The Potential of Wireless Handheld Devices to Enhance Pediatric Curriculum

For the past 5 years, we have seen rapid development of wireless handheld technologies, from Palm Pilot to iPod/iPad and smartphones. Inevitably, wireless handheld devices have become a common technology at work, school, and play. Almost all students at Saint Anselm College have some type of wireless handheld devices (WHD) that they use frequently to communicate and socialize. The quick growth and popularity of WHD helps bring an interesting new idea to our faculty members. Can we use wireless handheld devices in teaching? What is the potential of this technology tool to assist students’ learning? How can we integrate the use of wireless handheld devices into our curriculum?

The purpose of this pilot study was to investigate students’ perceptions on wireless handheld devices in learning and the effectiveness of using wireless handheld devices to enhance pediatric curriculum.

A wireless handheld device is a pocketsized computing device, typically has a display screen with touch input or a miniature keyboard, can connect to the Internet, has plenty of storage for electronic documents, as well as capabilities to host various applications.

A commonly used wireless handheld device is the personal digital assistant (PDA). PDAs have come a long way since the release of the original Palm Pilot in 1996. Today, PDAs offer a range of enhanced features, including color touch screen, audio capabilities, web browsing, operating system, media player, and synchronization.

During the past few years, we have also seen the rise of the iPod Touch, the iPad, smartphones, as well as tablet computers. Their convenient multitouch graphic user interface has won over enormous number of customers and has caught teachers’ attention for its potential educational uses. We have seen a dramatic increase of iPod Touch and iPhone ownership among our students, especially our freshmen student population.

Computers and related technologies sometimes are viewed as merely a delivery medium that students can learn from. This aspect is important. However, in this perspective, the technology is playing a rather passive role and does not engage learners in active learning. It is becoming increasingly clear that another aspect, which pertains to what students can do with the technology, needs to be considered by the educator. Technology should offer learners an intellectual partnership that transcends the limitation of human cognition, such as limitations to memory, thinking, and problem solving (Pea, 1985).

Computer-based cognitive tools, thus, are important to this way of conceptualizing relationships between users and computers. Lajoie (1993) grouped computer-based cognitive tools into four categories: tools that can support cognitive processing; tools that can share the cognitive load; tools that can engage learners in activities that would normally be out of reach; and tools that can support learners’ hypotheses testing. We believe that the wireless handheld device, due to its organized and immediate-access feature, can function as a cognitive tool to support and facilitate learning.

Cognitive load refers to the total amount of mental activity imposed on working memory at an instance in time (Cooper, 1998). Cognitive load researchers are interested in measures that can be taken to free working memory load so that more capacity can be made available for actual learning that facilitates schema construction. Our investigation focused on extraneous cognitive load, which refers to the demand imposed on working memory by the manner in which materials are presented and the activities required of the learner.

Students in the Child Health Nursing (NU341) course have to deal with a huge amount of clinical information that not only is impossible for them to memorize but also imposes extra load on their working memory. In the past, books serve as a tool to share this cognitive load. With the development of technology, we believe wireless handheld device can share learner’s extraneous cognitive load. With the use of wireless handheld device, learners can have access to several books at the same time on a small piece of equipment without switching books, flipping pages, and carrying heavy books. Information is also presented in an organized manner that facilitates content access. As a result, learners’ extraneous cognitive load can be reduced and their cognitive capabilities can be freed to focus on learning the materials rather than looking for and memorizing the materials.

There are certain aspects of cognitive processing that we as human beings do best and other aspects of cognitive processing that technologies do best. Therefore, computer-based cognitive tools should be designed so that “learners should be responsible for recognizing and judging patterns of information and then organizing it, while the computer should perform calculations, store information, and retrieve it on the learner’s command” (Jonassen & Reeves, 1996, pp. 697-698). Learners should be engaged in more meaningful cognitive processing, instead of reproductive processing.

For example, all the clinical data are saved and presented in an organized and accessible manner in the WHD. Thus, learners do not have to perform lower level cognitive processing tasks such as memorizing and organizing. These immediate-access and organized features provide learners a solid base to start higher level cognitive processing such as analyzing and evaluating, right at the field.

Wireless handheld technology use in nursing education began after the introduction of the first PDA in 1996. Nurse practitioner programs were the first to incorporate PDA use for students’ use (Koeniger & Donohue, 2008). Incorporating technology solutions into the daily practice of nursing has now become a part of every nurse’s role in practice. PDA’s or WHD give the students access to information at the bedside and has the potential to improve the quality and safety of care, thus reducing adverse effects and improving patient outcomes (Farrell & Rose, 2008). Students need to evaluate and synthesize information and apply it for their patients’ benefit (Billings, 2006).

