• advocate
• artificial intelligence (AI)
• asynchronous
• audiopod
• blended
• Blockcerts
• blockchain
• blog
• case scenario
• collaboration
• computer based
• continuing education (CE)
• copyright
• distance education
• distributed ledger technology (DLT)
• e-learning
• electronic mailing list
• email
• evidence
• face-to-face
• fair use
• Foundation of Knowledge model
• Generation Z (Gen Z)
• hybrid
• hypertext
• information literacy
• instant message (IM)
• iPod
• learning management system (LMS)
• MP3 aggregator
• MP4
• multimedia
• Net Generation
• online chat
• podcast
• portal
• portfolio
• problem based
• professional networking
• real time
• really simple syndication (RSS)
• reflective commentary
• resource description framework (RDF)
• role-playing
• simulation
• smartphone
• tutorial
• videopod
• virtual reality (VR)
• web based
• webcast
• web enhanced
• webinar
• web publishing
• wiki

Nursing informatics facilitates the integration of information, data, and knowledge to support nurses, patients, and other providers in their particular settings and decision-making roles. The Foundation of Knowledge model specifically prompts nurses to extend their theoretical and metaphorical knowledge into practical, holistic determinations based on a variety of factors and contexts. Because competencies in informatics include but are not limited to information literacy, computer literacy, and the ability to use strategies and system applications to manage data, knowledge, and information, the ability of nursing students to use computer-mediated communication skills is essential to their success in the nursing field and as a means to improve patient safety.

The COVID-19 pandemic caused an immediate rise of telecommunications and virtual technology use in health care. At the same time, education programs were also increasing their use of virtual or online teaching strategies to meet the needs of their learners, and nursing was no exception. Now, going far beyond the simple applications of word processing software or spreadsheets, technology applications have evolved greatly, taking advantage of modern capabilities to provide nursing and related healthcare students with simulations, complex multimedia, virtual reality-assisted clinical scenarios, and a host of information- and literature-gathering internet tools.

The COVID-19 pandemic triggered a paradigm shift with the shutdowns causing the loss of clinical access and face-to-face meetings. Those who only wanted to test the waters of virtual teaching and learning prior to the pandemic were now diving in to help their students continue their educational programs. Web-enhanced courses were developed that included online chats, forum discussions, instant messaging, blogging, and use of email, all of which ask the student to engage, digest, use, and disseminate information in new ways (Figure 19-1). In addition, mannequin-based or virtual simulations replaced 25% to 50% of some clinical experiences. How nursing students learned and were career readied had changed. Karim (2021) reported that “[p]rior to the pandemic, nursing students were required to spend at least 75% of their clinical time providing direct care to patients in hospitals” (para. 12). Many Boards of Registered Nursing reviewed their regulations and permitted 25% to 50% of the clinical hours to be completed using simulated experiences.

Figure 19-1 Types of Interactions in Web-Based Courses

Four boxes list the different types of interactions in various web-based courses.

The interactions are as follows. Learner to content: Flashcards; R S S feeds; YouTube videos; F A Q forums. Learner to instructor: Lessons; Quizzes and tests; Video conferences; Emails; Projects. Learner to learner: Chat; Discussion forums; Blogs; Wikis. Learner to interface: Computer-assisted instruction; Learning management system; Simulations; Virtual reality.

Data from: Juliano, R. (2014). Best practices guide to converting face to face courses to a distance learning format: Educational technology. www.manula.com/manuals/rachael-juliano/best-practices-guide-to-converting-face-to-face-courses-to-a-distance-learning-format/1/en/topic/educational-technology.

Twenty-first-century nursing informatics emphasizes technology usability, functionality, and accessibility in education and practice. Consequently, the need to learn nursing skills presented endless potential for software development. Recall that software comprises the instructions that direct a computer's hardware to work, whereas hardware consists of physical computer components, such as a mouse, keyboard, and monitor. Software essentially translates commands into computer language to allow the hardware to perform its functions. Applications software refers to the various programs individuals use to communicate with others, work, play games, or watch multimedia on a computer.

When evaluating software or hardware for purchase, careful assessment of the products and services will help an educator, administrator, or student make the best choices. The most important thing when evaluating software is to understand how well the software's functionality matches the learning goals and objectives. Although many programs are available for assisting a nurse educator who is evaluating software for particular learning purposes, the main criteria are content (Is the information accurate? Is it relevant?), format (How is information visually presented? Is it in frames? Does it come with graphics?), documentation style (What is the tone? Is it scholarly and applicable?), and strategies (Is the software useful for all students, including students with disabilities and remedial and accelerated students?) (Edwards & Drury, 2000). In addition, consider diversity, equity, and inclusion (DEI).

Hardware decisions depend on the way a computer system will be used in addition to considerations related to cost, ease of use, and durability. Systems purchased for personal use may differ dramatically from those purchased for online learning, virtual simulation, or smart classrooms. Remember that you must always consider the level of security that is needed. Because the technology inherent to workstations, servers, and computers, in general, tends to change rapidly, discussing large-system decisions with an information technology expert is likely to yield a better-informed decision. Other hardware considerations arise from the use of virtual simulation, including the realities and, specifically, virtual reality (VR). What type of head mounted-display (HMD) and controllers will be needed, and if entering the VR environment in non-VR, does this affect the type of computer the learner will need? Education innovators realized the need for additional functionality. Integrated learning systems have evolved from tracking, content management, and more individualized instruction or primarily the administration of the course and content, providing convenience for instructors and learners. The learners typically had only one learning management system (LMS) to learn. The LMS was used throughout the program, and the faculty and learners became proficient in its use. The next evolutions that are still in progress are the transition to a learner-centered approach and the integration of adaptive learning. Learning should be tailored to the learner, thus allowing them to have control over their learning, such as how they engage with the content and the pacing of learning. This means that the content must be available in a variety of formats to meet the learning style of each learner as well as providing teacher support and additional content delivery methods for clarity if they do not reach mastery. The LMS with integrated adaptive learning will not only track mastery but also be able to help the student achieve it. The faculty member must be able to offer any necessary support to each learner while monitoring the progress and needs of all the students in the course or learning episode.

