- Email: [email protected]
Using an online video to teach nursing skills
Teaching and Learning in Nursing (2011) 6, 172–175
www.jtln.org
Using an online video to teach nursing skills Kassie McKenny MSN, RN, CNE⁎ Clarkson College, Omaha, NE 68131, USA KEYWORDS: Video recording; Nursing; Teaching methods
Abstract Faculty are challenged to find teaching strategies that develop students' technical skills within the clinical learning laboratory. A step-by-step skill-specific video placed online allows students to learn these skills at the same level in comparison to traditional teaching methods. The author will describe how to develop a custom-made digital video for the skill of wet-to-dry sterile dressing change and the success of its use. © 2011 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
1. Introduction Why should students who appreciate the immediacy and engagement of YouTube not have a similarly engaging resource for their clinical education? Creation of a nursing skill video for online learning is a complex process. However, the powerful student learning that occurs with the use of such a medium is worth the faculty effort. Online video technology supports the visual and auditory learning preferences of students who are digital natives. Faculty can use digital video technology, instead of direct demonstration, when teaching students the skills required to provide safe patient care. For beginning nursing students, the practice that is required to become safe and confident practitioners usually takes place within a nursing clinical learning laboratory prior to actual patient contact. It is a constant challenge for faculty to find effective teaching strategies for this educational setting. Digital video technology offers an opportunity to expand the repertoire of effective alternative teaching strategies within the limits presented by the clinical
⁎ Corresponding author. E-mail address: [email protected]
laboratory (Winters, Hauck, Riggs, Clawson, & Collins, 2003). Specifically, a custom digital video, tailored to the needs of the student, can be produced by faculty to meet course objectives. This article discusses the development and evaluation of a custom online video to teach the skill of sterile wet-to-dry dressing change to first-year nursing students. The video has become a key resource that encourages students to be more active participants in their own learning.
2. Literature review Using video as a demonstration method has been widely reported to effectively present specific skills training including technical skills, interpersonal skills, and observational skills. Skill-focused videos allows for model practice to be presented in a manner in which specific details can be “seen in close up and stopped at strategic points or repeated for problem areas” (Nichols, 1994, p. 327). Corbally (2005) reported that film can also ensure consistency of content when multiple faculty are teaching the same topic and that video allows for a tailored and focused classroom experience. Recently, the use of digital video technology has been supported by Lashley (2005) when streaming digital video
1557-3087/$ – see front matter © 2011 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2011.04.003
Using an online video to teach nursing skills on the Internet to guide students on the correct methods of physical examination. The video focused on a complete head-to-toe physical examination that students were required to perform at the end of the course. This method of video use allowed students to repeatedly view the video prior to being evaluated performing the examination. Students reported that the digital video was the most helpful aspect of the course. Sorenson and Dieter (2005) used video vignettes when teaching master's level students about family dynamics and health promotion counseling in a community setting. These vignettes focused on verbal and nonverbal therapeutic communication. Students in this study were shown to be able to connect concepts between the video vignettes and actual families. Kelly, Lyng, McGrath, and Cannon (2009) evaluated student learning when using faculty-developed online videos for demonstration of nursing skills. Although the findings reported that there was no change in student performance, when compared with traditional methods, students reported satisfaction with self-management of learning. The authors recommended blending the use of such a teaching strategy with lecture. Depending upon the use intended by the instructor, a video may be able to tap all three domains of learning: cognitive, affective, and psychomotor (Nichols, 1994; Herrman, 2006). Indeed, using a correctly formatted video to teach a specific nursing skill allows a student to learn the physical action of completing the skill and the theory behind the action. A skill video can also demonstrate the type of interaction that needs to occur between a patient and a nurse to create a trusting and caring relationship. Often, it is difficult for faculty to help students progress in the affective domain of learning. However, video technology allows students to react emotionally to patient situations in a safe learning environment (Nichols, 1994).
