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eHospital: Experiences with E-Learning Activities for Patients Clara Barrafranca Holger Bienzle Théo Bondolfi Beatriz Cebreiro López Marie-Claude Esculier Carmen Fernández Morante Elisabeth Frankus Manuel Gromaz Campos Uwe Hoppe Stefan Kremser Maria Jose Rodriguez Malmierca Malgorzata Marciniak Maria A. Muñoz Cadavid Łukasz Nowak Isabel Porto Golpe Corinna Reisner Raphaël Rousseau Joanna Szczecinska Birgit Zens

The eHospital project partnership was formed by Project coordinator: die Berater Unternehmensberatungs GmbH Vienna, Austria www.dieberater.com Partners: CESGA, Supercomputing Center of Galicia Santiago de Compostela, Spain www.cesga.es University of Santiago de Compostela Santiago de Compostela, Spain www.usc.es Donau Universität Krems Krems, Austria www.donau-uni.ac.at Bildungswerk der Sächsischen Wirtschaft Chemnitz, Germany www.bsw-ggmbh.de ORT France 75116 Paris, France www.ort.asso.fr Academy of Management Lodz, Poland www.swspiz.pl The publication is a product of eHospital, a project (225761CP-1-2005 1-AT– GRUNDTVIG-G1) co-funded by the European Commissionis Socrates programme.

The content of the publication does not reflect the position of the European Commission.

Associated partner: Ynternet.org Lausanne, Switzerland www.ynternet.org

Ed. Holger Bienzle

Clara Barrafranca Holger Bienzle Théo Bondolfi Beatriz Cebreiro López Marie-Claude Esculier Carmen Fernández Morante Elisabeth Frankus Manuel Gromaz Campos Uwe Hoppe Stefan Kremser Maria Jose Rodriguez Malmierca Malgorzata Marciniak Maria A. Muñoz Cadavid Lukasz Nowak Isabel Porto Golpe Corinna Reisner Raphaël Rousseau Joanna Szczecinska Birgit Zens

eHospital: Experiences with E-Learning Activities for Patients

eHospital: Experiences with E-Learning Activities for Patients Editor:

Holger Bienzle

Authors:

Clara Barrafranca, Holger Bienzle, Théo Bondolfi, Beatriz Cebreiro López, Marie-Claude Esculier, Carmen Fernández Morante, Elisabeth Frankus, Manuel Gromaz Campos, Uwe Hoppe, Stefan Kremser, Maria Jose Rodriguez Malmierca, Malgorzata Marciniak, Maria A. Muñoz Cadavid, ´L´ukasz Nowak, Isabel Porto Golpe, Corinna Reisner, Raphaël Rousseau, Joanna Szczecinska, Birgit Zens

Production:

word up Werbeagentur

Publisher:

“die Berater” Unternehmensberatungsgesellschaft mbH Wipplingerstrafle 32/24–26 A-1010 Wien www.dieberater.com

© 2008 “die Berater” Unternehmensberatungsgesellschaft mbH ISBN 978-3-9502335-3-7

Content

Content

2. Austria: Job perspectives for young adult patients

38

3. Spain: Digital literacy: Computers, office and the Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42

4. France: How to use a computer and the Internet.

46

5. Poland: Creative workshops and history of art . .

50

Part 1: Context

6. Poland: Significance of motion for maintaining self-dependence . . . . . . . . . . . . . . . . . . . . . . . . .

52

Lifelong learning, ICT in education, and hospitals

7. Germany: Information management . . . . . . . . . .

55

8. Switzerland: The art of profiling on the web . . . .

59

Holger Bienzle

Introduction . . . . . . . . . . . . . .

5

Holger Bienzle

Chapter 1:

E-learning in hospitals in a European policy context . . . . .

8

1. Hospitals: new places of informal adult learning

8

2. E-learning: a new mode of education . . . . . . . . .

11

Stefan Kremser, Birgit Zens

Chapter 2:

Beatriz Cebreiro López, MarieClaude Esculier, Carmen Fernández Morante, Elisabeth Frankus, Stefan Kremser, Corinna Reisner

Chapter 5:

Life in hospitals . . . . . . . . . . .

62

1. Structural characteristics of a hospital . . . . . . .

62

2. Health – illness – hospitalisation . . . . . . . . . . . .

65

Examples of e-learning in European hospitals . . . . . . . . .

15

3. Consequences of the setting for the educator role

69

1. The present situation of (e)-learning in hospitals

15

4. Demands of hygiene in hospitals . . . . . . . . . . . .

70

2. An Austrian case: ECDL for children suffering from cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

Holger Bienzle, Théo Bondolfi, Marie-Claude Esculier, Carmen Fernández Morante, Uwe Hoppe, Maria Jose Rodriguez Malmierca, Joanna Szczecinska

Chapter 3:

Part 2: Practice

The eHospital project . . . . . .

