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Kevin Tressler Project Plan: !

Enhancing Second-Year
Nursing Experiences

Executive Summary
The purpose of the Enhancing Second-Year Nursing Experiences iPad integration project is to increase
student confidence and decrease student anxiety in clinical decision making as they transition into the
clinical environment as second-year nursing students. This project supports goal 3 of the Vision for the
University’s 3rd Century: Enable exceptional educational experiences. Successful completion of the
project will advance student competency as well as provide an example of technology-enhanced
learning experiences resulting in greater student achievement.

Introduction
Traditionally, nursing students have experienced a high level of anxiety with low confidence while
applying clinical decision making skills in a live clinical setting. A contributing factor to this problem
includes inexperience with accessing electronic health records (EHR) programs such as Epic. The
challenge is compounded by inexperience with reading and interpreting an EHR. Purposeful integration
of the iPad into didactic and clinical learning environments will provide opportunities for students to
gain practical experience in a risk-free, authentic situation. Making an impact on this aspect of the
nursing student experience has lasting effects for students, faculty, and the school as a whole. When
nursing students enter the active medical environment without the proper training they become a risk
factor the host site must monitor. Ineffective students reflect inadequate instruction and furthermore,
reflect a poorly-designed and implemented course of study. As a result, it is critical the school make
efforts to design learning experiences that prepare nursing students for successful transition to the
clinical environment.

The University of Virginia Parents Fund will be the targeted funding entity for the project. Once an
academic year, the UVA Parents Fund issues various grants for advancing instructional practice within
specific fields. If granted, the UVA Parents Fund will provide the funds needed to complete the project
and create the potential for a research-based scholarly article. The requirements of the Parents Fund
grant include both the instructional implications for the target group, as well as the broader impact
across the School of Nursing. Funding is granted for a one-year time frame with no continuing support.
Any costs associated with continuing the implementation will be absorbed by the School of Nursing.

Goals and Objectives:

The goals and objectives of the project reflect the desire to enhance learning experiences for
students to build the skills necessary for effective application in the clinical environment.

1. Second-year nursing students will be able to access and navigate the Epic electronic
health record system.
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2. Second-year nursing students will be able to read and interpret a patient chart in the
Epic electronic health record system.

3. Second-year nursing students will increase confidence while decreasing anxiety as it


relates to clinical decision making in the live nursing environment.

Success Criteria:

1. Increased confidence and decreased anxiety in clinical decision making: A goal


of the project is to enhance second-year nursing students’ learning experiences that
lead to more effective clinical decision making skills. Achieving this goal not only
impacts students in their course but also as they move forward into the nursing
workforce.

2. Increased engagement in learning experiences: Student engagement in learning


experiences lends itself to better outcomes. Transferring knowledge and skills from
the practice environment to the “real-world” setting is a critical component of the
learning experience that increased engagement can support.

3. Enhanced learning experiences via strategic technology integration: Planning


effective and appropriate technology integration into the learning environment is a
foundational component for the project to be successful. Well-designed experiences
with the available technology tools should reveal the perceived enhancement of
learning from both students and faculty.

Needs Assessment
Overview

Over the last several years, it has come to the attention of the second-year nursing faculty that students
within the BSN program do not reflect confidence in the necessary competencies to effectively navigate
the clinical decision-making processes. Although several strategies have been implemented, there has
not been a significant change in the student output. To solve the problem, a project team consisting of an
instructional designer, several leading second-year faculty, and an IT representative have created a plan
for moving forward. The project team proposes integrating a more authentic experience into the learning
environment through the use of instructional modification and technology.

