Indiana Partnership for Statewide Education Course Development Grant Proposal
Teaching Surgical Practice in Online Learning Communities
Indiana University

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Abstract

With 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 for increasingly complex patients The purpose of this proposal is to develop a Surgical Nursing Certificate Program that could be used by nursing students as an elective or capstone course or by nursing professionals to develop skills and enhance proficiency in specialized surgical procedures. The program will include a "didactic" component that can be taught on the Internet, a practice component that will be taught in the Virtual Surgical Lab at Indiana University School of Medicine and a clinical preceptored component that can be completed at local agencies where preceptors can be identified. This course/program can be offered in conjunction with a clinical component for use at other schools and health care agencies in a preceptored environment. Specific workforce development needs to be met by this program have been identified by Indiana University School of Nursing and Clarian Health Partners. Indiana University School of Nursing, through its eight campuses provides academic programs throughout the state and beyond; Clarian Health Partners with hospitals located throughout the state is the second largest health care provider in the United States. Thus, the audience for this course is substantial. Total project expenses are $12,000.

Narrative:

1. 2. Need To Be Addressed and Learners To Be Served

The use of surgical procedures continues to evolve as less invasive procedures are developed, and the demand for nurses prepared to work with patients who are receiving these procedures is increasing dramatically. Nurses needed to work in the surgical setting at Indiana University Hospital for example number more than 100 each year. Openings for new nursing positions in the operating room frequently are not filled. Lack of preparation for work in the surgical nursing area and limited exposure to this specialized clinical are two major reason cited. The only constant resource for new operating room nurses has been a clinical course offered at IU School of Nursing as a clinical elective. A review of newly hired registered nurses in the operating room at University Hospital shows that one half of all new hires in 1996, 1997 and 1998 were nurses who took the elective course (Sullivan, 1999). The proposed course will be developed to address the undergraduate nursing student and the needs of graduate nurses interested in becoming an Operating Room (OR) nurse and provide opportunities to enhance knowledge of current OR nurses.

Previous approaches to providing education for these learners have varied from one-on-one instruction to trial and error instruction. However, with the recent development of a surgical technology laboratory that includes virtual procedures and equipment for simulated practice, a more effective means for developing best practices is possible. The use of the Internet to deliver sound and motion demonstrations of use of equipment can enhance the teaching of nurses to work in the operating room. Nurses who must be prepared to use specialized surgical equipment can take advantage of the virtual equipment and simulated practice, as well as the asynchronous environment of Web-based courses that will permit nurses to remain in their own setting while they learn up- to -date procedures. Thus, the use of the Virtual Lab, which depicts in-time sequence of endoscopic surgical procedure coupled with on-line learning courses, will provide a place where the best practices in nursing can be learned. To this effect, this course will provide a professional community of practice for nursing students and professional nurses.

The proposed Certificate Program will be designed to meet the needs of students seeking basic nursing degrees and professionals seeking certification and continuing education. The course will be offered through Indiana University School of Nursing (IUSON) and the Virtual Surgery Lab at Indiana University School of Medicine Department of Surgery for baccalaureate nursing students. The certificate course for graduate nurses will be offered through IUSON Center for Teaching and Lifelong Learning as a continuing education offering targeting workforce development of graduate nurses employed or seeking employment in surgical nursing. College credit will be awarded for undergraduate students. Continuing Education Units will be awarded for graduate nurses certifying completion of the endoscopic training. Among the outcomes for the course are planned clinical elective in an undergraduate nursing program, a capstone module for use in other nursing programs, and a continuing education Certificate program that enhances workforce development and enhancement of quality performance are course outcomes

3. Rationale for Course and Technologies

This course is designed to meet the needs of student nurses at IUSON and other baccalaureate nursing programs who are preparing to work with patients in the surgical health care setting. It will also meet the needs of graduate professional nurses who are working in a surgical nursing position. The use of this course will bring the experience to those graduate nurses employed in locations and institutions that would not have the education otherwise available. The technology used will include the utilization of the IU School of Medicine’s surgical technology lab virtual productions for endoscopic surgery and, the Internet using on-line learning communities for instruction. This will facilitate the environment needed to enhance learning and retention of content by allowing interaction with virtual procedures. This instructional approach will enhance adult learning and retention of essential information. Examples of the use of a range of technologies include multi-media/ Internet conferencing, which will be essential components of the course. By combining the use of the Web-based course using Web CT as the course management software and virtual reality, this course enables teachers and participants to interact with three-dimensional models. This combination of methodology combines advanced network capabilities for learning surgical technique and how to assist with endoscopic and other surgical procedures.

