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Technology in the College of Nursing: Perception and Use to Achieve Learning Outcomes

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Iverson, L., Ball, S., Harms, A., Murcek, C.,Woods, S. & Young, T. (2016). Technology in the College of Nursing: Perception and Use to Achieve Learning Outcomes. Online Journal of Nursing Informatics (OJNI), 20 (1), Available at http://www.himss.org/ojni

The aims of this pilot study were to identify current use of mobile device technology by nursing faculty, staff and students; to compare and contrast policies and practices relating to mobile technology in nursing education; and to make recommendations to better align teaching strategies and learning outcomes. The pilot study consisted of a quantitative survey created by members of the College of Nursing's technology committee. The survey was distributed to faculty, staff and nursing students via a survey link. Results revealed implications for both the college and the university as a whole. Issues for the college to address include: a need for more technology training; an approved mobile application list to be shared with faculty, staff and students; and support of student mobile device use in the clinical setting. Implications that need to be addressed university-wide are: the difference between the computer operating system used by half the nursing student body and the computer operating system provided by the school; a need to address the direction of technology systematically; and the mobile device use and needs of faculty, staff and students.

Background

With the expanding needs of the healthcare system, nursing education has been charged with developing programs that further enhance the knowledge and skills of nurses as they enter the healthcare workforce (Institute of Medicine [IOM], 2010). Nursing faculty have responded to these increasing educational needs through the use of technological formats for both classroom and clinical instruction. While encouraging and taking advantage of the vast technological advances made in the past decade, nursing programs have only begun to track the use of that technology (Cahill & Li, 2011; Doyle, Garrett, & Currie, 2014; O'Connor & Andrews, 2015; Revell & McCurry, 2010; Ventola, 2014; Williams & Dittmer, 2009). Use of laptop computers, personal digital assistants (PDAs), iPads, iPods, and smartphones in both the classroom and clinical setting have increased (Ventola, 2014; Cahill & Li, 2011). Use of these devices is often introduced without a clear plan for implementation or coordination of use in nursing education (Williams & Dittmer, 2009). Current students, predominantly of the millennial generation, are touted as being increasingly tech-savvy (Revell & McCurry, 2010). Understanding, evaluating, and documenting how students, faculty, and support staff perceive and use technology in practice is required to validate whether these devices enhance student and individual learning and the ability to provide safe nursing care.

Purpose

This study identified the specific technology used by faculty, staff, and graduate and undergraduate students at a private Midwestern college of nursing. The study was designed to address two objectives - first, how the technology was used and accessed by all parties - and second, to evaluate the use of learning applications on personal mobile devices by all parties in the college. By addressing these two objectives, the study wished to identify if technology gaps existed between the faculty and student population and if these gaps had the potential for creating barriers to student learning in the didactic and clinical settings.

Methods

A simple quantiative survey was developed by the college's technology committee, which is composed of both undergraduate and graduate faculty, staff members, and the eLearning director (See Appendix). Participants completing the survey consisted of faculty, staff, baccalaureate-level undergraduates, and graduate nursing students at the college. Freshman undergraduate-level students were excluded from the study since they were still completing academic prerequisites prior to beginning the nursing curriculum and had yet to use mobile devices in nursing courses.

The research team obtained university Institutional Review Board (IRB) approval. Using a convenience sample, the survey was distributed during the middle of the spring 2015 semester to each potential participant by an emailed link to a secured electronic survey platform where all data was de-identified. A follow-up reminder with the attached link was sent one week later to the initial distribution list; the survey was closed after two weeks. The faculty, staff, and undergraduate and graduate students were given the same initial questions in each of the themed categories related to the technology used: Windows laptop or desktop, Apple laptop or desktop, mobile phone (not Internet-enabled), Internet-enabled mobile device (e.g., smartphone, tablet, etc.), and/or dedicated e-book device (e.g. Kindle, Nook, etc.). Follow-up questions in each category were designed to query each subgroup's in-depth understanding of technology: specific use, perception of usefulness in their daily role within the college, and advantages/disadvantages of the technology available. Faculty and staff were asked whether they felt disadvantaged not having access to Apple computers since many of the students owned Apple computers and the devices used by the college were PCs with the Microsoft Windows operating system.

