Hello. My name is Lydia Warth. I am an Instructional Technologist with Idaho State University. If any of you aren’t familiar with ISU. We are a located in Pocatello, ID and have a student population of about 15,000 students. I’d like to welcome you to “Using moodle to facilitate simulations for rural nursing professionals” and thank you all for attending. I hope you will find this presentation interesting. As we go along, please feel free to interrupt me if you have a question. We will have time for questions at the end of the presentation but my teaching style of such that I really don’t mind explaining things as we go along. So that I have an idea of who I am talking to; Who here are faculty members? Who teaches in a health care field? Who here are technical professionals? Great – thank you.
Before we begin I would like to acknowledge that this was far from an individual effort. Many people helped to bring this to fruition. Some of these people include: Deb Reiland – she has been the driving force behind this project – she created or collected most of the material used in the simulation, Nancy Renn and Mary Ovitt - both have been very helpful in the in-person simulations, Deana Molinari – she is the director of the School of Nursing’s Office of Professional Development – It was her idea to offer the simulation entirely online, Darren Gonzol – has spent countless hours capturing and editing videos, and Tamara Hollinger-forest – she coordinates OPD enrollments and communicates with the students.
For the past year one of my assignments has been to provide instructional and technological support to ISU’s School of Nursing. As part of this I have been working with various faculty members to redesign and improve their reality-based scenario simulation exercises. Today I would like to share with you a little about our development process and show you how Moodle can be used to enhance and facilitate simulations. Now I am going to be talking about a nursing-specific simulation but the pattern and processes could easily be adapted for use in other disciplines.We will begin by discussing the redesign and development of our in-person simulation. A great deal of effort has gone into making the in-person simulations as effective as possible. Because of this we had a very good pattern in place when we decided to make the move to online. Next we will talk about how we were able to offer the simulation entirely online. And finally I would like to show you our customized Electronic Health Record charting system. This was created because our students needed to be able to chart on the computer but all of the products available were just too expensive. Our solution was to create our own charting system using the Moodle lesson tool.Ok – let’s get started.
If you will bear with me. I’d like to take just a few minutes and give you a bit of background information. Some of you are health care professionals and some of you are techies – like me. Let me see if I can explain a few things so that we’re all on the same page.Reality-based scenario simulations are often used as a way for the students to practice various skills in a controlled environment. Simulations are also used to expose students to situations that may not be possible in the clinical setting. The simulation we have been developing focuses on leadership and team building skills. During the in-person simulations, the students participating were senior level undergraduate students. When we offered the simulation online we had to adapt to a different student demographic. The online students were nursing professionals working in the rural setting. They took the course for continuing education credit. At the beginning of the simulation, the students are given a scenario, assigned a role to play, and then are expected to work their way through the scenario as a team.They are given general information about diagnoses, medications, labs and potential nursing roles about a week before the simulation. They do not get specific information (such as patient information, specific diagnosis, and role assignments) until the start of the simulation.
At the beginning of the simulation, the course instructors take some time to explain the simulation scenario, answer any questions, and assign roles. To alleviate some of the pressure and stress, the students are told that they will not be graded on their nursing skills. Instead, they need to focus on implementing the things they have learned about leadership and team building. The “day” begins at 7:30 am with a report from the night-shift charge nurse (who is actually a faculty member). The students are told that they are working in a rural hospital with a team of 4 other nurses. They have five patients that they will be caring for during the day. The patients are played by volunteers from the community. Role assignments are based on the students’ strengths and/or weaknesses. The intention is to challenge the students and give them a chance to shine. Students who are not able to have a nursing role get assigned as Observers. The simulation runs for about 2 hours. A major event happens about every 20 minutes. These events, such as a patient falling or having a heart attack) help to move the simulation along and give the students many opportunities to practice their team building and leadership skills. The “chaos” created by these events also helps the scenario feel more realistic. Student assessment is done during a debriefing discussion at the end of the simulation. This discussion is an integral part of the simulation experience. Each student is asked to comment on what they thought went well and possible improvements. The observers are also asked to comment on what they saw during the simulation. This opportunity for reflection has proven to be very helpful both to the students and the instructors.
