Enhancing nursing students' understanding of threshold concepts through the use of digital stories and a virtual community called ‘Wiimali’
Introduction
Wiimali is a dynamic virtual community developed in 2010 and first implemented into our Bachelor of Nursing (BN) program in 2011. The word Wiimali comes from the Gumiluraai Aboriginal language; it means to light a fire.3 Consistent with the words of William Butler Yeats we believe that ‘education is the lighting of a fire, not the filling of a pail’ and it is this premise that underpins our program. Wiimali and the digital stories it comprises were designed to inspire and engage nursing students while enhancing their understanding of the threshold concepts integral to safe and effective nursing practice. In this paper we illustrate some of the key features of Wiimali with web links to a virtual tour of the community and a selection of digital stories. We explain how this innovative educational approach has the potential to lead to transformative learning about concepts such as social justice, person-centred care and patient safety. We conclude by providing examples of student evaluative feedback about this educational approach.
Section snippets
Threshold concepts and transformative learning
Wiimali was designed to bring complex and somewhat challenging health and sociological concepts to life. These ‘threshold concepts’ are integrated throughout our BN curriculum and an understanding of them is pivotal to students' successful transition from lay person to beginning nurse. Threshold concepts are explained by Meyer and Land (2003, p.1) as:
… akin to a portal, opening up a new and previously inaccessible way of thinking about something … [they] represent a transformed way of
Wiimali
Wiimali is a virtual community located in New South Wales, Australia. While the community is fictitious the demographic indicators are representative of the diversity of a semi-metropolitan context similar to the region surrounding our university campus. Wiimali is comprised of an interactive map with over 80 digital stories, each mapped to curriculum learning outcomes and unfolding over the three years of the nursing program. The community was developed in a consultative way, inclusive of the
Curriculum integration – Year 1
Students are introduced to Wiimali in their first semester of enrolment where it forms the stimulus for a core primary health care course. The emphasis at this stage is on exploring the community, its history, demographic profile, resources, problems and assets. In Australia, education about primary health is not keeping pace with reform agendas that promote expanded roles for nurses in illness prevention and health promotion (Keleher et al., 2010). To achieve the aims of current reforms,
Year 2
In second year of the program students meet Cyril Smith, an older man diagnosed with colorectal cancer. Students follow his journey from admission, through surgery, clinical deterioration, recovery and discharge. The threshold concepts that are introduced at this stage are patient safety with particular attention to recognition and management of the deteriorating patient. Students engage with a series of interactive scenarios (Hoffman et al., 2010) based upon Levett-Jones’ (2013) clinical
Year 3
Third year students learn about disaster management when Wiimali is ravaged by a flood. They also gain an understanding of critical care nursing in the Emergency Department of Wiimali hospital when they are involved in the care of a child who has drowned in the rising flood waters of the Gubiy River and the casualties of a multiple vehicle accident at a known ‘black spot’. The threshold concepts introduced in previous years are once again reinforced. Issues related to primary health care are
Feedback about Wiimali
The extent to which Wiimali has impacted students’ world view or had a transformative effect on their understanding of the threshold concepts is difficult to ascertain. However, anecdotal feedback from students has been positive overall and has allowed us to review, refine and improve the quality of Wiimali resources and delivery over time. Additionally, routine course evaluations indicate that during the period 2010–2013, 78–90% of students either agreed or strongly agreed with the following
Conclusion
Nursing academics are continually challenged to create new ways of teaching which are contemporary, authentic and engaging for students from diverse backgrounds and with different world views. At the same time learning innovations need to be based on sound educational theory, and support the integration of threshold concepts to enhance deep learning. The development and implementation of Wiimali sought to address these challenges. A virtual community that supports transformative learning about
Acknowledgements
The development of Wiimali was funded by a Faculty of Health & Medicine, University of Newcastle grant. We also acknowledge the community members, academics, professional staff and students who have generously given of their time so that the digital stories could be produced.