3. Video production When developing the video about chaning sterile wetto-dry dressings, the author transitioned through the three phases of preproduction, production, and postproduction. According to Corbally (2005), “the effort required to produce such innovations (teaching videos) is not be underestimated” (p. 378), and each of the three phases are essential to produce a high-quality video that will enhance student learning. In the first phase of preproduction, the focus was on planning. The most important consideration of this planning phase was scriptwriting. A well-developed script provided a blueprint for guiding all of the other phases of the video production and assisted in achieving a quality final product. Video recording and editing would have been chaotic without a well written script and clear idea of how the final video should appear. The script was developed using a scriptwriting table with considerations of critical sterile dressing change steps, voiceover dialogue,
173 film footage, footage dialogue, and other effects. As suggested by Corbally (2005), the author referred to the script time and time again to ensure that the project was progressing as planned. The second phase, production, involved the actual recording of the audiovisual material within the nursing skills laboratory. However, prior to pressing the record button, the set had to be properly prepared. The considerations for a well-developed set included ensuring supplies for multiple takes; creating a clean, organized, natural background without visual distractions; and assessing the lighting for brightness and shadows. Although only one camera was used to record the video, multiple takes were recorded to give a different perspective of the same scene. Corbally (2005) reported that multiple camera angles are important to relieve “the monotony of a single-shot film sequence.” Therefore, scenes from both front and side of the bed and from a full screen view to a close-up detailed shot were videotaped. Later, the voiceover sound was recorded in a multimedia support room using the Sound Recorder software program and a microphone. During postproduction, the film was evaluated and edited into a final digital video. Although it is ideal to have professional staff to assist faculty during this phase, Smith-Stoner and Willer (2003) report that many easy-touse software programs are available. Adobe Premier Elements was one such software program that provided a simple step-by-step guide and comprehensive help section to assist the author, who is not an expert in video production, to create a final high-quality video. The final skill video, created with no monetary resources, consisted of 12 minutes of step-by-step visual and auditory review of the critical elements required to satisfactorily complete the performance examination on sterile wet-to-dry dressing change. Display screens focusing on content related to the “Do's and Don'ts of Sterile Technique,” “Tips for Applying Sterile Gloves,” “Call the MD,” and “Documentation” were also inserted into the video to review key concepts. Additional postproduction work involved evaluation of the video by fellow nurse educators who taught medical/surgical content at the same institution. Seven nurse educators analyzed the video and completed a 4-point Likert rating scale for 35 statements that assessed content/organization, production quality/technical design aspects, and appeal/impact/appropriateness. Possible scores were 1 (minimum evidence), 2 (some evidence), 3 (usually evident), and 4 (almost always evident). Item scores ranged from 3.85 to 3.98. Several additional comments were provided by evaluators. Constructive comments mostly focused on the area of production quality and technical design. These comments included the following: inconsistent motion with splicing of the video during preparation of the sterile field, dragging of the video when applying sterile gloves, and room lighting that was not sufficient for some scenes. However, the overall comments made by
174 evaluators presented an optimistic view of the final video and included such statements as excellent, very appealing, nice job, and awesome. One evaluator stated, “The video did a great job explaining the procedure. It wasn't too wordy and was easy to follow and understand.” No changes were made to the final video used in the online section of the clinical course.
4. Video implementation In order to assess the effectiveness of the video and make good decisions about its use in our program, the author conducted a pilot test with two groups of students. The skill of wet-to-dry sterile dressing change was demonstrated using two different methods. Group 1 (n = 29) was shown the online video to demonstrate the skill whereas Group 2 (n = 10) received direct demonstration of the skill by the author. Following demonstration, participants in both groups were allowed time to practice the skill, within small peer groups, and receive feedback from faculty. Students were invited to use the nursing clinical laboratory during open laboratory hours to continue practicing the skill. Subjects in Group 1 also had unlimited access to view the video online. All students were scheduled for a performance examination the following clinical week. Both groups of students were successful in their return demonstration of the sterile wet-to-dry dressing change during the performance examination. A total of 26 of 29 of students from Group 1 in comparison to 8 of 10 from Group 2 met or exceeded the expectations of course faculty during their performance examination. There was no difference between the two methods used to demonstrate the skill of sterile dressing change on return demonstration during the skill performance examination. A simple 15-item multiple choice pretest/posttest was used to evaluate the development of student knowledge related to the skill of sterile wet-to-dry dressing change prior to demonstration and 1 week following return demonstration. The combined mean score for both groups on the pretest was 8.53; on the posttest, the score was 11.35. Subjects in both groups learned and retained information on the skill of sterile dressing change without regard to the teaching strategy used. All but three students improved their factual knowledge of the skill of sterile wet-to-dry sterile dressing change during the 3-week period, and there was no significant difference between groups.
