Apps & Games for Clinical and Patient Education © Bauman 2013

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This talk was presented at the 33rd Annual Dialysis Conference in Seattle, WA on March 11, 2013 © Bauman 2013

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Apps & Games for Clinical and Patient Education © Bauman 2013

  1. 1. Apps  &  Games  for  Clinical  and  Pa@ent  Educa@on:  Mechanism   for  Behavioral  Change   Eric  B.  Bauman,  PhD,  RN  ©Bauman  2013  Rights  Reserved  
  2. 2. Disclosures  &  Affilia@ons   ©Bauman  2013  Rights  Reserved   –  Center  Excellence  in  Simula@on   Educa@on,  DeVry,  Inc     •  Associate  Director   –  Division  Chief,  EMS  –  Blooming  Grove   Fire  Dept.   –  Managing  Member  –  Clinical   Playground,  LLC   –  Managing  Member  –  Forensic  Analy@cs     –  Springer  Publishing  –  Author     –  Adjunct  Faculty  –  CAE  Healthcare   –  Relevant  Stock  –  CAE,  Zynga,  GE,  Pfizer   –  Society  for  Simula@on  in  Healthcare       •  Serious  Games  &  VE  SIG  Co-­‐Chair   –  Interna@onal  Nursing  Associa@on  for   Clinical  Simula@on  and  Learning    Any  and  all  discussion  and  content  represents  the  views  and  scholarship  of  the  presenter  and  does  not  proclaim  to  and  may  not  represent  the  views  of  any  employer  or  affilia@ons  named  in  these  disclosures  
  3. 3. Objec@ves  •  Introduce  and  define  terms  relevant  to  game   and  applica@on-­‐based  educa@on  •  Introduce  and  review  pedagogy  that  supports   game  and  applica@on-­‐based  learning  •  Discuss  the  roles  of  game  and  app-­‐based   learning  for:   –  Clinical  Educa@on   –  Pa@ent  Educa@on   .  .  .  .  .  .  .  .  .  .  .               ©Bauman  2013  Rights  Reserved  
  4. 4. Terminology  •  Games  vs.  Simula@on  •  Gamifica@on  •  Ludology  •  Metagaming  •  Virtual  Worlds  [Environments]  •  Game-­‐based  Pla_orm  •  Augmented  Reality  •  Avatar  or  Player  Character  •  Non-­‐player  Character  •  Created  Environment   ©Bauman  2013  Rights  Reserved  
  5. 5. Games  versus  Simula@on   ©Bauman  2013  Rights  Reserved  •  Tradi@onal  Perspec@ve  on  Games   –  Goal  Oriented   –  Rule  Based   –  Sense  of  Consequence     •  Rewards  or  otherwise  •  Tradi@onal  Perspec@ve  on   Simula@on   –  Imita@on  of  something  real   –  Representa@on  of  key  design   elements  or  variables  of  a  system  or   process  
  6. 6. Gamifica@on  “The  use  of  game  design  elements  in  non-­‐game  contexts”                                Fitz-­‐Walker,  2012             “To  some,  gamifica@on  is  the  Next  Great  Hope  for  deep  user   engagement”                                          Machew  Jensen,  2012  •  Makes    content  more  engaging    •  Encourages  users  to  engage  in  desired  behaviors    •  Illustrates  a  path  to  mastery  &  autonomy    •  Provides  incen@ve  to  complete  chores  or  tasks  otherwise  seen  as  boring    •  Data  from  “gamified”  applica@ons  can  be  leveraged  for  CQI  Projects,  Curricula  and      ROI  Evalua@on                                                hcp://en.wikipedia.org/wiki/Gamifica@on   ©Bauman  2013  Rights  Reserved  
  7. 7. Engagement  through  Mechanics   ©Bauman  2013  Rights  Reserved   hcp://mashable.com/2010/07/13/game-­‐mechanics-­‐business/  
