Technology is Transforming Nursing Education

May 15, 2023

GW Nursing students working in Simulation Center

The future of healthcare education is here, and it’s brighter—and more immersive—than ever. Today’s nursing students practice clinical skills in virtual hospital rooms with animated patients powered by artificial intelligence. They listen to interviews with nurse leaders on their smartphones, and watch engaging, video-driven lectures delivered by talented nurse educators.

For nurses and other providers, technology has always played a pivotal role in patient care, but recent advancements have created new opportunities for educating nurses and improving patient outcomes.

GW Nursing is at the forefront of providing students with top-tier learning experiences. High-fidelity simulation and seamless online learning programs set the university apart, and helped place the school at number eight in U.S. News & World Report’s rankings for Best Online Master’s in Nursing Programs.

A primary goal for educators is to create engaging and interactive learning experiences, and GW Nursing helps its faculty and instructors do this with support from a cadre of experts who are passionate about using technology to enhance healthcare education.

Innovative Simulations

Former Dean Pamela Jeffries helped spearhead significant improvements to GW Nursing’s simulation program during her time at the school. An innovator in promoting and advancing the field of simulation education, Jeffries served as a consultant on the 2014 National Council of State Boards of Nursing (NCSBN) study that provided substantial evidence that high-quality, high-fidelity simulation can be effectively substituted for up to 50 percent of traditional clinical experience in all pre-licensure nursing courses. Her contribution to the field continued with the 2015 release of the National League of Nursing (NLN) Jeffries Theory that set forth guidelines on how simulation experiences should be developed.

Today, with more than 20,000 square feet of experiential learning space, GW Nursing’s Simulation and Innovation Learning Center is a sophisticated learning environment that prepares students with the skills needed to provide effective clinical care.

GW Nursing students do a lot of virtual and in-person simulations, and the curriculum is aligned with didactic content, skills labs, and simulation scenarios. “It’s all lined up that way so that they can apply everything they learned each week to providing simulated patient care,” Crystel Farina, PhD, RN, CNE, CHSE, the director of simulation and experiential learning, says. “They sit in lectures; then they learn a few skills; and then they are able to apply all that knowledge to providing care for that simulated patient.”

The Johnson Lab, named after the school’s founding dean, Jean E. Johnson, PhD, RN, FAAN, opened in October 2015. The space, which is designed to resemble a hospital, features patient beds populated by static and moderate-fidelity simulators (manikins that breathe and have a pulse to practice certain skills, but with fewer features than high-fidelity manikins) that allow students to practice basic skills and building connections at the bedside. A recent renovation added additional space to the lab to make room for linen carts and other equipment needed to simulate a hospital setting, creating accurate settings that will build the muscle memory critical to their future success, said Mary Doyle, an adjunct faculty clinical/skills lab instructor.

That type of muscle memory, as well as developing long-term memory, is crucial for nursing students. Clinical confidence can affect a nurse’s skills at the bedside, and clinical instructors report that simulation experiences are improving student performance, according to Farina.                 

“The students’ ability to talk to each other and to other care providers is definitely enhanced,” she says. “Their teamwork is also much better—they’re able to work as a team, and they don’t see things as individual tasks.”

GW Nursing is an early adopter of technology-enhanced immersive experiences, and has recently added virtual reality (VR) and augmented reality (AR) capabilities to its programs. While VR and AR experiences are popular among video gamers, these technologies have emerged as solutions for improving and enhancing healthcare education.

Students in the nurse practitioner program work through VR simulation scenarios provided by Oxford Medical Simulation software, using either a standard computer or with their own personal VR headset. The scenarios feature realistic animated patients and cases that help advanced practice nursing students develop the diagnostic reasoning and clinical decision-making skills that they need.

“It’s a great way of learning,” Farina says. “When a student is immersed in a simulation scenario, through a headset, everything else is blocked. It feels so much more realistic—you can see it and feel it, and that creates an emotional response.”

