Jesse EMeDonald Pave |2 Effective use of E-Learning in the Nursing Workplace: Lessons learned Jesse E McDonald, CCRN Introduction: In 2007 the author's institution began to develop its computer-based education for its medical and nursing staff. Over the past 14 months there have been many successes and some failures, This paper presents the lessons learned, and some of the challenges remaining, in implementing computer-based training (CBT) in the nursing workplace of a government operated, unionized, hospital in the United States. It presents principles of effective computer-based education (e-learning), discusses various types of e-learning, and the role nurse educators play in developing these courses as well as identifying significant barriers to the effective use of e-leaming. This paper focuses on clinical workplace leaning. In this context, nurse education and training are used interchangeably to identify the workplace needs. Some concepts may also apply to academic nursing education; however the education of nursing students is beyond the scope of this paper. ‘Computer-based or E-Learning has swept through business and professional workplaces (Atack & Rankin 2002;Hammoud et al, 2006;Huckstadt & Hayes 2005;Laird 2004;Stiffler D.J. 2008;The Sloan Consortium 2007). Healthcare, including nursing, has been using various forms of e-Learning for several years (Billings, Skiba, & Connors 2005;Clark & Mayer 2008a;StifMer D.J. 2008). However within nursing, as with other business and professions, there are various types of learning (Thatheimer W. 2008b). These include education focused on the transfer of information (Inform) and learning focused on changing behavioral performance (Performance) (Clark & Mayer 2008a). Workplace learning, while it includes both information-based and performance-based types of training, has its focus onJesse E McDonald Pave |3 improving job performance (Clark & Meyer 2008). This focus directs its purpose and outcome expectations (Clark & Mayer 2008a;Thalheimer W. 2008b). In the nursing workplace both knowledge (Inform) and clinical skills (performance) are important, It is important to remember that not all education is appropriate for an e-learning format. The development of fundamental nursing skills often requires the personal direction and coaching of an individual nurse educator. Skills, once developed, can be sharpened and critical thinking improved with well designed e-learning. Some skills will require the use of a “blended” approach where the knowledge component is presented on-line while the skill component is developed or evaluated during a personal session with an educator. Workplace leaming, regardless of its format, is evaluated ultimately by workplace behaviors (clinical performance). Successful clinical workplace training should produce practice changes that are aligned with the standards, goals and objectives of the organization (Brandon 2004) The key goal for asynchronous e-learning aimed at the nursing workplace is to engage the Jeamer in appropriate cognitive processing so that the leamed skills will transfer to clinical practice behaviours (Clark & Mayer 2008a;Kalyuga, Chandler, & Sweller 1999;Shank 2004). As Kathleen Iverson (2008) has pointed out, interaction is not engagement, Learning takes place when a student engages with the content and, through cognitive processing, intemalizes the concepts in such a way that they can be retrieved and applied (Clark & Mayer 2008a;Thalheimer W. 2008a). Types of on-line education: On-line education can vary from the posting of text-based documents with a quiz (EMS-CE 2008) to PowerPoint presentations with or without narration (Bartlett 2008;Pun 2007), and a gradation of interactive formats from the HTML “Page-turner” (Sullivan & Gardner 2007) through a full-scale educational game or “immersive learning simulation” (HalamekJesse E McDonald Page |4 2007;Hogg, Pirie, & Ker 2006;Kneebone et al. 2005;Stifiler D.J. 2008). Each of these may be successful if they are properly matched to their leaming goals (Bersin 2005). For example, if the learning goal is to document the dissemination of certain content a “page-turner” or even a written document with capture of when it was viewed may be much more appropriate than spending hundreds of hours building an immersive leaning game, However, if the goal is to improve the clinical practice behaviors for management of the septic patient a course which allows the practice of clinical skills and observation of outcomes will be more effective. Ultimately, workplace leaming is gauged on how well it meets its outeome objectives (Brandon 2004;Clark & Mayer 2008b) ‘The participant auclience is an integral part of the effective e-leaming design (Billings, Skiba, & Connors 2005). In order to be effective, workplace e-learning must be relevant, focused and practical. Engagement takes place in the leamer’s mind, Gary Woodill (2004) describes this as Intuitive learning is based on strategic learning activities, stimulating and supportive learning environments, and a certain degree of exploration - even “fooling around”. But this doesn’t happen unless the activities are of interest to the leamer. Ruth Clark (2008) and Gary Woodill (2004) both stress that it is the engagement in cognitive processing that creates learning connections. These connections allow for retention, retrieval, and application to workplace problems. [fa learner does not have in place adequate knowledge and concepts to connect to, they will be unable to eng with the content (Stape 2007). Conversely, if the e-learning course replicates the knowledge connections already in place, that leamer will experience the course as too basic and not engage. Structuring a course to connect to previous knowledge and provide sufficient challenge to engage the learner optimizes the germane (or learning) cognitive load (Clark R.C., Neuyen, & Sweller 2005). This concept, while well recognized in nursing education with the use of pre-requisite classes and course sequences, is a significant challenge to the e-learning developer.