5. Conclusion and recommendations Online video can be just as effective as direct demonstration for learning a nursing skill such as sterile dressing change. This opens up many avenues for increasingly scarce nursing faculty who have limited time to teach or
K. McKenny reinforce required content. Students could preview the online video prior to class to allow more time for supervised practice or as a review to increase depth of understanding after a demonstration. The online video offers students an opportunity to view the demonstration of skill, by an expert, an unlimited number of times, even when unable to attend live class. Currently, the author is using the sterile wet-to-dry dressing change video as a supplement to direct demonstration of the skill. All students attend direct demonstration by the faculty and have an opportunity to ask questions, then receive directions as to where they can find the video within the online course component. Students who perform above average on their psychomotor examination report that they watched the online video multiple times to learn the required steps. The video remains available to students as long as they are enrolled within the course. Based on this experience in developing and implementing a video demonstration, the author suggests that faculty consider using online skills videos to supplement their traditional teaching methods. An online video can be just as effective as direct demonstration when learning nursing skills and serves as a helpful asynchronous resource. Faculty may want to carefully consider the alternatives of developing their own videos for demonstration of nursing skills versus purchasing videos. There are currently many preproduced nursing skill videos on the market that can save faculty time. However, the experience of producing a video provides the opportunity to tailor the content to best suit a particular curriculum and learners and supports faculty in developing extended knowledge of content and technical aspects. Learning the complex details of skills video production also supports faculty becoming better and more informed consumers of educational resource media.
Acknowledgments The author was a participant in the 2010 National League for Nursing (NLN) Scholarly Writing Retreat, which was sponsored by the NLN Foundation for Nursing Education.
References Corbally, M. (2005). Considering video production? Lessons learned from the production of a blood pressure measurement video. Nurse Education in Practice, 5(6), 375−379. Herrman, J. W. (2006). Using film clips to enhance nursing education. Nurse Educator, 31(6), 264−269. Kelly, M., Lyng, C., McGrath, M., & Cannon, G. (2009). A multi-method study to determine the effectiveness of and student attitudes to, online instructional videos for teaching clinical nursing skills. Nurse Education Today, 29(3), 292−300.
Using an online video to teach nursing skills Lashley, M. (2005). Teaching health assessment in the virtual classroom. Journal of Nursing Education, 44(8), 348−350. Nichols, J. (1994). The trigger film in nurse education. Nurse Education Today, 14(4), 326−330. Smith-Stoner, M., & Willer, A. (2003). Video streaming in nursing education. Nurse Educator, 28(2), 66−70.
175 Sorenson, D. S., & Dieter, C. (2005). From beginning to end: Video-based introductory, instructional, and evaluation applications. Nurse Educator, 30(1), 40−43. Winters, J., Hauck, B., Riggs, C., Clawson, J., & Collins, J. (2003). Educational innovations. Use of videotaping to assess competencies and course outcomes. Journal of Nursing Education, 42(10), 472−476.
www.jtln.org
Using an online video to teach nursing skills Kassie McKenny MSN, RN, CNE⁎ Clarkson College, Omaha, NE 68131, USA KEYWORDS: Video recording; Nursing; Teaching methods
Abstract Faculty are challenged to find teaching strategies that develop students' technical skills within the clinical learning laboratory. A step-by-step skill-specific video placed online allows students to learn these skills at the same level in comparison to traditional teaching methods. The author will describe how to develop a custom-made digital video for the skill of wet-to-dry sterile dressing change and the success of its use. © 2011 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
1. Introduction Why should students who appreciate the immediacy and engagement of YouTube not have a similarly engaging resource for their clinical education? Creation of a nursing skill video for online learning is a complex process. However, the powerful student learning that occurs with the use of such a medium is worth the faculty effort. Online video technology supports the visual and auditory learning preferences of students who are digital natives. Faculty can use digital video technology, instead of direct demonstration, when teaching students the skills required to provide safe patient care. For beginning nursing students, the practice that is required to become safe and confident practitioners usually takes place within a nursing clinical learning laboratory prior to actual patient contact. It is a constant challenge for faculty to find effective teaching strategies for this educational setting. Digital video technology offers an opportunity to expand the repertoire of effective alternative teaching strategies within the limits presented by the clinical
⁎ Corresponding author. E-mail address: [email protected]
laboratory (Winters, Hauck, Riggs, Clawson, & Collins, 2003). Specifically, a custom digital video, tailored to the needs of the student, can be produced by faculty to meet course objectives. This article discusses the development and evaluation of a custom online video to teach the skill of sterile wet-to-dry dressing change to first-year nursing students. The video has become a key resource that encourages students to be more active participants in their own learning.
