Interactivity and evaluation tools

After reading Dr. May's and other colleague blogs, as well as general searches for interactive education tools, I can safely say that my previous knowledge of interactive education tools barely scratched the surface of what exists to aid faculty members.  I had previously used webex audio conferencing technology, in addition to video conferencing. I also knew that some online interactive quiz programs, existed, but had no idea the extent or creativity that exists in the programs available.  It seems so many educators, myself included, have been recreating the wheel when it comes to practice quizes, simulation and scenario writing, just to name a few.  VSIM and Free Nurse Tutor alone, could save immeasurable time for both the baccalaureate instructor as well as clinical educator.  Free nurse tutor could also be a great source for someone who is struggling with NCLEX preparation.  Another site I found is ArchieMD.  This site has a multitude of clinical interactive video animations.  Their format is designed to be best used with mobile and touch screen devices as well as web based applications.  Additionally, if they do not have a topic or subject area withing their library that meets an educator's needs, you can request that a learning module be developed for you.  However, I was unable to determine if there is an associated cost with custom applications.

The amount of pre-existing interactive educational tools is  overwhelming.  I personally had no idea the scope of material and programs that exist.   I feel like educators frequently recreate the wheel unnecessarily, and this lesson module further proved to me there is much opportunity to work smarter, not harder in the arena of interactive clinical education.

LMS and simulation

Learning management systems

Over the past two weeks, as we have been evaluating learning management systems, this process reminds me of the processes discussed in our informatics course used for adopting computer based documentation systems.  While the end product is different, the processes seem to mirror each other.  Evaluating the needs and limitations of the health care or academic system, involving key stakeholders, analyzing cost of both the system, implementation training and maintenance, as well as assuring the product is user friendly are all common steps.  I found it interesting that many of us from the IU cohort felt the need for our eLMS system to be accessed from off site.  While I understand the reasoning for the access restrictions, these boundaries were developed in a time when the healthcare economy and demands on the bedside nurses "looked" a little differently than it does now.  After the recent reduction in force, most every unit has had to do more with less.  The changes in workflow have left nurses with little time to manage anything outside of patient care.  As many of us discussed in the forum, if a predetermined time was allotted  for each eLMS module, that time could be paid upon completion, if the learner satisfied the requirements from an offsite (and presumably off duty) computer.


Simulation

Hospitals and nursing schools across the united states are turning to simulation as a means to increase exposure to a variety of clinical situations among learners of all types.  Simulation provides a safe environment and the possibility to experience high acuity, low volume situations without fear of harmful errors.  Although students frequently report "feeling better" about their experience or comfort with a situation, study after study results in no difference in outcomes related to cognitive ability or critical thinking skills.  Moreover, studies have also found no significant difference in cognitive skill  outcomes between simple mannequin simulation and high fidelity mannequin use in the same scenarios (Secomb, McKenna, & Smith, 2012).  As a frequent user of simulation, I find these results very disheartening.  Clinical resources for students are dwindling.  Nursing schools frequently have a need for qualified clinical faculty as well as clinical education sites.  With limited resources, other means must be utilized to assure that students are exposed to a variety of clinical situations.

While I have read several different articles regarding effectiveness of simulation, none that I have come across seem to have a good hypothesis as to why simulation seems to be relatively ineffective.  As per my normal curious nature, I have given this some thought.  It seems students who are not familiar with high fidelity simulation mannequins are often taken aback by the functions of the mannequins themselves.   I wonder if the eye opening, pupil dilating, coughing and breathing of these simulators becomes more of a distraction than an adjunct to teaching.  I wonder if the students were given an opportunity to get comfortable with the mannequin interactions prior to simulation exercises, if that would improve the grasp of concepts.  I believe that looking for and recognizing the cues given by monitors and the mannequins is key to a student's learning.  However, these cues are not always options with standard mannequins or just the discussion of a scenario or a computer generated learning module/ scenario.    

