Social media: How far to reach?

Rural patients and caregivers have limited access to health care and to information and classes regarding their own disease progress, and also to specialists and support groups all of which would enhance their knowledge and quality of life.  In addition, these areas lack a breadth of health care providers that can be easily accessed, due to lack of transportation and distance concerns.  These patients and caregivers are now looking to on-line resources to provide answers.  But as we have learned in class, are these necessarily of a quality that we want to have our patients utilizing, do they truly educate on disease and processes, are they private and protect the patient's identity, if they wish.  Social media is being used with increasing frequency to advertise, educate and also provide real-time communication with patients and their caregivers.  The program explored in this article provided a set patient scenario which was taken through several different modalities to discover methods to overcome barriers and increase education and support to patients.  These modalities included EHR (electronic health records), telemedicine, social media and clinical decision support.

The standardized patient was one that was being discharge with right sided weakness and slurred speech after a stroke.  The patient and caregiver were interviewed regarding health care resources and technology available to them (online resources).  These resources were used as part of the plan during the modules.  Social media was one module and that became further separated into interactive networks ( Facebook, twitter, webinars, and chats), websites for education and further care information, and static networks (YouTube, Podcast).  The doctoral students were to research these areas on the Internet for viable resources for the patient in the scenario.  The students were able to provide viable examples of each type of social media that could be accessed by the patient and the caregiver.  There was care taken to insure that any information posted was protected for privacy. 

There were some concerns regarding the use of on-line technology.  Obviously, access was limited in some areas due to Broadband capabilities.  The students were able to trouble shoot some methods of access such as use of libraries, community centers and relatives for increased access.  They also recognized the need for education on appropriateness of Internet resources and also teaching regarding use of the social media resources in order to protect their privacy.  Literacy challenges were also supported through link to video and audio information.

Overall this article was very informative, not in the presentation of new information on technology, but the varying uses of technology and how, as educators and nurses, we can think out of the box to use every available resource to support our patients and their caregivers.  Once again, nurses must step up to the forefront and be advocates for patients, to support them where they are and to encourage the best care of the patient, even while broadening their own horizons regarding technology and health care.


Rutledge, C., Renaud, M., Shepard, L., et al. (2011).  Educating Advanced Practice nurses in using social media in rural health care.  International Journal of Nursing Education Scholarship 8(1), 1-14.

On-line learning opens doors

In this new age of nursing, nurses and nurse specialists who wish to remain current in their knowledge and advance their degrees are looking at new technologically superior resources such as on-line learning to advance their knowledge.  Nurses today must be able to manage information technology and technology that advances equipment and resources on one hand, paired with advanced critical thinking skills to use in patient care.  With a shortage of nurses, many nurses are unable to spend time away in the clinical setting to update knowledge and skills, so on-line learning that is accessible, affordable and flexible is a boon to nurses.  But is knowledge learned on-line as effective and integrated as what is learned through more traditional methods - in classrooms and at the bedside? 

This article explores the idea that traditional learning in the classroom may not be as up-to-date and current as knowledge accessed from the Internet, or programs developed on-line where learners are required to research and provide answers.  (Much like the present class that I am taking on technology in nursing!)  On-line learning moves the educator into a role of facilitating learning, not the sage in front of the classroom.  Personally I feel that this type of learning is truly remarkable.  The dialogue between classmates regarding various practices with the instructor bringing the every day subjects back to the realm of education has been inspiring to me.  I feel that we can truly learn best from our peers and from sharing experiences, which is supported by the article.  Students learn the best and assimilate that knowledge when they can find their own "teachable" moments and can work at their own pace.  If a goal is set in mind and the student is encouraged to reach that goal, they can truly be in charge of how to learn, with resources provided.  What forward thinking!! 

Nurses critical thinking skills are put to the test every moment of the day.  This type of teaching allows them to further practice their judgment and critical thinking skills and promotes conceptual changes in their care of patients and in the way that they utilize the knowledge that they have.  Something that is now explored in the article, but of curiosity to me is the concept that as more nurses advance their education in post-graduate study, does that influence the practices of those nurses around them?  I know that I am excited by information that I learn in class, and share some ideas with my fellow nurses, hoping to influence their ideas and practices.  Might be something that I look into further!


Bromley, P. (2010). Online learning: anywhere anytime education for specialist nurse, Neonatal, Paediatric and Child Health Nursing 13(3), 2-6.

Let the Games Begin!

Simulation as a learning tool is a new and technologically sophisticated method of teaching nursing students.  Simulation gaming is a method that uses previous learning to react to a variety of different situations to promote deeper learning, while attempting to reach specified goals.  Students compete against one another for scores while attempting to respond to the scenarios is the best possible way.  One of the best accolades of this method is the fact that in a simulation, a patient cannot be put at risk, so the nursing students are encouraged to try many different responses to find the best solution.

