A VIRTUAL CARE ENVIRONMENT FOR HEALTH EDUCATION
Ger Cannon, AV technician. School of Nursing Dublin City University.
Pamela Henry , Lecturer, School of Nursing Dublin City University.
Morag Munro, Learning Technology Project Officer, Dublin City University.
ABSTRACT
The School of Nursing (SON) at Dublin City University (DCU) is currently in the process of developing the "Virtual Care Environment", a centralised resource and knowledge base that links education, research and clinical practice.
The application of Problem Based Learning (PBL) has been identified one way to facilitate the development of the skills and qualities required by today's nursing graduates (Alavi and Creedy 2001; Andrews and Jones 1996; Creedy and Hand 1994; Engal 2001; Williams 2001). At the hub of the Virtual Care Environment are generic case studies, composed of written documentation (patient notes, biochemistry/haematology test results etc., dialogues between staff/patients); images (X-rays, etc.); and audio and video clips. This “picture” of a patient can be adapted to form the basis of specific PBL scenarios and tasks, allowing flexible re-use of clinical information according to different subject areas and levels of expertise.
The Virtual Care Environment's navigational framework takes advantage of the general preference for graphical user interfaces that mirror “real life” information seeking models (Shneiderman 1992) by mimicking the organisation of information in authentic healthcare settings. For example, if a nurse in the professional environment were interested in learning something about coronary care, he or she would go and speak to the staff on the coronary care ward. Likewise, in the Virtual Care Environment he or she would “visit” the coronary care ward in the Virtual Hospital and locate the required information.
- INTRODUCTION
We are living in one of the most demanding and challenging times in nursing. Rapid, exponential and unpredictable change will continue to be characteristic of health care for the foreseeable future. Key issues for health care practitioners include technological innovation; the diminished life span of information; complex ethical and legal challenges; new policy initiatives; and increased public and professional expectations.
Krenz (2002) asks, "How can health care educators lead nursing students into this century using old, enmeshed and outdated approaches, to acquire knowledge that may or may not be relevant to them in the future?" It is clear that if we are to succeed in effectively preparing student nurses for professional practice, we must keep pace with ongoing developments in technology, research and practice, and we must revise our curriculum and pedagogy accordingly.
In June 2003, the ClaN (Computers, Library and Nursing) group was formed. The group initially focused on the redesign of NS406, a core nursing informatics module on the Dublin City University (DCU) Bachelor of Nursing (BNS) programme (Cannon, Henry and Munro 2003). The redesign of this module, along with national and regional issues relating to nursing and nurse education, lead to the conception of an outline framework for a "Virtual Hospital." As the project progressed it transpired that a more suitable framework for the environment would be a “Virtual Care Environment.”
The application of Problem Based Learning (PBL) has been identified one way to facilitate the development of the qualities and skills required by today's nursing graduates (Alavi and Creedy 2001; Andrews and Jones 1996; Creedy and Hand 1994; Williams 2001). At the hub of the Virtual Care Environment are generic case studies; these can be adapted to form the basis of specific PBL scenarios and tasks, allowing flexible re-use of clinical information according to different subject areas and levels of expertise. It is critical that reusable PBL case studies are developed centrally with input from all stakeholders; "It is not possible for separate, subject-centred groups of academics to plan, organise, implement and evaluate a problem-based learning curriculum; they must be department-centred" Engal (2002).
- Rationale for development of the virtual health care environment
The need for a Virtual Care Environment was driven by:
- National issues in relation to nursing and nurse education
- Regional issues within DCU
2.1 National issues
2.1.1 Changes in healthcare provision
The challenges facing Irish health care practitioners today are documented in the Brennan Report (2003). The commission make 136 recommendations and proposed the development of the newly appointed health executive and a national implementation committee for the implementation of their recommendations.
2.1.2 Information and communication technology (ICT) and nursing
Towards Workforce Planning The Nursing and Midwifery Resource (2002) highlights that information technology will impact greatly on the environment in which nurses practice, and also on the knowledge base and skills required to provide care.
2.1.3 Trends in nursing education
Skillbeck (2001) highlights that universities will need to adopt a more economically responsive approach to education in the future. He suggests that one way to achieve this is to educate, orientate and prepare students for employment. Tomorrow's nursing graduates will need to demonstrate the competencies necessary to deliver the goals and objectives documented in the Department of Heath and Children’s strategy, Quality and Fairness – A Health Strategy for you (2001). In order to achieve these levels of competency, nursing programmes must be pragmatic in their approach and foster independent learning.
E-learning is increasingly becoming commonplace in UK and Irish Higher education (Armitage, Browne, and Jenkins 2001) and in delivering undergraduate and continuing education programmes in health education (Ayer and Smith 1998).
