Learning Technology: Benefits and Challenges

As the nursing community increases its use of learning technology in education programs, community leadership is also concerned about faculty development, returns on investment and other issues in the life cycle of a training system, reports Group Editor Marty Kauchak.

A confluence of events is creating a demand to insert more technology into the continuum of learning for nurses. Simulations, simulators, distance learning and other training enablers allow prospective nurses to learn and refresh many of their skills more efficiently and more effectively. At the same time, the community’s leadership is grappling with returns on investment on these devices and support issues, including how faculty is prepared to use these instructional media.

Education Overview

New accessions into the U.S. nursing community complete different lengths of study commensurate with the levels of practice at which they will be employed. Learning technology has become a foundation of many of these programs.

Typically, practical/vocational nurses (LPN/LVN) complete a course of study over a year to 15 months. Registered nurses complete a course of study either through a diploma program (three years), associate degree program (two years), or a bachelor degree program (four years).

Beyond entry-level education, graduate degrees increase a community member’s intellectual prowess across a range of specialties, from research to specific academic subjects.

In November 2011, MEDSim had the opportunity to gain one in-depth insight on community education during a visit to the School of Nursing at the LSU Health Sciences Center. The center offers four degrees: a B.S. in Nursing, the Master of Nursing, an M.S. in Nursing and a Doctor of Nursing Science (DNS).

The school has tailored its’ degree programs to the dynamics of the workforce, the contemporary student and the profession.

There are three pathways to earn the baccalaureate degree in nursing at the New Orleans-based school. Aside from the traditional way of earning the B.S. in Nursing degree in four years following graduation from high school, previous awardees of a baccalaureate degree in any discipline may earn their nursing degree in less than a two-year timeframe of study through the Career Alternative RN Education option. Demetrius Porche, DNS, Ph.D., Dean and Professor at the School of Nursing, also pointed out that a third program, the RN to BSN Program, is a specialized program of study designed specifically for the RN with an Associate Degree or diploma in Nursing. “They are coming in to complete their BSN degree.”

Aspiring master’s degree candidates may specialize in administration, anesthesia, clinical nurse specialties (adult health), community health, nursing education and nurse practitioner (family and neonatal).

The Doctorate of Nursing Science is a research-focused academic endeavor.

Technology Insertion

For its part, the LSU nursing program is ambitiously integrating simulation and other learning technologies into its baccalaureate and masters programs.

Demetrius Porche, DNS, Ph.D., Dean and Professor at the School of Nursing, LSU. Image Credit: LSU

The school of nursing’s undergraduate and masters courses are based on a hybrid model of instruction – with residence instruction supplemented by a blend of learning technologies. “Even with our undergraduates who predominately come to class and sit in a lecture, courses have supplemental content that’s online. Some courses may supplement their lectures with podcasts and online discussion modules – discussion boards. Some may use online chat. And at the graduate level we do the same thing,” Porche said.

To help understand the amount of technology-enabled instruction at the school, the senior administrator pointed out that the LSU undergraduate clinical nursing programs have three foundations to clinical courses: a theory course, a clinical practicum course and a simulation course. “The simulation course is where they are completely going through simulation activity. And the amount of time spent in each respective activity depends on the course credit.”

The LSU School of Nursing uses an array of simulators and simulations to develop learning skills. Some representative devices include high-fidelity manikins, the NOELLE birthing simulator and soft-tissue replication products to build suturing skills. “We are simulating at all educational levels, from the clinical skills with low fidelity to the high fidelity – manikins – which are in a patient scenario. There the students have to learn to react, know to respond and also watch the patient’s response,” Porche explained.

LSU’s use of learning technologies mirrors instructional strategies across the community.

Janet Willhaus, the National League for Nursing’s simulation scholar-in-residence, observed the use of learning practices involving simulations and simulators is rapidly increasing in nursing education.

