Developmental ideas and implementation plan CCEL)

Hi there

I've come quite a long way with my thinking...Here is the final plan...

One of the exciting things I have learnt while doing this teaching certificate is about constructivism (learners constructing their knowledge) and applying this to my course. It is very easy for me as the ‘expert’ to think I have the knowledge to teach the students everything they need to know. But the more I’ve thought about this, the more I realize how limiting this is for the student. I admit my specialty is neurology and I could teach for ever around this topic. Recently I’ve spent a lot of time on cardiac wards with the students and have had to facilitate the students learning due to my limited knowledge in this area. This has helped me to grasp how in clinical settings there is so much contextual learning going on, and it is so much better to help the students make sense of this learning rather than me teach them what I think they should know.

As I’ve thought about this I’ve began to imagine how much more the students can learn by sharing experiences with each from their situational/contextual learning while on clinical placement. We do this already in our tutorials but this only reaches a limited number of students (about 8 in the tutorial). If the students were able to put this learning on line and also utilize reflection to expand on their learning then this could be accessible to all the 96 students enrolled in BN 233 throughout the year (96 students).

This is where the theory of connectivism, described as the learning theory of the new digital age (Siemens, 2004), has sparked my interest. Also an article Mereana talked about titled ‘using technology to foster reflection in higher education’ has been helpful. Connectivism is about learning as a process where people share a variety of opinions and viewpoints via connections that may include networking via technology.
Individuals feed information into the network, which then feeds information back to individuals as part of a cycle.
This is beneficial because information is always changing. This is very evident in healthcare. Connectivism allows people to connect with new information that is generated on an ongoing basis. Siemens (2004) is quoted as saying ‘while there is a right answer now, it may be wrong tomorrow due to alterations in the information climate affecting the decision”.
This theory has led me on to exploring the use of e portfolios. We already ask the students to construct a portfolio to evidence their learning as this is really the only way we have to assess them at present, i.e. looking at the portfolio they hand in, listen to what they tell us and to a small extent preceptor/ward feedback. The reason preceptor feedback is not given high priority is because the RN is often assessing different things from us (technical skills and relating well to patients and staff is what they often comment on). The RN may not understand what we as a nursing school are trying to assess in the way of knowledge and meeting nursing council competencies.
The development of e portfolio’s has been driven by the changing forms of learning such as; more student centred, greater emphasis on lifelong learning, flexible delivery and more emphasis on competency based assessment, (very evident in nursing). Our student population has also changed, many having been bought up with technology and a lot of students very use to social networking….New learning is also often described as been experiential, networked and facilitated by mentors. Another interesting fact I have learnt is that formal learning only accounts for about 15% whereas informal learning account for about 85%. Therefore it is important that we facilitate this informal learning to help students increase their knowledge in our course.
Issues of e portfolios…
Who owns the portfolio…i.e student not teacher..this means they decide what goes in it…closed or open system…in our course we would have it closed due to potential confidentiality issues with patients
Interestingly enough I asked my students the other day if they liked having to do a portfolio considering so much work was involved. They responded with a resounding YES it was essential for them to 'make' them learn the work.
June 2004 from www.infed.org/biblio/b-learn.htm. Using technology to foster reflection in higher education

My Course (This is in smaller font to differentiate from the new course)

Following satisfactory completion of this course, students will be able to:

1 Safely demonstrate clinical practice in the medical surgical care settings. This includes social, physical, intellectual, cultural, emotional and spiritual safety, and making safe informed professional judgements within their scope of practice;

2 Demonstrate professionalism in all aspects of nursing practice. This will include participation in the inter-professional process and taking responsibility for the direction of their learning needs;

3 Recognise and articulate legal and ethical issues that impact on their practice;

4 Demonstrate the development and utilisation of therapeutic relationships with patients in the medical/surgical care settings. This will include the use of effective communication skills and respect for the boundaries of a professional relationship;

5 Recognise and utilise opportunities for patient teaching and learning incorporating the principles of rehabilitation and recovery;

6 Utilise an appropriate framework for the assessment, planning, implementation and evaluation of medical/surgical nursing care, including aspects of rehabilitation and recovery;

7 Demonstrate the use of reflection to uncover the meaning of illness/hospitalisation experience in the medical/surgical setting for patients and implications for the student’s practice. This will include the uncovering of theory embedded in practice.

