Executive Summary of Results

Course two developments have progressed at a slower rate than the proposed timeline. Course one is posted in IUPUI Oncourse for baccalaureate nursing students preparing for the OR capstone experience. Development of course II continues and evaluation is planned using students in the summer session 2002 perioperative nursing class. Web-based content in course one is the “core” course for registered nurses new to the Operating Room in the Clarian Health System. Two new classes June 2002 and August 2002 enrolled 22 new RNs. Hospital educator’s work through the School of Nursing Center for Lifelong Learning for technical support and CE units.

Need for the Project

In the original proposal, the following statements were made and the need for the project developed with this grant money remains. The advent of new technologies in surgery and continuing technological advancements in health care, students and practicing nurses have an increasing need for professional development. Competency-based knowledge and skills are essential for nurses to provide safe, cost-effective care of increasingly complex patients. As the use of surgical procedures continues to evolve and less invasive procedures are developed, the demand for nurses prepared to work with patients who are receiving these procedures is increasing dramatically. More nurses are needed each year to work in surgical settings including the operating room. This Web-enhanced course will continue to be used to introduce student nurses to the role of the Perioperative Nurse. Course format, which includes didactic and clinical, gives a realistic preview of this role. The Web-enhanced course was offered to undergraduate students in the baccalaureate nursing program so that they could select the operating room as a place for the senior nursing Capstone experience.

This approach to teaching basic surgical nursing content enables more student nurses to explore the role of the O.R. nurse each semester. It provides a means for orienting new employees more frequently and can be used as the core course for registered nurses new to the O.R. Undergraduate nursing students are more technologically savvy than those in the past. This course meets the need of new, younger college students and the information needs of registered nurses. It appeals to different learning styles and allows the course to be taught at a distance over a short duration or within a full 14-week academic semester. Registered nurses complete course one in a two-week time frame and it is referred to as the O.R. nurse “Core” course.

Funding for this project provided needed equipment including a digital camera and new software used to enhance the existing course presentation. Camera images taken in the operating rooms at Methodist and University Hospitals were made and inserted in three of the seven modules of course I. Videos were made of nursing skills, opening sterile packages and pouring solutions to add to course one. Voice-overs were completed with the assistance of technicians at the Office of Professional Development. In addition, one of the technicians provided the appropriate “radio tone” voice which enhanced the presentation of sequence of steps in the procedure. Videos were made of live Endoscopic surgical procedures at Methodist Hospital using a camera borrowed from the IUPUI Center for Teaching and Learning. Consent to video was obtained from the surgeon and the patient for use in an educational setting. With assistance and technical advisement from individuals at the Center, the videos were edited and recorded in appropriate time for insertion into course two. Evaluation and feedback from undergraduate students and registered nurses rate the course highly.

Course development experience was presented at two national conferences over the school year.

1. September 24 & 25, 2001 Poster presentation in Columbus, Ohio at The Columbus Convention Center. Conference title: “Strategies for Success: HealthCare Management, Staff Development & Education” Sponsored by Ohio State University Medical Center – CPD (Center for Professional Development). Audience included nurse administrators, staff development educators and trainers, Nurse managers and other staff in leadership roles. A pre-conference workshop focused on developing Web-based training for hospital nurses. Poster topic “Teaching Surgical Nursing in Online Learning Communities. (See content in Power Point) Attachment 1
2. April 22, 2002 speaker at 49th annual AORN Congress (Association of Perioperative Nurses) Presented two 90-minute sessions "Teaching Perioperative Nursing in Online Learning Communities” April 22, 2002. This generated increased interest in the course and the Web approach to teaching and orienting new nurses in the operating room. Attachment 2

Use of Technology

Digital images and video streaming, animation and text content are posted in Web pages. The IUPUI Oncourse is the method for offering both the undergraduate and continuing education courses. I participated in summer Tech Camp III at the Center for Teaching and Learning where I learned how to use Premier, a program for streaming video. To date, we have created three video inserts with voice over for the perioperative course one and three videos for course two.

