Abstract
Development and adaptation of simulations in corporate training and learning is a modern tendency that is based on the fact that such tools are effective to make learners develop their skills and apply knowledge to real-life situations. In healthcare administration, many issues and topics can be learned with the help of simulations, including ethics, health care delivery, law, and human resources issues. The training sessions on healthcare ethics are often time-consuming, and the contemporary approach is important to organize the instruction effectively. In order to guarantee positive results of the staff’s training regarding the healthcare ethics and decision-making, it is necessary to utilize technologies in learning and training sessions, and the development of the detailed instructional design plan according to the ADDIE model is an important stage of the process.
Instructional Design Plan
Development and adaptation of simulations in corporate training and learning is a modern tendency that is based on the fact that such tools are effective to make learners develop their skills and apply knowledge to real-life situations (Bozarth, 2010; Kapp, 2012, p. 180). Today, simulations are actively used in the field of healthcare administration to save the costs and time associated with long-term training sessions. In healthcare administration, many issues and topics can be learned with the help of simulations, including ethics, health care delivery, law, and human resources issues. The training sessions on healthcare ethics are often time-consuming, and the contemporary approach is important to organize the instruction effectively. To guarantee positive results of the staff’s training regarding healthcare ethics and decision-making, it is necessary to utilize technologies in learning and training sessions, and the development of the detailed instructional design plan according to the ADDIE model is an important stage of the process.
Analyze
Needs Assessment
Ethics is a significant and challenging aspect in the area of health care that needs to be addressed in the majority of situations occurring in facilities’ settings. However, the problem is in the fact that many ethical situations can be faced by professionals every day, and they need to know how to make appropriate ethical decisions. The lack of time and resources is often a barrier to provide health care professionals with effective training that includes not only theoretical material but also a range of practical exercises. Being trained on health care ethics with the help of technologies, the staff receives the opportunity to organize the theoretical knowledge and effectively apply it to real-life situations.
Currently, healthcare providers spend much time on ethical training, but their knowledge is mainly theoretical. Such researchers as Holm and Severinsson note that the learned strategies to make ethical decisions are often non-working in practice when it is necessary to make immediate decisions (Holm & Severinsson, 2013, p. 2). Professionals need to consult codes of ethics and guidelines several times to formulate the decision. It is preferably that healthcare providers spend less time making effective ethical decisions because of their developed skills in applying theoretical knowledge to real-life situations. It is important to overcome this gap in the ethics training in the sphere of health care to make the facilities’ environments more ethical.
The proposed training plan aims to address the situation of the gap between learning the theoretical aspects of health care ethics and their application to practice. If the training plan is implemented successfully, it is possible to expect the development of professionals’ skills in making ethical decisions to save time and resources that are necessary for the analysis of individual cases.
Goal
To expect higher results after the completion of the training session in which the simulation is used, it is necessary to formulate the concrete outcome instead of a possible goal. The outcome of the proposed instructional plan is the following: Healthcare professionals will properly utilize their knowledge of healthcare ethics while addressing ethical dilemmas and making ethical decisions during their everyday working activities.
Target Audience
Training in health care ethics is necessary for representatives of different positions associated with administrative tasks and the actual provision of healthcare services. Therefore, it is expected to address the needs of the male and female staff aged 24-64. Much attention should be paid to the fact that the majority of the staff is females; the average age is 43 years, and the educational background is different. However, it is important to state that the training should be provided to nurse administrators and practitioners as well as to managers and physicians.
The learning styles of this large diverse group of healthcare providers are also different, depending on their age and experience (Wilson et al., 2009, p. 218). The determined target audience has the basic knowledge in the discussed area of healthcare ethics that is necessary to perform their daily professional duties. The majority of the staff has developed computer skills, and they are interested in using new technologies, but they are mostly traditional learners, and it is important to address this obstacle while proposing the effective simulation (Bedwell, Pavlas, Heyne, Lazzara, & Salas, 2012). The target audience has a medium level of motivation and expects that the training will be captivating. Only the basic guideline on the simulation’s rules and specifics is necessary because the technological platform of the simulation allows training with the focus on only a few clicks made by learners (Moreno-Ger, Burgos, & Torrente, 2009, p. 670). Much attention should be paid to the form in which information and scenarios will be presented in order to make the simulation interesting, but simple for the learners.