That emotional response causes the learning to become part of a long-term memory, which is critical to retaining the information and techniques required to provide quality patient care.

GW Nursing is also merging real and virtual worlds in its new e-REAL room, a mixed-reality environment for hybrid simulation. The space features three walls where scenes are projected to enhance the immersive simulation experience. Sounds and scenes surround the high-fidelity manikin to create a simulation scenario. The school worked with Access VR, a Virginia-based extended reality services firm to produce and film 360 video content, also known as 360 or immersive videos, where views in every direction are recorded. The videos feature professional actors and GW Nursing faculty and staff portraying a variety of scenarios, such as patient transfer and medication administration, to teach students how to speak up when they find a problem. Students can view the 360 videos through a VR headset to immerse themselves in a scenario. In the Access VR interactive scenarios, viewers answer questions about correct and incorrect actions to add to the fidelity of the experience.

ABSN students in sim lab

Assessment Solutions

When the COVID-19 pandemic forced school closures in March 2020, GW Nursing was well-equipped to pivot immediately to online learning for all students. Faculty and students were already prepared to engage in virtual didactic learning, but creating an entirely virtual skills assessment process presented new challenges.

For example, the school assesses nurse practitioner (NP) students through Objective Structured Clinical Examinations (OSCE). Before the pandemic, NP students traveled to the Ashburn, Va., campus for up to three days to participate in the OSCE activities, including workshops with hands-on procedures, practicing physical exams using standardized patients portrayed by actors, and final evaluations.

The OSCE workshops present advanced skills that only NPs and physicians are trained to use because of the possibility of infection, including how to suture, fix an ingrown toenail, and remove or drain a cyst. Students practiced and performed these skills in the OSCE simulation lab, but the pandemic prevented in-person assessments.

GW Nursing’s graduate students, who live around the country, didn't participate in on-campus activities for two years due to concerns about contracting the COVID-19 virus during travel. The faculty, simulation team, and Online Learning Instructional and Technology (OLIT) team developed several accommodations (including shipping practice materials) to create virtual OSCE programs. “It took a lot of support to pivot the OSCE events onto an online platform,” Farina says. “The students were able to do a telehealth visit instead of a face-to-face visit, and still meet with a standardized patient that was trained to mimic an illness or a case. Faculty assessed their performance by observing the telehealth visit.”

The program team coordinated shipments of suturing equipment, and simulated skin, toes, and cyst/abscess pads to practice on. Clinical Instructor Helen Brown, ACNP-BC, FNP-BC, FAANP, taught NP students the procedures in a virtual synchronous course, filmed using multiple cameras that allowed for high-definition close-ups.

This new approach helped the school during an unprecedented situation, but the GW Nursing faculty and students benefited from the simulation team and OLIT staff’s planning and depth of knowledge.

Instructional Experts

GW Nursing’s success implementing existing and emerging technology into its educational offerings is thanks in large part to the OLIT team, headed by Miro Liwosz, the assistant dean of the department.

Liwosz was hired in 2016 by Jeffries, who made strengthening the creation and delivery of online programming a priority. OLIT includes instructional designers, instructional technologists, multimedia producers, and eLearning specialists, who support and actively consult with faculty on academic projects that impact teaching, learning and research. Over the past few years, the team has assisted in developing more than 100 online, blended and electronic-presence courses, massive open online courses and open educational resources.

Before the OLIT team was expanded, faculty members had been mostly on their own, figuring out how to develop content and offer it online independently, no easy feat. “There were no standards for online learning, no accessibility accommodations, no multimedia closed captioning, and no common look and feel, which is important to how students navigate courses,” Liwosz says.

The common look and feel of online programming and other instructional tools is part of GW Nursing’s overall branding efforts, and helps students and instructors spend more time focusing on pedagogy and instructional techniques, and less time on navigating and locating resources.