Communications Audit
In order to understand the dissemination of information within the organization as a whole, an audit of
the communications procedures was completed. The significance of communication impacts the project
due to the manner in which instructional practices, including successes and failures, are recorded and
shared. While specific details of the project were not evaluated, the holistic snapshot provides a
foundation for evaluation of improvement and possible avenues for sharing results.
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Communications Audit Table

Promotional General staff Team


Social media posts Website
brochures communication Meetings

Format

Print (p) Online (o) Online Print Online Online In-person


Video (v)

The website is designed for The team


Typical communications
external users who may be working on the
Available brochures are via email. These are
The school uses seeking information as well project will be
currently include from various levels and
Facebook and as internal users who are a meeting once
Description of information for sources – the President’s
Twitter as the two part of the school. Internal every two
sample perspective BSN, RN office, the Provost’s
main social media areas of the website are weeks
to BSN, CNL, DNP, office, faculty, teams,
channels. protected via an intranet log throughout the
and PhD students. students, Collab LMS
in that requires Netbadge project
support, mangers, etc.
and Duo authentications. timeline.
Intended audience

Internal (I) External External External Internal External and Internal Internal
(E)

For external users the


primary purpose is
The main purpose of
information. External users
the brochures is to The primary purpose of
include potential students,
provide key most emails are
faculty and staff in other Plan project
information to communications of
Posts are designed locations/schools, and details, review
potential students important information
to spark interest, those who would have need progress,
who are exploring that impact faculty, staff,
highlight for accessing the modify plan,
Primary intended the program. The and/or students. Being in
achievements, and information. Internal users share data and
purpose team responsible for a support role, the
connect with other who access content via feedback, and
these isolate data majority of the emails I
nursing schools/ Netbadge and Duo prepare for
points of relevance receive are requests for
educators/students. authentication can access sharing of
to place into instructional support.
training resources, staff data.
infographics such as Sensitive information is
handbooks, and other
graduation rates and not shared via email.
relevant documents that are
US News rankings.
designed for staff and
faculty use only.

Yes – Most posts This depends on the Yes – The front facing page Yes - Each
Message had strong highlight student Yes – Each brochure nature of the shares valuable information meeting will
connection to achievements or is directly connected communication, but as for potential and current be focused
instruction and/or faculty research as a to student the role of each member students. Each area around the
students
means of attracting achievement and of the school ultimately addresses a specific aspect impact of the
Yes (Y) No (N) students to apply to advancement. impacts student work, I of being a student within project in each
the program. would say yes. the school. phase.

Perception of
effectiveness for the
communication

Very – blue
Moderately Effective Very Effective Effective Effective
Effective – green

Moderately – yellow

Not - red

I am not sure if the The only evaluation


Evaluation measure
student services measure I am aware of is
used?
No No No
team uses any traffic by site counter and
Yes (Y) No (N)
evaluation tools. clicks.
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Project Life Cycle


Scope and Justification
The project has been broken into six (6) phases spanning the fall 2019 and spring 2020 semesters.
Incoming second-year BSN students will be encountering the material for the first time, allowing them
to have a fresh perspective and experience with the content application. Between the two semesters,
students will complete courses which regularly utilize clinical decision making from introductory
understanding to more advanced application. At the completion of the spring 2020 semester, students
receive their “pin” which denotes the transitionary period from a beginning nursing student to one who
is ready to engage with more clinical, hands-on learning moments within the hospital. As a result, the
project must begin and end within the academic year.

Project Life Cycle

Phase Description of Phase

• Complete application for funding - Parents Fund

• Create and review survey

Phase 1: Data Gathering (pre) & Funding • Have SME review survey for approval

• Distribute survey to applicable students and faculty

• Plan with faculty for instructional change

• Conduct faculty development sessions

Phase 2: Implement Instructional Changes


• Finalize faculty integration plans

via iPad Integration and Faculty Development • Deploy iPads to applicable classes

• Support integration efforts across courses

• Create and review survey

Phase 3: Data Gathering (post) • Offer focus group interview opportunities

• Compile data from pre-survey, post-survey, and focus group interviews

• Review compiled data from surveys and focus groups

Phase 4: Review Data & Findings • Translate data into sharable graphics and summaries