Nursing educators are discovering that today's learners may not always respond in the same ways that the educators did during their own tenure as learners. Technology-savvy learners from the millennial age demand instant information delivered in an entertaining fashion, an expectation built on extensive exposure to email, text messaging, online chatting, and the internet (Ridley, 2007). In addition, many nursing departments are facing an increase in student enrollment and a corresponding growth in faculty. Although new nursing faculty members bring significant clinical experience to their academic positions, also apparent for some is an underlying tension and unfamiliarity with technological advances, outcomes-based accreditation initiatives, and teaching itself. Schools of nursing are scrambling to provide professional development for busy nursing faculty members and introduce them to best practices in teaching (Shaffer et al., 2006).

Learning is a multispatial function, and in the age of technology innovation, instructional delivery can inhabit many forms in both physical and virtual spaces. Spaces in academia are no longer defined by a class or its content but instead by the learning the class is trying to promote. To this end, learning spaces should support multiple modes of learning and delivery, including reflection, discussion, and experience, and facilitate face-to-face and online interaction within and beyond classrooms. Truly innovative delivery must support the learning activities whether in face-to-face classroom interaction, online engagement, virtual simulation, the realities, or a blended hybrid of technology and traditional classroom teaching.

Face-to-Face Delivery

Ridley (2007) suggested that although it is the most widely used teaching method among nurse educators, traditional face-to-face lecture yields only a 5% information retention rate over a 24-hour period, a rate that compares unfavorably with demonstration (30%), discussion groups (50%), practice activities (75%), and peer teaching (90%) (as cited in Sousa, 1995).

In addition, the inability of physical space to keep pace with the evolution of learning models inhibits the benefits gained from face-to-face interaction between teacher and student. For example, collaborative learning grinds to a halt when class is held in a room with chairs bolted to the floor, facing a lectern (Oblinger, 2005); this kind of spatial arrangement prohibits a sense of classroom community by inhibiting easy peer interaction, reducing students' ability to see one another, and concentrating all attention on the professor.

Conversely, in a collaborative learning environment, the professor guides conversation and sets up discussion, acting less as the classroom authority and more as a facilitator, helping students maintain focus, gently guiding discussion, and ultimately empowering students to push knowledge boundaries in a safe and secure atmosphere of peer support. This inductive, epistemological approach promotes active, critical thinking skills and assists students in learning not just facts but also how to learn. As future healthcare professionals determined to rely on quantification and rationale, nursing students will benefit from face-to-face classroom interaction that hones their ability to manufacture new personal truths through interaction with people and ideas in ways that cannot always be measured and counted.

Ridley (2007) suggested that such interactive, cooperative learning strategies might include gaming, role-playing, and problem-based learning. Because games are nonthreatening and fun, they promote critical thinking and teamwork by pushing students to work together in groups to find answers and achieve success. Role-playing is similar in that it allows students to try on real-life scenarios by filling either scripted or ad-libbed roles (e.g., doctor, nurse, patient, or clinician) without the fear or pressure of putting another's life at risk while trying to determine the best course of action or find a solution for a fictitious patient's health issue.

Problem-based learning, a well-accepted form of interactive learning, takes assignments out of a contextual vacuum and applies real-life scenarios to problems or challenges. Students work in groups to solve the dilemma presented by real patient cases and build on prior knowledge, using higher-level thinking skills and progressive inquiry to resolve the problem (Ridley, 2007). This process enhances the student's critical skills for acquiring and maintaining knowledge in practice.

Online Delivery

E-learning, online learning, and web-based education have caused a significant shift in learner-teacher relationships in nursing education. According to Oblinger (2005), not only are learning spaces no longer physical or formal, especially on campuses with wireless capabilities, but nursing students also expect to make use of wide ranges of cutting-edge technology during their academic tenure, exchanging the traditional “sage on the stage” for a technologically savvy “guide on the side” (Leasure et al., 2000) who gives up the role of gatekeeper and instead promotes and facilitates dialogue as central to teaching and learning (Aquino-Russell et al., 2007).

Learner centered and no longer limited to the domain of the classroom, laboratory, or even a patient's bedside, online learning allows educators to translate theory into practice by creating a virtual classroom space that promotes collaboration, engagement, discussion, and analysis. Studies show that web-based courses not only continue to gain in popularity but also enhance learning in ways that encourage learners to share personal experiences and support. Researchers cite many factors that make online learning laudable, with accessibility and convenience being two of the most frequently cited issues (Aquino-Russell et al., 2007).

The asynchronous and time-independent elements of web-based courses respond to the huge need for flexible class times among today's growing population of nontraditional learners. In addition, web-based and place-independent learning allows anyone with access, anywhere in the world, to participate. Exposure to online learning during healthcare professional education programs will facilitate continuing professional education during the practice tenure. Related to this issue is the democratizing effect of online learning such that all students have the same opportunity to participate without judgment. Web-based classes provide an easily accessible permanent record, a convenience for both teachers and learners (Aquino-Russell et al., 2007).

One of the challenges and criticisms of online education has been that the instructor does not know whether the student enrolled in the class is actually the person who takes the test or writes the paper. But the same can be said for instructors in face-to-face classes regarding who actually completes papers and out-of-class assignments. The only sure thing is that if students test in a classroom with the instructor, the instructor knows that they are the ones taking the test. Thus, verification of students' identity is critical to ensure that credit is given to the student who completed the work or took the test, especially in an online testing environment. Learner identity verification tools continue to evolve. Some critics believe that as with other technologies, students can find work-arounds. To meet the federal regulations and secure the testing environment, many believe that instructors should use one or more identity verification tools combined with a method for live proctoring. It is imperative that nurse informaticists and information technology experts work with educators and administrators to determine the technology tools necessary to accomplish student identity verification, based on their specific infrastructure and needs.

