Going the Distance

Women’s Health NP Specialty Director Ginny Moore considered using paper towel tubes and other easily obtained supplies to construct pelvic models when students couldn’t come to campus.

Last spring Associate Professor Ginny Moore, DNP, MSN’90, stood in her kitchen with empty paper towel tubes in hand, puzzling over the challenge in front of her. As director of the Women’s Health
Nurse Practitioner Specialty, she was trying to figure out the best way to build a makeshift model of a woman’s pelvis using household items like the paper towel tubes. The COVID-19 pandemic had shut down Vanderbilt’s campus, and her students in the School of Nursing needed a way to develop their hands-on skills at home.

In search of a durable solution, Moore moved on to PVC pipe, adding a skein of yarn—the open center would allow students to practice inserting a speculum—and then a rubber paddleball for the cervix. “First I used a dog toy, then I thought about superballs,” Moore remembers. “But the rubber paddleball worked perfectly because we could bore al ittle hole in it for the endocervix.”

Feeling that she was on to something, Moore sent a picture of her prototype to Mavis Schorn, PhD, FACNM, FNAP, FAAN, senior associate dean for academics. Dean Linda Norman, DSN, FAAN, green-lighted the project midsummer, and Moore brought in simulation lab director Jo Ellen Holt, DNP, to help improve the model.

“Once the decision was made to move forward, things went really quickly,” Moore says.

Due to its durability, PVC pipe eventually won out over paper towel tubes as the base for the models. The kits sent to students included the supplies a nurse practitioner would use during a pelvic exam.

Holt, an engineer before entering nursing, tweaked the model, swapping the yarn for a dishwashing glove before settling on a latex balloon, and later adding a nylon trouser sock to represent skin. When everyone was satisfied with the model, Holt’s team reproduced them in assembly line fashion, even designing a foldable cardboard stand to hold the model when the student practiced.

By August 2020, 30 models for exam kits were ready to be shipped to students around the country. “I stamped them with ‘Vanderbilt University School of Nursing Simulation Lab,’ and included an instruction manual,” Holt says. “I thought that would help if the post office X-rayed a package.”

Moore says the project was a success, and not just for the pandemic. “The students did really well with it,” she says. “It’s the first time they’ve had unlimited practice with the model they were tested on. We will continue to use this even when we return to in-person learning.”

The exam kit was so successful that faculty from other areas asked for their own. “Midwifery wanted in, and then the sexual assault nurse examiners asked for a version,” Holt says. “It’s exciting to me that this seemingly simple model allowed students to bridge the learning gap caused by the shutdown.”

 

Pivoting in the Pandemic

The brainstorming on the development of the exam kits is just one example of why the School of Nursing has long been a leader in innovative education and distance learning. The nursing school pioneered distance learning in 1996 and remains on the leading edge of educational innovation more than two decades later. When the pandemic hit in the spring of 2020, the school was better positioned than most to pivot to fully remote learning while keeping students on track.

“Most classroom teaching was already done at a distance,” says Betsy Weiner, PhD, FACMI, FAAN, the longtime senior associate dean for informatics and architect of the school’s innovative education program. “And our faculty happily thinks outside the box.”

Schorn agrees. “We already had a collegial and supportive network in place,” she says. “That combined with our practice of always putting students first got us off to a good start.”

That’s not to say that the pandemic pivot was simple. The goal was clear, but the question was how to execute. The impact on students was top of mind for everyone.

“Right before spring break in 2020 [late February], we were in crisis mode like everyone else—figuring it out day by day,” Schorn says. “The spring semester is a very busy clinical session for our students with experiential learning, which is essential to their education.”

Due to the spread of COVID-19, students’ clinical education in hospitals, clinics and other facilities was suspended in mid-March of 2020, followed quickly by the suspension of all in-person classes campuswide.

“When we made the decision to pull all the students out of clinical placements, our No. 1 focus was
student safety,” Schorn says. “This was the biggest crisis I’ve had to deal with in my professional career. We were running full tilt at maximum. It tested all our leadership skills.”

With the shutdown, the nursing school’s state-of-the-art simulation lab, the jewel of the $23.6 million
building expansion in 2018, was off-limits to students. To make up for the loss of hands-on teaching, PreSpecialty clinical faculty worked with Holt and her team to create virtual simulations to support pediatric, adult, obstetric and psychiatric-mental health care. For the first one, faculty members acted as avatars in the lab as students directed their actions over videoconference. A second faculty member observed and led a reflective debrief after the simulation.

“The student couldn’t just instruct the faculty avatar to take the patient’s vitals,” Schorn says. “They
had to be specific, asking for which vitals they needed and how they should be obtained and why, before the avatar would act. That’s because faculty needs to see that the student knows all the steps.”

The real test of the fully virtual clinical experiences would be with the students’ licensing exams. “We had already determined with the national accreditation body that the virtual learning would count hour for hour for hands-on training,” Schorn says. “But the exam results would prove whether the virtual learning worked.”

