Virtual simulation in healthcare education: a multi-professional, pan-Canadian evaluation.

BACKGROUND: As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community. METHODS: Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences. RESULTS: The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential. CONCLUSION: Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice.

An educator's toolkit for virtual simulation: A usability study.

BACKGROUND: The rapid change brought on by COVID-19 meant that many educators adopted virtual simulation quickly, often without having a strong background in the pedagogical principles of virtual simulation. To address this resource gap, a team of 21 Ontario virtual simulation-experienced educators created the freely available, online, interprofessional Virtual Simulation Educator's Toolkit. The Toolkit provides the theory, practical strategies and resources needed to teach effectively with virtual simulation. Because the Toolkit would include new content, resources and numerous untested design elements, the team conducted a usability test. DESIGN: A usability study, that followed a three-step process, was conducted. Participants were asked to carefully review the Toolkit, including all interactive components and complete an online survey based on the Technology Acceptance Model, to measure the ease of use and utility of the Toolkit. Lastly, participants were interviewed. PARTICIPANTS: In keeping with sampling principles for usability studies, twenty experienced virtual simulation educators from different disciplines participated in the study. METHODS: A validated survey and one-on-one interviews were used to measure educators' perceptions of the ease of use and utility of the Toolkit and their recommendations to improve it. Quantitative data were analyzed using descriptive statistics and qualitative data were coded and themes developed. CONCLUSION: The score of 90 % on the Toolkit Experience Survey indicated that participants found the Toolkit both easy to use and useful. Results from the interviews indicated that a practical, accessible professional development tool is urgently needed to support education with virtual simulation. Because the Toolkit introduces educators to different ways of implementing virtual simulation, as well as options, process considerations, and tools to enhance their teaching with virtual simulation, different disciplines and educators with different levels of simulation experience may benefit by using it.

User Engagement Using an Etextbook: A Descriptive Study.

Engagement is an integral pedagogical component underpinning effective educational activities and is of importance for educators using online platforms. Carefully designed, technology-enabled learning resources can increase student engagement. We developed an open educational resource etextbook on vital sign measurement using an interactive and multimodal platform to facilitate student learning. The etextbook design was informed by experiential teaching-learning theory. Students progressed through the etextbook at their own pace, following pedagogy informed by the iterative process of read, observe, practice, and test, commonly used in nursing education. The etextbook was introduced as a required reading in a first-year health assessment course at one university and two colleges. In this project, we explored the level of engagement experienced by users of the etextbook. We conducted a descriptive study using the User Engagement Scale to measure students' degree of engagement using the etextbook. Results from participants (N = 455) who used the etextbook in the study indicated a high level of engagement. The responses to an open-ended item on the survey provided context to the results and shed light on effective design practices. Several recommendations for best practices in developing etextbooks are identified for educators to consider.

A Canadian Massage Therapy Education Environmental Scan.

BACKGROUND: Massage therapists have been a part of Canadian's health care since 1919. The profession has gone through great change over the past 100 years including adjustments to entry-to-practice education. An important recent change was the implementation of massage therapy (MT) education program accreditation. In light of the likely disruption as a result of programs becoming accredited, a scan of the current state of MT education in Canada was undertaken. METHODS: An environmental scan informed by seminal medical education efforts was used to describe the thoughts and opinions of MT education stakeholders in Canada. Specifically, stakeholders were interviewed regarding the current state of MT education and their comments were analyzed for common themes. RESULTS: Twenty-one stakeholders participated. Four themes were constructed: variation, isolation, stagnation, and accreditation. Variation is described as the impact of differences in content and quality of the education provided in MT colleges. Isolation is described as the feeling of the participant being separated, or disconnected, from the regulator, accreditor, or colleagues due, at least in part, to a lack of communication or networking opportunities. Stagnation is described as a lack of activity, growth, or development within MT education. Participants talked about accreditation, both as a solution for some of the challenges previously mentioned, and as a potential challenge in itself. CONCLUSIONS: Several challenges to MT education were described by stakeholders that they hoped would be remedied by national MT program accreditation. Despite some limitations, this environmental scan forms a baseline for stakeholder views on massage education in Canada upon which future comparisons can be made. While the environmental scan results are most useful when applied to the MT in Canada context, stakeholders in other countries may also find them interesting and valuable when considering challenges facing their own education programs.

