Using Mobile Learning to Using Mobile Learning to Enhance Nursing Practice Enhance Nursing Practice

EducationEducationRichard Kenny & Caroline ParkRichard Kenny & Caroline Park

Athabasca UniversityAthabasca UniversityJocelyne Van Neste-Kenny, Pam Burton, & Jocelyne Van Neste-Kenny, Pam Burton, &

Jan MeiersJan MeiersNorth Island CollegeNorth Island College

The Promise of M-LearningThe Promise of M-Learning

Focus on knowledge that is location & Focus on knowledge that is location & situation dependent. situation dependent.

Fits a learner-centric, Constructivist view Fits a learner-centric, Constructivist view of learning. of learning.

Supports more situated, experiential Supports more situated, experiential learning, contextualized within specific learning, contextualized within specific domains. domains.

Delivers discourse in real time to wherever Delivers discourse in real time to wherever participants are. participants are.

Purpose of This PaperPurpose of This Paper

Explore potential of m-learning for Explore potential of m-learning for Nursing practice education. Nursing practice education.

Use Koole’s (2005) FRAME model to Use Koole’s (2005) FRAME model to clarify health care / Nursing literature clarify health care / Nursing literature on m-learning. on m-learning.

Present initial findings from our 2007 Present initial findings from our 2007 research study. research study.

M-Learning in Health Care & M-Learning in Health Care & Nursing: Review of LiteratureNursing: Review of Literature

Use has “exploded”. (Cahoon, 2002)Use has “exploded”. (Cahoon, 2002) 1/3 of Canadian physicians using 1/3 of Canadian physicians using

PDAs. (George,2005)PDAs. (George,2005) Medical use mainly relates to research Medical use mainly relates to research

on drugs, dosages & calculations. on drugs, dosages & calculations. There are major issues of There are major issues of

confidentiality. confidentiality.

M-Learning in Health Care M-Learning in Health Care & Nursing& Nursing

In hospital WAN use has been tried In hospital WAN use has been tried for access to records & recording for access to records & recording data at bedside in Great Britain data at bedside in Great Britain (Cacae, 2006). (Cacae, 2006).

Reports on benefits & barriers. Reports on benefits & barriers. Reports on likes & dislikes. Reports on likes & dislikes. Reports on usage. Reports on usage.

BenefitsBenefits

Quick access to current drug Quick access to current drug databases. databases.

The ability to manage patient & The ability to manage patient & procedural information. procedural information.

Patient health management with Patient health management with team access to current information. team access to current information.

Improved team communication. Improved team communication.

BarriersBarriers

Risks of storing confidential information. Risks of storing confidential information. Cost & ease of loss or damage to PDA. Cost & ease of loss or damage to PDA. Not enough research on use in nursing. Not enough research on use in nursing. Difficult to read. Difficult to read. Difficult to understand. Difficult to understand. Slow data entry. Slow data entry.

Nurse Practitioner PDA UsageNurse Practitioner PDA UsageStroud et.al. Stroud et.al.

To do Memo padTo do Memo pad CalculatorCalculator Expense trackerExpense tracker CalendarCalendar/date book /date book Patient manag’t toolsPatient manag’t tools Clinical refer. materialsClinical refer. materials Address/phone bookAddress/phone book Info exchange - Info exchange -

beamingbeaming E-mailE-mail Games Games Recreational reading Recreational reading Internet accessInternet access

Park (64)Park (64) Pharmacy & lab Pharmacy & lab

relatedrelated CalculatorCalculator CalendarCalendar Keeping up-to-dateKeeping up-to-date Referring to texts & Referring to texts &

guidelinesguidelines E-mailE-mail StudyingStudying

Reasons to Recommend Reasons to Recommend (Park, 2006)(Park, 2006)

SafetySafety Decrease in medication errorsDecrease in medication errors Safer than memory Safer than memory security blanketsecurity blanket

PortabilityPortability Lighter to carry than textbooksLighter to carry than textbooks Aids mobilityAids mobility

Organization Organization Concise & easy to transportConcise & easy to transport Edit & highlight most important information Edit & highlight most important information Add personal notesAdd personal notes

Reasons to Recommend Reasons to Recommend (Park, 2006)(Park, 2006)

Access to ResourcesAccess to Resources Valuable with right softwareValuable with right software Information available is immense & valuable Information available is immense & valuable Up-to-date informationUp-to-date information Back-up quick referenceBack-up quick reference

Decision-makingDecision-making Use to explore options with clientUse to explore options with client

ConvenienceConvenience Convenient useful toolConvenient useful tool

ImageImage Way of the futureWay of the future Looks professionalLooks professional

