A Computer Learning Game for Nurses

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COMPUTER LEARNING

Mary Beth Payne, RN, MA

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GAME FOR NURSES

- Alan H. Rowberg, M.D.

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Mount Saint Mary College, Newburgh, New York tt University of Washington, Seattle, Washington computer technology enabled. information systems to integrate all types of patient care services and nursing activities in various health care

ABSTRACT Microcomputers can greatly enhance nursing curricula although their use in nursing education is relatively new. "Handwashing" is a computer learning game on principles of infection control that utili7es the unique capabilities of the microcomputer to present dry, factual information in an exciting and stimulating format. Secondary reinforcement mechanisms within this software learning program demonstrate that learning can

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Nursing practice demand.s that nursing education produce grad.uates who are computer literate and. who will effectively utilize computers to improve patient care. 4. Nursing education requires small group instruction at the clinical setting, for application of knowled.ge and skills to patient care. This need. for highly individuali7ed instruction has only recently begun to be addressed through case study simulation on computer. 5. Only limited nursing education software is available to nursing educators who wish to use this mod.e. Computers have finally established. themselves as acceptable, useful tools in nursing curricula. The schools are obtainting the hardware, but are hard pressed to utilize limited commercially available software or develop their own software. This latter choice may seem formid.able to many nursing faculty.

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INTRODUCTION

Computers are now used. routinely in many phases of education, from kinder-

garten through postdoctoral studies. Yet the use of computers iD n rs:,ng education is relatively new. v -9 Several factors account for this delay. 1. Nursing is a highly personal, humanistic profession. As such, nurses may have ideological barriers to accepting anything that may produce less human contact or deprive them of personal or professional 2.

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freedom. Nursing has been slow to commit its resources to develop computeri7ed 5 According teaching methodologies. to a survey conducted in Spring 1983, almost 50 percent of the baccalaureate nursing programs in the United. States and. Canada currently own or have access to at least one microcomputer. But, among these schools, half of them indicate that their hardware is new and they are just

THE COMPUTER LEARNING GAME In response to this need for software, Payne designed an infection control series for computer assisted instruction. These programs are designed. as supplemental to undergraduate nursing curricula or stand alone software for continuing eduHandwashing cation of registered nurses. is the first of the series, addressing concepts of asepsis, principles of infection control, and. handwashing technique. Infection control underlies all patient contact, yet the content is "dry," factual, and not particularly enjoyable to teach. The concepts are not especially exciting or highly motivating to students. But the unique capabilities of a microcomputer can make these fundamental concepts both learned and. enjoyed. Learning

learning how to use it.6 Utilization of computers for curriculum implementation is in its infancy. Initial use of computer technology in hospitals in the 1960s and early 1970s, such as use of Hospital/Medical Information Systems (HIS/MIS), offered only particular business and. administrative atDlications. Not until the 1980s did the typical hospital nurse have frequent exposur3 to computer systems; for changes in

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CH2090-9/84/0000/0953$01.00 t 1984 IEEE

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The course was developed using PC/PIL@T which will run directly on any IBM PC

compatible computer, and. can be ad.apted. to run on any system that supports Pilot, 10 such as the Apple II computers. This allows easy transportability to a large number of institutions that alread.y have such computers.

involved. in producing the graphics and other special effects, and. partially because competitive factors force the implementation of these features. Apparently most course d.evelopers assume adults are not interested. in such "frills" with their educational systems, so available software is much more bland..

The course was designed. to not only meet instructional ob-ectives but to produce measurable evidence that the objectives have been met.

Consistent with the philosophy, learning can be fun, Hand-washing is a learning game. It has rules to be followed., an opponent (i.e., infection), a method. of keeping score and. of knowing when you have won or lost. The game provid.es the learner an opportunity to learn and. use a smart playing strategy. There is also a strong element of chance.

Evaluation of this computer learning game will occur in a division of nursing baccalaureate class with approximately 70 students, per each level. Fulfillment of course objectives is measured. during the program through a multiple choice qui7 presented. on the microcomputer's display screen. Questionnaires completed. by students and faculty measure their response to the format itself. The results of these evaluation methods will be presented. at the conference.

In ad.dition to the seduction of the game the learner's interest is promoted. through a series of reinforcers. The primary reinforcers are the classical ones -- positive reinforcement when correct responses are given and explanatory information when incorrect ones are given. These are always necessary and. their importance must not be minimi'ed.. Secondary reinforcers are used, but often at different times. They are used. to to reinforce the behavior of staying alert while advancing through the program, especially when presented content is very factual and necessarily repetitive. These secondary reinforcers include the following: 1. Sound -- Sound. is used in melodic and discordant forms. Brief passages from popular melodies are synthesized when apllicable to content. Discordant sound.s accompany sinister graphics, such as the presence of microoraanisms on an unwashed hand.. 2. Graphics -- Line d.rawings not only illustrate course content but also add visual appeal. Definitions of terms that relate to infection control are presented. between a pair of just washed hand.s. 3. Color -- Color is used. with many graphics, and. occasionally as part of the text itself, to highlight

