The research question of the study was: Is the efficacy for the use of a virtual community supported; as the source for gathering information necessary for completion of assignments, and thus achieving student learning outcomes?
History of the problem:
The motivation for the curricular change was the need to provide a more standardized learning experience and role specific patient interaction for the students. The necessity for change was identified based on student feedback regarding the challenges faced in arranging a practicum experience, lack of opportunity to apply new learning, and faculty report of inconsistent quality of student work related to those observation-only clinical hours. The faculty felt compelled to explore less traditional approaches for providing the students with: the opportunity for patient assessment, exploration of the community based nursing role and development of a plan of care. The choice to move in the direction of using a virtual experience was based on current literature and in-depth discussion with product providers (Fogg, L., Carlson – Sabelli, L., Carlson, K., & Giddens, J., (2013), Schuster, G., Foret Giddens, J., & Roehring, N. (2011), Cant, R., & Cooper, S., (2014).
A review of the Essentials for Baccalaureate Nursing (AACN, 2008) related to population health and clinical prevention in a community setting informed the review of current student learning objectives and writing of new ones to align with using a virtual community. Once this was accomplished, the next steps in developing the learning plan were to design the learning modules, identify from the chosen web-based program the activities to build assignments, and writing of assignment directions and rubrics. The goal was to achieve a high degree of interaction for the students with the virtual community. A scaffolding approach was followed to place the learning tools and assessments in the course design framework (Salyers, V., Carter, L., Cairns, S., & Durrer, L. (2014). A full course redesign was necessary in order to fully incorporate the scaffolding approach.
The course design moved students through activities beginning at an ‘explore new concepts’ level of learning, to navigating through the four nurses stories, to linking the nurses work in the virtual program stories to community based nursing role responsibilities and finally patient outcomes. Once these steps in the development were accomplished the course was subjected to faculty peer review. Slight modifications were made, then the course moved to the pilot stage and student review. In the final week of the course a free text narrative question was added seeking student feedback on the virtual community. These entries were compiled into a report for faculty review. A discussion group of teaching faculty yielded suggestions for changes to assignments, placement of assignments within the course and enhancement of rubrics. The responses provided by the students resulted in clarification of instructions for how to access the virtual community, assignment direction and more detail added in the assignment worksheets/tables.
The study results reveal that students encountered initial stress with first time access to the virtual community, but once entering the site they found it easy to navigate, the variety of information and presentation methods was appealing, as was the depth of detail on the nurses and patients. The students also report developing an emotional connection with the characters; even going beyond assigned episodes to find out what ‘happened next’ to the character. They also recognized that there were aspects of patients’ lives outside of their acute care practice setting that have an impact on how an effective plan of care is developed; which they had not considered. Another point of new learning was the breadth of the community based nurses role and the variety of ways they interact with and care for their patients.
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