4. Institution's Capacity and Commitment

There is a strong commitment to the development and implementation of this project from Indiana University, through the Office of the Vice President for Distributed Education, the IUPUI campus, Center of Excellence Surgical Excellence at Indiana University School of Medicine, the Department of Nursing at Clarian Health Partners, Inc. and the School of Nursing. This proposal is also consistent with the Indiana University Information Technology Strategic Plan and with the IUPUI Campus initiative to support distributed learning.

The School of Nursing has capacity to develop the didactic component of the Certificate Program for Web-based delivery. The instructional support team is composed of the Director of Lifelong Learning, Learning Resource Coordinator, Multimedia Developer, Database Manager, Video conferencing Coordinator, Instructional Designer, and Webmaster. The content expertise of the PI for this grant will provide direction for the instructional support team. The School of Nursing has five semesters of experience in the development and offering of Web-based courses. The team has also developed six Web-based courses for continuing education. Additionally, the School of Nursing has a grant from Lippincott, Williams and Wilkins publishers to use any of their electronic media in nursing courses without charge. In addition, support for the development of the program content will be provided in collaboration with the Clarian Health Partners, Inc., Center for Surgical Excellence. The Center for Surgical Excellence has access to technology and consultation with the manufacturers of equipment used for endoscopic procedures

5 & 6. Instructional Design and Delivery Plan: How Design Meets Needs of Target Audience

The instructional design plan includes planning, peer review, usability testing implementation and evaluation. First, a review of an existing perioperative nursing clinical elective course at IU School of Nursing and the orientation of graduate nurses for work experience in the operating room will be conducted. Course goals for the participants are to

1. Introduce the undergraduate nursing student to the role of the nurse in the operating room.

2. Experience real time procedures requiring new knowledge

3. Use information-age knowledge and technology to help understand how to assist with surgical procedures with emphasis on endoscopic surgery

Learning activities will be developed based on the standards of practice utilizing asynchronous learning. Standards of perioperative nursing identified by the Association for Operating Room Nurses (AORN, 1998) will serve as a basis for course content. Design will include active learning, collaboration and contact with instructors and clinical preceptors, and interaction with peers. The visual nature of the surgical setting and the OR practice specialty make it especially suitable for virtual and web based design. Course materials will be designed using 3-d graphics to simulate the steps required to assist with a surgical procedure. The course management software, WebCT, has been selected because of the completeness of the tool kit and ease of use.

The course will be structured to be offered during a specified time during which participants can complete modules independently and asynchronously. The Virtual Lab will be available for use to enhance learning. A structured clinical component will be designed for undergraduate nursing students and arranged for preceptor direction after completing the modules. The course will be offered for graduate nurses with modification of the clinical practice component to meet the needs of practicing nurses. After evaluation of system software, network configurations, improvement of design and course materials, the course will be structured to be offered to an audience statewide and beyond

7. Course Evaluation Plan

Frequent evaluation is necessary and critical for the development and implementation of a course that will be meaningful to undergraduate students and to practicing nurses. Usability testing and peer review will be conducted prior to offering the course. A formative evaluation will be done during the course and a summative evaluation will occur at the conclusion of the course. The participants will receive a follow-up survey at six months to determine the applicability of the content and the development of competencies in endoscopic procedures. Strategies for the usability testing will include peer review of the draft of the course. Peers and the instructional support team will also complete a test of the on-line functionality of the course. The formative evaluation will be done by having the course participants complete self-assessments of content and the completion of skills by use of virtual technology. The summative evaluation will include the completion of an evaluation of the course by the participants of both the content and the virtual skills. The participants will also evaluate the effectiveness of the use of the Web and the virtual lab in the presentation of the course. Evaluation instruments currently being used by the instructional support team will be reviewed and modified for use with this course. The follow-up survey of the graduate nurses will be developed prior to the start of the course. All of the evaluation instruments will be, or have been, developed for on-line administration, and results will be aggregated on a previously established database at the School of Nursing.

8. 9. Quality, Transferability, and Fit with Other Efforts

Peers, both undergraduate and practicing nurses will be asked to review the course. Their findings will be used to revise the course as will be necessary. At least 3 peer reviewers will be employed to review for content and applicability of the content in various organizations performing endoscopic procedures. These peer reviews will be used to further develop and refine the course for use by practicing nurses in various care settings.