The 33 theory and laboratory hours will be met in this course by the student attending 6 hours a week in each theory week (30 hours) plus 3 hours from the year two introductory week. The 17 self directed hours are allocated to allow the student to complete a portfolio, assessment and care plan while in the clinical setting. Students meet the 190 clinical hours by working in the acute care medical/ surgical setting with a Registered Nurse (RN) as a preceptor and with a lecturer from Otago Polytechnic providing supervision. Tutorials are included in the clinical hours.


Clinical assessment will be collaborative between the student, lecturer and registered nurse preceptor/s. Clinical assessment will be formative and summative, and result in an overall grade that reflects both the medical and surgical placement. A case study and care plan will be developed on either the student’s first or second placement and will include the assessment of a patient and the planning of nursing care. The case study and care plan will be assessed and graded by the lecturer and will contribute to the students overall clinical grade. The case study and care plan must be submitted to achieve outcomes of this course. A clinical portfolio will be developed by the student during their clinical placements that will support and evidence the meeting of outcomes of this course. The portfolio is also graded and contributes to the overall clinical grade of the course

My Revised Course

My Outcomes will not change because this is a curriculum issue; it is my learning strategies that I intend to change to meet outcome 2 and 7. Instead of compiling a hard copy portfolio, I intend to change this to compiling an e-portfolio. The reason I am changing this is because of the connectivism theory; this will allow students to connect with each others learning and construct new knowledge.

E- PORFOLIO

The purpose of this is for the students to construct their own knowledge from their clinical learning experiences. By commenting and reading other students work it will help them to increase their knowledge for the area they are working in.

A course wiki has been set up http:/moodle.op.ac.nz. Each student needs to enrol themselves as a participant in BN 233. Each clinical placement has it own wiki set up. If a student is placed in ward 4A then they will need to access this wiki. In this site they will need to make at least two contributions (they are welcome to make more) with at least one link to an interesting related article. There contributions can be about anything they have learnt during the 3 weeks. The more thought and effort they put into this, the more it will show us they are critically thinking and will impact on their grade. There will also be another page set up titled reflections. They need to place at least one reflection (utilising a framework such as Gibbs or de Bono) for each placement on this site. They will also be required to comment on at least one other reflection they have read.

They will not need to put there name on any of the work they submit however it is essential that they let the lecturer know in some way which is there work.

The e-portfolio learning activity links with outcome 2 and 7.

Learner analysis

In my learner analysis I talked about older, male and international students sometimes struggling with compiling a portfolio, because of the writing involved. I’m hoping that these students will benefit from seeing other peoples work, as it may help them to see how to write or how to lay things out. I also think that for the students who are struggling, the information that other students provide may be more at their level and will help them. Also the school leavers will probably enjoy been able to use technology because they are quite comfortable with it.
Our professional body, the Nursing Council of New Zealand (NCNZ) expects students and Registered Nurses to be able to articulate how they are meeting the NCNZ competencies in the form of a portfolio. This is one way of students learning from each other, how they can demonstrate these competencies.

Resourcing

I have already spent some time with Terry Marler and have the site set up. I also have a book titled “Using Moodle’ (Cole & Foster, 2008) borrowed from the university library which I’m finding very helpful. I will need more time with Terry when I am ready to put more things online. Ruth Wilson-Salt one of the lecturers is very experienced in blackboard and is keen to help me set up this site.

I will allow one of my early lectures to teach the students the basics of navigating the BN 233 course sites and explain things such as how to hyperlink. Before lectures start the lecturers will get together to make sure they can understand how to use the site.

Timeplan

September 2008 Contact Terry and get a site set up on blackboard and attach
videos of OSCES and links to helpful sites for students.

October 2008 Finish my plan and assignments completed for course

November 2008 Begin to set up site with clinical wiki’s, titles and links

December 2008 Reflect changes in new course outline and present to year two
team to go over and make suggestions

February 2009 Get together with lecturers to learn about moodle site, seek help
with any difficulties

March 2009 Be ready to go

May 2009 Meeting with lecturers to evaluate if things are going okay

July 2009 Evaluate semester one course and determine if changes need to
be made for semester 2.