25

1. A short project description . . . . . . . . . . . . . . . . .

25

2. The eHospital partner institutions . . . . . . . . . . .

27

Théo Bondolfi, Marie-Claude Esculier, Carmen Fernández Morante, Elisabeth Frankus, Uwe Hoppe, Maria Jose Rodriguez Malmierca, Joanna Szczecinska

Chapter 4:

Seven informal e-learning programmes piloted by eHospital

1. Hospitals, patient target groups and learning topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Providing informal e-learning for hospital patients

Clara Barrafranca, Holger Bienzle, Marie-Claude Esculier

Chapter 6:

35 35

Profile of e-learning facilitators in hospitals . . . . . . . . . . . . . .

73

1. What is a facilitator? . . . . . . . . . . . . . . . . . . . . .

73

2. Facilitation roles in a face-to-face context . . . . .

74

3. Facilitation roles in an online context . . . . . . . . .

75

4. Formation of a team of facilitators . . . . . . . . . . .

76

5. Involvement of hospital staff in the facilitation .

78

3

Content

Holger Bienzle, Uwe Hoppe

Chapter 7:

1. Two modalities of e-learning in a hospital context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Management of e-learning projects in hospitals . . . . . . .

80

1. The main phases of an e-learning project for hospital patients . . . . . . . . . . . . . . . . . . . . . . . . .

80

2. Formal or informal cooperation? . . . . . . . . . . . . .

82

3. Visibility and promotion of the e-learning project

83

4. Communication as a key challenge . . . . . . . . . . .

85

5. Whose e-learning project? . . . . . . . . . . . . . . . . . .

87

3. Virtual tools for learning and communication . . . 113 4. Frequent problems . . . . . . . . . . . . . . . . . . . . . . . 117 5. Security concerns . . . . . . . . . . . . . . . . . . . . . . . . 118 6. Usability and accessibility aspects . . . . . . . . . . . 120

Théo Bondolfi, Raphaël Rousseau

Maria Jose Rodriguez Malmierca, Malgorzata Marciniak, ´L ´ ukasz Nowak, Joanna Szczecinska

Chapter 8:

2. Technical infrastructure in hospitals . . . . . . . . . 112

Chapter 11: E-culture for patients and facilitators . . . . . . . . . . . . . . . 122

The preparatory phase . . . . . .

89

1. First contacts with hospitals . . . . . . . . . . . . . . . .

89

1. Codes of conduct for communication and e-learning in the Internet . . . . . . . . . . . . . . . . . . 122

2. Identification of patient target groups and their needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

91

2. Assessment of existing ICT and e-culture skills and experiences . . . . . . . . . . . . . . . . . . . . . 125

3. Analysis of infrastructure . . . . . . . . . . . . . . . . . .

94

4. Financing of the e-learning offer . . . . . . . . . . . .

95

5. Establishing an organisational basis for cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

96

6. A checklist for the preparatory phase . . . . . . . . .

98

Educational strategies of e-learning activities . . . . . . . .

1. Definition of the aims and contents of the e-learning programme . . . . . . . . . . . . . . . . . . . .

Birgit Zens

Chapter 12: Evaluation of e-learning activities in hospitals . . . . . . . 134

Isabel Porto Golpe, Beatriz Cebreiro López, Carmen Fernández Morante, Malgorzata Marciniak, Maria A. Muñoz Cadavid, ´L ´ ukasz Nowak

Chapter 9:

3. E-mail – some elements of good practice . . . . . . 130

1. Reasons for conducting evaluations . . . . . . . . . . 134 2. The four main steps of planning an evaluation . 134 99

3. Defining goals: Four golden rules . . . . . . . . . . . . 135 4. When to conduct the evaluation: the evaluation design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

99

2. Patients as adult learners . . . . . . . . . . . . . . . . . . 101 3. Strategies to exploit the potential of ICT for patient learning . . . . . . . . . . . . . . . . . . . . . . . . . 105

5. What and when to evaluate . . . . . . . . . . . . . . . . . 137 6. Target groups . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 7. Methods and instruments . . . . . . . . . . . . . . . . . . 140 8. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Manuel Gromaz Campos, Uwe Hoppe, Maria Jose Rodriguez Malmierca

Chapter 10: Hospital specific e-learning know-how . . . . . . . . . . . . . . . 111

4

Holger Bienzle

Chapter 13: Success factors of informal e-learning for hospital patients 146

Introduction

The concept of e-learning, used in its broadest

Introduction

sense in this publication: all scenarios of

Holger Bienzle

teaching and learning using electronic media, ranging from computer-based training (CBT) to more advanced and interactive forms of

The present publication has one principal

web-based training (WBT).

purpose: It aims at promoting computer assisted lifelong learning opportunities for adult hospital patients who are forced to spend a long period in healthcare institutions due to severe or chronic illnesses.

The basic underlying assumption to be argued for such learning offers is that engagement into informal learning activities while at hospital can have a beneficial effect on the emotional and perhaps even physical recovery of hospital patients.

