E-Learning for Nursing The University of Texas M. D...

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A Journey of Discovery and RewardThe University of Texas

M. D. Anderson Cancer Centerand the ONS Experience

Robin Toms, PhD, RN, CNAA, BC

E-Learning for Nursing Professional Development

Education Programs for Nurses

� Clinical Nurse Education - Inpatient and Ambulatory Care� Nursing Education Outreach for external customers� Wound Ostomy Continence Nurse Education Academic Program � Professional Education for Prevention and Early Detection� Student Programs

Customers

� Internal - over 2000 Clinical Nurses, APNs, and Research Nurses� External - United States & International Nurse Visitors,

M D Anderson Espana, Madrid

The University of Texas M. D. Anderson Cancer CenterDepartment of Nursing Professional

Development and Education

� Identify four steps in the development of computer based instruction

� Discuss hardware, software and technology support needs

� Discuss learner characteristics and competency requirements

� Describe implementation and outcomes evaluation strategies utilized in the development of ONS online courses

� Describe methods for effective re-purposing of existing educational products to meet online learner needs

Learning Objectives

Skill Validation

Blended LearningBlended Learning

Demo/PracticeE-Learning

The JourneyA journey of a thousand miles begins with the first step.

How did we get there?

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Provide flexible learning opportunities

to a large number of participants

24 hours a day, 7 days a week�.

anywhere�..anytime

The ObjectiveThe Objective� E-Learning provides learning opportunities at the

point of need, �24/7� at work or at home

� E-Learning �fit�s into� a busy unpredictable schedule for nurses and can be provided in small modules

� E-Learning meets the adult learner�s needs

� Complements instructor-led classes (blended learning)

� Provides opportunity for individual reinforcement

Advantages of E-Learning

� E-Learning reduces the need to travel to distant learning sites

� May be more cost effective than traditional classes

Advantages of E-Learning

� Bandwidth �the rate at which information moves across the net work. Sometimes does not accommodate graphics and sound

� Not all courses should be delivered by e-learning.Some required a more personal touch and face-to-face communication ie:teambuilding

� E-Learning takes more time and money to develop than expected

� Not everyone has access to high speed computers

Selected Disadvantages of E-Learning

� Is there a nurse with a �passion� for computers, web development, graphic design?

� Could we enhance existing skills at local colleges, universities or graphic design schools?

� Is anyone else in the organization already doing some of this?

� What type of hardware is in place? Will it handle what we want to do?

� Are the computers where nurses can access them?

� Are the nurses (end users) interested?

Identifying Resources In the beginning�

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e-Learning: Evolutione-Learning: Evolution

Blood Product Administration

Overview

We did not start with an online module

Blood ComponentsBlood Components

RBC

Cellular components of blood

WBC

Plts

Plasma- the liquid portion of blood contains proteins such as immunoproteins, clotting proteins, and ABO antibodies (which are immunoproteins)

Plasma-Alb-Ig

-FFP-Cryo

Graphics, Animation & Sound

Bedside CheckThe same two individuals who initially checked the blood

product must verify at the bedside:

! Name/ hospital number on patient�s name band is same as the patient�s name and hospital number on both the blood bag label and on the Blood Bank Form 1

Video with Sound

Patients who leave the unit with a blood product infusing must be accompanied by ________

LVN from sending unit

RN from receiving unit

RN from sending unit

Transportation personnel

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There was no E-Team (2001)

Dedicated Development Team

Who do I need on my team?� Project Manager-capable of dealing with diverse

work styles

� Instructional Designer-an experienced educatorfamiliar with computer-delivered instruction

� Programmer or author to use the authoring tool(s)

� Graphic artist

� Subject matter expert (SME)

� Webmaster

� Someone to obtain funding from management

Developing the Talent You Have

�I WANT YOU�

�Oh no! Not me! �You need someone with much more

experience!�

�It�s not so much that we�re afraid of change or so in love withthe old ways but it�s that place in between that we fear�

it�s like being between trapezes.

