Interactive video: an analysis of its value to nurse education

Rod Ward

This paper attempts to explain the emerging technology of interactive video and examine its possible place in nursing education. A brief description of the media is given with an exploration of the educational theory and justification underlying its

use. A range of approaches to the evaluation of the technology itself and software

available are given, which examine advantages and disadvantages for individual learners and for an organisation considering investment in this area.

The possible role of interactive video in nurse education is discussed and a recommendation given that nurse educators need to keep up-to-date with developments in this type of educational technology and develop software suitable for the needs of nurses, rather than having to use packages developed for other purposes which have limited application for nursing.

INTRODUCTION

Interactive video (IV) is a relatively new edu- cational technology which may have a place to play in the future education of‘ nurses at all levels. It is based on educational principles which view the student as an active participant in the learning process, and is likely to increase their learning because of the way in which they

become involved. Practical difficulties do exist in

the introduction of this new technology to nurse

education, not least among these are the cost and

Rod Ward RGN DPSN RCNT BSc (Hans), Nurse Teacher at Southampton University College of Nursing and Midwifery. At present on a Post Graduate Diploma in Education for Health Care Professionals at Southbank Polytechnic. Address: 108 Clarendon Road, Shirley, Southampton SO1 4GE, UK (Requests for offprints to RW) Manuscript accepted 24 August 1992

464

the resistance likely from teaching staff,

however, in the long-term, financial and perso-

nal benefits can be identified.

Any new technology must show its value both

in terms of educational potential and cost

effectivess. IV offers the opportunity for indi-

vidualised and active learning. Its place has been

recognised in many fields of education from

primary schools to higher education institutions.

In the USA it is now as accepted as videos or

Computer Aided Learning (CAL). In the UK

developments in medical, human relations, and

management education have all recognised its

potential. The fear is that nursing will be left

behind, unless we are able to harness the

potential of the technology, using it in ways

which develop its use appropriately for nursing,

rather than having to accept packages developed

for other disciplines.

The ability of IV to present realistic simu-

lations to learners without risk to themselves or

NUKSE: EDLJc:A-1‘10N 1‘ODAY 465

patients/clients will enhance their abilities in the

real situation as the learning achieved by this process has been shown to have a high degree of transferability to real life situations.

The UKCC (1986) recognised the importance of educational technology for the future prepar- ation of nurses:

The use of technological aids that will allow students to experience situations at a distance, and not to infringe unnecessarily upon pri-

vacy, will be vital.

If IV is to play a part in the future education of

nurses a wide range of issues concerning the appropriateness of its use will need to be con- sidered. The educational principles behind the

use of IV as a tool will need to be understood and its usefulness evaluated by nurse teachers, clinical staff and learners. The place of such educational technologies need to be set in a wider cultural and educational context of increasing computer literacy and use. The tech-

nical specifications of the equipment involved will need to be explored, and the, at present limited, range of software available evaluated. The cost effectiveness of this technology will of course need to be assessed, and its place within a nursing curriculum evaluated.

The main thrust of this paper will be the development of an evaluation scheme for this educational technology as a whole including its cost effectiveness and some proposals for criteria which could be used for individual software.

Evaluation instruments which have been used for CAL materials can provide a basis for this

evaluation, but other facilities provided by IV also need to be recognised in its evaluation.

WHAT IS IV?

IV is a progression from the fields of educational video and the programmed learning approach of CAL.

The interactive video system consists of a TV screen, videodisc player (which is similar to a record player but uses laser to read the informa- tion in the same way as a CD player), a computer which controls the program and may provide the

text, and a method for the student to interact with it which may be a keyboard, mouse or light pen.

An IV system can present the student with information in a variety of ways. Moving images

can be combined with text, still pictures, audio and other media which can be presented in a

variety of orders, but if this were all it could do it would be no more than a glorified video player.

IV provides an opportunity to use the now accepted educational technology of video images in a more exciting way which provides for active rather than passive involvement on the part of the learner. Stages can be built which can test learners cognitive abilities in connection with the subject area, the level being decided by the tutor or student. Eaton (1990) set up an interactive program on communication skills for nursing students using a microcomputer to control a tape video recorder, however she recognises the limi- tations of this system when compared with videodiscs.

