CIN Plus Section Editor: Linda Q. Thede, PhD, RN-BC

Integrating Laptops Into an Undergraduate Nursing Curriculum: Implementation and Evaluation Roger Carpenter, PhD, RN, NE-BC Stacey Culp, PhD School of Nursing, West Virginia University, Morgantown. DOI: 10.1097/CIN.0000000000000074

Key Points: • Uses for laptops in an undergraduate nursing curriculum.

• Evaluations of student and faculty responses. • Challenges for the future.

The demand for technology in education is strong and will only continue to grow. The increased use of technology in many settings is pushing this demand, calling for educators to develop educational processes that use technologies comparable to those used in daily life.1 Advances in technology and access to information have enabled learning to occur anytime, anywhere, and any place. Educators have also been challenged to rethink how they teach. The American Association of Colleges of Nursing, National League for Nursing, and Institute of Medicine have all called for educators in health sciences to shift from provider of knowledge to facilitator of learning,2,3 from curricula that is heavy in content to one that is conceptually based,4 and from implementing strategies that provide passive learning to strategies that encourage self-directed, active learning.5 In addition to curricular and strategic change, educators have been asked to personalize student education. Personalized learning has been defined as “… adjusting the pace

(individualization), adjusting the approach (differentiation), and connecting to the learner’s interests and experiences.”6 Educators are challenged to shift from rigid, standardized approaches to a pedagogy that emphasizes a differentiated approach to instruction.7 Differentiated teaching and learning refer to developing teaching materials so all students, regardless of ability, can learn effectively. It involves providing different methods for students to acquire, process, and make sense of content.8,9

LAPTOP TECHNOLOGY In response to these challenges, the school of nursing (SON) at a southern, land-grant university implemented a laptop program in the undergraduate baccalaureate program. Laptop use is well documented in primary, secondary, and higher education10,11 and has become a common approach to integrating technology into education. It has been strongly suggested that laptops bring added value to teaching and learning. Research suggests that teachers use laptops in their teaching for productivity and research applications12 and that laptops allow teachers to design learning activities that are more inquiry-based and student-centered, relying less on lecture.13 The use of laptops in higher education provides practical advantages, including allowing full access to a technology-rich learning environment; providing a more personal atmosphere in class, compared with a computer laboratory; and allowing flexibility in classroom configuration.14 The use of laptops in health sciences education at this university has been well established. The Office of Information Technology (OIT) sponsors the laptop program for schools that are part of the Health Sciences Center. The cost of the program is built into student tuition. The program provides students with laptop, support services (including a help desk, repairs, and loaner laptops), and an orientation to the program. When a school participates in the laptop program, it is required that all students in that program enroll in the laptop program and that the school integrates the laptop into the curriculum. The school of pharmacy (SOP)

CIN: Computers, Informatics, Nursing • June 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.


has more than 5 years of experience, and the school of medicine (SOM) has more than 15 years of experience with using laptops as a required part of the educational program. In the fall of 2010, the SON was the third school in the Health Sciences Center to implement a student laptop program. The program was implemented in the undergraduate BSN program, which includes both traditional BSN students and the second-degree BA/BS-BSN student. The BSN program is an on-site program that enrolls between 325 and 350 students from the sophomore to senior year. The purpose of this article was to provide an overview of the planning, implementation, and evaluation of this laptop program and to discuss pedagogical challenges and future directions.

PLANNING Planning for the SON laptop program began 18 months prior to implementation and was led by a SON administrator who also had a faculty position teaching in the undergraduate program. The goals for the SON laptop program were to provide advanced learning opportunities and greater access to educational resources, leverage technology to provide personalized learning, and incorporate computerized testing. The SON had the benefit of being the third program in the Health Sciences Center to implement the laptop program, which provided a wealth of experience on which to build. Major areas of planning were identified: assessment of faculty and students, OIT support, communication, administrative support, training, and faculty involvement. Interviews, surveys, and focus groups provided a rich source of information that was incorporated into the planning and implementation of the SON laptop program. Interviews were conducted with the SOM and SOP faculty and administrators, collecting information about advantages and disadvantages of the laptop program. To assess SON faculty readiness for this program, a survey assessing use and attitudes toward technology was administered. To assess the student perspective, focus groups consisting of students from all levels of the BSN program were conducted. Information gathered from this initial assessment indicated that additional supports would need to be built into the SON laptop program. Commitment from the OIT was ensured for student support, for faculty support in the classroom and testing, and for faculty development on instructional technology. The need for a structured communication and feedback plan was addressed by ensuring faculty and student representation on the Student Computer Curriculum Committee, which is run by the OIT and meets quarterly to discuss any issues related to the laptop program. In addition, it was decided that a SON staff person would be assigned to administer the program. A faculty development series, led by an instructional designer from the OIT, was offered to all faculty participating 250