It�s Linus when his blanket is in the dryer. There�s nothing to hold on to. �

Marilyn Ferguson, American Futurist

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2001 to 2004The Birth of the M. D. Anderson E-Team

MaryProject Manager,subject

matter expertand instructional designer

VeniceAdministrative

Asst./Graphic Designer

Helpful Terms� Internet- a huge global network of computers

established to allow the transfer of information from one computer to another. Created to exchange information.

� World Wide Web, WWW- created to display informationE-Learning-the use of technology based tools andprocesses to provide for customized learning.

� Learning Management System,LMS- uses Internet technologies to Manage the interaction between users and learning resources.

� SME � Subject matter expert

Helpful Terms (continued)� Platforms - tools which allow creation of learning

programs directly on the web

� Synchronous - live delivery

� Asynchronous - no live component (most e-Learning programs)

� Multi-media - computer based training that uses two or more media including text, graphics, animation, audio and music

� Computer assisted instruction - any instruction where a computer is used as a learning tool

The Teaching-learning process

does not change

E-Learning is just another

teaching strategy

�It is not the medium but rather the instructional

method that causes learning�

�It is not the medium but �It is not the medium but rather the instructional rather the instructional

method that causes learning�method that causes learning�

Bad training in a flashy package is still just bad training!

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Adult Learning PrinciplesAdult learners must:

� See a direct relationship between the information to be learned and the real world where knowledge is used.

� Be actively involved in the learning process, rather than sit passively and watch.

� Must have independence to learn where, what, and how they learn best.

� Need privacy for self-paced instruction so they can learn at their own rate.

Source: The Adult Learner: A Neglected Species. Malcolm Knowles 1990

If we build it�..will they come?

Determining Needs

� Ask the participants

� Ask the bosses of the participants

� �What are all the possible subjects that will help our people to do their best?�

Source: Evaluating Training Programs The Four Levels, 1996 Kirkpatrick

If we build it��

Will they know how to use it?

The mouse does not work byrubbing it on the screen!

0102030405060708090

owncomputer

usecomputer

Survey question: Do you own/use computers to assist you with your personal affairs?

81% of the respondents indicated they have computer 81% of the respondents indicated they have computer in their home, only 42% indicated they use a PC to in their home, only 42% indicated they use a PC to assist with their personal affairs (Year 2000).assist with their personal affairs (Year 2000).

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Basic Computer Skills

�� Basic PC: Identify hardware componentsBasic PC: Identify hardware components

�� Key board: Locate and identify functions: Key board: Locate and identify functions: cap lock, number lock, space bar, tab key, cap lock, number lock, space bar, tab key, backspace, delete, shift, control, enterbackspace, delete, shift, control, enter

�� Mouse: Move and position cursor (steady), Mouse: Move and position cursor (steady), single click, double click, click and drag, single click, double click, click and drag, shift click, control click. shift click, control click.

�� Windows: size and move, min/max/closeWindows: size and move, min/max/close

Basically Green

Moderately Blue

Vitally Rose

Point-Click-Drag-Drop-Open-close�This is Fun!!

Planning E-Learning Development Procedure

Create the storyboard-the text and graphics that go into each screen of the program

Create and assemble media elements, meet and discuss to make final determinations about production

Perform on-line reviews-test, debug and review. Have an �end-user�, nurse on the unit run through it. LISTEN and revise

Deliver and implement the course

4. Lesson Structure7. Build Program

2. Goals, Objectiveand Content

1. Assess Needs

3. Instructional Methods &Multimedia8. Test/Debug

5. Screen layout6. Storyboard

9. Implement

10. Evaluate

Se ction 1

START

Design Cycle

Identify Learning Objectives

If you don�t know where you are going�.

How will you know when you�ve arrived?

E-Learning course evaluation will be directly tied to these objectives to make them measurable.

