Leppa Report 1

Carol J. Leppa, PhD, RN

Professor, Nursing, University of Washington, Bothell, US

and

SCEPTrE Fellow 2007-08

University of Surrey, UK

Final Report

16 June 2008

I. Introduction and Background Review for Fellowship

The stated overall goal for my SCEPTrE Fellowship was to develop International Faculty-to-Faculty and Faculty-to-Student research and practice partnerships between University of Washington, Bothell in the United States (US) and the Division of Health and Social Care in the Faculty of Health and Medical Sciences at the University of Surrey in the United Kingdom (UK). The fellowship work built on my initial work that resulted in the five-year Memorandum of Agreement in collaboration with the leadership of University of Washington (UW) Nursing Programs at the three campuses of Bothell (UWB), Seattle (UWS), and Tacoma (UWT) signed in 2005. This agreement established the framework for collaborations that were to explore and include faculty staff and student exchanges as well as research and practice collaborations.

My initial focus in the SCEPTrE fellowship was to understand the importance of a visual link via webcam technology in online communications. I was impressed with the enormous amount of information gained from a visual link between a faculty and student on placement that was presented at the SCEPTrE workshop in March-07 by Steve Rowett. It was clear that being able to observe the student deal with and think through a question posed by the faculty member was a much richer depiction of the learning process than was possible to gain with solely text-based (email) or verbal (telephone) connection. In order to deconstruct my observation of this experience, I began to explore the research on effective E-Learning, the research on nonverbal (or paralanguage) communication, and the research on effective Virtual Teams in the business literature.

From the E-Learning literature, I found a great deal written about the success of a hybrid format that combined face-to-face and asynchronous discussion. The hybrid format increases student interaction in establishing and maintaining social presence (participants are ‘real’ to each other) and increases student satisfaction and student learning (1,2,3,4).

From the Communications literature, I learned about the behaviors and gestures that are an integral part of effective communication. The paralanguage of voice inflection, facial expression and hand and body gestures are an integral part of effective communication (5,6) with a general statement that approximately 60% to 65% of communication relies on these nonverbal cues (7). The breadth and depth of the information obtained by being able to see a person communicating supports the success of the hybrid format for E-Learning. We gain much more information and suffer much less miscommunication and misinterpretation when we can meet face-to-face or at least see each other (7).

Finally, the Business literature contains a great deal of research on the effectiveness of virtual teams as they have become more common in the global economy. This literature also reports on the importance of at least one face-to-face or visually linked (video conference) meeting at the beginning of the team formation. Teams who had a real-time visual link with each other at the beginning of a project experienced a smoother working process and relationships and were more productive than virtual teams that relied solely on text-based links for their collaboration (8,9,10).

I now had a better understanding of why a visual, real-time link (webcam) was so powerful in developing and sustaining international collaborations. While international linkages using text-based links (e.g. email, wikis, blogs) can be productive, the addition of a visual link could potentially enhance the experience by making the process smoother, decreasing the chance of miscommunication and misinterpretation, and increase productivity. Using webcams to make these linkages is an easy and inexpensive way to connect international participants in research and education about complex health care issues.

II. Progress on Goals Identified in original Proposal

The following boxed text is taken from my original proposal, with the narrative report on progress following each goal of the five goals.

Intended work
Goal 1 / When done / How and with whom / Anticipated changes
Explore inclusion of international linkage as part of Masters programme at UNiS / September to December 2007 / Discussion/course revision with V. Vydelingum and M. Volante / Trial for inclusion of an option for international linkage as integral part of masters course or student assessment

Progress: Initial discussions with Dr. Vasso Vydelingum and Dr. Margaret Volante in October-07 began to identify possible UNiS staff and courses/modules for links with UWB. We decided to focus on the UWB led links for this year due to the significant changes in positions and unrest amongst staff at UNiS. This allowed us to proceed with UNiS staff in connection with UWB staff and UWB students.

UWB students have 6 course credits of Fieldwork that serve as experiential elective credits. The pilot projects developed during the SCEPTrE fellowship will be offered to them beginning autumn-08 and will also be offered to UNiS students as a voluntary option in addition to their graduate programme work.

Intended work
Goal 2 / When done / How and with whom / Anticipated changes
Identify practice and research linkage opportunities for UWB masters students and Surrey masters students to work with faculty across institutions / September-07 to April-08 / Developing a ‘practice/research link brokerage’ that identifies potential partners and advertises these internally at both institutions / Initial faculty-student linkages.