Duke (1983) argues that IV offers oppor- tunities for constructive symbiosis between the computing and television worlds; and holds out to the educational technologist an exciting new component with which to construct interactive, individualised learning systems.

The major advantage of IV, however, depends on the way in which it can be controlled by the learner’s interaction with it. The order,

speed, level and even format in which informa- tion or simulations are presented depend on the actions of the student. IV is a medium which allows students to work at their own pace and in their own time. It encourages active participa- tion rather than the passive learning offered by lectures, watching videos and some other tradi-

tional instructional techniques. Exponents of IV in educational fields argue that it is cost effective and can, if used appropriately, provide guaran- teed results.

EDUCATIONAL THEORY/ JUSTIFICATION FOR USE

Howard (1990) sees a positive step in nursing education, as the increasingly individualised

466 NURSE EDUCATION TODAY

approaches being taken to students’ needs. She goes on to quote a range of authors arguing that CAL has the advantage of allowing students to work at their own pace and provides classifi- cations of CAL by subject, internal technique and education paradigm culminating in a divi- sion between the behavioural approach and active learning in which users construct their own internal knowledge structure.

This approach of attempting to categorise the teaching and learning strategies used in edu- cational media is developed by Chandra et al (1990) who use Cagne’s (1967) five varieties of learning - motor skills, attitudes, verbal information, intellectual skills and cognitive stra- tegies and nine instructional events in the design of IV courseware. The nine instructional events identified by Gagne are:

gaining information informing the learner of objectives stimulating recall of prerequisites presenting stimulus material providing ‘learner guidance’ eliciting the performance providing feedback assessing the performance enhancing retention and transfer.

IV has advantages in many of these areas over ‘talk and chalk’, video or audio tape and CAL. Wishart (1988) has shown that computer pro- grams which offer the user control are strongly motivating; they are therefore likely to gain

attention. IV provides the opportunity for learner control to a much greater extent than CAL packages presently available.

Objectives can be presented by IV software, or the learner can be offered a choice depending on their previous experience and knowledge. Stim- ulus material can be presented in a wide variety of formats which maintains interest and involve- ment, it can also provide feedback at any point the student requests or at stages built in by the software designer. The use of IV systems in assessment are still to be fully explored, but Lenburg & Mitchell (199 1) argue in its favour because of the variety of cognitive and psycho- motor skills which can be assessed in this way. Programs such as the Marie Curie Foundation’s

cancer care IV disc can also have an effect on the affective domain (Jonas et al 1990). Cognitive development can be facilitated by gathering a wide range of material (as in a series of text-

books) and presenting it in a way which is easy for the student to access. IV packages allow the student to skip backwards and forwards as they

might in a textbook in a way that is largely unavailable in CAL or video recordings. The psychomotor domain is another area where IV holds distinct advantages over other media, the aircraft simulator being perhaps the best known example of the computer being able to control visual images, monitor instruments and control equipment (e.g. the plane’s joy-stick) so that the

student can both see and feel the effects of their actions. In America this technique has been used

in resuscitation training; by connecting a ‘Kesusci-Annie’ to the IV equipment the student can be given a tutorial about the actions required and then their performance monitored and feedback given until the student achieves a pre-set level of competence (Hekelman et al 1990; Hon 1982; Umlauf 1990).

This ability to test cognitive and pyschomotor domains has been recognised as providing ‘a dramatically different type of performance examination. It has major advantages of insur- ing maximum comparabihty of test episodes and

providing opportunities to assess students’ abili- ties in complex, inaccessible or unpredictable clinical situations’ (Lenburgh & Mitchell 1991).

EVALUATION OF IV AS AN EDUCATIONAL TECHNOLOGY

A variety of attempts have been made to explore and evaluate the educational usefulness of IV. Many of the comments and evaluative criteria used can be applied to other educational techno- logies. However the unique facilities available from IV need special consideration.

Some of the criteria suggested by other authors are set out in the Table, and require consideration of content structure, instructional strategies and learning style. The main factor which distinguishes IV from other techniques is

NURSE EDUCATION TODAY 467

Table 1 Evaluation criteria

Criteria

Presence of overt statements of goals, objectives or intent What are the expected performance outcomes?