Despite the pandemic upheaval, the students didn’t miss a beat. “They did fine,” Schorn says. “Our pass rate for the exams was 97 percent—better than last year and rivaling the highest pass rate we’ve ever achieved.”

Lectures also took on a new look as faculty hastened to get all their instruction moved online. Associate Professor Abby Luck Parish, DNP, MSN’05, FNAP, named director of education innovation in fall 2020, appreciated the mix of formal faculty development along with colleagues simply helping colleagues.

“We knew who had great ideas in each trench and we helped each other,” Parish says. Closed captioning was added to many recorded lectures, and transcripts were more often available. “Those changes increased access for students with disabilities, and students without disabilities also reported appreciating the flexibility of multiple lecture formats,” she adds.

Parish says that faculty also used the transcripts to edit their presentations and then recorded shorter, more concise lectures with better graphics. “Students often have to spend more time on online classes, and a lot of that has to do with the professor’s delivery,” she says. “We’ve found that a longer face-to-face lecture often can becut down t o a more succinct version for online consumption, and the students’ experience is better when it’s shorter.”

Parish also pointed to the online course design institute held by Vanderbilt University’s Center for Teaching. “The faculty participants were forced to be students as they experienced remote learning,” she says. “It’s always a great experience for educators to step back into the shoes of students.”

Parish, who favors a “backward design” approach to curriculum development, saw the concept being deployed repeatedly as faculty rushed to adapt their classes to the new environment. “It’s such a learner-focused approach,” she says. “You begin with the goal—what students need to learn from this course—and work backwards from there.”

The 1997 cohort of PMHNP students were pioneers in distance learning.

Many of these teaching adaptations are here to stay, Parish says. “We all realized pretty quickly that these changes weren’t going to go away after the pandemic,” Parish says. “We’ve been given the opportunity to be really intentional and innovate. From the day I started here 11 years ago, the philosophy at VUSN has always been‘ think about the way it could be’ instead of ‘this is the way we’ve always done it.’ ”

The philosophy at VUSN has always been ‘think about the way it could be’ instead of ‘this is the way we’ve always done it.’ ”

– Abby Parish, associate professor

Early Adopters

The nursing school’s distance-learning roots go back to 1996, when then- Dean Colleen Conway-Welch charged Professor Susie Adams, PhD, PMC’13, FAANP, FAAN, with expanding the Psychiatric-Mental Health Nurse Practitioner program beyond Middle Tennessee. Adams would need to recruit students from all over, but most prospects had jobs and families, making relocation to Nashville a huge barrier.

Specialty Director Susie Adams with student Nancy Trevor during 1997 pinning ceremonies for the first distanced PMHNP class.

Adams hit on the concept of a modified distance-learning program. “What if students came to campus for just a few days each semester?” Adams says. “We could deliver the lectures online, and they could do their clinical rotations at home.”

The initial idea was to video stream the lectures. But the internet of the late 1990s with its dial-up modems couldn’t deliver, especially in rural areas. After just one day of choppy service and lagging videos, Adams and her team switched to pressing the recorded lectures onto CDs and mailing them out overnight.

Conway-Welch knew the school’s distance-learning program needed to continue to evolve. In December 1999, she reached out to Weiner, then the director of academic computing at the University of Cincinnati. Weiner had an impressive education innovation track record. She had received one of IBM’s first grants for innovative education in the late 1980s, and created, along with collaborators, an award-winning, informatics-based labor and delivery simulation that changed the way that nursing students prepared for their clinical obstetrics experience. Nearly all nursing schools in the country included the videodisc in their curricula.

Behind the school’s immersion in distance learning was a commitment to the resources needed on the technology end, whether equipment or talented personnel.

In their first meeting, Weiner handed the dean a one-page statement outlining her vision for the first
decade of the program, accompanied by a requirement that the dean commit to ongoing resources. “To do it right, I had to have a team and I had to have resources,” Weiner says.

Weiner joined the leadership of the nursing school in 2000 as the senior associate dean for informatics, the first person in the nation with that title. Weiner, who retired in late 2020, was at the leading edge of VUSN’s progress during her 20-year tenure.

“When [Conway-Welch] hired me, she also signed on to having these resources available,” Weiner says. “It was a strategic decision. There was an actual budget for creative new ideas.”

Her foresight is apparent throughout the school with the tech-friendly infrastructure, top-notch simulation labs, and a constant enthusiasm for education innovation. Under her leadership, the IT team grew from four people to more than 30, including web developers, instructional designers, graphic artists, videographers, simulations d informatics faculty.

Senior Associate Dean for Research Ann Minnick, PhD, FAAN, teaches PhD students via Scopia videoconferencing in the early 2010s.