Design

Identify and write learning objectives

Develop an outline

Write content-following the outline

Put content into storyboard format

Source: Teaching Nursing:The Art and ScienceComputer Assisted Instruction, Linda Caputi 2004

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Design

Plan graphics, sound, animation to support & reinforce content

Expand the storyboard as needed

Plan reinforcing strategies: i.e. practice, clinical examples

Design test questions


Writing for the Computer Screen� Screens should be aesthetically pleasing and

intuitive. The user should know automatically what to do

� Use the headache test: �Can I look at this screen for more than 20 minutes on a day I have a bad headache?�

� Keep the number of font types to two and colors to three

� Be consistent with use of fonts and limit to two types

� When in doubt, make the text slightly larger


Writing for the Computer Screen

� Be succinct. Eliminate unnecessary information

� Be creative not boring

� Avoid flashy colors and various fonts

� Use headings and bullets to focus the eye and structure the text

� Put the most important information first and less important information in descending order of importance


� Use a light background with dark text, easier to read

� Be careful using background textures. May become overwhelming on a large screen.

� Avoid using too many special effects�flying, spinning, flashing


Writing for the Computer Screen

Faculty Training

�� Program design: Program design: StoryboardingStoryboarding�� Software skills: Software skills: Power Point Power Point �� Hardware skills: Hardware skills: PC Skills; CD BurnerPC Skills; CD Burner�� Multimedia skills: Multimedia skills: Scanner; Digital Camera; Digital Scanner; Digital Camera; Digital

CamcorderCamcorder

It takes nine months to have a baby, no matter how many people you put on the job.

American saying

It takes time and patience�..

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Implementation:Involve the End User

� Provide support in person if possible for �end user�

� Have a nurse or several nurses on the unit run through it.

� Does it meet the stated objectives for the learner?

Evaluation

� Incorporate evaluation of learning into the process.

� What knowledge was learned?

� What skills were developed or improved?

� What attitudes were changed?

Role of the Director / Supervisor

If you are leading but no one is following�..

You are really just out for a walk

Old Adage

Role of the Director / Supervisor� Establish the vision

� Communicate the vision

� Gain a place at the table within the larger organization to support e-learning development for nurses

� Provide the resources: hardware, software, humanware

Cheerlead!

E-learning as a cost-cutting Measure�� Online EfficiencyOnline Efficiency

�� 25 25 �� 60% less time to convey the same amount of learning 60% less time to convey the same amount of learning �� Instant scalability Instant scalability �� more employees trained in a shorter time, more employees trained in a shorter time,

anywhereanywhere�� Course development more expensive � but delivery is Course development more expensive � but delivery is

substantially cheapersubstantially cheaper

�� Faster Time to MarketFaster Time to Market�� Rapid deployment Rapid deployment �� get learning to employees, channels get learning to employees, channels

�� Effective Hiring and Training of New Effective Hiring and Training of New EmployeesEmployees�� Shorten the learning timelineShorten the learning timeline�� PrePre--hire tool hire tool

�� Smarter Employees Adapt Better & FasterSmarter Employees Adapt Better & Faster�� Avoid lost opportunity costsAvoid lost opportunity costs

EdwinProgrammer /

Developer GinaNursing Instructor,

Computer based education

Building the Team

CaroleInstructional Designer,

Content expert

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GinaNursing Instructor,Computer Based

Education

MultimediaStudent

CaroleInstructional Designer/

Content expert

RobinDirector NPD & E

VeniceAdministrative Asst./Graphic

Designer

EdwinProgrammer /

Developer

MaryNursing Instructor

e-LearningCoordinator

Slide Not Available

Slide Not Available Slide Not Available

hematopoeisis1.swf

Hematopoesis e-Learning

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bloodComp3.swf

Blood Products e-Learning

elearning1.swf

Safety Glide e-Learning

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A Journey of Discovery and Reward

The M D Anderson and ONS Experience


A Journey of Discovery and Reward

The M D Anderson and ONS Experience

Robin Toms, PhD, RN, CNAA, BCRobin Toms, PhD, RN, CNAA, BC

ONS Distance LearningONS Distance Learning

Laurl Matey RN MSNEducation AssociateLaurl Matey RN MSNLaurl Matey RN MSNEducation AssociateEducation Associate

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The Shift toward eLearningThe Shift toward eLearning

Data driven?Future driven?

OUR RESPONSIBILITY:We should know

what you don�t yet know that you need to know!

Data driven?Data driven?Future driven?Future driven?

OUR RESPONSIBILITY:OUR RESPONSIBILITY:We should know We should know

what you don�t yet know what you don�t yet know that you need to know!that you need to know!

eVisioneVision

AccessibilityNo time zones No travelNo borders No waiting!

