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ASU acts fast to help nurses transition to ICU

July 14, 2020

Edson College of Nursing, Office of Applied Innovation and The Learning Enterprise collaborate on free, online continuing education course

Despite all hope that warmer weather might allow for a brief respite to the rapid spread of the coronavirus, temperatures aren’t the only thing soaring in Arizona this summer. In late May, not long after businesses began to reopen and residents began to let their guards down, the number of cases in the state began to climb at an unprecedented rate.

The alarming and — so far — consistent upward trend has only underscored the urgent need to bolster the ranks of our hospitals’ ICU staff. Nurses of all backgrounds and training specialties are promptly transitioning to care for critically ill patients suffering the devastating respiratory and other effects of COVID-19. It’s not an easy task, though, and usually takes a good deal of time to train nurses for such a transition: Aliria Rascón’s own ICU orientation lasted eight weeks, and that was with four and a half years of medical-surgical nursing experience.

“If you’re coming from a traditional, medical-surgical unit where you have four or five patients at once and you see them maybe every hour or two hours, now in the ICU you are caring for one or two patients and you're seeing them sometimes every 15 to 30 minutes,” said Rascón, a clinical associate professor at ASU’s Edson College of Nursing and Health Innovation. “So it's a culture shift and it's a skill set shift. And there is a lot of training that goes into that, even in a regular environment,” never mind a pandemic.

Fortunately, thanks to the swift work of Rascón and colleagues at Edson, the Office of Applied Innovation and The Learning Enterprise — a new division of the university formed to facilitate ongoing learning — nurses can now be supported in their speedy transition to the ICU under urgent circumstances. “Introduction to Adult ICU Nursing and Mechanical Ventilation” is a free, seven-module continuing professional education course that is accessible online for nurses to take at their own pace and includes an “ask an expert” feature to discuss related issues or questions that might not be Google-able. As of July 14, the course already has more than 1,295 registered nurses enrolled.

“As COVID-19 increases demand on intensive care units, resources like this course can help health care facilities quickly address critical staffing and skill shortages by retraining their existing RNs to help care for patients made ill by the pandemic,” said Andrew Nelson, program manager for strategic network advancement in the Office of Applied Innovation.

Each module in the course covers a different subject related to critical COVID-19 patient care, and in addition to basic content, each includes an assessment quiz and supplemental resources, such as videos, the “ask an expert” discussion board and the opportunity to give feedback.

While sourcing and developing content for the course, Rascón solicited feedback from nurses taking the course and nurse educators to ensure the content was accurate, comprehensive and consistent with their needs.

Candace Keck, a faculty associate at Edson and an ICU nurse educator at Honor Health with over 20 years’ experience, said she was happy to provide feedback, calling it “instrumental in developing a plan for these nurses.”

“As critical care nurses, we are asked to do highly technical, labor-intensive tasks more so now than ever before,” Keck said. “Guidelines for many things are changing daily. Nurses are patient and family advocates, so it is important that we stay current. It is also important to stay current for our own safety.”

Since the beginning of the pandemic, she and her fellow nurses have had to rethink even the simplest everyday tasks, like how to get in and out of a patient’s room for supplies, since every time the door is opened, there is potential for exposure.

“As you can imagine, that is a lot of personal protective equipment (PPE). So now, in this new era as a nurse, we need to ‘cluster’ our care. Before, we could complete our assessment, go get medications, come back later and give a bath and so on. Now we need to complete these tasks all in one setting. So now we plan more,” Keck said.

In addition, they are taking on tasks that they may not have normally performed in the past in order to decrease exposure to ancillary staff.

“We draw our own labs, we do our turns without the help of a patient care tech (CNA). Sometimes we are giving breathing treatments for respiratory therapists.”

Course content was also vetted by a team of experts led by Managing Director of Health and Clinical Partnerships Dr. Susan Pepin.

Arizona is hardly the first state that has had to quickly train nurses for the ICU, though, and there are already a lot of training courses available, including one Rascón helped develop at the behest of New York City’s Mount Sinai Hospital.

“There was already a lot of stuff floating around out there, so we were trying to be really conscientious to not be duplicative or redundant and really identify a gap where we could meet a need,” Rascón said.