Streaming media demonstrating clinical skills were incorporated into course one. Resources from IUPUI include the Center for Teaching and Learning – Office of Professional Development. The undergraduate version of course I is posted in IUPUI Oncourse, title Perioperative Nursing, number J360. Visitors can access syllabus and schedule. All other access is gained by registration for the course and use of an assigned number. The continuing education version also appears in the IUPUI Oncourse listing for fall and spring semesters. These sites require an IUPUI identification number to proceed. The course number is J360.

Instructional Design Plan

Describe how the use of technology used supported your teaching approach:

• What student learning outcomes were expected?
• How did your teaching plan encourage active learning, provide feedback, address respective learning styles, and build collaboration?
• What resources were used? (campus technology support services, etc.)
• Would your project be easily understood and executed by other faculty?

J360 is a Web-supported course in which 85% of the theory content is posted in Oncourse. Seven modules are indexed to the right of the Web screen with subtitles that explain content. Students navigate the course using “mouse” clicks to select a topic. Each module includes cognitive objectives and content application guidelines for clinical experience. The course is not a stand-alone media based package; rather it provides academic theory content and a practice component in the operating room. This approach enables the learner to achieve cognitive and practical outcomes for the course. Student expectations included performance on the quizzes and exams to demonstrate knowledge and clinical applications in the O.R. Students have been highly successful in meeting course expectations.

Active learning and feedback are essential components of the course. Perioperative nursing content requires the student to have hands-on experience. In Module III students learn about Counts in O.R. That is, counting instruments, needles, sponges and items that might be lost during a surgical procedure. When a student registers for the course, they attend a two-hour classroom session where clinical information is discussed. Each receives a packet containing examples of two O.R. sponges and an instrument to be used when learning content in Module III. Students can download the entire course to read and highlight if needed. Feedback session using Oncourse discussion chats are scheduled in addition to the class room sessions. This promotes student teacher and student-to-student interaction.

Resources from UITS and the Oncourse management and learning tools provided support for creating and maintaining the Web-based teaching of this course. Oncourse allowed university students and RN students added by the Center for Lifelong Learning to access and take full advantage of the Perioperative Nursing course. Having a single, consistent Web interface is a major advantage for IUPUI faculty member. Class rosters, user profiles and the tools to determine performance on quizzes and exams made offering of the course during a regular semester easier.

The grant budget asked for student stipends for artwork and graphic design. Two students in the New Media major at IUPUI provided exceptional artwork. We advertised in the IUPUI School of Informatics and Engineering and students sent samples of their work. Artwork enhanced presentation and clarity of content. Additional artwork remains to be completed for course II.

Other faculty could easily understand and utilize this approach to developing teaching modules. Nursing content can be presented using more than one medium and the Perioperative Nursing project provides an example of a traditional pedagogical faculty member who became a “wired professor” could do. New learners are less afraid of taking a ride in cyberspace.

Potential to Impact Student Learning

Clearly define how your project improved student learning - include specific examples of how your project:

• Fostered depth of learning
• Supported efforts to improve retention
• Fostered the learning of large numbers of students
• Has broader applications that will affect learning K-12 or community environments?

Students can access the course content any time and from any computer, at a distance or asynchronously. Depth of learning is improved by using technology differently. The author in comparison to the traditional Operating Room course teaches this over the past 25 years. Students feel free to access content, contact the instructor, utilize the learning laboratory, confer with clinical preceptors and express their ideas. The type of student interactions is of quality and different from the pedagogical approach used prior to the Web format. While the start date for the course is the same for all students in the semester, the completion dates vary according to individual students’ needs. Numbers of students in any one course remain small because of the clinical component. However, the Web format allows more successive offerings of the course in a year and therefore, greater numbers of students are involved.

J360/K490 is a college-based course.

Assessment Plan

Briefly explain the effectiveness of your assessment plan:

• What measure of assessment was used?
• How did your approach obtain measures of performance?
• Did you feel your measurement was accurate and effective?