It is important to use tools that facilitate learning, such as introducing social media into nursing education. X (formerly Twitter; https://twitter.com/home) can be used to focus and hone student perspectives. Each posting, or tweet, cannot exceed 280 characters. As learners critically think about what they want to add to the discussion, they must act as wordsmiths to express their views succinctly and concisely given the character limitation. Other social media that can be used in education include the following sites:

• Diigo (www.diigo.com), a social bookmarking tool to collect, tag, and share online sources (Meyer, 2015)
• Feedly (https://feedly.com/i/welcome), an online feed aggregator to notify the subscriber of new content on blogs and websites of interest (Meyer, 2015)
• Flickr (www.flickr.com), for photo sharing
• Instagram (www.instagram.com), for customizing and sharing photos and videos (Meyer, 2015)
• Pinterest (www.pinterest.com), a social bookmarking tool used to prime discussions (Meyer, 2015)
• Pixton (www.pixton.com), to create comics or cartoons
• Prezi (https://prezi.com), to create zooming presentations
• Scoop.it (www.scoop.it), an online content curation tool used to collect web resources, comment on them, and publish the source and commentary (Meyer, 2015)
• SlideShare (www.slideshare.net), a community for sharing presentations
• YouTube (www.youtube.com), to watch and share videos
• VoiceThread (https://voicethread.com), to share images, videos, documents, and commentary (Meyer, 2015)
• Wordle (www.wordle.net), to create word clouds from text

Students can use these sites to facilitate their presentations and for team collaboration. The use of social media not only exposes the students to their use but also promotes the development of skills that will support professional collaboration as students enter the practice arena. Meyer (2015) reported that using social media in education helps students put concepts in context, maintains currency in course content, and fosters a sense of community. Figure 19-2 demonstrates the purposes and time required for proper use of social media.

Figure 19-2 Social Media Time Estimates

A tabular illustration underscores the necessity of dedicating time for the effective use of social media.

The illustration features a table with an upward arrow on either side. The table is titled Commitment to effective social media use takes time. The row entries are as follows. Row 1. Build community: Facebook; LinkedIn; X, Twitter; Ning. More than 5 to 10 hours per week. Row 2. Publish: Blogger; WordPress; Typepad; Flickr; YouTube. More than 3 to 5 hours per week. Row 3. Participate: Facebook; LinkedIn; X, Twitter; Hootsuite; Seesmic; TweetDec. More than 30 minutes per day. Row 4. Promote: Digg; X, Twitter; BizSugar; HelloTxt; Ping.fm; ShareThis; AddThis; dlvr.it. More than 20 minutes per day. Row 5. Listen: Google Alerts; Social Mention; Attensity 360; Scout Lab; Radian. More than 15 minutes per day. Row 6. Read: Google Alerts. More than 15 minutes per day.

Data from: Holly A. (2016). Find 10 tips that help you take time to be social. The Social Observer. www.thesocialobserver.com/take-time-to-be-social.

Educational Applications for Blockchains and Distributed Ledger Technology
As you read about these applications, envision how this technology could work, and think about other educational uses for it.
Decrease Fake Diplomas
There are more than 200,000 fake diplomas sold by fake diploma mills every year in the U. S., and recently there were arrests surrounding more than 7,600 fake nursing diplomas issued from Florida schools alone (Bernstein, 2023). The verification process is personnel intensive, and some have suggested that blockchain technology can be used to store these credentials. Learning Machine “has collaborated with the MIT Media Lab to launch Blockcerts-an open infrastructure for creating, issuing, viewing and verifying blockchain-based certificates” (Vander Ark, 2018, para. 4). The issue of diploma fraud and fake diplomas could be eliminated with the use of blockchains because Blockcerts would facilitate verification of blockchain educational credentials (McArthur, 2018). According to Coca (2021), if all institutions would put blockchain in place to protect against fake information, the number of diploma mills and fake universities would decrease.
File Storage and Security
Educational entities must protect their student information from being corrupted, altered, or lost. Distributed ledger technology (DLT) cloud storage could offer a safer and less expensive alternative to traditional options (Vander Ark, 2018; Yedigaryan, 2019).
Library Holdings
DLT could facilitate a library's expansion of its “services by building an enhanced metadata archive, developing a protocol for supporting community-based collections, and facilitating more effective management of digital rights” (Vander Ark, 2018, para. 34).
Credits or Credentials From Multiple Educational Entities
Blockchains or DLT could track and maintain credits received over time from multiple educational entities. This technology would provide authentic, verifiable, accurate records of student credentials and competencies (McArthur, 2018). References Bernstein  L. (2023, May 18). Bogus nurses, fake diplomas: Officials search for unqualified health workers. Washington Post. www.washingtonpost.com/health/2023/05/18/fake-nurses-bogus-diplomas Coca  A. (2021, February 22) Designing applications to reduce academic fraud. AACSB. www.aacsb.edu/insights/articles/2021/02/designing-the-application-process-to-reduce-academic-fraud McArthur  D. (2018, May 21). Will blockchains revolutionize education? EDUCAUSE Review, https://er.educause.edu/articles/2018/5/will-blockchains-revolutionize-education Vander Ark  T. (2018, August 20). 20 ways blockchain will transform (okay, may improve) education. Forbes. www.forbes.com/sites/tomvanderark/2018/08/20/26-ways-blockchain-will-transform-ok-may-improve-education/?sh=7d64aa6f4ac9 Yedigaryan  L. (2019). Blockchain applications in education: Use cases. Nooor. https://nooor.io/blog/blockchain-in-education/

Hybrid or Blended Delivery

Traditional courses are more frequently being offered as online virtual classes (i.e., distance education)-learning that occurs other than in the traditional classroom and consequently requires special course design, planning, techniques, and communication. A hybrid of this delivery mode includes learning in which traditional classroom time is enhanced or broken up with online components, thereby creating a class in which blended learning occurs. Forms of hybrid learning include web-enhanced learning, such as asking students to blog responses to a reading or class discussion, and learning that takes place in and makes use of smart classrooms (e.g., teaching in a wired room equipped with classroom learning technologies).

Smart classrooms, also known as digital and multimedia classrooms, integrate computer and audiovisual technologies by providing a ceiling-mounted projector with an access point at the front of the room, an instructor podium or workstation, sound, and network access. An enhanced smart classroom also provides networked student workstations instead of traditional desks, allowing students to follow along online and perform network or web searches, chat, blog, or a myriad of other activities as directed by the professor. For example, at the Penn State College of Nursing, users can access announcements, course materials, faculty information, websites, and other tools through the electronic course management system, which enables the nursing faculty to extend learning beyond the physical classroom walls.