“Introduction to Adult ICU Nursing and Mechanical Ventilation” differs from other offerings because of a couple of things: its emphasis on educating nurses, in particular, and the “ask an expert” feature.

“That was a really important distinction to make, because I'm a nurse; I'm not a respiratory therapist or a physician or a nurse practitioner. So we wanted to focus on the role of the practicing, registered, bedside nurse, new to the ICU environment. Which seems like a pretty narrow focus, but there are millions of practicing, bedside, registered nurses in the U.S., and many of them could benefit from this course if they’re asked to quickly serve in an ICU setting during this pandemic,” Rascón said.

“And then, with the ‘ask an expert’ platform, I was just trying to think about all my friends working in the ICU right now. … You can take all the classes you want, you can watch all the videos you want. You can take all these quizzes that say you're competent, but there will come a day when you walk into your shift and you see something that you haven’t seen a module on. Human beings are unpredictable and they don't always follow the algorithms. So we wanted some way to support the nurses who are taking this course with those kinds of questions.”

The roster of experts includes Rascón, a handful of Edson clinical faculty specializing in critical care, Edson alumni with at least two years’ career experience and several nurses from around the Valley who volunteered to help out.

With 2020 having been named the year of the nurse, Rascón is merely happy to be able to help in some way.

“It's really nice to not only be the one to educate new nurses and send them out there, but thinking about all of my colleagues out there who are facing this pandemic, who have limited supplies, who are stressed out and scared — to be able to support them in this way is huge,” she said.

Nelson said it’s just another example of ASU doing what it does best.

“This course is an example of ASU fulfilling its charter and taking fundamental responsibility for the overall health of the communities we serve,” he said. “Given ASU’s leadership in online learning, we were well prepared to deliver this world-class content from our incredible faculty in a safe, scalable manner in the middle of a global pandemic. Now, nurses everywhere can freely access this course for as long as the information is needed.”

Introduction to Adult ICU Nursing and Mechanical Ventilation will remain available to any registered nurse, regardless of location, as long as there is an ongoing need for the information. While the course is intended to support nurses orienting to the ICU at a rapid pace during a crisis, it is not intended to train nurses to be ready to work in the ICU as a result of taking the course alone — all nurses intending to work in the ICU will need a site-specific orientation as well as other support.

Top photo courtesy iStock/Getty Images

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ASU gathers experts to prepare teachers for fall at 'REMOTE' faculty summit

July 14, 2020

2-day conference promoted tools for online and blended learning to help faculty design the most engaging experience for learners

A pandemic is the perfect time to transform the role of faculty and to broaden their reach around the world, according the Arizona State University President Michael Crow.

“We’re sitting at a unique carpe diem moment,” Crow said on Monday at the opening session of "REMOTE: The Connected Faculty Summit," a free virtual event hosted July 13–14 by ASU and designed for faculty who are preparing courses for fall 2020. 

“We have a global pandemic that is driving us to deeply understand the limits and the potential of our institutions,” he said. “And we’ve got 5,000 faculty members here at ASU who have, in miraculous ways, transformed themselves into a powerful force of nature, able to take on things and do things in ways that I think have been profound.”

More than 25,000 faculty members from 2,000 institutions in 60 countries registered for REMOTE, which included more than 60 sessions over two days on distance learning. Besides best practices, other virtual classroom topics included equity, course design, field trips, assessments and advanced labs. 

Crow said that the antiquated model of faculty teaching to small clusters of students and then hoping to have their research published in a journal will only lead to further social inequity. Universities must be nimble to quickly respond to crises like pandemics and climate change, he said.

And faculty have to be empowered.

“Faculty have been largely bureaucratized, and this has limited intellectual creativity, not of the individual but in the ways that disciplines have evolved,” he said.

ASU tries to create “super faculty,” he said.

“A super faculty member is a person who is empowered by their own education and has access to everything they need to continue their education, and who can move across disciplines,” he said.

“They would have research and creative activities going on throughout the academy, not just at some selective institutions, and they have students clustered around them who are also creators, not supplicants.

“Then you underpin all of this with a technological platform that allows all of the hard and fast boundaries of the university to be eliminated.”

