Nursing faculty are faced with the challenge of delivering competency-based education to baccalaureate nursing students. In addition to addressing the Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing [AACN], 2008) in both the didactic and clinical/experiential learning for prelicensure and RN-to-baccalaureate nursing (BSN) degree students, nursing faculty also need to incorporate the gerontological nursing concepts outlined in Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults (AACN, 2010). In order to address these competencies, faculty may elect to integrate gerontological nursing concepts across the curriculum or, as in our case, offer a free-standing gerontological nursing course. Ensuring that gerontological nursing concepts are effectively integrated across didactic and clinical curricula or incorporated into a designated course is a formidable endeavor that can result in multiple faculty using multiple, diverse resources and learning activities. Faculty goals for continuity in course curricula and quality of instructional strategies motivated efforts among faculty who are responsible for teaching gerontological nursing content to share resources and lesson plans.
Many baccalaureate nursing programs have migrated to the use of blended curricular models using learning management systems for course delivery that facilitate the delivery of eLearning content, also known as learning objects. Learning objects are defined as any entity, digital or nondigital, that can be used, reused, or referenced during technology-supported learning (Wiley, 2000). The purpose of this article is to describe a systematic approach to identify, evaluate, and curate gerontological eLearning materials (e.g., web-based videos and other resources, case studies, tutorials) and tool kits for innovative experiential learning, which are then housed in the learning management system to serve as an online digital repository for faculty. Using the Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults (AACN, 2010) as a guide for curricular mapping and linking the curated eL-earning objects and experiential learning tool kits ensures the delivery of competency-based, baccalaureate-level gerontological nursing content.
Setting and Problem
Our prelicensure BSN curriculum includes a 3-credit hour didactic course in gerontological nursing and the care of older adults along with a 2-credit hour clinical experience. The RN-to-BSN curriculum includes a 4-credit hour course delivered in a hybrid format with 42 clinical hours enrolling eight cohorts of students in locations across North Carolina. Each year, up to five different faculty members teach sections of these courses. With more than 110 prelicensure and approximately 75 RN-to-BSN baccalaureate nursing students taking the required gerontological nursing course each year, faculty teaching the course proposed an innovative approach to delivering competency-based gerontological nursing education.
The gerontological nursing faculty were already using learning objects they had identified and embedded in their courses; these supplemental materials were used to enhance the student learning experience and promote integrative learning to complement textbook and other assigned readings and faculty-generated lectures and slides (Kennedy-Malone, 2010; Oermann, 2015). Faculty sharing of these learning objects was sporadic, and there was an increasing appreciation that each faculty had resources that would be helpful to others. Thus, we wanted to develop a process to make available these learning objects to faculty in other courses. Taking this initiative a step further, we determined that establishing the digital repository would provide all faculty access to a variety of gerontological materials that could fill gaps in our course curriculum, such as faculty-developed lesson plans, experiential learning activities, and assignments, in addition to web-based resources such as videos, TED Talks, slide sets, and information garnered from governmental and professional organization websites such as the National Institutes of Health and Quality and Safety for Nurses (n.d.). Therefore, we decided to develop a peer-reviewed, curated repository of gerontological learning materials that would ultimately enhance the delivery of competency-based education across a on the gerontological nursing courses.
Stufflebeam's (1983) Content, Input, Process and Product (CIPP) evaluation model was used to guide the process of identifying existing educational resources and gaps in resources to enhance student learning, evaluating all learning materials and creating the digital repository of gerontological eLearning materials. The eLearning materials that could be used to facilitate both in class and online learning were found and reviewed. Applying the CIPP framework evaluation to review the nursing education curriculum has been shown to be an effective guide for reviewing nursing curriculum (Lippe & Carter, 2018).
Curricular Mapping With the Recommended Baccalaureate Competencies
Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults (AACN, 2010) served as a guide for curricular mapping. The geriatric competencies were created to ensure that educators are addressing content that is vital to the nursing care of older adults. The AACN/Hartford competencies utilize the framework of the AACN's Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). Ultimately, a curricular map was created to provide a practical guide for nursing faculty to map their course content effectively to these essential competencies (Blais, 2002).
This educational improvement process began with the completion of a crosswalk between the topical outlines with the Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults (AACN, 2010). The crosswalk was completed when consensus was reached among gerontological course faculty as to how the competencies were being addressed. The eLearning objects were then linked to these recommended gerontological nursing competencies. The value of process evaluation is the establishment of a feedback mechanism.
Systematic Evaluation of Geriatric eLearning Objects
Learning objects are resources or interactive software such as videos, simulation, or images that can be used to enhance lectures or be embedded in course management systems for online learning (Wiley, 2000). To begin the vetting of web-based learning objects, a literature review was conducted to identify evaluation tools. The Learning Object Review Instrument (LORI) (Leacock & Nesbit, 2007) was selected to critique the learning objects identified for potential use by the individual faculty. The LORI is a quality rating tool for digital learning resources developed by the eLearning Research and Assessment Network ( https://www.elera.net). LORI uses a review format to address nine categories to facilitate critique and comparison of learning objects. The categories are content quality, learning goal alignment, feedback and adaptation, motivation, presentation design, interaction usability, accessibility, reusability, and standards compliance. Objects are rated high (5) to low (1) (Leacock & Nesbit, 2007). All faculty involved in this project were provided with the LORI instruction guide. Initially, five faculty reviewed the same three learning objects to establish interrater reliability. For the eLearning materials already used in courses, two faculty were assigned to systematically review each learning object by using the LORI (LORI 1.5) (Leacock & Nesbit, 2007). Faculty were then provided with a list of learning objects by content area from the resources currently being used in their individual course to evaluate, with two faculty assigned to review each learning object. As a first step in this process, a course shell was created in our learning management system to populate with resources imported from each section of the gerontology courses into modules that encompassed the topical areas for the AACN gerontological competencies.