It was these three concepts of adult education which the European pilot project eHospital applied to the particular target group of patients and to the very specific institutional context of hospitals as places of learning. In local cooperative ventures between educational providers and local hospitals the eHospital partnership developed and tested seven informal e-learning activities in Austria, Spain, France, Germany, Poland, and Switzerland.

The learning topics covered were as varied as

Three global educational concepts are inher-

the types of patient groups targeted. The for-

ent in this undertaking:

mer ranged from learning fields like computer and internet literacy or employability and job

The concept of lifelong learning, defined as all

(re-) orientation to health education and per-

learning activity undertaken throughout life,

sonal development. They were chosen as a

with the aim of improving knowledge, skills

result of a needs analysis phase conducted

and competences within a personal, civic,

with patients and hospital staff. Other topics

social and/or employment-related perspec-

would have been equally possible. As they

tive.

1

are, they illustrate how diverse – with regard to purposes and topics – informal learning in

The concept of informal learning: While formal

hospitals can be:

learning takes place in education and training

It may serve the purpose of enhancing

institutions, leading to recognised diplomas

patients’ professional competences and thus

and qualifications, informal learning takes

easing the re-integration into the labour mar-

place alongside the mainstream systems of education and training and does not typically lead to formalised certificates. Informal learning may be provided in the workplace.2 or in other new places of learning.

1

COM(2001) 678): Making a European area of lifelong learning a reality.

2 A Memorandum on Lifelong Learning, SEC(2000) 1832.

5

Introduction

ket. But other purposes are as adequate and

hopefully serve as a source of inspiration for

rewarding: developing interest in a new field

similar and perhaps more elaborate educa-

of study like art history or using blended

tional activities of this type.

learning methodologies for acquiring useful knowledge about one’s own state of health,

The publication addresses and encourages

enhancing personal and social skills or simply

staff in adult education institutions to cooper-

focusing attention on something different

ate with healthcare institutions in order to

from illness and hospital routine. Learning,

offer informal learning provisions to their

and in particular e-learning can open a win-

patients. Such partnerships between the edu-

dow to the world outside the hospital and thus

cation and health fields will be terra incogni-

give a boost to motivation and hope.

ta for most education professionals involved.

They will require a basic knowledge about

This publication has been produced on the

health issues, hospital psychology and health-

basis of the experience gained in the

care institutions, as well as specific educa-

eHospital project. It was written by a team of

tional, managerial and technical approaches

educators, e-learning facilitators and project

which they do not usually apply in their pro-

managers from the seven partner institutions

fessional practice.

in the six countries involved. As a jointly developed document it may lack the homogeneity

Accordingly, the publication was produced for

one usually expects from a monographic pub-

three main groups of addressees:

lication, but through this diversity it reflects

• adult educators: programme developers,

the varying approaches and perspectives of the European partners who were involved.

trainers and online tutors, • managers of educational institutions, and,

to a lesser extent, The authors are also well aware that the publi-

• experts in information and communication

cation is not a comprehensive guide book on

technologies: e-content producers and

how to provide high-quality e-learning in hos-

technicians.

pitals. This would need many more projects

6

and initiatives of this kind, since informal

Not all of the target group will find all chap-

learning for patients are still very unusual, if

ters of this publication equally relevant for

not entirely exotic in most European hospitals.

their particular roles and tasks. But it is not so

Instead, the publication may be received as a

much a book to be read from the start to the

an attempt to share some of the experiences

end, but designed rather as a collection of

and insights the eHospital project partners

experiences, tools, and recommendations

gained in planning, organising and delivering

which may be useful for specific purposes and

computer-assisted, informal learning activi-

at different stages of implementing e-learning

ties for patients in European hospitals. It will

in hospitals.

Introduction

Part 1: Context of the publication provides

relevant theoretical inputs, recommendations

background information to the idea of e-learn-

and tools for planning, organising, imple-

ing for hospital patients. It locates the concern

menting and evaluating e-learning projects in

of the publication to the broader educational

hospitals.

contexts in which it is embedded: Lifelong

Chapter 6: Profile of e-learning facilitators in

learning policies, the potential of ICT for educa-

hospitals indicates the complementary

tion, and the sociology of illness and hospitals.

knowledge and experience required to

Chapter 1: E-learning in hospitals in a

facilitate e-learning activities in hospitals.

European policy context explains the link

Chapter 7: Management of e-learning projects

between informal computer-assisted learn-

in hospitals highlights some key issues in

ing in hospitals and the underlying Euro-

the cooperation between education pro-

pean policies of lifelong learning and pro-

viders and hospitals.

motion of information and computer technologies in education.

Chapter 2: Examples of e-learning in European hospitals presents the results of a survey on existing (e-)-learning activities for hospital patients and describes in more detail a successful Austrian case of patient education.

Chapter 3: The eHospital project gives a brief description of the eHospital project and its partner institutions.

Chapter 4 introduces the Seven informal elearning programmes piloted by eHospital as examples on informal, technology-supported learning of adult patients.