Here's a wrapup of some of the highlights from the REMOTE conference: 

'How AI Can Spark Curiosity and Engagement in Online Discussion'

Almost all educational institutions are planning fall semesters with various incarnations of online learning. New approaches to distance learning help keep students engaged with a sense of community. 

Doreen M. Fisher-Bammer from HACC, Central Pennsylvania’s Community College, discussed her institution’s efforts to spark curiosity in online discussion through an innovative use of artificial intelligence that helps students engage in meaningful, powerful dialogue with instructors and peers. 

Last summer the college took part in a study using artificial intelligence for online education. Packback is an AI-supported online discussion platform. The study found Packback increased motivation for students by creating conditions where people motivate themselves.

Packback is based on self-determination theory. It’s focused on students asking questions. “This is part of what motivates them to be engaged with the content and the discussion premise,” Fisher-Bammer said. 

Autonomy and competence fosters motivation and engagement, resulting in enhanced performance, persistence and creativity.

Face-to-face discussion can be a challenging way for some to engage in the classroom. Many students are hesitant to speak up in class.

But AI can enhance classroom discussion. Packback teaches students how to ask open-ended questions to improve critical-thinking skills. It coaches them in writing effectively. 

A digital teaching assistant moderates the discussion. Students can read, comment, or counter-comment and receive a score for every aspect of their argument.

The study found three things:

  • A high student quality of work motivated faculty to be more engaged. 
  • Increased instructor satisfaction with discussion.
  • Statistically significant increase in positive grade outcomes.

Students using it were more likely to have earned an A in their course than a student using a traditional learning management system discussion.

“We’ll continue looking at student success outcomes,” Fisher-Bammer said.

Student works on a laptop in a dorm room

Photo by Jenny Dupuis/ASU

'Trust Your Students'

When Cathy Davidson says “trust your students,” what she means is ask them what they need — from you as a teacher, from the class and from other students.

“If we trust one another and trust our students, we can have the kind of active learning in synchronous or asynchronous spaces that we need to make online learning a productive, valuable and even endearing way to interact with our students and help them prepare for their futures,” she said.

Davidson, a Distinguished Professor and founding director of the Futures Initiative at the City University of New York, led Monday’s “Trust Your Students” section of REMOTE conference along with her colleague Christina Katopodis, an adjunct instructor at Hunter College.

Both argued that unless we’re careful to make sure online learning is inclusive and engaging, it can replicate the faults in our current learning system, which Davidson explained relies too much on the hierarchical, top-down mode of learning that began in the early 19th century as a way to turn farmers into factory workers, and that was more about “subjugating humans, children, to a new world order” than it was about liberation, social mobility and equality.

Instead of a one-to-many teaching model, they advocate for a many-to-many model that allows students to engage and exchange ideas with one another, and in which teachers are also learners.

Davidson quoted Lee Skallerup Bessette of Georgetown University, who said that “physical proximity is not a precondition of good education,” but that it does require the following: that it be informed by issues of equity and justice, that it is interactive and engaging, that it is challenging and effective, that it involves practice, and that it includes an instructor who is visible and active, and who exhibits care, empathy and trust for all students.

“The challenge for us is how to give students a sense of agency,” Davidson said, then offered a few examples of how she does so, such as handing out index cards at the beginning of the semester, before even handing out the syllabus, and asking students to write down what they hope to get from the course, which demonstrates to them that they are the most important thing to the instructor.

Katopodis called the tactic an “entry ticket,” or something students partake in at the beginning of the class that ensures 100% participation. She also employs “exit tickets,” such as asking students at the end of the class to write down and turn in the one last burning question they have for the day, which can easily be adapted to online learning, with students submitting questions through Zoom chat or other such forums.

“It’s not that hard to show students that they have a voice in their own education and to invite them to share it,” Katopodis said.

'Affecting Connecting: High Instructor Presence Through Videos'

Creating engaging online video content can be as effective as in-person education if an instructor is willing to put in the time and effort.

Liza Hita, an associate professor and director of Online Programming and Digital Immersion at ASU, said videos are an easy and effective way to bridge literal and figurative gaps in learning environments, and can even give a personal touch to education.