Additionally, the ability to write a good scenario is key.  The learners must have through provoking incidents, find themselves with options of treatment decisions, and be able to quickly rationalize a best choice.  Scenarios must pose good questions and opportunities for discussion following the exercise.  Good scenario writing includes a background and history from which the learner can incorporate patient focused assessment and intervention.  The quality of the scenario is  more important the the method in which the scenario is delivered.  I have found simulation to be very valuable both as a learner and as an instructor.    Below is a video of a code situation for nursing students.  This scenario allows for the students to identify the deterioration of the patient prior to the code, as well as practice clinical skills of intervention and delegating team member roles.

Patient Simulation Demo     

Reference

Secomb, J., McKenna, L., & Smith, C. (2012).  The effectiveness of simulation activities on the       cognitive abilities of undergraduate third-year nursing students:  A randomized control trial.   Journal of Clinical Nursing, 21, 3475-3484.

Digital Storytelling

     Digital storytelling has become a relatively new method utilized in nursing education.  Through digital storytelling, educators can focus attention on key points of a topic.  Digital storytelling allows for the learner to not only hear the information, but be exposed to emotion and circumstances that may promote remembering a point, as well as clinical application and understanding.  Digital storytelling seems to be particularly effective when related to caring practices or how to improve communications within nursing.
    IU Health has utilized a career advancement ladder system, with a review board which I am privileged to be a member.  Briefly summarized, this process of advancement has required that nurses write stories of their practice, so that the board may stage their practice from novice to expert, as defined by Patricia Benner.  While these stories are not digital, they are often very revealing of one's thoughts, emotion and "what the nurse is up to" as she/he practices.  Because of these connections, I remember clinical nursing stories from areas in which I have never worked.  These stories, and this process have had great impact on my own clinical knowledge as well as professional development.  (As a side note, I have become very entrenched in Benner's work).    My experience with digital storytelling is very limited, but given the connection I have had with written stories, it seems reasonable that when more senses are engaged, the connections, memory and application of the story stands to only be stronger.
    Over the past two weeks as I have gotten more familiar with digital storytelling, and have learned many things.  One of the most significant points to emphasize with creation of a digital story is to first write a clear story.  If the writer gets caught up in music, transitions and computer "fanciness", the point of the story can be overshadowed or lost.  Additionally, there are many ways to create a digital story.  The possibilities are as endless as the creativity and individuality of the storyteller. Here are a couple of videos describing methods and key points in creating a digital story:

   

 By engaging nursing students and creating a connection to a situation, patient care interaction or critical thinking process, students are more likely to apply the information to their own practice.  It is a way of modeling behaviors and simulating more than the clinical information gained from rote memorization.

Communication and Collaboration

     As the semester progresses, I am certainly learning many new ways to use technology in education.  The educational tools for communication and collaboration seem to be endless.  I have found great value in programs such as google drive and wikis in regard to working in groups to revise documents.  Based on the videos Dr. May has posted, as well as other sources  regarding these programs, it seems there is some overlap between google drive and wikis.  However, google drive seems to offer many more applications.  As with any technology, more options can also lead to more confusion when collaborating with a group.  Depending on the goal of the project, a wiki may be more straightforward, even though it has fewer options.  Google drive also has a mobile app available, providing easy access for those who frequently work on the go.  Here is a link to elaborate on the possibilities google drive offers.  PBworks also offers an educational edition that is specifically focused on meeting the goals of academic wiki needs.   Click on this pbworks link to get connected to more wiki resources.

Additionally, in the past two weeks, the presentation exercise was very educational for me.  I chose to use Prezi for my presentation.  While there was a bit of a learning curve for me initially, once I got the hang of it, my presentation came together without too much trouble.   I will say, I found it to be easier to utilize prezi from my Mac desktop than my windows based laptop.    I am not sure if the operating system was the greatest influencing factor, or if just the fact that a desktop was easier for me.  The voice recording function was also much easier on my desktop computer.  I posted my prezi in a separate blog entry, just for my own ease of reference, but here is the prezi link again, just in case you missed it.  This assignment was also very beneficial to me, as I got to see multiple types of presentation technologies in action by viewing my classmates' presentations.    I particularly enjoyed Jessica Clendenen's screencast presentation, Mercier Cooney's prezi and Erin Hoying's prezi, all for various reasons.   The screencast presentation is something I have not used before, and believe to be particularly useful in the academic setting.  Jessica did a nice job with the demonstration of how to use the technology, as well as the educational content of the presentation as well.  Mercier jazzed up her prezi with some snappy music, and Erin embedded video.  These tools were engaging and serve to improve the learner's attention to the content.  I certainly plan to try these formats and tools both in my personal academic endeavors as well as my teaching.