2.2 Regional Issues
2.2.1 Inclusive learning
A central tenet of DCU SON’s strategy is to support all students: from novice, full-time undergraduate students, through to part-time students working as experienced clinicians. The blended PBL model employed by the Virtual Care Environment is ideally suited to part-time students, while inculcating the skills of novice practitioners.
2.2.2 Nursing skills centre
In January 2004, DCU's SON relocated to a new purpose-built facility – the first of its kind in the Republic of Ireland. The building houses a state-of-the-art Nursing Skills Centre (NSC), which replicates real-life healthcare settings. The school is also in the process of developing a large audio/visual and multimedia resource archive; it is logical that the organisation of our electronic resources is an extension of our new physical environment.
2.2.3 Moodle Virtual learning deployment
DCU recently made a strategic commitment to an enterprise-wide deployment of the Moodle virtual learning environment (VLE). As an open source VLE, Moodle allows the development of custom applications, making it the natural platform for the development of the Virtual Care Environment.
- Developing the Virtual Care Environment
3. 1 Phase 1A
Phase 1 began in June 2003, with the formation of the ClaN (Computers, Library and Nursing) group. The group initially focused on the redesign of NS406, a core nursing informatics module on the DCU SON BNS programme (Cannon, Henry and Munro 2003). The redesign of this module lead to the conception of an outline framework for the Virtual Hospital, and subsequently the Virtual Care Environment.
The Virtual Hospital (Figure 1) was intended as a centralised information and activity resource that would allow students to master the key cognitive skills required for their professional practice: questioning; critical thinking; searching for sources of information; discussion and collaboration with peers; and synthesis of information. The hospital's navigational framework would take advantage of the general preference for graphical user interfaces that mirror “real life” information seeking models (Shneiderman 1992) by mimicking the organisation of information in authentic healthcare settings. For example, if a nurse in the professional environment were interested in learning something about coronary care, he or she would go and speak to the staff on the coronary care ward. Likewise, in the Virtual Care Environment he or she would “visit” the coronary care ward in the Virtual Hospital and locate the required information.
Figure 1: Virtual Hospital navigational outline
Problem-based learning employs approaches to teaching and learning in nurse education that develop meaningful links between education and practice (Creedy and Hand, 1994). At the hub of the Virtual Hospital would be generic case studies, composed of written documentation (patient notes, biochemistry/haematology test results etc., dialogues between staff/patients); images (X-rays etc); and audio/video clips. These generic case-studies could be adapted to form the basis of specific PBL scenarios and tasks.
It was anticipated that the Virtual Hospital would be modular. As a new area of curriculum was developed new case studies, or new wards/departments could be added; making it easy to accommodate the needs of all modules, present and future. There would be no need for the duplication of resources; important to ensure consistency of information output and the creation of re-usable information.
3. 2 Phase 1B
On the basis of the specification developed in phase 1A the group was awarded funding to develop the Virtual Hospital, using the Moodle VLE as the development platform. In February 2004 the development of a systems requirement specification commenced. At this stage it was essential to ensure that the Virtual Hospital would serve the wider needs of all stakeholders. An explanation of how a Virtual Hospital might operate was distributed to SON staff, and they were also invited to participate in three focus group sessions, during which a number of broad questions were raised as a seed for further discussion. Two core themes arose:
- The "Virtual hospital" model was the subject of much debate, as was the terminology used to describe it. Staff felt that it was too narrow and that it should be revised to better represent the changing role of hospitals and healthcare professionals, as well as the broader healthcare environment that nurses would encounter in their professional practice.
- As nursing is a practice-focused discipline, academic staff stressed that they saw the Virtual hospital as a resource, rather than a replacement for face-to-face teaching.
The project team adapted their original model in reaction to these issues. Instead of a "Virtual Hospital" the project was broadened to form a more inclusive "Virtual Care Environment" of which the hospital was a part (Figure 2). A prototype front end will be delivered in June 2004.
Figure 2: Virtual Care Environment navigational outline
3.3 Phase 1C
Between July and September 2004, user testing and refinement will be carried out on the front end of the environment. Development of the back end of the system will also commence. A key aspect of this will be the development of case studies and data sets relating to particular patient cases. It is critical to the success of the project that these are developed centrally with input from all stakeholders; according to Engal (2002), "It is not possible for separate, subject-centred groups of academics to plan, organise, implement and evaluate a problem-based learning curriculum; they must be department-centred".
Supporting the datasets and case studies will be a patient record database. System data will be stored in the back end database and will be presented to users in the form of specific episodes of care. It is anticipated that this database will use international data standards for health care terminology, such as: North American Nursing Diagnosis Association Classification (NANDA); Nursing Intervention Classification (NIC); and Nursing Outcome Classification (NOC).
Also crucial to this phase will be the development PBL scenarios that challenge students to develop higher order thinking skills, moving them to the analyse, synthesise and evaluation levels of Blooms (1956) taxonomy scale, the skills that Boud and Fellitti (2001) claim are key to success in any profession.
