Authentic and CollaborativeCase-Based Learning:A New Model for TeachingFamily and Community Nursing OnlineBeth Register PhD, RN-BC, MPH, CCMVera Polyakova-Norwood MEdCollege of NursingUniversity of South Carolina

Graduate Nursing Programs at the University of South CarolinaMSN and DNP degrees and NP certificate program are delivered primarily onlinePhD program is being adapted for online delivery

Course Objectives:Describe key concepts of advanced practice nursing with families and communities.Utilize relevant concepts, theory and current research to plan advanced practice nursing care with families and communities.Apply principles of cultural competence to advanced practice nursing with diverse family and community groups.Examine the role of the advance practice nurse as family and community advocate.

Who are the students?Future nurse practitioners enrolled in the MSN, DNP, and NP certificate programs Different generations Geographically dispersed Work full time or part time Varying levels of clinical experience Multiple family responsibilitiesSpring 2009:26 students

Future nurse practitioners enrolled in the MSN, DNP, and NP certificate programs

Different generations

Geographically dispersed

Work full time or part time

Varying levels of clinical experience

Multiple family responsibilities

Traditional Lecture-Based Model

Traditional Lecture-Based Model Faculty Perspective:It can be awfully lonely in the studio classroom … Student Perspective:The course does not add to my preparation as nurse practitioner.

The ChallengeMake the course feel relevant to future advance practice nursesIntroduce authentic learningOvercome student biases and stereotypesCreate excitement and engagementEnhance student skills set for critical thinking, collaboration, and problem solving

Authentic learning focuses on “real-world complex problems and their solutions, using role-play exercises, problem-based activities, case studies and participation in communities of practice.”(Lombardi, 2007, p.2)

Designing authentic learningReal world relevanceIll-defined problemSustained investigationMultiple sources and perspectivesCollaborationReflectionInterdisciplinary perspectiveIntegrated assessmentPolished productsMultiple interpretations and outcomes(Lombardi, 2007)

What We Decided to Do

Let students work on cases!Each Case Management Team is presented with an authentic patient record containing:DemographicsComplete clinical informationFamily informationResidence/community information

What did students have to do?Work in teams to create, implement and evaluate a patient-centered care planMobilize family and community resources to meet patient’s needs

Students learned about the patients and their familiesLive web meetingfor case intake between the faculty and student case management team

Students assessed communities and available resources

Students made real referrals… we scheduled a tour of the MUSC Children’s Hospital for March 2, 2009, arranged for the parents to stay at the Ronald McDonald House during the induction phase, and arranged for a tour of the Ronald McDonald House on March 2, 2009. We referred the parents to the Leukemia, Lymphoma Support Group in Myrtle Beach, to the ALL-Kids Listserv for online support at http://listserv.acor.org/archives/all-kids.html, to the Candlelighters childhood cancer support group at http://www.inspire.com/groups/candlelighters-childhood-cancer/, and referred the family to Caring Bridge for online support to help keep them connected with friends and family - http://www.caringbridge.org/. This included a coordinated referral for Pediatric Hematology/Oncology. We spoke with Amy Strohecker, appointment coordinator for Pediatric Hematology/Oncology, at 843-876-0444 about an initial appointment for the Dawsons with Dr. JacquelinKraveka. According to Ms. Strohecker, the appointment will be on March 2nd at 1400 at 35 Rutledge Avenue, and Kyra will check in at MUSC Children’s Hospital on March 3rd.

Implementing the Plan: Oops…We need to re-group!Lesson Learned:Work with your patient. He is a real person and if you do not have him on board, your plan is not going to work no matter how brilliant it is.

Teams presented cases to the entire class for critiqueTeam two has provided care for Mrs. Esther Bellantonio, an 81 year old patient with ovarian cancer, who is suffering the side effects of neuropathy. Our team has created a plan to help Mrs. Bellantonio resume her daily activites, as well as utilize community resources to enhance her living, while remainig in her home. We invite you view our wiki, and we welcome your feedback. Hope you enjoy!

Learning and making connectionsFacultyVirtual Patient and FamilyStudentMembers of the Team People in the CommunityClassmatesCommunity Resources

Connecting through technology … and telephone, cell phone, texting, email, group discussion boards …

Role-playing: Learning to work with patients, families, and communitiesDr. Register, I have just a few more questions to ask you/Mrs. Bellantonio: Is she interested in us arranging rides to church services/activities? If so, does she mind if we contact the church to see if any of the members would be willing to provide transportation? Well, I don't want to bother anybody. I know a lot of people at the church. They asked me before if I needed a ride. I guess that would be nice. Yes. Maybe give them a call for me. Thank you. …

Supportive learning environment

Instructional team!Course content knowledge and skills Instructional design Teaching experience Best practices in online education Technology expertise Willingness to try new approachesTeamwork

What did students take away from this course?End-of-course reflections

Understanding of Family and Community Health NursingNursing 708 has been an illustration of how patient care not only involves the patient, but also the community, family members, and support persons. Necessary medical treatment is only part of patient care. This class had demonstrated the mobilization of people and organizations to reach a projected outcome on a first hand basis.NURS 708 Student, Spring 2009

Patient advocacyThe most important overall lesson learned in Family and Community Health is to always be a patient advocate. … A nurse is not just someone who passes out pills anymore. A nurse provides the link between client and everyone else. … Nurses’ roles have changed drastically over the past twenty years, and patient advocacy is a defining characteristic of an advanced practice nurse.NURS 708 Student, Spring 2009

Teamwork and online collaborationI learned how to work with an online group. This was very difficult because parts of the project had to be completed prior to progressing to the next step. This was very frustrating because you could not tell when things would be posted. I found myself doing other people’s work so I could complete mine. The positive side was that they, in turn, would critique my work and provide extra input. This resulted in a better product. The group members soon identified what each member excelled in and tapped into those talents.NURS 708 Student, Spring 2009

A new approach to learningThe case-based learning approach stimulates creativity in the planning of care, regardless of the community setting. It affords the opportunities to apply different strategies to engage the patients and their families in their care. This approach provides valuable real world interaction with real patient scenarios and the resources available in the community with a focus on planning patient care according to where they are in their illness. This is not textbook “ideal” community health nursing, it is real “hands on” application of family and community health nursing. NURS 708 Student, Spring 2009

New learning skillsThis semester has taught me to look at the big picture initially and then systematically break it down to each medical problem/concern.An important new learning skill I have acquired over the course of the semester is simply learning how to tap into others knowledge base to learn more about a phenomenon I knew little about. Learning to use others know-how skills is an important tool to have to obtain the knowledge one needs. NURS 708 Students, Spring 2009

Increased self awareness… I became more aware of my own thoughts and how they may be perceived by others. I became more aware of my own beliefs and how acceptance of others beliefs can positively impact healthcare. This course has given me self awareness I will not only use in my practice as a nurse, but in life.NURS 708 Student, Spring 2009

Professional growthNURS 708 has been an invaluable course for my MSN preparation. The information and experiences obtained through this course will affect my everyday practice as a family nurse practitioner. … I felt as though I learned so much, and I am more confident in my ability to care for families and communities. … This was a wonderful course, and I am a better nurse for having taken it.NURS 708 Student, Spring 2009

Questions?Comments?Beth Registermeregis@mailbox.sc.eduVera Polyakova-Norwoodvnorwood@mailbox.sc.eduThe 15th Sloan-C International Conference on Online LearningOctober 29, 2009