Chapter 8: The preparatory phase suggests how education providers may approach hospitals for joint e-learning projects.

Chapter 9: Educational strategies of e-learning activities deals with important pedagogic aspects to be taken into consideration when planning and implementing e-learning activities for hospital patients.

Chapter 10: Hospital specific e-learning knowhow focuses on online tools, networking, and required hardware and software to set up and support e-learning in hospitals.

Chapter 11: E-culture for trainer and patients draws the readers’ attention to issues of

Chapter 5: Life in hospitals gives an introduction

netiquette and basic virtual communica-

to the characteristics of the the organisation

tion rules hospital patients and their learn-

hospital and to the central concepts of health

ing facilitators should respect.

and illness and thus attempts to explain the setting of the e-learning activities.

Chapter 12: Evaluation of e-learning activities in hospitals describes a possible evaluation strategy of an e-learning project in hospitals.

The second part of the publication deals with

At last on the basis of the previous chapters

the educational, organisational and technical

some concluding remarks on Success factors

aspects of Providing informal e-learning activ-

of informal e-learning for hospital patients are

ities for hospital patients. It offers practice-

made in Chapter 13.

7

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

Chapter 1 E-learning in hospitals in a European policy context

ambitious goals set by the Lisbon European Council in March 2000, i.e. for Europe to become, within 10 years, the most competi-

tive and dynamic knowledge-based economy in the world, capable of sustained economic growth with more and better jobs and greater social cohesion.

In the European context lifelong learning is

Holger Bienzle

defined as:

all learning activity undertaken throughout life, with the aim of improving knowledge, One might initially ask:

skills and competences within a personal,

Why should people learn while staying at hos-

civic, social and/or employment-related

pital?

perspective.3

And why should they even engage in e-learning, a rather sophisticated form of edu-

According to the communication of the

cation?

European Commission lifelong learning is

From the point of view of the European Union

more than acquiring new competences in

there are clear answers to this question:

order to improve one’s chances in the labour

Providing learning opportunities for long-term

market. Lifelong learning has four broad and

hospital patients contributes to the realisation

mutually supporting objectives: personal ful-

of lifelong learning policy aims in Europe. It

filment, active citizenship, social inclusion

supports the important goals of bringing learn-

and employability/ adaptability. As a conse-

ing provisions closer to the learner, widening

quence of this wide definition which goes

access to lifelong learning and promoting the

beyond narrow economic and vocational aims

use of information and communication tech-

the complementary term life wide learning

nologies in education.

has been coined. It emphasizes that learning covers all aspects of life, and can occur in formal, as well as in informal settings.

1. Hospitals: new places of informal adult learning

A number of strategies and political processes have been implemented since 2000 to realise the European lifelong learning policy,

For around a decade the promotion of lifelong learning has been a central policy aim of the

starting with the Memorandum on lifelong

learning and a related consultation and dis-

European Union. Lifelong learning is placed high on the EU’s political agenda, as it is seen to play an important role in reaching the

8

3

Making a European Area of Lifelong Learning a Reality COM(2001) 678

cussion process in the member states. Further

ter learning opportunities throughout adult

landmarks of this policy development are:

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

life is important for both efficiency and equity reasons given the challenges identi-

• Council Resolution of 27 June 2002 on

fied above. Not only does adult learning

lifelong learning (2002/C 163/01)

help make adults more efficient workers

• Communication from the Commission of

and, better-informed and more active citi-

21.11.2001: Making a European Area of

zens, it also contributes to their personal

Lifelong Learning a Reality (COM(2001)

well-being.4

678 final) • Communication from the Commission of 23

(2) Widening access and increasing participation

October 2006: “Adult learning: It is never too late to learn” (COM(2006) 614 final) • Decision No 1720/2006/EC of the Euro-

…priority should be given to the following:

pean Parliament and of the Council of 15

providing access to lifelong learning

November 2006 establishing an active pro-

opportunities for all, regardless of age,

gramme in the field of lifelong learning

including specific actions aimed at the most disadvantaged persons, those not

Among the European lifelong learning aims

participating in education and training…5

four main messages coming from some of the

An additional 4 million adults would need

policy documents mentioned above may be

to participate in lifelong learning in order

highlighted here:

to achieve the participation rate of the benchmark agreed by Member States in the framework of the “Education and

Messages from lifelong learning policy papers

Training 2010” process.6 (3) A learner-centred approach A key characteristic |of lifelong learning| is

(1) Promoting adult learning

the centrality of the learner.

Definitions of adult learning vary, but for the purpose of this Communication it is defined as all forms of learning undertaken by adults after having left initial education and training, however far this process may have gone (e.g., including tertiary education).

Raising the overall level of skills of the adult population by offering more and bet-

4

Communication from the Commission of 23 October 2006: Adult learning: It is never too late to learn (COM(2006) 614 final) 5 The Council Resolution of 27 June 2002 on lifelong learning (2002/C 163/01) 6 Communication from the Commission of 23 October 2006: Adult learning: It is never too late to learn (COM(2006) 614 final)

9

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

The consultation feedback emphasises a

…Provide lifelong learning opportunities as

shift from ‘knowledge’ to ‘competence’

close to learners as possible, in their own

and from teaching to learning, placing the

communities and supported through ICT-

learner at the centre ...

based facilities wherever appropriate.

