September 12, 2012

What the new Apple iPhone 5 and iPod Touch mean for nurse educators

Today Apple announced the new iPhone 5, an updated iPod Touch, a new iPod Nano, and a new OS for the iOS devices. What will be of most interest are the iPod Touch and iPhone 5. These now come with a larger, high quality display and faster processors. There are improvements to the inner workings for things such a lower power Bluetooth connection. On the outside they are thinner, lighter, and taller. The width is the same.

The iPod Touch has long been my favorite recommended device for nursing students who do not want the monthly cost of an iPhone. All smartphones require a monthly data fee. The iPhone 5 in the US will work with Verizon, AT&T, and Sprint but all require a minimum extra cost of $30 per month. However, for as price sensitive as students claim to be I find that nearly all of my students now have an iPhone or an Android smartphone.

For nursing faculty who want to recommend software that will work on any student's smartphone they will be limited to the major commercial reference titles. If you want to have students use the hundreds of other healthcare apps the best choice is the iOS line of devices. This includes the iPhone, the iPad, and the iPad Touch. Only the iPhone requires a monthly charge. The iPad and iPod Touch will work with WiFi access to the Internet.

Another advantage of the iOS system is that students only need to go to one place, the iTunes Store, to download apps. There are many free and low cost apps available.

Both the iPhone 5 and the new iPod Touch have a taller screen. Most apps will probably not take advantage of this increased real estate at first. I would expect that the developers of the major commercial apps will be updating their apps within a few months from now. All older apps will run fine but in a "letter-boxed" format so you won't see a stretched image.

I will post more ideas about how these devices affect nursing faculty as soon as I get my hands on one. I will be ordering one on Friday when preorders become available.

August 5, 2012

NPR addresses the Nursing Faculty shortage

On August 3, 2012 the NPR radio program Morning Edition presented a balanced and informative story about the nursing faculty shortage. The story probably has nothing nursing faculty were not already aware of, but it is told with some real-life examples to illustrate the facts.

I also encourage you to see the comments section for that story. It has always made me angry at the number of people who believe the answer to a nursing shortage is to lower standards. We don't do that for any other profession but even nurses will denigrate the need for more education. I have always asked for where it says that less education is better than more education in any discipline?

May 18, 2012

Nurses' name tags have names on them, right?

I have seen reports that some nursing programs are eliminating last names from student name tags for security purposes. This is troubling to me for several reasons. The purpose of the name tag is so patients and other staff can identify you. That is part of the openness necessary for patient praise or complaints. Nursing students are also new faces to the staff on a unit who also may need to identify a student. The other issue is one of professionalism. It is fine for my mechanic or waitress to display only first name because that is all the information I need in this transaction; but professionals should exhibit a little more formality. I really don't want my neurosurgeon to only be known as Doctor Phil. A physician-patient and nurse-patient relationship needs to be at a high level of trust. When a nurse refuses to reveal her last name then the message is sent to all patients that they are not trusted.

We give up much in the name of security even when it protects very little. Anecdotal stories of nurses being stalked are not enough to make decisions that diminish the role of nurses in patient care. A patient crazy enough to stalk a nurse or nursing student is probably also resourceful enough to find out her last name.
Nursing faculty need to be modeling a professional image for students. Cowering in fear over minimal risks sends the wrong message to students and patients.
Let's keep full names on the name tags of nursing students and faculty. Send a message to your students and patients that we are professionals engaged in mutual trust.

Now let me tell you what I think of the security measures of the TSA...


May 9, 2012

Calculators in Clinical? I sure hope so.

Recently I heard about a nursing clinical faculty member who refuses to let students use a calculator in the clinical setting. I was stunned. Not knowing the rationale for this policy I will speculate that teacher thinks using a calculator will somehow soften students' thinking, or make them reliant on a machine that may not be available. Neither of these rationales have much merit.

Clinical education needs to focus on teaching students how to solve clinical problems. The overriding educational principle should be on how nurses would solve those problems and teach students that process. I cannot imagine a nurse refusing to use a calculator to check a dosage or other calculation.

We need to keep focusing on what skills students really need to function clinically. Calculators are ubiquitous. Even the NCLEX-RN exam has a pop-up calculator. Scenarios of blackouts or no calculators on a unit are too farfetched for faculty to be worrying about in our limited time with students.

This principle needs to be applied to all of our faculty decisions. Ask yourself if your methods of teaching or your assignments are helping students to make good clinical decisions? If are they vestiges of teaching the way your were taught, or an attempt to "toughen them up" then please let me know why they are still used?