FRAME Model (Koole, 2005)FRAME Model (Koole, 2005)

(Reproduced with permission)

Research Study – Phase 1: m-technology Research Study – Phase 1: m-technology in a community-based practice in a community-based practice

experienceexperience

Koole’s FRAME Model for Nursing Practice Education (adapted with permission)

Social Context of Practice(clients, clinicians, instructors, students, agencies, community)

StudentDevice(PDA, software)

Connectivity(device-to-device &internet)

Learning activities (peer-to-peer, student/instructor interactions)

Learning activities

M-learning supportedstudent practice at the point of care

Practice EnvironmentCommunity-based course

North Island CollegeCourtenay, Vancouver Island

Vancouver Island, British Columbia

Mobile Learning to Improve Mobile Learning to Improve Clinical Nursing Education Clinical Nursing Education

Two stage formative evaluation: one –on–Two stage formative evaluation: one –on–one trial & field trial.one trial & field trial.

Stage 1:Stage 1: Three 4 Three 4thth Year Nursing students & Year Nursing students & 2 Nursing instructors teaching Nursing 357 2 Nursing instructors teaching Nursing 357 in Stage 2 field trial. in Stage 2 field trial.

Stage 2: Stage 2: 33rdrd Year spring NIC Nursing Year spring NIC Nursing practice course, Nursing 357 – 5 weeks practice course, Nursing 357 – 5 weeks duration.duration.

2 groups: mobile learning (12) and 2 groups: mobile learning (12) and comparison group (6). comparison group (6).

Research QuestionsResearch Questions

Implement & sustain in independent Implement & sustain in independent learning setting? learning setting?

Useful in practice setting? Useful in practice setting? Appeal to / comfort for target audience in Appeal to / comfort for target audience in

real life instructional settings?real life instructional settings? Mobile learning strategies enhance Mobile learning strategies enhance

reflective practice, facilitate reflective practice, facilitate communication, & support theory / communication, & support theory / evidence-based practice?evidence-based practice?

Research Methods – Stage 1Research Methods – Stage 1

One-on-one trial One-on-one trial N=5 (2 instructors / 3 4N=5 (2 instructors / 3 4thth Year Year

students)students) Pre-study demographics surveyPre-study demographics survey Semi-structured interviews.Semi-structured interviews. Reflective logs kept by faculty.Reflective logs kept by faculty.

Research Methods – Stage 2Research Methods – Stage 2

Field trial in actual class - Nursing 357.Field trial in actual class - Nursing 357. N=17 (12 mobile / 5 comparison)N=17 (12 mobile / 5 comparison) Instructors’ observations (Reflective journal / Instructors’ observations (Reflective journal /

log ). log ). Pre-study demographics survey. Pre-study demographics survey. Post survey of student use . Post survey of student use . 4 – 6 Semi-structured interviews (mobile group). 4 – 6 Semi-structured interviews (mobile group). Student practice narratives / notes about their Student practice narratives / notes about their

practice experiences kept on mobile devices. practice experiences kept on mobile devices. Cell phone & data download statistics on device Cell phone & data download statistics on device

usage.usage.

Demographic Survey Demographic Survey ResultsResults

Age RangeAge Range Stage 1 (N=5)Stage 1 (N=5) Stage 2 Stage 2 (N=17)(N=17)

18 - 2518 - 25 00 44

26 - 2926 - 29 11 44

30 - 3930 - 39 33 66

40-4940-49 11 33

Demographic Survey Demographic Survey ResultsResults

Own mobile Own mobile devicedevice

Stage 1 Stage 1 (N=5)(N=5)

Stage 2 Stage 2 (N=17)(N=17)

Cell PhoneCell Phone 44 1313

PDAPDA 22 66

NoneNone 11 33

Demographic Survey Demographic Survey ResultsResults

Comfort with Mobile Comfort with Mobile DevicesDevices

Stage 1 Stage 1 (N=5)(N=5)

Stage 2 Stage 2 (N=15)(N=15)

Very uncomfortableVery uncomfortable 00 00

Somewhat Somewhat uncomfortableuncomfortable

00 33

Somewhat Somewhat comfortablecomfortable

00 1010

Very comfortableVery comfortable 55 22

Demographic Survey Demographic Survey ResultsResults

Expertise - Expertise - MobileMobile

NoneNone

S1 S2S1 S2BeginneBeginne

rr

S1 S2S1 S2

Comp.Comp.

