Developing a digital wound care course for student nurses

Most commonly, wound management education has been facilitated experientially in the practice setting and in a teacher-centred format in nursing curricula. Although these methods are effective, the learning styles and the needs of students have changed in recent years in response to the use of digital technology in everyday life. Students are immersed in the use of technology to connect to their peers and to complete research for academic work and assessment in school and college settings. This has, consequently, influenced learning styles and it is important to consider this when optimising learning opportunities for students.

Nurses who are involved in teaching students, whether they are associated with the practice or education setting, may regard developing digital learning as challenging, despite having the ideas and practical expertise. Sharing expertise and understanding how to develop effective digital learning resources are essential to enhance student learning. To that end, this article describes how a digital learning wound care course was developed by nurse lecturers for student nurses.

Why develop a digital learning wound care course?

Identifying the need for the wound care course defines a clear rationale for the proposed development in terms of time and use of resources. For the development team, consisting of a clinical nurse specialist, nursing lecturers, and learning technologists, there were a number of issues that prompted the decision to explore the idea of a digital learning course.

First, the number of hours needed to effectively teach students fundamental wound care principles in groups, face-to-face, would amount to more than the time available. There was a risk that key concepts such as wound healing would not be revisited to make sense of wound assessment and dressing choice. Furthermore, some students had already participated in wound care activities in the practice setting so had a depth of knowledge and experience that others did not and this would impact on the learning developed.

Students required learning resources related to their practice experiences that they could access on demand rather than attending fixed face-to-face learning. This, combined with the request for a resource that covered all the relevant components of wound care (the skin, the physiology of wound healing, wound assessment and choosing suitable dressings) made a strong case for the development of a fully online course.

From an educational perspective, the intention was to offer deeper learning and understanding based on constructivist pedagogical principles (Biggs and Tang, 2011). The aim was to build on previous experiential practice by providing digital learning materials presented in a logical, concise and consistent format ranging in complexity in order to facilitate effective learning (Garrison and Vaughan, 2008; Rolloff, 2010). Flexibility was also an important factor in enhancing the learning experience so that materials could be accessible for students to fit around work and home commitments (Cook et al, 2010).

Furthermore, students could work through course materials at their own pace, which encourages engagement because they can revisit different concepts to consolidate understanding (Button et al, 2014; Sinclair et al, 2014). It was also recognised that students can be present in face-to-face teaching but not fully engage, or fail to attend and the opportunity to learn is lost.

Accepting that students can learn just as effectively using digital learning media as face-to-face teaching was initially challenging for the nurse lecturers. Lecturers acknowledged they needed to develop new skills and adapt to changing learning needs. Relinquishing traditional teaching methods required recognition that the majority of students do have a strong sense of self-efficacy and motivation, and this provided reassurance that digital learning would be an effective way to learn (Kuiper et al, 2010). It would also assist development of lifelong self-directed learning skills. For example, completion of digital learning courses could be used to maintain currency in terms of evidence linked to skills and knowledge to meet future revalidation requirements (Nursing and Midwifery Council, 2015).

Using principles of digital learning design: maximising student engagement and learning

Defining what students needed to learn about wound care was important to ensure that the course was focused and relevant to the student. Breaking down the different course components was essential so that the specified outcomes for each were seen to be achievable (Morris et al, 2005) and attained when students completed the course (Gagne et al, 2004). If students cannot quickly identify the purpose of the course and see it is attainable they may decide not to continue.

As nurses, the most important aspect of beginning to develop the wound course was working with learning technologists who had expertise in digital learning course development and design. Although the nurse members of the team had clinical expertise, they lacked the knowledge and skills to transform the concept into an engaging, effective and innovative resource. To assist the nurse members of the team to understand how the course components should be designed, the learning technologists applied Mayer's (2014) principles of instructional design theory. Mayer recommended the use of multimedia instruction using images such as photographs, combined with either words in text or spoken form, to promote interaction and enhance learning and engagement. This instructional technique also focuses on the learning need of the student rather than the technology, where the style should not override the substance of what is required to be learnt.

Mayer (2009) specified 12 principles that should underpin the design of activities (such as the wound care course) that use multimedia instruction. These principles (Table 1) are linked to optimising and managing learning by presenting the student with a resource that minimises content unrelated to the focus and uses effective structuring to aid understanding and learning. Employing these principles when designing the course was intended to reduce the focus on non-essential information (coherence) and enhance how students processed the information to increase learning. For example, to attract and engage students with the course materials they were introduced in a video by team members who had expertise in the part of the course the student would be studying.

The video was informal and each presenter aimed for a warm and friendly manner directly addressing the student (voice and personalisation principles). This, combined with direction (signalling) linked to how the course would be presented in small manageable topics (segmenting), was expected to make absorbing what was a relatively large amount of theory related to practice achievable from the student's perspective.

It was expected that the student who would be using the resources would already have some knowledge of terms and content because they were in year two of their programme. This knowledge and being able to relate theory to practice would inform deeper topic learning (pre-training principle). In terms of page design, activities were presented with text and relevant images, or images and voice presentations with only relevant information on the same page to focus on essential information (spatial, temporal, modality and multimedia principles).

Although Mayer did not link reward to learning achievement it has been suggested this is a motivator to encourage students to complete learning activities (White and Shellenbarger, 2018). Formative assessment of learning was intended to be varied and interactive (Figure 1), with reward for each part of the course completed leading to the award of an electronic badge and certificate for the student's portfolio. A badge was designed (Figure 2) to appeal to students because it has been suggested that perception of relevance to the student may be a factor in completing work to attain it (Abramovich et al, 2013).

Conclusion

This is the first wound care digital learning course developed by members of the nurse lecturing team with learning technologists and is currently being evaluated. Time spent in terms of developing new skills and building the course may appear substantial, however, this investment has benefits. It is important to remember that the rationale for course development was based on the changing learning needs of the students as they have been exposed to digital technology for the majority of their life.

Within one course principles of wound care can be explored in a logical sequence building in complexity as the student begins to understand the theoretical content. The most important aspects of using digital learning is to permit the student to learn at a convenient time at their own pace, giving opportunity to revisit course resources to aid understanding.

It has to be acknowledged that this is a change in role for the nurse educating students and they may find it challenging to relinquish traditional approaches to teaching and learning. Developing digital learning courses focuses on what the student needs to know in specific terms when they may not have a depth of knowledge. Once the fundamental aspects of wound care are understood, students can expand learning from practical or theoretical perspectives that are relevant to their own needs.

Trusting students to be adult learners and complete digital learning courses needs to be done if they are to be lifelong learners who are responsible for learning as registered nurses. From the perspective of the nurse engaged in teaching students it is time, as Morrison (2014) put it, to reconsider being ‘the sage on the stage’, and instead become ‘the guide on the side’.