Progress: Consulted with V. Vydelingum and K. DeVries on development of three initial linkages:

  1. Certificate in Essentials of Palliative Care (CEPC) educational programme – a feasibility study of adaptation or adoption for UWB of the CEPC programme offered by the Princess Alice Hospice.
  1. Concept Mapping comparative study – exploring the use of concept mapping in evaluating teaching/learning of cultural identity and health care services disparities comparing US and UK Nursing students.
  1. Replication of research on Quality of Life in Nursing Home Residents – pilot study completed in the US, to be replicated in the UK. Project to be led by faculty with future secondary data analysis options for students from UNiS and UWB.

Intended work
Goal 3 / When done / How and with whom / Anticipated changes
Establish pilot international faculty linkage partnerships in research or practice / September-07 to April-08 / e.g. K. DeVries at Surrey to link with UWB grad students on palliative care protocols; C. Leppa at UWB to link with Surrey grad students on quality of life research measures / International partnerships with written goals for faculty-faculty and faculty-student links

Progress: The three pilot projects identified above were addressed as follows.

Pilot #1: Palliative Care Essential Education program

This has been the most immediately successful of the three pilot programmes. The opportunity to work with an established course at UWB and have the webcam link be one of the options for a required assignment provided a structure and timeline for development. The Palliative Care training programme was one of three options students could select.

UWB Nursing Masters students were invited to participate in a feasibility study as part of their core course “Program Planning and Evaluation in Health Services Delivery” which ran from 04 April through 06 June, 2008. The following description appeared in the course syllabus (course guide):

Team 1 Client:Dr. Carol Leppa

Project Title:Palliative care training program development

April 11 Intro Time:7-8AM (Web Conference with London collaborator)

Brief Description:Students will work on a needs assessment and planning phase for an interdisciplinary palliative care training program. We will have a model training program from the Princess Alice Hospice in England and will collaborate with Dr. Kay deVries, director of education at Princess Alice. We will meet with Kay via web-cam/video conference as scheduled on April 11. Kay will also be at UWB at the end of May. Other web-conferences may be scheduled as needed. I want to explore the best way to provide palliative care education in the UWB/Seattle area. Princess Alice Hospice Website:

Participants from UK:

  • Dr. Kay DeVries, Lecturer at EIHMS, University of Surrey and Director of Education at Princess Alice Hospice
  • Dr. Vasso Vydelingum, Senior Lecturer at EIHMS, University of Surrey and external evaluator of Palliative Care Education at Princess Alice Hospice
  • Lynne Kovan, Nurse at Princess Alice Hospice and manager of Certificate in Essential Palliative Care Education at Princess Alice.

Participants from US:

  • Dr. Carol Leppa, UWB Professor of Nursing and SCEPTrE Fellow, University of Surrey
  • Students enrolled in masters level UWB Program Planning Course

Patricia ArteagaAngela Holroyd

Mary LawsDebbie Luttman

Valerie LytleGail Muller

Dana Scharfenberg

  • Charlotte Green, RN, Second-year MN student at UWB with fieldwork focus on palliative care education.

Webcam links: (dates, length of time, goals for meeting)

11 April 2008

One hour webcam meeting 7:30 to 8:30 am UWB time and 3:30 to 4:30 UNiS time

Meeting goals: introductions and initial exploration of palliative care essentials programme covering history of Princess Alice programme and questions from students to clarify how programme works as currently offered.

The meeting was held in staff offices with all the students crowded into my office at UWB, and the three UK participants present in Vasso Vydelingum’s office. We had some technical problems at the UWB end, no trouble at UNiS end. We had approximately 45 minutes of clear webcam connection.

Students were very excited about the project and meeting the UK faculty via webcam. Anecdotally they reported being highly interested in “learning about the UK programme,” “actually talking with real UK faculty involved in the programme,” and “seeing how the UK programme might fit or inform a similar programme in the UWB area”.

9 May 2008

One hour webcam meeting at same time as first meeting

Meeting goals: clarification of Princess Alice programme details, beginning exploration of comparison of US and UK health care systems in regards to end of life care delivery and funding, planning for pending UK faculty visit to UWB.

We had no technical difficulties with this link. The students elected four spokespersons for their group, which greatly facilitated the meeting.

Students began to question UK faculty about the structure of end of life care delivery and funding and appreciated the opportunity to explore some of their assumptions and begin to make comparisons with the US system. Students began to identify opportunities and limitations of both systems in these comparisons in how end of life care is delivered. Similarities and differences were highlighted, and potential barriers to palliative care education were also explored based on experiences in both countries.

Pilot #2: Concept Mapping Comparative Study

The idea for this collaboration came from the Concept Mapping workshop conducted by David Hay at UNiS in October-07. I got a copy of the DVD of the workshop and began to think about how this might be used by faculty at UWB.