November 2009 Evaluate semester 2 and present to nursing school a summary of
how the changes went


Cole, J. & Foster, H. (2nd ed.) (2008) Using Moodle Teaching with the Popular Open Source Course Management System. OReilly Community Press: California

video on e portfolio

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Constructing courses to enhance learning

Grading clinical is a question I stuggle with. When our students are on clinical for 6 weeks in the medical/surgical setting they receive a grade at the end of this. How to allocate a grade is difficult because often it is reliant on the students abilitiy to articulate verbally or written, what they have learnt. Many of you like me have been learning about learner styles during this certificate. People who learn auditory or through reading are usually people who can also express themselves well this way. However for many learners kinsethetic is the way they learn which is why they are so good on practical placements. But the only way we have to assess them at present is to look at the portfolio they hand in, listen to what they tell us and to a small extent preceptor/ward feedback. The reason preceptor feedback is not given high priority is because the RN is often assessing different things from us (technical skills and relating well to patients and staff is what they often comment on). This is particurly so if the RN wasn't edcuated in the degree system and received an apprentciship style of training. The RN may not understand what we as a nursing school are trying to assess in the way of knowledge and meeting nursing council competencies.

So using portfolios and judging on how the student answers our questions is given the most emphasis. This disadvantages students who cannot express themselves well. It also means consistancy amongst lecturers in the course can be difficult because we often have different things we favour that we want to assess. This is why going pass/fail would make it easy. However my concern is that if we did this the students may not attempt to make links with theory courses and focus on completing ward tasks. Interestingly enough I asked my students the other day if they liked having to do a portfolio considering so much work was involved. They responded with a resounding YES it was essential for them to 'make' them learn the work..If we went pass/fail this would not encourage the students who do put the extra effort in.

So...my latest thoughts is to seperate out health assessment as a new course (we can do this soon, as we are having curriculum review). Run this alongside clinical and this course will receive a grade but will be linked in to their clinical experience..i.e refelection, case study and pathophysiology will be the assessment outcome for the health assessment course. This means they would still have to try and link clinical but the lecturers on clinical can assess pass/fail. What do other people think about pass/fail in comparison to grading???.

Constructing Courses to Enhance Learning

I thought I would start today while my ideas are fresh thinking about the design of my course and my developing ideas.

I have talked about my theoretical perspective on the wiki as been the social and situational orientation. I believe it is important that the students are given chance to reflect on their practical experiences to allow deep learning to occur and to make sense of their practical by linking it with theory. One of the ways we do this at present is by asking the students to construct a portfolio. However this has difficulties in that not everyone is able ot articulate their learning in writing. The other problem is consistency, as the students will usually work with 2 different lecturers in the course who have different ideas as ot what they like in the portfolio.

An idea is forming in my mind to look at the use of e-portfolios so I'll do some research on this. I'm also very interested in setting up a journal for each student in a course wiki in moodle. This course wiki will also have a wiki for each different ward in the hospital that the students work in. The students will be asked to contribute at least 2 times to the ward wiki. This means throughout the year each ward will have a resource which has been set up by the students and will help all students who end up on that ward.

If I was to introduce this I would need a to give a lecture on how to use wikis and e portfolio's and I'm thinking camtasia might be a good resource for this..... Any way this is just a quick note on my developing thoughts and I will be adding more as the ideas evolve...Cheers! have ot go and deal with kids!!!

Feedback from DFLIP Assignments

Hi there to all my colleagues in DLIP. Bronwyn suggested I paste the link to feedback on assignment 3 in case it helps you in any way.

I also have feedback on assignment 1 and initial feedback on original plan

DFLIP Final Summary of Blog Comments

Topic Range Evidence ratings from 1-5

Orientation and introductions
Brief but did introduce myself, was busy about to go to California

What is flexible learning?
3 3 1 Just learning how to manage blogs so hyperlinking not yet apart of it. Referenced some reading I had done

Why we need flexible learning
3 4 1 Yes a lot of my own thoughts in here, beginning to hyperlink

Examples of Flexible Learning - distance, correspondence, online
4 4 4 I think I am now really getting into this topic and exploring my ideas and also other ideas and readings

Examples of Flexible Learning - part time, block, blended
4 5 5 Again I think this was done well

Examples of Flexible Learning - open, networked, RPL
3 3 5 Quite in-depth this one a lot of reflecting on my practice is beginning

Planning for flexible teaching and learning
3 3 3 Final plan ended up been very different to what I proposed in the end. All part of my journey. Beginning to see an increase in my digital literacy as I have begun a research project to increase this

Issues with flexible learning - The modern Internet
4 4 4 Good summary this week relating to my experience as a Mum trying to work at home

Issues with flexible learning - Sustainability
3 3 3 Brief comments on sustainability…a new issue for me to think about

Issues with flexible learning - access and equity
5 5 5 I think this was a good piece of work from me looking at these issues!

Issues with flexible learning - Cultural diversity
3 3 3 Okay piece but pretty brief

Flexible learning in educational organisations
3 3 3

National and International support for flexible learning development
2 2 1 Didn’t spend a lot of time on this topic

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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