Presentation 6
a. Knowledge Acquisition and Sharing
The shift from computer literacy to information literacy and management has
drawn attention to interactivity and design as the most important components of
interactive Web-enhanced and Web-based courses in providing effective learning
environments. Thurmond (2003) and Thurmond and Wamback (2002) discussed the
four types of interactions related to Webenhanced courses based on their literature
reviews: (1) learner– learner, (2) learner–content, (3) learner– instructor, and (4)
learner–interface interactions.
In traditional learner-learner exchanges within educational settings, students
engage in interactive processes that foster collaboration, problem-solving, and the
exchange of diverse perspectives and solutions. This form of peer interaction is
essential for enhancing learning outcomes and promoting deeper understanding of
academic content.
One of the key aspects of learner-learner exchanges is the opportunity for
students to troubleshoot challenges together. By working collaboratively, students can
identify and address obstacles or misunderstandings in their learning process.
Through discussion and debate, peers can share their perspectives, clarify concepts,
and collectively explore alternative approaches to solving problems. This
collaborative troubleshooting not only enhances individual problem-solving skills but
also cultivates a supportive learning environment where students feel empowered to
seek and offer help to their peers.
Moreover, learner-learner exchanges encourage the exchange of solutions
generated from different perspectives. Each student brings unique experiences,
insights, and approaches to the table, enriching the learning process through diverse
viewpoints. By sharing their solutions and reasoning with peers, students gain
valuable feedback, refine their understanding of concepts, and broaden their
perspective on how to approach academic tasks. This exchange of solutions not only
enhances the depth of learning but also promotes critical thinking and creative
problem-solving skills as students consider multiple angles and potential outcomes.
Furthermore, learner-learner exchanges promote active engagement and
participation among students. Through collaborative activities such as group
discussions, debates, peer reviews, and joint projects, students are encouraged to
articulate their thoughts, defend their ideas, and engage in constructive dialogue with
their peers. This active participation fosters communication skills, teamwork, and
interpersonal relationships, which are essential competencies for success in both
academic and professional settings.
In addition to academic benefits, learner-learner exchanges contribute to the
development of social and emotional skills. Collaborative learning environments
nurture empathy, respect for diverse perspectives, and effective communication
strategies. Students learn to listen actively, consider others' viewpoints, and negotiate
differences, fostering a sense of belonging and community within the classroom.
Moreover, learner-learner exchanges can be facilitated through various
instructional strategies and technologies. For example, collaborative learning
platforms, online discussion forums, and virtual classrooms enable students to interact
and collaborate asynchronously, overcoming barriers of time and space. These digital
tools not only expand opportunities for peer interaction but also support personalized
learning experiences tailored to individual needs and preferences.
Furthermore, educators play a critical role in promoting effective learner-
learner exchanges by designing meaningful collaborative activities, establishing clear
expectations for participation, and facilitating constructive feedback and reflection.
By creating a supportive and inclusive learning environment, educators empower
students to actively engage in peer interactions, take ownership of their learning, and
develop lifelong learning skills that extend beyond the classroom.
Looking ahead, the integration of learner-learner exchanges into educational
practices continues to evolve with advancements in educational research, pedagogy,
and technology. Emerging trends such as cooperative learning, project-based learning,
flipped classrooms, and blended learning models further emphasize the importance of
peer collaboration and interaction in enhancing educational outcomes and preparing
students for future academic and professional challenges.
In summary, traditional learner-learner exchanges play a crucial role in
educational settings by promoting collaboration, problem-solving, and the exchange
of diverse perspectives and solutions among students. By engaging in collaborative
activities, troubleshooting challenges, sharing solutions, and participating actively in
peer interactions, students develop essential skills and competencies that contribute to
their academic success, personal growth, and readiness for lifelong learning in a
dynamic and interconnected world.
Traditional and familiar, both learner– content and learner–instructor
interactions expect students to work directly with course content or the faculty
member and then participate in relevant course activities, such as tests and reviews.
Learner–interface interaction includes the ways students access their coursework and
their ultimate success or failure in finding, retrieving, and using what they need.
When Web enhanced, these interactions include online chats, forum discussions,
participation in electronic mailing list groups, instant messaging, blogging, and use of
email, all of which ask the student to engage, digest, use, and disseminate information
in new ways.
b. Evolution of Learning Management Systems
In the 21st century, nursing informatics emphasized technology usability,
functionality, and accessibility in education and practice. Computer-assisted
instruction (CAI) arrived early on the scene and has had an enormous impact on
nursing informatics and nursing education, with many CAI programs offering
individualized instruction in the form of customizable scenarios, frameworks, and
programs for study. Additionally, CAI contributed to better understanding of material
by supporting all learning styles, types, and paces. Consequently, nursing skills–
development needs presented endless potential for software development, making the
effective use of software and hardware by educators and students a prime necessity.
Recall that software comprises the instructions that direct a computer’s
hardware to work, whereas hardware consists of physical computer components, such
as a mouse, keyboard, and monitor. Software essentially translates commands into
computer language, allowing the hardware to perform its functions. Without hardware
and software, computer technologies are moot; moreover, without software, hardware
does not function (McHugh, 2006). Applications software refers to the various
programs individuals use to communicate with others, do work, play games, or watch
multimedia on a computer.
The most common software package sold with computers is an office suite,
which is an essential tool for both personal and professional use. This package
typically includes a variety of applications designed to meet a wide range of
productivity needs. One of the core components of an office suite is a word
processing program. This application allows users to create, edit, format, and print
text documents. It is indispensable for writing reports, drafting letters, creating
resumes, and producing any form of written communication. Popular word
processors, such as Microsoft Word or Google Docs, often come equipped with
advanced features like spell check, grammar check, and a wide selection of templates
to streamline document creation.
Another critical component of an office suite is the spreadsheet application.
Spreadsheets are incredibly versatile tools used for data analysis, financial planning,
statistical analysis, and various other tasks that require the manipulation of numerical
data. Applications like Microsoft Excel or Google Sheets provide powerful
functionalities, including complex formulas, pivot tables, and data visualization tools
like charts and graphs. These features help users manage budgets, track expenses,
analyze trends, and make informed decisions based on data.
A presentation graphics program is also a standard part of an office suite.
Programs such as Microsoft PowerPoint or Google Slides enable users to create
engaging and visually appealing presentations. These tools are essential for business
meetings, educational lectures, and any situation where information needs to be
communicated effectively to an audience. Presentation software typically includes
features like slide transitions, animations, multimedia integration, and a variety of
design templates to enhance the visual impact of the presentations.