  8. 8. Game  Design  over  Gamifica@on!   ©Bauman  2013  Rights  Reserved  “Games  are  Machines  For  Gaining  Competence”   Reward  should  come  from  Mastery     Game  Does  not  by  Defini@on  =  Fun  Thus  Gamifica@on  is  not  always  Playful  nor  Fun   Sebas@an  Deterding   GLS  8  –  June  15,    2012  
  9. 9. Game-­‐Based  Learning  and  Reward   Intrinsic     Extrinsic    Reward  comes  from  Mastery   Tangible  Reward  Goals  are  clear,  meaningful  and  situated   Goals  assigned  Progress  is  intui@ve  apparent  and   Progress  is  determined  or  assigned  immediate  [real-­‐@me  or  just-­‐in-­‐@me]   outside  of  the  current  ac@vity  Endorses  or  reinforces  behavior  you  are   If  you  complete  this  task  you  will  be  given  already  commiced  to  or  hope  to  engage   access  to  another  task  –  Hierarchical  in  the  future  –  Represents  Player  Agency   Direc@on   Autonomous     Directed   Ac@ve  Learning   Crea@ve   Shallow   Compliance   Deep  Meaning   Outcome  Driven   ©Bauman  2013  Rights  Reserved  
  10. 10. Ludology   “We  are  entering  the  Ludic  Century…  …  we  will  use  games  to  shape  the  future  of  educa@on”     Eric  Zimmerman,  NYU  Games  Center   6/15/2011  at  GLS7   www.ericzimmerman.com/   hcp://gamecenter.nyu.edu/tag/eric-­‐zimmerman   ©Bauman  2013  Rights  Reserved  
  11. 11. Ludic  Pedagogy   The  manner  through  which  games  teach  [learners]   players  to  play  [Learn]…  hcp://etd.lsu.edu/docs/available/etd-­‐11092011-­‐154402/unrestricted/jbroussard_disserta@on.pdf   The  ac@vity  of  play,  par@cularly  when  engaging  a  new   game  always  represents  a  learning  process   ©Bauman  2013  Rights  Reserved  
  12. 12. Metagaming  It  is  the  use  of  out-­‐of-­‐game  [out  of  curriculum]  informa@on  or  resources  to  affect  ones  in-­‐game  [prac@ce]  decisions…  Transcends  a  prescribed  rule  set  …uses  external  factors  to  affect  the  game  [prac@ce],  or  goes  beyond  the  supposed  limits  of  the  game  [prac@ce]  environment  hcp://en.wikipedia.org/wiki/Metagaming   ©Bauman  2013  Rights  Reserved  
  13. 13. Metagaming   ©Bauman  2012  Rights  Reserved  hcp://www.gcrme.med.miami.edu/harvey_features.php  Imagine  a  mobile  applica@on  or  game  that  could  be  leveraged  for  unique  learning  and  later  as  a  cogni@ve  aid  during  actual  prac@ce   ©Bauman  2013  Rights  Reserved  
  14. 14. Metagaming   ©Bauman  2012  Rights  Reserved   hcp://www.hollandcollege.com/admissions/full_@me_programs/prac@cal_nursing/  
  15. 15. Metagaming   ©Bauman  2012  Rights  Reserved  
  16. 16. Augmented  Reality   Augmented  reality  supplements   the  real-­‐world  such  that  actual   objects  exis@ng  in  the  real-­‐world   appear  to  coexist  with  virtual   objects,  computer  generated   images  that  are  representa@ons   of  actual  objects.   (Univ.  of  Picsburgh  Simula@on  &  Medical  Technology  Center)   (Azuma,  Behringer,  Feiner,  Julier,  and  MacIntyre  2001;  Bauman,  2012)    
  17. 17. Avatar  or  Player  Character  The  term  avatar  is  originally  from  Hindi  mythology.  The  gods  would  take  the  shape  of  mortals  in  the  form  of  human  avatars  to  walk  the  earth.  In  video  games  and  virtual  environments,  an  avatar  transcends  two  planes  of  existence:  the  real  world  and  the  in-­‐world  or  virtual  world.  The  avatar  or  player-­‐character  is  the  embodiment  of  the  person  playing  the  game.  Players  live  in  and  interact  with  the  virtual  or  game-­‐based  environment  through  their  avatars.  (Bauman  2010  p.183).  
