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.