After these resources were evaluated, faculty were assigned topical areas to locate new learning objects that would then be evaluated. After faculty completed their assessments, the whole group reconvened to analyze and discuss the results. Learning objects that received scores of at least 3.5 and over were included in the Gerontological Nursing Digital Repository site in the learning management system. All approved eLearning objects were matched to the gerontological competencies by the topical outline.
Effectiveness of the Innovation
Using Stufflebeam's CIPP evaluation model for enhancing competency-based gerontological nursing resulted in the development of a digital repository. A value of the evaluation method is establishment of a feedback mechanism to help identify gerontology content area gaps that were then targeted in the web search for learning objects. For example, faculty searched for and added additional resources they identified for content areas that had few learning objects.
Faculty review and evaluation of the digital repository indicated a high degree of satisfaction regarding the ready availability of a wide variety of learning objects that could be added to their course. Faculty have continued to populate the digital repository with new resources.
By using a systematic evaluative approach to identifying, evaluating, and then curating eLearning materials, faculty have readily available multifaceted gerontological resources to infuse into the gerontological nursing course and other nursing courses where relevant learning resources are needed to address concepts related to gerontology and evidence-based care of the older adult. Developing a digital library is a means of having all training materials in a centralized library and where training materials can be easily updated for all courses by all faculty enrolled in the Gerontological Nursing Digital Repository learning management system site.
An added benefit for faculty who participated in this innovative project was the sharing of resources they used in their own gerontological course with other faculty, fostering faculty collaboration and communication about a course that is taught each year to all baccalaureate nursing students by several faculty. Each faculty has individually developed innovative instructional strategies, assignments, and materials and has identified novel high-quality web resources for use by their colleagues. Collectively sharing expertise enhances the quality and availability of the teaching materials available to faculty for the development of lesson plans (Oermann, 2015).
An additional consideration for developing the Gerontological Nursing Digital Repository was to consider the extent to which the gerontological nursing course could be redesigned using web-based learning objects and other instructional materials in lesson plans that would supplant the course textbook. For many students, purchasing textbooks is a financial burden and efforts to alleviate this burden have led to interest in eBooks and course redesign. The wealth of information and resources on the Internet makes this endeavor an important possibility for faculty to consider.
The initial pool of learning objects retrieved from course curricula from the five faculty members included 42 web-based resources and links, as well as faculty-developed slide sets, assignments, and worksheets. Faculty contributed over 40 new learning objects to the digital repository. The learning objects are distributed in the learning management system modules and are readily accessible to faculty. Some learning objects may be placed in more than one module. For example, a video on visual perception changes in dementia may be used in the module on age-related sensory changes, fall risk in the older adult, and on neurodegenerative changes and cognitive impairment in the older adult.
We encountered several limitations in our processes. Our learning management system lacked a search function to locate learning objects in the modules. Instead, faculty needed to scroll to the module and then search that collection, a process that could be time consuming and potentially frustrating, especially as the number of learning objects increased. Another limitation is that the LORI, which included the faculty review and comments, was not linked to the learning object in a way that provided easy access; thus, information about the learning object description, target audience, key content covered, and other descriptions may not be reviewed, and instead faculty may independently review the learning object. In addition, although each of the original learning objects were peer reviewed, as faculty added new learning objects, completion of the LORI was not required; faculty used the guidance from the evaluation process in the LORI to make decisions on the learning objects to include new eLearning objects in the digital repository.
We have proposed an innovative approach to identifying, evaluating, and curating content that is then housed within a digital repository created in the learning management system where it can be easily shared with faculty teaching courses with similar content. Furthermore, it could be a model for working collaboratively to strengthen the delivery of competency-based education. Innovative technology in nursing education engages the active learner; thus, having a selection of multifaceted resources provides faculty with an efficient solution to course enhancement (Oermann, 2015). Having a way to readily share peer-reviewed instructional materials and resources linked to clinical competencies affords continuity and quality in course delivery.
Using multifaceted learner-centered approaches to the delivery of gerontological nursing content in undergraduate nursing education has been shown to enhance students' overall attitudes and willingness to work with older adults (Mastel-Smith, Nash, & Caruso, 2016). Given the rising older adult population, it is imperative not only to deliver competency-based education but also to ensure that students are exposed to cutting edge, interactive learning opportunities. The process afforded by this project is easily replicable by other faculty teaching multiple sections of courses, as well as for faculty who wish to incorporate gerontological content in their course and lesson plans (e.g., including gerontological learning objects on polypharmacy and potentially inappropriate medications in a pharmacology course). Future improvement to this project includes exploring other digital platforms that enable search functions to facilitate efficient access to learning objects.
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