Competency-Based Learning

More robust LMSs are particularly well suited to support competency-based learning. Nursing competencies have been well defined by professional and accrediting organizations, such as Quality and Safety Education for Nurses (QSEN); American Association of Colleges of Nursing (AACN), through its Technology Informatics Guiding Education Reform (TIGER) initiative and the essentials of nursing education delineated for undergraduate and graduate study; and Healthcare Information and Management Systems Society (HIMSS), through its promotion of informatics competencies.

Database technologies within LMSs offer the ability to track competency achievement, as Pijl-Zieber et al. (2014) explained: “Such technologies could be shared, at least to some degree, between nursing student and nursing instructor, much like clinical evaluation tools are shared on paper, to jointly track skills, knowledge, abilities, critical thinking, clinical reflection, and developing competence” (p. 677).

Certain social trends emerging from the morass of both traditional and innovative technology tools include the use of technologies attempting to meet the needs of members of the Net Generation, or the millennials (i.e., those born between 1981 and 1996). These students have grown up inside a wired world of instant access and online everything, and they are connected, digital, experiential, and social learners. Through the use of software, hardware, drivers, dedicated servers, plug-ins, and internet connections, students can chat, collaborate, play games, or interact electronically with a peer in some way, all with little to no learning curve or effort. Because visual media are now the vernacular of this highly digital culture, such tools might take the shape of interactive tutorials, a created city within a virtual reality landscape, high-fidelity simulations, serious games, or even a multimedia action maze that prompts users to choose different outcomes within a scenario. Generation Z (Gen Z) learners are those born between 1997 and 2012. Schrader (2022) believed that their learning must be flexible so that they can self-pace and be highly collaborative in nature. These learners want their reality to be seamless from the real world through any of the virtual reality experiences.

Members of Gen Z are entering nursing schools and the workplace. This generation is currently the most racially and ethnically diverse of all the other generations, and they are very comfortable with technology, especially when using the internet and wireless devices to obtain information when they need it. The number of technologies and devices they use could cause them to mainly interact virtually; their expert use of sophisticated digital tools could result in immature social skills and the inability to make and maintain relationships, placing them at risk for isolation and related issues of anxiety, loneliness, and depression. Stillman (2019) stated that “about half of Generation Z spend 10 hours or more each day online. . . . [The] favorite social media sites of Generation Z include Instagram, YouTube, and Snapchat” (para. 2). Gen Z will be a 2.56 billion population by 2020. When Gen Z grows up, they'll make up 40% of U.S. consumers. In view of the size of the Gen Z population, all educational institutions must consider and adjust to their learning needs (Morgan, 2020; Todorov, 2023).

Regardless of the particular tool employed, technology can perform only as well as the pedagogy that drives it. Therefore, the faculty and learners must be considered and supported in order to sustain the nursing programs.

Tutorials

The modern tutorial mimics lectures by guiding users through a series of objectives or tasks, which they are usually allowed to complete at their own pace (Edwards & Drury, 2000). Generally, tutorials stand alone as autonomous multimedia that may use animation, text, graphics, sound, questions, and various kinds of interactivity to engage and intrigue the user. They tend to promote active learning by prompting users to answer sets of questions, follow clickable hypertext, or complete quizzes. For example, users might be asked to fill in worksheets after reviewing anatomy concepts, take a quiz, post an answer to a question, or click through a scenario by choosing the best course of action in a mock clinical situation.

Some tutorials, such as those used by medical students at the Morgan Stanley Children's Hospital of New York, are designed to be brief (10 minutes), interactive, very focused, and immediately relevant. In this case, medical students bustling through a busy clinical rotation who accessed the tutorials actually raised examination grades (Pusic et al., 2007).

Because most students benefit from being able to contextualize a lesson's framework and purpose, the most effective tutorials provide users with understandable navigation, such as a table of contents at its beginning, or additional navigational aids, such as icons, buttons, or text, that indicate where and how they need to progress (Dewald, 1999). Effective tutorials surpass the simple presentation of information in a web-based format; instead, they address certain pedagogical and student-centered needs by identifying and considering specific factors, such as instructional content, the educator's purpose and teaching goal, the initiative's overall purpose, the potential need for special conceptual input, the learners' ultimate objectives in completing the tutorial, and the standards that determine what qualifies as successful completion of the tutorial (DeSantis, 2002).

Although most tutorials are created to stand alone, some of them may also benefit and supplement face-to-face instruction, such as the interactive information skills tutorial developed at the Institute for Health and Social Care Research in Salford, United Kingdom. This tutorial divides a traditional lecture series into chunks and incorporates questions into the text that would normally arise during the session and provides hyperlinks to the answers. This organization allows users to browse to different parts of the tutorial, open a database in a new window to perform a practice search, and access other features (Grant & Brettle, 2006). In all their iterations, tutorials urge students to hone and develop effective critical thinking skills. Short tutorials may also be created on an organization's intranet to educate practicing professionals on a new policy, procedure, organizational initiative, or healthcare technology. Since the tutorial is electronic, access and time spent on the tutorial can easily be tracked.

Case Scenarios

Professional organizations are increasingly recommending performance-based assessments of students in professional degree programs, and enacting case scenarios provides an opportunity for students to practice procedural responses and improve patient safety. The case scenario, a form of problem-based learning, has evolved and is now available through simulation software and virtual reality programming. This kind of learning assessment, in which students must respond within context to a perceived situation rather than a theoretical or fact-based question, allows educators to gauge procedural knowledge and determine how well a student executes a skill or applies concepts and principles to specific situations (Garavalia et al., 2008). For example, in a clinical context, a student could explain a specific procedure, but such knowledge is declarative rather than procedural; therefore, for some evaluators, it is not as valuable. Conditional knowledge is also often reflected in procedural knowledge that demonstrates a student's ability to know when and why action is or is not taken and how. As more programs move toward interprofessional education, case scenarios are a great way for students to hone collaboration skills and gain an understanding of the roles of other professionals.