April 23, 2012

We must keep student access to handhelds in clinical

I just got back from a great trip to speak with folks from the Florida League for Nursing. During our conversations about the use of handheld computers many nursing faculty in attendance relayed stories of being denied use of handheld computers in the clinical settings. The reasons given for such a ban by a hospital are always a little fuzzy but I believe they are based on a few fears. As we know fear usually comes from lack of knowledge. Each of these fears can be easily answered.

Here are some of the fears and how nursing faculty need to respond:
1. A smartphone/handheld computer could be used for a HIPAA violation.
Response: There have always been ways to violate privacy of patients. All nurses and students are expected to act ethically, and there should be consequences if they don't. We just need to make the privacy rules clear, and the consequences for violations clear and consistent.

2. Those devices will cause interference with equipment that will endanger patients.
Response: Hospitals are full of radio interferences from the telemetry devices themselves, security radios, cordless telephones, light dimmers, fax machines, floor buffer motors, elevators, nearby cell towers, and of course visitors' cellular telephones. There is little evidence of interference unless the transmitting device is right next to the receiving device. Some ultrasounds and telemetry devices can be affected but just stepping back a few feet will stop the effect.

3. Patient satisfaction scores will be hurt because patients will think the nurses/nursing students are playing on their phones.
Response: I would first want data to see if there is even merit to this concern. I have had students using handhelds in the clinical setting for over 12 years and found patients like to see nurses looking up information that helps their care. Nurses need to explain and show what they are doing on the handheld, and the hospital needs to engage in some education through signs or orientation brochures explaining this is how nurses and physicians practice now.

We nursing faculty must be assertive in speaking with the hospital administration about the importance of this access. In the 21st Century it is impossible, and not even desirable, for nurses to know all the facts about the drugs, surgeries, procedures, and test results of their patients. There are more facts available every day but our brains stay the same size.

Nurses are users not just recipients of knowledge. Handheld devices help nurses use the facts to make clinical decisions.

And as a final argument, it was pointed out that the administration says nothing about physician use but feels it is OK to single out nurses for these restrictions. If I was at such an institution I would really press the administration for their reasons for such a double standard.

Nursing faculty cannot just let this happen without a fight. We need to be assertive and press our points. It is not only helps nursing education but nursing practice as well.


March 19, 2012

Apple's New iPad: A Nursing Textbook Replacement Device?

After a long day waiting for the FedEx truck I have trying out the new third generation iPad (or New iPad) from Apple. I have been a big fan of the first iPad that I have been using for nearly two years. As much as I enjoyed it I found that reading books from the iBooks app or Amazon Kindle app was a struggle. The first generation iPad is heavier and, like the iPad 2, has half the screen resolution of the newest iPad. This meant that using it as e-reader was a challenge after a few dozen pages. I found it hard to get used to the weight and the slight fuzziness of the fonts grew tiresome.

With the third generation iPad the lighter weight and crisp display make reading a pleasure. There are still issues with glare in very bright environments but the overall experience is a big improvement. I found myself able to read much longer without eye fatigue. Text is now as sharp as the Kindle and other e-ink style readers but with full color and the versatility of a laptop computer.

For nursing educators I think this new iPad would be an acceptable substitute for a paper textbook. This is the first time I have ever thought that. The increased clarity means that texts can have richer content and smaller text while still being legible and useful.

Of course the next step is up to the publishers. They will need to direct energies to exploring the best way to design texts for iPad use. Apple has already created a textbook store in its iBooks Store. These books are currently aimed at high schools students but I suggest you take a look at the free Biology text they offer. It shows off the capabilities of the iPad to do more than display text. It includes 3D models and videos embedded in the text. Just imagine what nursing faculty could do with such a tool.

March 7, 2012

Apple's New iPad: What it means to nursing education

Apple has announced the third generation iPad which offers some implications for nurse educators. This blog has addressed the advantages and possibilities of the iPad before but there is one new feature that changes its utility in education: Resolution. The new iPad has a resolution near that of the iPhone 4/4S called a Retina Display. What this means is that the iPad now has a readability much closer to the sharpness of the Amazon Kindle and other e-readers but with the versatility of a PC. Despite speculation that this generation would be called iPad HD it is simply called iPad. Confusingly, the old iPad is still iPad 2.

For educators this level of resolution brings the day that paper nursing textbooks can be replaced with electronic versions. The monochrome Kindle-type reader cannot be seriously considered as textbook replacements due to their lack of color, video, and audio capability. The new iPad will allow books to appear as clear as paper but with the portability of an e-reader and the versatility of a laptop computer. I look forward to seeing how nursing textbooks will look on this screen. The other step will be to incorporate high resolution video into texts.