Learners should, as much as possible,

For some groups, such as the disabled, it

actively seek to acquire and develop

is just not always possible to be physically

knowledge and competences.7

mobile. In such cases, equal access to learning can only be achieved by bringing learning to the learners themselves. ICT

(4) Open and flexible forms of learning

offers great potential for reaching scattered

The consultation feedback emphasised

and isolated populations in cost-effective

the importance of adequate levels of open

ways – not only for learning itself, but also

and flexible education and training provi-

for communication that serves to maintain

sion at the local level for bringing learning

community identity across large distances.

and (potential) learners together….8

More generally, ‘round-the-clock’ and ‘onthe-move’ access to learning services – These four central aspects of lifelong learning

including online learning – enables every-

are closely linked with each other. In other

one to use their learning time to the best advantage, wherever they may physically

words: The emerging knowledge society

be at any given moment …

demands from all citizens to engage in formal

Bringing learning closer to home will also

and informal learning activities at all stages of

require reorganisation and redeployment

their lives. If the rate of participation in learn-

of resources to create appropriate kinds of

ing is to be substantially increased, educa-

learning centres in everyday locations where

tional offers must start from the social and

people gather – not only in schools them-

educational needs of the learners and apply flexible,

learner-centred

selves, but also, for example, in village

methodologies.

halls and shopping malls, libraries and

Moreover, educators should seek to make

museums, places of worship, parks and

learning activities possible where the learners

public squares, train and bus stations,

are, instead of waiting for the learners to

health centres and leisure complexes, and

come to a classroom:

workplace canteens.9

7

Communication from the Commission of 21.11.2001: Making a European Area of Lifelong Learning a Reality (COM(2001) 678 final) 8 Communication from the Commission of 21.11.2001: Making a European Area of Lifelong Learning a Reality (COM(2001) 678 final)

10

9

Commission staff working paper of 30.10.2000: A memorandum on lifelong learning (SEC(2000) 1832)

As referred to in the document quoted above hospitals and other healthcare institutions are

2. E-learning as a new mode of education

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

such new places of learning which need to be explored by educators.

Adult patients in European hospitals may not be permanently disabled, but many of them are without doubt restricted in their mobility

What is e-Learning?

In the e-learning Action Plan, the European Commission defines e-learning as

the use of new multimedia technologies

and therefore temporarily excluded from most

and the Internet to improve the quality of

learning provisions. The only way to give them

learning by facilitating access to resources

access to education during hospitalisation is

and services as well as remote exchanges

to make it possible for them to learn where

and collaboration.10

they are: supported by computer-based learning and educators who leave their classrooms and go into hospitals.

This is a rather advanced definition of e-learning which focuses on Internet-based and col-

The time spent in hospital patients may use for all kinds of learning purposes, most of them informal, normally will not lead to formal certificates: to improve vocational compe-

laborative forms of learning. Wider approaches extend the term e-learning also to forms of computer-based learning which do not involve the Internet, i.e. learning with a CD-ROM:

E-learning (electronic learning): Term cov-

tences and employability, to learn about the

ering a wide set of applications and

health problem and methods to come to terms

processes, such as Web-based learning,

with it or improve it, or to discover new areas

computer-based learning, virtual class-

of interest for personal fulfilment.

rooms, and digital collaboration. It includes the delivery of content via Internet, At the operational level the European funding

intranet/extranet (LAN/WAN), audio- and

programmes for adult education, i.e. the

videotape, satellite broadcast, interactive

Grundtvig action line in the Socrates (2000– 2006) and Lifelong Learning (2007–2013) programmes have actively promoted adult learning activities in European hospitals. eHospital, the Grundtvig project on whose experience this publication is based, under-

TV, CD-ROM, and more.11 It is in this broader sense that the term e-

learning is used in this publication: it stands for various learning scenarios of teaching and learning which have in common that they use electronic media.

took to bring (e-)learning to (adult) hospital patients. The project was the first of its kind, and e-learning offers still seem to be unusual exceptions to the routine of hospitals in Europe.

10

Communication from the Commission: The e-learning Action Plan. Designing tomorrow’s education (COM (2001) 172 final) 11 http://www.learningcircuits.org/glossary

11

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

Electronic media can have different functions depending on the pedagogic scenario:

Type

Learners´ view

Function

e-learning by distribution

Learn from information (links, downloadable documents provided): use of information for self-organised and steered learning

Support by distribution of information

e-learning by interaction

Learn from feedback (assessment, lessons, voting): use of forums, chat, blackboard

Support by interaction beween the users

e-learning by collaboration

Learn from multiple perspectives: use of problem solving tasks by groups or peers

Support by collaboration of the learners

Fig. 1: Functions of electronic media in e-learning12

als and face-to-face sessions used together to When using the term e-learning in this book,

deliver instruction. Another example would be

we are referring to a teaching and learning

using active learning techniques in the physi-

scenario using computers, the Internet or an

cal classroom and a social web presence

intranet in addition to face-to-face learning:

online. Good examples of blended learning

blended learning.

scenarios have the following simplified stages:

Blended Learning is the combination of multi-

• kick-off meeting with instructions

ple approaches to learning and presents more

• self learning period

advantages for adult learning in hospitals.