Several North American universities have implemented WHD into a range of nursing programs (Huffstutler, Wyatt, & Wright 2002; Miller et al., 2005; Rice, 2003; White et al, 2005). WHD have been shown to enhance learning in the clinical environment by the rapid and efficient acquisition of information that can be assessed for patient care. In addition, leadership skills and confidence is improved by evidence-based information in real time as required by the student (White et al., 2005).

The Child Health Nursing (NU341) course focuses on the care of the child in the context of the family. Principles of growth and development, health promotion, child advocacy, and communication are integrated throughout the course. A holistic framework is used to critically examine the biological, psychological sociocultural, developmental, and spiritual variables that influence the child and family’s response to alterations in health status. Clinical practice takes place in hospitals and community settings such as schools and child clinics. Nursing informatics are integrated throughout the course.

Participants were 41 students from seven intact Child Health Nursing (NU341) classes at a 4-year Catholic college in the northeastern part of the United States. These classes shared similar demographics: about 94% were Caucasian, 2% were Hispanic, 2% were Black, and 2% were Asian. In addition, 90% of the students were female, and 10% of the students were male.

Six PDAs were purchased for students in the pediatric clinical rotation in the spring of 2008. All PDAs are preloaded with Unbound Medicine software and five textbooks. During the first class session, students were given the PDA along with a brief tutorial. Students were required to bring the PDA to each clinical experience in order to access information on their pediatric client’s diseases and medication ordered. Beginning in spring 2010, iPod Touches were also added to the study. A survey was administered at the end of the semester. Interviews were conducted randomly among participants.

To understand the effects of handheld device use in learning, both quantitative and qualitative data were collected and analyzed. The triangulation of the quantitative data and qualitative data provided a more complete picture of the learning impact.

To answer the first research question, both quantitative and qualitative data were collected through surveys and interviews. There were two parts of the survey. First, students were asked to rate their general technology use, efficiency level, and attitudes toward technology use. The second part of the survey focused on their perceived impact of wireless handheld device on learning as well as its ease of use. At the end of the course, the instructor interviewed students and asked them to reflect on their learning experience using the wireless handheld devices. A range of questions was asked on attitudes, ease of use, problems, perceived efforts, and effectiveness. Some sample questions included “what do you think of the wireless handheld devices?” “Is it helpful? How easy was it to access information for medications? If so, how?” Interviews were conducted with 50% of the students randomly chosen from the treatment group.

To answer the second research question, quantitative data were collected through course final exam. This instrument consisted of 100 multiple choice questions covering topics included in the course. It was used to gather information on the degree to which students acquired the pediatric nursing concepts taught in the course. The instrument was administered as posttest only.

In answering the first question “What are students’ perceptions on wireless handheld devices in learning? What are their general attitudes?”, survey and interviews were conducted to determined students’ attitudes and perceived effectiveness of handheld devices. The survey results indicated that 91% of the students agreed that WHD were easy to use; 88% of the students believed WHD made their learning mobile, more interactive, and interesting; 76% of students indicated that WHD helped them organize their learning; 85% of students agreed that WHD allowed them to focus on key content; and 56% of students believed that WHD helped them learn and score better.

Three major themes emerged from the interview data analysis. (1) WHD provided a quick and easy way to look up drug and disease information, along with pathophysiology of the disease. Students indicated that, prior to administering medications, it was easy to look up the required mg/kg information on pediatric drugs. (2) WHD helped them answer questions that patients and their family might have. Students pointed out that it was easy to answer parents’ questions, as they could instantly find the information without leaving the patient’s room. (3) WHD helped them determine abnormal lab values. Student could easily look up normal vs. abnormal lab values quickly and accurately.

In answering the second question, “Does the use of wireless handheld devices have an impact on learning and enhance the pediatric curriculum?”, a two-way unpaired t test was conducted to determine if the scores were significantly different between the control group and the treatment group. The results revealed a significant difference in performance scores between the two groups: p < 0.0015 (see Table 1).

The results indicated that the treatment group (wireless handheld group) scored significantly higher than the control group (no-wireless-handheld group), p < 0.0015.

As wireless handheld devices have played an increasingly critical role in nursing practice, it is important for nursing educators to adopt this technology for use in their classrooms to prepare students for their career. Our study shows that the use of WHD has enhanced the learning of students in the Child Health Nursing (NU341) course in both the classroom and the clinical component of the course. Student’s expressed positive attitudes towards the use of WHD in both the classroom and the clinical area.

Students indicated that the use of WHD made it easier for them to answer parents’ questions, determine safe administration of medication, and to recognize normal vs. abnormal lab values. Students who used WHD in the course also performed significantly better in the final exam portion of the course than students who didn’t use WHD. We conclude that the use of WHDs in nursing education enhances the student’s abilities to quickly access information that they need to care for the pediatric patient.

Based on the encouraging results from this study, the college plans to extend the WHD program across the nursing department to include other areas such as health assessments and professional nursing. Further study will include a larger sample size and incorporate expanded use of learning applications in iPod Touch and smart phone platforms.