Mobile Advocacy in Nursing Programs

Introduction and Advocacy

Nurse educators, students in nursing programs and nurse practitioners are all very busy with their responsibilities for teaching, learning, and patient care.  Mobile technologies have an opportunity to aid nursing professionals with their various responsibilities in the classroom and with their clinical activities providing a digitally mediate forum for: educating new nurses; providing continuing education opportunities for nurse practitioners; a way for students to stay in contact with their professors and preceptors; a way for preceptors to monitor activities of nursing students in the field and provide them with feedback on their clinical work; and connecting nurse educators and their students through social networking tools to a global network of nurses.  Having a mobile device with mobile data and internet access can provide nurses with a powerful tool that can improve the care they provide their patients, improve their educational outcomes and allow access to information, learning materials and experts, all in the palm of their hand. 

This paper advocates for nursing education programs to require their students to have some form of a mobile device, either a smartphone or tablet, as part of their curriculum requirements.  Additionally, nursing programs should provide essential medical and nursing applications, databases, and content for their students to use on their mobile devices.  Utilizing these mobile devices with the appropriate software and resources will provide great value to nurse educators and their students, in the classroom and as part of their clinical learning environment.  

Challenges in Nursing Education

In post-secondary education, nursing education programs span the range from associate degrees to doctoral programs.  One of the main challenges nursing programs face is a scarcity of nurse educators at a time when the nursing profession is seeing increasing student enrollments in community colleges, for-profit educational institutions and universities.  Nurse educators, students and practitioners face various challenges in the classroom and in their clinic learning environments; mobile technologies can help address some of these needs.

Nurse educators face challenges including:

• Increasing enrollments in nursing programs and not enough qualified nurse educators, makes it difficult for educators to provide personalized contact with students in the classroom and significantly more difficult to keep in contact with students in their clinical learning environments, which may be in rural and remote areas (Yoost, 2011). 
• Keeping up-to-date with technological innovations that students expect as part of their classroom education. 
• Keeping up-to-date with technology nursing students and practitioners use in a clinical environment. 
• Keeping up-to-date with current medical practices and procedures. 
• Providing busy students with flexible options for their learning.

Nursing students face challenges including:

• Very busy schedules both in the classroom and in the clinic. 
• A large amount of medical information to learn in the classroom, through textbooks, and working in the field.
• Conducting their clinical work in remote locations can make students feel isolated from their instructor or preceptors (Park, Van Neste-Kenny, Burton, & Kenny, 2010). 
• Students have many heavy textbooks and reference books to carry around.
• Due to work and family obligations, which could include overnight shifts, students cannot always make it campus for every class, but they need to keep up with the syllabus and course materials.
• In the clinic, nursing students may have to make patient care decisions without guidance or consultation with their instructors or preceptors.  

Nurse practitioners face challenges including:

• The need to continue learning after completing their nursing program.  Participating in continuing medical education programs is critical for nurses.
• Very busy schedules necessitate the need for flexibility in terms of how they receive instruction. 
• Managing patient care for multiple patients and tracking their recovery.

Use of Mobile Devices in Nursing Curricula

Adding mobile devices into a nursing curriculum can benefit both students and their instructors by providing: manageability of course materials and student learning artifacts; ability to review course materials on-demand; convenience and immediacy of access to instructors, course related information and subject matter experts; and collaboration with classmates and global experts. 

With an influx of students into nursing programs and scarcity of nursing instructors, educators need tools that allow them to manage their communication with students, manage students in the classroom and online, and assess their students’ outcomes.  While nurse educators have responsibilities to their students in the classroom, they need to be kept up-to-date on the progress their students are making in the field, and they must keep their skills current.   Needless to say, nurse educators are very busy people.  In terms of classroom management and communication, along with the ability to assess student outcomes, there are many mobile applications that can aid educators, which connect to learning management systems commonly used by educational institutions.  Mobile apps developed for Moodle, Blackboard, Desire2Learn and soon to be developed apps for SAKAI allow educators to stay in contact with their students and the latest developments within their course on their mobile devices.  Instructors can view class rosters, review discussion postings, journals, blogs and other course related activities.  Having access to their courses on mobile devices can provide busy instructors with the ability to check-in on their course and students while they are between classes or on the way to the clinic. 

Accessing course materials and participating in discussions, wikis and journals on a mobile device will also provide students with great benefits as they can participate in their courses and access learning materials while they are on-campus, commuting, or working in remote and rural environments.  Mobile devices also provide students with the ability to review lectures that have been captured in the classroom.  It is quite common that students will capture the audio in the classroom either through digital recorders or digital recording software on their mobile devices.  Many colleges and universities have invested in lecture capture systems that will allow students to review the full classroom experience with audio, video and instructional materials all synchronized together and available for review on mobile devices.  The ability to review lectures as many times as needed on mobile devices can prove a powerful learning tool for students as they prepare for examinations and their term papers.  Additionally for students who cannot attend class because of work or family obligations, they are able to keep up with the class by reviewing recorded lectures (DeBourgh, 2008).