Portfolios

Portfolios in healthcare professional education have grown in popularity as useful tools for documenting students' exposure to educational experiences. A portfolio allows a student to document a variety of unquantifiable skills, such as creativity, communication, and critical thinking. Further, portfolios can reflect achievement of goals, self-evaluation, and professional development and provide a way for returning students to log and document past work or life experiences in a creative but structured way without taking a standardized test. The usefulness of a portfolio for an undergraduate depends on a structured system of organization, such as an identification page with a resume, a table of contents, and separate and clearly marked sections. In this way, portfolios can monitor program outcomes, positively influence employment and graduate school admission, and provide a clear snapshot of a student's strengths and abilities. See Box 19-1 for an overview of electronic portfolios and specific information on developing a professional portfolio.

Box 19-1 What Is an Electronic Portfolio?
Glenn Johnson  JeffSwain  Today's information technology infrastructure allows users to easily build web-based collections that include evidence of their knowledge and skills. Users can upload artifacts that represent evidence of their learning experiences, inside and outside of the classroom. Electronic portfolios (e-portfolios) may also contain a blog element where students reflect on their total experience and demonstrate growth in their areas of study. E-portfolios can be built using a range of technologies. Some individuals use PowerPoint presentations to capture and present evidence. Web-based e-portfolios are built using common web publishing tools to create web pages, such as Web 2.0, Web 3.0, or open source tools; the web pages are then published on the internet. Web 3.0 and an increasing number of institutional e-portfolio systems have emerged to transform how students, educators, and institutions can log on and then upload, enter, and share information or evidence related to their experiences. Students and educators can interact, collaborate, and share learning accomplishments. Examples of e-portfolio systems include the following:
Association for Authentic, Experiential, and Evidence-Based Learning: https://aaeebl.org Digication: www.digication.com Facebook: www.facebook.com LiveText: www.livetext.com Myspace: https://myspace.com PebblePad: www.pebblepad.co.uk Typepad: www.typepad.com Watermark: www.watermarkinsights.com
Why Create an E-Portfolio?
Although academic institutions may use e-portfolios for assessment of student learning, for the individual, e-portfolios are all about opportunity. Such opportunities might include supporting a working relationship with a mentor, networking with other professionals, or representing certain qualities and characteristics to prospective employers. The e-portfolio allows students to track, monitor, and assess their learning to gain significant insights throughout their program of study. In all of these cases, going through the process of developing an e-portfolio requires critical examination of which qualities make individuals who they are and why these qualities are important to them and their profession. It is important for all professionals to have a foundational understanding of where they are in their career trajectory and how this fits with their long-term professional goals. Practically speaking, e-portfolios are efficient. When introducing oneself in an email message, a self-starting individual who has taken the initiative to develop and publish an e-portfolio can add this line to the message: “Here is a link to my e-portfolio.” The recipient can click on this link, which automatically opens that individual's e-portfolio in a web browser. Metaphorically, the senders of such messages have just walked into the recipient's office with information that illustrates who they are, what they know, what they can do, and what they value as important; they have just walked in with what could be a multimedia showcase of their qualities. The internet is a very powerful communication medium, and individuals with professional e-portfolios are simply taking advantage of this fact.
E-Portfolios in Higher Education
As an instructional strategy, portfolios have been around for a long time. Instructionally, portfolios, whether electronic or paper based, require students to demonstrate or provide evidence that they have attained specific learning outcomes. For instance, in the arts, portfolios have been used to demonstrate the depth and breadth of the work of an artist. Although performance-based programs of study are more likely to be familiar with the concept of the portfolio as a demonstration of what a student knows and can do, other areas of study have also begun to adopt this method of assessment. Portfolios can be particularly helpful in areas where higher-level thinking and analysis are essential. For instance, being a good healthcare professional encompasses much more than simply being able to get high scores on examinations. Professionals need to be able to collect information, analyze the information presented and relate it to past experience, apply related knowledge, and evaluate various options and, from all this, present a diagnosis and a plan of action. In short, healthcare professionals need to be able to think critically and make informed decisions. In learning to become a healthcare professional, portfolios can be used to capture, support, and improve this type of thinking as it develops. Like the artist, the healthcare professional student can connect, share, and present cases and findings and include with this evidence the reflective commentary that serves to unveil how they arrived at a decision, which information or experiences were vital, and how their action plan evolved. However, given the vast variety of evidence that individuals might potentially use to represent themselves, what should one select, and how should this be shared?
E-Portfolios for Professional Development
Using an e-portfolio to support professional networking involves a predetermined and focused purpose. This purpose may be to foster better communication between oneself and a mentor, or it may be to establish how what a professional is doing fits with the goals of the institution for which the individual works or would like to work. A professional e-portfolio is evidence based and uses this evidence to make a case that highlights the individual's capacity not only to perform but also to grow and develop professionally within their chosen field.
The E-Portfolio Process
The four steps involved in developing an e-portfolio are recursive in nature, meaning that during the process, one can backtrack to fill in missing pieces or reevaluate earlier decisions that were made. The four steps are (1) collect, (2) select, (3) reflect, and (4) connect. See Figure 19-3 for an image of the portfolio creation process. Figure 19-3 Portfolio Creation Process A cyclic diagram depicts the stages of the portfolio creation process: collect, select, reflect, and connect. Collect Evidence should demonstrate what a person knows and can do or the values that they hold as being important. When it comes to developing e-portfolios, it is important to think of evidence in very broad terms. This evidence might include the results of what someone has learned in courses taken as a student, especially in terms of demonstrating a new skill or knowledge of a subject. More importantly, evidence can come from experiences that take place outside of the classroom. For instance, someone may have been involved in an internship or clinical observation where they had the opportunity to connect what was learned in the classroom with how this information is applied in a real-world setting. Such an experience not only is valuable but also represents the individual's understanding of how this knowledge can be applied; thus, it enhances others' perceptions of the depth of what the person knows. Resumes are evidence documents. They are very important, and every professional should have an updated copy available. However, resumes simply list an individual's experiences or accomplishments. By comparison, e-portfolios go beyond the resume to emphasize personal attributes that are very important in the specific profession. These attributes include, but are not limited to, interpersonal skills, leadership skills, appreciation of diversity, ability to work in a team, and self-sufficiency. These attributes are difficult, if not impossible, to demonstrate in a resume. When reflective commentary accompanies evidence of an individual's involvement, these attributes and values can become the highlights of an e-portfolio. Select Everyone has their own unique pool of evidence from which to pull, and over time this evidence pool can become quite large. What will someone choose to feature and why? Putting together a professional e-portfolio requires that several intertwining questions related to purpose and audience be addressed. What is the purpose? What is it that someone is attempting to gain by putting an e-portfolio together? Is the purpose related to personal development (i.e., feedback and advice about the professional direction that is being taken)? Is the purpose to connect with colleagues? An individual may, for example, be interested in using their e-portfolio to find a job or gain admission into a graduate program. Although an e-portfolio can link to everything that a person has accomplished, this may not be the best strategy. Instead, it is essential that an individual consider the audience and establish a plan that enables them to select the most appropriate pieces of evidence for their particular purpose and audience. A helpful way to start is to select the top five pieces of evidence that support the plan. Next, the individual should consider why they selected these pieces of evidence. What is it about each piece of evidence that makes it representative of who the individual is and what they know, can do, and value as important? Reflect Reflection and reflective commentary take an e-portfolio to the next level. This component may take the form of a single reflective statement, or it may be attached to the evidence throughout the e-portfolio. Reflective comments should open up a window into why an individual thinks this evidence is important, the ways in which the individual values what they learned, or why the individual thinks it is important for the larger profession. For instance, the individual may present an experience where they were challenged to provide assistance. Describing this experience would be important; however, the reflective comments can extend this description, enabling the individual to talk about the alternatives considered as the basis for how they made a decision to provide the specific type of assistance and the manner in which it was provided. By itself, a description of this experience is good. With reflective comments, readers have a much more thorough perception of and insight into an individual's professional thinking. This is where having a blog element as part of an e-portfolio becomes extremely powerful. Unlike static web pages, a blog page is a space designed to be interactive. The blog owner posts commentary, thoughts, and experiences for others to read and respond to. Regular entries on a blog give others a reason to return to one's e-portfolio site repeatedly. It is an opportunity to share one's perspective on topics of interest and is critical to the chosen field. A blog is a place where conversation happens. It provides a nice counterbalance to the static web pages, such as a resume and project pieces. Most blogging platforms allow users to select from a range of templates, which include a blogging element along with static web pages. Platforms such as WordPress, Moveable Type, and Google are free for at least the basic service, which enables the user to create a dynamic e-portfolio without having to build web pages. Most platforms allow entries to be in both text and multimedia format, so the blog becomes the perfect place for personal expression. A blog is quickly becoming a standard part of an e-portfolio. Connect (Connections) and Feedback The connection and feedback step is important to validate the assertions people make about what they know, understand, or value. Individuals may choose to receive feedback from those who are close to them and then from there reach out to others, who may provide different perspectives. For instance, if healthcare professionals were thinking about using their e-portfolio to apply for a position, they might want to start by getting feedback from friends and family. They might also share their e-portfolio with a mentor or faculty member, which raises the bar by getting professionally grounded feedback before sharing their e-portfolio with a prospective employer.
Challenges and Issues: Privacy and Security
The ease and popularity of web-based social networking and professional e-portfolio tools also raise several challenges and issues for users. Never before has information for individuals been so accessible, nor has such personal information been so readily made public. For this reason, issues related to privacy and security need to be addressed. What might be appropriate socially can be deadly in a professional context.
E-Portfolio Process: Summary Comments
In summary, one might think about the process of developing a professional e-portfolio as boiling down to the telling of a rather simple story, albeit a story that has three parts: looking back, looking around, and looking ahead. Readers should think of their own evidence pool as they answer these questions:
Looking back: What have you done? In which activities and with which organizations have you been involved? Where have you been? With whom have you worked? How did this help get you where you are today? Looking around: In what are you currently involved? Why are you doing this? What are you getting out of it? Looking ahead: Where would you like to be in 2 years? Where would you like to be in 5 years? Why do you feel this way? What makes you think your goals are realistic?