There has been much debate about whether simulation games are truly educational at the levels of higher education, or just entertainment.  But with the increase in experiential learning, traditional methods of nursing education have been challenged and methods that can incorporate students coming together to problem solve, and include reflection (oh no, more reflection!) on the experience are worthwhile methods of learning in nursing education.  Although it has been my Achilles heal, reflection does play an important part in nursing education today.  Without reflection of the players, the game is not education, just a "dog-eat-dog" method of getting a result.  Reflection brings in the aspects of adult education, for example in allowing the learner to create their own meaning through interaction with an environment.  The reflection of the students on the activity and the critical feedback that is given by the facilitator of the simulation game is essential for the student to develop and grow their knowledge base, skills and attitudes. 

There are some downfalls to simulation gaming.  It is difficult to discern the individual student's knowledge as most of the time simulation is a group activity.  Debriefing allows the most meaningful impact to the students, but staff must be skilled in debriefing the exercise in order for it to be effective.  There is also a concern that simulation gaming is an expensive undertaking:  simulation equipment and set up is expensive and maintenance of the technology requires staff with skills in programing and game codes to maintain different scenarios, which can also be expensive.  But these obstacles can be overcome to provide a simulation that allows the students to use this technology effectively.

So, overall simulation gaming is a method of learning that is highly interactive, with students gaining knowledge through different situational interactions and by debriefing these situations with a facilitator.  It is my hope that these virtual reality scenarios don't allow the students to "depersonalize" their actual care that their patients receive - after all, caring is one of the hallmarks of nursing. 

Peddle, M. (2011). Simulation gaming in nurse education; entertainment or learning? Nurse    Education Today 31, 647-649.

Differentiated Instruction

Ahh, a subject near and dear to my heart.  Well, not really, but I certainly hear about it constantly in my job as a school nurse.  Why would I hear about it? After all, I am not a teacher! In the elementary schools that I work in, the teachers are working diligently on finding ways to wrap their minds and their teaching efforts around differentiated instruction.  With students coming from many different life situations and learning styles, cultures and even health conditions, it is important to find out what works for each student and to maximize their learning.  That can be accomplished through differentiated instruction.  Even for school nurses, it is important to realize that we need to incorporate this everyday in our interactions with parents and students, while teaching about health concerns.  It allows us to meet the students where they are, at the place that they are ready to learn, and to gear instruction to stimulate learning for the student.

This learning methods also carries over to the adult learning environment.  It is important to know that it is not just simplifying material for a student, but is presenting the information in different manners at the level of the student to allow them to progress and learn.  Parents use differentiation when teaching their own children and working through developmental levels.  Differentiated instruction is the heart of teaching, in my opinion, and allows everyone to learn.  Isn't that what teaching is all about?

So the important aspect is how to incorporate this when teaching as a nurse, whether it be with a family and patient concerning their health needs, a staff regarding updates in procedures or policies, or nursing students at college.  As an educator, you want all of your students to learn, to be able to grasp the information and use it.  Technology is one way to incorporate this, but I feel that we must be careful not to assume that technology makes learning easier for everyone.  Many adult learners are not as comfortable with technology, and this will decrease what they are able to learn from those efforts.  Vella (2002) stated in her article that it was important to assess the needs of the learner, and I can't think of a better time then when addressing differentiated instruction.  I appreciated the idea of contacting the students in the class prior to the start of class and discussing their learning needs.  Clarification of what they expect to learn, as well as some discussion of their learning style will help to differentiate instruction if needed.  It is a huge task, and one that needs constant adjustment, but differentiating instruction is well worth it, in my opinion.

e-Learning, the time is NOW!

As an aspiring nurse educator, sometimes I limit myself to thinking that I am going to be teaching in a classroom, in front of my students, delivering well prepared, technologically advanced formats.  But at times I limit myself to thinking that technology is there just to enhance my lectures, not to replace them.  The authors of this article were challenged to find other effective means to educate the nursing staff of a hospital in order to keep them up-to-date on best practices, thus ensuring positive outcomes for the patients.  Their traditional method of teaching was to given power point enhanced lectures covering multiple topics that the staff needed updated on.  This was not cost effective as nurses needed to have time away from the bedside, nor was it effective in helping the staff remember and learn the information presented. 

Thus the nursing educators decided to utilize an e-Learning format that allowed the nurse to update themselves each year on the pertinent changes in best practices.  This e-Learning format allowed the nurse to access information during “down” times at work, at prescheduled times designated by the manager, or at home.  It also allowed progress to be saved, so learning could take place incrementally.  It is important in adult learning that learning can take place at the optimal time for the student.  The authors found that there was increased nurse satisfaction with teaching in this method, that there was more compliance with the modules, and that there was a cost savings associated with this change. 

I appreciated this article not because their beta testing research was recorded and not for the ability to reproduce the research, but because the article delineated an effective method of change in a hospital system.  They detailed the process used to change from the didactic method of teaching, to the more flexible and still effective e-Learning modules.  I felt that I could use the information provided in the article to promote a change to e-Learning in my work environment utilizing the process they outlined.  The method of teaching was a given in this case, but the broader use of how to implement the use of technology is something that I will refer back to if the case arises.  It was a refreshing article showing such positive change that I was able to reflect on how technology can be used to teach outside of the world of academia.  Hmm, food for thought. . .