Design
Objectives
The instructional objectives correlated with the outcome of the proposed training plan are the following ones:
- By the end of the three-hour simulation, the learners will be able to properly evaluate the ethical situation depending on different real-life scenarios.
- By the end of the one-hour video course and three-hour simulation, the learners will be able to apply their knowledge on ethical standards, rules, and norms to resolving ethical issues while making ethically correct decisions nine times out of ten.
- By the end of the one-hour video course and three online discussions, the learners will be able to use their skills and knowledge to appropriately defend their ethical decisions in all cases, including ethical dilemmas.
Assessment
The assessment should demonstrate that upon the completion of the training session, the learners are able to take various roles to make relevant ethical decisions depending on the knowledge acquired during the training sessions and on skills developed as a result of the simulation (Moreno-Ger et al., 2009). While evaluating the learners’ achievements, it is important to compare their results with the previously set outcome to determine the areas in which healthcare providers do not demonstrate progress. The assessment tools that are necessary to evaluate the progress are developed to be correlated with the set objectives.
The declarative knowledge can be assessed with case studies proposed after the training sessions in order to evaluate the learners’ understanding of specific concepts and differences in ethical situations as well as the completion of the first objective (Kapp, 2012). The procedural knowledge should be assessed with frequency records that are used to state what the frequency of an employee’s appropriate application of learned ethical standards, rules, and norms is (Bedwell et al., 2012). This approach to assessing the achievements is correlated with the second objective. The problem-solving knowledge can be assessed with the help of checklists developed to fix learners’ successes in their defending ethical decisions made in relation to different real-life situations.
Develop
Facilitation
Simulation. To help professionals in the field of healthcare improve their knowledge and skills in ethics, it is important to train them using simulations organized as scenarios. To accompany their textbooks on healthcare ethics, Jones & Bartlett developed a series of video simulations that are appropriate to be used in the corporate training of healthcare providers (LearnScapes, 2015). These video simulations are known as LearnScapes: Navigate Scenarios, and they are effective to provide the learners with the necessary experience in the area of healthcare ethics to develop skills in ethical decision-making.
The concept of LearnScapes is to provide healthcare professionals with opportunities to take a variety of roles while observing different ethical situations and scenarios and to make ethical decisions using the knowledge on healthcare ethics. Learners are able to participate in video interactions, use interactive guidelines, consult supporting characters, use documents, and refer to the checkpoint diagnostics (LearnScapes, 2015). The simulation addresses the set objectives for the training because it provides learners with the necessary knowledge on healthcare ethics and allows applying the knowledge while evaluating ethical situations, resolving questions, making decisions, and addressing ethical dilemmas. The setting of the simulation is realistic, and learners need to play a specific role according to several different scenarios within the environments of different healthcare organizations. The navigation of the simulation is the decision tree, and each step of the learner leads to the unique development of the scenario to observe the consequences of decision-making (Motola, Devine, Chung, Sullivan, & Issenberg, 2013).
Researchers state that simulations are actively used in the area of healthcare ethics because this tool allows making the learning closely associated with the healthcare providers’ daily activities (Motola et al., 2013, p. 1512). According to Smith and the group of researchers, simulations associated with ethical concepts are most effective to train learners because of the specifics of materials on healthcare ethics (Smith, Witt, Klaassen, Zimmerman, & Cheng, 2012, p. 391). As a result, the training becomes active, practically-oriented, and meaningful for the practitioner.
Advantages of using LearnScapes in training sessions for the healthcare providers are in possibilities to choose the order of cases, to take different roles and participate in different environments, to control the progress and follow several scenarios of developing the situation as well as to check decisions. However, there are also barriers in using this simulation for the ethical training associated with the lack of rewards and motivators for learners (Azadegan & Riedel, 2012, p. 486). Additional bonuses should be determined by the trainer.
Social Media. Depending on the goal of the corporate training and on the age and preferences of the target audience, it is reasonable to choose Twitter as an appropriate type of social media to help learners practice in defending their ethical decisions in cases that are based on ethical dilemmas. The YouTube channel can be used as the supporting tool to provide learners with the theoretical information on the healthcare ethics presented in a convenient form of video guidelines.