Content structure How well does the information flow?

Reference

Bolweli 1990

Bolwell 1990

Is it presented in linear or multiple branching modalities?

Is the learner able to enter and leave the program at any point?

Is the learner able to interact with the program? What level of interaction is possible? (Nebraska Scale)

Is it relevant to real situation and does it meet learners needs?

Chandra et al 1990

Rizzolo 1989; Van Reenan 1990 and others

Jones et al 1990; Gorgen 1990

Are emotions and behaviour emphasised as well as fact? Is a holistic approach involved?

Instructional strategies Is the instruction logically organized? What strategy choices are available?

Jones et al 1990

Bolwell 1990

Does it challenge learners to commit themselves?

Learning style

Jones et al 1990

Are there variations in textual, graphical, verbal, visual, and tactile learning modes?

Is training private to learner?

Are testing and opportunities to practice built into the program?

Are ‘remedial loops’ present? Are self tests included?

What kinds of feedback are available? Is it positive or negative, formal or informal? Is it appropriate for the intended learning outcomes?

Bolwell 1990

Palmer 1987

Bolwell 1990

Eaton 1990

Bolwell 1990; Jones et al 1990

What kinds of evaluation are available? Does the program achieve what it intended to teach?

Does the material lead to further study?

Bolwell 1990

Jones et al 1990

the amount of interaction the student is able to achieve with the program.

In North America, where the use of IV in a range of educational contexts is more advanced than in the UK, a scale of interactive capabilities, called the Nebraska Scale, has been developed ranging from materials played in a linear way, as on video tape, to the possibility for the learner to

decide when and where to interact with the program, gaining access to several pathways or decisions at different times. This approach has been described as the ultimate in learning creati- vity (van Keenan 1990).

vary between learners. The ease with which IV programs can be used by the learner, entering or leaving at will, and the selection of appropriate sections of content are an important advantage. It may also be argued that the process model, rather than specific objectives, is more important with IV. The extent to which learners become involved with IV has been a significant feature of most of the research in the area (Barker 1988; Bolwell 1991; Sprunt 1989). Wishart (1988) has taken this one stage further and shown a directly attributable increase in learning gain as an effect of involvement.

Statements of intent or specific objectives can The wide variations in material and its

be included as with any CAL package, however, presentation are seen as the major advantage of these may be limiting in that the objectives may IV by many authors (e.g. Bolwell 1990), as

468 NURSEEDU(:ATIO~;TODA~

frequent changes in format maintain concentra- tion for longer than single format approaches. It is also important to consider factors such as the use of colour, sound and screen arrangement as with any educational technology, to achieve an easy to use, and not too distracting appearance.

The advantages of being able to present the learner with real situations from the video material held on the video is espoused by Jones et al (1990). They used interviews with real patients and recordings of real situations in their program on cancer nursing as a good way of emphasising the emotions involved in patient care, and provoking discussion of these, rather than concentrating on factual material. Van Keenan (1990) argues that this realism ‘holds the

most promise as a system that will address the gap between acquiring information and apply- ing it to patient care’. Which is in accord with the UKCC’s (1986) view of the use of technology in nurse preparation.

The use of real situations and interviews has the disadvantage of limiting the extent to which the user can select options and then see the outcomes of their decisions as recommended by Chandra et al (1990).

Generally, the use of IV as an educational technology fits with an educational ethos in which the learner is an individual, with particu- lar needs and objectives, who can work at an individual pace and in their own way. The methods involved will not suit all students, and a fear of the technology may be a barrier to some. However, the opportunities thus afforded should not be ignored.

ORGANISATIONAL CONSIDERATIONS

Some considerations which need to be addressed by the educational organisation considering the use of IV have also been described, particularly by Palmer (1987). These can be summarised as:

l Is access easy (location and time)? l Are results consistent? l Does this method save time over other

methods?

0

l

Can training be distributed? What is the expected life of hardware and software?

The way in which the IV facility is used will affect learners’ approaches to it and its effectiveness. A way of increasing access for individual use may be to place it in a library or other area with easy access. However, it may be more appropriate for group use to stimulate discussion (Bolwell 199 1).