Other cool features of the new iPad are new 4G-LTE support for high speed data connections when out of Wi-Fi, a processor that runs 4X faster than the original iPad, voice dictation whenever the keyboard is displayed, and an improved camera, all at the old price for an iPad 2 starting a $499 (up to $829 for a 64GB 4G-LTE version). The iPad 2 will still be available but is now $100 cheaper.

I will be ordering one as soon as the Apple Store goes back on line. I will report on it soon after it arrives. Rumors are that it should be delivered around March 16th.

February 27, 2012

How to Present iOS Nursing Applications to a Classroom

I previously discussed the technical aspects of how to display the output of an iOS device but now it's time to look at what to teach students in the use of an iPad or iPod Touch or iPhone (all using the iOS operating system).

1. The Hardware: Buttons and Switches. The first thing to do is to be sure everyone knows how to turn on the device at the Power button or by pressing the Home button if it is asleep. The next most important control is the volume toggle. Finally, show students the Lock switch. The Lock switch can be used to lock the orientation or as a Mute switch. It is best on this step and the rest to have students practice on their own devices as you teach.

2. Basic Gestures. The nice thing about iOS devices is that they are pretty intuitive but there a few gestures you should demonstrate. First, the swipe. From the Home screen show how to swipe back and forth through the home pages. Second, the pinch gesture. Open a Safari web page and demonstrate how to navigate with swipe and then pinch in or pinch out for zooming in and out.

3. Basis Settings. If you are teaching first time owners of an iPad they should know how to open Settings and adjust WiFi and General settings. The others can wait until later.

4. The Healthcare Apps. I recommend that all nurses have reference apps. My favorite is Nursing Central from Unbound Medicine but there are others from Skyscape and PEPID that many nursing schools use. Students should first be given a walkthrough the dictionary, drug guide, diseases, and lab guides. Be prepared with some initial search terms to demonstrate. Ask a student to give you a term, drug, or lab test and then show how you would look it up. Finally, give the class some terms to look up. Discuss and difficulties they are finding and solutions you or their colleagues found.

5. App Management. This is a good time to show how Apps can be moved around the home screen, be put into folders, and deleted. Also, go to the App Store app and show how an application can be purchased or reinstalled. Also show how to search the App Store for healthcare-related apps.

6. The Variety Show. At this point in the instruction it is good to give quick exposure to some of the other healthcare apps you recommend. Explain why you would use them, then show how they work. There are around 1000 free and inexpensive apps of in the App Store so there are plenty of examples to prepare for your particular teaching needs.

These are my recommended steps for students' first introduction to the iOS device. As they become more familiar you can add future classes on troubleshooting, backing up, and more specific clinical uses of the apps.

February 15, 2012

"Situated Caring": An Integration of Nursing and the Environment

Olga Jarrin PhD RN (who was a student of mine during her undergraduate days) has posted a very interesting presentation on her work on the concept of Situated Caring. Situated Caring is nursing care that is highly cognizant of the context, or situation, of the care. The context includes the external environmental influences as well as the internal influences of both nurse and patient (of course "patient" can be individuals, families, groups, and communities who interact with nurses). What I particularly like is her attempt to bring together what are often presented as competing worldviews of subjective and objective perspectives of health. She presents this as "left brain" and right brain" views. I never liked this dichotomy as most of us have two working hemispheres, and we approach the world with both. Her work really emphasizes that nursing care does not take place in a vacuum. As nursing educators we need to examine how we include context into our teaching of nursing concepts.

If your department is considering changes to the curriculum or philosophical framework I urge you to read her paper in Advances in Nursing Science: 35(1) 14-24. For a short time you can download a pdf of the paper here.

January 30, 2012

How to use an iPad 2 to teach handheld nursing applications

I have been a long time advocate of using handheld computers as a reference resource during nursing clinical all the way back to the days of the Palm computer. Ever since then one of the most difficult tasks has been how to teach using the software with students. The difficulty is that it is hard to display to a group what is appearing on a small screen such as an Apple iPod Touch.

The original iPad released in 2010 had some video out capability but it was limited by the software. Developers needed to add code to software to let it be displayed, and very few did. The iPad 2 eliminated this restriction by providing a mirror display capability. In a mirror display whatever you see on the iPad will also be displayed on the external monitor. Unfortunately, there are still some considerations for nursing faculty hoping to show their students software in operation.

