Designing Online Nursing Education Based Upon Learning Science and High Impact Learning Strategies

Patricia Benner, R.N., Ph.D., FAAN

John Benner, Ph.D. Candidate, School of Education, University of Washington, Seattle

June  9, 2020

With the COVID-19 Pandemic, nurse educators must transform in-classroom teaching and learning to online learning. Understanding how students learn is the starting point for all teaching and learning, regardless of how a course is taught. Joshua Eyler (2018) notes that learning sciences have determined that “curiosity, sociality, emotion, authenticity, and failure” are essential for learning. These vital sources in education are challenges for online learning but can be deliberately designed into augmented forms of online learning.  We can solve significant online difficulties such as sustained engagement, retention, and low-performance outcomes if we attend to curiosity, sociality, emotion, and authenticity. We recommend that all online design strategies be guided by current learning science and incorporate these five essential aspects of learning in any modality.

Affordances and Constraints of Online Learning

As with any context, there are affordances and constraints to a given learning context, be it a small discussion group, a lecture, an apprenticeship, or an online nursing class. With the advent of easy-to-use online meeting platforms combined with commonly used asynchronous learning management systems (like Canvas, or even Educating Nurses!), a wide range of options are unavailable to in-person instruction. With these advances, we may think that the constraints of in-person education and training magically vanish in a technological solution. The research shows that a more nuanced understanding of online learning is required.  In the chapter on digital learning in the book How People Learn II, Learners, Contexts, and Cultures (National Academies of Sciences, Engineering, and Medicine, 2018), the authors identify the following affordances of digital learning:

Interactivity: Technologies that respond to the actions of the learner, such as online simulations or online discussions or chats with instructors and classmates, create a higher level of engagement, as the learner becomes an active participant. Viewing videos or reading materials are not interactive because the learners have no impact on the learning material, and information flows only from material to learner.

Adaptivity: The capacity for the technology to adjust to learner choices and behaviors. An example of this would be clinical simulations where patient outcomes change over time, according to student responses. This is different from a quiz or other form of assessment that does not vary depending on responses given. Situated cognition and knowledge-use can be learned with this enriched situated feedback based upon the student’s interventions, actions, and evaluation of the outcomes.

Feedback: Like in-person learning, instructors can give rapid feedback to student responses, guiding them towards deeper understanding as in the case of online discussion boards. Technologies can also be designed to provide feedback on clinical decisions in simulations and alert instructors to knowledge gaps evidenced in practice, which supports a closer relationship between assessment and instruction. Programs providing analytics that demonstrate where the student’s responses indicate mistakes and knowledge gaps can be a powerful source of learning. Students with similar knowledge gaps or misunderstandings can be gathered in a chat room or online discussion group to clarify the knowledge gaps or misconceptions.

Choice and Non-Linear Access: Digital learning can provide learners with a range of choices to modify their experience according to their needs and interests. Options include adjusting the pace of learning, the timing of when and what material is learned, the order that learning tasks are completed, and even the possibility of extending knowledge beyond provided course materials through independent research.

Open-Ended Learner Input: Digital technologies allow learners a wider range of across multiple modalities. Beyond writing papers or answering quizzes, learners can express themselves and learn through drawings, writing, video presentations, chat discussions, and even the creation of memes to convey concepts.  For example, here is a meme about sepsis a nurse blogger created: https://licensetonurse.com/post/178344157906)

Nursing Meme about Sepsis

Communication: With the advent of Zoom, Skype, and Google Meet, online meetings are now accessible and allow additional opportunities for students to meet and collaborate beyond discussion boards or text-based chats. Students can also react in real-time with questions delivered via text. Also, creating breakout groups can allow small group learning.

As with any context, unique affordances bring distinct constraints. The most apparent digital learning constraint, of course, is access to the technology itself. The digital divide and access to high-speed internet is an ongoing problem in rural areas and impoverished urban areas. Low-income students are also less likely to have access to the technological requirements to participate fully in online learning. Additionally, there are the constraints that come with learning to navigate new technologies, a challenge for both professors and students alike (as those of us who have struggled with a Zoom connection or website crash can attest). Even if students have access to flawless technology, online learning spaces bring their challenges. Online learning can also cultivate a sense of isolation when peers are only able to connect superficially. They can create a disconnect between content and context when they rely on Cartesian epistemologies, such as an outdated information processing computer model of the mind (Dreyfus, 1986). They can limit learner agency and curiosity by restricting student expression to responses to quizzes or simulations. They can also be an avenue to distraction, as the same tool that we use to learn on, we use for entertainment, and the context cues to attend and learn that place-based learning affords are missing. Mitigate these constraints through thoughtful design and the application of evidence-based instructional strategies.

Teaching for Curiosity and Discovery.

Teachers and students can create strategies and climates that foster curiosity, engagement, and ownership for learning. In the following interview, H.L. Dreyfus contrasts teaching for learning that fosters curiosity, inquiry, and teaching to deliver well-delineated concepts and content.

This full video is only available to our members but please enjoy our preview below.

Dreyfus considered himself foremost as a learner. Openness and curiosity were evident in his interactions with students. In his full interview on mastery in teaching-learning, he genuinely seeks to learn from his students with each encounter with philosophical texts. Because Professor Dreyfus was such an engaged, curious learner, his students modeled his style of curiosity and learning. As teachers, we do well to consider how our form of teaching-learning influences our student’s education.