Palmer (1987) and others have described how the results achieved by IV are consistent and unbiased. The system can record the achievement of certain objectives by the user or keep completed test scores. These can also be presented to users, along with feedback about their answers, as immediate reinforcement rather than waiting weeks for assignments or tests to be returned.

Several studies (Barker 1988; Copeland 1986; Sprunt 1989) show in their studies that learning objectives have been achieved more quickly with IV than with traditional lecture/discussion tech- niques. However some of the objectives chosen, could be argued to have lent themselves to this

approach. In all these studies limited objectives on a single session were assessed. It is likely that any one learning strategy is unlikely to be most suitable for all learners. Van Keenan (1990) found evidence from studies of brain dominance that CAL/IV techniques were most effective with right hemisphere dominant subjects, but that those with left hemisphere dominance learned more effectively and more quickly with tradi- tional teaching approaches. Wishart (1988) pos- tulates a psychological approach with a finding that those with an internal locus of control fair better with CAL/IV techniques as opposed to those with an external locus of control for whom lecture/demonstration techniques are likely to be more eff-ective.

Another identified advantage of IV systems is the possibility of distributing the system via cables to other sites, which may be significant in larger colleges of nursing based on several sites. However the technology needed to achieve this is still beyond the scope of most nursing colleges and probably will be for some years to come. A method of overcoming this is described by

NURSE EDUCATION TODAY 469

Umlauf (1990) and Hekelman (1990) who recommend that the IV equipment be trolley mounted and taken to the staff who can make use of it in quiet periods during their work.

The cost effectiveness of IV systems needs to be further explored. Generally, workstations

should be chosen which can be expected to have a useful life of at least 5 years. The life of the software will depend on the content of the material. If it changes rapidly then investment is unlikely to be cost effective, however if the changes needed are to the textual material generated by the computer program rather than the videodisc, the cost and difficulty of changes

are reduced. A major consideration for any establishment

considering the considerable investment in this type of technology is the provision of both technical and educational expertise in the area.

The amount of computer literacy among nurse teachers, and clinical staff, has increased over

the last few years, but new specialist knowledge will be required to make full use of the possibili-

ties offered by IV. To achieve this level of competence both time and motivation will be needed in an era when the pressures on teaching staff are already considerable. The long-term benefits possible will need to be weighed against an initial outlay of time and money.

IV IN NURSE EDUCATION

IV has a range of applications within any nursing curriculum for both individual and group work. The nature of the medium encourages learner involvement and further study on a topic area, as a result it will have implications for library and teaching resources. The ever increasing links

with higher education may mean that IV facili- ties are available to the students in university libraries and the like, although the range of software which is suitable for nursing will need to be assessed. The use of individual programs will depend on their content and level which need to be assessed by individual teachers for their relevance to their fields, but they may be suitable as a stimulus for group discussion or as a recommended resource for individual learners.

It is unlikely that their use will be for someone to work through from beginning to end as pro- grams take several hours to complete and only some of the material is likely to be of use, however, the flexibility of the approach means that learners can dip in and out to get what they need in much the same way that a textbook could be used. Unlike many CAL packages or lecture presentations the learner does not need to sit through the whole program to get what they need.

IV material may be used as a supplement to material presented in other ways, allowing members of large groups, perhaps in pre-regist- ration courses, to work in their own time and at their own pace. It may also be appropriate for more specialised post-registration and higher education courses, where individuals may all be exploring different areas.

Programs such as the ‘Secrets of Study’ from MLS Ltd could be used in introductory study skills or return to nursing, it is even possible that completion of this package could be a prerequi- site for entry. Programs on particular subject areas could be used for relevant courses or areas of larger curricula, an example is ‘Cancer

patients and their families at home’ from Marie Curie Cancer Care, components of which could be used for oncology and pain management work, but other areas may be suitable for those looking at community care or areas of interper- sonal and communication skills. The interperso- nal skills and management training areas are already well supplied with software, e.g. ‘Effective team-work’, ‘Appraisal and selection interviewing’, ‘Understanding change’, ‘An

introduction to assertiveness’ and ‘Face to face’. Other areas of health care education have begun to develop material which may also be of use in nurse education - anatomy, physiology and microbiology are all areas in which software is being developed. The Central Council for Edu- cation and Training in Social Work have recog- nised the potential of IV to train 40,000 assessors for the introduction of the National Vocational Qualifications (NV@) in Social Care and com- missioned the production of a series of IV programs entitled ‘Training for NVQ assessors in social care’. Perhaps the need to train even

470 NURSE EDUCATION TODAY

larger numbers of health care assistants to assist students with some aspects of their clinical

qualified nurses will lend itself to this approach. experience.