Twitter is selected among other social media because the learners representing different age groups often have Twitter accounts and know principles of micro-blogging (Bahner, Adkins, Patel, Donley, & Nagel, 2012, p. 2). Twitter is useful to address the objective of applying knowledge to defending ethical decisions in cases associated with ethical dilemmas. This tool allows the real-time and continued communication between learners (Bozarth, 2010, p. 27). Twitter can be connected with the learner’s e-mail to receive notifications about new topics for discussion. This situation will be similar to the real-life discussion of ethical situations by the group of experts. Thus, Twitter allows using advantages of the “just-in-time” training, when the knowledge received while playing the stimulation can be used after the short period to discuss ethical dilemmas with the help of Twitter posts (Kamdar, Kessler, Tilt, Srivastava, & Khanna, 2013, p. 44). YouTube can be used as the source to find ethical principles and standards. As a result, using Twitter and YouTube, the learners will meet such objectives as the application of ethical standards, rules, and norms to ethical situations while making ethically correct decisions and the use of skills to defend the decision while resolving ethical dilemmas.
Researchers pay much attention to the effectiveness of using social media in corporate training. Giordano and Giordano state that social media are appropriate for making learning more informal and similar to the real-life communication (Giordano & Giordano, 2011, p. 79). The other researchers focus on the role of social media to promote the collaborative learning based on principles of debates (Bahner et al., 2012, p. 3). In this context, social media are useful to make learning flexible and based on the team-building principles. Learners can collaborate as a team, and their real-life communication is changed with the online communication (Giordano & Giordano, 2011).
The advantages are in using Twitter as a tool for the constant online exchange of ideas on certain topics to resolve ethically difficult situations. Thus, Twitter provides the platform for brainstorming necessary for the group work. As a result, the individual learning with the help of the simulation is combined with the group work to achieve the learning goal more quickly (Bozarth, 2010, p. 28). The advantage of using YouTube is in the possibility to receive ethical guidelines and learning materials in a simple form of a video. Nevertheless, the barriers in using Twitter and YouTube include the resistance of learners to perceive these media as effective tools for learning, and the additional motivation is necessary to balance the perception of such training as both serious tasks and fun activities. Twitter accounts should be created for the training session to avoid using personal information.
Logistics
Simulation. LearnScapes will be implemented at the stage following the introductory YouTube video course. The trainer acts as a provider of necessary guidance to direct learners’ activities and as an evaluator of the learners’ results. The first step in implementing LearnScapes is the division of learners in groups depending on their work responsibilities. Each group will be provided with the introductory word on the principles of using the simulation and instructions on navigating the character as well as the list of scenarios. Learners are expected to perform as individual players during a series of scenarios. Evaluations for each scenario are integrated into the simulation, and they help learners assess their successes at the primary stage of training (LearnScapes, 2015). The task of the trainer is to answer the questions associated with navigating the simulation and analyzing the evaluation results.
Social Media. YouTube will be implemented in the training session as the online introductory video course that includes videos on the principles, standards, and norms of health care ethics. The role of the trainer is to provide instructions for using the video course. Twitter is expected to be used when it is necessary to practice in resolving ethical dilemmas, in defending the position, and in communicating with group members. Twitter will be used for messaging to support the online communication, for brainstorming, updating topics for discussion, commenting on ethical decisions of other learners, asking questions, and receiving the updated information on successes (Bahner et al., 2012, p. 4). In this context, the trainer’s role is to perform as a discussion moderator.
Implement
YouTube Introductory Video Course
During the introductory YouTube video course, the trainer asks the learners to view videos on principles, standards, and norms of healthcare ethics before participating in the main training sessions. The trainer also provides guidelines for watching the videos and making necessary notes. The learners have the opportunity to watch the videos during a week before training sessions at any time convenient for them. Before starting the simulation, the learners need to complete the test. The learners also receive notifications regarding the group in which they will work during the following sessions.
LearnScapes
The second stage of the training process includes the work with separate groups of employees. The learners and trainer meet at the room equipped for the training session. The instructions on using the simulation and navigating the character are provided by the trainer for each group before starting the scenario. Individual participants in each group need to complete three one-hour scenarios for three days. After each hour of the work, the learners need to check their progress with the basic integrated assessment.