Eyler (2018) notes that findings from the learning sciences show that inquiry-oriented approaches and fostering curiosity should be central to any pedagogical approach. Designing and imagining that teaching-learning equals telling and information-giving fails to stimulate student learning and dampens students’ curiosity. Inquiry must be central to any course design.  In the Carnegie Study of Nursing Education (Benner, Sutphen, Leonard-Kahn, & Day, 2010), we found that nursing faculty often had single, correct answers in mind, and engaged in “call and response” forms of questioning, rather than asking inquiry-oriented open-ended questions. Single correct answers do not lend themselves to authentic inquiry nor to fostering curiosity and discovery. Eyler (2018) points out:

            An easy way to change fact-based questions to questions that will help generate discussion is to ask ourselves, “So what?” every time we come up with something, we want to ask our students. If we have developed a closed-ended question, this instigation will provide the impetus to change our question into something that addresses significance rather than memorized material (Eyler, 2018, pp. 47-48).

While open-ended and why questions are essential to stimulating curiosity and inquiry, questions should not be so broad or so open-ended that students do not engage in a focused discussion. Such discussions can be so open that student’s responses are too unrelated or disconnected from one another.

When we revert to the default Cartesian paradigm of learning, online instructional activities can often devolve into passive forms of learning. For example, students watch videos of lectures or do assigned readings and then may be assigned single answer multiple-choice questions that do not require curiosity, creativity, or authentic inquiry. When we imagine learning as occurring only in the head, we see students as isolated receptacles of information, rather than what they are in the process of becoming: contributing members of healthcare teams and a wider community of practice of nurses. In online or in-person spaces, we must give students relevant experiences that do not just require knowledge of the content, but also the capacity to evaluate complex situations and identify salient information out of a cluttered field of information. Clinical practice is nuanced and collaborative, so it is essential to create online learning situations that duplicate that complexity and provide feedback to help student nurses learn to interpret and act productively.

Essential questions organize each field, and nursing and health care are no different. Most clinical courses require that the students learn to engage in situated clinical reasoning and consider what is most salient for recognizing changes in patients and the most urgent priorities for patient care interventions. What might be early warnings that a patient’s clinical condition is changing?  What responses are most critical for patient safety and rescue? How can “never events” be avoided?  What are patient/family concerns in a particular clinical situation? How does the patient/family understand the illness conditions, the most important therapeutic interventions, and the typical course of treatment, recovery/rehabilitation?  The patient’s clinical condition necessarily spawns the most relevant questions and approaches in caring for the patient.

Sociality, Attunement, Moods, and Embodiment

Increasingly the importance of social learning is emphasized in learning sciences (Bandura, 1977; Vygotsky, L.S., 1980; Barkley, Cross, and Howel Major; 2005, Walton & Cohen, 2011; ) Learning is contagious and sparked by the curiosity, engagement, questions, and ideas of other learners. Dreyfus (2009) noted:

Certain classroom conditions lead to proficiency, e.g., where the teacher and learner sense that they are taking risks in each other’s presence, and each can count on criticism from the other [in the Dreyfus Model of Skill Acquisition].  Additionally, only by acting in the real world can one acquire expertise (Dreyfus, 2009, Location, 1921, Kindle) …meaningful distinctions require commitment and vulnerability, which require our embodied finitude [situatedness and engagement]. (Dreyfus, 2009, Location, 1933, Kindle).

Online discussions and collaborative projects can increase students’ engagement, risk-taking, and create stakes in learning. Lee Shulman, former President of The Carnegie Foundation, noted that one of the greatest learning disabilities of students is the invisibility of the student to the teacher and to one another. It takes extra planning and effort to get to know students in online learning, but it is an effort that yields engagement, retention, and greater learning outcomes.

The sociality, and sense of belonging calls for an understanding that the social is prior to the private individual, and involves a refutation of a Cartesian, representational view of the mind, a rebuttal currently strong in the neuro-sciences of learning (See Dreyfus, 2009). In summarizing research on virtual communities of practice, Ardichvili (2008) identified the following as essential to cultivating engagement in online learning communities: promoting members’ sense of belonging to the community, fostering conditions for an open, uninhibited exchange of ideas and information, by creating time and space for exchanging stories and expertise, and by teaching community members about the value of storytelling and how to develop and share stories. The research shows that online or in-person learning is dependent on trust and positive social interaction. In both settings, nurse educators should strive to create a learning community that fosters these qualities.

Social moods, such as a shared climate of curiosity and interest, come before the individual’s own emotions, and are what open learners up to common disclosive spaces of understanding and commonly held meanings. Attunement to emotions and moods shared by others is central to perception and shared understanding and action. The mind is not separate from the embodied, embedded, intelligent agent engaged in the world. Situated learning is particular and central to any practice discipline such as nursing, medicine, teaching, and so on.

One challenge for designing online learning is creating highly interactive, social learning from peers. It is equally challenging to create online learning for the engaged, embodied intelligent agent (Taylor, 2016). Clinical reasoning about particular patients requires an engaged, embodied intelligent agent for a deep understanding of unfolding complex clinical situations. No one algorithm for decision making can replace the engaged sequential understanding of the intelligent, agent-practitioner in multifaceted, multicausal clinical situations.  Passive, single answer or call and response instruction online or in-person fail to provide these kinds of critical experiences that nurses need to enter the profession.