“GW Nursing has the most well-branded online educational format of any school of nursing that I’ve ever seen,” Melissa Batchelor, PhD, RN, FNP, FAAN, the director of the Center for Aging, Health and Humanities, says. “The continuity from course-to-course makes it easier for students to find content.”

OLIT also trains faculty and staff on effective use of instructional technologies, manages a multimedia studio for high-quality audio and video recording, and assists in the development and ongoing operations of the simulation center.

Part of Liwosz’s role is staying abreast of emerging instructional technologies. He’s currently assisting in the launch of a pilot program utilizing PlayPosit, a new interactive video platform. PlayPosit enriches existing video content by adding embedded pop-up elements such as questions, images, and audio. Three faculty members were trained to use the software and implemented it into their fall semester courses, and the training recently became available to all faculty members. Liwosz hopes to apply PlayPosit to at least 20 percent of GW Nursing courses during the two-year pilot.

Instructional design research shows that students learn better by watching and listening, and enjoy video content more than static text, according to Liwosz. OLIT works with faculty to create engaging content, and PlayPosit is a new method to engage students during the didactic portion of their online courses. “When you do one thing over and over the same way, it becomes monotonous,” Liwosz says. “Because all of our courses are asynchronous, it’s important for students to engage with faculty, and for faculty to engage with students. We want to make sure our students understand the content, and to ensure that we have to increase our interactive learning options.”

In addition to the new PlayPosit software, faculty have been using VoiceThread, an interactive collaboration tool that elevates and extends engagement and participation. Faculty and students can easily add voice comments and annotation to documents, slide presentations, videos and photos. VoiceThread offers a more natural interaction for students to present, defend and share their opinion in online courses in a manner that closely resembles traditional in-person classroom discussions.

Karen R. Dawn, DNP, RN, PHCNS-BC, CDE, an assistant professor, used VoiceThread assignments in a disaster preparedness course to engage students at different cognitive levels. For a project assessing comprehension, students identified a disaster and its impact, then analyzed the disaster preparedness of a particular community and applied what they learned to develop a public service announcement (PSA) for a chosen community. Some students even shared that PSA with community leaders.

In addition to the emphasis on creating interactive video-based content, the OLIT team is catering to students’ desire to listen to course content via podcasts. Educational podcasts are becoming more popular as a tool to make lessons accessible, engaging and informative. OLIT has developed an instructor toolkit with extensive resources on how to use instructional technology to engage students in online learning, and podcasting resources are a recent addition to that toolkit.

OLIT collaborated with Melissa Batchelor, PhD, RN-BC, FNP-BC, FGSA, FAAN, the host of her own popular podcast, This is Getting Old: Moving Towards an Age-Friendly World, to create the podcast toolkit. “Everybody learns in a different way; sometimes hearing the same message in multiple formats helps you retain what you’re learning,” Batchelor says. “Learning through storytelling is important—you remember stories; it’s hard to remember facts.”

Batchelor has become known as an instructional technology champion at GW Nursing, and is eager to try out emerging technologies in her courses. She’s also one of the faculty members participating in the PlayPosit pilot. When Batchelor began her teaching career in the early 2000s, she sought to include educational technology in her class, but found that some of the emerging technologies and tools she introduced were too challenging for students to master. “I try to find the sweet spot between not overwhelming the class with too much novelty and matching the content to the best teaching tools to make it engaging and interactive,” she says.

Interviews with authors and nursing experts make lessons more entertaining. Batchelor teaches a health policy course for undergraduate and graduate students, and has recorded interviews with Alison Hernandez, PhD, RN, a policy advisor for the United States Senate. “I did an interview with Alison on why nurses should be engaged in policy,” Batchelor says. “It’s a direct example of how nurses can get into the policy arena, and gives practical tips on how to effectively engage policymakers.” She’s also interviewed Diana Mason, PhD, RN, FAAN, the author of her course’s textbook.

“Using diverse strategies for learning within a course helps to engage more students,” Batchelor says, “and when they have access to a variety of learning opportunities, students can pick and choose what resonates with them the most.”