Results

The data were placed into a SPSS 22.0 version statistics software data editor, where descriptors related to technology use and the relationship to learning outcomes were analyzed by each specified participant group. A total of 144 students started the survey; 105 completed at least 95% of the survey questions. Forty-two faculty and staff started the survey; 31 completed it. Surveys with a minimum of 95% of the core questions answered were included in the data analysis.

Three predominant themes were identified to help understand the need for technology and mobile device support for faculty, staff, and students. The first theme that indicated a need for improvement was related to the question: "How many applications have you downloaded to your mobile device specific to your role in the College of Nursing as a student, faculty, and staff? "(Figure 1). The most frequent answer was 1-3 downloaded applications for both the student and faculty/staff groups. In addition, about 20% of both the students and faculty and staff had 4-6 applications downloaded. These responses identified a gap where a little more than 10% of the students and 20% of faculty and staff had not downloaded any applications to their mobile devices.

Figure 1: Breakdown of downloaded applications on a mobile device specific to each subject group.

The second theme requiring attention was related to the question: " What do you appreciate the most about using applications and/or the Internet on your mobile device?" The top four sub-themes for both students and faculty/staff were convenience, student access to information, size and mobility, and increase in quality and safety of care ( Figure 2). A follow-up question was: "Are mobile devices essential for students in the clinical setting?" Approximately half of the faculty and staff (48%) and slightly more than half of the students (53%) indicated the devices were essential in the clinical setting, while 15% of the faculty/staff and 11% of the students disagreed, stating the devices were not essential in the clinical setting. Approximately 40% of the student and faculty/staff groups felt that mobile devices were not essential in the clinical setting.

Figure 2: "What do you appreciate the most about using applications and/or the Internet on your mobile device?"

In the open response areas, students referenced the use of mobile devices as learning tools that enabled them to look up pertinent information that made them more knowledgeable and prepared to properly care for patients, and that gave them instant access to guidelines and other information to assist with patient teaching. One student elaborated, "Mobile devices allow us to access information specific to patient care. Patients may have questions we need supplemental information to help answer, and mobile devices give us that hands-on access."

The final theme reflected the gaps in the technology used by faculty and students. When asked, "Please indicate the electronic equipment you currently own or plan to buy in the next three months," students predominantly selected Apple products (50%), with Windows coming in second (33%), while faculty/staff selected Windows/PC laptop (55%) as the first choice and Apple laptop (33%) second. To determine whether students, faculty, or staff preferred to choose their own devices versus having the type predetermined by the college, the survey included a question asking whether having a preference was important. A little more than 80% answered "no" to this question. Several comments indicated it would be advantageous for the college to use the same format as the rest of the university campus so that there would be consistency in operating systems.

Discussion

The first theme identified similarities between students and faculty/staff regarding application downloads on a mobile device. However, it is interesting to note the minimal numbers of downloaded applications from both groups, considering that all traditional students are required by the college to have a mobile device. The technology committee plans to include the undergraduate and graduate curriculum committees in the discussion and development of a plan of action. Students and the technology committee recommended that a list of clinical applications for mobile devices be compiled and distributed to students and faculty at the start of the school year. This list would provide information that would give students and faculty access to and similar knowledge about appropriate applications. This may further encourage the use of applications among students and faculty or staff who may not otherwise use the resources.

Students have always been expected to maintain up-to-date knowledge of clinical guidelines when providing patient care. The use of mobile devices in the clinical setting may allow an opportunity for students to take personal responsibility for learning and being accountable for their education. For example, if a clinical instructor asks a student about the current guidelines for deep vein thrombosis (DVT) prophylaxis, the student may use a mobile device to search for these guidelines. This, in turn, should help prepare students for professional practice.