One strategy to encourage a sense of community and sense of belonging in asynchronous contexts is to use video messages. Short, five to six-minute personalized messages from faculty to students and from students to class members can be very effective for increasing a sense of belonging and social connection.  Faculty videos should be warm and engaging, and informal, reflecting the faculty styles of learning and engagements. These do not have to be highly polished but should be thought out in terms of learning goals and current topics in the class. These videos should show gestures, movement, posture, and stances to convey the teacher’s embodied connection with the subject matter and with the students.

Emotion

During the reign of cognitivism (Dreyfus & Dreyfus, 1988), a view of the mind as an information processing computer, the role of emotions as the portal for attentiveness, perception, and learning were all but ignored. In the information processing model of the mind, emotion was seen as disruptive “noise” that interfered with rationality and thinking. While it is true that emotions such as fear, alienation stemming from a sense of not belonging, and other disruptive emotions do block perception and learning. Perception and learning, however, do require positive emotions related to openness and receptivity, attunement, and concern. Additionally, the emotions accompanying curiosity, such as excitement and engagement, are essential for perception and learning. These positive emotions are linked to rationality, discernment, and judgment (Damasio, 1994; Dreyfus, 1992; 2009).

Strategies for including emotions such as openness, responsiveness, excitement, etc. include designing assignments that use short student videos about new insights gained, changes in understanding as a result of the course, assignments, discussions, or readings. These classroom disclosures about student learning, discoveries, changes in understanding will infuse the class with a contagion for learning and engagement. Another effective strategy is the use of first-person-near narratives about clinical learning (Benner, Hooper-Kyriakidis, Stannard, 2011). In these narratives, students are encouraged to share their concerns, questions, emotional responses, and questions.  The narratives should not be overly prescribed, but instead framed in terms of new insights about clinical care, a story of excellence, or practice breakdown or a situation where the student learned something new. Context-free categories do not easily evoke memory (e.g., “Tell a story about ambulating a patient”), is less effective in evoking narrative memory than a story of significance such as “Can you describe a time when you were really worried about a patient?”. Usually emotional tones, and significance trigger memory more effectively than formal categories or classes of events. Emotional openness and significance (mattering) are required for noticing, and noticing comes before any assessment can begin (Damasio, 2005; Benner & Wrubel, 1989). Emotion is a gateway for perception, attunement, and more. Objectified, removed, decontextualized information is not quickly learned nor remembered. It lacks emotional connection, embodiment, and situatedness. Adding significance and positive emotions of engagement and connection make online learning more salient and exciting (Brown, Collins, Duguid, 1989).

Authenticity

The authenticity of students and faculty is more readily discerned in face-to-face seminars and classrooms. Cognitive authenticity is central to learning (Eyder, Herrington & Herrington, 2007 ) Eyler notes:

            Deep learning demands authenticity, and it is no different with college students….Like babies, we continue to learn the most from realistic problems and authentic scenarios….This kind of learning requires what some have called situated cognition. Cognition is situated insofar as it is heavily dependent on context and environment  (Eyler, p. 153-154).

Authenticity has to be demonstrated and designed into online learning. Again, short faculty videos showing personal connections with the lesson are beneficial. Students’ narratives and accounts of learning can make learning real and connected with the person’s goals. We have many discussions about “socialization” in professional education, and fewer about the engaged learner trying to become who and what they need to be in order to be a good nurse, doctor, or teacher, i.e., formation and ethical comportment (Benner, Sutphen, Leonard-Kahn, & Day, 2010). Formation, developing ethical comportment in practice, requires more than role messages from team members. The student nurse must engage in personal insight about how they need to change to meet the challenges of being a good nurse in specific clinical situations. Demonstrating your authentic concerns about learning, giving real examples of making a medication error, or being able to be present in the face of patient-family suffering show more than “knowing that” or “knowing about,” it demonstrates “knowing how and when,” as well as “situated thinking in action”. Authentic examples demonstrate how you embody your practice, your ability to take risks in the face of challenging situations, your genuine concern for patient/family welfare.  Disclosing real upending learning experiences in practice can be powerful (Kerdeman, D. 2004). Gadamer (1975) points out that “experience,” if counts as experience, and not just mean passage of time, it requires changing one’s pre-understandings, beliefs, expectations, i.e., being turned around or upended in situations. We will speak to this further in the section on learning from failure. Grabinger, Dunlap, and Dunlap (1995) note:

…we consistently rely on decontextualized instructional strategies. In our desire to cover as much material as possible, we focus our instructional activities on abstract basic skills, concepts, and technical definitions. We believe that decontextualized skills have broad applicability and are unaffected by the activities or environments in which they are acquired and used. However, when we do this, students do not learn when to apply [use] those skills or within what kinds of contexts they work (Grabinger and Dunlap, 1995, p. 7)

We rely on generalization across diseases and context to reduce repetition and content in our courses. However, this approach to streamlining material covered has its limits. In practice disciplines, situated cognition, and an understanding of commonalities between situations, along with a dialogue between the particular case and the general, such as a population statistic, are central to all clinical reasoning, which is a form of practical reasoning:  Clinical reasoning requires: ”Reasoning across time through changes in the particular and or, changes in clinician’s understanding of the situation” (Benner, Hooper-Kyriakidis, Stannard, 2011). Deep learning, situated cognition, knowing how and when, require higher-order thinking based upon experiential learning. Productive, situated use of knowledge requires more than the mere application of knowledge (e.g., the technique of measuring blood pressure). Higher-order, productive thinking requires the situated interpretation of particular blood pressures for particular patients across time.