Simulations

Simulations have been widely used within healthcare circles, but they experienced a recent upsurge due to the pandemic and the widespread availability of high-quality simulation equipment and software along with a reduction in the cost of this technology. Ranked by fidelity, or the level of realism the equipment provides, simulation may take various forms, from mannequin-based to computer-based simulation in which software is used to simulate a subject or situation (e.g., an interactive tutorial featuring a nurse-patient situation) to full-scale simulation in which all the elements of a healthcare situation are recreated using real physiology, people, and interaction to, as closely as possible, resemble a real-life environment. These immersive virtual simulations make the learners suspend reality and feel like they are really in the situation. Simulation scenarios aid nursing instructors in assessing competency achievement. For a more comprehensive discussion of simulation as a teaching and learning tool, please see Chapter 20, Simulation, Game Mechanics, Virtual Worlds, and the Realities in Nursing Education.

Virtual Reality

In traditional virtual reality (VR), the user receives multiple sensory inputs either mediated or generated by a computer through nasal stimulation as smells or scents, visual stimulation (i.e., glasses, goggles, and screens), audio input (i.e., earphones, microphones, and synthesizers), and touch (i.e., gloves and bodysuits). A form of simulation training that was once considered a science fiction technology of the future is the increasing use of virtual reality healthcare training.

Because virtual worlds foster unintentional learning through gamelike technology in which students discover and create knowledge to accomplish something rather than experiencing traditional outcome-based learning, their experiences may result in greater comprehension and deeper knowledge. In a virtual clinical scenario, for example, a simulated, immersive environment presents invaluable learning opportunities for the student who is assuming the role of healthcare provider. Faculty can monitor the interaction and interrupt as necessary to leverage those teachable moments and assess the learner's thought process and proposed next actions to apply specific skills within a clinical setting. Scott (2018) stated that VR “is being incorporated into college classrooms all over the country. Making sure they [the classrooms] are ready for deployment is just as important as the lessons being taught” (para. 1). This surge occurred prior to the pandemic and then the pandemic helped to continue its use. Because so much of the data nurses rely on are complex and because so many patients' cues are lacking in concrete language or responses, the animated, immersive, three-dimensional environment of virtual worlds allows students to practice skills, try new ideas, and learn from their mistakes while receiving feedback from educators within a globally networked classroom environment. Virtual reality tools are a great way to implement competency-based education. Some students may struggle to participate in virtual communities for various reasons. Increasing comfort with multidisciplinary learning among students and educators improves patient safety and encourages the refinement of best practices. Chapter 20, Simulation, Game Mechanics, Virtual Worlds, and the Realities in Nursing Education, provides a more comprehensive discussion of this technology.

