Final Plan for Flexible Learning

I've appreciated peoples feedback re my plan.
Comments
Further Comments

The changes I am making to the original plan is to definitely continue down the road of finding a lockable room for Annie the simulater and a computer with preloaded scenario's, then allow students open access via a booking system. I will ask our lab technician to be involved in the booking system.

Another sugestion was to video our scenarios and load them onto the computer so students can access these as well, to see the correct procedure. I plan to do this and also load on to the computer the online resources that demonstrate assessment skills. They can review these skills while also practising. All this will be avialable on the computer next to Annie. This plan will allow flexibility for students to continue to practise the essential skills in a practical way. Following is my plan....

Project Name: Development of scenario based simulation learning

Date: 30th July 2008

Organisation: Nursing School Otago Polytechnic

Auther: Raewyn Lesa lecturer in School of Nursing. raewyn@tekotago.ac.nz


Executive Summary:By March 2009 I intend to have our manikin (a simulator) available for access, to students enrolled in year 2 medical/surgical nursing. Scenarios will be downloaded into the vitalsim in 'Annie' (the simulator) to develop scenario based learning. This is to support our current teaching strategies for teaching nursing assessment skills and critical thinking. Scenarios are available from Leardal.I also plan to develop some of our own. These scenarios will be downloaded onto the computer next to 'Annie' the simulator so students can access them to see the results of their actions. Annie will be on a locked room with swipe card access and a booking system for students to use. To supplement this I will also provide videos of correct procedures and links to online resoures on assessment, on the computer.

Project background:
For the last few years we have had a very expensive manikin in our nursing laboratory (worth around $15000) which has hardly been used. This manikin has a vitalsim unit and remote control allowing us to program ‘Annie’ to make realistic noises, take BP’s, pulse, respiration rate, listen to different heart, lung and abdominal sounds and perform many procedures such as catherisation, nasogastric insertion etc. We have only used Annie so far to let students listen to sounds if they want. This is a huge waste of an expensive resource.

Over the last few years nurses have been encouraged to develop their assessment skills, particularly in the area of physical assessment. We have responded to this in our undergraduate nursing program and started teaching students a wide repertoire of assessment skills. However we have many RN’s in the clinical setting who do not know these assessment skills. As a result our students are finding it very difficult to access opportunity on clinical to practice listening to lung, breath, abdominal sounds and to distinguish between normal and abnormal. We want our nurses to be able to take their assessment findings, develop a picture of what is happening and then know what to do with their findings (critical thinking)


Using simulation to aid student learning has developed greatly over the last few decades. Laerdal is an international company in New Zealand that specialises in simulation and training for staff. They talk about the many benefits simulation can provide such as realistic preparation for rare and difficult cases, you can make errors without causing harm to patients and you can keep repeating certain scenario’s until the students has learnt it. An example is you can program through your computer and then load it into the vitalsim a scenario related to a patient going into ventricular fibrillation (VF). You program the event and interventions you want the students to do. If they don’t do these interventions in certain times you can program the manikin to go into cardiac arrest or if they do correct interventions, patient goes back into sinus rhythm.

Recently I've become more aware of the limitations of lectures...I've noticed more and more they do not retain a lot of the information I have given them. To stimulate their learning I believe it helps if they can relate the theory to something they are experiencing. This is where simulation can be a huge advantage, they can see the results of the actions they take or hear what different sounds are like without having to subject patients to too much while they are learning.

Aim:
To provide realistic clinical situations in our skill labs, using simulation with our manikin ‘Annie”.


Objectives:

1) To continue my training in the use of simulation. I have already attended one and a half training days this year
2) To familiarise myself with the online website www.simulation.laerdal.com so I can access more scenarios and participate in forums.
3) Begin to programme simple scenarios into the vitalsim
4) Practice these scenario’s with colleagues before using them in the laboratory.
5) Video the correct procedures and load them onto computer
6) Next year introduce this onto my BN 233 course with the potential to extend this into third if the trial is successful


List of performance indicators (outcomes):

Outcome 1 A selection of programmed scenarios available in the vitalsim manikin.
Performance Indicators a) Have the scenarios ready for review by colleagues in September 2008. b) Make any necessary adjustments to scenarios c) continue to practice them with colleagues in my course. d) Have them ready to go to trial in labs March 2009.

Outcome 2 Videos of assessment skills available for students on the computer
Performance Indicator: a)Check out readily available resources of videos and make them available on course on student as a start b) Make a video of any skills that there isn't already available and copy this into course on students c) Continue to search for online resources that will benefit our students and add these sites to course on students as well d) November 2008 develop a shell on blackboard or noodle to add these resources to

Outcome 3 Consider extending this resource by making it available ot third years
Performance indicators a) Evaluate sessions throughout 2009 next year by getting student feedback after lab sessions and course feedback at the end of each semester.

Outcome 4 Provide flexibility by allowing students access to a locked room via a booking system to practice their course related scenarios and skills using the simulator 'Annie'
Performance indicators a) Explore the possibly of setting up a space in our clincal skill labs b) discuss with lab technician possibilities and best way to set up a booking system, ongoing support and swipe card access c) if required explore other options including funding availability

Flexible learning analysis:Perceived flexible learning needs of the students:

My students are mostly full time. The biggest difficulty they face in getting learning opportunities, is access to patients who may require certain skills. Also they are also often working with RN's in practice who are not skilled in advanced physical assessment skills. The use of simulation exercises with Annie in the lab times and by having the simulator available during daytime hours, they will get more opportunity to practice these skills and this will help deepen their learning.

