trained project faculty and staff. College of Nursing technical staff working on the project developed a Web portal to allow students to access the CIS from anywhere there is an Internet connection. Project faculty and staff are developing learning activities for students. Project faculty are conducting the initial implementation of student learning activities with a group of students in a junior-level clinical nursing course during the spring semester of 2009. Project faculty and staff will develop additional learning activities and will incrementally increase the numbers of participants over the course of the three-year grant project.

During the presentation, the authors will discuss strategies, challenges, and successes associated with the deployment of an open-source CIS in an academic setting. The presentation will also include discussion of nursing student learning activities associated with the project and their relationship to informatics education and quality and safety education.

Yale University

The need to integrate technology into nursing education stems from a variety of sources. Teaching smarter and faster with more efficient resources is chief among the motivational factors. But there is also a need to provide asynchronous education that spans learning and geographical barriers. Podcasting is a form of educational technology that helps faculty teach smarter by developing an audio recording of a course that is made available via the internet 24/7. The audio file crosses time and space barriers and can meet the needs of students with different learning capacities. It is a high-tech form of education that can be facilitated through student’s Ipods. Podcasting is defined as digital audio MP3 file that is usually made available for download on the internet. In this form of technology, course lectures, case studies, discussions and conferences can be recorded and uploaded to the internet as MP3 files. Students may download the file to their Ipods, or other MP3 device, and listen when and how they want. Students can choose to listen to the file in short time periods or repeatedly to enhance learning.

The team leader was introduced to podcasting during her prior academic appointment and requested support at Yale University School of Nursing (YSN) to pilot podcasting in a primary care course at the school. The course focuses on assessment and management of chronic illness, highlighting management of patients with co-morbid disease. The course spans all years of the specialized master’s education program and is required for adult, family, gerontological, women’s health, and psychiatric-mental health nurse practitioner students. The podcasts were made of lectures given in this class. Students could then listen to the lecture at a later date if they had missed the class, or wanted to review it again to enhance understanding or prepare for examinations. While no formal evaluation of the podcasting was conducted, most students had an IPod or suitable MP3 player on which to listen to the podcasts and appreciated the availability of the lectures outside the assigned classroom time. Of note, a student with a learning disability expressed an added interest in the ability to listen to a lecture over an expanded time period, as is possible with podcasting.

While the initial implementation of the podcasting resulted in a positive response, much more can be done with this form of technology. Both the depth and breadth of podcasting can be expanded to make this meet the needs students and faculty. Voice and sound quality can be enhanced with more education and experience with the system to professionalize recordings. Podcasting can also be expanded beyond the simple recording of lectures for uploading to the internet. Podcasts can be used to communicate with students and facilitate discussions. Moreover, podcasts can be effectively integrated into classesV2, our online learning platform to enhance the school’s educational technology support system. Within this platform, podcasting becomes part of technological package that enhances learning and can be used for both the facilitation and assessment of knowledge.

YSN has built a solid reputation in traditional teaching pedagogy and is now poised and ready to expand traditional teaching practices using advanced technology. The team encompasses faculty within the adult and family health specialties, covering key courses including health assessment, the four semester primary care courses and clinical conferences. Thus, the team represents an ideal group of faculty to integrate expanded technology seamlessly into the adult health specialization, providing both a template and leadership for adoption by the rest of the school.