Authenticity in teaching and learning requires the critical importance of authentic caring (Benner & Wrubel, 1989; Gordon et al., 1996; Valenzuela, 1999), not just for nurses in practice, but also by nursing educators for their students. Professors and students are living through previously unimagined turmoil as the shelter-in-place orders are extended or recklessly rescinded, and our lives and the lives of our loved ones are at risk. Our students of color are under additional pressure as the COVID-19 Pandemic has had a higher incidence of morbidity in their population. These pandemic demands are further exacerbated and made even more challenging by the continued episodes of police racism and violence, which lay bare the racial injustice permeating our society. Academic achievement and well-being are interdependent, and the expression and experience of care from one’s professors can make all the difference for students struggling with heavy burdens. This is why it is essential to include research-based knowledge on the social determinants of health and disease in our nursing curricula. As faculty we have to embody a concern for student well-being, as well as patient well-being. While accountability is always important, in these trying times, grace, compassion, and flexibility are more critical than ever and will make a lasting impression on the next generation of nurses.

Failure

If you are like me, you like to skirt around “failure talk” because we always want to avoid failure and protect our students’ self-esteem. We never set out to fail, but like it or not, “to err is human,” and central to learning. The point of failure is not to raise the specter of shame and blame, but rather as a requisite for learning. As noted above, Gadamer’s (1975) insight that “experience” depends on a turning around of prior taken-for-granted assumptions; otherwise, it does not count as experience. Large or small failures are at the heart of all experiential learning.  Schultz (2010) points out that the capacity to err is central to knowledge and our humanity:

            Far from being a moral flaw, it [to err or fail] is inextricable from some of our most humane and honorable qualities: empathy, optimism, imagination, conviction, and courage. Far from being a mark of indifference or intolerance, wrongness is a vital part of how we learn and change. Thanks to error, we can revise our understanding of ourselves and amend our ideas about the world. (Kathryn Schulz, pp.117-118, 2010).

An important point here is the concept of “productive failure.” (Kapur & Kinzer, 2009)  Productive failure refers to situations where learners struggle to make sense of and solve a complex problem. It is precisely through this struggle, including mistakes, that essential and meaningful learning takes place. Productive failure is cultivated in “ill-structured” problems, scenarios that contain rich, relevant, and irrelevant information and require students to engage in collaborative problem-solving.  They can share in sense-making as they wrestle with determining a course of action from a realistic clinical presentation. In addition to online simulations, another option is to take advantage of the asynchronous and synchronous modalities together. For example, give students a chance to read through a case or a patient chart asynchronously, but use an online meeting to discuss together what is salient and what should happen next. These socially grounded interactions also give nurses vital practice in articulating their reasoning for their decisions in care.

Online simulations allow faculty and students to diagnose misunderstandings that cause errors. For example, a common Sentinel Event for new graduate nurses in NovEx (Disclosure: Drs. Patricia Hooper-Kyriakidis, Patricia Benner, and Tom Ahrens are Co-Owners NovExToExpert.org), an online clinical simulation program, stems from not clearly understanding the distinctions between an occlusive, clot-based stroke, and a hemorrhagic stroke.  Consequently, they are likely to make a life-threatening error and give a blood-thinning agent to a patient with a hemorrhagic stroke. It is far better to make this fatal error with a simulated patient than with a real patient. With rich feedback and corrective directions to review the lessons, the student can work through their misunderstanding and avoid making such an error with actual patients. Identifying the knowledge gaps that spawn these mistakes through program analytics can enhance learning and enhance patient safety. Students are authentic in their desire never to make patient care errors that threaten the patient’s life and need situated coaching to learn from “online simulated” errors. Faculty can gather students together who have made errors based upon shared misconceptions, and ensure active learning, and the formation of a narrative memory that will ensure improved patient safety and decrease incidents of “failure to rescue” when caring for real patients (HealthImpact.org also see, Roberts, 2016). The ethos of never covering up errors (indeed, disclosing, learning from, correcting, and preventing similar errors in the future) is at the heart of professional integrity and accountability. Developing this ethos of reporting, correcting, and preventing errors is more likely to occur if there is a strong culture of learning from mistakes. Assignments designed to help students reflect on learning from errors can help create a habit and expectation of learning from errors.

