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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.
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.
Success Criteria:
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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Format
Internal (I) External External External Internal External and Internal Internal
(E)
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
Phase 1: Data Gathering (pre) & Funding • Have SME review survey for approval
via iPad Integration and Faculty Development • Deploy iPads to applicable classes
Phase 4: Review Data & Findings • Translate data into sharable graphics and summaries
• Create digital and hard copy versions for distribution to various stakeholders
Phase 6: Develop Long-term Plan • Share plan details with Associate Dean
Deadline: February 7
Deadline: September 16 Deadline: January 17
Resource Management
Roles
Role Description
Stakeholders
Project Manager
Work with faculty to design and develop integrations for
Kevin Tressler
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
Christine Kennedy
Evaluate the project and provide feedback, approval,
Associate Dean for Academic Approving entity denial for implementation and the potential for
Programs sustainability
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
Distribute survey to
1: Data gathering Bethany Coyne August 19, 2019 September 16, 2019
faculty & students
Faculty development
2: Implement Kevin Tressler August 19, 2019 November 22, 2019
sessions
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
Kevin Tressler
Distribute findings to
5: Share findings Bethany Coyne
January 17, 2020 February 7, 2020
faculty
Sarah Craig
Kevin Tressler
Bethany Coyne
Kevin Tressler
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.
Decrease in student
clinical decision making Medium High End of semester
confidence
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
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.
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
Using a scale of large extent to no extent, to what extent did the use of the iPads:
To what extend did you perceive enhanced learning and critical thinking from the
iPads:
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 use my knowledge of anatomy and
physiology to interpret information I gathered about the client’s current problem.
*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?
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.
Date TBD
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
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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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:
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:
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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• 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 list of clients.
• 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
• 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 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?