in the laptop program. The training objectives focused on how Web-based instructional design could help faculty take advantage of integrating educational technologies to enhance teaching and learning, support students with diverse learning needs, and motivate students to extend their learning outside the classroom. A total of 15 hours of structured continuing education, along with additional individual project support to develop instructor-specified learning modules, was provided to faculty. It was recognized that faculty involvement in all aspects of the laptop program was essential for meeting the goals of the program. Several processes were established to encourage and maintain faculty involvement. Each year, faculty had the opportunity to evaluate and give input on the selection of the laptop model to be used. Faculty were asked to assist in identifying any learning needs they might have related to technology use and to participate in the planning of the faculty development continuing education series offered to all faculty teaching in the laptop program. Faculty were encouraged to explore software applications and to assist in coordinating vendor demonstrations of software that could be used in teaching and course management. In addition, faculty were provided a forum to share successes and lessons learned in using the laptops in teaching. All of these activities were coordinated by the SON Technical Resources Committee, which has faculty representation and is open for any faculty to participate.

IMPLEMENTATION The program was initiated with student preparation prior to the first week of classes. Student preparation began with communications before admission to the nursing program. Students received information about the laptop program prior to their coursework in prenursing classes (the freshman year), preparing them for the requirement of purchasing a laptop from the OIT laptop program upon acceptance into the nursing program in their sophomore year. Upon acceptance into the nursing program, all students attended a mandatory laptop orientation session. This orientation took place on the first week of classes in the sophomore year and included receiving the laptop, an overview of the program, and training on any software that was being used in the program. Prior to the start of the semester, arrangements were made to secure laptop-appropriate space for teaching and to provide OIT support in the classroom and for testing. Classrooms and laboratories that could support the technology were essential for successful use of the laptop in teaching. The ability to connect to the Internet was usually required for most classes. Large-screen projection and the ability to “plug in” to the server were needed for classes with a large number of students and in all testing situations because of the limited ability of the WiFi network to handle a large

CIN: Computers, Informatics, Nursing • June 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

number of users in close proximity to each other. Testing was delivered on a secure server from the course management system. Support from the OIT was present in the classroom at the beginning of testing to ensure that all students successfully signed on to the secure server and that the laptop and plug-in cables were working properly. All course materials for classes using laptops were made available to students on an electronic course management system. Many of the classes taught were audio and/or video recorded using webcasting, Camtasia lecture recording (TechSmith, Okemos, MI), and Wimba Live Classroom technologies (Blackboard Inc, Washington, DC), and links to these resources were posted in the electronic course management system. In addition, the course syllabus, handouts, and tests were made available electronically. In 2010, the following student accountability statement was included in the syllabus of all courses using laptops: “All materials necessary to fully participate in the course, such as laptop, laptop cables, required browsers, etc, are the student’s responsibility. Failure to prepare prior to class or bring these items to class will result in the student’s inability to fully participate in class. If the student does not have the items necessary to take exams or fully participate in class, no credit will be given for missed class content or missed exams.”

INNOVATIVE EXAMPLES FROM TEACHING A review of the first 3 years of the SON laptop program demonstrated that faculty had steadily incorporated the laptop technology into their teaching. The laptop was used in most of the core classes, in all clinical courses, and for student support services. As a guide, faculty used the laptops in line with the SON goals for the laptop program. Examples from teaching in the first 3 years of the SON laptop program corresponding to each of those goals are described below. The laptop program provided greater access to educational resources. Software resources were included on the laptops as part of the program. In addition, software packages could be downloaded for specific courses. For example, in the Health Assessment class, OneNote (an electronic filing system to organize class materials) (Microsoft, Redmond, WA) and StudyMate (gaming software for learning activities) (Respondus, Redmond, WA) were used. OneNote was also used in the NCLEX Review course to construct a portfolio that included a student’s assignments, tests, personal reflection on his/her study process, and action plans to improve knowledge in specific content areas. The audience response software Turning Point (Turning Technologies, Youngstown, OH) was used in most didactic courses for general and NCLEX-style polling question. In addition to software, the laptop provided immediate access to educational resources in the clinical setting. The use of laptops in the clinical setting enabled students to build