Blended learning can be accomplished through the use of blended virtual and physical resources. A typical example of this would be a combination of technology-based materi-

• face-to-face session with evaluation, feed-

back and control mechanisms • self learning period • closing with a face-to-face session with

final evaluation.

12

Gertsch, Fredi (2006): Das Moodle Praxisbuch, München.

12

Both face-to-face and e-learning elements have their advantages and disadvantages.

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

Face-to-face versus e-learning Advantages

■

■ ■ ■ ■

■ ■ ■ ■ ■

Face-to-face Social contacts between the learners are established immediately Tutor and learner get to know each other personally All comprising communication Learners help each other Progressive discussions e-learning Learners can learn how, when and where they ever want to The learner determines their own learning speed Flexible methodology and didactics Individual usage of multimedia according to the learner type Huge source of information and knowledge

Disadvantages

■ ■

■ ■ ■

Face-to-face All learners have to be at the same place at the same time All learners should have a similar preknowledge

e-learning Misunderstanding of learning content is possible but is not recognized High level of self learning competence and discipline is required No automatic social contacts between the learners

Fig. 2: Advantages and disadvantages of face-to-face and e-learning scenarios

E-learning in the educational context of learning in hospitals

interest of patients who are forced to adhere to a rather rigid hospital routine.

In the specific context of adult education in hospitals e-learning has a great potential.

Flexibility of time and space

Hospital patients are restricted in their mobility and can therefore profit from being inde-

The most salient advantage of e-learning is

pendent on the time-space arrangements of

its flexibility. E-learning is not limited to

conventional face-to-face learning. Learning

direct personal interaction and scheduled

becomes possible at any time and place. Also,

class times. Hospital patients are restricted

social interaction and joint learning activities

in their mobility and can therefore benefit

with peers become possible with the help of

from becoming independent on the time-

virtual tools. The flexibility and autonomy

space arrangements of conventional face-to-

e-learning offers needs to be exploited in the

face learning.

13

Chapter 1

Chapter 1 E-learning in hospitals in the policy context of lifelong learning

Roles of teachers and learners E-Learning provides few regulatory mechanisms that ensure the learning progress of the patients. Hence, learners are challenged to become active and responsible for their own learning experience. Consequently, the roles

nication is more appropriate for the social dimension of communication and for discussing controversial issues. When planning an e-learning curriculum, the importance of the social dimension of learning has to be thoroughly considered.13

of teachers and learners change. The teacher as a lecturing expert who is imparting factual knowledge becomes transformed into a facilitator who enables learning by selecting and applying appropriate methods, helps to solve problems, and enhances dialogue.

Virtual communication Virtual communication in an e-learning environment can be characterized to be synchronous, asynchronous, or both. The Internet technology provides various tools for facilitating these interactions. The essential characteristic of synchronous communication is the immediacy of mutual interaction (e.g. face-toface, chat, or video conferencing), whereas asynchronous communication allows for greater temporal flexibility (e.g. e-mail and discussion forums).

In the context of e-learning, discussion boards and e-mail are currently the most frequently used communication tools. These asynchronous tools provide spatial and temporal flexibility to the participants and allow participants to interact with one another at any place and time convenient for them. Thus, the immediacy of feedback is low. On the other hand, the learners are able to reflect, edit, and revise messages before sending, and an in-depth engagement with the subject matter is fostered. In contrast, face-to-face commu-

14

13

Zens, B. (accepted for publication). Evaluation Research on E-Learning in Higher Education. SelfRegulated Learning, Online Communication, and Achievement (working title). VDM Verlag Dr. M端ller.

Chapter 2 Examples of e-learning in European hospitals

pitals for adult patients, focusing on e-learn-

Stefan Kremser, Birgit Zens

in hospital; learning patients; online courses

ing activities. The purpose was to identify good practice on which the eHospital project could build.

For the actual state analysis, a Google

Chapter 2

Chapter 2 Examples of e-learning in European hospitals

Internet search was conducted using search phrases and terms like: e-hospital; e-learning

patients. Additionally German, Spanish and Polish search terms were used. Consequently, In many European countries there are educational provisions for children who are temporarily prevented from going to school

it has to be taken into account that the results mainly refer to English, German, Spanish and Polish speaking countries.

because they are forced to spend longer periods of time in hospital. Hospital schools ensure that their school education is not interrupted. Such hospital schools, however, end with compulsory school age. There are several interesting projects which make use of information and communication technologies in schooling hospitalised children.