2. Literature review Using video as a demonstration method has been widely reported to effectively present specific skills training including technical skills, interpersonal skills, and observational skills. Skill-focused videos allows for model practice to be presented in a manner in which specific details can be “seen in close up and stopped at strategic points or repeated for problem areas” (Nichols, 1994, p. 327). Corbally (2005) reported that film can also ensure consistency of content when multiple faculty are teaching the same topic and that video allows for a tailored and focused classroom experience. Recently, the use of digital video technology has been supported by Lashley (2005) when streaming digital video
1557-3087/$ – see front matter © 2011 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2011.04.003
Using an online video to teach nursing skills on the Internet to guide students on the correct methods of physical examination. The video focused on a complete head-to-toe physical examination that students were required to perform at the end of the course. This method of video use allowed students to repeatedly view the video prior to being evaluated performing the examination. Students reported that the digital video was the most helpful aspect of the course. Sorenson and Dieter (2005) used video vignettes when teaching master's level students about family dynamics and health promotion counseling in a community setting. These vignettes focused on verbal and nonverbal therapeutic communication. Students in this study were shown to be able to connect concepts between the video vignettes and actual families. Kelly, Lyng, McGrath, and Cannon (2009) evaluated student learning when using faculty-developed online videos for demonstration of nursing skills. Although the findings reported that there was no change in student performance, when compared with traditional methods, students reported satisfaction with self-management of learning. The authors recommended blending the use of such a teaching strategy with lecture. Depending upon the use intended by the instructor, a video may be able to tap all three domains of learning: cognitive, affective, and psychomotor (Nichols, 1994; Herrman, 2006). Indeed, using a correctly formatted video to teach a specific nursing skill allows a student to learn the physical action of completing the skill and the theory behind the action. A skill video can also demonstrate the type of interaction that needs to occur between a patient and a nurse to create a trusting and caring relationship. Often, it is difficult for faculty to help students progress in the affective domain of learning. However, video technology allows students to react emotionally to patient situations in a safe learning environment (Nichols, 1994).
3. Video production When developing the video about chaning sterile wetto-dry dressings, the author transitioned through the three phases of preproduction, production, and postproduction. According to Corbally (2005), “the effort required to produce such innovations (teaching videos) is not be underestimated” (p. 378), and each of the three phases are essential to produce a high-quality video that will enhance student learning. In the first phase of preproduction, the focus was on planning. The most important consideration of this planning phase was scriptwriting. A well-developed script provided a blueprint for guiding all of the other phases of the video production and assisted in achieving a quality final product. Video recording and editing would have been chaotic without a well written script and clear idea of how the final video should appear. The script was developed using a scriptwriting table with considerations of critical sterile dressing change steps, voiceover dialogue,
173 film footage, footage dialogue, and other effects. As suggested by Corbally (2005), the author referred to the script time and time again to ensure that the project was progressing as planned. The second phase, production, involved the actual recording of the audiovisual material within the nursing skills laboratory. However, prior to pressing the record button, the set had to be properly prepared. The considerations for a well-developed set included ensuring supplies for multiple takes; creating a clean, organized, natural background without visual distractions; and assessing the lighting for brightness and shadows. Although only one camera was used to record the video, multiple takes were recorded to give a different perspective of the same scene. Corbally (2005) reported that multiple camera angles are important to relieve “the monotony of a single-shot film sequence.” Therefore, scenes from both front and side of the bed and from a full screen view to a close-up detailed shot were videotaped. Later, the voiceover sound was recorded in a multimedia support room using the Sound Recorder software program and a microphone. During postproduction, the film was evaluated and edited into a final digital video. Although it is ideal to have professional staff to assist faculty during this phase, Smith-Stoner and Willer (2003) report that many easy-touse software programs are available. Adobe Premier Elements was one such software program that provided a simple step-by-step guide and comprehensive help section to assist the author, who is not an expert in video production, to create a final high-quality video. The final skill video, created with no monetary resources, consisted of 12 minutes of step-by-step visual and auditory review of the critical elements required to satisfactorily complete the performance examination on sterile wet-to-dry dressing change. Display screens focusing on content related to the “Do's and Don'ts of Sterile Technique,” “Tips for Applying Sterile Gloves,” “Call the MD,” and “Documentation” were also inserted into the video to review key concepts. Additional postproduction work involved evaluation of the video by fellow nurse educators who taught medical/surgical content at the same institution. Seven nurse educators analyzed the video and completed a 4-point Likert rating scale for 35 statements that assessed content/organization, production quality/technical design aspects, and appeal/impact/appropriateness. Possible scores were 1 (minimum evidence), 2 (some evidence), 3 (usually evident), and 4 (almost always evident). Item scores ranged from 3.85 to 3.98. Several additional comments were provided by evaluators. Constructive comments mostly focused on the area of production quality and technical design. These comments included the following: inconsistent motion with splicing of the video during preparation of the sterile field, dragging of the video when applying sterile gloves, and room lighting that was not sufficient for some scenes. However, the overall comments made by
174 evaluators presented an optimistic view of the final video and included such statements as excellent, very appealing, nice job, and awesome. One evaluator stated, “The video did a great job explaining the procedure. It wasn't too wordy and was easy to follow and understand.” No changes were made to the final video used in the online section of the clinical course.