Formative and summative evaluation of content and course format is conducted. An expert in periOperative nursing reviewed content for validity and accuracy prior to use in the course. Once content was posted in the Web format, students in a traditional periOperative course reviewed the modules for clarity and to assist with establishing expected time required to complete course I. The department of lifelong learning at IU School of Nursing administers formal evaluation to each RN participants. Analysis of the evaluations by class provides suggestions for improvement and support for the approach to teaching and learning. Plans are to continue to develop and evaluate course II. Revisions and additions to course I will be conducted to assure best practices and any update of content.

Plan for Colleague Development

Describe your role and activities as a mentor:

• What mentoring activities were implemented to assist colleagues?
• How did you help to develop colleague's instructional technology skills?
• How do you think your contributions to the Knowledge Base will help colleagues planning similar projects?
• Is your project approach potentially applicable to other contexts or disciplines?
• What tips would you offer?

I have served as a mentor for a faculty member in the School of Nursing who is attempting to develop a Web-based clinical course. In addition, my content and course format has been shared with colleagues in the Center for Lifelong Learning of the School of Nursing. These actions have proven helpful to these individuals planning similar projects. Among the tips offered to persons beginning this project, are: 1) Recognize the project can take more time than developing a traditional course. 2) Identify someone who can design and produce graphics that are of high quality and 3) Utilize the support services of the IUPUI Office of Professional Development if available.

I attended the Center for Teaching and Learning - Tech Camp III summer of 2001 and increased my knowledge of Web page development. In March 2002, I attended the CTL’s Tech Camp IV where I learned about multimedia authoring and basics for Web, CD-ROM and DVD authoring. I encouraged my school to purchase one of the common authoring programs and will continue to use this software for module and course development.

Final Comments on Project Results

• Do you think you met the goals of your project?
• What, if anything,would you do differently?
• Did you have any unexpected outcomes? (positive or negative)
• Would you recommend this teaching approach to colleagues?
• What other comments or suggestions would you offer to complete this report?

Work on this project began February 2001 in addition to my full teaching load that included classroom and clinical nursing courses. During summer session II in 2001, the project was the entire focus of academic efforts. Revision plans for course one were accomplished. The focus was to enhance to meet needs of adult learners. Suggestions from course participant evaluations have provided data for course revisions. Enthusiasm about the course as an “educational package” by service educators in the operating rooms at Clarian brought new opportunities for the course. Wishard hospital operating rooms and Clarian Health surgical services utilized the Web format for a “core course” for registered nurses new to the operating room. Evaluation and feedback from these nontraditional adult learners was extremely positive. One area on the evaluation asked the level of agreement or disagreement about use of computers to deliver nursing content. All students rated this medium highly. In each class as many as 50% of the RN students had never taken a Web-based course.

The core course was offered fall 2001 to two new RN classes and two new RN classes spring 2002. Additional classes are scheduled for registered nurses new to the O.R. for June and August 2002. Undergraduate students completing the Web-supported course spring 2001- (7), fall 2001 (3) and spring 2002 (7) prepared for the senior Capstone experience. Maximum enrollment advertised is seven (7) during the academic year. This is primarily due to my regular teaching load and the clinical and classroom instruction in required senior nursing courses. Student feedback continues to be highly positive and to this end, I have met part of the project goals. Course two is still under construction and will be tested during summer session I.

A positive outcome from this project is the demand by the community for the course to be used in staff and workforce development. IU School of Nursing and Clarian Health are partnering to form a Center for Surgical Excellence and this course package will be an essential part of the center offering. IUSON has increased visibility for the commitment to a specialized area of nursing in which nurses are desperately needed.

I have become interested in MERLOT (Multimedia Educational Resources for Learning and Online Teaching) to help gather ideas about the increasing collection of online learning materials. A noon hour workshop sponsored by the IUPUI CTL titled “A Taste of Merlot” advised that MERLOT can help faculty enhance instruction and share with a community of faculty who are working on projects similar to this project. Plans are to make full use of this organization in the future.

Recommendations to colleagues:
Time to develop and improve the course is an important consideration. Assuring quality of the content and course required more time to complete than anticipated. Often this author worked without salary. Having a creative streak is extremely beneficial or one must hire someone to think through and identify creative means for presenting content.

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