Creating authentic multimedia activities to teach caring and critical thinking in large online classes

Whether in a traditional classroom, a laboratory setting, or online, student engagement is essential for a successful learning experience.  Students are more likely to engage and persevere toward task completion in an environment which encourages active learning based on authentic and meaningful tasks. Within nursing education, simulation has been successful as an authentic setting for learning clinical skills and critical thinking. In laboratory environments, students role-play the steps of specific procedures or providing care to patients in detailed scenarios and receive feedback on their performance.  This approach meets the learning needs of the millennial and Gen Z students as research suggests that these students have a preference for interactive and experiential learning styles.
High and low fidelity simulation, case studies, and role play exercises have been widely used in nursing education to provide students with authentic learning opportunities. When nursing courses are adapted for online delivery, special attention should be given to creating authentic learning activities similar to those performed in simulation labs to keep students engaged and focused on attaining critical thinking and problem solving skills and developing a caring attitude for patients.
This education session, based on a successful online course for undergraduate nursing students at a large Southeastern university, will describe how widely available technological tools – a course management system and digital communication devices – were combined to create multimedia learning experiences simulating complex and emotional real life situations and discuss their impact on student learning.
Pre-licensure nursing students are eager to practice hands-on skills in labs or clinical settings. To build on this enthusiasm and to provide multiple opportunities for performing authentic tasks, the course instructor created a complex multimedia case study and rolled it out to students in several installments over the semester. The case study is based on an older adult patient, who experiences several changes in her physical and psychosocial status, and covers scenarios, which nurses are likely to encounter when they provide care for this population. The students’ challenge is to optimize the patient care at each turn of events.
The multimedia elements – images, audio and video files – allow students to see their patient and explore her environment. They make the experience feel real and enable additional learning tasks that would not be possible in a text-based presentation. The instructor produced multimedia files using her own iPhone and laptop computer. Images, video and audio files were imbedded in the case narrative posted on the course site in the learning management system. All elements of the case study were made accessible to learners with disabilities.
After reading, viewing and exploring each case study episode, students are required to answer questions.  Constructing the answers prompts students to think through a wide range of professional nursing tasks: assessing the patient at different points in her care, identifying patient problems and needs, recommending nursing interventions, selecting effective communication techniques, “observing” the patient in stressful situations, advocating for her and exploring available community resources.  These tasks support the development of critical thinking skills essential to caring for older adult patients.
Most of the questions are open-ended, calling for application and synthesis of course concepts, investigation, problem solving, and personal reflection. There are no wrong or right answers to most of the case study questions and students receive full credit for completing the weekly case assignments. Students submit their answers through an assignment link on the course site. Treating the case study as a low-stakes assessment contributing only a small percentage to the course grade reduces stress associated with learning assessments and encourages students to describe their thinking processes without fear of being punished for making mistakes. This approach also saves instructor time when teaching high enrollment courses and allows her to focus on giving feedback.
Feedback was provided to the class each week in a multimedia recording. The multimedia format enables the instructor to maintain her presence in the course and carry an ongoing conversation with the students about their learning, to point out strengths and weaknesses in student thinking and provide further explanation of difficult concepts.  The instructor also used these recordings to model professional ways of thinking and problem solving and challenge students to demonstrate those in their responses to upcoming case study questions. Additionally, she provided individual written feedback through the grade center as she reviewed each student’s submission.
Working with one patient throughout the semester significantly enhances student learning. This strategy enables the instructor to gradually increase complexity in the context surrounding the patient, demonstrate how different course concepts connect and build on each other, provide opportunities for students to observe changes over time and explore different aspects of the case. It sustains student interest and engagement, which promotes deeper analytical skills and better problem solving. Additionally, dramatization, which was built into every case study episode, is an effective strategy for increasing awareness, understanding of human situations, and development of empathy and caring. Immersion in the scenarios helps students examine and adjust their own professional value systems and become more accepting of others.
Formative midterm evaluation showed that 99% of the students felt that the case study activities allowed them to apply new knowledge in clinical contexts in a safe and stress free environment. Students stated that they enjoyed getting to know the patient “personally” and felt the realism of the case study added to their learning.
Students also reported that they felt the low stakes assessments integrated into the case study created a non-threatening learning environment.  Weekly instructor feedback videos were reported to have increased the feeling of connectedness and interaction among students and faculty.  The students stated that they felt that “faculty was really there all semester.” 
Continuous low stakes assessments and timely encouraging feedback increased the instructor’s ability to accurately identify students’ performance levels and suggest ways for improvement based on existing strengths. As the semester progressed, students were able to meet the instructor’s expectations and demonstrated improvement in critical thinking and problem solving abilities.
Multimedia case study development should be approached as a long-term project, which can take several semesters. After completion of the writing and production stages, giving student feedback requires the most time. As the instructor gains experience working with the case study and develops the ability to anticipate student responses, outlines can be developed for providing feedback for each scenario. Using outlines can save time in recording feedback videos and inserting written comments to student answers. It also ensures the consistency of information received by each student while still allowing for individualization where needed.
The teaching strategy described in this presentation can be implemented in blended and fully online courses in many disciplines and can accommodate large groups of students. To be effective, the case study narrative must be based on real-word problems, build on multiple concepts and include different types of data; it should prompt students to investigate, analyze and suggest solutions and/or alternatives. Multimedia components can be created using personal digital communication devices such as cell phones, iPads or web cams. Collecting student responses through a testing or survey feature in a course management system makes it easy for the instructor to view aggregated data and identify common themes. Making responses to case study questions a low stakes assessment or giving full credit for completion reduces stress and allows students to describe their thinking without fear of penalty. This enables the instructor to monitor and assess improvement in student critical thinking as the case study unfolds. Timely feedback from the instructor is essential to sustain student interest in the activity and to effect improvement in critical thinking skills.
As our experience demonstrates, it is possible to create authentic, exciting and meaningful learning experiences for online students using simple and widely available technology tools. It requires creativity, determination, and inter-professional collaboration between course instructors, instructional designers and IT professionals.
Our objectives for this education session are to discuss the benefits of incorporating an unfolding multimedia case study into an online course design; to describe how to use this activity as a learning and assessment tool for large numbers of online students; to identify available technologies for creating multimedia components; to describe how to make multimedia materials accessible to learners with disabilities; and to share time saving tips. Attendees will be able to implement discussed strategies in a variety of online teaching/learning contexts. 
We are very interested in other perspectives for the use of multimedia-based authentic learning activities and we plan to invite participants to ask questions, offer comments, share their success stories, and discuss the application of the described strategy to other disciplines and institutions. The presentation will be visualized with screen shots and video clips and supported by the data from formative and summative course evaluations.