• Create digital and hard copy versions for distribution to various stakeholders

• Distribute relevant data to faculty and grant organization

Phase 5: Share Findings • Submit abstract for review to AECT conference

• Submit abstract for review to relevant journals

• Meet with SME and grant-associated faculty to develop plan

Phase 6: Develop Long-term Plan • Share plan details with Associate Dean

• Map roll out across courses

Phase 1: Data Gathering Phase 4: Review Data &


Phase 5: Share Findings

(pre) & Funding


Findings

Deadline: February 7
Deadline: September 16 Deadline: January 17

Phase 2: Implement Phase 3: Data Gathering Phase 6: Develop Long-


Instructional Changes
(post)
term Plan

Deadline: November 22 Deadline: December 18 Deadline: March 13


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Resource Management
Roles

Role Description

Project Manager Oversees the entire project

Instructional Designer Works with faculty to redesign learning experiences

Subject Matter Experts (SME) Faculty experts in nursing

Approving entity Person/people approving aspects of the project

Supporting all hardware and software needs for the


Instructional Technology (IT)
project

Stakeholders

Stakeholder Role Purpose

Project Manager
Work with faculty to design and develop integrations for
Kevin Tressler

Instructional instruction as well as lead the professional learning


Instructional Designer
Designer experiences for applicable faculty.

Bethany Coyne
Director of the Bachelor of Science in Nursing program
Assistant Professor of Nursing SME overseeing the development of students from second to
BSN Program Director fourth year

Sarah Craig
Faculty member responsible for clinical faculty continuity
Assistant Professor of Nursing SME with didactic classroom instruction; course instructor
Third Year BSN Level Coordinator focused on clinical decision making

Support the mobile device management (MDM) setup


Robert Shifflett

IT and continue maintaining of programs needed for


Systems Engineer
learning

Christine Kennedy
Evaluate the project and provide feedback, approval,
Associate Dean for Academic Approving entity denial for implementation and the potential for
Programs sustainability

Target learning audience who will be utilizing the tools


Second-year BSN Students N/A
available while experiencing the modified instruction

UVA Parent Fund organization Approving entity Evaluate grant submission and determine funding

School of Nursing BSN Clinical Work with other faculty and Kevin to plan and implement
SME
Faculty instructional enhancements.
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Tasks Timeline
Task Phase Person(s) Responsible Start Date End Date

Kevin Tressler

Funding & Purchasing 1: Data gathering & funding Bethany Coyne


June 3, 2019 August 1, 2019
Parents Fund

Create pre-survey Kevin Tressler

1: Data gathering August 12, 2019 September 16, 2019


questions Bethany Coyne

Distribute survey to
1: Data gathering Bethany Coyne August 19, 2019 September 16, 2019
faculty & students

Plan with applicable


1: Data gathering Kevin Tressler August 1, 2019 September 16, 2019
faculty

Faculty development
2: Implement Kevin Tressler August 19, 2019 November 22, 2019
sessions

Plan integration with Kevin Tressler

2: Implement August 19, 2019 November 22, 2019


faculty Applicable faculty

Deploy iPads to Kevin Tressler

2: Implement August 26, 2019 November 22, 2019


classes Robert Shifflett

Create post-survey Bethany Coyne

3: Post-data gathering September 19, 2019 December 18, 2019


questions Sarah Craig

Bethany Coyne

Focus group interviews 3: Post-data gathering November 22, 2019 December 11, 2019
Sarah Craig

Kevin Tressler

Compile data 3: Post-data gathering December 11, 2019 December 18, 2019
Bethany Coyne

Bethany Coyne

Review data 4: Review data & findings December 18, 2019 January 17, 2020
Sarah Craig

Create digital & hard-


4: Review data & findings Kevin Tressler January 6, 2020 January 17, 2020
copy distributions

Kevin Tressler

Distribute findings to
5: Share findings Bethany Coyne
January 17, 2020 February 7, 2020
faculty
Sarah Craig