S1 S2S1 S2ExperiencExperienc

ee

S1 S2S1 S2

TelephoneTelephone 00 22 00 11 11 22 44 55PhotographPhotographyy

22 33 11 22 00 33 22 22

EmailEmail 22 44 11 11 11 33 11 22InternetInternet 22 55 22 22 00 11 11 22Text Msg.Text Msg. 33 44 11 00 00 44 11 22

Demographic Survey Demographic Survey ResultsResults

Expertise - Expertise - MobileMobile

NoneNone

S1 S2S1 S2BeginneBeginne

rr

S1 S2S1 S2

Comp.Comp.

S1 S2S1 S2ExperiencExperienc

ee

S1 S2S1 S2

Audio Msg.Audio Msg. 44 66 00 11 00 11 11 22Word Proc.Word Proc. 22 55 11 22 11 11 11 22SpreadsheSpreadsheetet

33 66 00 22 11 11 11 11

DatabaseDatabase 33 66 00 22 11 11 11 11Nursing Nursing 22 66 00 11 11 22 22 11

Prior Knowledge of Mobile Prior Knowledge of Mobile DevicesDevices

Ample cell phone experienceAmple cell phone experience Novices – no direct PDA use Novices – no direct PDA use

experienceexperience 11stst experience with mini computer - experience with mini computer -

PDAPDA Used Windows / MSOffice / Hotmail / Used Windows / MSOffice / Hotmail /

Skype on PCSkype on PC Aware of PDA Nursing softwareAware of PDA Nursing software

Features Needed to LearnFeatures Needed to Learn

Use of touch & thumbing keyboardsUse of touch & thumbing keyboards Use of cursive to text transcriptionUse of cursive to text transcription To enable wireless connectivity for To enable wireless connectivity for

email & Internetemail & Internet Use of Nursing drug & lab values Use of Nursing drug & lab values

softwaresoftware Use of text & audio messaging (Skype) Use of text & audio messaging (Skype)

Ease of UseEase of Use

1 -3 hours learning after 2 hour 1 -3 hours learning after 2 hour orientationorientation

Easy to master overallEasy to master overall Cell phone & camera easy to useCell phone & camera easy to use Pocket Word much like MSWordPocket Word much like MSWord Nursing software user friendly & Nursing software user friendly &

most used feature in trialmost used feature in trial

Barriers to UseBarriers to Use

Lack of WIFI connectivity in hospital Lack of WIFI connectivity in hospital & community& community

Problems obtaining GPRS connectionProblems obtaining GPRS connection Lack of GPRS wireless coverage in Lack of GPRS wireless coverage in

rural communitiesrural communities Inability to access WebCT course Inability to access WebCT course

website website

PortabilityPortability

Suitable to carry in purse or pocketSuitable to carry in purse or pocket 2 carried iPAQ in uniform pants (leg) 2 carried iPAQ in uniform pants (leg)

pocket in hospitalpocket in hospital Convenient to have handy for Convenient to have handy for

immediate referenceimmediate reference Easy to access when needed Easy to access when needed

VisibilityVisibility

Clear to read re. colour & type sizeClear to read re. colour & type size Brightness adjustableBrightness adjustable Screen size correct (bigger means Screen size correct (bigger means

heavier) heavier) Requires websites that can be Requires websites that can be

formatted for up – down scrolling formatted for up – down scrolling (e.g., by Google)(e.g., by Google)

Usefulness in Nursing Practice Usefulness in Nursing Practice EducationEducation

Option to reference Nursing software Option to reference Nursing software at bedsideat bedside

Ability to remain current via software Ability to remain current via software updatesupdates

Aids in patient teaching by using Aids in patient teaching by using “layman’s” language.“layman’s” language.

Option of use of phone or email to Option of use of phone or email to contact instructorscontact instructors

Usefulness in Nursing Practice Usefulness in Nursing Practice EducationEducation

Potential to allow private Potential to allow private communications via mobilitycommunications via mobility

Disadvantage of being constantly Disadvantage of being constantly accessible accessible

Useful for document storage and Useful for document storage and accessaccess

Permits students to participate in Permits students to participate in technology-driven societytechnology-driven society

We welcome your questions, ideas, We welcome your questions, ideas, commentscomments

Demographic Survey Demographic Survey ResultsResults

Time owned mobile Time owned mobile devicedevice

Stage 1 Stage 1 (N=5)(N=5)

Stage 2 Stage 2 (N=17)(N=17)

NeverNever 00 33

1 year or less1 year or less 00 44

2 - 3 years2 - 3 years 11 55

4 – 5 years4 – 5 years 11 33

6 – 10 years6 – 10 years 11 22

10 years +10 years + 11 00