High Impact Learning

George Kuh (2008) defined High Impact Learning as comprised of ten components of undergraduate education:

    1. First-year seminars and experiences. The University of Pennsylvania School offers a great example of seminars related to nursing practice implications of science pre-requisites during the first two years of college See: View Full Video here
    2. Development of common intellectual learning experiences.
    3. Active learning communities.
    4. Writing-intensive courses.
    5. Collaborative assignments: Collaboration requires more just group assignments with individual roles, where assignments require collaboration and teamwork in learning.
    6. Undergraduate research.
    7. Emphasis on diversity and global learning.
    8. Service-learning and community-based learning. This is usually central to clinical practica. However, with limited clinical practica, faculty will have to generate new options for community-based learning.
    9. Internships. Again, senior internships will have to be re-designed during the COVID-19 Pandemic.
    10.  Capstone Projects and Courses.
    11. Learning Portfolios were added to Kuh’s original ten High Impact Learning Practices (Linder & Hayes, (2018)

    Linder and Mattison Hayes (2018) demonstrate how expert online educators create design solutions for these online High-Impact Learning activities. In the COVID-19 need for physical distancing, design for these High Impact Learning Strategies becomes even more challenging, since so many natural face-to-face experiences are not possible.

    We welcome learning from you, our readers, on how you have designed for experiential learning for these kinds of High Impact Learning experiences with the current necessity of physical distancing. For example, using one’s family or social grouping for reflection and inquiry may be a possibility, with care taken for permission and privacy rights. Learning portfolios can be developed based upon the student’s narratives of clinical learning. Dramas and documentaries of illness experience, drug addiction, or facing death can form a base for experiential learning described and reflected in a learning portfolio. Immediate past clinical experiences can be reconsidered and become a basis for new levels of inquiry. We offer Learning Resources for Online Teaching that follow this article, including clinical videos that can be shared and discussed by students from EducatingNurses.com.

    We are truly in unchartered areas of online learning during this time of physical distancing. As always, our teaching and learning need to be designed based upon learning science (The National Academies of Sciences. Engineering. Medicine, 2018; Talbert, 2017; Linder, K.E., Mattison Hayes, C. 2018). We need to study our students’ experiences and learning outcomes to improve nursing education continually. Online or in-person, designing for curiosity, sociality, emotion, authenticity, and failure are essential for instruction that prepares our students to not just master content but become nurses capable of meeting the challenges of our uncertain times. In a future newsletter, we will present ways of evaluating online and online clinical replacement learning.

    (References for this article follow the list of Learning Resources)

    Learning Resources:

    Getting up to speed in presenting high quality, learning science-based online courses

    Discussion Triggers, Patient Scenarios Available on EducatingNurses.com

    The Patient in 9-Window

    When she was a nursing instructor to first-year students at Columbia University and Adelphi University, Dr. Elizabeth Cohn hoped to teach her students how to support, educate and relate to their patients as whole persons, rather than just “The Patient in 9-Window”. She wrote and delivered a monologue from the perspective of the patient that helped student nurses understand that there’s more to nursing than performing tasks.  This monologue was presented about the third or fourth week of Nursing Fundamentals class before the students began clinical. This full video is only available to our members but please enjoy our preview below.

    Discussion Triggers can Help Students Discover Blind Spots, and Biases

    Patricia Benner, RN., Ph.D., FAAN June 24, 2016 Copyrighted This month,  we offer all our newsletter subscribers free access to a wonderful new video on people’s responses to the news that someone has been recently diagnosed with cancer. Kristin Johansen and Ben Dziuba collaborated on this collection of people’s responses to the news that Ben was diagnosed with a rare and aggressive cancer, one week after they were married nearly six years ago. In this dramatized video they share the humor and pathos in peoples’ difficult responses, and offer alternative, more empathetic responses.  Continue reading

    Healing in Chisasibi

    This is a wonderful Ph.D. documentary from a doctoral dissertation.  It is perfect for any cross-cultural and public health class on the health impact of colonization. Many of the stories have to do with addiction to alcohol and drugs. In each case healing involves recapturing a sense of Cree identity and spirituality. The short video clips 2-7 minutes can be used as discussion triggers in the classroom.

    Kitra Cahana: My father locked in his body but soaring free

    Students will be inspired and instructed  by Ted Fellow Kitra Kihana. This strong loving family, and the strong spirit and love of life, has moved Rabbi Cahana beyond a “locked in brain syndrome.” The family began exercise range of motion exercises immediately, and wove a web of love, and direct action in the care of Rabbi Cahana. This Ted Talk will make an excellent “Discussion Trigger.” It is gratifying to know that Rabbi Cahana is now able to speak to his congregation, albeit from a wheelchair, but is still engaging in his life and soaring in his spirit.

    Kari Martinsen: The Art of Sensing and Meeting the Patient in Authentic Care

    Part 2:

    Nursing takes place largely in Health Care Industrial organizations where efficiency, speed of completing tasks, are emphasized. This emphasis runs counter to many caring practices central to excellent nursing…the art of listening, of being present, available to respond to the concerns of patients and families.  Dr. Kari Martinsen’s work on caring emphasizes meeting the other with openness and presence, rather than a critical or judgmental eye.

    This full video is only available to our members but please enjoy our preview below.

    Being Present, Meeting the Patient as a Person, Preserving Personhood, Taking up the Ethical Call of Nursing

    I lay there listening to the sickening sounds of my mechanical breathing, all the while praying the oxygen tank wouldn’t run dry. If the hose got twisted and the oxygen stopped flowing, a short alarm would sound. Immediately, a nurse would appear to correct the problem. But what if the tube slipped out of my throat?  What if the alarm malfunctioned?  What if the oxygen concentration wasn’t high enough?”