10. Marketing Plan

The course will be marketed to hospitals, surgical centers, doctor’s offices, professional organizations, and to interested participants worldwide. The course will also be marketed to schools of nursing throughout the state of Indiana and across the United States. Information on the course will be posted on the IUSON Web page and the IUSON-Continuing Education page. Other strategies to gain interinstitutional acceptance will include discussion at meetings of the Indiana Deans and Directors of Schools of Nursing. The course will also be marketed to members of the American Organization of Operating Room Nurses in Indiana.

11. Project Timeline

``````````````````````` January –February 2000 Complete course design; confer with staff development sources at Clarian; develop learning activities; select resources including on-line and virtual lab; prepare course guide; conduct technical team meetings. Collaborate with education resources in the Clarian Health – O. R. departments
March – 2000 Peer review course draft and revisions.
February – March Technical specifications development; course module created in WebCT. Identify Virtual lab support ware
March, 2000 Announce course offering to target audiences
April – May, 2000 Register and enroll undergraduate students
June, 2000 Offer course; formative evaluation.
Summative evaluation by peer reviewer, participants, technical team, project course development personnel Revise as indicated
July, 2000 Register and enroll graduate nurses
August, 2000 Offer course for graduate nurses (RNs)
Summative and Formative evaluation by peer reviewer, participants, technical team, project course development team.
December 2000 Follow up-evaluation

Key Course Development Personnel
Marchusa A. Huff, DNS,RN Associate Professor of Nursing, Indiana University School of Nursing, Course Developer and faculty for J360 Introduction to Perioperative Nursing and K490 Clinical Practice in the Operating Room Clinical nursing elective.
Janice Ward, MSN, RN, Director of Life-long Learning, Indiana University School of Nursing
Staff Development Nurses in the Operating Rooms at Indiana University Hospital, Methodist Hospital and Riley Hospital of Clarian Health Care.
Instructional Support Staff at Indiana University School of Nursing

The total budget request for this proposal is $ 20,162. The request to the IPSE Course Development Grant Program is for $12,000 for salaries for the faculty and instructional design staff and an honorarium for peer review of the course.

The following salaries were derived as a percentage of salary and fringe benefits follows:

Marchusa Huff, Lead Faculty. Will develop and teach the course Salary: Academic semester: $2,622 Fringe: $918 (35.02%) $4,524 Summer: 852 132 (15.4%)

Michael Vaughn, Director of Information Technology. Will design user interfaces; develop multimedia tutorials/case studies. Salary: $2,428 (5%) Fringe: $850 (32.05%) $3,278

Dennis Dell, video conferencing Coordinator. Will develop examples of video-based instructional materials. Salary: $2,251 ( 6%) Fringe: $788 (35.02%) $3,039

 

Photographer O.R – Methodist Hospital operating rooms. Will assist with accurate Visual images of operating room set-ups and digital photos for 3-D design Honorarium. $659

 

TBA, Peer Reviewer. Will review course during development stages and provide. Formative evaluation; will also review on-line teaching and learning at the end of the course (using the on-line record of discussion, chats, collaborative learning activities, and others) $500 $12,000. The School of Nursing will contribute personnel, software and hardware as follows:

Nursing:

School of Nursing Learning Resources Web Programmer (Louise Watkins) (Uploading files to WebCT; enroll students into the course software; manage site) Salary: $2,412(12%) Fringe: $583 (24.18%) $2,995

School of Nursing LAN Manager (Novell Graves) Salary: $804 (3%) Fringe: $194 (24.18%) $998

File server, course management software (site license to IUPUI), Flashlight Current Student Inventory (site license to IUPUI), marketing (brochures, announcements, Web page)

Administrative Assistant Continuing Nursing Education (TBA) Will register participants, award certificates, CE coordination fees. Salary: $1,187 (4%) Fringe: $416 (35.02%) $1,603

School of Nursing Learning Resources Coordinator Serena Novosel Will identify appropriate on-line resources and Web sites. Salary: $791 (3%) Fringe: $277 (35.02%) $1,068

School of Nursing Database Manager (TBA) Will program database for on-line course evaluation and provide summary data and reports. Salary: $804 (3%) Fringe: $194 (24.18%) $998

IUPUI Libraries. Will assist with on-line course reserves. $500$8,162.