and update care plans during the clinical day. By using laptops, students were able to access information about diseases and treatments that applied specifically to their assigned patient. Care plans were then completed by the end of clinical postconference and submitted electronically to the instructor, making this instruction method completely paperless. In addition, the care plan could be projected onto a screen or shared electronically with all students in the group for discussion in the postconference setting. The laptop program allowed for more personalized learning opportunities. In both clinical and didactic settings, the choice of various instructional methods using the laptop made learning more personal for students. The adult health class allowed students to access content through prerecorded lectures (webcasts), audio-recorded live lectures (Camtasia), and an online live classroom (Wimba) outside the scheduled lecture time. Prerecorded lectures included traditional class lectures; added learning modules, such as focused presentations of content not covered in class; and case studies, scenarios, and questions for consideration and discussion among peers. Audio-recorded live lectures provided a recording of the 3-hour weekly lecture that all students were expected to attend. Online live classroom sessions provided real-time interactions to supplement interaction time between the faculty and students outside the scheduled 3-hour lecture time. These live, online sessions were used to offer study sessions, peer tutoring, test reviews, and review of specific content identified by the faculty or students as challenging and requiring more discussion. Another example of personalized learning through the laptop program was the use of eBooks. Second-degree BA/BS-BSN students in the Health Assessment class utilized eBooks instead of the hardcopy textbook. This allowed the students to construct their own personalized textbook to align with course content. Academic counselors also used the laptop program to provide personalized learning for students. The counselors used Learning System RN (MEDS Publishing, Stilwell, KS), which is a software program that links the student’s test results to sections in the text book and to references where information on topics can be reviewed, gives a pattern or areas where the student is having difficulty, and provides ideas of how to think about the questions from the test. Using the laptop, the academic counselor worked with students to use these sources to enhance their study and test-taking skills. Faculty used the laptop technology to provide advanced learning opportunities. In the fundamentals of nursing class in the sophomore year, the students were assigned a service learning project. Working in groups of six, the goal of this project was for students to work with a community agency in assessing the educational needs of the system served by the agency and then to provide an educational intervention for the agency, the community served, or both. Students took their laptops to the project setting and used them to conduct research about the agency, the community served, the

CIN: Computers, Informatics, Nursing • June 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.


educational need, and methods of addressing the educational need. The laptops were also used for collecting data from the people in the agency or the community about the educational needs. For students who excelled in coursework, the incorporation of group work and tutoring via the laptop provided the opportunity to serve in the general class setting assisting others to achieve the learning outcomes of the courses. For example, in the test review process, faculty divided students into small groups of five to seven students. The test was retrieved on the electronic course management system for the student groups to review. Students then engaged in dialogue with each other about the test questions and the answers, effectively coming to consensus on the correct response. This provided advanced students the opportunity to tutor peers in course content. The use of the laptops allowed for the incorporation of computerized testing into teaching activities. Faculty used the laptops to administer both examinations and weekly quizzes to both large and small groups of students. This provided students with a testing experience similar to that of licensure and certification examinations, while at the same time providing immediate feedback. This was all accomplished without the need for a specialized computerized testing center.

EVALUATION Data were collected from students and faculty during the spring of each academic year, after the initiation of the laptop program. The SON collected data from students for year 2011 (n = 128) and year 2012 (n = 154). In 2013, the OIT implemented a Health Sciences Center laptop program survey that evaluated the SON, SOM, and SOP together, without separating out the results of each school (n = 193). The SON surveyed faculty in 2013, at the completion of the first cohort. Students were asked about the topics of hardware, maintenance, help desk support, software, testing, interaction, and learning. Surveys revealed strengths and areas in need of attention for the laptop program. Most students were satisfied to very satisfied with the model of laptop used in the program, and 62% stated that the laptop was their primary computer. Students were comfortable with using the laptop for testing (89%), indicating that they had no difficulty with laptop testing, were satisfied with the ease of testing using the laptop, and were comfortable with the reliability of using the laptop for testing. However, a majority of students indicated that software included on their laptop for use in coursework was not utilized. Turning Point was not used by 84% of students, and OneNote was not used by 56% of students. In addition, evaluations indicated that only 21% of students thought that the laptop allowed for more interaction in the classroom “often/almost always.” Finally, 252

just under half (47%) indicated that the laptop was beneficial in learning. Faculty were asked about their use of the laptop, benefits, barriers, and their needs. Faculty indicated that they used the laptop to engage students during class by using audience response software and online resources and for quizzes and testing. Faculty highlighted the benefits of increased student interaction and engagement with the technology, the ability to track student attendance, and the automatic grading of quizzes and tests. Barriers included technical difficulties during class, time burden on faculty to develop teaching activities using the laptop, and student distraction during class by using the laptop for e-mail, Facebook, and the Internet. Faculty indicated the need for additional OIT support while in class and the need for a faculty champion to mentor faculty in the use of the laptop in teaching. Faculty emphasized that they thought this mentor should be faculty who teaches, not an OIT professional.

