Web-based simulation: a tool to teach critical care nursing

Transcription

1 Universidade Federal de São Paulo Programa de Pós-Graduação em Enfermagem Web-based simulation: a tool to teach critical care nursing Sayonara de Fátima F. Barbosa Heimar de Fátima Marin

2 Introduction The development, expansion of Internet and its impact upon society The need of the educational institutions to apply IT to innovate the teaching-learning process, thus becoming able to offer educational resources that may correspond to the new needs of the contemporary society (Kemczinski, 2000) Nursing educators are progressively becoming more involved with the explosion of distance learning and Internet (Gasper, 2003) New technologies and the proliferation of informatic culture = a invitation of the new model of learning, with informatics technology as a resource 2

3 Definining the problem Informatics in health teaching complex information and in a great amount to support decision Peculiarity of critical care nursing teaching The possibility of introducing an innovative and complementary proposal to teaching Student may learn without harm the patients Freedom to construct their own knowledge Emphasis on the safety promotion in healthcare 3

4 Objectives To develop and implement a web-based simulation with a focus on critical care nursing teaching To evaluate the simulation as a teaching tool to undergraduate nursing students 4

5 Literature review 5

6 Web-based learning The online learning must be based on a teaching-learning model (Starr RM, 1997) The literature from does not present a consensus on the better manner to design, develop, manage and evaluate web-based learning (Gasper ML, 2003). Distance learning in nursing is growing, but it seems to have a lack on a general plan to define and integrate the computer and information technology in nursing curriculum (Lewis D, 1997; Reinert BR, Fryback PB (1997); Ryan M, Carlon KH (1999); Billings DM, Connours HR, Skiba DJ (2001). 6

7 Materials and methods 7

8 Materials and methods Study type Applied research of descriptive type, on the research area Informatics, Information Technology and Communication in health and nursing, of the Núcleo de Informática em Enfermagem, da Universidade Federal de São Paulo (NIEn/UNIFESP). Study subjects webdesigners and programmers Critical care nursing teachers and critical care nurses Undergraduate students of the 6th academic semester of nursing course at Federal University of Santa Catarina Brazil Ethical aspects The project was approved by the UNIFESP's Ethics Committee (process number 395/04). 8

9 Methodology Instructional design Computational modelling Ergonomic evaluation Pedagogical evaluation Implementation Usability evaluation Andrade AF, Franciosi B, Beiler A, Wagner PR. (2001) 9

10 Instructional design Definition of the pedagogical architecture of the simulation Definition of objectives Content definition Tasks to be developed Competencies determination, considered according to the syllabus of the course 10

11 Computational modelling Data layer Requisites to the development and implementation of the simulation Three tier client/server architecture Database development MySQL Application layer Apache webserver with PHP Client layer 11

12 Entity-relationship diagram Chen, P. (1990) 12

13 Ergonomic evaluation Applied to four webdesigners and programmers Evaluation tool (form) with 15 items and three criteria Organization (4 items) Apresentation (5 items) Technical criteria (6 items) The items were distributed in a value scale with five categories of answers: (1) bad; (2) regular; (3) good; (4) very good and (5) excellent. 13

14 Pedagogical evaluation It aimed to evaluate the relationship of the theoretical content with the knowledge base It was applied a form to four critical care nurses and four critical care nursing teachers Composed of 44 items, distributed in three criteria: Content evaluation (12 items), Content organization and presentation (27 items) Learning evaluation (5 items). Items were distributed in a Likert-type scale with five categories of answers: (1) strongly disagree; (2) mildly disagree; (3) no opinion; (4) somewhat agree; and (5) strongly agree. Reeves TC, Harmon S (1998), Elissavet G, Economides AA (2003) 14

15 Implementation Implementation of the simulation It happened after the two previous evaluations and the adjustment of eventual alterations proposed 15

16 Usability evaluation It aimed to detect the level of satisfation, motivation and difficulties of students with the use of the simulation Evaluation tool (form) applied to 25 students after the use of simulation Composed of 17 items, distributed in three criteria: general reaction to the use of simulation (5 items), screens (9 items), learning (3 items). The items were distributed in a scale with five categories of answers, varying according to the intensity of the item evaluated: Chin JP, Diehl VA, Norman KL (1998). 16