The third stage of the work is connected with simulations because Twitter is used to train the learners in resolving ethical dilemmas and defending their position referring to ethical principles after each simulation scenario. After the first simulation scenario, the learners receive notifications inviting them to participate in the online group communication to propose and discuss solutions on ethical dilemmas and comment on discussion topics. The trainer moderates the discussion of ethical problems and uses the checklist to evaluate each participant’s activity.
Evaluation Plan
To state whether the training elements are effective for the concrete group, it is necessary to propose assessments for the learners and the self-assessment for the trainer after each stage of the training session. To conclude about the effectiveness of the video course, one day before the start of the second stage of training, the learners need to complete the short quiz designed to check their understanding of the information provided in the video course. The trainer concludes on the element’s effectiveness referring to the percentage of correctly completed quizzes. If the percentage is low, the trainer interviews the employees on the advantages and disadvantages of the approach to propose the working alternative.
Conclusions on the effectiveness of simulations are made depending on the results of preliminary evaluations for each scenario that are integrated in the simulation as well as on the learners’ feedback regarding the scenarios. The evaluation of Twitter’s effectiveness is made depending on the analysis of the learners’ participation in discussions, brainstorming, and commenting on the posts and on the feedback.
Evaluate
Simulation
Criteria for evaluation. The simulation will be evaluated with references to such criteria as the provision of immediate feedback on the learner’s actions to develop different types of scenarios; possibilities for the training of certain skills based on the knowledge application, and possibilities to refer to the consequences of wrong actions. If these criteria are met, the simulation can be discussed as appropriate for use in corporate training (Wiebenga, 2005, p. 21).
Method of assessment. To determine the learners’ progress in meeting the goal of the training session, the trainer uses such assessments as case studies and frequency records in addition to the immediate evaluation integrated into scenarios. The case studies proposed after all stages of the training are developed according to the information from the videos and scenarios. Frequency records are filled in with references to the learner’s success while completing three scenarios, and they are also used during several weeks after the training to check the application of skills.
Kirkpatrick’s training evaluation model. The evaluation process is directly related to Kirkpatrick’s evaluation model including Reactions, Learning, Behavior, and Results because Reactions are assessed with references to the learners’ feedback on possible benefits or difficulties in working with the scenarios; Learning is assessed with references to evaluations integrated in the simulation; Behavior is assessed with references to the case studies; and Results are evaluated with references to frequency records (Steensma & Groeneveld, 2010, p. 321).
Evaluations are conducted by the trainer after the completion of the scenario by each group and at the end of the second stage. The results of the evaluation are used to adapt the instructions for the following scenario to address the learners’ needs noted according to their reactions.
Social Media
Criteria for evaluation. The effectiveness of using Twitter will be evaluated with references to such criteria as the provision of “just-in-time training”; possibilities for online interaction; possibilities for the real-life discussion and decision-making.
Method of assessment. To assess the learners’ progress in meeting the third objective, it is necessary to use checklists in which the trainer can note how actively a learner participates in discussions; whether he proposes decisions to all provided ethical dilemmas; how actively a learner defends his position; how accurately a learner uses the knowledge to defend the position; and how accurately a learner reacts to the other employees’ comments.
Kirkpatrick’s training evaluation model. The evaluation of using social media is also related to Kirkpatrick’s model because Reactions are assessed with references to the learners’ feedback and activeness regarding the participation in Twitter discussions; Learning is assessed with references to short quizzes and accurateness of comments in Twitter; Behavior is assessed with references to resolving ethical dilemmas in Twitter and defending positions; Results are evaluated with references to checklists stating the level of collaboration in the organization.
Evaluations are conducted by the trainer at the end of the YouTube video course and after the completion of Twitter discussions by each group after each session. The results of the evaluation are used to adapt the theoretical material and instructions for starting the scenarios and to improve the approach to moderating Twitter discussions.
Conclusion
The instructional design plan is developed to organize the corporate training and learning for healthcare professionals on the norms of healthcare ethics. The plan is designed according to the principles of the ADDIE model, where the main focus is on developing such stages as the Analysis, Design, Development, Implementation, and Evaluation. The proposed instructional design plan utilizes such resources as the simulation and social media, including Twitter and YouTube, in order to train the healthcare professionals to use the knowledge on ethics while addressing various ethical situations and dilemmas.
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