In addition to word processing, spreadsheets, and presentation graphics, an
office suite often includes a database management system (DBMS). A DBMS, such as
Microsoft Access or MySQL, allows users to create, manage, and manipulate
databases. This is crucial for storing and retrieving large amounts of structured data
efficiently. Databases are used in a variety of applications, from managing customer
information in a business to organizing research data in academia. They provide tools
for querying data, generating reports, and ensuring data integrity and security.
The distribution methods for software packages have evolved significantly
over time. Traditionally, software was distributed on physical media such as compact
disk read-only memory (CD-ROM) or digital versatile disk/digital video disk (DVD).
These disks allowed users to install software by inserting them into their computer’s
optical drive. While physical media provided a tangible and reliable method of
distribution, it also had limitations, including the need for storage space and the risk
of physical damage to the disks.
In recent years, the most common method of software distribution has shifted
to the Internet. Users can now download software directly from a vendor’s website or
through digital distribution platforms like Microsoft Store, Apple App Store, or
Google Play. This method offers several advantages, including immediate access to
the latest software versions, the convenience of downloading software from anywhere
with an internet connection, and the elimination of physical storage requirements.
Additionally, internet distribution allows for easier updates and patches, ensuring that
users always have the most current and secure version of the software.
The transition to digital distribution has also enabled the growth of
subscription-based software services. Instead of purchasing a one-time software
license, users can subscribe to services like Microsoft 365 or Adobe Creative Cloud,
paying a monthly or annual fee for access to a suite of applications. This model
provides continuous access to the latest features and updates, along with cloud storage
and collaboration tools, which are increasingly important in today’s interconnected
and remote-working environments.
Overall, office suites have become an integral part of the modern computing
experience, providing essential tools for productivity and efficiency. The evolution
from physical media to digital distribution reflects broader trends in technology and
consumer preferences, emphasizing convenience, accessibility, and continuous
improvement. Whether used for personal projects, educational purposes, or
professional tasks, these software packages play a vital role in enabling users to
achieve their goals and streamline their workflows.
When evaluating software or hardware for purchase, careful assessment of the
products and services will help an educator, administrator, or student make the best
choices. Most important when evaluating software is to understand how well the
software’s functionality for computer-assisted learning matches the learning goals and
objectives. Although many programs are available for assisting a nurse educator who
is evaluating software for particular learning purposes, the main criteria concern
content (Is the information accurate? Is it relevant?), format (How is information
visually presented? Is it in frames? Does it come with graphics?), documentation style
(What is the tone? Is it scholarly and applicable?), and strategies (Is the software
useful for all students, including remedial students and accelerated students?)
Hardware decisions depend on the way a computer system will be used, in
addition to considerations related to cost, ease of use, and durability (Clochesy, 2004).
Systems purchased for personal use may differ dramatically from those purchased for
online learning laboratories or smart classrooms. Because the technology inherent to
workstations, servers, and computers in general tends to change quite rapidly,
discussing large system decisions with an information technology expert is likely to
yield a better-informed decision.
When evaluating and implementing a computer system, several factors need to
be considered to ensure it meets the specific requirements and operates efficiently.
One of the primary considerations is the location where the system will be stationed.
For instance, if the system is intended for home use, it might be designed for personal
tasks such as browsing the internet, streaming media, or gaming. On the other hand, a
system deployed in a learning laboratory must accommodate the needs of many
students and support various educational applications.
The scale of the deployment is another critical factor. A single desktop setup
significantly differs from managing a few dozen computers. In a home environment,
you might only need one or two desktops, whereas in a school or a large organization,
the number of desktops can easily range from a few dozen to several hundred. This
difference influences the choice of hardware and software, as well as the management
and maintenance strategies.
Networking capabilities are also essential, particularly in an educational or
corporate setting. If the system is to be integrated into a school's internal network, it
must be compatible with existing network infrastructure. This includes ensuring
proper connectivity for file sharing, access to educational resources, and
communication tools. Network configuration should be robust to handle multiple
users simultaneously, with considerations for bandwidth, network security, and data
privacy.
Printing needs further complicate the system setup. In a learning laboratory or
office, access to printers is often necessary for producing physical copies of
documents, assignments, and other materials. The system must therefore include
compatible printing solutions, whether network printers accessible to all users or
individual printers for specific workstations. Print management software might be
required to handle print queues, monitor usage, and control costs.
Security is another paramount concern, particularly in environments with
sensitive information. Different settings require different levels of security. A home
system might prioritize protecting personal data and preventing unauthorized access
through robust antivirus programs and firewalls. In contrast, a school or corporate
network requires more sophisticated security measures, such as secure login
protocols, regular software updates, encrypted communications, and comprehensive
data protection policies to safeguard against potential breaches and cyber-attacks.
Additionally, user access levels must be managed carefully. In a school setting,
students and teachers will have different access permissions to ensure that sensitive
information remains secure while providing appropriate resources to each user group.
Implementing role-based access control can help manage these permissions
effectively.
Furthermore, considering the system’s scalability is important for future-
proofing. As needs evolve, the system should be able to accommodate additional
users, new software applications, and increased data storage requirements without
significant downtime or expense. This involves choosing hardware with potential for
upgrades and ensuring that the software infrastructure is flexible and adaptable.
Lastly, the system's maintenance and support infrastructure should be planned.
Regular maintenance, timely updates, and reliable technical support are crucial to
ensure the system's longevity and efficiency. This may involve setting up a dedicated
IT support team, particularly in larger deployments like schools or organizations, to
handle troubleshooting, repairs, and user training.
In summary, a thorough understanding of the intended use, scale, network
integration, printing needs, security requirements, user access levels, scalability, and
maintenance plans is essential when designing and deploying a computer system.
Each factor plays a significant role in ensuring the system's effectiveness, reliability,
and security, whether it is for personal use at home or for multiple users in an
educational or professional environment.
Higher education is moving away from its traditional emphasis on the
instructor, however, replacing it with a focus on learning and the learner. Higher
education is also moving away from a standard form factor for the course,
experimenting with a variety of course models. These developments pose a dilemma
for any LMS [learning management system] whose design is still informed by
instructor-centric, onesize-fits-all assumptions about teaching and learning. They also
account for the love/hate relationship many in higher education have with the LMS.
The LMS is both “it” and “not it”—useful in some ways but falling short in others.