When we redesigned the in-person simulation last fall we moved all of the paperwork online. Our intention was to have the students chart, submit orders, fill out vital sign sheets, and look up patient information all from within Moodle. This didn’t work very well for a few reasons. Even though they had been told ahead of time that they could use web-ready devices, the students either didn’t have them to use or chose not to use them. This meant that they had to use the stationary lab computers outside of the patients’ rooms.The students felt overwhelmed by trying to deal with the computer, the patient and the team all at once.Information ended up getting written on random pieces of paper which made collecting and reviewing it very difficult.(Show Simulation Course) Ultimately it was determined that the students needed to fill some things out hard copy just from an ease of use stand point. The only paperwork that was retained online was the charting tool.The online charting tool was created using a Google form. The students would fill it out and submit it. This tool was significantly better than paper charting – especially since most of the facilities no longer use paper charts. (Show charting tool) However it did have some draw backs. In order to include all of the body systems the form had to be very long. Sometimes the browser will time out while the students were charting so that when they clicked submit they would loose the information that they have entered.Since all of the responses submit to the same spreadsheet it would be difficult for this tool to be used by multiple instructors.We ended up creating our own Electronic Health Record charting tool which we will be talking more about later in this presentation.The Feedback tool in Moodle has been very helpful during this process. We created a likert scale survey to collect student opinions regarding the various aspects of the simulation. Based on their feedback many changes have been made.
Ok – you are probably saying to yourselves that this is all well and good but what does it have to do with offering the simulation online using Moodle? Well what I was hoping to demonstrate with this background information is that we already have a good working model in place. We didn’t have to recreate things we just had to adapt them to meet the needs of the students and the restrictions of the delivery method. Early on we could see that there were essentially four main challenges to offering the simulation entirely online. These were:How can we make the simulation available to online students and have it be effective? - We did this by using a combination of video clips, Moodle forums and a synchronous meeting software (WebEx). How can we facilitate communication? – There were several types of communication in this simulation. Student-Instructor communication took place in WebEx. The students were able to ask questions either verbally or by chat and the instructor (called Central command) would respond. Nurse-Patient communication took place inside the “patient’s room” which was a Moodle forum. Team communication had been intended to take place in a Moodle forum created specifically for that purpose, however it turned out that it was easier for the students to communication in the patient rooms. This caused a bit of confusion for the patients but nothing that create a problem. Nurse-Doctor communication also took place in a forum. Since forums in Moodle aren’t synchronous all of the simulation participants had to frequently refresh their screens to see new posts. Now you are probably wondering why we chose to use Moodle forums rather than the chat – especially since the chat is a synchronous tool. We did this for a couple of reasons. First, our students already had experience using the forums so we thought it would be less intimidating than a new tools. Second (and more importantly) we needed to be able to link to the video clips and attach files. Since this isn’t as easy to do in the chat we determined that the forum would be the better option.How can we make the online environment “feel” like reality? – We recorded one of our in-person simulations and used the video clips with the online students. The students were able to “administer a treatment” or “assess their patient” then they could watch a video of what was happening with the patient at that particular time in the simulation. We also had a video of each major event (such as a patient falling) that we played over WebEx at certain intervals. This added to the “chaos” and helped the simulation be closer to reality.How can we make sure that the students will have the tools and skills needed to be successful online? – We didn’t want the technology to get in the way of what we wanted the students to learn. We tried to give them as much information as possible before the simulation so that they could prepare. We gave them a brief “how-to” document before the simulation and we spend about 45 minutes going over the technical things that the students would experience. We had them practice posting to a forum, make sure that the videos would play on their computers and gave them a chance to ask any questions they had. Some of the students didn’t take advantage of these resources and experienced problems.
For the online simulation we used the same scenario as was used in the in-person simulation. However we only used 4 of the 5 patients. We created accounts for each of the patients in Moodle to help create the illusion of reality – it looked like the responses were actually being posted by the patients instead of by someone else. WebEx was used for pre-simulation training and for Student-Instructor communication. Since WebEx plays videos automatically we used it to play the patient crisis videos. Moodle was used for all other communication and interaction with the patients.Let me show you our online simulation (Show Online Simulation Course).