Dr. Vasso Vydelingum had begun using concept mapping in the CulturalAcademy that he initiated for students with colleagues at UNiS. At UWB we have one undergraduate core course and one graduate core course on cultural/social disparities in health care, as well as four elective courses that explore culture and healthcare. We currently have six faculty with an interest in this area (Associate Professor Mary Abrums, Assistant Professor Selina Mohammed, Assistant Professor Cheryl Cooke, Senior Lecturer Jerelyn Resnick, Lecturer Elayne Puzan, and Lecturer Beth Madison). All have been involved in teaching the courses at one time or another.

I contacted all the UWB faculty including the six identified above, and provided a copy of the David Hay DVD for their review. I also provided copies of three of Hay’s articles on concept mapping.

I scheduled a workshop day during Vasso Vydelingum’s visit to UWB in May to begin conversations about potential collaborations. Eight UWB faculty/staff attended the workshop including Abrums, Cooke and Resnick, identified above.

During the three-hour workshop on 28 May, Vasso presented his poster on his experiences with the UNiS Cultural Academy, and discussed the lessons learned and plans for the future. We ended with brainstorming potential uses of concept mapping in various courses and in different time frames. A follow-up concept mapping session is planned for autumn-08 when all faculty/staff have returned. If feasible, we will connect Vasso to this workshop via webcam link.

I hope to ‘broker’ collaboration on concept mapping cultural identity among these faculty during the 2008-09 academic year. There was high interest in exploring how this might be accomplished and I will assist with making these links possible. While there was no use of webcam linkage at this time on this pilot project, I believe the successful initial face-to-face meeting has set the stage for future linkages.

Pilot #3: Replication of research on Quality of Life in Nursing Home Residents

The focus of this pilot was to get the research started in the UK. I completed a pilot study of quality of life in nursing home residents in the US, interviewing residents in two nursing homes in the Puget Sound area. This study was approved by the University of Washington Institutional Review Board (ethics approval) and partially funded by a UW-Bothell Faculty Scholarship Award. Initial results had been presented at the Sigma Theta Tau International Nursing Scholarship conference in Montreal, Quebec, Canada in July 2007.

In October 2007 I visited the UK and with Kay DeVries, we made initial contact with nursing home owners/managers in Sussex to determine interest in participating in a replication study. We had a positive meeting with Carol Dilley, Sussex Health Care, and decided to move forward.

Dr. DeVries began writing the research ethics application for review at the University of Surrey. We collaborated via email on writing this, and brought in Dr. Vydelingum who took the lead on presenting this for ethics review.

The proposal was submitted in April 08, and we received a request for clarifications and additional information and re-submitted in May 08. We received ethics approval in May 2008. We will begin data collection in June 08.

The goal for this project is to collect data to assure the usability of the instruments in the UK, and to begin initial comparisons between US and UK nursing home residents. This will serve as the pilot work for a larger multi-site study in both the UK and the US.

The plans for the future include bringing masters level students from UNiS and UWB into the work of data analysis, and potential secondary analysis or future related research. This will be an option for students in the autumn of 2008.

Intended work
Goal 4 / When done / How and with whom / Anticipated changes
Create discussion page, blog, or wiki for sharing experiences / January to May 2008 / Collaborate with S. Rowett at Surrey and A. Brockhaus at UWB to create a discussion and document creation space / Faculty and students will learn about and contribute to blogs and wikis in relation to their partnership work. e.g. creation of shared research report document using a wiki

Progress: No activity on this goal as written. The focus of the fellowship remained on establishing webcam linkages and procedures. To this end, I wrote a grant for internal UWB technology support funds to purchase and support webcams for student/staff check out and use at UWB. I collaborated with IT staff, Media staff, UWB Educational Technologist, and Nursing faculty and student advisors in three meetings dedicated to drafting the grant proposal. I served as lead author and we applied for funds from the UWB Student Technology Fund, a fund based on technology fees collected from students, and distributed by a student-led review board.

We were awarded a total of $5,100.00 to support the purchase of webcams to be available for checkout, plus the funding of 9 months of hourly wages for a student worker to support student/staff training and troubleshooting in use of the webcams. Funds will be available beginning in September-08 and we will conduct a review of the use of the webcams in spring-09 in anticipation of recommending any further funding of this technology.

Intended work
Goal 5 / When done / How and with whom / Anticipated changes
One formal large group video conference linking faculty staff participants in project. / May 2008 / SCEPTrE and UWB media support / Sharing projects and progress in international linkages between UWB and Surrey

Progress: This goal was achieved in part by having three face-to-face meetings, one for each pilot project in May 2008 when Vasso Vydelingum and Kay DeVries visited UWB from 26 to 31 May. The face to face meetings were possible given the visit of Surrey staff in person, and more effective in developing staff and administrative support for the pilot projects as well as for the webcam linkages planned in the future.