  18. 18. Virtual  Worlds       Game-­‐Based  Pla_orm  Virtual  worlds:  an  environment  that  hosts  a  synchronous  digital  environment,  persistent  network  of  people,  represented  as  avatars,  facilitated  by  networked  computers  (Bell,  2008)  Game-­‐based  pla6orm:  An  environment  that  provides  a  narra@ve  and  system  of  rewards  for  accomplishing  specific  tasks  and  objec@ves.  Game-­‐based  pla_orms  use  virtual  environments  to  stage  the  game.  Not  all  virtual  reality  environments  are  game-­‐based  (Bauman,  2010,  p.  186).   ©Bauman  2013  Rights  Reserved  
  19. 19. Non  Player  Character  In-­‐world  agents  of  and  from  the  game  or  virtual  environment.  NPCs  are  a  func@on  of  programming  and  do  not  exist  outside  of  the  game  or  virtual  environment.  NPCs  are  in-­‐world  characters  that  the  players’  (learners’)  avatars  interact  with  (Bauman,  2010  p.  186)     Player   Character   Player   Non  Player   Character   Character  
  20. 20. Created  Environment  Created  Environment  An  environment  that  has  been  engineered  to  replicate  a  real-­‐world  space,  producing  sufficient  authen@city  and  fidelity  to  allow  for  the  suspension  of  disbelief.  Simulated  environments,  whether  fixed  in  the  case  of  mannikin-­‐based  simula@on  laboratories  or  exis@ng  in  virtual  reality,  as  in  a  game  or  applica@on-­‐based  environments  are  created  environments.   Bauman,  2007,  2012  
  21. 21. Pedagogy   In  general  many  of  the  theories  that  support  simula@on  and  game-­‐based  learning  have  their  roots  in  Experien9al  Learning   Kolb  
  22. 22. Schön: Thinking-on/in-action ©Bauman  2013  Rights  Reserved          In  Schön’s  theory  the  professional  engages  in  a   dialog  with  a  problema@c  situa@on  or  experience  and   listens  to  back-­‐talk,  a  form  of  self  generated   feedback  that  helps  guide  and  inform  decision-­‐ making     •  Thinking-­‐on-­‐ac@on     •  Thinking-­‐in-­‐ac@on  
  23. 23. Benner: Thinking-in-action ©Bauman  2013  Rights  Reserved        Argues  that  thinking-­‐in-­‐ac9on,  the  use  of   previous  experiences  to  reflect  on  during  real   world  prac@ce,  differen@ates  the  quality  of  the   decisions  made  by  novices  and  experts  
  24. 24. The  Experien@al  Challenge   ©Bauman  2013  Rights  Reserved  •  The  “newbie”  or   true  novice  cannot   think  “In  ac@on”  •  They  may  not  even   be  prepared  to   think  “on-­‐ac@on”   hcp://www.glasbergen.com/  
  25. 25. Situated  Learning   ©Bauman  2012  Rights  Reserved  Designed  Experience  …is  engineered  to  include  structured  ac@vi@es  targeted  to  facilitate  interac@ons  that  drive  an@cipated  experiences.    These  ac@vi@es  are  created  to  embody  par@cipant  experience  as  performance.     Squire,  2006  Socially  Situated  Cogni=on  Refers  to  learning  theory  that  is  situated  within  a  material,  social,  and  cultural  world.    Learning  that  is  situated  takes  place  in  contextually  specific  and  authen@c  environments  with  a  host  of  values  and  expecta@ons     Gee,1991,1993  
  26. 26. Situated  Learning   ©Bauman  2013  Rights  Reserved   Ecology  of  Culturally  Competent  Design  Addresses  the  rigors  and  challenges  of  accurately  situa@ng  culture   within  virtual  environments  using  a  four-­‐element  model  that   emphasizes  the  importance  of:    ac9vi9es,  contexts,  narra9ves,  and  characters.•       Ac@vity:  What  is  there  to  do  in  the  created  environment?  •       Context:  What  is  the  context  of  the  ac@vity  taking  place  in  the  environment?  •       Narra@ve:  How  does  the  story  unfold  based  on  the  decisions  that  the  player(s)    make  in  the  environment?  •       Character:  How  does  the  player  iden@fy  or  embrace  their  in-­‐world  iden@ty?   Bauman  2012,  Bauman,  2010,  Bauman  &  Games  2011,  Games  &  Bauman  2011  
