Last week, I had lunch with several of my educator colleagues who were expressing their frustrations about cell-phone usage in hospital settings.

Following that conversation, I decided to look at the evidence. I was shocked to discover that adults living in the United States spend an average of 3-5 hours daily on their smart phones (Anderson, 2016).  Smart phone minutes will exceed television as the source attracting the most usage in the United States within the next five years.

Therefore, I began to wonder how we can we utilise smart-technology in rural and remote settings to enhance learner engagement.

What is Engagement?

Engagement implies meaningful involvement throughout the learning process.

Martin and Torres (2004), describe three components of engagement:

• Behavioural;
• Emotional; and
• Cognitive.

The challenges and opportunities for rural nurse educators lie in their abilities to recognise these issues and create learning opportunities that stimulate, motivate, and engage nurses.

Behavioural Engagement: Embracing Technology

YouTube has become a part of our global culture. It provides a platform for individuals and groups to communicate, educate and inspire creativity in teaching and learning (Logan, 2012).

Educators who choose to share content via YouTube can share video clips that are a maximum of 15 minutes in length and upload them to the site for viewing.

There are three different privacy settings available to the educator after the video is uploaded:

• Public allows for anyone who logs onto the site to view;
• Unlisted allows viewers who have a link to the video to view the presentation; and
• Private is limited to those viewers who the educator provides an email address or YouTube username to access the video.

If you are designing education programs that focus on new technology or changes in policies or procedures I encourage to pilot YouTube as a delivery mode for nurses working on all shifts and in remote areas.

You can provide your rural nursing colleagues with the keys to learning opportunities. The creation of YouTube videos can also provide a repository for educational programs that can be integrated into nursing orientation or competency-based training sessions.

Emotional Engagement: Storytelling with a Twist

Storytelling has been a part of our nursing culture for centuries. Many of my graduate students have told me that they remember concepts such as blood flow, diabetic ketoacidosis, and comfort care because of the case studies or “stories” that I shared from my personal experience as a bedside nurse.

I encourage you to consider utilising “storytelling with a twist” as strategy to enhance engagement in educational programs.

The twist lies in your ability to provide the answer to the case while allowing the nurses to build the story either in person or through the use of smart technologies!

Reverse case studies have been used by educators in university settings for more than a decade.

Jones (2017) states that this teaching strategy allows learners to apply past concepts of learning to current situations thus enhancing learner engagement.

A reverse case study provides the learners with an outcome to their physical, cognitive, or psychiatric illness. It is then up to the learners in the audience to propose the details that led to that outcome.

This strategy can be implemented through the use of blogs or emails that can be sent through the hospital Intranet or simply posted on an education board in a setting that has limited Wi-Fi capabilities.

This process can be shared and built upon by nurses on all three shifts over a one-week period of time.

The following is an example that I hope will get you thinking:

An 89-year old widowed woman is sent home from the emergency room with right toe redness and swelling. The diagnosis that is written on her discharge paperwork is gout. Two days later the woman arrives at her primary care doctor’s office for follow-up and her laboratory results reveal a normal uric acid level. The woman continues to experience severe pain in her right foot and is unable to ambulate without assist. She reports taking the medication (Allopurinol) that the physician had prescribed and she confirms keeping her foot elevated. However, her pain continues to be a 10:10. She tells the nurse that she would rather die than live with the pain! What are we missing?

The story that you share can be built upon through ongoing emails or postings by nurses and the educator monitoring the program.

For example, if the responses begin to decrease the educator is encouraged to ask questions to stimulate critical thinking such as: How can the nurse work collaboratively with the physician to provide the patient with support and education?

This type of teaching strategy builds emotional engagement and personalises the story for learners.

By the way, the answer to this reverse case study (my 89-year old mother) is that the patient was referred to a rheumatologist on the suggestion of a nurse and she was diagnosed with pseudo-gout. An adjustment in her medications and physical therapy have allowed her to return to her baseline quality of life.

Cognitive Engagement

I believe that the most effective educators are successful because they are able to walk in the shoes of their learners.

I encourage you to motivate your clinical staff to host programs such as “grand-rounds” and “best-practices” within your rural settings and create podcasts using smartphone applications.

This is an out-of-the-box version of a flipped classroom that can provide incredible learning opportunities with minimal technological requirements.

Summary

It is my sincere hope that this blog has left you with more questions than answers.

The ability to engage rural nurses in education is limited only by your creativity. Remember, keep your eye on the prize and take risks with the teaching strategies that you implement. Ask your staff about their willingness to experiment with technology that may be as close as the palm of their hands!

References

• Anderson, M. (January 29, 2016). More Americans using smartphones for getting directions, streaming TV. Fact Tank: News in the Numbers. Retrieved from: http://www.pewresearch.org/fact-tank/2016/01/29/us-smartphone-use/
• Jones, T. (2017). Playing detective to enhance critical thinking. Teaching and Learning in Nursing, 12(1). 73-76. doi.org/10.1016/j.teln.2016.09.005
• Logan, R. (2012). Using YouTube in Periooperative Nursing Education. AORN Journal, 95(4). 474-481. doi: org/10.1016/j.aorn.2012.01.023
• Martin, J. & Torres, A. (2004). User’s guide and toolkit for the surveys of student engagement:
• The high school survey of student engagement (HSSSE) and the middle grades survey of student engagement (MGSSE). National Association of Independent School. Retrieved from: https://www.nais.org/Articles/Documents/Member/2016%20HSSSE%20Chapter-1.pdf