Prezi on RSI medications

I attempted a new presentation tool called prezi.   I had a little trouble, but overall not too bad.  For some reason, the narration that coordinates with the first slide does not play.   It shows on the pathway/ edit toolbar down the side, but does not play in presentation mode.   I am not sure why.

Here is my prezi on RSI medications, if you would like to take a look
https://prezi.com/sypgnqarh2b9/

Becoming more blog savvy

   

     Throughout the majority of the past week, I have found myself incredibly frustrated with my new adventures in blogging.   A good majority of the time, I couldn't even manage to log into my own blog. What I did not realize at the time was even though I had not opened my UIndy email with that particular session on the computer, it was still up and going in the dark reaches of my computer's background/ brain.  After a cry for help (thanks Dr. May),  and a purposeful attempt to step away and regroup, I am back to blogging again.  

     One thing I have learned is the trick to adding a link.  While there is the obvious Link  on the toolbar, there is also some sneaky details of requiring all the URL details.  So, here is the link for learning how to add a link.  Let's hope it works!   There is also a page with instructions for adding an image.  Both of these links are from the blogging for dummies website.  As I was searching the web, I felt that site might be most applicable to me!  Blogging for dummies was very helpful for me, and there are more topics on their site to help, but I am taking baby steps.  

     Throughout my technology exploration, I have read multiple articles about the usage of technology in nursing education.  One article I found particularly interesting was an executive summary report from the state of Oregon.  In effort to stretch the faculty resources and reach as many students as possible, Oregon schools of nursing have implemented video conferencing, simulators and other avenues of technology.  There were common barriers identified, but, found the barriers were worth the improvements in curriculum delivery.  

     An educational technology newsletter focusing on the nursing profession was published by UMASS Boston.  This newsletter addresses the use of technology in nursing, and also has live links that redirect to a wide variety of technology adjuncts and how they may be applied to nursing curriculum.  This newsletter was also quite interesting.

Introduction

Greetings!

My name is Daphne Hurm, I am a staff nurse in the IU Health North in the ER.   I graduated Nursing school in 1996, and began my career in Evansville in Emergency Medicine.  Along the way, I have worked in the Neuro Critical Care at Methodist, in the Methodist ER and also with LifeLine.  The vast majority of my career has been spent in emergency medicine. While I arrange the vast majority of the unit based orientation and education for our department,  I would like to obtain a more formal position as an educator for emergency medicine services.

An educational project I would like to focus on is the development of a program that helps develop competency in low volume, high acuity procedures.   We seem to have a handful of procedures and/or situations that occur in the ER on a fairly infrequent basis, but, are high stakes situations.  When working in the Methodist ER, not only were those situations more frequent, but there were always more staff members around to ensure someone knew how to manage the high acuity event.  In a smaller ER, there are fewer staff members, and less frequency of high acuity events.   An example of such a procedure is an elective intubation with rapid sequence intubation drugs and the appropriate use of sedation and chemical paralysis after intubation.

Learner objectives would include :

1.  The learner will demonstrate understanding of the steps of RSI procedure and the nursing role.

2.  The learner demonstrates competent understanding of RSI drugs such as Fentanyl, etomidate, succinylcholine, nimbex, rocuronium, versed, propofol, etc. Learner should be able to discuss indications, onset, duration of action,  and contraindications for these medications and any other frequently used medications for sedation and chemical paralysis.

3. The learner knows the appropriate equipment to prepare for intubation procedure as well as the difficult airway equipment in case of unexpected complications.


These objectives need a lot of polishing, as I am not well versed in writing objectives.  But, that is a skill I anticipate I will be learning soon.  Additionally, other things I have learned in the past two weeks include basics of blogging, and opportunities that technology presents for improved delivery of education.  Technology offers so many options for enhancing learning opportunities.  I didn't even know avenues such as Diigo even existed prior to this course.