Using Simulation with Wikis and Journals to Teach Advanced Clinical Practice

Introduction

Recent changes in nursing in the UK have been designed to produce a new type of practitioner who will be emancipated, critically reflective, creative and autonomous (Casey 1996). The move away from ward based training and task orientation to the University has therefore created an ideology toward critical thinking, clinical judgement and autonomy of practice. Biley and Smith (1998) observe that the term nurse “training” has now been replaced by “education” suggesting personal development for life, rather than apprenticeship. These changes need to be addressed in a complex society with changing demographics, increasing costs and decreasing resources (Betchel et al 1999, Greenwood 2000). This has coincided with changes in the education sector. Biggs (1999) observes that the past ten years have seen an “extraordinary” change in the structure, function and financing of universities. Jarvis et al. (1998) document the many changes that have taken place in education over the past few years as follows:

• • education to learning,

• • childhood to adult to lifelong learning,

• • teacher-centred to student-centred,

• • face-to-face to distance,

• • liberal to vocational,

• • theoretical to practical,

• • single discipline to multi-disciplinary to integrated knowledge,

• • knowledge as truth to knowledge as relative,

• • rote-learning to reflective learning, and

• • welfare provision needs to market demands.

In addition, there is also a greater emphasis on continuing professional development with employers rather than students frequently being the clients of educational institutions (Greenwood 2000).

Against this background, the author has seen her programme for post-registration nurses training to be specialists in Infection Control practice move from a face-to-face delivery, to paper, to paper supported online and finally to a fully elearning course. The challenge has been to continue to produce practitioners who are demonstrably competent in practice to be registered by the regulatory body.

Background

The programme in question is for nurses aiming to become expert practitioners. Benner (1984) defined an expert as someone who no longer relies on analytical principles such as rules and guidelines when assessing a situation and acting appropriately, having a deep and intuitive grasp of the whole situation from extensive experience. According to the regulatory body, the hallmark of a specialist practitioner is demonstration of higher levels of judgement, discretion and decision making in their clinical practice (UKCC 1998).

A social constructivist virtual learning environment (VLE) was determined to be most suitable to facilitate this, offering an approach to learning which emphasised student centeredness and enabled learning to be related to context and to practice (Oliver and McLoughlin 1999). It has been observed that distance learning provides a unique context in which to “infuse” constructivist principles as it’s expected that learners will behave as “self-motivated, self-directed, interactive, collaborative participants in their learning experiences” (Tam 2000 p1).

As nursing is situational, much of the knowledge needed for effective practice is embedded in practice itself. Delivering learning within a situated context enables this tacit knowledge to become explicit, structures knowledge relevant to its use and facilitates modelling of expert performance (Jonassen, Mayes and McAleese 1993). The aim was thus to facilitate situated learning.