Mobile technologies provide a significant level of convenience for both students and educators. Nursing students can have several large textbooks and reference guides that they utilize in their course work that are heavy and awkward to carry.  Being able to reference these materials on a tablet provides students with all of their textbooks on a mobile device that weighs less than two to three pounds.  In addition to lightening a student’s physical burden of carrying textbooks, students can more easily take their reference materials into the clinic or hospital, they can easily search their materials for the information they need, and the digital textbook be can more engaging with high-quality videos and simulations embedded into the text as reference information. 

For educators, student interactions can be moved online, they can review student work, and more easily monitor students working in remote areas.  Online office hours provide both the instructor and students with conveniences so that office hours can be offered at greater frequency and both students and their instructors do not need to be in a physical location together.  Since students and instructors have very busy schedules, the convenience of meeting in a virtual office through mobile devices affords a significant level of convenience and interaction with students. 

Nursing students who are completing clinical requirements within a nursing curriculum can feel disconnected from their classmates and instructors.  Mobile technologies for nursing students allow them to keep in contact with their instructors and fellow students through mobile services like: SMS (text messaging), using audio and video calling capabilities built into modern smartphones, sending emails, and utilizing social networking technologies.  All of these capabilities can increase collaboration between students and their instructors.  These collaborative activities can be critical as they will keep remote students connected to the experts they need access to, ensuring that they will successfully complete their course of study. 

Use of Mobile Devices in Clinical Learning Environments

Mobile devices with access to mobile data or WIFI can be valuable for nursing students as they enter the clinical phases of their curriculum; the student’s clinical learning environment could be far from campus and their instructors.  Mobile devices can provide a wealth of benefits for students, including a way to cite examples of their learning experiences for their instructors to review and assess. 

Content for mobile devices can prove exceedingly beneficial for students in clinical environments.  Through their mobile devices, students can review recorded lectures or access medical reference materials and databases that can improve the care nurses provide to their patients.  With access to these resources on their mobile devices, nurses can make quicker decisions without needing to check-in with their instructor or delay prescribing care until their next visit with the patient.  A South African project provided nurses with mobile devices pre-loaded with medical databases so that as they were working with their patients they could more quickly diagnose a problem and prescribe care in the field.  If they had any questions regarding a particular condition, they could send an SMS to an expert back at the hospital for further guidance (Qualcomm, 2011). 

E-portfolios are becoming important assessment tools in nursing programs, especially as students are completing their clinical requirements.  An e-portfolio allows students to post learning artifacts from their work in the field and instructors can review the work students are doing as well as monitor their activities and progress.  Learning artifacts could include: journal or blog entries, audio recordings of the day’s activities, or a video of work with a patient –if the patient provides consent to be recorded.  All of these learning artifacts can be created on or with a mobile device.  The e-portfolio provides a history of the student’s learning and progress throughout the curriculum, which may be helpful as they apply for jobs or continue their education (Garrett & Jackson, 2006). 

Nurses are working in multi-cultural and multi-lingual environments.  Using mobile devices, potentially using a video-calling feature, nurses in remote locations could connect patients to native language speakers to help diagnose a patient’s condition and prescribe a course of action for their care.  For patients who maybe taking a mixture of medications, it is critical that they know how the drugs will interact with each other and their side effects.  If nurses can have someone explain the instructions for their patient’s medicines in their native language through the mobile device, it could literally save their patient’s life. 

Using mobile devices can aid in the learning process for using electronic medical records.  More hospitals are moving to electronic records and if nursing students have a deep understanding for how to read electronic charts, it will make them more effects as they graduate from their nursing programs and begin practicing.  Tablets can be an effective form factor for reading electronic medical records and entering data into the records.  Mobile devices can also aid nurses in recording and track dosing information for their patient’s medications and provide a patient history that they can reference when visiting their patient in the future.

Why Advocate for Requiring Mobile Devices in Nursing Education Programs?

Given the responsibilities and workloads that nursing students and nurse educators are responsible for, mobile devices can provide a better quality of life as they manage their busy schedules.  Advocating that nursing curricula require students to have mobile devices will increase the costs students pay for their education, but the benefits outweigh the costs.  Many students come to campus with mobile devices: smartphones, tablets, or both types of devices, so the costs for requiring these devices may not add to their financial burdens.  If prospective students understand that mobile devices are a requirement for their program, they can budget for these devices as a cost component for attaining their degree.  Students should be encouraged to purchase the most modern devices with the fastest processors, highest resolution screens and most memory they can afford, since they will need to use these devices over their two or four year program.  Nursing programs should not dictate which devices students should use, they should be supportive of the devices students come to campus with, but at the same time, they should also recommend mobile devices as students may not be conversant with the latest mobile technologies. 