“This is about your personality,” said Hita, who taught a REMOTE session Monday about how to achieve connection through the medium of video. “You can really show who you are in these videos and can demonstrate a teacher’s investment.”

She said learning environments often crave a more personal touch and large-scale classes can make that challenging for some instructors.

Hita suggested informal “homegrown videos” because the content can be fun, inventive, witty and engaging and offer a variety of tools through Camtasia, a software suite for creating video tutorials and presentations. The software can incorporate pop-ups, captions, photos, animation, PowerPoint and YouTube videos. 

Videos should be transparent, informal and accessible, Hita said. 

And for teachers who aren’t tech savvy, she offered this simple advice: “There is a learning curve, but it’s not insurmountable.”

Student works on a laptop

Photo by Jared Opperman/ASU

'A Discussion of Anti-Racist Practices for Digital and Online Learning'

Universities have been using digital learning for decades, but the pandemic has created an unprecedented reliance on these tools.

One of the myths that needs busting is that technology is neutral and doesn’t exacerbate the embedded inequities in higher education, according to Jessica Williams, director of the Every Learner Everywhere network. She spoke Tuesday at a REMOTE session titled, “A Discussion of Anti-Racist Practices for Digital and Online Learning.”

“Technology alone can’t solve complex societal problems,” she said, adding that racism is as systemic in higher education as it is in all other American institutions.

And while some people believe that online classes equalize all students, that’s another myth. Everyone has implicit bias, and research has shown that instructors unconsciously assign attributes based on students’ backgrounds, names and language choices. The answer is to be aware of how implicit bias can shape attitudes. She compared fighting implicit bias to trying to lose weight, where a lifestyle change brings more success than a one-time effort. 

Online instructors also rely on evidence-based teaching practices, but those are usually based on quantitative research that ignores those on the margins.

“We design for white, cisgender, upper-income, heterosexual men and women who become overrepresented in data collection and are what we refer to as ‘all students,’” Williams said.

Course designers, who also tend to reflect those demographics, must use more qualitative data that digs deep into the experiences of students who are low-income, LGBTQ or people of color. 

Instructors also must be aware that not all students are accessing classes with reliable internet on a laptop. Many use cell phones, she said.

“And we’re finding that there are other issues that are pressing and unexpected, like not being able to find a quiet workspace or not being able to manage time effectively or not being able to learn independently,” she said. 

Williams said that engaging students with a culturally relevant curriculum is crucial, as well as working to build a community.

“A lot of students of color really need a one-on-one personal connection to stay engaged,” she said. “That’s one thing that’s important and a lot of that is lost when you’re in an online setting.”

'Will Robots Take my Job?'

The panel title was a bit dramatic, but online learning does pose concerning questions for faculty workload, job security and academia as a competitive career option. What new policies will be needed? How will faculty be evaluated? What new skills will be required? 

“We’ve all been forced to go that way,” said Professor Loretta Feris of the University of Cape Town. “All of a sudden … we are being catapulted into this space.”

Both faculty and students are now forced to rely on technology more than in the past.

Nothing is going to replace a wonderful class where discussion went completely into the unexpected, said Diana Laurillard of the University College London Institute of Education.

“Learning is a very complex human interaction,” Laurillard said. “I find it very hard to believe that any time soon robots will be able to do much of that.”

Thomas Schneider of the University of British Columbia, Vancouver is a trained historian.

“I take a laid-back attitude to developments,” he said. The pandemic has exacerbated some developments you see in some countries, forcing everyone to examine how they’re teaching, which is why he calls it more a cultural shift than a technological shift.

“We haven’t been culturally prepared,” Schneider said. “We (now) have been forced to examine what universities will be in the future.”

Feris said the threat to low-level or early-career academics is the most problematic aspect of online learning.

“It’s the area of research support that is the biggest threat,” she said. Universities should not be doing any hiring rather than cutting early-career jobs, she said. 

“They are doing a lot of what helps us in the teaching and support of students,” Laurillard said. “They are going to be the academics of tomorrow. We don’t want to lose them. … I really hope that universities will not reach for that inevitable easy action. … Let’s let some of the senior academics take the hit. We can afford that.”

Schneider pointed out that Canada just funded research labs across the country. No layoffs have been made at Chinese universities, he added.