Brown and colleagues also describe the Next Generation Digital Learning
Environment (NGDLE) as reimagining the education system. Key characteristics of
the NGDLE include: Interoperability and integration: These allow for seamless
exchange, transfer, and utilization of content; the addition of learning tools; and the
aggregation, integration, and analysis of learning data. Personalization supports the
ability of instructors, departments, and students to configure the learning environment
to meet specific needs. Analytics, advising, and learning assessment: This component
supports learning assessment and assessment of competency-based education and
provides data analysis tools for these assessments. It also integrates progress planning
and advising functions. Collaboration may occur within the course among students
and instructors, but in the NGDLE collaboration may also occur among disciplines,
institutions, and professions, particularly if the system adheres to interoperability
standards. Accessibility and universal design: This component takes into account
special needs of persons with disabilities and supports prospective design of
accessible features and components.
c. Delivery Modalities
Nursing educators are discovering that today’s students may not always
respond in the same ways the educators did during their own tenure as students.
Technology-savvy students from the millennial age demand instant information
delivered in an entertaining fashion—an expectation built on extensive exposure to
email, text messaging, online chatting, and the Internet (Ridley, 2007). Additionally,
many nursing departments are facing an increase in student enrollment and a
corresponding growth in faculty. Although new nursing faculty bring significant
clinical experience to their academic positions, also apparent for some is an
underlying tension and unfamiliarity with technologic advances, outcomes-based
accreditation initiatives, and teaching itself. Schools of nursing are scrambling to
provide professional development for busy nursing faculty and introducing them to
best practices in teaching.
Learning is a multispatial function, and in the age of technology innovation,
instructional delivery can inhabit many forms in both physical and virtual spaces.
Spaces in academia are no longer defined by a class or its content, but instead by the
learning the class is trying to promote. To this end, learning spaces should support
multiple modes of learning and delivery, including reflection, discussion, and
experience, and should facilitate face-to-face and online interaction within and
beyond classrooms. Truly innovative delivery, whether face-to-face classroom
interaction, online engagement, or a blended hybrid of technology and traditional
classroom teaching, supports learning activities rather than standing independently of
them.
Ridley (2007) suggests that although it is the most widely used teaching
method among nurse educators, traditional face-to-face lecture yields only a 5%
information retention rate over a 24-hour period, a rate that compares unfavorably
with demonstration (30%), discussion groups (50%), practice activities (75%), and
peer teaching (90%; as cited in Sousa, 1995). Additionally, the inability of physical
space to keep pace with evolution of learning models inhibits the benefits gained from
face-to-face interaction between teacher and student. For example, collaborative
learning grinds to a halt when class is held in a room with chairs bolted to the floor,
facing a lectern (Oblinger, 2005); this kind of spatial arrangement prohibits a sense of
classroom community by inhibiting easy peer interaction, reducing students’ ability to
see one another, and concentrating all attention on the professor.
Conversely, in a collaborative learning environment, the professor guides
conversation and sets up discussion, acting less as classroom authority and more as
facilitator, helping students maintain focus, gently guiding discussion, and ultimately
empowering students to push knowledge boundaries in a safe and secure atmosphere
of peer support. This inductive, epistemological approach promotes active, critical
thinking skills and assists students in learning not just facts, but how to learn. As
future healthcare professionals determined to rely on quantification and rationale,
nursing students will benefit from face-to-face classroom interaction that hones their
ability to manufacture new personal truths through interaction with people and ideas
in ways that cannot always be measured and counted.
Ridley (2007) suggests that such interactive, cooperative learning strategies
might include gaming, role playing, and problem-based learning. Because games are
nonthreatening and fun, they promote critical thinking and teamwork by pushing
students to work together in groups to find answers and achieve success. Role playing
is similar in that it allows students to try on real-life scenarios by filling either
prescripted or ad-libbed roles (doctor, nurse, patient, clinician, and so forth) without
the fear or pressure of putting another’s life at risk while trying to determine the best
course of action or find a solution for a fictitious patient’s health issue.
Problem-based learning, a well-accepted form of interactive learning, takes
assignments out of a contextual vacuum and applies real-life scenarios to problems or
challenges. Students work in groups to solve the dilemma presented by real patient
cases and build on prior knowledge, using higher-level thinking skills and progressive
inquiry to resolve the problem (Ridley, 2007). This enhances the student’s critical
skills for acquiring and maintaining knowledge in practice.
Online Delivery E-learning, online learning, and Web-based education have
caused a significant shift in student–teacher relationships in nursing education.
According to Oblinger (2005), not only are learning spaces no longer physical or
formal, especially on campuses with wireless capabilities, but nursing students also
expect to make use of wide ranges of cutting-edge technology during their academic
tenure, exchanging the traditional “sage on the stage” for a technologically savvy
“guide on the side” who gives up the role of gatekeeper and instead promotes and
facilitates dialogue as central to teaching–learning.
Student-centered and no longer limited to the domain of the classroom,
laboratory, or even a patient’s bedside, online learning allows educators to translate
theory into practice, creating a virtual classroom space that promotes collaboration,
engagement, discussion, and analysis. Detractors of online learning initiatives
suggest, however, that sharing an online space undermines the student–teacher
relationship, makes building peer relationships difficult, and generally disrupts the
normal classroom dynamic, thereby creating an unfamiliar, uncomfortable
atmosphere. Despite these concerns, studies show that not only do Web-based courses
continue to gain in popularity, but they also enhance learning in ways that encourage
students to share personal experiences and support. Researchers cite many factors that
make online learning laudable, with accessibility and convenience being two of the
most frequently cited issues.
The asynchronous and time-independent elements of Web-based courses
respond to the huge need for flexible class times among today’s growing population
of nontraditional learners. Additionally, Web-based and place-independent learning
allows participation by anyone, anywhere in the world, with access. Exposure to
online learning during healthcare professional education programs will facilitate
continuing professional education during the practice tenure. Related to this issue is
the democratizing effect of online learning, such that all students have the same
opportunity to participate without judgment. Web-based classes provide an easily
accessible permanent record, a convenience for both teachers and learners.
It is important to use tools that facilitate learning, such as the introduction of
social media into nursing education. Twitter (www.twitter.com) can be used to focus
and hone student perspectives. Each posting or tweet cannot exceed 140 characters.
As they critically think about what they want to add to the discussion, students must
act as wordsmiths to express their views succinctly given the character limitation; that
is, they must present their viewpoints concisely.
These sites can be used by students to facilitate their presentations and team
collaboration. The use of social media not only exposes the students to their use but
also promotes the development of skills that will support professional collaboration as
students enter the practice arena. Meyer (2015) reported that using social media in
education helps students put concepts in context, maintains currency in course
content, and fosters a sense of community.