Another reason that nursing programs should not dictate the mobile devices students should use in their program is that mobile devices are a deeply personal technology.   What one student finds easy to use, may not fit the needs of another student; this policy will provide a greater support burden for technical support staff.  As students move into their clinical learning environments, form factor will become important and personal.  Some nurses may find that a mobile phone fits easily into their pockets and a small lightweight device meets their clinical needs.  However with the recent popularity of tablets and the hundreds of medical applications available for tablets, a larger screen device may be better for some nursing students.  The point is, students should choose which device they feel will allow them to become successful nurses. 

Nursing programs should provide their faculty with mobile devices for use in their teaching environments, be it in the classroom, online or in the clinic.  Educators need to be familiar with how nurses use mobile devices, medical applications and databases as they provide patient care.  As this paper advocates that nursing programs need to be open to supporting the devices students come to campus with, it is important that nurse educators are provided by their institution with multiple mobile devices on various operating systems so that they can also provide a level of support for their students.  Also it is important that nurse educators stay up-to-date with technologies for medicine and health informatics.  Mobile devices will be an important technology that practitioners will need to utilize in the field and developing a deep understanding of these devices is essential for effective use in the field. 

Administrators who manage nursing programs need to understand the benefits of utilizing mobile devices within their programs, and why it is important that they require these devices within the curriculum.  If program administrators support the requirement that students must have and utilize mobile devices within their programs, this will help engrain a culture of support for mobile technologies by faculty, support staff and students.  Support from those in leadership positions within an institution can help implement these changes to curricula, but it must be in collaboration with the faculty so that they do not feel as those this is a top down policy decision for which they have no input.    

Supporting faculty by providing them with mobile devices is an investment that the institution will need to make for their programs to stay relevant to the communities and hospitals that they serve.  Administrators will need to invest in support staff for faculty and students.  Support staff will play a critical role for insuring that mobile devices are effectively implemented into curricula.  Beyond technical support, training and orientation sessions will be needed for both faculty and students and time must be allotted in the nursing programs for such sessions; these cannot be one off training sessions, training must happen throughout the program as new technologies emerge. 

Administrators can take actions to help alleviate the costs of utilizing mobile devices within a curriculum.  First, administrators can partner with mobile providers to gain discounts for their students.  Since these mobile devices will be used for educational purposes, mobile phone providers could offer the institution a bulk discount on the devices and the data plans if a certain percentage of students use the provider’s services and devices.  Second, students will need reference materials, databases and textbooks for their mobile devices.  Administrators should work with content providers to lessen the costs to students for this content; if the curriculum is standardized across the institution, bulk purchases could be utilized.  If for example, all first year nursing students must purchase: the Medical Encyclopedia and Human Structures App, maybe the institution can negotiate a discount for its students?  Or through a technology fee, the program can help offset the costs of digital materials for their students.

Further Thoughts for Discussion

There are certain needs that fall outside of an educational context that must be addressed when planning to implement mobile devices within a classroom or a clinical learning environment.  Considerations must be addressed for the following needs:

• To assist program administrators and faculty with evaluating the usage and success of mobile devices within their curriculum, quarterly or half-yearly surveys should be administered to gauge student usage of mobile devices.  Collecting this survey data will provide administrators and faculty with information needed to make adjustments to their programs to better serve the needs of their students. 
• Students need access to content and databases that will assist them at the point-of-care and this information needs to be easily accessed and searched.  This may require nursing programs to partner with publishers and database providers to design applications that meet the needs of nurses in clinical learning environments (Kenny, Park, Van Neste-Kenny, & Burton, 2010).
• Hospitals and clinics need to update their policies regarding the use of mobile phones so that these devices can be readily available for students to utilize in the field.  Students may need to be trained on the proper use of mobile devices so that they are not using their devices for personal use when working. 
• Data entry on mobile devices can be difficult especially when managing a large number of patients throughout the day.  Data entry mistakes are easy to make on mobile devices when you are not in a rush, but when moving from patient to patient it may be even easier to make data entry mistakes, which could have life and death ramifications.  To aid nurses, standardized codes should be developed and used as a form of shorthand for nurses to use when entering information into mobile devices. 
• Mobile devices are only as useful as their batteries allow them to be.  Hospitals and clinics need to provide mobile device charging station so that in downtimes, these devices can be charged for use throughout an entire shift.  It may be important to choose devices with removal batteries or provide nurses with cases that contain batteries so that the device can be utilized throughout a shift.  

Conclusion

This paper is advocating for a broad policy regarding the need for nursing programs to institute policies requiring students purchase mobile devices as part of a nursing curriculum.  Nursing programs vary by institution, and administrators and faculty must work together to best utilize mobile technologies in their curriculum.  It may be controversial to require these devices since some faculty may not want to use these devices or know how to use them, and students may not like being required to purchase another piece of technology for their program which will add to the costs of their education. 

However, the long-term benefits for the program and students are significant.  Utilizing mobile devices within a nursing program may provide institutions with a competitive advantage, as their students will utilize modern technology in their education, which is valued by hospitals and clinics. Nursing students who have used mobile technologies in their nursing programs may have an advantage when applying for jobs as they will require less training on mobile devices and apps than students who may not have had experiences with mobile technologies in the classroom or the clinic. 

References

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