JaniceHawkins_authorphoto By Janice Hawkins PhD, RN
BethTremblay_authorphoto Beth Tremblay MSN, RN
LynnWiles_authorphoto Lynn L. Wiles PhD, MSN, BSN, RN, CEN
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Designing a virtual learning environment takes a village

When we determined our students at Old Dominion University School of Nursing needed to strengthen their safe medication administration knowledge and skills, we reached out to the multimedia instructional design team at our university for assistance. We had a history—they’d helped us create a virtual handwashing simulation—and we knew they could help us build something new and exciting. Through this interprofessional partnership, we created an interactive virtual learning environment (VLE) to promote patient safety skills in novice nursing students. In our VLE, students navigate an avatar through the steps of safe medication administration. 

Here's a demo:

 


How we built a VLE
After defining the educational focus, the first step was to assemble a team of content and skill experts. We connected with Instructional Designers skilled in multimedia and game-based learning tools. Our process began with a face-to-face meeting where we shared our collective visions for the project. Next, the nursing content experts created a storyboard and script of our scenario and filmed a rough rendition of the sequence of events. We also photographed our equipment from multiple angles. Providing the visual and audio content illustrated the steps and tools needed for the IDs to build the animation. Our IDs produced the animations and graphics using Blender, an open source 3D animation program. Blender offers pre-designed 3D models of common objects as well as the ability to customize model nursing specific equipment such as the Omnicell. The 3D models were transferred to Adobe Captivate software, where our IDs added video and graphic interactions to create the virtual simulation. Working with IDs on this project was a learning experience that has expanded our options for building technologically savvy educational resources. 


Lessons learned
One lesson learned was that both IDs and nurses have a unique language and work culture. Our initial verbal and written descriptions of the steps of safe medication administration did not translate clearly to IDs unfamiliar with our processes. Filming the storyboard was vital to helping them visualize how nurses interact with patients and equipment. Successful creation of the Safe Medication Administration VLE required multiple edits with continual engagement to clarify details. 

We also learned that a discussion about departmental workflows and project timelines is a necessary step. We started with a general timeline rather than a prescriptive one. The lack of defined due dates and task-accountability resulted in project delays. Also, our ID department had different schedules; their “busy months” were not the same as ours. An early discussion of shared expectations and departmental time constraints would contribute to better project management. 


Introduction on grand stage
We were thrilled to have the opportunity to introduce our VLE to Sigma members at the 45th Biennial Convention in 2019. Participants of our clinical workshop used teamwork, problem-solving skills, and clinical knowledge during a hands-on escape room experience. Our Safe Medication Administration VLE served as the “entry pass” to gain admission to our escape room simulation. Together, participants unlocked clues and advanced through a scenario to safely administer required medications. We shared our strategies, tools, and lessons learned in creating and implementing educational escape rooms. 

We originally housed our VLE on a learning management system only available to users within our institution. But, participating in Sigma’s convention sparked the idea to move this to an open access forum so we could share it with others. So many of the faculty who attended our sessions wanted access to the game. We walked out with multiple business cards and came home to multiple follow-up emails. So, our instructional design team helped us convert the VLE format to an accessible platform. As we promised at convention, the full gaming simulation is now available as an open access resource which can be uploaded into course platforms or offered directly via internet browsers. 


The value of the VLE
We were surprised that our students practiced in the VLE multiple times. One value of the VLE is that repeated use leads to skill mastery and automaticity (Pront, 2018). The immediate feedback of game-based learning allows for continual self-assessment and timely corrective action while the reward system of “winning” the game motivates learners to engage. Digital game-based learning tools are a good financial value, too, offering advantages of convenient, easy access with opportunities for repeated engagement (Pront et al., 2018).

Since releasing the VLE for open access, there have been over 700 downloads from locations in Alaska to Australia for use in nursing curricula and hospital nurse residency programs. Learners (n=938) who accessed the VLE reported increased confidence (93.87%) and knowledge (93.76%) of safe medication administration. A majority (93.98%) felt that the learning exercise was beneficial. They reported that the VLE was a realistic, fun, and creative way to learn and liked the ability to make corrections in a virtual simulation. 

This experience has been a complete team effort where the whole is much greater than the sum of the parts. It also opened our eyes to future possibilities with our ID partners!


References
Pront, L., Müller, A., Koschade, A., Hutton, A. (2018). Gaming in nursing education: A literature review. Nursing Education Perspectives, 39(1), 23-28. doi: 10.1097/01.NEP.0000000000000251


Acknowledgments
Safe Medication Administration Virtual Learning Environment developed by:

• David Figgs, Nursing Simulation Technician
• Dan Greenwood, Instructional Technology Specialist Manager
• Janice Hawkins, PhD, RN, Clinical Associate Professor
• Deborah Norris, MSEd, Instructional Designer
• Beth Thompson, DNP, RN, Simulation Educator
• Beth Tremblay, PhD(c), RN, Lecturer
• Lynn Wiles, PhD, RN, CEN, Associate Professor|
• Brian Williamson, BS, Multimedia Designer• Old Dominion University


Janice E. Hawkins, PhD, RN, is a clinical associate professor and undergraduate departmental adviser at Old Dominion University School of Nursing in Norfolk, Virginia, USA, and a retired Army nurse. In addition to being a retired army nurse and a Sigma UN Liaison, she is a member of Sigma’s Epsilon Chi Chapter at Old Dominion University. 

Beth Tremblay, MSN, RN, is a lecturer at Old Dominion University School of Nursing and a member of Sigma’s Epsilon Chi Chapter at Old Dominion University and Epsilon Phi Chapter at Duquesne University in Pittsburgh, Pennsylvania, USA. 

Lynn L. Wiles, PhD, MSN, BSN, RN, CEN, is an associate professor at Old Dominion University School of Nursing and a member of Sigma’s Epsilon Chi Chapter at Old Dominion University and Epsilon Phi Chapter at Duquesne University.

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