SECONDARY REINFORCEMENT MECHANISMS The philosophy underlying the Handwashing program is that learning can be fun even if the content to be learned is comparatively routine and. not inherently of great interest. This is implemented. through a series of second-ary reinforcement mechanisms. These include the use of graphics, color and. sound.. There are many examples of the application of this philosophy in our daily

lives. Television advertising involves the transfer of a small amount of very basic information about the product, often only its brand. name. While most of us express disdain for commercials, we often watch them attentively. This is largely because of the use of second.ary factors in producing commercials. They show creative use of graphics, color, sound. and motion. These are organi7ed. to produce a positive emotional response. Ind.eed., more money is spent producing a one minute commercial than a one minute segment of the program material that it interrupts. The result is that the commercials are usually watched, and. watched. repeatedly, despite their almost total lack of intrinsically interesting content.

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While these techniques are commonly used on computers, they are generally not

applied to med.ical or nursing educational programs. They are highly effective in video games and have been adapted. to some extent in educational systems that are marketed to large audiences, such as educational hardware and software for children. This is partially because the large market ;ustifies the extra work

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signidicant content. Motion -- While motion is most often used. with graphics, it is also used. with textual material, where it is much more easily implemented.. For example, titles glid.e across the screen, rather than just be displayed. Personalization -- The student is not only addressed by name throughout the program, but his past performance is commented irnon as he is urged to proceed. Choices are presented, such as deciding which d.efinitions he wishes to review out of

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a list of 10 terms. The stud.ent may also return to previous screens at different times in the course, promoting his sense of control and. individuali7,ed. learning. Humor -- Humor can effectively relieve tedium and. promote an attitud.e of eagerness for learning.

Thus the computer learning game, "Hand.washing." rresents "dry," factual data in a stimulating, creative manner. But attractive software alone d.oes not guarantee computer acceptance. For successful implementaion of computers in nursing education, acceptance by educational administration as well as by faculty and. stud.ents is vital. Specific techniques to promote acceptance and. minimize resistance are d.escribed. in other refer11,12 ences. These strategies are applicable to nursing education and. are beginning to be d.ocumented in nursing

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CONCLUSION Nursing ed.ucation can be effectively implemented. with the assistance of computers. Content areas that lack appeal to both stud.ents and. instructors are id.eal for courses d.esigned. for use on a computer; for the computer can provid.e a unique advantage in providing secondary reinforcers that stimulate stud.ent interest in the learning process and. promote initial learning as well as improved retention of material.

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Even hand.washing can be fun!

REFERENCES

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Ruth H. Carlsen. "Computer Assisted. Instruction: An Educational Issue for Nursing," Proceedings of the Seventh Annual Symposium on Computer Applications in Medical Care. Edited. by Ruth E. Dayhoff. Silver Spring, MD.: IEEE Computer Society Press, 1983. Diane J; Skiba, "Computer Literacy: The Challenge of the '80s" The Journal of New York State Nurses Association, vol. 14, pp. 6-11, March 1983 S.E. Norman, Computers: The New Approach. Computer Assisted Learning -- Its Potential In Nursing Education." Nuirsing Times, vol. 78, pp. 1467-68, Sept. 1-7, 1982. John Abbott Worthley, Managing Computers in Health Care. Washington, D.C.: AUPHA Press, 1982. Carlsen, op. cit. Mosby Times Mirror July 1983. Virginia K. Saba, ACGeneral Nursing

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Applications," Proceedings of the Seventh Annual Symposium on Computer Applications in Medical Care. Edited. by Ruth E. Dayhoff. Silver Spring, MD.: IEEE Computer Society Press, 1983. Washington Computer Services, Bellingham, Washington. Registered. Trademark of International Business Machines Corporation. Registered Trademark of Apple Computer, Inc. Worthlev. on. cit. Dorothy Pocklington, "Guidelines for Evaluating Faculty-Student Acceptance and. Effectiveness of Computer Technology in Schools of Nursing," Proceedings of the Seventh Annual Symposium on Computer Applications in Medical Care. Edited. by Ruth E. Dayhoff. Silver Spring, MD.: IEEE Computer Society Press, 1983. Betty L. Chang, Maryalice Jordan Marsh and. Alice F. Chang, "Nursing Expectations of Computers in the Hospital," Proceedings of the Seventh Annual Symposium on Computer Applications in Medical Care. Edited. by Ruth E. Dayhoff. Silver Spring Spring, MD.: IEEE Computer Society Press, 1983. Teresa J. Jacobsen and. Steven E. Fennell, "Systems Life Cycle: Strategy for Managing the Impact of Information Systems on Nursing," Proceed.ings of the Seventh Annual Symposium on Computer Applications in Med.ical Care. Ed.ited. by Ruth E. Dayhoff. Silver Spring, MD.: IEEE Computer Society Press, 1983.