Also built into the system is a lasting pledge to quality, from both an organizational commitment and framework. That vow is evident from the yearly review of software and hardware used in the nursing school to the annual start-of-school personal device configuration sessions for students, faculty and staff.

For more than a decade, the school has subscribed to the Quality Matters framework, developed by educators to measure and guarantee the quality of courses, specifically those offered online. The globally used QM approach evaluates coursework with a rubric of design standards and a peer-review process. The IT team uses QM’s eight research-based standards to continuously evaluate and improve their efforts.

Syncing different types of PDAs was just one small challenge Betsy Weiner’s IT team faced as technology evolved.

The philosophy is to approach curriculum development from a learner’s point of view. “You don’t use technology just to use technology,” Weiner says. “You ask yourself first: What is the problem I’m trying to solve? Then you develop possible answers.”

Adams and the PMHNP faculty and staff worked closely with Weiner’s IT team over the years to integrate interactive learning, imbedded case studies, simulated cases, online testing, discussion boards and other emerging strategies. “We were pioneers,” Adams says. “The IT team was always bringing us new ideas to pilot. With their support, we were fearless early adopters of online teaching-learning strategies.”

During the nursing school’s two decades setting the national pace for distance learning, its rankings have steadily risen. In the 2022 U.S. News & World Report Best Graduate School survey released in March, Vanderbilt University School of Nursing was again named a top-10graduate nursing school. Vanderbilt’s Master of Science in Nursing advanced to be the nation’s No. 8 program and its Doctor of Nursing Practice program ranked No. 6. Additionally, the Psychiatric-Mental Health Nurse Practitioner MSN program repeated its 2021 position and remained ranked No. 1. Other MSN specialties achieved top-5 rankings as well.

‘How Might We’ Mindset

At the onset of the COVID-19 pandemic, senior leadership at the nursing school stepped into action. Norman, dean and Valere Potter Menefee Professor of Nursing, was tapped to lead the university-wide Public Health Advisory Task Force that served as a resource for Vanderbilt during the pandemic. She also set up a communication plan that included regular strategy sessions with associate deans and faculty-wide town halls.

Meanwhile, nursing faculty and staff leaders collaborated formally and informally to take the brakes off hands-on learning. As the ideas that bubbled up from front-line instructors tied into strategies set by the leadership, everyone had a role to play. “I saw renewed camaraderie and enthusiasm for innovation,” says Betsy Babb Kennedy, BSN’89, MSN’93, associate dean for non-tenure-track faculty affairs and advancement. “Faculty members were sharing their varied expertise, whether it be clinical, teaching approaches or technology.

“We also really saw how much support we have through our IT team— instructional experts, academic support, tech experts and more,” she adds. “This crisis highlighted how collaborative and innovative their work is.”

Kennedy echoes Parish’s belief that the pandemic presented a unique opportunity. “I was so proud of everyone that in such a time of disruption and uncertainty, they doubled down on their commitment to innovation and excellence,” she says.

PreSpecialty students participating via video give directions to faculty “avatars” performing patient care tasks during simulations designed to support clinical learning during the early days of the pandemic

As campus prepares to return to regular schedules for the fall 2021 semester, the nursing school faculty is ready to move forward. Kennedy says the first step will be a look back. “We’ll take a pause and do a debrief, just like we do after clinical sessions with students,” she says. “We’ll closely examine what we did and what informed our decisions, then we’ll integrate that with our data and outcomes. That will drive us forward.”

Patricia Sengstack, DNP’10, took over as senior associate dean for informatics in January 2021. She stresses that the school was able to perform during the shutdown because of Weiner’s vision. “Other schools were scrambling, while it really was more of the same for us, with a twist, of course,” Sengstack says. “Betsy positioned the school so we were ready to handle this.”

Going forward, Sengstack sees that faculty will continue to use these new tools in their teaching toolbox. “Remote learning can’t replace all the hands-on training, but we’ve learned how much it can enhance it,” she says.

Moore has been gathering data on the success of the pelvic model. “We knew fairly early on that we would want to share the project with other schools and organizations,” she says. “We’ve had lots of positive feedback from the students.”

Holt appreciates the camaraderie and innovation galvanized by the pandemic’s challenges. “This brought my team together with a ‘how might we’ mindset to achieve awesome feats with our faculty and instructors to provide a safe, immersive learning experience,” Holt says. During the shutdown her team created several different kits to be mailed to students, including one for practice of small procedure skills like treating abscesses—all to give students a realistic learning experience. “My team really bridged the gap, meeting with the faculty and instructors many times to get their visions to come to life.”

It is this sort of creative problem-solving for which the school has long been known. The obstacles in rolling out remote-learning tools—from the early days of dial-up internet and on through the pandemic—have only helped to strengthen the school’s mission and point the way forward.

“This has given us new inspiration to continue leading in distance learning,” Kennedy says. “No one wants k to the way it was. We have learned so much, and backwards isn’t where we are going.”

 

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Features Summer 2021