References (23)
- et al.
Sadness, socialisation and shifted perceptions: school pupils' stories of a pre-nursing scholarship
Nurse Educ. Today
(2014) - et al.
Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study
Int. J. Nurs. Stud.
(2010) - et al.
Using a virtual community to enhance nursing students' understanding of primary health care
Collegian
(2014) - et al.
Learning and engagement with a virtual community by undergraduate nursing students
Nurs. Outlook
(2010) - et al.
Stagnant perceptions of nursing among high school students: results of a shadowing intervention study
J. Prof. Nurs.
(2009) - et al.
Patient safety in nursing education: contexts, tensions and feeling safe to learn
Nurse Educ. Today
(2014) - et al.
Educating Nurses: a Call for Radical Transformation
(2010) - et al.
Storytelling in Organizations. Why Storytelling is Transforming 2lst Century Organizations and Management
(2005) - et al.
Challenges and benefits od using a virtual community to explore nursing concepts among baccalaureate nursing students
Int. J. Nurs. Educ. Scholarsh.
(2011) - et al.
Building a virtual community for nursing education: the town of Mirror Lake
J. Nurs. Educ.
(2009)
Tell me a story – a conceptual exploration of storytelling in healthcare education
Nurse Educ. Today
Cited by (30)
Use of theory to guide integration of virtual reality technology in nursing education: A scoping study
2023, Journal of Professional NursingCitation Excerpt :Regardless of the equipment and degree of immersion, the common element of VR is interactivity (Fox et al., 2009). Applications of virtual environments have been used in nursing education for various purposes, such as to help students develop and practice clinical skills (Berg & Steinsbekk, 2021); learn complex concepts through participation in a virtual community (Levett-Jones et al., 2015; Shuster et al., 2011); role-play in simulated and unfolding patient/family scenarios (cite); and collaborate in interprofessional teams (Davis et al., 2016). VR provides unique opportunities for learning that are not available in traditional in seat, hybrid, or online asynchronous classrooms.
Enhancing learning in an online doctoral course through a virtual community platform
2021, Journal of Professional NursingCitation Excerpt :Tyng and colleagues asserted that understanding emotional influences on learning can be used to develop more powerful learning environments “emotion modulates virtually every aspect of cognition” (Tyng, Amin, Saad, & Malik, 2017, p1). Previous studies have shown virtual communities as effective in facilitating an emotional connection to characters and creating integrated learning experiences with the use of those characters portrayed in the virtual environment (Levette-Jones et al., 2015; Shuster, Giddens, & Roehrig, 2011; Walsh & Crumbie, 2011). The course culminated with a summative case study/analysis and virtual poster fair.
Exploring the impact of digital stories on empathic learning in neonatal nurse education
2020, Nurse Education in PracticeCitation Excerpt :Snow et al. (2016) found that undergraduate medical students’ learning and confidence improved after viewing patient stories about a specific procedure. Other research in nursing concurs, finding that digital stories can bring to life the patient voice, providing learners with a powerful and effective way to learn, remember and reflect (Christiansen, 2011; Stacey and Hardy, 2011; Levett-Jones et al., 2015; Waugh and Donaldson, 2016). Research by Bas-Sarmiento et al. (2017) and Levett-Jones et al. (2019) has explored educational interventions to enhance empathy.
Podcasting in nursing and midwifery education: An integrative review
2020, Nurse Education in PracticeCitation Excerpt :Marrocco, et al. (2014) also noted some students viewed podcasts as extra work, although those with learning disabilities appreciated the technology as it suited their needs. Similar to this review, Levett-Jones et al. (2015) highlighted that if tutors did not use digital stories or relate to them in class, some students became disinterested due to a lack of exchange. Some of the building blocks needed to deliver podcasting as an educational intervention identified in this review have also been discussed elsewhere.
Current issues with the identification of threshold concepts in nursing
2020, Nurse Education in Practice