Wahl, S.E., & Latayan, M.B. (2011). Nursing education innovation: Using e-learning technology to meet learners’ needs. Journal of Continuing Education in Nursing, 42(11), 483-484.

Another use for iPods?

How to integrate technology in the classroom is a valid concern for educators in higher learning institutions.  Is technology a benefit or a distraction when it comes to learning information?  Does technology help the student retain information, or is it just an easy or lazy method of doling out information to students?  This study was conducted on a sample of 35 nursing students, some with access to iPods, some just attending lectures, and some using the podcasts for review prior to their tests.  The iPods portability, interactivity and video-streaming capabilities make it a perfect device to utilize when promoting effective and efficient techniques to educate nursing students, and also other students in higher education. 

Literature was reviewed that showed support of the iPod as an interactive device that was accessible and allowing distribution of content to many students, who could access podcasts when convenient to study and support their learning.  The literature review did show that efficacy was based on the student’s style of learning, not just on the accessibility of the device.  It also noted that while the human brain has plasticity, it does not do well with multitasking.  Thus using the iPod in a manner that allowed distractions, or while multitasking, may not be effective. 

The researchers felt that the iPods would be found to be effective in enhancing the grades of the undergraduate nursing students, and they were surprised to find that it was just the opposite.  When comparing the control group with the iPod using group on the final exam, there was a significant (p=0.058) difference, with the iPod group getting poorer grades.  This only occurred though, when incorporating the effects of the “super user” group, those students that used their iPods not only for learning in this experiment, but on an ongoing basis.  Because these “super users” were very technologically savvy, they were exposed to the effects of multitasking more frequently and may have been poorer students overall. 

I was very surprised at these findings.  I felt that the iPods would increase their access of the teacher’s lectures, allowing students to review information presented and pick up on things that they might have missed.  I think that it would be very worthwhile to study the effects of the multitasking, something that they included in the study, but was not significant with results.  Did the student’s replace the lecture with the podcasts (attendance was not part of the study)?  The podcast was basically the lecture that was taped.  Was this visually effective enough? 

This article really made me pause and think about the effectiveness of technology and our assumptions that using technology is always “better” for learning.  As we learned in our Vella article, there are many different learning styles and life experiences that need to be taken into account before assuming technology enhances learning.  Along with access to the devices and ease and knowledge of use of the device, maybe we need to teach how learning can be circumvented by incorrect methods of using technology and by the effects of multitasking.  Those points were the most poignant of the article to me, and that knowledge is what I am going to take forward to my use in the classroom.

Johnston, R., Hepworthy, J., Goldsmith, M., & Lacasse, C.  (2010). Use of iPod technology in medical-surgical nursing courses:  Effect on grades.  International Journal of Nursing Education Scholarship, (7)1, 1-17.

Let's talk about adult learning

Jane Vella (2002), has written the first chapter in her book, “Learning to listen, learning to teach”, to describe adult learning concepts.  She describes the twelve principles that she feels must be present to have effective adult learning.  In fact, she says that these are so intertwined, that adult learning cannot take place without all of them.  I would agree.  She is very succinct in her description of the twelve principles, and one of the principles that resonated with me was the first, which was needs assessment. 

I found it very thought provoking to agree that all adult learners come with their own life experiences and know what they need to learn in a given subject.  That as educators, we must listen and create dialogue that will help us begin to “know” our students, their lives and thus their needs.  In nursing, we assess this with every interaction with patients and families, and this felt very natural to me.  In fact, it is amazing that we could even think of trying to teach without this information.  Her suggestion in the chapter that this needs assessment even passes cultural boundaries was very intuitive and resonated with me.  This is one area that I feel comfortable in, but I also feel that I will need to be mindful of when getting caught up in the work of an educator.

The second area that enlightened me was one that I struggle with, the area of praxis.  Praxis has been defined as action with reflection.  As I journey through this role as a graduate student, while I enjoy every class and all the knowledge that I am gaining, I think that the reflection on what I have learned continues to be the most difficult learning experience.  I am used to having an internal dialogue, of a sort, that looks at say, a class that I have taught to students about a health topic, and runs through what was effective and ineffective, what I would like to change and what I thought “worked” about the class.  But I find this inner process difficult to describe on paper, and even more difficult to say “why” something doesn’t work and “why” I need to change it.  For me, it is such an intuitive process, but I am learning that it is important to use the knowledge that I am gaining in my classes to make changes.  How much more effective will it be to use this knowledge base to support my teaching!  So I work hard to incorporate praxis into my education of myself as Vella asserts, to allow this reflection as part of the dialogue of personal experiences that will lead me to become a better teacher.

Vella, J. (2002). Twelve principles for effective adult learning. In Learning to listen, learning to teach: The power of dialogue in educating adults (pp.3-28). San Francisco: Jossey-Bass.