  27. 27. Expansion  of  the  Clinical  Space  How  do  we  expand  the  educa@onal  space  in  terms  of  Clinician/Student   Educa@on  and  Pa@ent  Educa@on?     Games  and  Mobile  Applica@ons  
  28. 28. Games  and  Simula@on  for  Clinical  Educa@on   Illustration  2.1   Rethought  Simulation  to  Practice  Pathway ©  Bauman  2010  ©  Bauman  2012Knowledge Acquisition Behavior Simulation Games Experience Clinical Practice Didactic Games Cogitative  Aid
  29. 29. Games  and  Apps  for  Pa@ent  Educa@on   Games  and  Applications  for  Patient   Education  ©  Bauman  2013Knowledge Acquisition Behavior Reinforcement Games Extrinsic Behavioral Intrinsic Change Didactic Games Cogitative  Aid
  30. 30. Mobile  Applica@on  Examples   iPad  Skin  Prep  Applica@on  
  31. 31. Mobile  Applica@on  Examples   ProgenitorX  
  32. 32. Why  Games  Macer  How  you  provide:   –  Just  in  Time  Informa@on   –  Just  in  Time  Prac@ce   –  Just  in  Time  Feedback  Games  come  with  built  in  surveillance:   –  Allows  for  data  collec@on   –  Analysis  for  correla@on    
  33. 33. M.  Presky,  2001   ©Bauman  2013  Rights  Reserved  Digital  Na=ves  People  who  were  born  with  (contemporary)  digital  technologies    already  in  existence.  Digital  Immigrants  Those  who  were  born  prior  to  (contemporary)  digital  technologies  and  migrated  into  the  digital  realm  adop@ng  the  technology  later  in  life.  
  34. 34. Take  Home  Message   Game-­‐Based  Learning  leverages  created   environments  so  that  learning  takes  place  as   performance  though  carefully  designed  experiences  that  o~en  use  a  contextually  situated   narra9ve  to  promote  curriculum  objec@ves   ©Bauman  2012  Rights  Reserved  
  35. 35. Ques@ons?   ©Bauman  2013    Rights  Reserved  R.  Kyle  
  36. 36. Selected  References  &  Recommended  Readings  Azuma,  R.T.,  Baillot,  Y,  Behringer,  R.,  Feiner,  S.,  Julier,  S.,  and  MacIntrye,  B.  (2001).  Recent  advances  in  augmented  reality.  IEEE  Computer  Graphics  and  Applica9ons,  21(6),  34-­‐37.  Bauman,  E.  (2007).  High  fidelity  simula@on  in  healthcare.  Ph.D.  disserta@on,  The  University  of  Wisconsin-­‐Madison,  United  States.  Disserta@ons  &  Thesis  @  CIC  Ins@tu@ons  database.  (Publica@on  no.  AAT  3294196)    Bauman,  E.  B.  (2012).  Game-­‐based  Teaching  and  Simula9on  in  Nursing  &  Healthcare.  New  York,  NY:  Springer  Publishing  Company.    Bauman,  E.  (2010).  Virtual  reality  and  game-­‐based  clinical  educa@on.  In  Gaberson,  K.B.,  &  Oermann,  M.H.  (Eds)  Clinical  teaching  strategies  in  nursing  educa9on  (3rd  ed).New  York,  Springer  Publishing  Company.  Bauman,  E.B.  and  Games,  I.A.  (2011).  Contemporary  theory  for  immersive  worlds:  Addressing  engagement,  culture,  and  diversity.  In  Cheney,  A.  and  Sanders,  R.  (Eds)  Teaching  and  Learning  in  3D  Immersive  Worlds:  Pedagogical  models  and  construc9vist  approaches.  IGI  Global.    Benner,  P.  (1984).  From  novice  to  expert:  Excellence  and  power  in  clinical  nursing  prac9ce.  Menlo  Park,  CA:  Addison-­‐Wesley.  Benner,  P.,  Tanner,  C.,  &  Chesla,  C.  (2009).  Exper9se  in  nursing:  Caring,  clinical  judgment,  and  ethics.  New  York:  Springer  Publishing  Company    Broussard.,    J    (2012).    Making    the    MMOst    of    Your    Online    Class.    