The iPad 2 mirror display requires a HDMI-capable monitor, an iPod-to-HDMI adapter (called the Apple Digital AV Adapter), and a HDMI cable. The adapter is available in the Apple Store and HDMI cables are easy to find, but many nursing programs do not yet have HDMI-capable displays.

Apple Digital AV Adapter

Most computer monitors and LCD projectors that are now ubiquitous in classrooms do not have HDMI capability. HDMI creates a digital "handshake" between the monitor and the device to limit copying. It is on every flat screen screen television sold in the last few years.

For nursing faculty this means we must push for the acquisition of HDMI-capable displays. They are a good investment as we migrate to high-definition instructional videos using Blu-Ray players it will be useful more than just handheld computer teaching.

When hooking up the iPad 2 to the adapter be sure to also plug in the power connector as you will run out of battery power very quickly without it. I also recommend you get a very long HDMI cable. They are available in many lengths but I suggest at least 12-foot. The most common 6-foot cords will not leave you much room to get into an area appropriate for pointing out what students will see on the monitor.

Some other tips:
• Software designed for the iPhone will display as an iPhone shaped rectangular screen. Use the 2X button to enlarge the display.

• Use the Orientation Lock next to the volume button to keep the screen from shifting from vertical to horizontal as you move the iPad.

• Have students follow along as you demonstrate a capability of the software. Then ask them to call out something they would like to do and then demonstrate that. Give students other tasks to do, such a look up a med or procedure, then see who is having difficulty. Ask a student who is able to do the task come up and demonstrate to the class.

• This advice will also work with the Apple iPhone 4S released in the summer of 2011.

Do you have any other tips or advice?


January 20, 2012

Apple's Education Initiative and Nursing Education

Apple's Education Event announced yesterday brings some exciting opportunities to nursing educators. The event introduced three new things:

iTunes U: A course management system that works through iTunes. It lets faculty manage courses and post content.
iBooks 2: The next generation of iBooks for the iOS devices (iPod Touch, iPhone, and iPad). It adds new navigation, highlighting, interactivity, study cards, tap word glossary.
iBooks Author: Mac software that enables educators to write their own interactive textbooks.

The addition of iBooks Author has the greatest potential effect for nursing faculty. Imagine writing and publishing your own textbook that your students can download directly to an iPad. Self-publishing has not been a big factor in nursing academia but the advent of e-books is stimulating a change. I can foresee faculty creating their own books that will illustrate important concepts in nursing using video, audio, and links to Internet resources.

This new option also creates new questions about student purchases of technology and e-books, who owns the book, and who gets paid for the work. I recommend you view the Apple video and see where you think nursing education can go with this.

January 16, 2012

NLN Webinar on Curricula Implications of Informatics and Social Networking

Here's a blatant advertisement for an upcoming webinar series by the NLN called Curricula Implications: Informatics and Social Networking. This is a three-part series on teaching electronic health records, integrating informatics into the curriculum, and the implications of social networking in nursing education.
A webinar is a one-hour audio/video conference you watch from any computer connected to the Internet. There is a question and answer period at the end. This webinar consists of three one-hour sessions held on Monday afternoons in February.
I am going to be teaching part of the session on the curricular implications of social networking. I hope you can join in.

January 9, 2012

4 Technology Issues for Nursing Educators in 2012

As we begin a new year nursing educators face many challenges. What are some of the technology issues of interest to all those who teach nurses?

  • Need to incorporate electronic health records (EHR) into the curriculum. Documentation has long been taught but faculty now need to address how EHRs affect assessment and evaluation of patients.  Additionally, students are entering clinical sites with a need to quickly adapt to various EHRs. Faculty must consider how to teach the principles of EHRs.
  • Need to assure access to EHRs by students and faculty. In the past, no hospital would think to deny student access to the patient charts but with the advent of EHRs some hospitals are now doing that. Nursing administrators or staff development people who are faculty liaisons must understand that they must push back when an IT person declines student access to an EHR. Faculty must be clear about learning needs, how they fit the mission of the hospital, and that IT should not be in charge of nursing education.
  • Need to plan how social media fits into your nursing program. While nursing students are heavily involved with Facebook and Twitter, how many nursing faculty even understand what they are? Remember when e-mail arrived and some faculty struggled to change the way they communicated? That is happening again with social networking. Nursing programs will need clear guidelines on how to use these media for external marketing and internal communication.
  • Need to evaluate your nursing program's use of technology to enhance learning. Technologies that have strong pedagogical advantages are available to faculty at lower cost and are easier to use. Make 2012 the year you investigate how to use Wikis, Blogs, Podcasts, Photo sharing, and Social networking.