    Assessing for Suicidal Risk

    In this life actor simulation, the patient is an adolescent who is depressed and has expressed some suicidal thoughts. The students are assigned the task of assessing the level of this Adolescent’s depression and risk for suicide. The whole “flipped classroom”, particularly the portion “Assessing for Suicide Risk” can be used to help students prepare to discuss this 15 minute role play with different students assigned to address different aspects of assessing this adolescent’s risk for suicide.

    This full video is only available to our members but please enjoy our preview below.

    Pilot, an Airline Safety Expert, Seeks to Improve Patient Safety after the Death of his Wife

    This is a dramatization of the medical error that caused the death of this Pilot’s wife, in what should have been a simple routine surgery. This is a great presentation on patient safety and team work problems that contribute to patient care errors.  In this re-enactment of a real event, the physicians are fixated on intubating a patient, and despite the nurses’ clinical grasp that a tracheostomy is needed, the nurses fail to command the attention and action of the physicians.  This is a great consciousness-raising video on the danger of silence and lack of patient advocacy for the patient’s safety. Students should look up the current safety protocol on intubation, where limits are set on number of trials before tracheostomy is recommended.

    Advanced Directives, and Planning for End-of-Life Discussion

    Senior Nursing Students work with Esther, a patient with COPD, who is anxious about her friend with COPD who has just been placed on ventilator assisted breathing, and also anxious about her own disease progression, since she is just home from the hospital. This is a great discussion trigger about working with anxious patients, and with patients who are concerned about their approaching decline and death.  Students can discuss how and the extent to which these senior students were able to help calm Esther and address her fears about end-of-life care.

    This full video is only available to our members but please enjoy our preview below.

    The Use of Narratives in Research, Practice, and Education

    Patricia Benner describes the historical development of the use of narratives. She explains and illustrates different ways of using first person experience near narrative accounts for research, practice and education.  Links are made with the Dreyfus Model of Skill Acquisition, particularly, the use of perspectives in clinical practice by proficient to master levels of performance. Ways of using narratives of students for reflection on practice are presented, including what to avoid, and examples of successful uses of narratives for teaching in practice and education.

    This full video is only available to our members but please enjoy our preview below.

    Using Real Unfolding Clinical Cases to Trigger Classroom Discussion with Sarah Shannon

    Sarah Shannon, who teaches clinical nursing ethics, provides real clinical cases that raise ethical issues and asks students what they would do in the situation.  The case featured here is compelling and involves the ethical demand of disclosing the error of starting resuscitation on a patient who has a DNR order, unbeknownst to the clinical staff in the radiology suite.  This is a great example of challenging students to think about what they would do, and consider what their ethical obligations are to the family of the patient.

    Research-Based Books Related to Learning Science:

    Peter C. Brown Henry L. Roediger III, and Mark A. McDaniel (2014) Make It Stick: The Science of Successful Learning. Los Angeles, CA: Dreamscape Media LLC, Publisher

    Joshua R. Eyler (2018) How Humans Learn: The Science and Stories Behind Effective College Teaching. Morgantown, VA.: West Virginia University Press.

    Darby, Flower with James M. Lang. (2019). Small Teaching Online. Applying Learning Sciences in Online Classes. San Francisco: Jossey-Bass (A Wiley Brand) Kindle Edition.

    Dreyfus, H.L.(2009) On the Internet.(Thinking in Action) 2nd Edition. New York: Routledge, a Taylor Francis Group.

    Dreyfus, H.L., Dreyfus, S.E. (1986) Mind over Machine: The Power of Human Intuition and Expertise in the Age of the Computer. New York: The Free Press.

    Linder, K.E. Mattison Hayes, C. (Eds.) (2018) High-Impact Practices in Online Education. Stylus.

    National Academies of Sciences, Engineering, and Medicine 2018. How People Learn II: Learners, Contexts, and Cultures. Washington, DC: The National Academies Press.

    Richardson, W., Mancabelli, R. (2011) Personal Learning Networks: Using the Power of Connections to Transform Education (Essentials for Principals)Bloomington, IN. The Solution Tree Press.

    Talbert, R. (2017) Flipped learning. A guide for higher education faculty. Stylus

    Taylor, C. (2016) The Language Animal. The Full Shape of Human Linguistic Capacity. Cambridge, Mass: Harvard University Press

    Web Based Resources for Designing Online Courses

    What you need to know and where to find it.

    5 minute introduction to the Flipped Classroom

    ATI TESTING

    Virtual Clinical Replacement Lesson Plans. 34 ready-to-use lesson plans cover  12 topic areas. Each supports an ATI screen-based solution with prepared independent and online group activities. Novice or seasoned educators can quickly and easily create customized lesson plans by interchanging activities as needed to replace clinical hours.  

    Online Clinical Plans. Comprehensive sets of faculty lesson plans, student checklists, and educator implementation guides accompany immersive screen-based simulation scenarios to replicate a full clinical day. They include pre- and post-conference activities for 5 RN and 3 PN topic areas and strategically adhere to NCSBN guidelines and INACSL’s Standards of Best Practice: SimulationSM. Each begins with prebriefing, weaves together ATI screen-based solutions, and ends with debriefing and evaluation.   