AccessibilityAccessibilityNo time zones No travelNo time zones No travelNo bordersNo borders No waiting!No waiting!

eFormeForm

� Provide as many products as possible in multiple formats

� Technology progress - get on board� Translate sound and video better than a

book; more interaction than a tape, archive, or teleconference; inexpensively link members around the world (McConnell, 2000)

�� Provide as many products as possible Provide as many products as possible in multiple formatsin multiple formats

�� Technology progress Technology progress -- get on boardget on board�� Translate sound and video better than a Translate sound and video better than a

book; more interaction than a tape, book; more interaction than a tape, archive, or teleconference; archive, or teleconference; inexpensively link members around the inexpensively link members around the worldworld (McConnell, 2000)(McConnell, 2000)

eFormeForm

Advantage for Nursing� Immediate need of skilled and

knowledgeable nurses post-graduation� �Hit the floor running� mentality causes

need for application forums that are safe� Take risks, make quick decisions without

risking patient � Increase critical thinking skills (Simpson, 2002)

Advantage for NursingAdvantage for Nursing�� Immediate need of skilled and Immediate need of skilled and

knowledgeable nurses postknowledgeable nurses post--graduationgraduation�� Hit the floor running� mentality causes �Hit the floor running� mentality causes

need for application forums that are safeneed for application forums that are safe�� Take risks, make quick decisions without Take risks, make quick decisions without

risking patient risking patient �� Increase critical thinking skillsIncrease critical thinking skills (Simpson, 2002)(Simpson, 2002)

eFunctioneFunction

� Not difficult to learn� Builds upon earlier skills� If you can click a mouse, you can

take a course� Addresses adult learning concepts� Economics advantages for you, for

us

�� Not difficult to learnNot difficult to learn�� Builds upon earlier skillsBuilds upon earlier skills�� If you can click a mouse, you can If you can click a mouse, you can

take a coursetake a course�� Addresses adult learning conceptsAddresses adult learning concepts�� Economics advantages for you, for Economics advantages for you, for

usus

Why Web CT?Why Web CT?

� Widely used at universities� Easy to use for faculty and learner� Has learning checkpoints throughout � Has chat forums and discussion boards� Allows ONS to design � Good price value

�� Widely used at universitiesWidely used at universities�� Easy to use for faculty and learnerEasy to use for faculty and learner�� Has learning checkpoints throughout Has learning checkpoints throughout �� Has chat forums and discussion boardsHas chat forums and discussion boards�� Allows ONS to design Allows ONS to design �� Good price valueGood price value

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When your author is in Alaska� Global Participation

When your author is in Alaska� Global Participation

� Very technologically comfortable� Expert knowledge� Self-motivated� Good with timelines� Available for conference calls� Values high degree of communication� Recognizes need for multiple editing sessions� Experience with item writing (or willing to

learn)

�� Very technologically comfortableVery technologically comfortable�� Expert knowledgeExpert knowledge�� SelfSelf--motivatedmotivated�� Good with timelinesGood with timelines�� Available for conference callsAvailable for conference calls�� Values high degree of communicationValues high degree of communication�� Recognizes need for multiple editing sessionsRecognizes need for multiple editing sessions�� Experience with item writing (or willing to Experience with item writing (or willing to

learn)learn)

Just when you think it�s complete�..

Just when you think it�s complete�..Field review

� ONS member participation� Confidentiality� User friendly forms� Reasonable timeline� Acknowledgement

Field reviewField review�� ONS member participationONS member participation�� ConfidentialityConfidentiality�� User friendly formsUser friendly forms�� Reasonable timelineReasonable timeline�� AcknowledgementAcknowledgement

There�s more�There�s more�

Copy EditingJust three things to remember:

Edit!Edit!

And then when you think you�re done�Edit again!

Copy EditingCopy EditingJust three things to remember:Just three things to remember:

Edit!Edit!Edit!Edit!

And then when you think you�re done�And then when you think you�re done�Edit again!Edit again!

