In fall of 2017 we utilized the iPad with sophomore Bachelor of Nursing students in the skills lab. Our goal was to simulate the electronic medium utilized in the clinical setting. In our first year there were challenges, rewards, and lessons learned for future success.
Healthcare has undergone tremendous changes in the last ten years. The implementation of electronic medical records, digital imaging, electronic scheduling, and programs such as EPIC and Care Everywhere have permanently changed the healthcare work environment. However, despite fundamental changes to the clinical environment, nursing education often provides little exposure to digital technology in the skills lab. The utilization of handouts, mock paper charts, and worksheets continue to be standard, although most students will never utilize paper documentation in their career.
In fall of 2017 we utilized the iPad with sophomore Bachelor of Nursing students in the skills lab to document mock patient data, retrieve information, and upload assignments. Our goal was to simulate the electronic medium utilized in the clinical setting. Although innovation is invigorating to some, change is also met with a fair amount of skepticism. In our first year there were challenges, rewards, and lessons learned for future success.
The integration of information technology in nursing education has been increasing in recent years. In the beginning mobile programs were often problematic and institutional support networks ill equipped for widespread use. Early efforts by faculty to utilize mobile applications in the classroom were often wrought with little success and much frustration. Although early challenges were frustrating for both students and faculty, it is crucial that nursing education continue to meet these challenges to prepare nursing students for the clinical setting. Evidence suggests that nursing students must not only be exposed to information technology (IT), but also taught to utilize IT as a means to improve patient outcomes (Ramen, 2015).
Early introduction and integration of mobile applications and information technology within nursing programs may be key to preparing new graduate nurses to utilize IT in the clinical setting. George, Murphy, DiCristofaro, and Sims (2017) argue that “the implementation of apps early in the nursing curriculum encourages active learning and the use of current, evidence-based resources when providing nursing care”.
In the fall of 2017 we sought to increase the use of the iPad in the Fundamentals Skills Lab with sophomore nursing students. Moving from paper-and-pencil worksheets would require both students and faculty to embrace the use of mobile technology.
Implementation required us to identify the mobile applications for use, orient faculty and staff to the use of applications, and ensure adequate support for all. We met with lab faculty, many of whom were adjuncts, and provided an orientation to the applications students would be using and the blackboard-grading platform for grading electronically submitted assignments. A user guide to blackboard grading was sent to lab faculty via email.
Students received iPad orientation from the College of Nursing as part of their orientation. The student’s IT orientation included information and instruction on mobile applications frequently utilized in the College of Nursing. Course lead faculty in lecture reinforced orientation.
There were many challenges experiences during the implementation process. We discuss challenges as they emerged with faculty and students uniquely. Despite attending iPad orientation many students lacked a basic understanding of how to use their iPad. Course lead faculty identified several students who were unable to access information on their iPad weeks into the semester. In week five of the semester misconceptions and misunderstandings, related to the use of mobile applications to create and submit assignments, were common among students.
Faculty also struggled with the use of the iPad in the skills lab. Faculty challenges included the utilization of e-books, mobile applications, and blackboard grading. An impromptu question and answer session was provided for lab faculty and students in week six. An instructional designer joined course lead faculty to answer questions and address issues. Through this process we identified that there was a lack of buy-in among some lab faculty. Lack of buy-in among lab faculty emerged as our greatest challenge to implementation.
Although there were many challenges in implementation, we also experienced success. Several lab faculty embraced the new format early on in the process. These faculty members cited decreased time lapse for students to receive feedback, decreased time spent grading, and the personal convenience of grading electronically as advantages to the new format. There were also early adopters among the student groups. Many students enjoyed the format and shared their enthusiasm with others. Some students emerged as leaders and were able to help other students when issues arose during lab time.
From the perspective of course lead faculty, the electronic format provided continuous access to all aspects of student work and faculty grading. This provided an opportunity to review student work periodically and identify issues as they arose rather that at the end of the course. For example, we were able to identify faculty who were not providing feedback to students in a timely manner and address the issue by offering support to the faculty. We were also available to easily provide support and feedback to lab adjuncts when issues arose where they were unsure regarding grading.
Implications for future success include the wisdom one gains from doing something the first time. It is important to consider that both course lead faculty were implementing the paperless model for the first time. Throughout the process we identified ways we could improve implementation in coming years.
We identified through informal student feedback that student retention from the iPad orientation course was poor. Many students reported “information overload” and that the information was “too much”. Future success could be improved with small group orientations with sophomore course lead faculty and instructional designers. Having the students in smaller groups using their iPad in real time could help faculty identify individuals who need assistance prior to the first day of classes.
In regards to overall implementation, the importance of faculty buy-in cannot be overstated. We identified a clear correlation between negative student attitudes related to the use of IT in the lab and the attitudes held by lab course faculty. Poor role modeling among faculty can have a detrimental effect on the implementation of IT in education (Ramen, 2015). Students look to faculty as leaders and are often unlikely to embrace something that the faculty view as negative.
Although easy to identify, faculty attitudes and preferences are more difficult to address and often slow to change. The persisting notion that how older nurses were educated is the best way to learn, continues to prevail in undergraduate nursing education. In our experience implementing IT in the skills lab, faculty struggled more than students, however students were quick to take on the attitudes of lab course faculty who they identified as leaders. Future success could hinge on our ability to garner buy-in of faculty.