    Tilt Higher Ed: Making goals of learning activities transparent:

    Promoting students’ conscious understanding of how they learn

    Enabling faculty to gather, share and promptly benefit from current data about students’ learning by coordinating their efforts across disciplines, institutions and countries

    Chronicle of Higher Education Online Articles on Online Courses.

    Going Online in a Hurry: What to Do and Where to Start

    5 Low-Tech, Time-Saving Ways to Teach Online During Covid-19

    How to Be a Better Online Teacher

    Inside Higher Ed.

    By Jean Dimeo November 15, 2017 Take My Advice

    TEACHING IN HIGHER ED PODCAST

    This is the space where we explore the art and science of being more effective at facilitating learning. We also share ways to increase our personal productivity, so we can have more peace in our lives and be even more present for our students.

    ACUE Faculty Development Website:

    With Great Teaching, Students Succeed

    ACUE prepares, credentials, and supports faculty to teach with the practices that improve student achievement and close equity gaps.

    We are grateful to provide support to faculty that have made an extraordinary transition to online course delivery. Our free Online Teaching Toolkit and webinar series on Effective Online Instruction are designed to provide immediate guidance. After months in development, we’re also now offering our Effective Online Teaching Practices course, as well as online micro-credential options, to ensure longer-term student success.

    Now, more than ever before, we are committed to collaborating with our institutional and higher education association partners to ensure great teaching – in the classroom or online – so student succeed.

    Higher Ed Teaching Strategies from Magna Publications

    Welcome to our free newsletter and website that’s dedicated to higher ed and instructors like you! Faculty Focus publishes articles on effective teaching strategies for the online and college classroom.

    Faculty Focus was the winner of the 2017 MERLOT Faculty Development Classics Award and is currently ranked #8 in the Teach100 daily ranking of education blogs. Faculty Focus has been an important tool for instructors to share what they are implementing in the classroom and to learn what other instructors are doing worldwide.

    EdChange – An excellent website for multi-cultural approaches to community building, critical multicultural pavilion:

    Strategies and Preparation from Multi-Cultural Pavilion:

    Strategies for Choosing and Using Activities and Exercises for Intergroup Learning
    You’re developing a diversity workshop or facilitating an intergroup dialogue and looking for ways to engage your participants. This document lays out eight strategies for effectively selecting and incorporating activities and exercises into your programming efforts.

    A Guide to Setting Ground Rules
    Ground rules or community norms can help your program or class run more smoothly. This guide describes commonly used ground rules and strategies for naming and enforcing them.

    Icebreakers:

    Knowing the Community: Ethnicity Exercise
    Continues community building. Participants introduce themselves by sharing information on their ethnicity and background, highlighting the similarity and diversity among members of the group.

    Name Stories
    Works toward bringing the stories of individuals to the fore in the multicultural experience. Participants write and share stories about their names and nicknames, what they mean, why they were given them, and how they relate to them.

    Sharing Ourselves: “Who I Am” Poems
    Begins active introspective process while continuing to provide opportunities for individuals to make connections with each other. Participants write short poems, starting each line with “I am…,” encouraging them to describe in their own words who they are and what’s important to their identity.

    Introspectives:

    The Depth and Breadth of “Multicultural”
    Explores the definition of “multicultural,” the dimensions of culture, and the consistency with which we define our culture and the cultures of others. Participants go through a series of steps to gain a better understanding of the complexity of “multicultural”ness, and are then challenged to apply this both to themselves and to how they understand each other. An extra step challenges educators to rethink their conceptualization of “Multicultural Education” based on their perceptions of their own cultural dimensions.

    Understanding Prejudice and Discrimination
    Introduces concepts of prejudice and discrimination through self-reflection. Participants share stories regarding their experiences with prejudice or discrimination, as either victim or perpetrator.

    Exploring Definitions
    Considers language as a vital aspect of multicultural education and awareness. Participants discuss how they define words such as prejudice, discrimination, racism, sexism, classism and homophobia. Issues of power and institutional discrimination emerge.

    Circles of My Multicultural Self
    The Circles activity engages participants in a process of identifying what they consider to be the most important dimensions of their own identity, concurrently developing a deeper understanding of stereotypes as participants share stories about when they were proud to be part of a particular group and when it was especially hurtful to be associated with a particular group.

    Inclusion/Exclusion
    Participants share their own experiences as students, exploring different ways people are made to feel included in, or excluded from, the learning process. The existence of different learning needs and the necessity for a wide range of teaching styles emerge.

    Student Fishbowl
    A student fishbowl gives pre-service and in-service educators an opportunity to hear the experiences, ideas, and critiques of current students while giving the students an opportunity to be active in the dialogue on multicultural education and education transformation.

    Equity Awareness Quiz
    Critical thinking about all media and information is an essential aspect of equity learning. Test your and your students’ or participants’ understanding of race, gender, and socioeconomic class with this activity, leading seamlessly into a dialogue on stereotypes, misinformation, and prejudices and how they inform teaching and learning.

    Facilitating the Difficult Dialogue: Role Plays
    Teachers are often hesitant to introduce topics like racism, sexism, classism, and heterosexism in the classroom because their training has not prepared them to handle the issues and exchanges that may result. This activity provides participants an opportunity to share stories about when discussions about these topics took an unexpected turn they were unprepared to handle, then to share ideas about how to address these circumstances in the future.