- The Future
4. 1 Phase 2
This will see the backend database become functional and more case studies, resources and so on will be added. A major evaluation of project will be conducted at the end of this phase (September 2005). A beta version will be launched at the start of the 2005/2006 academic year.
4. 2 Phase 3
By September 2006, the virtual heath care environment will be fully functional and widely used by school staff. To ensure its relevance and utility the environment will require ongoing evaluation, updating, and maintenance.
- CONCLUSION
Although the project it is still at a very early stage, this phase is in many ways the most important: it is the blueprint and the foundation for all that follows. Consultation with all stakeholders will be vital if a project so wide in scope and ambition is to achieve its aims, and a key challenge for the development team is to develop a model that will facilitate and accommodate the future demands of the schools educational needs.
REFERENCES
Alavi, C. and Creedy, D. 2001 Problem-based learning in an integrated nursing curriculum IN: Boud, D, and Feletti, G (eds.). The challenge of Problem-Based Learning. 2nd edition. Kogan Page: London
Andrews, M. and Jones, P. 1996. Problem based learning in an undergraduate nursing programme: a case study, Journal of Advanced Nursing, 23, pp357-365
Armitage, S. Browne, T. Jenkins, M. 2001. Management and implementation of Virtual Learning Environments A Universities and Colleges Information Systems Association (UCISA) funded survey. [Online] Available from:< 15 March 2004].
Ayer, S. & Smith, C. 1998, 'Planing flexible learning to match the needs of consumers: a
national survey', Journal of Advanced Nursing, Vol. 27, No. 6, pp. 1034-1047.
Bloom, B. et al (eds) Taxonomy of Educational Objectives: The classification of educational goals, Handbook 1, Cognitive domain. New York: David McKay pp201- 207 .
Boud, D. and Feletti G.(eds) 2001. The Challenge of Problem Based Learning. 2nd edition. Kogan Page: London
Carpenito-Moyet, L. 2002 Handbook of Nursing Diagnosis. 10th Edition. Lippincott Williams & Wilkins: Philadelphia.
Cannon, G., Henry P., Munro M. 2003. Thinking "outside the box" in Nursing. IN: HISI and EUROREC '03, 8th Annual Conference and Scientific Symposium proceedings November 12th-15th, 2003
Creedy, D. and Hand, B. 1994. The implementation of problem-based learning: changing pedagogy in nurse education, Journal of Advanced Nursing Education, 20, pp. 696-702.
Department of Health and Children. 2001. Quality and Fairness – a health system for you. Dublin. [Online]. Available from:< 15 March 2004]
Department of Health and Children. 2002. Towards Workforce Planning The Nursing and Midwifery Resource: Final Report of the Steering Group. Dublin.[Online]. Available from:< 15 March 2004]
Department of Health and Children. 2003. Brennan Report - Commission on Financial Management and Control Systems in the Health Service. Dublin [Online]. Available from:< 15 March 2004]
Engal, C. 2001. Not just a method but a way of learning IN: Boud, D, and Feletti, G (eds.). The challenge of Problem-Based Learning. 2nd edition. Kogan Page: London
Krenz, M. 2003. The Use of the Nursing Outcomes Classification to Direct Competency – Based Curriculum Part Six Moorehead, M. Johnson, M. Maas, M. 2003. Nursing Outcomes Classification (NOC) Iowa Outcomes Project. Third Edition. Mosby.
Moodle virtual learning environment [Online]. Available from:< 26 March 2004]
Moorehead, M. Johnson, M. Maas, M. 2003. Nursing Outcomes Classification (NOC) Iowa Outcomes Project. Third Edition. Mosby.
McCloskey, J. Dochterman, G Bulecheck, M. 2004. Nursing Interventions Classification (NIC) Fourth Edition. Mosby.
McKenna, L. & Ribbons, R. 2000. Integrating information and health care technologies in
undergraduate nursing programmes. IN: Nursing Informatics 2000 : one step beyond: the evolution of technology and nursing : proceedings of the 7th IMIA International Conference on Nursing Use of Computers and Information Science., Saba, V., Carr, R., Sermeus, W. & Rocha, P. (eds), Science Adis International, Auckland, pp. 288-294.
Open Source Initiative (OSI) [Online]. Available from:< Accessed 26 March 2004]
Skillbeck, M. 2001. The University Challenged: A Review of International Trends and Issues with particular reference to Ireland Conference of Heads of Irish Universities and Higher Education Authorities. Dublin. HEA/CHIU. [Online]. Available from:< Accessed 15 March 2004]
Shneiderman, B. 1992. Designing the User Interface - Interface Strategies for Effective Human-Computer Interaction. 2nd Edition. Addison Wesley.
Williams, B. 2001. The theoretical links between Problem-based learning and self-directed learning for continuing professional nursing education. Teaching in Higher Education, 6 (1) pp85-98