Laurillard predicted the future of higher education as a mix of online and in-person.

“I don’t think we’re going to go back to the old normal,” she said. “The payoff is you get a much greater support of students. You can also scale up your numbers if you’re clever about how you do that. You don’t have to recreate the same course year after year. … We will also be able to be more inclusive.”

The myths of online learning have been exposed in the past six months. 

“One of the things we need to do is expose those myths,” Laurillard said. “One of them is that it’s cheaper. It’s not cheaper.”

'Transitioning Courses and Labs to Online: Considerations and Paradigm Shift'

Millions of people use YouTube videos to help them apply their makeup, fix their car, do home repairs and meditate. 

But it looks like education is about to lap them all. 

Amina El-Ashmawy, a chemistry professor at Collin College in Texas, said videos also came in handy when the school was forced to transition to an all-online format during the first U.S. wave of the coronavirus pandemic in March.

“It was a crazy, chaotic, mad rush to get ready because our college has over 50,000 students,” El-Ashmawy said. “Not only did we have to make this transition but it was really important to put something together for adjunct faculty to plug in and start teaching.”

El-Ashmawy said trying to out figure out how to teach a lab online was particularly challenging given its hands-on nature. She said YouTube videos filled the gap for labs while Zoom worked well for online lectures, activities and breakout rooms for team-based learning. 

Assessment of her students’ work at the end of the semester produced an interesting result: The grades of the higher-performing students dropped while the lower-performing ones rose. She didn’t have an answer as to why, but said she’s more confident the fall semester will be better for everyone.

“We plan on having classes on campus but with social distancing in place,” El-Ashmawy said. “Right now there’s not a need or impetus to go online but who knows? We’re planning for online just in case but if not, it’s a bonus.”

'Digital Accessibility: Collaborating with Faculty for Accessible Online Course Delivery'

Accessibility benefits everyone. That was the key takeaway from Tuesday’s “Digital Accessibility” panel, which saw contributions from Ana Palla-Kane, senior IT accessibility and user experience specialist; Sue Johnston, instructional designer for accessibility learning; and Tawny McManus, assistant vice provost for accessibility and disability services; all of the University of Maryland.

The recent move from in-person to online instruction has created a higher demand for accessibility services, something Palla-Kane said is everyone’s responsibility. And though it can be a difficult task to ensure your course is designed for accessibility, things like free accessibility checklists and how-to’s that are available online can make it much easier.

Johnston shared her own checklist for ensuring content is accessible:

1) Headings: Make sure to structure web pages and documents properly, with appropriate headings. Use style settings to change up the look, help provide structure and make content easier to navigate and understand.

2) Links: Avoid phrases like “click here.” Instead, describe what will be found at the link to make it more meaningful.

3) Color and contrast: Use color, but avoid using it alone. Use color in things like pie charts, but also add labels, as students who are colorblind won’t benefit from color alone. And make sure there is enough contrast between the color of the text and the background.

4) Images: Be sure to use alternate text to convey the meaning of an image for blind or visually impaired students. Think about what information a sighted person gets from the image that someone who is visually impaired needs to know. Never use the file name for alternate text.

5) Tables: Avoid using tables to format documents. If do use them, be sure to include column and row headers.

6) Media: Captions can be autogenerated by platforms like Vimeo, but be sure to edit them for accuracy. You should also provide a transcript and slides.

Johnston also pointed out that students with disabilities aren’t the only ones who benefit from courses designed with accessibility in mind: “Accessibility also means making your course better for all students,” since not all students disclose their disability, some don’t know they have one and others may face barriers to technology access in this current environment.

Both she and McManus stressed that considering such factors when you design your course, rather than waiting until a student with a disability has enrolled, saves a lot of time.

And the number one question McManus said she gets from faculty about accessibility is: Where do I start? In addition to the aforementioned free online checklists and how-to’s, she recommends trying out an online training course, many of which are available at any time to demonstrate best practices. And when all else fails: Google it, and share resources with other faculty.

“Work together,” McManus said. “No one of you has to do this alone.”

Mary Beth Faller, Emma Greguska, Scott Seckel and Marshall Terrill contributed to this article.