4. Video implementation In order to assess the effectiveness of the video and make good decisions about its use in our program, the author conducted a pilot test with two groups of students. The skill of wet-to-dry sterile dressing change was demonstrated using two different methods. Group 1 (n = 29) was shown the online video to demonstrate the skill whereas Group 2 (n = 10) received direct demonstration of the skill by the author. Following demonstration, participants in both groups were allowed time to practice the skill, within small peer groups, and receive feedback from faculty. Students were invited to use the nursing clinical laboratory during open laboratory hours to continue practicing the skill. Subjects in Group 1 also had unlimited access to view the video online. All students were scheduled for a performance examination the following clinical week. Both groups of students were successful in their return demonstration of the sterile wet-to-dry dressing change during the performance examination. A total of 26 of 29 of students from Group 1 in comparison to 8 of 10 from Group 2 met or exceeded the expectations of course faculty during their performance examination. There was no difference between the two methods used to demonstrate the skill of sterile dressing change on return demonstration during the skill performance examination. A simple 15-item multiple choice pretest/posttest was used to evaluate the development of student knowledge related to the skill of sterile wet-to-dry dressing change prior to demonstration and 1 week following return demonstration. The combined mean score for both groups on the pretest was 8.53; on the posttest, the score was 11.35. Subjects in both groups learned and retained information on the skill of sterile dressing change without regard to the teaching strategy used. All but three students improved their factual knowledge of the skill of sterile wet-to-dry sterile dressing change during the 3-week period, and there was no significant difference between groups.
5. Conclusion and recommendations Online video can be just as effective as direct demonstration for learning a nursing skill such as sterile dressing change. This opens up many avenues for increasingly scarce nursing faculty who have limited time to teach or
K. McKenny reinforce required content. Students could preview the online video prior to class to allow more time for supervised practice or as a review to increase depth of understanding after a demonstration. The online video offers students an opportunity to view the demonstration of skill, by an expert, an unlimited number of times, even when unable to attend live class. Currently, the author is using the sterile wet-to-dry dressing change video as a supplement to direct demonstration of the skill. All students attend direct demonstration by the faculty and have an opportunity to ask questions, then receive directions as to where they can find the video within the online course component. Students who perform above average on their psychomotor examination report that they watched the online video multiple times to learn the required steps. The video remains available to students as long as they are enrolled within the course. Based on this experience in developing and implementing a video demonstration, the author suggests that faculty consider using online skills videos to supplement their traditional teaching methods. An online video can be just as effective as direct demonstration when learning nursing skills and serves as a helpful asynchronous resource. Faculty may want to carefully consider the alternatives of developing their own videos for demonstration of nursing skills versus purchasing videos. There are currently many preproduced nursing skill videos on the market that can save faculty time. However, the experience of producing a video provides the opportunity to tailor the content to best suit a particular curriculum and learners and supports faculty in developing extended knowledge of content and technical aspects. Learning the complex details of skills video production also supports faculty becoming better and more informed consumers of educational resource media.
Acknowledgments The author was a participant in the 2010 National League for Nursing (NLN) Scholarly Writing Retreat, which was sponsored by the NLN Foundation for Nursing Education.
References Corbally, M. (2005). Considering video production? Lessons learned from the production of a blood pressure measurement video. Nurse Education in Practice, 5(6), 375−379. Herrman, J. W. (2006). Using film clips to enhance nursing education. Nurse Educator, 31(6), 264−269. Kelly, M., Lyng, C., McGrath, M., & Cannon, G. (2009). A multi-method study to determine the effectiveness of and student attitudes to, online instructional videos for teaching clinical nursing skills. Nurse Education Today, 29(3), 292−300.
Using an online video to teach nursing skills Lashley, M. (2005). Teaching health assessment in the virtual classroom. Journal of Nursing Education, 44(8), 348−350. Nichols, J. (1994). The trigger film in nurse education. Nurse Education Today, 14(4), 326−330. Smith-Stoner, M., & Willer, A. (2003). Video streaming in nursing education. Nurse Educator, 28(2), 66−70.
175 Sorenson, D. S., & Dieter, C. (2005). From beginning to end: Video-based introductory, instructional, and evaluation applications. Nurse Educator, 30(1), 40−43. Winters, J., Hauck, B., Riggs, C., Clawson, J., & Collins, J. (2003). Educational innovations. Use of videotaping to assess competencies and course outcomes. Journal of Nursing Education, 42(10), 472−476.