Submit abstracts for Kevin Tressler

presentations & 5: Share findings Bethany Coyne


January 17, 2020 February 7, 2020
publications Sarah Craig

Kevin Tressler

Meet with grant- 6: Develop & plan for long-


Bethany Coyne
February 10, 2020 March 13, 2020
associated faculty term integration
Sarah Craig

Bethany Coyne

Share plan with 6: Develop & plan for long-


Sarah Craig
February 10, 2020 March 13, 2020
Associate Dean term integration
Christine Kennedy

Kevin Tressler

Map roll out across 6: Develop & plan for long-


Bethany Coyne
February 10, 2020 March 13, 2020
courses term integration
Sarah Craig
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Risks
The table below outlines the risks of the project, the potentiality of the risk happening,
the impact of the risk, and the timing of each risk.

Risks Risk Potentiality Risk Impact Risk Timing

Low number of student


Low Medium Beginning and end of semester
responses

Low number of faculty


Low Medium Beginning and end of semester
responses

Decrease in student
clinical decision making Medium High End of semester
confidence

Increase in student clinical


Medium High End of semester
decision making anxiety

Ineffective learning
experiences as perceived
Medium High End of semester
by faculty due to
integration

Lack of interest/desire to
use the provided tools by Low - Medium High Beginning and middle of semester
faculty and/or students

Negative response from


Parent Fund Grant team Low Medium End of semester
based on data

Evaluation
In order to evaluate the project several data collection instances will be implemented at the beginning
and ending of the course semester. Surveys for both faculty and students will be distributed using
Qualtrics survey tools available at the university to maintain privacy and protection of data. Structured
focus group interviews will also be conducted with faculty and students in separate sessions. Student
questions will focus on confidence and anxiety in clinical decision making as well as engagement and
usage of the integrated technology strategies for learning. Faculty questions will focus on usage and the
impact of instructional strategies with integrated technology.

Appropriate sources of evidence:



Pre survey: Confidence and anxiety in Clinical Decision Making [students]

Post survey: Engagement [students]

Confidence and anxiety in Clinical Decision Making [students]


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Usage [faculty and students]

Focus group: suggestions for improvement [students, faculty]

Start of semester: Collect baseline data from students on confidence and anxiety

End of semester: Collect post data from students on engagement, confidence and
anxiety

Collect post data from faculty on usage

Focus group with students and faculty on potential future usage

Engagement (Montenery, Sorensen, Thompson, Kirklin, White, & Ross, 2013)

Using a scale of large extent to no extent, to what extent did the use of the iPads:

Impact participation in class/lab

Enhance my learning experience in a positive manner

Increase attention in class/lab

Enhance satisfaction in class/lab

Provide an effective tool for learning

To what extend did you perceive enhanced learning and critical thinking from the
iPads:

5 Large extent 4 Moderate extent 3 Neutral 2 Limited extent 1 Not


at all

Confidence and anxiety in CDM (White, 2014) NASC-CDM©

A 27 item self-report instrument to measure perceptions of levels of self-


confidence and anxiety during clinical decision-making.

Directions: Reflect thoughtfully upon each item and answer it as accurately as possible. There is
no right or wrong answer to questions in the survey. Read each of the 27 statements and choose
the option which reflects how you currently feel.

Answer both the self-confidence and the anxiety portion for each item. Please select your
numeric score from this scale for each part of the item. 1 = Not at all; 2 = Just a little;
3 = Somewhat; 4 = Mostly; 5 = Almost totally; 6 = Totally

Plan to use dimension II: Using information to see the big picture (7 items on full
scale). Focuses on seeing patterns and relevance of information; recalling past information
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learned (i.e., labs, anatomy and physiology) to help interpret information; seeing the full clinical
picture

I am ___ self-confident and ___ anxious in my ability to easily see important patterns in the
information I gathered from the client.

I am ___ self-confident and ___ anxious in my ability to identify which pieces of clinical
information I gathered are related to the client’s current problem.

I am ___ self-confident and ___ anxious in my ability to see the full clinical picture of the
client’s problem rather than focusing in on one part of it.