Usability of the Participation and Quality of Life (PAR-QoL) Outcomes Toolkit Website for Spinal Cord Injury.

Background: Quality of life (QoL) is an important parameter to monitor during rehabilitation; however, accurate assessment is challenging. Among individuals with spinal cord injury (SCI), assessing QoL is further challenged due to complex sequelae, such as secondary health conditions and factors related to community integration. A Participation and Quality of Life (PAR-QoL) toolkit was created to aid clinicians and researchers in the selection of QoL outcomes tools specific to SCI. Objectives: The aim of this study was to evaluate the use and usability of the PAR-QoL toolkit. Methods: A cross-sectional study was conducted using an online survey from December 2013 to November 2016. Google Analytics were collected from April 2012 to April 2018. Survey sections addressed "use" (behavioral practices and actual use) and "usability" (perceived ease of use and perceived usefulness). Any person who visited the PAR-QoL website was invited to complete the survey. Summary statistics and percent concordances were calculated to describe results from the survey and Google Analytics. Results: The PAR-QoL website had 188,577 users. The five most visited webpages were outcome tools, with bounce rates ranging from 77% to 90%. Of the 46 survey respondents, 67% were not current users of the PAR-QoL website, and 87% intended to use the resources in the future. Conclusion: Uptake of the PAR-QoL website is currently limited. Usability of the PAR-QoL website may be improved by modifying navigation, removing the "less useful" components, ensuring regular updates of content and resources, and promoting the website.

The Impact of Positive Space Training on Students' Communication With LGBTTQ+ Communities.

The lesbian, gay, bisexual, transgender, two-spirit, and queer (LGBTTQ+) communities have experienced discrimination from nurses and other health care professionals, resulting in health inequity. The purpose of this study was to examine the impact of positive space training on students' knowledge and comfort level with LGBTTQ+ communities. A quasi-experimental study with surveys and focus groups was conducted with 160 students. All participants perceived an increase in knowledge and comfort in communicating with LGBTTQ+ people after training. Positive space training can be part of the bank of learning strategies we offer students to increase their knowledge and comfort when interacting with LGBTTQ+ communities.

Virtual gaming to develop students' pediatric nursing skills: A usability test.

BACKGROUND: As competition for specialty clinical placements increases, there is an urgent need to create safe, stimulating, alternative learning environments for students. OBJECTIVE: To address that clinical gap, our team developed a virtual game-based simulation to help nursing students develop their pediatric nursing skills. DESIGN: A usability study was conducted using the Technology Acceptance Model as a research framework. SETTING AND PARTICIPANTS: The study was conducted at a community college and included nursing students, nursing faculty/clinicians and two gaming experts. METHODS: The two experts evaluated the game using a heuristic checklist after playing the game. Participants engaged in a think-aloud activity while playing the game and completed a survey and interview based on the Technology Acceptance Model to explore ease of use and utility of the game. RESULTS: We found a high degree of user satisfaction with the game. Students reported that they had learned about pediatric care, they had become immersed in the game and they were keen to keep playing. Several design changes were recommended. CONCLUSION: Usability testing is critical in the early stages of simulation development and the study provided useful direction for the development team in the next stage of game development.

Can emergency nurses' triage skills be improved by online learning? Results of an experiment.

INTRODUCTION: Emergency nurses deal with increasing complexity of patients. In 2003 there were over 14 million ED visits in Canada. The Canadian Triage and Acuity Scale (CTAS) is a 5-level system used by ED triage nurses to classify patients. There is a need for standardized training for all triage systems. In an effort to improve access to CTAS training, a 6-week Web-based CTAS workshop was developed. We determined the impact of Web learning on the accuracy of the triage skills of registered nurses (RNs). METHODS: An experimental method was used in which 132 RNs were randomized to an intervention group (n = 65) or control group (n = 67). All RNs received exactly the same content and learning activities. The experimental group differed from the control group in 3 ways: a mandatory tutorial, awarding of marks for online discussion, and completion of a workplace project. Data were collected using standard instruments, chart audit, and interviews. RESULTS: The Web course provided a standardized and effective educational experience that enhanced emergency nurses' triage accuracy. The mandatory online tutorial, online discussion, and workplace project increased the RNs' preparation for online learning, and these educational methods were successful in transferring triage learning to practice. DISCUSSION: Web learning can help professionals maintain competency and support professional practice. Further research is needed to provide evidence for best practices in E-learning for RNs. The accuracy of the RN's triage assessment impacts patient health, hospital accreditation, and funding.