DISCUSSION As identified in evaluation data, the program as implemented was a good start, but not optimal for student learning. Student surveys suggested that software included on the laptop was not used in coursework and that having the laptop did not promote more engagement in the classroom. However, faculty reported that students were engaged with the technology. This discrepancy between student and faculty perceptions of engagement might be explained by the faculty comments that indicated students were distracted by using the Internet on the laptops during class. Indeed, the students were engaged with the technology in front of them, but that did not promote more engagement in the classroom. This suggests that if engaging technology is given to the students, emphasis needs to be placed on integrating it into classroom so that it does not become a distraction and thus a barrier to learning. These findings are consistent with studies of laptop programs in higher education, citing a high potential for the laptop to distract students during class.15 Faculty surveys identified the need for professional development in integrating the technology into the curriculum, and such training could provide faculty with the skills necessary for shifting student engagement toward learning activities during class. Although a faculty development series was provided to all faculty implementing the laptop program, more time and emphasis on pedagogy were needed to assist faculty with integrating technology into the classroom, rather than having the technology be an accessory to established teaching practices. To implement this laptop program within a large undergraduate nursing program, the logistics of putting the laptop technology into place were heavily emphasized. Resources fell short on faculty preparation, which is a consistent finding in the literature on laptop integration into

CIN: Computers, Informatics, Nursing • June 2014 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

teaching practices.7,16 The need for mentorship in integrating laptop technology into teaching has been identified in the literature, stating that faculty need to learn a new set of skills to be effective in teaching with laptop technology.14 Faculty need mentorship to transition from a teaching paradigm that focuses on transmission of content knowledge to one that uses the laptop to facilitate student participation in meaningful and productive learning activities. Such activities include student-led inquiry, projectbased learning, independent research, and collaborative learning.17 This suggests that programs considering implementing a laptop program should recognize and plan for the fact that faculty will need to adopt new teaching methods to fully integrate the laptop into the curriculum. This will require a considerable amount of faculty development and may require hiring an instructional designer on faculty. A major strength of the laptop program as implemented was the level of faculty involvement. Faculty were engaged in all aspects of the program, and this involvement was essential for meeting the program goals. Throughout the implementation process, faculty shared successes, which provided motivation to keep the program moving forward. For example, one major success emphasized by faculty was testing. Implementing laptop testing considerably reduced the burden of the testing process on faculty, allowing faculty to devote more time to course preparation and classroom instruction. Motivated by demonstrated benefits, faculty continue to remain engaged in the laptop program, continue to explore educational resources, and have strongly identified the desire for faculty development related to new pedagogy using technology. A final point of discussion is that the SON laptop program was evaluated retrospectively based on program goals that were established prior to implementation. Necessarily, several of those initial goals focused primarily on the physical placement of the technology into the undergraduate nursing program. In addition, the evaluation data summarized only the subjective experience of students and faculty. While this evaluation did provide valuable information to inform future directions of the program, planning for metrics of success focused on student learning, pedagogy emphasizing engagement, and curriculum integration are needed. Those planning to implement a laptop program in the future should consider developing goals, forming an evaluation plan, and collecting baseline data that will allow for the evaluation of well-defined metrics of success.

FUTURE DIRECTIONS In moving forward, the SON will continue to implement and evaluate the laptop program while focusing on faculty development, student engagement in the classroom, and program evaluation. To address faculty development and student engagement, the program administrator, along with

other faculty, will initiate a more targeted approach by focusing on specific educational topics that lend themselves to instruction through technology. Taking a targeted approach on a specific topic will provide an opportunity for a faculty member with expertise in instructional design to demonstrate concrete examples of technology use that will engage students in the classroom. We are currently exploring the integration of genetics and genomics into the curriculum through the use of the laptop technology. Faculty will be trained in the various software applications used to deliver this content and will be given suggestions on how to incorporate the appropriate genetics and genomics topics into each specific course. Since this content will be spread across the curriculum, students in each cohort will be exposed to genetics and genomics topics through the technology for three academic years. Throughout those 3 years, student perception of classroom interaction through technology will be measured. Faculty perception will also be measured. These measurements will be compared over time and also compared with the original data collected for this evaluation.

CONCLUSION While the initial goals of the laptop program were achieved, many opportunities exist to move this program forward to enhance student learning. To be successful in teaching with the technology, faculty need to be oriented to the educational resources that have been reported by the students as being unused. To reinvent the classroom and to accommodate the new learning processes resulting from the incorporation of laptops into teaching, faculty need mentorship to develop teaching methods that promote active learning with the laptop. Attention to faculty development will allow the laptop program to provide students with an educational process that successfully incorporates the technology that is ubiquitous in daily life. The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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Integrating laptops into an undergraduate nursing curriculum: implementation and evaluation.

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