Whether the software is to be brought off the shelf or developed by subject specialists and nurse educationists, training and support of the staff involved will be necessary. Although the equipment itself is generally easy to use, the ability to gain the maximum possible educational benefit from it will require new skills from those teachers who are able to see its possibilities. Visits may be possible to higher education and industrial establishments where the technology is in use will be time well spent, as would

consideration of IV in the projects already established to increase nurse teachers’ informa-

References

Barker S P 1988 Comparison of effectiveness of interactive videodisc versus lecture-demonstration instruction. Physical Therapy 68, 5: 699-703

Bolwell C 1990 Evaluating interactive videodisc programs. Nursing Educators Microworld 5, 2: 15

Bolwell C 1991 10 year meta-analysis of interactive video. Nursing Educators Microworld 5, 4: 31

Chandra P, Hinton T, Phillips N 1990 Design considerations for the development of interactive video in nurse education. Computers and Education 15, l-3: 183-188

tion technology and computing skills.

CONCLUSION

Copeland P 1986 Interactive video: rationale, use and evaluation. Unpublished doctoral thesis. University of Sussex. .

Duke J 1983 Interactive video: implications for education and training. Working Paper 22, Council for Educational Technology, London

Eaton N 1990 Skills on tape. Nursing Time 86,48: 36-37

IV is an educational tool which holds possibilities for the future of nurse education.

Nurse teachers must develop strategies to evaluate both the educational possibilities offered by an IV system and the individual software. Many criteria can be used in this evaluation and all systems will score more highly on some criteria than others, therefore an assess- ment needs to made of those which are most important and beneficial to the learner.

The organisational considerations involved in purchase and/or development of this technology must be weighed against the potential benefits for learners, recognising the possibilities which have already been identified in higher education and some areas of industrial training. The increasing computer literacy of those entering and working within nursing needs to be recog- nised and used to enhance their education.

Nurse teachers must be prepared not to accept software which has been developed for other purposes if they do not meet their needs and clearly identify what they want the IV fSacility to achieve. Nurse education can not afford to bury its head in the sand and ignore technological solutions to some of its needs; who knows, perhaps by the year 2000 we will be evaluating the potential of virtual reality to provide

Gagne R M 1967 The conditions of learning. London: Holt, Rinehart and Winston

Gorgen A 1990 Training trends. Emergency 22, 3: 42-44

Hekelman F P, Phillips J A, Bierer L A 1990 An interactive videodisk training program in basic cardiac life support: implications for staff development. Journal of Continuing Education in Nursing 2 I, 6: 245-247

Hon D 1982 Interactive training in pulmonary resuscitation. Byte 7, 6: 108

Howard B 1990 Nurse education and convergent information technologies. Nurse Education Today 10, 2: 145-150

Jones R V H, Ingram D, Finlay I, Lant A 1990 CAL in cancer nursing: an adult learning approach. Information technology in nursing 2, 3: 34-35

Lenburgh C B, Mitchell C A 1991 Assessment of outcomes: the design and use of real and simulated nursing performance examinations. Nursing 8e Health Care 12, 2: 68-74

Palmer R 1987 What is CBT interactive video. Manchester: NCC Publications

Rizzolo M A 1989 What’s new in interactive video? American Journal of Nursing 89 (3): 407-408

Sprunt B 1989 Interactive video in higher education. Unpublished report from the Department of Teaching Media, Universitv of Southamnton.

Van Reen& .J 1990 Technology for health’care education. The Canadian Nurse 86, 10: 24-26

Umlauf M G 1990 How to provide around-the-clock CPR certification without losing any sleep. Journal of Continuing Education in Nursing 2 I, 6: 248-25 1

UK<:<; 1986 Project 2000: A new preparation for practice. London: UK<;<:

Wishart J 1988 User involvement with microcomputer software. Unpublished PhD thesis, University of Surrey.