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Collaborating with an instructional designer for online training

Troxel, Dyan MSN, RN; Inge, Erica MEd, EdS

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doi: 10.1097/01.NURSE.0000615116.70468.35
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STRIVING FOR excellence in the delivery of quality healthcare is a cornerstone of the mission statement in healthcare facilities. Nursing professional development (NPD) is integral to this effort. Nurse educators facilitate lifelong learning in healthcare by providing instruction to clinical nurses. But while they have expertise in nursing, they may not possess the technologic skills to provide online training.

Instructional designers (IDs) are professionals trained to support and collaborate with staff educators to engage learners.1 They can help to build online training components for nursing teams, lowering costs and positively affecting facility and department education initiatives.2 IDs design and develop strategies for improved learning by combining theoretical knowledge with practical skills. This article discusses the benefits of collaborating with IDs in the development of online content for nursing education.


According to the Association for Talent Development, a nonprofit association devoted to developing talent in the workplace across multiple industries, approximately half of all instructional learning hours came from traditional, face-to-face, instructor-led classrooms in 2016.3 However, the utilization of technology-based methods of education is increasing. Although 66% of companies are interested in offering online educational content, only 30% have the skills and support they would need to develop these programs.4

The authors' organization, the United Network for Organ Sharing (UNOS), manages the US organ transplant system. With learners located across the country, UNOS offers nearly all of its educational programs for healthcare professionals online.

Like many nurse educators, the curriculum development instructors (CDIs) at UNOS are not trained on software applications to create digital content. Instead, they work with IDs to create online courses and hold meetings to determine the scope of projects. Additionally, IDs and CDIs communicate with subject matter experts and perform multiple reviews to ensure quality throughout the process. Although each role has individual tasks, each is accountable to the other, fostering collaboration in the delivery of projects on time and under budget.

ADDIE framework

The instructional team at UNOS uses the ADDIE (analysis, design, development, implementation, and evaluation) framework to create online educational events.5 ADDIE is similar to the NPD standards of practice (assessment and identifying learning needs, outcomes identification, planning, implementation, and evaluation).6 The parallel relationship of these corresponding methods in the healthcare setting is described below.

Analysis. Using the NPD standards, nurse educators begin an assessment by gathering and analyzing relevant information about their target audience. With ADDIE, the analysis phase focuses on learner needs and how learners accomplish tasks to ensure an emphasis on changes in practice. By focusing on the end results, the instructional team stays informed on all project goals, from writing learning objectives to creating assessment tests.

As part of this phase, IDs are trained to assess needs, analyze information, and develop content. They determine how learners will interact with the educational content and break the curriculum into appropriately sized installments.7 This requires them to pose questions such as:

  • What do successful learning outcomes look like? For example, a successful outcome for new hand hygiene protocols would be decreased infection rates.
  • What does the learner need to do after completing the offering? In this example, healthcare professionals must follow the hand hygiene protocols established by their facility according to CDC guidelines.8

Design. In this NPD standard, nurse educators identify goals and learning objectives related to the desired outcomes. On the other hand, ADDIE's design phase determines the content needed to meet these goals. IDs incorporate the most effective means to deliver information and develop a design concept to ensure consistent standards in these offerings.

One 2015 study stated that “training participants need context, guidance, and feedback, especially in remote learning settings.”9 IDs must stay abreast of industry standards to meet those needs and develop interactions to keep participants engaged. For the appropriate educational context, IDs provide learners with an opportunity to apply their education in realistic scenarios to mimic their work practices.

Another important task for IDs is identifying technical issues or obstacles. They must consider their participants' browser compatibility, particularly with different web browsers and operating systems. Additionally, information security, functionality, and user learning management systems (LMSs) are important considerations. IDs should be in touch with hospital or healthcare technology professionals to ensure user educational needs are met.

Development. The planning phase of the NPD standards corresponds to the ADDIE development phase. Nurse educators develop content and collaborate with the ID to create an instructional offering, including presentation slides, audio recordings, and/or e-learning modules. Determining the best method to address educational needs and outcomes is a critical part of the ID skill set.

Skilled IDs use various software tools to support learning (see Digital education options). They must consider whether content requires participants to remember information, practice tasks, or implement new processes and choose methodologies based on specific content types. For example, an infographic may be the best format for reinforcing hand hygiene protocols. Similarly, videos help nurses to see how a task is completed successfully, and e-learning modules give nurses the chance to practice before interacting with patients.5

Digital education options

Implementation. The implementation phase is included in both the NPD standards and the ADDIE framework. It ensures congruency between the planning and the final product. Nurse educators complete formative reviews and determine successful completion, while IDs publish the final offering in an accessible LMS that provides learners with a documented way to keep track of completed courses and continuing-education opportunities.10 Courses are accessible to all employees, including those returning from a leave of absence.

Evaluation. Like the implementation phase, evaluation is also a key part of both the NPD standards and the ADDIE framework. It revolves around a comprehensive measurement of effectiveness, including any necessary revisions and inactivations. User surveys may be offered initially, but this subjective tool may not be effective in determining the broadscale application of new knowledge.11

Evaluation measures “knowledge, skill, attitude, confidence and commitment.”12 The ability to measure behavioral changes as participants apply their education will lead to an accurate assessment of the degree to which the business need was met. IDs have the knowledge and skills to help analyze the data gathered and assess each of these levels. Documenting and measuring the effectiveness of an educational program showcases both its value and that of the nursing department.

In practice

A nurse educator is tasked with providing an education program to reduce patient falls within a healthcare facility. He or she considers the time required to plan and implement a 30-minute, face-to-face staff development session and compares these factors to those involved in creating a 15-minute video. Developing the content will take 10 hours in either scenario. It will take longer to deliver ten 30-minute, face-to-face staff development sessions, however, at 5 hours for the presentations and approximately 5 additional hours for preparation and cleanup. It will also take longer for the nursing staff to attend, at approximately 50 hours for 100 total nurses. Given these estimates, the educator needs 70 total hours to complete the face-to-face option.

Collaborating with an ID for a 15-minute video on the healthcare facility's LMS will add 20 hours to the project for video development, but it also eliminates the 10 staff development hours from the educator's schedule. Additionally, at 25 hours for 100 nurses, the shorter video reduces the time the nursing staff must take to become familiar with the new information. The total time spent on the video option is only 55 hours. As such, it may reduce costs based on total work hours. This option also allows the educator to spend more time working on the nursing units while the ID develops the video.

Patient fall rates must be measured before and after instruction to document the business outcome. Once completed, these data can be collected and analyzed to determine the course's effectiveness, and additional materials such as laminated documents may be distributed to reinforce the content or obtain feedback. If the facility's education costs and fall rates decrease, data will support the benefits of online training. If fall rates stay the same or increase, the nurse educator may consider a root cause analysis.

Valuable return on investment

Technology-based education is an increasingly popular strategy that saves time and money. Although collaborating with an ID may require nurse educators to change some long-standing educational practices, it may yield a substantial return on investment and improve the effectiveness of nursing staff development efforts.


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