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Apps	
  &	
  Games	
  for	
  Clinical	
  and	
  Pa@ent	
  Educa@on:	
  Mechanism	
  
                                for	
  Behavioral	
  Change	
  
                                            Eric	
  B.	
  Bauman,	
  PhD,	
  RN	
  




©Bauman	
  2013	
  Rights	
  Reserved	
  
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	
  
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	
  
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	
  
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	
  
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	
  
Engagement	
  through	
  Mechanics	
  
                                                                     ©Bauman	
  2013	
  Rights	
  Reserved	
  




                     hcp://mashable.com/2010/07/13/game-­‐mechanics-­‐business/	
  
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	
  
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	
  
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	
  
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	
  
Metagaming	
  
It	
  is	
  the	
  use	
  of	
  out-­‐of-­‐game	
  [out	
  of	
  curriculum]	
  informa@on	
  or	
  
resources	
  to	
  affect	
  one's	
  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	
  
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	
  
Metagaming	
  
                                                           ©Bauman	
  2012	
  Rights	
  Reserved	
  




           hcp://www.hollandcollege.com/admissions/full_@me_programs/prac@cal_nursing/	
  
Metagaming	
  
                 ©Bauman	
  2012	
  Rights	
  Reserved	
  
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)	
  	
  
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).	
  
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	
  
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	
  
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	
  
Pedagogy	
  
 In	
  general	
  many	
  of	
  the	
  theories	
  that	
  support	
  simula@on	
  and	
  
game-­‐based	
  learning	
  have	
  their	
  roots	
  in	
  Experien9al	
  Learning	
  




                                                   Kolb	
  
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	
  
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	
  
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/	
  
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	
  
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	
  
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	
  
Games	
  and	
  Simula@on	
  for	
  Clinical	
  Educa@on	
  
                                                             Illustration	
  2.1	
  
                                              Rethought	
  Simulation	
  to	
  Practice	
  Pathway
                                                  ©	
  Bauman	
  2010	
  ©	
  Bauman	
  2012

Knowledge Acquisition


       Behavior



                           Simulation
      Games
                           Experience            Clinical Practice

       Didactic




                                                               Games



                                                      Cogitative	
  Aid
Games	
  and	
  Apps	
  for	
  Pa@ent	
  Educa@on	
  
                                                Games	
  and	
  Applications	
  for	
  Patient	
  
                                                   Education	
  ©	
  Bauman	
  2013


Knowledge Acquisition


       Behavior



                           Reinforcement
      Games                  Extrinsic                 Behavioral
                              Intrinsic                 Change
       Didactic




                                                               Games



                                                     Cogitative	
  Aid
Mobile	
  Applica@on	
  Examples	
  




      iPad	
  Skin	
  Prep	
  Applica@on	
  
Mobile	
  Applica@on	
  Examples	
  




            ProgenitorX	
  
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	
  	
  
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.	
  
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	
  
Ques@ons?	
  
                                 ©Bauman	
  2013	
  	
  Rights	
  Reserved	
  




R.	
  Kyle	
  
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	
  Benner's	
  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	
  
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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Apps & Games for Clinical and Patient Education © Bauman 2013

  • 1. Apps  &  Games  for  Clinical  and  Pa@ent  Educa@on:  Mechanism   for  Behavioral  Change   Eric  B.  Bauman,  PhD,  RN   ©Bauman  2013  Rights  Reserved  
  • 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. 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. 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. 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. 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. Engagement  through  Mechanics   ©Bauman  2013  Rights  Reserved   hcp://mashable.com/2010/07/13/game-­‐mechanics-­‐business/  
  • 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. 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. 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. 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. Metagaming   It  is  the  use  of  out-­‐of-­‐game  [out  of  curriculum]  informa@on  or   resources  to  affect  one's  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. 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. Metagaming   ©Bauman  2012  Rights  Reserved   hcp://www.hollandcollege.com/admissions/full_@me_programs/prac@cal_nursing/  
  • 15. Metagaming   ©Bauman  2012  Rights  Reserved  
  • 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. 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. 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. 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. 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. Pedagogy   In  general  many  of  the  theories  that  support  simula@on  and   game-­‐based  learning  have  their  roots  in  Experien9al  Learning   Kolb  
  • 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. 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. 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. 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. 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. 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. Games  and  Simula@on  for  Clinical  Educa@on   Illustration  2.1   Rethought  Simulation  to  Practice  Pathway ©  Bauman  2010  ©  Bauman  2012 Knowledge Acquisition Behavior Simulation Games Experience Clinical Practice Didactic Games Cogitative  Aid
  • 29. Games  and  Apps  for  Pa@ent  Educa@on   Games  and  Applications  for  Patient   Education  ©  Bauman  2013 Knowledge Acquisition Behavior Reinforcement Games Extrinsic Behavioral Intrinsic Change Didactic Games Cogitative  Aid
  • 30. Mobile  Applica@on  Examples   iPad  Skin  Prep  Applica@on  
  • 31. Mobile  Applica@on  Examples   ProgenitorX  
  • 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. 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. 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. Ques@ons?   ©Bauman  2013    Rights  Reserved   R.  Kyle  
  • 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  Benner's  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. 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