Willhaus, a doctoral student from Washington State University studying the science of using simulation technologies in nursing education, is able to quantify these developments. She noted that in 2007, with funding from Laerdal Medical Corporation, the NLN conducted the first national, multi-site, multi-method study to build the science related to the use of simulation in nursing education. “A 2010 survey of all nursing programs from the National Council of State Boards of Nursing reported that of the 1,060 schools that responded, 87 percent offer some kind of simulation experience with either high or moderate fidelity manikins. “Technology has spurred the development of several techniques for learning outside the clinical environment.” Willhaus continued, “Although full-body static manikins used for practicing nursing skills have been around for years, it is only in the last 10 years or so that computerized versions which have heart, lung, and vocal sounds have become affordable for health care professional education. These manikins can be programmed to respond to student actions and their use provides a safe alternative to beginning practice on real patients. Many schools of nursing are purchasing simulators for student practice and learning.”

ROI and Other Challenges

During an interview with MEDSim in his downtown New Orleans office, Porche noted the state of medical and learning technologies are moving so quickly, that it is often difficult for industry to offer cost-effective learning devices with adequate degrees of fidelity for wide use. And the senior administrator pointed out another intriguing limit to the wider use of learning technologies. “It is the faculty development that also must occur. The faculty no longer must stay clinically competent only in their respective area. They have to also remain clinically competent in educating – how do use this technology to educate. And the other piece is you have to know how to use the technology. You have faculty with various levels of sophistication with everything from computers to other technologies. So, it’s the faculty development and the costs – which are unbelievable.”

Faculty competency in learning technologies was also of interest to Willhaus, who noted that schools that purchase equipment without investing in their staff and faculty are not really helping the students. “Owning an expensive tool does not improve learning when it never gets out of the box and into the hands of students”.

Help may be on the way, in part, with the NLN’s creation of initiatives such as the Simulation Innovation Resource Center (SIRC) website (http://sirc.nln.org/) with courses and resources for faculty and a year-long Leadership Development Program for Simulation Educators, now in its second year. The efforts designed for those interested in assuming a leadership role in the field of simulation in nursing education.

How much simulation is enough in a nursing education program? Image Credit: Laerdal Medical

Porche, as a senior administrator with budget oversight of state of Louisiana education funds, also expressed his attention to returns on investment in learning technologies. He noted that when 600 to 700 students participate in simulation activities there is tremendous wear-and-tear on the devices. “It’s expensive – not to mention the faculty resources. If you are going to do simulation there is a common misunderstanding that you take less faculty. That’s not true because you need more faculty because you want to simulate in small groups and so you can debrief in small groups.”

And beyond the investment in simulation devices, are the related costs of simulation support infrastructure. Indeed, when MEDSim visited the LSU School of Nursing, two new simulation labs were being built with debriefing rooms and other facilities.

Yet, Porche was upbeat on the school’s ROI in learning technologies and other aspects of instruction. “We are getting a very good return. Our employers of our nurses are satisfied and the students’ pass rates on their certification and licensure exams are very high.”

Asked for a “help wanted” list to provide to the health care learning technologies community, Porche placed faculty development on the top of his list. Noting that while industry’s technology offerings are good, he noted the challenges of keeping up with technology trends, learning how to teach with those technology devices and maintaining desired outcomes.

The school of nursing dean also noted his staff’s efforts to bolster inter-professional simulation – team building in clinical settings. Projects that integrate medical, respiratory therapy, nurse anesthetists and undergraduate nursing students into the same virtual domain are being developed. “We’re trying to look at team competencies – and to really understand each other’s role. That’s where we need to go – in the area of inter-professional simulation while they are here.”

Other Downstream Developments

The NLN and at least one national governance body are examining other challenges and opportunities in using learning technologies in community programs.

Funded by a three-year grant from Laerdal Medical, a subgroup of the NLN Presidential Task Force on High Stakes Testing, is laying the groundwork for the use of simulation for high stakes testing in nursing education, identifying program outcomes that can be evaluated using simulation, and developing and piloting test simulation scenarios and evaluation tools at schools of nursing across the country.

Willhaus noted there is currently a national research study of simulation in nursing education being conducted by the National Council of State Boards of Nursing. “Ten schools of nursing and hundreds of students are participating in an investigation of how much simulation is enough in a nursing education program. The study will last three years and will follow the students through the nursing education part of their education. Some of the students will be followed after graduation as they move into the work setting.”