When Inova Mount Vernon Hospital’s John Lawrence, BSN, RN, CPHQ, NPD-BC, sepsis coordinator, and Donna Thomas, MSN, RN, critical care nurse and nurse educator, were searching for ways to create education around trends leading to patient deterioration, they knew they needed to consider clinicians’ busy schedules. Their previous experience with brief, just-in-time training was effective, but their reach needed to extend beyond these one-on-one educational conversations at the bedside.
While participating in Inova Health System’s 16-week evidence-based practice fellowship, they embarked on a professional practice gap analysis and literature review and determined that microlearning would be the best modality of education for this crucial topic. Utilizing an app, they created a 12-week series of modules, targeting nurses working in progressive care units at five hospitals. Nurses engaged in weekly learning via QR codes and email links, with each module taking five minutes to complete. The results of their EBP fellowship project were promising and provided reasons to incorporate microlearning in their standard educational offerings.
Utilizing Adult Learning Principles
“Less is more” is the key to microlearning. Nurses are taking in and responding to so much information daily, from huddle messages to assessing patients and responding to their evolving clinical needs. The result of constant stimulation wears on their cognitive load, requiring NPD practitioners to think creatively in their education planning to ensure learning is received and processed for maximum impact. Microlearning utilizes adult learning concepts by delivering small amounts of actionable information incrementally, thereby improving retention (Carr & O’Mahony, 2019). Microlearning used within app-based technology leverages the trending popularity of convenient learning via brief video and text on hand-held devices and phones.
John and Donna chose to capitalize on these ideas through their app-based format, utilizing short videos, audio, limited text, quiz questions, and links to other content for expanded learning. By leveraging adult learning principles and strategies to promote memory and learning, they created content that was delivered strategically with the intent to maximize learning, and ultimately, to impact patient outcomes (Hawkes, 2022; Kelter et al., 2019).
Educational Content Development
As they began planning content for the course, John and Donna connected with an Inova Health staff member experienced in microlearning. Leaning on this networking opportunity, they solidified plans to leverage best practices in their educational strategy, e.g., limiting education provision to need-to-know concepts, utilizing animated text, using realistic case studies, and making modules immersive.
John and Donna knew that they needed to identify potential causes for any practice gaps by performing environmental scanning (Harper et al., 2015). Hospital patient and diagnosis data afforded information commonly associated with patient deterioration. By utilizing a learning needs assessment survey, they gleaned potential gaps in knowledge, skills, and practice related to the hospital data. The survey results drove their content outline in order to address the identified gaps.
The 16-week timeframe of the EBP fellowship required a rapid turnaround from assessment to implementation of their 12-week educational initiative. For John and Donna, this meant they had about one week to create each module. Creating the brief modules was more of a lift than initially expected; Donna and John needed time to narrow down subjects into the most-important takeaways to determine the final content inclusion.
Committing to the use of an app-based platform for this microlearning series involved extensive technical and creative work – designing each page, sourcing data, and filming and editing videos. Despite the significant lift, Donna and John committed to the importance of spending the necessary time on the microlearning project to ensure each module was engaging and effective.
Donna and John needed to ensure their education allowed nurses to learn in the domains that would most impact their practice. In implementing microlearning strategies, the team leaned on best practices in education modality research and structured many of their modules around recorded simulations and clinical case studies, allowing the nurse to view brief recorded simulated patient care scenarios and anticipate the next steps in care (Liu et al., 2023; Mak & White, 2021). Modules focused on nursing care associated with decompensating patient management, such as appropriate clinical decision-making, effective communication, and predictive/anticipation of patient needs based on an assessment of trends. They shared with ANPD an example of one of their microlearning modules, which readers can view.
John emphasized the importance of knowledge retention and focusing on essential and critical information in providing education. Utilizing microlearning enables educators to skip the “fluff” and analyze their material, narrowing in on what is most important (Kohnke, 2021). John encourages reflecting, “If my student could remember just one thing from this course, what would it be?”
Learner Engagement
The microlearning modules created by John and Donna as part of their EBP fellowship did not replace any mandated or routine education about deteriorating patients but rather served as a supplement to education on this topic. Nurses opted into receiving email or text message reminders about the optional microlearning modules and had access to QR codes via posters across the hospitals. Other engagement strategies included reminders and advertising efforts from unit leadership.
Nurse engagement was high at course onset, with over 140 nurses completing the microlearning modules. Participation waned with a significant drop in engagement at week five, with 40 - 80 nurses engaging each week through the remainder of the course. Donna and John estimate a 25% participation rate of the targeted units’ nurses within the five hospitals. At one point, Donna employed a favorite NPD encouragement strategy: giving out candy to encourage nurses to complete the modules.
Promising Outcomes
A course evaluation survey revealed 83% of responding participants agreed or strongly agreed they had made changes to their practices as a result of the course. Notably, 100% of novice nurse evaluation respondents indicated a change in practice. John and Donna were not surprised by this, as exposure to decompensating patients and robust development of clinical reasoning skills often do not occur until after nursing school when the novice nurse is practicing in the clinical environment (Hart, et al., 2016; Herron, 2018). Respondents (n=24) cited the microlearning modules as being influential in their ability to detect patient changes earlier, as well as their likelihood to use patient data trending and physical assessment to evaluate a declining patient.
Comments they received from participants were largely positive, and many shared a preference for microlearning over traditional teaching methods often employed such as PowerPoints and long online modules.
As often when evaluating the effects of a singular educational intervention, it is challenging to measure an isolated and direct effect of its outcome on nursing practice and patient outcomes. An evaluation of hospital data during the timespan of the microlearning offering showed a decrease in patient transfers to higher-level care beginning mid-education, a statistic that continued post education implementation. Data showed a decrease through the training period from 10.3 to 8.5 transfers per 1000 patient days.
Looking Forward
Although the microlearning modules involved a substantial initial investment of development time and will require updating with changes in practice, the modules are evergreen and aren’t sequential, so nurses can access content in real time when it’s most applicable to their practice. John and Donna noted they can now be used by preceptors and educators as needed.
John and Donna have utilized microlearning for other projects at Inova Health since their initial project, including modules for Sepsis Awareness Month in September and a series educating nurses on effective oral care to prevent aspiration and pneumonia. In the future, they’re planning a hemodynamics class that will be full-length but will utilize microlearning to solidify concepts.
Inova Health System’s use of microlearning showed promising results as an effective education modality. This innovative approach could be a strategy to add to your NPD toolbox going forward.
Sources
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John Lawrence, BSN, RN, CPHQ, NPD-BC
Sepsis Coordinator
John Lawrence is the sepsis coordinator at his hospital, overseeing an interprofessional team to improve sepsis care through data analysis, case studies, coaching, and collaboration. He has helped his hospital and healthcare system become a recognized national leader in sepsis care. John also chairs the hospital’s Nursing Research & EBP Council.
Donna Thomas, MSN, RN
Critical Care Nurse and Nurse Educator
Donna Thomas is a critical care nurse and nurse educator with a background in critical care, progressive care, and emergency nursing. She currently works as a bedside nurse floating to critical care units across her health system. In addition, she educates on topics such as ultrasound IV insertion, targeted temperature management in post arrest care, and ICU competencies. She is currently leading a fellowship revision effort for nurses new to critical care for the health system. She chairs a system committee on Implementation Science that is leading EBP efforts across the system. Additionally, she chairs the system ICU nursing committee arm of shared governance that works to improve the practice environment for all the of ICUs.