The second theme of this study was how students and faculty/staff perceived their ability to access applications and the Internet on their mobile devices. Both students and faculty/staff identified the importance and convenience of having the Internet and/or mobile devices available. There were several identified barriers to using a mobile device in the clinical and education settings. These were related to infection control, use of social media, etiquette, cost, confidentiality, policy limitations, and lack of knowledge about available clinical applications. Although using technology and mobile devices in the clinical setting assists with provision of quality care and improved patient outcomes, the barriers to use can be extensive and limiting. One student commented, "Students need to be able to utilize resources to support the care they provide...they are not allowed to utilize these devices on the clinical floor... they are allowed to utilize these off of the clinical floor." Another student noted that she did not use a mobile device or applications in the clinical setting because all needed information was provided on the organization's website.

The final theme analyzed the gap that exists between the technology used by the faculty and the technology used by the student base. Students and faculty members both identified the frustration that accompanies not having compatible technological devices, which make it difficult at times to communicate and complete assignments because of different interfaces. Faculty identified that it was difficult to teach and support students who use different operating systems, particularly when a faculty member was not familiar with the differences in accessing aspects of the software related to the different operating platforms.

Limitations

Potential limitations that will be addressed with future research include the initial use of the measuring instrument and inconsistency in participation levels. Although the information obtained from the survey tool was adequate to evaluate the use of technology within the college, future research studies will be required to establish the validity and reliability of the survey instrument to accurately obtain the data needed to assess the use of technology within a defined organization. The second potential limitation to consider is the inconsistency of the participation between faculty members and students. The existing faculty participation rate was 49%, whereas the student participation rate was 59.4%.

Implications for Future Practice and Research

The technology committee at the college will present these findings to the curriculum committee to determine whether all undergraduate students, including accelerated nursing students, should be required to have a mobile device. Faculty/staff and students will be encouraged to use the list of clinical applications for patient care. Possible education and training sessions on different operating systems or mobile devices may be incorporated into orientations for faculty/staff and students. Discussion with college administration needs to occur to consider the option of offering a choice to faculty/staff in computer operating systems to address the discrepancy between what students use to access required technologies and the access faculty/staff are provided to support student use of the required technologies. Future research should include surveying clinical site administrators and patients regarding their perceptions regarding the use of mobile devices in the clinical setting. Continued support and monitoring on the use of mobile devices in the clinical setting needs to be encouraged and implemented at all clinical sites.

Conclusion

This study explored the use of electronic technology, particularly of mobile devices, by faculty, staff, and students at a college of nursing within a private Midwestern university. Findings indicated discrepancies between what is required and what is actually used. While some form of mobile device (smartphone, tablet, dedicated e-book device, such as Kindle, Nook, etc.) has been required for a number of years, not all faculty, staff, or students actually have taken advantage of these resources. To fully appreciate the utility of technology, a number of barriers need to be addressed. As the technology committee addresses these gaps and barriers, sharing the knowledge with others will allow them to ask the question: Are there gaps between differing technologies used by faculty, staff, and students that prevent quality interface within our curriculum?

References

Cahill, K. & Li, R. (2011). The potential of wireless handheld devices to enhance pediatric curriculum. Distant Learning, 8(2), 1

Doyle, G. J., Garrett, B., & Currie, L. M. (2014). Integrating mobile devices into nursing curricula: Opportunities for implementation using Rogers' Diffusion of Innovation model. Nurse Education Today, 34(5), 775-782

O'Connor, S., & Andrews, T. (2015). Mobile technology and its use in clinical nursing education: A literature review. Journal of Nursing Education, 54(3), 137

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=R1

Revell, S. M., & McCurry, M. K. (2010). Engaging millennial learners: Effectiveness of personal response system technology with nursing students in small and large classrooms. The Journal of Nursing Education, 49(5), 272-275

Ventola, C. L. (2014). Mobile devices and apps for health care professionals: Uses and benefits. Pharmacy and Therapeutics, 39(5), 356

Williams, M. G., & Dittmer, A. (2009). Textbooks on tap: Using electronic books housed in handheld devices in nursing clinical courses. Nursing Education Perspectives, 30(4), 220-225