17 Analysis and discussion of results 17

18 Implementation and interface screens 18

19 Nursing history 19

20 Oxigenation 20

21 Vascular regulation 21

22 Physical safety 22

23 Care plan 23

24 Observations for the student 24

25 First assessment results 25

26 End of simulation 26

27 Evaluations 27

28 Validations Data codification - Microsoft Excel 2003 as a database Statistical treatment by SPSS for Windows Application of descriptive statistical analysis to the variables of database Difference tests between means of some itens of students and faculty, by analysis of variance (α= 0,05). 28

29 Ergonomic evaluation Mean General mean 29

30 Ergonomic evaluation Mean General mean 30

31 Ergonomic evaluation Mean General mean 31

32 Pedagogical evaluation Mean 32

33 Pedagogical evaluation Mean 33

34 Pedagogical evaluation Mean 34

35 Pedagogical evaluation Mean 35

36 Pedagogical evaluation Mean 36

37 General pedagogical evaluation It creates the possibility of the students have their selfevaluation related to assessment and care of critical care patient and a learning stimulation The emission of positive messages and the incentivation of user The simulation is interesting, innovator and with a potential to help learning The utilization of a problem list may turn confused the establishment of interventions adequated to reach each one of the needs The simulation was a bit long and repetitive The impossibility to go back and stop the study to return later 37

38 Usability evaluation 38

39 Usability evaluation 39

40 Usability evaluation 40

41 General usability evaluation Easiness of use makes student think and remember the theoretical content Easy to use and does not need a great knowledge related to use of computers Contribution to learning with a rapid answer to the questions The impossibility to go back to previous evaluation and to compare with the current evaluation The presentation of some data was considered difficult to evaluate as some students forgot the reference values 41

42 Difference tests between means ANOVA Source Sum of squares Mean square F P-valor Critical F Learning 0,0546 0,0546 0,2452 0,6239 4,1596 Knowledge 1,0946 1,0946 5,7762 0,0224 4,1596 Easiness of use 0,0256 0,0256 0,0987 0,7553 4,

43 Final considerations The ergonomic, pedagogical and usability evaluations showed a general satisfactory analysis The objectives were reached and the simulation may represent a consistent proposal to undergraduate nursing teaching. The use of a standard terminology like ICNP would present results with greater possibility of measurement, and creates the need to develop another experiments and analysis The use of open-source is viable, as the utilization of servers and commercial databases may increase the cost to the development of those applications 43

44 References Kemczinski A. Ensino de graduação pela Internet - um modelo de ensino semipresencial. [dissertação]. Florianópolis (SC): Universidade Federal de Santa Catarina; Gasper ML. A developmental case study of the design and implementation of a web-enhanced nursing health assesment course. [Doctoral Dissertation in Education]. Pittsburgh: University of Pittsburgh; Billings DM, Connours HR, Skiba DJ. Benchmarking best practices in Web-based nursing courses.ans Adv Nurs Sci Mar;23(3): Reinert BR, Fryback PB. Distance J Nurs Educ Nov;36(9):421-7 learning and nursing education. Ryan M, Carlon KH, Ali NS.Evaluation of traditional classroom teaching methods versus course delivery via the World Wide Web. J Nurs Educ Sep;38(6): Chen P. Modelagem de Dados: A abordagem Entidade - Relacionamento para projeto lógico. São Paulo: Makron Books;1990 Reeves TC, Harmon S. Educational WWW Sites Evaluation Instrument. Capturated at [28/10/2004]. Available at Elissavet G, Economides AA. An Evaluation Instrument for Hypermedia Courseware. Educational Technology & Society. 2003; 6(2): Chin, J. P., Diehl, V. A., and Norman, K. L. Development of an Instrument Measuring User Satisfaction of the Human-Computer Interface. Proceedings of CHI Conference on Human Factors in Computing Systems, May 15-19, 1988.New York: ACM,