And more�And more�

Pilot

� ONS volunteer member pilot reviewers

� Reasonable timeline� If you ask for opinions, use them!� Voucher for free CE

PilotPilot

�� ONS volunteer member pilot ONS volunteer member pilot reviewersreviewers

�� Reasonable timelineReasonable timeline�� If you ask for opinions, use them!If you ask for opinions, use them!�� Voucher for free CEVoucher for free CE

Now you�ve built it�but will they come?

Now you�ve built it�but will they come?

Thoughtful Marketing� First clue: field reviewers� Begin as soon as you know the product

exists� Target market - forget time zones and

borders - but don�t try to be all things� Novel approaches� Don�t forget student nurses, non - nurse

audiences

Thoughtful MarketingThoughtful Marketing�� First clue: field reviewersFirst clue: field reviewers�� Begin as soon as you know the product Begin as soon as you know the product

existsexists�� Target market Target market -- forget time zones and forget time zones and

borders borders -- but don�t try to be all thingsbut don�t try to be all things�� Novel approachesNovel approaches�� Don�t forget student nurses, non Don�t forget student nurses, non -- nurse nurse

audiencesaudiences

Online EvaluationOnline Evaluation

Required to obtain continuing education

� Provide online certificate only after evaluation is completed

Required to obtain Required to obtain continuing educationcontinuing education

�� Provide online certificate only after Provide online certificate only after evaluation is completedevaluation is completed

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Online Evaluation: Insight for the futureOnline Evaluation:

Insight for the future� Appropriateness of venue, teaching

methods, content, organization� Successfulness of marketing strategies� Level of programming: meeting the need?� Evaluation of objectives� Student type - key to future courses� Future programming interests - listening

to the membership

�� Appropriateness of venue, teaching Appropriateness of venue, teaching methods, content, organizationmethods, content, organization

�� Successfulness of marketing strategiesSuccessfulness of marketing strategies�� Level of programming: meeting the need?Level of programming: meeting the need?�� Evaluation of objectivesEvaluation of objectives�� Student type Student type -- key to future courseskey to future courses�� Future programming interests Future programming interests -- listening listening

to the membershipto the membership

Re-purposingRe-purposing

AKARe-writing?

Re-distributing?Re-organizing?

Re-inventing?

AKAAKAReRe--writing?writing?

ReRe--distributing?distributing?ReRe--organizing?organizing?

ReRe--inventing?inventing?

Re-purposingRe-purposing

Consideration of existing products for reformatting for an alternate venue

anddevelopment of products designed to

be reformatted for different venues and/or audiences

Consideration of existing products for Consideration of existing products for reformatting for an alternate venuereformatting for an alternate venue

andanddevelopment of products development of products designed designed to to

be reformatted for different venues be reformatted for different venues and/or audiencesand/or audiences

ONS ExamplesONS Examples

Health Policy Advocacy(extension of the live workshops)

Healthcare Economics(Steering council priority: need among the membership)

Health Policy AdvocacyHealth Policy Advocacy(extension of the live workshops)(extension of the live workshops)

Healthcare EconomicsHealthcare Economics(Steering council priority: (Steering council priority: need among the membership)need among the membership)

ONS ExamplesONS Examples

Safe Handling of Hazardous Drugs(Extension of publication:

addresses ONS mission)Cancer Basics Series(Further development of original OES

workshop: addresses ONS mission)

Safe Handling of Hazardous DrugsSafe Handling of Hazardous Drugs(Extension of publication:(Extension of publication:

addresses ONS mission)addresses ONS mission)Cancer Basics SeriesCancer Basics Series(Further development of original OES (Further development of original OES

workshop: addresses ONS mission)workshop: addresses ONS mission)

You�ve got potential, baby!You�ve got potential, baby!� Initial response

� Workshops overflowing?� Enthusiastic evaluations? � Disgruntled participants?

� ONS Mission� Educational Blueprint priorities� Incorporation of surveys

(Microsoft Office clip art gallery 5.0 accessed 8/18/04)

�� Initial responseInitial response�� Workshops overflowing?Workshops overflowing?�� Enthusiastic evaluations? Enthusiastic evaluations? �� Disgruntled participants?Disgruntled participants?