    Collaborative Problem-Solving: Case Studies in Education
    The purpose of this activity is to engage teachers in a process of collaborative problem-solving around multicultural issues through the use of case studies. Participants will develop an understanding and appreciation for the necessity to include a variety of voices and perspectives to successfully address issues that arise around race, gender, culture, sexual orientation, or any other identity dimension. They will also begin to better understand the collaborative process and how they tend to participate in it.

    Considerations for Evaluation in Simulation-based Education during COVID-19:

     

    Vanderbilt Guides

    Research based advice on effective use of videos for online teaching and learning. Length of videos should be around 6 minutes for maximum student engagement.

    Etale.org

    Encourages and instructs students develop their own personal Personal Learning Network related to student’s self-selected topics related to the course.

    UW Video Podcast: Tapping the power of asynchronous learning

    In a new podcast, University of Washington College of Education faculty members Megan Kelley-Petersen, Sara Lopez and Miriam Packard and instructional designer Britta Ossim discuss how developing asynchronous learning experiences for students can be more than a lifeline when school buildings are closed — it can open more avenues for students to share their ideas and learn.

     

    References for “Designing Online Nursing Education Based Upon Learning Science and High Impact Learning Strategies”:

    Ardichvili, A. (2008). Learning and Knowledge Sharing in Virtual Communities of Practice: Motivators, Barriers, and Enablers. Advances in Developing Human Resources, 10(4), 541–554. https://doi.org/10.1177/1523422308319536

    Bandura, A. (1977) Social Learning Theory. Prentice-Hall,

    Barkley, E., Cross, P. Howell Major. (2005) Collaborative learning  techniques: A handbook for college faculty.Jossey-Bass.

    Bawa, P. (2016). Retention in online courses: Exploring issues and solutions ? a literature review. SAGE Open, 6(1), doi:https://doi.org/10.1177/2158244015621777

    Benner, P., Wrubel, J. (1989) The Primacy of Caring: Stress and coping in health and illness. Prentice-Hall.

    Benner, P., Hooper-Kyriakidis, P., Stannard, D. (2011) Clinical Wisdom and Interventions in Acute and Critical Care, Second Edition: A Thinking-in-Action Approach, New York: Springer.

    Brown, J.S., Collins, A., Duguid, P. (1989) “Situated cognition and the culture of learning.” Educational Researcher. 18, 32-42.

    Damasio,  (2005)  Descartes error: Emotion, reason and the human brain. Penguin Books.

    Dreyfus, H.L. (1986) “Misrepresenting human intelligence. THOUGHT VoI. 6 1 No. 243, pp. 430-442.

    Dreyfus, H.L. (1992) What computers still can’t do. A critique of Artificial Intelligence. M.I.T. Press.

    Dreyfus, H.L. (2009) On the internet, 2nd Ed. Routledge.

    Eyler, J. R. (2018)  How humans learn: The science and stories behind effective college teachers. West Virginia University Press.

    Grabinger, R., Dunlap, R.S., Dunlap, J.C. (1995) “Rich environments for active learning: A definition.”Research in learning technology. 3:2, pp.5-34.

    Herrington, A.J., Herrington, J.A. (2007) “What is an authentic learning environment?” In Online and distance learning: Concepts, methodologies, toos, and applications. (Ed.) L.A. Tomei, Hershey, PA: Information Science Reference. Pp. 68-77.

    Kapur, M., & Kinzer, C. K. (2009). Productive failure in CSCL groups. International Journal of Computer-Supported Collaborative Learning, 4(1), 21–46. https://doi.org/10.1007/s11412-008-9059-z

    Kerdeman, D. (2004)” Pulled up short: Challenging self-understanding as a focus of teaching and learning. In J.Dunn & P.Hoga (Eds.) Education and practice: Upholding the integrity of teaching and learning. (pp. 144-158) Blackwell.

    Kug, G. (2008) High-impact educational practices: What they are, who has access to them, and why they matter. Association of American Colleges and universities.

    Linder, K.E., Mattison Hayes, C. (Eds.) (2018) High-impact Practices in online education. Stylus Publishers.

    Mursing Managed. (n.d.). Mursing Managed. Retrieved June 5, 2020, from https://licensetonurse.com/post/178344157906

    National Academies of Sciences, Engineering, and Medicine. (2018). Ch. 8 Digital Technology. In How People Learn II: Learners, Contexts, and Cultures (pp. 163–196). National Academies Press. https://doi.org/10.17226/24783

    Roberts, J. (2016) Experiential Education in the College Context: What it is, how it works, and why it matters.Routledge.

    Schulz, K. (2010) Being Wrong: Adventures in the margin of error. Ecco.

    Talbert, R. (2017)  Flipped learning. A guide for higher education faculty. Stylus

    Walton, G.M., Cohen, G. “A brief social-belonging intervention improves academic and health outcomes of minority students.” Science 331. March 18, 2011: 1447-51.

    Vygotsky, L.S. (1980)  Mind in society: development of higher psychological processes. Cole, M. John-Steiner V., Scribner, S. & Souberman, E. (Eds.) Harvard University Press.

     

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