The consensus in nursing education suggests that any technology that allows users to interact and engage with materials and one another is useful. More specifically, the Foundation of Knowledge model qualifies this observation with the caveat that technology must display user-friendly capabilities to provide benefits to its users, thereby allowing students not just to find information and one another online but also to engage, challenge, and institute their discoveries. Providing nursing students with easy-to-use, free internet tools for reaching the first step in this process (i.e., gaining access to materials and peers) has been addressed by the proliferation of communication technologies available to any user with an internet connection. Beyond the gadgetry, with the development of new strategies, practices, applications, and resources in technology comes the need for instructional strategies that not only appeal to this newer generation of students but also enhance learning. Such strategies, when coupled with easily accessible and highly functional tools, encourage nursing students to see beyond the right answer and seek out information that encourages them in developing approaches to issues and resolutions for problems. According to Hughes (2022), “Make sure that your strategies are agile, customizable, and ready for the momentum of Generation Z” (para. 33).

Because of the shift within the teaching-learning context from the individual seeking answers to the group trying to construct new knowledge from available information, the most effective learning solutions require new digital communication skills, new paradigms, new pedagogies, and new practices. A collaborative, student-centered approach uses the best tenets of inductive teaching by imposing more responsibility on students for their own learning than is assumed in the traditional lecture-based deductive approach. These constructivist methods are built on the widely accepted principle that students are constantly constructing their own realities rather than simply absorbing versions presented by their teachers. Collaborative methods often involve students' discussion of questions and in-class problem-solving, with much of the work (in and out of class) done by students in groups rather than individually (Felder & Prince, 2007).

Johnson and Johnson (1990) identified five significant elements for successful collaborative learning that are still pertinent today:

1. Face-to-face interaction between students, allowing them to build on one another's strengths
2. Mutual learning goals, which in turn prompt students to exhibit positive interdependence rather than individualized competition
3. Equal participation in the work process and personal accountability for the work one contributes
4. Regular debriefing sessions as a group after meetings or presentations, during which time feedback is shared and observations are analyzed
5. Use of cooperative group process skills learned in the classroom

Although collaborative learning relies heavily on student investment and participation, institutions must ultimately create the best physical, electronic, and immersive settings in which collaboration is encouraged. Creating these settings can be achieved with a sound educational and technological infrastructure, reliance on proven working models, adaptable physical spaces, and even pedagogical support in the form of preceptors or mentors.

Especially useful for nursing students is the collaborative fieldwork model in which two or more students share a clinical setting and the same fieldwork educator. In this model, learning happens in a reciprocal fashion, with students constructing knowledge by watching each other and exchanging ideas. The most effective fieldwork experiences are highly structured with clear outlines of responsibilities, duties, and expectations to ensure that the experience matches the learner's expectations. The sharing of perspectives and viewpoints results in the generation of new knowledge and the restructuring or reorganization of existing knowledge. All activities performed by students, such as conducting evaluations, are done jointly so that peers provide each other with objective feedback, which eventually leads to increased self-confidence (Costa, 2007).

Libraries have also begun to recognize their role in students' success with and predisposition toward collaborative learning by creating redesigned spaces that reflect students' need to huddle in small groups; sit closely together without barriers; chat about their work; and view digital information without physical hindrances, such as carrels or work stalls. A leader in this movement has been Indiana State University, whose information commons features completely overhauled furniture, software, monitors, processing power, and wireless access to the university's network. Students can now collect as a group at kidney-shaped tables; better see the information loaded on the flat-screen monitors; make use of brainstorming, design, and planning software; and discuss their work in a chat-friendly zone. Some faculty members have even scheduled classes at the learning stations, and students, including those in nursing, have responded enthusiastically to the evolved space (Gabbard et al., 2007).

In addition to adaptable physical spaces that encourage discussion and group work, students require a supportive infrastructure that provides the essential elements for successful research and scholarship. These elements include professional development support in the form of workshops that help students acquire or refresh skill sets; presentation opportunities; and hardware, software, and resource support. One such example involves the participation by nursing students at the University of Texas Medical Branch School of Nursing in the Scholarly Talk About Research Series (STARS), in which students and faculty give presentations of their work before presenting those materials at professional conferences (Froman et al., 2003), thereby eliciting collegial feedback, collaborative troubleshooting, and shared research ideas. Imagine how powerful such a process would be in a cross-discipline healthcare education school.

Simply adopting a collaborative, inductive method of learning, however, will not necessarily lead to better learning and more satisfied students. As with any form of instruction, collaborative teaching methods need skilled and careful implementation. Because students can be resistant to instruction that makes them more responsible for their own learning, those who attempt to implement an inductive learning method should adhere to best practices, such as providing adequate scaffolding, which is extensive support and guidance when students are first introduced to the method and gradual withdrawal of that support as students gain more experience and confidence in its use (Felder & Prince, 2007).