Traditional courses are more frequently being offered as online, virtual classes
(i.e., distance education)— learning that occurs elsewhere than in the traditional
classroom and consequently requires special course design, planning, techniques, and
communication. A hybrid of this delivery mode includes learning in which traditional
classroom time is enhanced or broken up with online components, thereby creating a
class in which blended hybrid learning occurs. Forms of hybrid learning include Web-
enhanced learning, such as asking students to blog responses to a reading or class
discussion, and learning that takes place in and makes use of smart classrooms (e.g.,
teaching in a wired room equipped with classroom learning technologies, such as the
Blackboard Learning System).
Smart classrooms, also known as digital and multimedia classrooms, integrate
computer and audiovisual technologies by providing a ceilingmounted projector with
an access point at the front of the room, an instructor podium or workstation, sound,
and network access. An enhanced smart classroom also provides networked student
workstations instead of traditional desks, allowing students to follow along online and
perform network or Web searches, chat, blog, or myriad other activities as dictated by
the professor. For example, at the Penn State College of Nursing, users can access
announcements, course materials, faculty information, websites, and other tools
through the electronic course management system, enabling the nursing faculty to
extend learning beyond the physical classroom walls.
More robust learning management systems (LMSs) are particularly well suited
to support competency-based learning. Nursing competencies have been well defined
by professional and accrediting organizations such as Quality and Safety Education
for Nurses (QSEN); the American Association of Colleges of Nursing (AACN),
through its Technology Informatics Guiding Education Reform (TIGER) initiative and
the essentials of nursing education delineated for undergraduate and graduate study;
and informatics competencies promoted by the Healthcare Information and
Management Systems Society (HIMSS). As the U.S. Department of Education (2014)
explained, Transitioning away from seat time, in favor of a structure that creates
flexibility, allows students to progress as they demonstrate mastery of academic
content, regardless of time, place, or pace of learning.
Competency-based strategies are an innovative approach to education that
prioritize the mastery of specific skills and knowledge over the traditional time-based
progression through coursework. These strategies provide a remarkable level of
flexibility in the way that academic credit can be earned or awarded, allowing for a
more personalized and student-centered learning experience. Unlike the conventional
educational model, which typically measures progress in terms of hours spent in a
classroom or the completion of a fixed curriculum within a set timeframe,
competency-based education (CBE) focuses on students demonstrating their
understanding and proficiency in particular competencies or learning outcomes.
One of the most significant advantages of competency-based strategies is their
ability to accommodate diverse learning styles and paces. Students are no longer
bound by a rigid schedule that requires everyone to move through the material at the
same speed. Instead, they can progress through their studies as they demonstrate their
competence in each area. This means that students who grasp concepts quickly can
move ahead without waiting for their peers, while those who need more time to
understand the material can take the time they need without feeling pressured to keep
up with a predetermined pace.
Moreover, competency-based strategies often incorporate various forms of
assessment to evaluate student learning. These assessments can include traditional
tests and quizzes, but they also frequently involve projects, presentations, and
practical applications that provide a more comprehensive picture of a student's
abilities. This multifaceted approach to assessment ensures that students are not only
learning theoretical concepts but also developing the practical skills necessary to
apply their knowledge in real-world scenarios.
In addition to offering flexibility in pacing, competency-based education
provides students with personalized learning opportunities that are tailored to their
individual needs, interests, and career goals. Educators can design learning
experiences that align with each student's unique strengths and weaknesses, helping
them to focus on areas where they need the most improvement while allowing them to
advance in areas where they already excel. This personalized approach can be
particularly beneficial for students with diverse educational backgrounds or those who
have previously struggled in traditional educational settings.
Furthermore, competency-based strategies can be particularly effective in
preparing students for the workforce. By emphasizing the acquisition of specific
competencies that are directly relevant to professional skills and job requirements,
CBE ensures that students graduate with a clear understanding of what they need to
succeed in their chosen careers. Employers often value this approach because it
guarantees that graduates have demonstrated their ability to perform essential tasks
and possess the necessary skills for the job.
The flexibility of competency-based education also extends to the way
learning is delivered. With the rise of digital learning platforms and online education,
students can access a wide range of resources and learning materials at any time and
from any location. This accessibility allows students to engage with the content in
ways that best suit their learning preferences, whether through videos, interactive
simulations, reading materials, or collaborative online discussions. The use of
technology in CBE not only enhances the learning experience but also helps to
develop digital literacy skills that are increasingly important in today's technology-
driven world.
Another critical aspect of competency-based strategies is the role of educators
in this model. Teachers and instructors become facilitators and mentors rather than
just providers of knowledge. They guide students through the learning process,
offering support, feedback, and encouragement as students work to master each
competency. This shift in the educator's role fosters a more supportive and
collaborative learning environment, where students feel empowered to take charge of
their education and are more motivated to succeed.
Finally, competency-based education has the potential to improve educational
equity. By allowing students to progress at their own pace and providing personalized
learning experiences, CBE can help to close achievement gaps and ensure that all
students have the opportunity to succeed, regardless of their starting point. This
approach recognizes that students come from diverse backgrounds with different
levels of preparedness and provides the flexibility needed to address those differences
effectively.
In summary, competency-based strategies offer a flexible and personalized
approach to education that emphasizes the mastery of specific skills and knowledge.
By allowing students to progress at their own pace, providing a variety of assessment
methods, and focusing on real-world competencies, these strategies create a more
inclusive and effective learning environment. With the integration of technology and
the supportive role of educators, competency-based education prepares students for
success in their academic pursuits and future careers, while also promoting
educational equity and accessibility.
Database technologies within LMSs offer the ability to track competency
achievement, as Pijl-Zieber, Barton, Konkin, Awosoga, and Caine (2014) explain:
“Such technologies could be shared, at least to some degree, between nursing student
and nursing instructor, much like clinical evaluation tools are shared on paper, to
jointly track skills, knowledge, abilities, critical thinking, clinical reflection, and
developing competence”
d. Technology Tools Supporting Education
Certain social trends emerging from the morass of both traditional and
innovative technology tools include the use of technologies attempting to meet the
needs of members of the Net Generation or Millennial Generation. These are students
who have grown up inside a wired world of instant access and online everything who
are connected, digital, experiential, and social learners. Through the use of software,
hardware, drivers, dedicated servers, plug-ins, and an Internet connection, students
can chat, collaborate, play games, or interact electronically with a peer in some way,
all with little to no learning curve or effort. Because visual media are now the
vernacular of this highly digital culture, students and faculty are also embracing
technology tools that allow for the creation and interpretation of visual images.
Such tools might take the shape of interactive tutorials, a created city within a
virtual reality landscape, highfidelity simulations, serious games, or even a
multimedia action maze that prompts users to choose different outcomes within a
scenario. Regardless of the particular tool employed, technology can perform only as
well as the pedagogy that drives it, thus creating a need for integration, support, and
sustainability within nursing education programs willing to implement new
instructional and assessment strategies.