Another perceived learning need is students have different styles of learning and for some students lectures are not the easiest way to learn. For students who learn best by visual or kinaesthetic styles, simulation will be of great value because they can both see the results and also get hands on experience. See the VARK categories for more information.

This type of service we already use but to a very limited extent, that is in labs they are givenn the oportunity to listen to heart and breath sounds but this is not linked to a specific scenario. We already use scenarios in labs however adding simulation exercises related to these scenarios there is the potential to enhance learning opportunities. See information about simulation to read about advantages of simulation to support learning. I am targeting this resource as it is a way of linking theory in lectures, to more practical real life situations. It is not intended to replace clinical experience. 'Annie' can be made more realistic by using clothing and setting up the environment. We will only do this to a small extent as it can be costly and also we are only using this as a supplement to clinical. However I will ask students if they want to donate clothes or wigs for 'Annie'

A major goal of this plan is to set the manikin up so students can access it out of lab times and practice their scenarios, therefore offering flexibility in regards to time and learning style. However it will only be available during nursing school hours by seeing recption to make a booking and obtain swipe card. At the moment I am planning to explore making some room in H202/H205 for 'Annie'. I also want to talk with our lab technician to see if she is willing to be the support person during her working hours. There will be no access after hours at this stage although this option could be explored later.

The flexible learning services I'm providing is mostly learning support strategies to compliment our use of lectures, labs and tutorials which we already offer. The students will be shown how to use and access the scenarios during our scheduled lab times


Sustainability: Lecturer release time will be the biggest sustainability issue. This is because there is 3 lecturers involved in our course and learning how to use the vitalsim can be time consuming because it is technology based. It can be easy to forget unless it is used frequently. It also requires time to load, make up new scenarios related to our course and learn the scenarios. 2 of our lecturers have not had any training in the use of simulation. ‘Time’ is a precious resource and presently all 3 of the lecturers have full workloads and are still studying to obtain their teaching qualification. We will need to have more than one lecturer plus our lab technician on board and trained in how to use vital sim.

Time to develop flexible learning is known to increase workloads and this is one of the reasons why teachers, schools and universities are resistant to change. However if there is the ability to decrease the workload of teachers this can make more time available for more and higher quality support activities.(teacher and learner workloads)e

To address this I will look at options such as applying for funding from the teaching and leaning innovation fund to provide lecturer release time. I will also develop this resource at a slow pace, starting with just a few scenarios and evaluate this by seeking student feedback. Once lecturers are pretty keyed up with the use of simulation then it should be pretty straight forward to update scenarios and the laerdal website and also the rep provide continued support. The Leardal website also keeps abreast of the many changes in healthcare and this site will be very useful to help us maintain currency with our scenarios


Access and equity will be a problem because at this stage we only have one manikin. If the students want to practice scenarios at flexible times then there will need to be a booking system and a locked room where it can be set up. Also it will be very difficult to allow access after hours due to giving the students access via a swipe card only obtainable from reception. I am going to continue to explore and advocate for his option.

However for students who have missed out some opportunity in clinical to practice skills, then having simulation available if students are keen to practice, increases access and equity for students learning clinical skills.

Cultural diversity is addressed very well by using simulation because it caters for various learning needs. In nursing we teach our students to be culturally sensitive and consider assumptions we may bring with race, age, gender, socioeconomic groups etc. The learning needs can be very different for people in any of these groups. For example an older student may have difficulty with technology because they haven't been brought up with it...Also some people haven't been able to afford computers so may not be as IT literate. By using simulation students can choose who they work with in groups who have learning needs similar to their own. The students can also choose the scenarios which they need to practice, to meet their particular learning need.

Once the sceanrios are loaded you don't need a high degree of IT literacy to be able to practice on the manikin.

As far as I'm aware students from differnt cultures will not object to using a simulator, it may instead help them be meore at ease as it is not a real person exposing themselves. However when I first address how to use 'Annie' I will ask students to let me know if they feel uncomfortable in any way using a manikin.


This plan aligns with OP's strategic direction of becoming excellent teachers and using and managing our resources effectively. Lecturer contact with students has been decreasing over the last few years as we try to manage within budgets. Simulation hopefully will enhance the students learning opportunity. By using simulation to supplement learning it aligns with the vision of Otago Polytechnic's charter to produce "Graduates who are work ready and prepared to work in a global market place"; provide a "curricula which engages challenges and fosters creativity and learner indpependence" and has "creative use of innovative technology"

I do not see simulation as a way of saving lecturer or preceptor time because these are still absolutely critical to help the student in clinical practice make links and also 'make sense' of the 'meaning of the experience' for the patient. A simulator can never do this.

Budget
Laptop computer to stay with Annie style (hopefully one can be sourced for free from within the polytechnic. (free)
2 weeks leave for 2 lecturers and the lab technician to focus on learning and developing these scenarios; may need to pay for a casual lecturer to provide cover.($3500)
Possibility of employing some students on a HRC summer scholarship and it could be developed as an action research project.

Timeline
September 2008 Begin to load preprogrammed scenarios into vitalsim
October through to March 2009. Practice and make asjustments of scenarios with lecturers
September through to November 2008. Continue to search for online resources, make videos of skills and load onto a blackboard/moodle shell
March 2009 Have at least 4 scenario’s ready to go for our skills labs
March 2009 have ‘Annie’ set up to be used by students at flexible times
March 2010 If successful begin to implement this with third year students



References
Otago Polytechnic Charter
Leardal Website
Teacher and Learner Workloads

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