Nursing preceptors and mentors, for example, can provide this kind of scaffolded support as clinically active role models (Armitage & Burnard, 1991) and problem-solving advocates and collaborators (Gagen & Bowie, 2005). As individuals who are primarily concerned with the teaching and learning aspects of the relationship, preceptors help students learn by acting as clinical practitioner role models from whom the students can copy appropriate skills and behaviors. Kramer (1974) introduced the concept of nurse preceptor to address the theory and practice gap, which is the difference between what is taught in class and what actually happens in nursing practice. Preceptors enhance clinical competence through direct role modeling, which is especially valuable in a field where competence and clinical ability are paramount (Armitage & Burnard, 1991). Mentors, who are similar to preceptors, provide equally valuable assistance to nursing students in the form of a facilitator. Mentors are most often used in nursing and education to support new professionals who are trying to fulfill the rigors of a new position while negotiating the stress inherent to a new environment (Gagen & Bowie, 2005). According to Jokelainen et al. (2011), “student mentoring in nursing clinical placements integrates environmental, collegial, pedagogical and clinical attributes” (para. 6). Mentors tend to address student needs through open conversation, student advocacy, feedback on student progress, facilitation, teaching, and general support (Neary, 2000). Artificial intelligence (AI) agents are also available to students to support them throughout their educational programming.

Generally, these and other forms of institutional support promote students' adoption of a meaning-oriented approach to learning, as opposed to a surface or memorization-intensive approach. Collaborative, inductive learning promotes intellectual development that challenges the dualistic thinking that characterizes many entering college students, which holds that all knowledge is certain, professors have it, and the task of students is to absorb and repeat it (Felder & Prince, 2007, p. 55). Further, this kind of learning helps students acquire the self-directed learning and critical thinking skills that characterize the best scientists and engineers (Felder & Prince, 2007). The active, engaging elements of collaborative learning increase self-confidence, promote autonomy in students, and foster a commitment to lifelong learning (Costa, 2007), all of which are necessities for the success of a new millennial information-literate student.

Sharing stories and experience from a clinical point of view accomplishes much more than simply promoting camaraderie or empathy (although this kind of engagement is infinitely valuable in its own way); sharing experiences of clinical learning can help convey lifesaving information to other clinicians in a way that is more memorable and palatable and less imposing than warnings delivered outside a social context. Clinical and caring knowledge, often rooted in everyday exchanges, becomes socially embedded such that those with experience in particular clinical settings share common knowledge and understanding. The social embeddedness of caring and clinical knowledge is a result of shared and shaped collective understanding of practice and sometimes provides an alternative view.

The power of pooled knowledge in combination with knowledge produced in dialogue with others helps to limit tunnel vision and is a powerful strategy for maximizing the clinical knowledge of a group. Whether the nurse is networking, presenting, or seeking continuing education or recertification, an understanding of socially embedded knowledge coupled with the multiple perspectives of skilled practitioners allows for a rich and vibrant opportunity to apply nursing skills effectively (Benner et al., 1997).

As we adopt more technology-based tools in education, we need to be mindful of what constitutes fair use of materials and copyright laws. Nurse educators should be careful to model ethical behaviors by attributing works to their rightful authors as they acquire and use education materials. Fair use refers to a legal concept that permits the use of copyrighted works for specific purposes without obtaining permission from the author or paying for the use of the work. Originally, fair use evolved for written work and allowed for uses that include journalists' reporting the news, teaching, or scholarly research. As digital technology and the web burst upon the scene, fair use expanded to apply to the copying and redistribution of digital media, including photographs, graphics, music, videos, audio, and software or computer programs.

Four factors must be considered in determining whether a particular use is fair. These factors are derived directly from the fair use provision (www.copyright.gov/title17/92chap1.html#107) of Section 107 of the U.S. Copyright Law (U.S. Copyright Office, n.d.):

1. The purpose and character of the use, including whether such use is of commercial nature or is for nonprofit educational purposes
2. The nature of the copyrighted work
3. The amount and substantiality of the portion used in relation to the copyrighted work as a whole
4. The effect of the use upon the potential market for, or value of, the copyrighted work

The first factor tends to favor educational institutions and nonprofit entities. The second factor relates to the nature of the work; courts have consistently protected creative works and those that have not yet been published. The third factor that must be considered relates to the amount of use. Typically, you should determine how much of the overall work you are using; if it represents the core, or essence, of the work, you should not replicate or use it. The fourth and final factor relates to the effect on the creator's market share. If you are using a substantial portion of a text or software work that is offered for sale, you can adversely affect its owner's earning potential. The term itself should make you reflect on all these factors and decide whether your proposed use is fair.

Copyright refers to the exclusive right of the creator of a work to distribute, sell, publish, copy, lease, or display that work in whatever manner they choose. Copyright laws are not only misinterpreted but also are constantly being challenged by our advancing technological capabilities. Think about AI and ChatGPT. Who owns the content AI generates? How should we cite it? Even though you use American Psychological Association formatting, for example, and cite the authors, you might be overstepping your rights and infringing on the author's copyright; you might not be accused of plagiarism, but you should always cite where you obtained your information or digital media.

All users of others' work, in whatever medium, must fully understand, be aware of, and comply with copyright and fair use principles. Typically, you should try to think of what reasonable use is and always make sure that you cite the authors. Reflect on all four fair use factors before making your decision to use another's work for educational purposes. Also, remember that you are serving as a role model regarding copyright and fair use behaviors for your students.

There are several exciting and interesting education technology trends to monitor in the future. Virtual reality-embedded education has exploded onto the academic scene and offers the potential for interdisciplinary inquiry and sharing across the curriculum and university and globally. Makerspaces are labs provided on university campuses (and in some healthcare institutions) to allow students and healthcare workers to experiment with developing new technologies or modifying existing technologies and equipment to better fit needs. These spaces are frequently equipped with three-dimensional printers and lots of tools and materials that allow for rapid prototyping of ideas.

Several universities around the country, such as the University of South Florida, University of Pittsburgh, Yale University, and Arizona State University, are sponsoring healthcare innovation competitions. Other universities are partnering with industry leaders to sponsor student ideas for healthcare innovations. The Internet of Everything (IoE), which is another trend, is touted as the next step beyond the connections of physical things (Internet of Things, or IoT):

This chapter highlighted the technology tools and delivery modalities that support nursing education. Nursing education is evolving and will be structured by competency achievement and supported by technologies. In an ideal world, nurses would work against the assumption that technology runs itself and take proactive roles in helping to design the education and technologies necessary to best prepare them for real-world scenarios. Consider that flash is not substance and drama is not depth; technology performs only as well as the pedagogy that undergirds and sustains it. Plan for and use technology with care so that its best features consequently enrich your experiences as an educator or a learner.