The modern tutorial mimics lectures by guiding users through a series of
objectives or tasks, usually allowing the user to do the work at his or her own pace
(Edwards & Drury, 2000). Tutorials generally stand alone as autonomous multimedia
that may use animation, text, graphics, sound, questions, and different kinds of
interactivity to engage and intrigue the user. They tend to promote active learning by
prompting the user to answer sets of questions, follow clickable hypertext, or
complete quizzes. For example, users might be asked to fill in worksheets after
reviewing anatomy concepts, take a quiz, post an answer to a question, or even click
through a scenario by choosing the best course of action in a mock clinical situation.
Some tutorials, such as those used by medical students at the Morgan Stanley
Children’s Hospital of New York, are designed to be brief (10 minutes), interactive,
very focused, and immediately relevant. In this case, medical students bustling
through a busy clinical rotation who accessed the tutorials actually raised examination
grades.
Because most students benefit from being able to contextualize a lesson’s
framework and purpose, the most effective tutorials provide users with
understandable navigation, such as a table of contents at its beginning, or additional
navigational aids, such as icons, buttons, or text that indicate where and how they
need to progress (Dewald, 1999). Effective tutorials surpass the simple presentation of
information in a Web-based format; they instead address certain pedagogic and
student-centered needs by identifying and taking into consideration specific factors,
such as instructional content, the educator’s purpose and teaching goal, the initiative’s
overall purpose, the potential need for special conceptual input, the learners’ ultimate
objectives in completing the tutorial, and the standards that determine what qualifies
as successful completion of the tutorial.
Although most tutorials are created to stand alone, some may also benefit and
supplement face-to-face instruction, such as the interactive information skills tutorial
developed at the Institute for Health and Social Care Research in Salford, United
Kingdom. This tutorial divides a traditional lecture series into chunks, incorporating
questions that would normally arise during the session into the text, and providing
hyperlinks. This organization allows users to browse to different parts of the tutorial,
open a database in a new window to perform a practice search, and access other
features. Tutorials in all their iterations urge students to hone and develop effective
critical thinking skills. Short tutorials may also be created on an organization’s
intranet to educate practicing professionals on a new policy, procedure, organizational
initiative, or healthcare technology. Since the tutorial is electronic, access and time
spent on the tutorial can be easily tracked.
Professional organizations are increasingly recommending performance-based
assessments of students in professional degree programs, and enacting case scenarios
provides an opportunity for students to practice procedural responses and improve
patient safety. The case scenario, a form of problembased learning, has evolved and is
now available through simulation software and virtual reality programming. This kind
of learning assessment, in which students must respond within context to a perceived
situation rather than a theoretical or fact- based question, allows educators to gauge
procedural knowledge; it allows them to determine how well a student executes a skill
or applies concepts and principles to specific situations.
For example, in a clinical context, a student could explain a specific
procedure, but such knowledge is declarative rather than procedural and, therefore, for
some evaluators, not as valuable. Conditional knowledge is often also reflected in
procedural knowledge, demonstrating a student’s ability to know when and why
action is or is not taken, and how. As more programs move toward interprofessional
education, case scenarios are a great way for students to hone collaboration skills and
gain understanding of the roles of other professionals.
Viewed in the 1980s as realistic evaluative tools of student accomplishment
and learning, portfolios in healthcare professional education are growing in popularity
as useful tools for documenting students’ exposure to educational experiences. A
portfolio allows a student to document a variety of sometimes unquantifiable skills,
such as creativity, communication, and critical thinking. Further, portfolios can reflect
achievement of goals, self-evaluation, and professional development, also providing a
way for returning students to log and document past work or life experiences in a
creative but structured way without taking a standardized test. The usefulness of a
portfolio for an undergraduate depends on a structured system of organization: an
identification page with a résumé, a table of contents, separate and clearly marked
sections, and so forth. In this way, portfolios can monitor program outcomes,
positively influence employment and graduate school admission, and provide a clear
snapshot of a student’s strengths and abilities.
Although academic institutions may use eportfolios for assessment of student
learning, for the individual, e-portfolios are all about opportunity. Such opportunities
might include supporting a working relationship with a mentor, networking with other
professionals, or representing certain qualities and characteristics to prospective
employers. In all of these cases, having gone through the process of developing an e-
portfolio requires critical examination of which qualities make individuals who they
are and why these qualities are important to them and their profession. It is important
for all professionals to have a foundational understanding of where they are in their
career trajectory and how this fits their long-term professional goals.
Practically speaking, e-portfolios are efficient. When introducing oneself in an
email message, a self-starting individual who has taken the initiative to develop and
publish an e-portfolio can add this line to the message: “Here is a link to my e-
portfolio.” The recipient can click on this link, which automatically opens that
individual’s e-portfolio in a Web browser. Metaphorically, the senders of such
messages have just walked into the recipient’s office with information that illustrates
who they are, what they know, what they can do, and what they value as important;
they have just walked in with what could be a multimedia showcase of their qualities.
The Internet is a very powerful communication medium, and individuals with
professional eportfolios are simply taking advantage of this fact.
As an instructional strategy, portfolios have been around for a long time.
Instructionally, portfolios, whether electronic or paper based, require students to
demonstrate or provide evidence that they have attained specific learning outcomes.
For instance, in the arts, portfolios have been used to demonstrate the depth and
breadth of the work of an artist. Although performance-based programs of study are
more likely to be familiar with the concept of the portfolio as a demonstration of what
a student knows and can do, other areas of study have also begun to adopt this method
of assessment. Portfolios can be particularly helpful in areas where higher-level
thinking and analysis are essential. For instance, being a good healthcare professional
encompasses much more than simply being able to get high scores on examinations.
Professionals need to be able to collect information, analyze the information
presented, relate it to past experience, apply related knowledge, and evaluate various
options, and from this present a diagnosis and a plan of action. In short, healthcare
professionals need to be able to think critically and make informed decisions. In
learning to become a healthcare professional, portfolios can be used to capture,
support, and improve this type of thinking as it develops.
e. Simulation in Nursing Informatics Education
The patient call bell is ringing; you enter the room to find the patient
verbalizing complaints of chest tightness. In a moment, the patient becomes
unresponsive and a code is called. The team quickly responds, initiating resuscitation
measures per advanced cardiac life support (ACLS) protocol. You review the EHRs
with the attending physician while simultaneously discussing your assessment before
the code. After a short while, the resuscitation efforts are successful and the patient is
stable enough for transfer to the intensive care unit. You complete your documentation
in the patient’s EHR, the simulation scenario ends, and the debriefing begins.
