Redesigning Clinical Skill Training through Technology

Grant:

Gilbert Whitaker Fund for the Improvement of Teaching

Academic Year:

2009 - 2010 (June 1, 2009 through May 31, 2010)

Funding Requested:

$9,934.00

Project Dates:

Fri, 05/01/2009 - Fri, 04/30/2010

Applicant(s):

mabersol

bmkh

Overview of the Project:

Project Summary: The purpose of this project is to restructure and redesign clinical laboratory teaching and learning activities for the sophomore year in the School of Nursing baccalaureate program using eLearning technologies. Goals are to increase student access to skill learning activities to improve proficiency, increase quality and safety of student clinical performance, establish consistency in teaching skills, reduce costs by reducing the number of faculty necessary for clinical skills training, promote integration of knowledge and skill learning from an evidence-based perspective, and improve student and faculty satisfaction with clinical skill training. School of Nursing faculty, Clinical Learning Center and information technology staff will review, evaluate, select, and develop educational technology that will restructure lab clinical skill teaching and learning in the sophomore year. Appropriate products will be purchased from vendors and some tools such as additional modules will be developed with an expert in instructional design. An educational program for faculty will be planned and implemented in consultation with an expert in teaching methods using new technologies. Students will have unlimited opportunities to review and learn skill development through eLearning systems, develop more proficiency in clinical skill performance prior to hospital placements, and become more responsible and accountable for their learning through self-directed experiences. The School of Nursing will benefit from reduced faculty costs, and improved utilization of hospital clinical placements with students better prepared to care safely for patients. [Project Duration]: Planning for the project implementation began in April of 2009. The revisions to the undergraduate courses N254 and N221 began in September of 2009 for N254 and mid-August 2009 for N221. The revisions that were rolled out were the complete redesign of the skills lab portion of each of those courses. The revisions to N256 rolled out in January 2010. All faculty and instructors associated with the skills lab were trained in the new format in August of 2009. [Overview of the Project]: In the first term, sophomore students enroll in two lab based courses, Assessment of Health and Illness and Health Maintenance I. In these beginning nursing courses, students learn basic skills necessary to assess the health status of individuals from infancy through old age. Emphasis is on the assessment of physical, developmental, psychosocial, cultural, and spiritual dimensions of the clients. Students learn to distinguish normal from abnormal and judge the functional abilities of the client. Key objectives address mastery of basic nursing skills necessary to provide proficient evidence-based nursing care. The following term, students enroll in Health Assessment II and Health Maintenance II. In these courses, students expand their assessment and skill repertoire, integrating content from other courses such as pharmacology and pathophysiology. Usually 14-16 students are assigned to a course section with one clinical lab instructor per section. Each instructor teaches skills through demonstration and supervision of students in their section. This results in inconsistency in teaching and evaluation of skill mastery and limits opportunities for students to practice those skills. In addition, multiple faculty are required to supervise the lab sections. Additionally, the teaching strategies have focused on traditional methods to deliver content. Our students come from a diverse background and our teaching methods need to embrace more learner-centered approaches and more multi-contextual learning environments (Giddens, 2007). [Phase One]: We reviewed, evaluated, selected and developed appropriate educational technology that will allowed us to restructure the sophomore lab learning experiences for two courses, Health Maintenance I and Health Maintenance II. These courses focus on fundamental skill development such as vital signs, medication administration, tube care, and catheterizations. By redesigning teaching and learning methods to incorporate new technologies, students: • have access to unlimited opportunities to review explanations and demonstrations through eLearning activities to better prepare them for skills practice and evaluation • learn skills from uniform content and performance expectations, and consistent teaching approaches • become more proficient in clinical skill performance prior to hospital placements, thus promoting patient safety and maximizing hospital clinical experiences • become more responsible and accountable for their learning through self-directed learning experiences • demonstrate greater satisfaction and enthusiasm for their learning. The School of Nursing has benefited from reduced instructional costs, improved utilization of hospital clinical placements, and improvement in student and faculty satisfaction.