The resulting web sites were analyzed with regard to the following criteria: • Are the given learning activities targeted to

adult patients?

• Do the given learning activities have an ICT

element?

• Do the activities deal with education and

For people older than 15 or 16 there are hard-

learning or exclusively with therapy of the

ly any educational offers in hospitals, in spite

illness in question?

the declared aim of European and national

• Are there any aspects of these learning

lifelong learning policies to ensure access to

activities which might be valuable for the

education for all European citizens.

eHospital project?

The search according to the selection criteria did not provide satisfactory results; therefore,

1. The present state of (e-)learning in hospitals

the criteria were extended to e-learning activities in hospital for children and learning activities for adults in general. Subsequently,

Aims and method of the analysis

interesting offers were selected. In order to

As part of the eHospital project an analysis

get more detailed information, additional

regarding e-learning in hospital in Europe was

questionnaires and telephone interviews were

conducted in 2006 and pursued the goal to

used for the selected projects and pro-

investigate existing learning activities in hos-

grammes.

15

Chapter 2

Chapter 2 Examples of e-learning in European hospitals

The results of the Internet search were classi-

Project website in German:

fied into educational activities for children

http://www.schule-fuer-kranke.de/projekte/

and educational activities for adults.

digitales-klassenzimmer.htm

E-learning for children in hospital Usually, children staying in hospital for a longer period are involved in educational activities. Therefore, hospitals provide special classes for the young patients which enable them to deal with (some of) the subject areas which would be covered in their respective

Fig. 1: Patient learner

school year. Many of these hospitals schools across Europe are members of the HOPE Hospital Organisation of Pedagogues in

school. It is possible to follow the lesson, to

Europe (http://www.hospitalteachers.eu).

pose questions, to view the notes on the

Such hospital schooling activities were not

board, and to communicate with classmates.

subject of the eHospital investigation. It

Assignments are distributed and sent back by

turned out to be relevant, however, to have a

e-mail.

look at some of the recently growing number of projects which use ICT elements for teach-

Virtual School, W端rzburg, Germany

ing and learning of children in hospital

The main aim of the project is to give the

schools. Many such examples can be found

young patients the possibility to participate in

all over the world. In the following, a few are

the everyday school life outside the hospital

illustrated.

and thus to stay in contact with the outside world and keep in touch with friends. Another

16

Governmental Hospital School Munich, Germany

goal is to ease the re-integration of the pupils

The main goal of this project is to connect ill

For that purpose, online and offline course

children with the world outside the hospital

materials were developed for all subjects and

and thus to decre ase the isolation in hospital

age ranges in order to support the children in

and providing a little piece of normal life.

their self-regulated learning activities in hos-

Therefore, besides traditional teaching, video-

pital and rehabilitation centres (University

conferencing is used for children with cancer.

Hospital, Psychiatric Polyclinic for Children,

The videoconferences connect the patients in

and the Centre for Therapy of Ancestral Cells).

hospital directly from their bedside to the net-

The target groups are children with chronic

worked school. The patients thus are able to

diseases, children undergoing ancestral cells

actively participate in the classes of a regular

therapy, children having psychical diseases,

in their normal life outside the hospital.

Project Website in German:

Link to the portal:

http://virtuelle-schule.server-five.i-contento.

http://virtuelles-klassenzimmer.connectiv.de/

de/www_virtuelle_schule/home_1_1_0_f.htm

Chapter 2

Chapter 2 Examples of e-learning in European hospitals

Fig. 3: Screenshot

uted through the platform and sent back by eFig. 2: Screenshot

mail. Moreover, the platform contains a “break hall� where the pupils can play games.

and children undergoing rehabilitation. Tutors and teachers of the regular school support the patients in their learning process. Also, videoconferences between the hospital and the regular partner school are realised.

Mater Hospital Special School, Queensland, Australia In the Mater Hospital Special School, technology plays an important role whereas the

Virtual Classroom: Learning at the Bedside, Germany

goal is to enhance student learning and to provide the possibility of communicating with others outside the hospital. The school serves

As for the examples mentioned above, the

day students and hospitalised children at the

main aim of the project at the Bonifatius

Mater Children’s Hospital, the Mater Adult

Hospital in Lingen is to connect the young

Hospitals

and

the

Princess

Alexandra

patients with regular schools outside the hospital. The hospital provides a virtual class-

School website:

room for the child-patient. The patients

http://www.materschool.eq.edu.au/

access the virtual classroom through laptop computers directly at their bedside and thus get connected to their classmates and teachers outside the hospital. Besides communicating with peers (by chat or discussion forum), materials and assignments are distrib-

Fig. 4: Screenshot

17

Chapter 2

Chapter 2 Examples of e-learning in European hospitals

Hospital. The patients have Internet and e-

leisure objectives, all of them on a secure

mail access, which enables them to commu-

online environment for children. Special care

nicate with others. Also, digital teaching and

was taken to create an attractive, nice-looking

learning activities through the internal

interface with an intuitive design and user-

intranet are realised.

friendly communication tools.

