Use of an Instructional Design Model in Validating an Online Animated Case-Based Systems Thinking Module

Sunday, 22 July 2018: 2:45 PM

Ann M. Stalter, PhD, MEd, RN
College of Nursing and Health, Wright State University, Dayton, OH, USA
Carol M. Wiggs, PhD, RN, CNM, AHN-BC
School of Nursing, The University of Texas Medical Branch, Galveston, TX, USA


A decade ago, medical errors caused more than 98,000 preventable deaths. Today, medical errors are the third leading cause of death in the United States (Makary & Daniel, 2016). Medical errors are not unique to the United States, but occur globally. Medical errors are not unique to the United States, but occur globally with an estimated one million patients dying across the world due to preventable health care errors (Godschalk, Hartel, & Sbrzensy, 2017). The increasing error trend is linked to Inadequate Organizations Systems or Processes to Improve Safety and Quality (Emergency Care Research Institute, 2017). Researchers in quality and safety assert a crucial need for systems thinking education among nurses and healthcare professionals (Stalter, Phillips & Dolansky, 2017). Innovative animated case-based instruction involving online education is an example of best teaching practice (Mayer, 2014).

The purpose of this study was to retrospectively determine if the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design was used effectively to develop and test an e-learning systems thinking module. The use of the ADDIE model employs best practice in online design evaluation. In this study, ADDIE is used to validate the effectiveness of the systems thinking module. The systems thinking module is consistent with the concept analysis conducted by Stalter et al. (2016). Animated case studies and gaming provided learners with opportunities to understand general systems theory, medication reconciliation and to learn
from mistakes using a just culture framework where professionalism is nurtured to improve systems decision-making.


A mixed method design involved a record audit review of the instructional designer’s journal and calendar entries, learner pre and post test results, and learners’ perspectives of the systems thinking module from discussion boards within a learning management system. A researcher designed checklist based on the seminal work by Danks (2011) was used to determine if ADDIE steps and key activities were evident. An interactive pre- and post-test determined if learners (n=8) increased in systems thinking knowledge.


Frequency statistics validated which steps were followed. Content from the instructional designer’s journal, calendar and the discussion boards were analyzed to determine which key activities occurred.


Findings revealed that 100% of key activities were evident in each step and that learners increased systems thinking knowledge. Recommendations for change to the module were primarily technology-related.