I am ___ self-confident and ___ anxious in my ability to recall knowledge I learned in the past
that relates to the client’s current problem.

I am ___ self-confident and ___ anxious in my ability to interpret the meaning of specific
assessment finding related to the client’s problem.

I am ___ self-confident and ___ anxious in my ability to evaluate if my clinical decision


improved the client’s laboratory studies.

I am ___ self-confident and ___ anxious in my ability to use my knowledge of anatomy and
physiology to interpret information I gathered about the client’s current problem.

Focus group potential questions:

*Each question will be asked of participating students and faculty in separate groups.

Would you recommend continuing the use of these tools for instruction? Why or why not?

What would you change about the experience? What would you keep the same?

How would you describe your learning experience?

Conclusion

The team is hopeful that the changes instituted will allow students to be more prepared to enter the
nursing field. While students are at the center, the final results of this project have implications reaching
further than whether it is a success or failure. Not only will the students be more equipped and the
school continue in its reputation, but the potential exists to influence a complete redesign in clinical
decision making instructional practices for undergraduate and graduate students. Disseminating the
results to a broader audience outside of the university will add another voice to the continuing
conversations around learning in the 21st century.
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Project Extension
A possible extension to the project has been discussed by the team and includes reaching out to an app
developer for the creation of an adaptive learning iOS application to be used on the iPads in learning
experiences. The RFP for the extension, which would seek funding beyond the Parents Fund, is included
below. All dates included in the RFP are tentative.

Request For Proposal

Date TBD

TO: App developer company

FROM: Kevin Tressler


Instructional Designer

SUBJECT: Adaptive Response iOS App – School of Nursing

I am pleased to send you the attached Request For Proposal for an adaptive response iOS app for second year
nursing students.

I would ask that you submit the proposal to me no later than August 15, 2019

Please forward your proposal to:


Kevin Tressler
Instructional Designer
UVA School of Nursing
225 Jeanette Lancaster Way
Charlottesville, VA 22903
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I. Background

The University of Virginia’s School of Nursing has a tradition of equipping students with the skills to be
effective practitioners and leaders in the field. One of the critical components in continuing this tradition is the
need for faculty to help students increase their confidence and decrease their anxiety when making clinical
decisions in authentic nursing environments. In order to do so, the school is piloting the strategic integration of
iPads into learning experiences. These experiences will leverage the technology available via the connected
UVA Health System (EPIC, Mobile Iron, etc.) and reflect the current practices of integrated technology within
the broader UVA Health System.

The purpose of this project is to create a learning environment in which students can gain real-world experience
while increasing confidence and decreasing anxiety for clinical decision making situations. Through the
proposed app request, students will be able to evaluate and make critical decisions for a variety of cases across
the spectrum of patient needs. Making the app adaptive will allow for leveling in questions and answers,
garnering a higher level of skill and ability within student knowledge.

Currently, students have access to some resources that involve clinical decision making, but the majority of
them are removed from the learning environment. Since the iPads will be used by students in the clinical
practice setting, being able to work through a case within that environment will also add to the confidence
needed for effective clinical decision making. It is my hope that your team will be able to support our students
in enhancing their learning experience and contributing to the tradition of our school.
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II. Scope of Work

Target Audience

The target audience will consist of approximately 85 second-year nursing students using iPads within their
clinical learning environment as well as four (4) instructional faculty.
• It is understood that the majority of the students are high-level iOS users and are comfortable in
navigating interactive technologies.
• The four (4) instructional faculty are all average iOS users and have some comfortability in
navigating interactive technologies. This will be significant as instructors will need to be able to
deliver instruction to students on how to use the app.
• All members of the target audience are involved in both academic and clinical learning experiences.
• None of the target audience will be accessing the app remotely outside of the scheduled learning
environment (classroom, clinical setting).