The instructor plays a crucial role in the educational process by providing
comprehensive feedback that goes beyond merely evaluating the actions taken within
a simulation scenario. This feedback encompasses multiple facets of the learning
experience, ensuring that students gain a deep and holistic understanding of the
subject matter. Specifically, the instructor offers detailed critiques and guidance not
only on the clinical decisions and actions performed during the simulation but also on
the effective utilization of the Electronic Health Record (EHR) system as a vital
resource for patient information and documentation.
Within the simulation scenario, the instructor carefully observes the students’
actions, assessing their ability to apply theoretical knowledge to practical situations.
This involves evaluating how students perform specific clinical tasks, such as
administering medications, conducting physical examinations, and implementing
treatment plans. The instructor provides targeted feedback on these actions,
highlighting areas of strength and identifying opportunities for improvement. This
feedback is essential for helping students refine their clinical skills, ensuring that they
are prepared to deliver high-quality patient care in real-world settings.
In addition to critiquing clinical actions, the instructor emphasizes the
importance of the EHR system in modern healthcare practice. The EHR is an integral
tool that healthcare professionals use to access and document patient information. It
includes a wealth of data, such as medical histories, lab results, medication lists, and
treatment plans, which are crucial for making informed clinical decisions. The
instructor guides students on how to navigate the EHR system efficiently, teaching
them how to locate and interpret relevant patient information quickly.
Furthermore, the instructor provides feedback on how students document their
clinical findings and actions within the EHR. Proper documentation is a critical aspect
of patient care, as it ensures continuity of care, supports clinical decision-making, and
meets legal and regulatory requirements. The instructor reviews the students’ entries
in the EHR, assessing their accuracy, completeness, and clarity. Feedback in this area
focuses on improving students’ ability to record patient information systematically
and professionally, emphasizing the importance of clear, concise, and accurate
documentation.
The instructor also highlights best practices for using the EHR to enhance
patient care. This includes demonstrating how to utilize the system’s features, such as
decision support tools, alerts for potential drug interactions, and templates for
standardized documentation. By mastering these tools, students can improve their
efficiency and effectiveness in managing patient care.
Moreover, the instructor addresses the importance of maintaining patient
privacy and confidentiality when using the EHR. This involves adhering to legal and
ethical standards, such as those outlined in the Health Insurance Portability and
Accountability Act (HIPAA). The instructor provides guidance on how to protect
sensitive patient information, ensuring that students understand the significance of
confidentiality in maintaining trust and professionalism in healthcare.
In addition to individual feedback, the instructor may facilitate group
discussions and debriefing sessions following the simulation scenarios. These sessions
provide an opportunity for students to reflect on their experiences, share insights, and
learn from each other’s perspectives. The instructor leads these discussions,
encouraging critical thinking and collaborative learning. This collective reflection
helps students to integrate their learning experiences, solidify their understanding, and
apply the feedback to future practice.
To support continuous learning and improvement, the instructor may also
recommend additional resources and learning activities. These could include further
reading, online modules, or practical exercises designed to reinforce the concepts and
skills covered in the simulation. By providing a variety of learning opportunities, the
instructor helps students to deepen their knowledge and enhance their competencies.
Overall, the instructor’s feedback is a vital component of the educational
process, encompassing a broad spectrum of elements within the simulation scenario
and the use of the EHR system. By offering detailed, constructive feedback on clinical
actions, documentation practices, and EHR utilization, the instructor plays a key role
in developing students’ proficiency and confidence. This comprehensive approach
ensures that students are well-prepared to deliver high-quality, patient-centered care in
their future healthcare careers.
Perhaps it is the first day of a new course and, rather than a lecture-based class
with an accompanying textbook, the instructor uses an active learning approach with
case studies delivered through an EHR interface to facilitate the learning and
application of clinical concepts. In this example, rather than being part of an entire
simulation scenario, the EHR itself is the learning tool providing learners with a
hands-on learning opportunity centered on accessing and using the information
contained within the patient record. Choi, Park, and Lee (2016) concluded that
academic EMRs (AEMRs) would improve students’ understanding of clinical
practice; “the findings of this study will provide important developments by applying
an AEMR, which will augment students’ informatics competencies and critical
thinking, into the nursing curricula to better prepare the future workforce”
f. Nursing Informatics Competencies in Nursing Education
In the late 1990s, it was identified that healthcare professionals needed to
possess both skill and knowledge of informatics. Additionally, information technology
has been identified as a key measure in improving patient safety and quality of care.
In response to this increasing demand for practitioners to become skilled in this area,
coupled with the absence of research-based informatics competencies, a Delphi study
was used to identify informatics competencies for nurses at four different levels of
practice (Staggers, Gassert, & Curran, 2002). In essence, this seminal study created
informatics competencies for entry-level nurses through informatics specialists and
innovators, with a focus on computer skills, informatics knowledge, and informatics
skills.
Although informatics competencies for nurses have been identified, the degree
to which schools of nursing have woven them into the curriculum varies greatly
(Carty & Ong, 2006). In a study conducted by Fetter (2009), a survey of graduating
senior nursing students ranked the following competencies with which they had no
experience or minimal skill: (1) using applications to document, (2) creating an
electronic care plan, (3) valuing informatics knowledge for practice, (4) valuing
informatics knowledge for skill development, and (5) using applications for data
entry. Hunter, McGonigle, and Hebda (2013) developed the online selfassessment
tool, TIGER-based Assessment of Nursing Informatics Competencies (TANIC); this
instrument assesses the Level I: Beginning Nurse and Level 2: Experienced Nurse
competencies. McGonigle, Hunter, Hebda, and Hill (2014) developed the Nursing
Informatics Competency Assessment (NICA) for Level 3 (L3): Informatics Nurse
Specialist and Level 4 (L4): Informatics Innovator based on the seminal work of
Staggers, the current literature, and expert input.
The question then becomes, which best practices will ensure that students
become prepared in informatics? In a position statement by the National League for
Nursing (2008), results from a survey of nursing educators and administrators
indicated that only 50– 60% of respondents said that informatics was integrated
throughout the curriculum and that experience with nursing informatics was provided
during clinical rotations. Findings also suggested that little clinically related
informatics content and few such learning experiences were provided in nursing
programs. Use of technology tools containing careplanning software and clinical
information systems were least likely to be incorporated into the courses. This
continues to be an issue, and one area of concern is the nursing informatics
preparation of the faculty. Rajalahti, Heinonen, and Saranto (2014) made several
recommendations, including the following: “A description of nursing informatics
competencies for nurse educators is needed at a national and global level. Advanced
nursing informatics programmes are needed in the nurse educators’ training
programme”. Nursing faculty must be prepared to use these technologies.