Internationally educated nurses' experiences with an integrated bridge program.

BACKGROUND: Countries around the world are experiencing a current and projected ongoing shortage of nurses. Internationally educated nurses are an underused, valuable human resource that could reduce the nursing shortage. A bridge program, with several innovations bundled into one program, was developed specifically to meet the needs of internationally educated nurses. METHODS: A qualitative study using interviews was conducted with internationally educated nurses. Data were collected in the first semester, at the end of the program, and after nurses started work. RESULTS: Although knowledge of the health care system is critical, an understanding of the adopted country's educational philosophy is also important. Occupation-specific language training and ample clinical time are essential for program success and for helping participants to secure employment. CONCLUSION: "One-stop shopping" bridge programs that provide a range of curricular supports for internationally educated nurses are essential to support this pool of highly skilled nurses in preparing for practice in their new home.

Getting the right information to the table: using technology to support evidence-based decision making.

Healthcare executives report that it is difficult to access the research literature and once found, it is frequently not relevant. A study was conducted to explore ways in which healthcare executives, enrolled in the EXTRA program, used a virtual desktop environment. Despite some design and function limitations, the desktop was perceived positively by most participants and was effective in supporting evidence-informed practice and decision making.

Emergency medical and health providers' perceptions of key issues in prehospital patient safety.

OBJECTIVES: To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. METHODS: A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. RESULTS: Two major themes were identified under the category of key issues: clinical decision making and EMS's focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through "scope creep." If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. CONCLUSION: The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.

The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning.

A recent national assessment of emergency planning in Canada suggests that health care professionals are not properly prepared for disasters. In response to this gap, an interprofessional course in disaster management was developed, implemented and evaluated in Toronto, Canada from 2007 to 2008. Undergraduate students from five educational institutions in nursing, medicine, paramedicine, police, media and health administration programs took an eight-week online course. The course was highly interactive and included video, a discussion forum, an online board game and opportunity to participate in a high fidelity disaster simulation with professional staff. Curriculum developers set interprofessional competency as a major course outcome and this concept guided every aspect of content and activity development. A study was conducted to examine change in students' perceptions of disaster management competency and interprofessional attitudes after the course was completed. Results indicate that the course helped students master basic disaster management content and raised their awareness of, and appreciation for, other members of the interdisciplinary team. The undergraduate curriculum must support the development of collaborative competencies and ensure learners are prepared to work in collaborative practice.

Improving infection control competency through an online learning course.

BACKGROUND: While most staff are aware of the basics of infection prevention and control, this can be eroded over time. In addition, it is difficult to keep up with emerging best practices. AIM: To develop an online course to improve infection prevention and control competency and access to training. METHOD: Surveys were conducted with 76 healthcare professionals, most of whom were nurses, before and after the course. RESULTS: Participants made significant increases in competency scores, and satisfaction with the course was high. DISCUSSION: A number of barriers to online learning in the workplace were identified. Organisational support in terms of protected training time, computers and internet access are essential. CONCLUSION: Online learning can be an effective way for nurses to learn or refresh their skills and knowledge but needs employer support to be successful.

Evaluation of patient satisfaction with tailored online patient education information.

Patients are using the Internet for access to standardized health information in ever-growing numbers. Although increased access to health information can be helpful, the quality of information varies widely. All too often, the information retrieved is incomplete, inaccurate, or inappropriate. An interdisciplinary team of clinicians, librarians, software engineers, and multimedia designers developed an online patient education system that enables clinicians to "prescribe" tailored, evidence-based health information. The system provides access to text and video that patients can adapt for language, vision, and hearing preferences. Usability testing was conducted with eight patients in a usability laboratory using the "think-aloud" method, surveys, and interviews. Results indicated that patients were highly satisfied and that the site has the potential to become a valuable resource in disease management. Patients made several recommendations regarding system appearance, function, and content that will have application for other groups developing online patient education systems.

Impact of an online course on infection control and prevention competencies.