Final Report Fields

Project Objectives:

The goals of Phase I of this project focused on improving the student clinical lab experience during the sophomore year and included: 1. Increase student access to skill learning activities that improve proficiency 2. Increase quality of student clinical skills performance 3. Establish consistency in laboratory teaching 4. Reduce cost by reducing the number of faculty members necessary for basic clinical skills training 5. Promote integration of knowledge and skill learning from an evidence based perspective 6. Improve student and faculty satisfaction with clinical skill training

Project Achievements:

To meet the above goals the entire lab experience was completely re-designed. Originally, students were organized in clinical groups (a total of 16 clinical groups which were doubled for labs) with a clinical instructor for each group providing skills lab education to the students. These instructors would demonstrate and teach skills in a variety of methods to the students and, as a result, the process lacked consistency and was very labor intensive. During the re-design, oversight of the clinical skills lab was moved to the Clinical Learning Center (CLC) under the direction of the Lead Faculty for the center. The student groups were re-organized and reduced to six groups with 2 instructors per group. The total lab time was also reduced from 20 hours per semester to 12 hours per semester, allowing 8 hours to be moved to on-site clinical experiences. E-learning materials were developed under the direction of the CLC and were standardized across all groups. Instructors were orientated to the lab learning materials and procedures. Students were expected to view pre-learning content prior to the lab so that lab time was focused on practicing skills rather than having instructors explain and demonstrate skills. Pre-learning materials consisted of e-learning modules selected to meet the training needs of the students. These modules are web-based and accessible from any computer. Additionally e-learning modules were developed for patient safety education with the Whitaker funding. A C-tools site was established for student access to the pre-learning materials. The e-learning materials contain written directions and video demonstrations for clinical skills. As part of these learning activities, students were given information on the latest evidence- based guidelines for each procedure. Instructors were also expected to reviewing the e-learning material and use that content and approach when practicing and guiding the students, thus providing a standardized and consistent learning experience. Clinical skills labs were organized to promote case- based, self-paced learning opportunities. Through the use of technology and the training models/simulators students are now able to practice skills independently during lab sessions and optional practice sessions. This change in practice has facilitated the students entering the clinical environment after they have been able to practice all of their basic skills in the lab/simulation area. This gives the students more confidence in their role as a student and makes the care they deliver safer to the patients. This also allows the clinical faculty to guide the students to a higher level of learning and competency which will ultimately allow us to graduate students that will be more successful in their first jobs as newly graduated nurses. Approximately 200 undergraduate students in three courses were impacted by this project. The cost savings for this re-design was a reduction in the number of lab hours and associated personnel costs. Student satisfaction was measured by surveying students at the end of each semester. Students were asked to rate their overall lab experience on a scale of 1-5 with 5 being extremely helpful. After two semesters, students rated the lab experience 4.4. Written comments indicated that students liked the hands on practice but wanted more demonstration from instructors. . As a result of these activities, the goals of Phase I were achieved including increased student access to learning activities, improved skill performance, consistency in lab teaching, reduced costs, integration of evidence-based learning, and satisfaction with skill training. One of the additional benefits to the new process is the change from faculty lead to student centered learning. Instead of faculty teaching everything to the students, the students were responsible for their own learning and the faculty provided reinforcement and support to facilitate student learning. This teaches students life-long learning skills that will ultimately benefit them. These achievements set the stage to fully implement lab clinical skills training under the direction of the CLC starting in Fall 2010.

Continuation:

The grant activities have been completed. The learning materials that were developed are now being used fall term, 2010 for students in the basic, fundamentals nursing course, N254, Health Maintenance and Restoration I and will be used for N256 in the winter. We conducted an evaluation of the changes after each semester last academic year and made some modifications for the upcoming 2010/2011 academic year based on feedback from students, instructors and faculty. We will submit an application for Phase II to continue this work for the nursing health assessment course, N152.

Dissemination:

Dr. Aebersold has discussed the development of the learning materials with School of Nursing faculty. The new skills lab redesign has been shared at undergraduate faculty meetings with the School of Nursing and was used as an example for our curriculum redesign at the undergraduate level. A poster presentation was done at the Drexel Nursing Conference in June 2010.

Advice to your Colleagues:

It is important to get administrative support to do this type of redesign work and to appoint a lead faculty to oversee the work and to collaborate with faculty and instructors in the actual design of the materials.

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