With the advent of emerging technologies in nursing and healthcare education,
there is a growing emphasis on incorporating these advancements to enhance the
learning experience and address existing educational shortcomings. Among these
technologies, simulation stands out as a particularly effective tool. Simulation
provides students with opportunities to engage in informatics actively and in a context
that mirrors real-life scenarios, fostering an authentic and realistic learning
environment. This approach holds immense potential for remedying the gaps in
traditional nursing and healthcare education.
Simulation-based learning enables students to apply theoretical knowledge in
practical settings, bridging the gap between classroom instruction and clinical
practice. By immersing students in simulated environments that replicate real-world
clinical situations, they can practice and hone their skills without the risk of harming
actual patients. These simulations often include high-fidelity mannequins, virtual
reality scenarios, and computer-based models that mimic a wide range of clinical
conditions and emergencies. Through repeated practice in these controlled settings,
students build competence and confidence in their clinical abilities.
One significant advantage of using simulation in nursing and healthcare
education is its ability to integrate informatics into the learning process. Informatics,
which encompasses the use of information technology in managing and processing
healthcare data, is becoming increasingly crucial in modern healthcare practice. By
incorporating informatics into simulation scenarios, students learn to navigate and
utilize electronic health records (EHRs), clinical decision support systems, and other
digital tools that are integral to contemporary healthcare delivery.
In these simulated environments, students can experience firsthand the
importance of accurate data entry, timely information retrieval, and effective use of
clinical decision support tools. They learn to document patient encounters, access
patient histories, and interpret lab results using EHR systems. This hands-on
experience with informatics ensures that students are not only proficient in clinical
skills but also adept at leveraging technology to enhance patient care.
Furthermore, the use of simulation and informatics in education fosters critical
thinking and problem-solving skills. Students are often presented with complex
patient scenarios that require them to make real-time decisions based on the
information available in the EHR and other digital resources. This dynamic learning
process challenges students to think critically, analyze data, and prioritize actions,
preparing them for the multifaceted decision-making processes they will encounter in
actual clinical settings.
Simulation also allows for the replication of rare or high-risk clinical
situations that students might not frequently encounter during their traditional clinical
rotations. For example, they can practice responding to medical emergencies such as
cardiac arrests, severe allergic reactions, or complex surgical procedures in a
simulated environment. This exposure ensures that students are well-prepared to
handle such situations with competence and composure when they arise in real life.
Another critical aspect of using emerging technologies in nursing and
healthcare education is the facilitation of interprofessional education and
collaboration. Simulation scenarios can be designed to involve students from various
healthcare disciplines, such as nursing, medicine, pharmacy, and allied health
professions. By working together in these simulated settings, students learn to
communicate effectively, collaborate on patient care, and understand the roles and
responsibilities of different healthcare team members. This interprofessional approach
is essential for fostering teamwork and improving patient outcomes in actual clinical
practice.
Moreover, the integration of simulation and informatics into education
promotes a culture of continuous learning and improvement. After each simulation
session, students engage in debriefing sessions where they reflect on their
performance, receive feedback from instructors, and discuss areas for improvement.
These debriefings are crucial for reinforcing learning, identifying strengths and
weaknesses, and developing strategies for better performance in future scenarios. The
iterative nature of simulation-based learning encourages students to strive for
excellence and adopt a mindset of lifelong learning.
The use of technology in nursing and healthcare education also extends
beyond simulation to include other innovative tools such as virtual reality (VR),
augmented reality (AR), and mobile learning applications. VR and AR can create
immersive learning experiences where students interact with 3D models of human
anatomy, practice surgical techniques, or explore virtual patient care environments.
Mobile learning applications provide flexible access to educational resources,
enabling students to learn at their own pace and convenience.
In summary, the integration of emerging technologies, including simulation,
into nursing and healthcare education offers a multifaceted approach to addressing the
shortcomings of traditional educational methods. By providing students with
authentic, realistic, and technology-enhanced learning experiences, these approaches
prepare them to meet the demands of modern healthcare practice. The active use of
informatics, the development of critical thinking and problem-solving skills, the
promotion of interprofessional collaboration, and the emphasis on continuous
improvement collectively ensure that future healthcare professionals are well-
equipped to deliver high-quality, patient-centered care in an increasingly digital and
complex healthcare landscape.
g. A Case for Simulation in Nursing Informatics Education and Nursing Education
A simulation recreates a real-life set of conditions or events with as much
fidelity as possible (Alessi, 1988). Aldrich (2010) contended that simulations develop
cognition (learning-to-know skills), ethics and roles (learning-to-be skills), and
application capabilities (learning-to-do skills). Unlike games, however, simulations
are not necessarily designed to be fun.
Simulations contain four major components: pre-brief, enactment, debrief, and
assessment. Every simulation should have these elements in order to prepare and
assess students while also facilitating learning through doing and reflection. The most
important translational PEDA component is the debrief. When done well, debriefing
helps the learner reflect on the authentic experience and solidifies the learning by
facilitating the transfer of theory and skills to their real practice setting. Harris,
Shoemaker, Johnson, Tompkins-Dobbs, and Domian (2016) believed that simulation
could assist family nurse practitioner (FNP) students with their role transition from
generalist to advanced.
Simulations may be experiential and task based, where the learner takes on a
first-person role and executes a self-chosen series of decisions, manipulating the
variables in the simulation toward a desired outcome (Gredler, 1996; Weatherford,
n.d.). Simulations may also be symbolic scenarios, where the learner directly
manipulates variables, sees the results of changes, and then makes decisions on how
to continue in the simulation. Spreadsheets are often used for this type of simulation.
Symbolic simulations are good choices for discovering principles, misconceptions,
and relationships, and for fostering understanding, prediction, and solution
development.
Simulations may use a process known as scaffolding (Jonassen, 1999;
Podolefsky, Moore, & Perkins, 2013) to assist in acquiring the accepted level of
proficiency. An example of scaffolding is when corrective feedback is initially used,
correcting user mistakes and ensuring success, and then the feedback fades away
when it is no longer needed. Medical simulations use realistic three-dimensional
computer models of humans to investigate new medical possibilities and to test
assumptions (learningto-know skills). Simulations of drawing blood and complex
medical operations are used to teach learning-to-do skills.
In general terms, a simulator can perhaps best be described as a tool designed
to emulate some aspect of the clinical practice environment, which may be focused on
a single task or designed to mimic a complete patient care situation (Gaba & DeAnda,
1998). At its essence, it is any device that is used to create a realistic learning
experience for the learner but that removes the risk associated with learning during
hands-on patient care. A simulator offers the unique ability to create a realistic
learning environment that is safe, structured, and supportive for the learner.