So how did the experience turn out? Well, just like in the in-person simulations, we had some positive results and some not-so positive results. On the positive side:First of all it actually worked. Which is a big positive. I agreed to do this presentation before we did the online simulation. One of my biggest worries was that I would have to come here and tell you that it hadn’t worked and here is why not.It was a bit more difficult but we saw that the students were still able to practice their leadership and team building skills even though they were interacting with their team online.Many of the outcomes were similar to the outcomes that we saw in the in-person simulation.Weaker Nurses would get frustrated and feel overwhelmedStronger Nurses would step up and help lead teamThe focus of the simulation would get over shadowed at times by patient care – nurses were more focused on treating their patients then on implementing the leadership and team building skills they were supposed to be practicing.Even online the “squeaky wheel” patients would get more attentionStudents said that they felt the feelings of urgency and drive to help their patients even though the simulation was online. It was as close to reality as possible.On the negative side:It took longer online – due to computer lag and the need to type everythingIt required more people to facilitate it. We can run the in-person simulation with 2-3 staff members. For the online simulation we had to have someone play each patient, the doctor and central command. A total of 6 staff members.We had one group of students at the same location. They tried to work as a group on the same computer but it didn’t work very well and they expressed extreme frustration. In the future we will suggest that each student their own computer.Students didn’t make use of the preparatory materials. Consequently not everyone started out at the same level and we as the instructors had to take some time to explain and demonstrate things.Students got frustrated because responses were not instant. This was really only a problem right at first. Once we asked them to be patient and wait for posts – since they were being typed in – this was no longer a problemStudents also got frustrated because it wasn’t as easy to ask questions online as it would have been in a traditional setting.Ultimately the online simulation went – in my opinion – very well. The problems experienced were mostly expected and fixable. None of them were bad enough to stop the simulation. The outcomes were very similar to the outcomes of our in-person simulation. In listening to the debriefing at the end of the simulation it sounded like the students had learned and found value from their experience. They also gave us several good ideas for improvements.
Now I would like to take a few minutes and show you our Electronic Health Record. (Show EHR) As I mentioned earlier, this project came about because our students needed to be able to practice charting on the computer. There are several products out there that schools can purchase for this purpose but the prices are prohibitive. So we decided to try to create something ourselves. Using the Google form didn’t work very well so we decided – well I guess I should say that I decided since it was my idea – to move it into a Moodle lesson. Here is what we came up with. It still has some limitations but it is definitely better than what we had before.
Well I think that is all I have. Thank you all for your participation. Does anyone have any questions or comments?
Using moodle to facilitate simulations for rural nursing(1)
Using Moodle to Facilitate Simulations for Rural Nursing Professionals<br />Presented by: Lydia K. Warth M.Ed.<br />Idaho State University – Instructional Technologist<br />
Redesign/development of in-person simulation<br />What are simulations used for?<br />How was this simulation setup?<br />How did we use Moodle to facilitate the simulation?<br />Online simulation<br />How did we adapt the simulation for use online? <br />What tools were used to facilitate the online experience?<br />Electronic Health Record<br />Customized online charting tool.<br />Overview<br />
Practice in a controlled environment<br />Facilitate exposure to specific situations<br />Our simulation<br />Focuses on leadership and team building skills<br />Each student is assigned a nursing role<br />Must work as a team to get through the scenario<br />Reality-based Scenario Simulations<br />
Roles<br />5 nursing roles<br />Charge Nurse<br />RN1<br />RN2/Nurse Educator<br />LPN<br />CNA/ward clerk<br />Observers<br />Family members<br />Doctor – not on site.<br />Environment<br />6 bed medical-surgical unit at a rural hospital<br />7:30am to 11:30 am shift<br />Major scripted events occur about every 20 minutes.<br />Simulation Setup<br /><ul><li>Patients
End-Stage Ischemic Cardiomyopathy</li></li></ul><li>Used Moodle to disseminate information.<br />Created an online charting tool using Google forms.<br />Used Feedback tool to collect student responses.<br />Modifications and improvements made based on responses.<br />“This simulation was the best <br />simulation I have been involved with so far. It was very organized. There was so much information available on each patient. I like that there was actual lab values, ECG, orders. This simulation was <br />more like real life than any previous simulation.” – student comment Nov. 2010<br />In-person Simulation<br />Simulation Course<br />Physical Assessment – charting tool<br />
Challenges<br />Availability – Effectiveness<br />Communication<br />Realistic experience<br />Student technological proficiency<br />Solutions<br />Using a variety of tools.<br />Using an online meeting tool (WebEx) and Moodle forums.<br />Using video clips and synchronous tools.<br />Preparatory information – including step-by-step instructions and multiple ways to ask questions.<br />Moving Online<br />
Same Scenario<br />Only had 4 patients<br />WebEx Live Meeting<br />Communication with students<br />Posting “chaos” videos<br />Used Moodle<br />Team communication<br />Nurse/patient interaction <br />Contact doctor<br />Online Simulation<br />Online Simulation Course<br />Assessment Video - sample<br />Crisis Video - sample<br />Chaos Video (WebEx) - sample<br />
Positives<br />It Worked!!<br />Students were able to practice desired skills.<br />Outcomes similar to outcomes of in-person simulations<br />Feelings of stress and frustration<br />Strong leaders would shine<br />Chaos and patient care<br />Care priorities<br />Realistic Experience<br />Negatives<br />More time required<br />More personnel required<br />Students needed to be on their own computers.<br />Lack of preparation<br />Slow response time<br />Communication limitations<br />Online Simulation Results<br />
Electronic Health Record<br /><ul><li>Patient Information