Content

The developed app will provide a useful supplement to classroom instruction. Estimated practice time available
via the app will be roughly 4 hours. Topics should include:

• Clinical decision making


o What is it?
o Best practices
• Pediatric case
o Provide a case study of clinical decision making with a pediatric patient in an authentic
situation
• General medicine case
o Provide a case study of clinical decision making with general patients in an authentic
situation that reflects real-world diversity of patients (gender/sexuality, race, religion, etc.)
• Elderly care case
o Provide a case study of clinical decision making with elderly care patients in an authentic
situation
• Patient safety and quality control
o Provide a case study complete with photos and examples of potential hazards within the
clinical environment for identification and rectification

Each case should have a sequence of branching questions that are also adaptive in nature to level to the
student’s level of knowledge. By creating these types of situations and feedback structures, the goal will be for
the application of content knowledge to increase confidence and decrease anxiety in clinical decision making.
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Deliverables

The learning content should be contained within an iOS app that can be accessed by students on their school-
issued devices.

The final deliverable of the app must meet the following criteria:

• Able to be distributed through the MobileIron MDM system


• Have iOS compatible interactives
• Adaptive leveling to meet the response level of students
• Contain authentic document views and/or interactive electronic health record examples
• Have a variety of potential patients (pediatric, geriatric, general population, acute care, etc.)
• Provide feedback based on answer selection within the clinical decision making practice
• Provide the option for users to capture and/or send response data
• Not collect any user data/information to be stored on cloud servers
• Meet UVA vendor requirements (to be shared)
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III. Working Relationship

The work described here will be accomplished in a team context with team members having professional
expertise in the areas cited above. The general working relationship is described here. Any additional
responsibilities will be detailed in a specific contract.

• Project managers will be assigned by both the School of Nursing and the vendor and will act as the single
point of contact.
• It is understood that selected vendors will need to interface with School of Nursing teams. Vendors may
need to travel to the University site for reviews or meetings. Vendors will submit a detailed project plan and
schedule with key project milestones.
• Vendors will submit weekly status reports and participate in weekly status meetings, if required.
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IV. Vendor Response

To establish your qualifications, please provide the following in your response:

• A well-defined project approach for scope of work including a description of interactivity and media
treatments.

• A project schedule and workplan that depicts intermediate tasks and milestone events.

• A description of your courseware development process.

• A summary of corporate experience in successful completion of multimedia or web-based courseware


projects. (If experienced in more than one delivery method, please include examples of each).

• A list of clients.

• A description of quality control processes.

• A description of your organization


⇒ Number of employees
⇒ Locations
⇒ Years in business
⇒ Awards & Honors

• Project costs in a firm, fixed price.

• Indicate which project functions, if any, are outsourced to contractors.

• Three professional references (key contact names, titles, and telephone numbers). The School of
Nursing would like to speak with people who have direct knowledge of your ability to provide these
services for similar projects.
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V. Evaluation Criteria

Proposals will be reviewed with the following criteria in mind.

• Performance Capability: The extent to which the vendor demonstrates the ability to provide the depth and
breadth of experience, skills, and knowledge generally required by this work. This will include a review of
professional references.

• Cost: The total cost to the University of Virginia School of Nursing reflects a desire to meet the needs of the
school while maintaining a realistic budget with all potentialities shown up front prior to contract signing.

• Completeness and Quality of Bid Response: The thoroughness and concern for quality in the vendor’s
response with the expectation that the vendor would have their own questions prior to responding. This will
reveal the interest the vendor has in the project.

• Questions for vendor response: All of the below questions must be answered by the vendor and will be
reviewed by a team of faculty and instructional staff.

o Have you worked with an educational institution before and if so, what level and in what capacity?

o Have you ever developed a similar app? If so, what was the focus of the content?

o Have you ever worked with medical training resources and/or instructors?

o Who will review the user experience and the content?

o Do you currently have an app for review available via download on iOS devices?

o Who makes up your team? Do you have a learning/instruction focused member to support the
development?

o How often would you foresee updates being made to the app?

o How will you seek feedback from the initial user experiences? What will you do with the
information?

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