Teaching    and    Curriculum    Dialog.  Culhane-­‐Pera,  K.A.,  Reif,  C.,  Egli,  E.,  Baker,  N.J.,  and  Kassekert  (1997).  A  curriculum  for  mul@cultural  educa@on  in  family  medicine.  Family  Medicine,  29(10),  719-­‐723.  Faragher,  J.F.,  Boese,  T.,  &  Decker,  S.,  Sando,  C.  (2011).  Standards  of  best  prac@ce:  Simula@on.  Simula9on  in  Nursing,  7(4),  S1-­‐S20.  Fitz-­‐Walter,  Z.  (2012).  hcp://gamasutra.com/blogs/ZacharyFitzWalter/20120426/169287/Gamifica@on_Thoughts_on_defini@on_and_design.php  Games,  I.  and  Bauman,  E.  (2011)  Virtual  worlds:  An  environment  for  cultural  sensi@vity  educa@on  in  the  health  sciences.    Interna9onal  Journal  of  Web  Based  Communi9es  7(2).    Gee,  J.P.  (2003)  What  Videogames  Have  to  Teach  Us  About  Learning  and  Literacy.  New  York,  NY:  Palgrave-­‐McMillan.  Gore,  T.,  Van  Gele,  P.,  Ravert,  P.,  &  Mabire,  C.  (2012).  A  Survey  of  INACSL  membership  about  simula@on  use.  Clinical  Simula9on  in  Nursing,  8(4),  e125-­‐e133.  Jenson,  M.  (2012).  Engaging  the  learner:  Gamifica@on  strives  to  keep  the  user’s  interest.  T  &D,    January,  2012,  41-­‐44.  Kolb,  D.  (1984).  Experien@al  learning:  Experience  as  the  source  of  learning  and  development.    Upper  Saddle  River,  NJ:  Pren@ce  Hall.  Larew,  C.,  Lessans,  S.,  Spunt,  D.,  Foster,  D.,  &  Covington,  B.  (2006).  Innova@ons  in  clinical  simula@on:  Applica@on  of  Benners  theory  in  an  interac@ve  pa@ents  care  simula@on.  Nursing  Educa9on  Perspec9ves,  27(1),  16-­‐21.    Nursing  Midwifery  Council  (2007).  Nursing  and  Midwifery  Council  Circular,  36(2007),  United  Kingdom.  Prensky,  M.  (2001).  Digital  na@ves,  digital  immegrants,  part  1.  On  the  Horizon  9(5).  Popkewitz,  T.  (2007).  Cosmopoli@anism  and  the  age  of  school  reform:  science,  educa@on  and  making  a  society  by  making  the  child.  Routledge.  Taekman  J.M.,  Segall  N.,  Hobbs  G.,  and  Wright,  M.C.  (2007).  3DiTeams:  Healthcare  team  training  in  a  virtual  environment.  Anesthesiology.  2007:  107:  A2145.  Schön,  D.  A.  (1983).  The  reflec9ve  prac99oner:  How  professionals  think  in  ac9on.  New  York:    Basic  Books.  Skiba,  D.  J.  (2009).  Nursing  educa@on  2.0:  A  second  look  at  Second  Life.  Nursing  Educa9on  Perspec9ves,  30,  129-­‐131.  Squire,  K.  (2006).    From  content  to  context:  Videogames  as  designed  experience.    Educa@onal  Researcher.    35(8),  19-­‐29.    Squire,  K.,  Giovaneco,  L.,  DeVane,  B,.  &  Durga,  S.  (2005).  From  users  to  designers:  Building  a  self-­‐organizing  game-­‐based  learning  environment.  Technology  Trends,  49(5),  34-­‐42.  Taekman  J.M.,  Segall  N.,  Hobbs  G.,  and  Wright,  M.C.  (2007).  3DiTeams:  Healthcare  team  training  in  a  virtual  environment.  Anesthesiology.  2007:  107:  A2145.  Tervalon,  M.  and  Murray-­‐Garcia,  J.  (1998).  Cultural  humility  versus  cultural  competence:  A  cri@cal  dis@nc@on  in  defining  physician  training  outcomes  in  mul@cultural  educa@on.  Journal  of  Health  Care  for  the  Poor  and  Underserved,  9(2),  117-­‐125.    Turkle,  S.  (1995)  Life  on  the  screen.  Iden9ty  in  the  age  of  the  Internet.  New  York:  Touchstone.   ©Bauman  2013  Rights  Reserved  
  37. 37. Contact  Informa@on  ebauman@clinicalplayground.com   @bauman1967   Clinical  Playground  LLC   Eric  B.  Bauman,  PhD,  RN   ebauman@clinicalplayground.com   www.clinicalplayground.com   hcp://www.linkedin.com/in/ericbbauman   hcp://www.slideshare.net/ebauman  

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