�� ONS MissionONS Mission�� Educational Blueprint prioritiesEducational Blueprint priorities�� Incorporation of surveysIncorporation of surveys

(Microsoft Office clip art gallery 5.0 accessed 8/18(Microsoft Office clip art gallery 5.0 accessed 8/18/04) /04)

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Lost in translation?Lost in translation?

� Identify an author EARLY

� Raw data into platform format ASAP� It didn�t look like that on paper�

� Where are the �linking� words?

�� Identify an author EARLYIdentify an author EARLY

�� Raw data into platform format Raw data into platform format ASAPASAP�� It didn�t look like that on paper�It didn�t look like that on paper�

�� Where are the �linking� words?Where are the �linking� words?

It�s not a monograph, it�s not a movie�what is it?It�s not a monograph, it�s not a movie�what is it?

Good online products� Adult learning

� Focus on the �need to know�� Immediate, hands-on examples/application� High degree of control

Pace, sequence, participation, feedback� Give the �Why�- Part-to-whole relationships� Short attention span - make it brisk

(Parry, 2000)

Good online productsGood online products�� Adult learningAdult learning

�� Focus on the �need to know�Focus on the �need to know�� Immediate, handsImmediate, hands--on examples/applicationon examples/application�� High degree of controlHigh degree of control

Pace, sequence, participation, feedbackPace, sequence, participation, feedback�� Give the �Why�Give the �Why�-- PartPart--toto--whole relationshipswhole relationships�� Short attention span Short attention span -- make it briskmake it brisk

(Parry, 2000)(Parry, 2000)

Interact with me�Interact with me�

� This is better than eBay�..

� Visual interest �Moving Parts�

� If I had wanted to read a book�

� Check up on me!

�� This is better than eBay�..This is better than eBay�..

�� Visual interest �Moving Parts�Visual interest �Moving Parts�

�� If I had wanted to read a book�If I had wanted to read a book�

�� Check up on me!Check up on me!

Did they learn?Did they learn?

Quality Posttests and Evaluations� Item writing� Truly reflective of key concepts� Application versus knowledge questions� Quality objectives: measurable, applicable� Ask all the questions you really want to

know� Use it as a window to the members

Quality Posttests and EvaluationsQuality Posttests and Evaluations�� Item writingItem writing�� Truly reflective of key conceptsTruly reflective of key concepts�� Application versus knowledge questionsApplication versus knowledge questions�� Quality objectives: measurable, applicableQuality objectives: measurable, applicable�� Ask Ask allall the questions you really want to the questions you really want to

knowknow�� Use it as a window to the membersUse it as a window to the members

Do you want fries with that burger?Do you want fries with that burger?

� Links to other products� Required

� Key to fulfilling objectives� Safe Handling Online

(Copyright 2003, ONS)

� Suggested� Opportunities to promote related products

�� Links to other productsLinks to other products�� RequiredRequired

�� Key to fulfilling objectivesKey to fulfilling objectives�� Safe Handling OnlineSafe Handling Online

(Copyright 2003, ONS)(Copyright 2003, ONS)

�� SuggestedSuggested�� Opportunities to promote related productsOpportunities to promote related products

Future plansFuture plans

� Cancer Genetics Series� Cancer Biology Series� ONS Access Device Guidelines� OCN® Review Course� AOCNP® /AOCNS® Review Course

�� Cancer Genetics SeriesCancer Genetics Series�� Cancer Biology SeriesCancer Biology Series�� ONS Access Device GuidelinesONS Access Device Guidelines�� OCNOCN®® Review CourseReview Course�� AOCNPAOCNP®® /AOCNS/AOCNS®® Review CourseReview Course

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You�ve got the whole world in your hands�.

You�ve got the whole world in your hands�.

Planned programmingNot everything translates

StretchRisk

ExploreTry

(Microsoft Office clip art gallery 5.0 accessed 8/18/04)

Planned programmingPlanned programmingNot everything translates Not everything translates

StretchStretchRiskRisk

ExploreExploreTryTry

(Microsoft Office clip art gallery 5.0 accessed 8/18/04)(Microsoft Office clip art gallery 5.0 accessed 8/18/04)

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