Shock Skills Critical Care Simulations Scenarios A software development project

2. Shock Skills Critical Care Simulations Scenarios A software development project Ian Cole Lecturer in ICT Department of Health Sciences University of York

3. Carl Background • TIDC funded project (£2500). • Project Team • Content provider (Alison Foster - nursing expert). • Content developer (myself – software designer). • Researcher (Carl Thompson – Clinical Judgement Analyst). Alison Ian

4. Project Outline • The Proposal • Combine a piece of networked e-learning software. • With web based simulation scenarios. • To teach nursing students the principals of dealing with clinical shock. • Research Aims • To develop an effective means of capturing the judgment policies of (student) nurses. • To determine what changes are made by a educational intervention (lecture / software)

5. Project Plan • Phase 1 = Research study using web based simulation scenarios. • Phase 2 = Creation of the piece of learning technology (Shock Skills) • Phase 3 = Replacement of a Lecture with Shock Skills. • Analyse results.

6. Carl Phase 1 - Research Study • The social judgement approach • Attach varying weights to associated ‘cues’. • Examine these weights to see how people make a judgement. • Research Method • Judgment of diagnosing someone in hypovolaemic shock. • Judgment based on 6 clinical cues. • These cues presented as 20 online scenarios. • 3 levels – abnormal, normal & equivocal

7. Carl Web based scenarios method • Web pages created and linked to Macromedia Coldfusion platform. • Created a database of results. • Exported as a text file into SPSS.

9. Carl Research Study – Phase 1 • A group of 2nd year nursing students (23). • Asked to judge if a fictitious patient was in shock (pre-test). • Students then given a lecture. • (this would be replaced in phase 3 by a piece of learning technology – Shock Skills) • After lecture, students come back and retake the test (post-test). Alison

10. Research Study – Initial Results We Wanted: • To know if the lecture make a difference? • Compare results with a future student group when the lecture is replaced with Shock Skills. We Found: • A greater variability in the use of some cues than others. • A wide variety of judgements. • Pre test = similar importance to all cues except GCS. • Post test = respiratory rate was the most important factor.

11. Phase 2 – Shock Skills • Involved the content expert & developer. • Used Parson’s & Oja System Development Life Cycle. • Network Software /CD-Rom. • Internet limited for video use. • Limited by 650Mb CD-Rom. Alison Ian

12. Analysis - Lots of interactivity Mini Quizzes & Click ’n’ Drag exercises. Video of clinical procedures. Animations. Lots of images. Planning. Project Plan. Macromedia Director / Flash. Spent the money (Software / video camera). Usability Evaluation Team (12) Phase 2 – Shock Skills SDLC Ian

13. Design. Storyboarded the lecture in PowerPoint. Navigation model designed. Design metaphor. Phase 2 – Shock Skills SDLC Ian

15. Implementation. Prototype Implementation Aug 2003 Planned for April 2004 – SLIPPED!!!! Planned for September 2004 Phase 2 – Shock Skills SDLC Ian

16. Testing. Usability Evaluation Dec 2003 to Jan 2004. Team of 12 evaluators (Staff & Students). 58 Question Questionnaire. Based on Shneiderman’s usability scale & criteria. 1 member performing a Cognitive Walkthrough Experiment. Phase 2 – Shock Skills SDLC Ian

17. No: Questions Descriptors (0 to 9) Mean Q8 Navigating from this screen is? Hard to Easy 8.4 Q55 Overall Reactions Terrible to Wonderful 7.5 Q55 Overall Reactions Dull to Stimulating 7.7 Q55 Overall Reactions Difficult to Easy 7.2 Q55 Overall Reactions Frustrating to Satisfying 7.2 Q55 Overall Reactions Rigid to Flexible 6.5 Q56 Learning to use the software is? Difficult to Easy 7.7 Q57 The ‘TC’ character image is? Pointless to Excellent 6.0 Q58 Educational content is? Poor to Excellent 7.5 Q59 Software usability is? Poor to Excellent 7.6 Shock Skills Usability Results Criteria: • Images • Readability • Colour • Navigation • Interactivity • Reactions

18. Shock Skills Methodologies • System Design Life Cycle • Norman’s Seven principles of User-Centered Design • 1: Use both knowledge in the world and knowledge in the head. • 2: Simplify the structure of tasks. • 3: Make things visible: bridge the gulfs of Execution & Evaluation. • 4: Get the mappings right. • 5: Exploit the power of constrains, both natural and artificial • 6: Design for error. • 7: When all else fails, standardize.

19. Project started in Summer 2002. Phase 3 should have started April 2004 Project should be finished now. Underestimated the time needed. Underestimated the funding. No protected time. For content expert. Should have held back some money to buy in a proof reader. 80 screens to proof read. Phase 3 – The end is in sight!

20. What's Next? • August 04: Finish the software proof reading. • September 04: Install on network • October 04: Another group of nursing students. • Undertake the pre-test /Shock Skills /post test • Analyse and compare differences. • Publish end of the year (we hope!!!). • Regardless the project will be completed.

21. Conclusions: • We have an effective method of analysing judgement policies. But more research is needed. • We used a clearly defined development path. BUT!!!! • Don’t underestimate the amount of time & money software development takes. • Don’t only have one content expert. • Everybody needs protected time to work on e-learning projects.