AIM: This paper is a report of a study to examine the impact of an online course on nurses' and allied healthcare professionals' competency in infection prevention and control and the influence of organizational climate on knowledge transfer. BACKGROUND: Nosocomial infection, globalization, international travel and bacterial resistance are among the factors contributing to heightened awareness of the importance of infection prevention and control in today's healthcare environment. An online course in infection control was developed to facilitate the delivery of standardized training to large numbers of health providers. METHOD: A quasi-experimental, pre-and post-test study using questionnaires and open-ended questions was conducted in 2006 with a convenience sample of 76 healthcare professionals, the majority of whom were Registered Nurses. FINDINGS: Participants made statistically significant increases in their perceptions of competency in infection control following the course. The majority were very satisfied with the course and reported that what they had learned was useful and relevant to their practice. Participants who worked in supportive organizations that were open to change reported a higher incidence of knowledge transfer activities. Two course design features in particular, video and interactive quizzes and games, motivated learners and enhanced the learning experience. CONCLUSION: Online learning can provide ongoing, convenient and effective access to up-to-date information on best practices in infection control and prevention. This standardized delivery approach minimizes demand on limited training resources which are under strain and gives learners the opportunity to refresh 'rusty' infection control and prevention skills.

Development of an online, team-based programme in telecare.

Few health-care providers have experience of delivering telecare and access to formal training is limited. We therefore developed an online training programme in telecare. A participatory design approach was used and telecare providers were invited to participate in each stage of the course design cycle. The course content, learning activities and learning materials such as video were based on the results of interviews with providers from various health disciplines and observations in the telecare workplace. The approach led to the development of a six-week, multimedia, online course for members of the health-care team. Participants were asked to review the prototype course for completeness and accuracy of content, quality of course design and the utility of learning activities. Overall feedback was favourable. Learners found the course content and learning activities helpful, and it met their needs. The learning material was then reviewed by a panel of experts and further revisions were made. Including providers in the development process led to the creation of a course that appears likely to improve the implementation and practice of telecare.

Becoming a web-based learner: registered nurses' experiences.

AIMS: The purpose of the study was to describe Registered Nurses' experiences when taking a web-based course from either the workplace or home, and the impact of their learning on clinical practice. RATIONALE: Little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting. Even less is known about whether nurses transfer their web-based learning to clinical practice. METHODS: A qualitative design employing focus group interviews was used. Participants included hospital and community nurses from three Canadian provinces and one territory. Data were collected at three points over a 6-month period and analysed using a thematic analysis process. These findings emanate from a larger study using survey method and focus group interviews. RESULTS: The focus group interviews captured the hurdles nurses faced during the first weeks when they struggled with technology, re-framed their views of teaching and adjusted to web-based learning from home and work. These first stressful weeks were followed by a period during which nurses developed relationships with the teacher and peers that enabled them to focus on learning and prevented attrition. Most nurses reported the web course was convenient and that they would be interested and comfortable using technology for learning and work purposes in the future. Six weeks after the course was completed, nurses articulated a number of ways the course had improved their practice. CONCLUSION: Initial weeks in a web-based course can be very challenging for novice Internet users, however, most nurses who completed the course reported a positive learning experience. Nurses, employers and educators should evaluate computer skills, computer access and the learning environment when preparing for web-based learning.

A descriptive study of registered nurses' experiences with web-based learning.

AIMS: To describe the experiences of registered nurses (RNs) who enrolled in a web-based course from either their home or the workplace. RATIONALE: In order to maintain competency in rapidly changing health care systems, and meet the challenge of overcoming traditional barriers to continuing education, RNs need access to innovative educational delivery methods. As yet, little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting. METHODS: The article focuses on the results from questionnaires conducted with 57 RNs enrolled in a web-based, postdiploma course. These findings emanate from a larger study using survey method and focus group interviews. Nurses' experiences were measured using the Online Learner Support Instrument which was developed and tested for use in the study. RESULTS: Most nurses found the course highly satisfactory. Not all experiences were positive however, and a number of challenges were faced. Access to the course from home was reported as very satisfactory for the majority, while work users encountered a number of serious barriers such as insufficient time and limited computer access. The RNs made significant gains in their learning with e-mail, Internet, keyboarding and word processing skills during the 16-week course. Lack of computer skills, erroneous perceptions of course workload and inadequate preparation for web learning were largely responsible for the majority of withdrawals. CONCLUSION: Web-based learning can be an effective mode of delivery for nursing education. Advance preparation by educational institutions, employers and prospective students is essential. Teachers, peers, technology, course design and the learning environment are key variables that influence the learners' experience and success.