Using the Stilwell Multimedia Virtual Community to Enhance Nurse Practitioner Education Dr Mike Walsh & Ms Kathy Haigh University of Cumbria
Why Stilwell? Frankie Stilwell : Outlaw Born 1856, Involved in the Gunfight at the OK Corral and was suspected of 3 killings including that of Morgan Earp, Wyatt s brother. Frankie Stilwell was shot dead by Wyatt Earp in Tombstone in 1882. Or is it named after another Stilwell???
The Stilwell Virtual Community A virtual community is an online teaching application featuring a fictional community with multiple intersecting and unfolding character stories (Giddens et al 2010). In simple English it is a multi media soap opera. Telling the story from perspective of the person creates a picture of all the people involved, the inter-professional nature of their problems Dialogue allows students to explore their own advanced role and the perspectives of other professionals.
The Stilwell Virtual Community : Key Points Stilwell is an area of the town of Brigstow (real places, fictional names). It is not an avatar based gaming environment 77 characters, age 0-80+ Realism is essential, stories are challenging and sometimes contain offensive material. Virtual practicum in which students can apply theoretical learning to realistic problems Focus on individuals, families and their context, includes the perspectives of those around them Started in nurse practitioner education but now spread to include students in health & social care, police and local government. Used in Canada and Australia also. Founded on narrative pedagogy.
Educational Theory : Narrative Pedagogy Stilwell is informed by Diekelmann s Narrative Pedagogy (2001) 1. Learning from story by interpreting the meaning of story 2. Multiple perspectives and different points of view 3. Discussion leading to sharing of understanding, challenging assumptions, stereotypes and conventional wisdom. 4. Insights into emotions such as guilt, pain, anguish & dilemmas of choice
How Stilwell Works Storytelling Narrative Pedagogy Case Study
Stilwell Virtual Community : Elements The web site contains: Case notes, social histories and police files A video tour Photo-gallery Statistical profile, maps and written description Professionally made videos of critical incidents in people s lives Podcasts of residents and practitioners Front page of the local paper Blogs kept by professionals (nurse, paramedic, police officers etc). Blogs kept by residents. These resources create realistic context & are narrative devices telling the stories of the characters in Stilwell.
Aerial View Stilwell
Stilwell : St Peters Lane
Rehearsing Derek Donald : Homeless Alcoholic Eva & Max Bernstein : Alzheimers
On Location with Stilwell Rehearsing in the Rain At Durranhill Police Station
Debbie Ryan : An Adult Survivor of Childhood Sexual Abuse Getting ready to shoot Debbie and the practice nurse
Preparing Sam s Story : Domestic Violence, Child Abuse
Consequences
The unseen story of Maureen Black We all engage and discuss issues with friends, but is the information / advice we receive always helpful, knowledgeable, relevant or can it lead to misinformation and cause worry? The following clip is the first in a series of Maureen Black and her quest for knowledge into her newly diagnosed condition Theme of Student Task: Advanced communication, information gathering (history taking) from patients and the subsequent educative aspects of these clinical encounters. Task: Watch the first of Maureen s 3 videos and critically evaluate the conversation between Maureen and her friend
Maureen Black
Selection of student responses The dialogue with Maureen and her friend demonstrates the importance of recognising influence of peers and family in people s health beliefs. (Holt & Kumar, 2010). A key point is that much of the health education material available requires a year 10 reading ability, but the average reading age in the UK is estimated to be at year 4 level (roughly nine years of age). Thus there was a considerable gap in the readability of existing healthcare publications and the reading ability of the general population when this research was undertaken (Wilson et al 1997). Noticeable signs of anxiety from Maureen, facial expression, hands, seems to be seeking reassurance
Feel empathy for Maureen, newly diagnosed, confused, overwhelmed by information already given, seems to be searching for answers What was discussed in the previous consultation. The notion that diabetes is mild or borderline needs to be challenged in clinical practice. Who told her this? Did the previous practitioner chunk and check with Maureen? How many information leaflets was she actually given
Themes arising from Student responses Previous healthcare encounters Use of leaflets (multiple perspectives, language, type, childs, adults) Patient attitudes towards own health Level of disease knowledge within the general population Peer support and influence Language barriers, use of language line etc Understanding the patients knowledge base and ability and tailoring education to patient needs and expectations (New 2010, SIGN 2010) Patient education programmes such as Xpert and DESMOND The complexity of the patient and the challenge of consultations
What students wanted for future consultations Ensuring the patient is a partner in care. Ensuring that the next consultation explores the ideas, concerns and expectations (ice) of the patient as a priority. Utilising frameworks to ensure a therapeutic helping relationship is established Challenging own knowledge base and our own abilities to communicate in plain English with no medical jargon Educational aspects of consultations ALL OF THIS FROM A 2 MINUTE VIDEO CLIP!
Evaluating Stilwell : Student Feedback Very realistic stories, some very disturbing. Students engaged fully with the narrative and repeatedly commented on its realism. (High production values) Students felt grateful for the tutorial support they were given (child protection and child sexual abuse stories) Supporting material very helpful, encouraged users to go off and find out more for themselves. Linked theory and practice Students talked about characters as if they were real. A totally different way of learning, changed students way of thinking and understanding.
Conclusion Stilwell is an exciting, innovative & interactive teaching/learning tool. Equally effective for classroom and distance learning It provides an appropriate context for both IP learning and assessment, which can be continually added to & refined. Further details from mh.walsh@cumbria.ac.uk