Simulators encompass a broad range of devices, such as partial task trainers
(e.g., an IV insertion arm); screen-based simulations, including simulated EHRs,
simulated documentation, and simulated environments replicating a realistic patient
care area (virtual simulation); and complex computer-driven human patient simulation
manikins (latex-based simulation). Web-based virtual standardized patients are also
increasing in use. It is important to understand which of these products you are using:
one in which you enter and interact in a virtual world, access a web-based product, or
interact in a latex-based lab. Although each of these simulation modalities can be used
alone, collectively they can be powerful learning tools when used together to create a
realistic patient care scenario. When designing simulation learning environments,
“[i]nnovative educators design learning environments that encourage active
engagement in the learning process. . . . Active engagement creates a personal
connection with the learning experience and motivates the learner to take greater
responsibility in the learning process” (Fisher, 2016, p. 9). The goal of simulation,
according to Gaba (2004), is a seamless immersion into the simulated practice
environment during which learners are drawn into the reality of the environment or
task at hand. Hertel and Millis (2002) noted that this is a cooperative process whereby
learners come together in an authentic setting and begin to learn from one another.
Darragh et al. (2016) recommended realistic scenarios that elicit autonomous problem
solving and decision making to immerse and engage the participants in active learning
and critical thinking.
Considering the realistic nature of simulation and its hands-on active approach
to learning, it seems that the use of simulation modalities can be a powerful tool in
moving student nurses—indeed, any practitioners— toward achieving the informatics
competencies. In the first example, the EHR is part of a larger simulation scenario that
mimics a real-life clinical case. In the second example, the EHR itself functions as a
simulator and becomes a true-to-life learning tool. In either case, simulation is used to
incorporate nursing informatics into the context of patient care, thereby giving
students an authentic learning experience that can be applied in clinical practice.
According to the NCSBN National Simulation Study (Hayden et al., 2014),
50% simulation can be effectively used in various program types, in different
geographic areas, and in urban and rural settings with good educational outcomes.
The NCSBN study results and the lack of available or quality clinical/practicum
placements are prompting the move to integrate more simulation into nursing
education. Virtual and latexbased simulations are valuable educational assets at all
levels of nursing education. They provide a safe, authentic environment to develop
knowledge, skills, and attitudes prior to interacting with actual patients. There is no
risk to patients, and students can practice and receive assessment and feedback for
controlled episodes, including unusual events. Simulation relates well to adaptive
learning methods, such as branching logic, that allow the learner to guide the learning.
The nurse educator can tailor the simulation to the learning needs of the students,
providing deliberate practice with feedback. The learner can learn, relearn, and hone
skills while safely practicing in dynamic and complex situations with a view to
decreasing and eliminating mistakes.
h. Incorporating EHRs into the Learning Environment
There are two main approaches to the incorporation of an EHR into the
learning environment, whether used within a simulated clinical environment as part of
a patient care scenario or as a stand-alone learning tool. First, the EHR can be created
specifically for simulation purposes; options range from a well-developed Microsoft
Access database to commercially available products designed specifically for
simulation purposes. Second, the simulation may use a real EHR system, either within
a hospital-based simulation center or through a partnership with a healthcare facility
or an EHR vendor.
There are certain advantages and disadvantages to each simulated
documentation. As Brown (2005) noted, whereas “live” documentation systems
provide learners with a realistic experience and can be incorporated into the learning
environment, they also present certain drawbacks: (1) they are designed for the patient
care environment, not the learning environment, and therefore lack an efficient
feedback mechanism for learners; (2) they are designed to work in real time, not
simulated time, creating issues with data recall, especially when a record may be used
repeatedly over a period of months or years; and (3) if a system is overly complex, it
may unintentionally focus the learning on the specific system, rather than the process
of data retrieval and documentation. Refer to Research Brief 1 for more on the
challenges of teaching clinical documentation skills in an EHR.
One system designed specifically for simulation is the Web-based medical
chart (WMC), as described by Brown (2005). This system requires four components:
(1) a database, (2) dynamic webpage shells, (3) a server, and (4) computers with
access to the Internet. With this system, a Microsoft Access database is created to hold
administrative information about the simulation scenario and other pertinent overview
information accessible only by the instructor, as well as simulated patient data,
simulated patient documentation, student documentation entries, and learner feedback
from instructors. Each time a learner logs into the WMC system via the Internet, the
server custom-creates the requested page using the existing database information,
user-specific information, and the webpage shells to create a realistic EHR for use by
the student. Although this type of system offers a great deal of flexibility, because it is
custom created by the end user (but is certainly a cost-effective solution), it requires
that the simulation instructor have a strong background in computer science and
information technology to create and maintain the database and supporting materials.
One example of a commercially available solution is Elsevier’s Simulation
Learning System (2010). This system includes all of the elements needed for
preparing, programming, running, and debriefing a simulation scenario, including a
fully functional EHR. The EHR is linked to the simulation scenario and contains all of
the pertinent patient information for learners to access before or during the simulation
scenario. This system also incorporates the ability for learners to document just as
they would in an actual clinical setting, with the capability of submitting the
documentation to the instructor for evaluation and feedback. A major strength of this
type of system is that it is a prepackaged Web-based solution that does not need to be
created from scratch.
Additionally, there are many learning systems designed for simulation that
contain all of the necessary tools for the instructor or simulation center staff to build
the simulation scenario, including (but not limited to) programming guides, staging
and scripting information for the scenario, and debriefing guides. Two potential
disadvantages with any commercially available solution, however, are the cost to
purchase it, which varies depending on the product and vendor, and the ability for or
cost associated with customization.
Although the main disadvantages of a live system were discussed at the
beginning of this section, the use of a real EHR system clearly provides learners with
a truly authentic experience. One innovative solution to bridge this gap was developed
out of an academic–business partnership between the Cerner Corporation and the
University of Kansas School of Nursing. The Simulated E-hEalth Delivery System
(SEEDS) incorporated the use of Cerner Corporation’s clinical information system
and PowerChart application.
Similar to the WMC system discussed previously, instructors developed the
patient data stored within the Cerner Corporation’s clinical information system
database, creating virtual patients within the system. Students could navigate through
the system and view pertinent patient data and then document assessment information
and create a plan of care within the PowerChart application. Additionally, the
instructor could access student documentation for evaluation and feedback. According
to the University of Kansas Medical Center (2016), “[SEEDS] marks the first time
that a live-production, clinical information system designed for care delivery is being
used in a simulated way for teaching curriculum content to health professional
students” (para. 1). Refer to the Research Brief 1 for a discussion of a study on the use
of the SEEDS approach.