The latest initiative is Solas, a portal facilitat-

Aít Eile Project, Dublin, Ireland

ing communication through video-link, e-mail, live chat, and SMS texting. Moreover, the

The interactive portal Aít Eile (Another World)

children can compose music, create pieces of

is based in the hospital schools and links

art and play games and maintain their own

fourteen hospitals throughout Ireland. The

blog.

target group are chronically ill children who are undergoing severe treatments and who suffer from protective isolation for long peri-

Mundo de Estrellas Project, Spain

ods. The goal is to offer potential help for chil-

The Mundo Estrellas project (Star World)

dren to cope with these challenges, through

started at the Andalusian Hospital Uni-

communication, entertainment, and educa-

versitario Virgen del Roc’o. Initially, the aim of

tional resources. The project has developed a

Mundo de Estrellas was to contribute to the

virtual online community with chat, audio and

well-being of hospitalized children by way of

videoconference, e-mail messaging and

providing virtual worlds where the children

teaching activities with both educational and

can create characters and stories, share activ-

Link to the portal:

Website:

Aít Eire: http://www.aiteile.ie

http://www.estrellas.org

Solas: http://www.solas.ie

Fig. 5: Screenshot

18

Fig. 6: Screenshot

ities, are part of a group, and share their hos-

tion. In the following, two examples are illus-

pital experiences.

trated.

Two of the spaces created for the first phase of the project stand out: the virtual classroom

Nurse Diane

and the virtual surgery, as they both have

Nurse Diane is a portal providing lessons

interesting educational features.

and videos regarding specific topics that are

Also, the project provides videoconferencing

important for the patients while staying at

(Estrella Educativa 2000) in order to connect

hospital and after leaving. The lessons aim

the patients in hospital to regular schools and

to help the patients and families leave the

give them the possibility to take part in the

hospital with knowledge and information

classes.

they need for better health care and compli-

The project Mundo de Estrellas was such a

ance with care instructions, e.g. Diabetes or

great success that it spread to all the public

New Born Knowledge. By increasing the

hospitals in Andalusia. Likewise, 71% of par-

patients’ knowledge of their illness, also

ents ensure they have seen their children’s

doctors and nurses are relieved from some

spirits rise after the use of this pioneering pro-

of their duties.

gramme. On the other hand, 98% of children

The service is commercial, but no fees are

users claim that this activity makes the day go

required from the patients.

Chapter 2

Chapter 2 Examples of e-learning in European hospitals

by more quickly and almost 100% have stated that thanks to Mundo de Estrellas their

Website:

stay in hospital is more enjoyable.

http://www.patientprogrammes.com/

Adult Education in Hospital Hardly any examples for adult education in hospital can be found. Training for adult patients usually concentrates on illness-related therapy, psychotherapeutic activities and training of skills (physiotherapy, art therapy, music therapy, group therapy, and many more), whereas educational activities helping

Fig. 7: Screenshot

the patients to stay connected with their normal lives outside the hospital were not discovered.

Though, there are a few examples for the use

Patient Education Institute

of Internet technology in order to support

The Patient Education Institute provides

patients in health care and health informa-

multimedia clips and interactive online tuto-

19

Chapter 2 Examples of e-learning in European hospitals

classes becomes possible for the young

http://www.patient-education.com/

patients as well as to stay connected to the

Chapter 2

Website:

outside world and to their friends and families in an easy and self-directed way. Thus the goal is to decrease the isolation of the hospitalized children, enhance their psychological well-being, and ease their re-integration into the regular educational system.

Two main lessons can be learned for adult patient education from the various examples of e-learning for children in hospitals: Fig. 8: Screenshot

• E-learning offers should have an element of

rials in order to support health information of

edutainment, as this seems to be a strong

the patients. The tutorials contain voice, text,

motivating factor for learning in a life situ-

and graphics, as well as interactive questions

ation which is often depressing.

to be answered by the patient. The tutorials

• Communication of patient learners with

are in English and Spanish. Besides informa-

tutors/teachers and with peers inside and

tion about disorders, surgery, diagnosis and

outside the hospital is vital. The learning

therapy, the tutorials also cover health, well-

provision should have a strong interactive

ness, and other special topics (e.g. “advance

character which can be enhanced by com-

medical directives” and “understanding

munication tools like forums, chat, SMS

health issues”). As for the “Nurse Diane” les-

texting or video-conferencing.

sons, the tutorials are commercial.

Summary

For adults, hardly any specific e-learning offers could be found. Sporadic web-based

20

The actual state analysis revealed many

resources for adult patients concentrate on

examples of educational activities for children

therapy and health related issues and aim to

in hospital using e-learning methods. As tra-

provide patients with information regarding

ditional classes for children in hospital are

their respective diseases and to support

common, it is not surprising that, in this

health care after leaving the hospital. Such

respect, new technologies are gaining in

offers, however, could potentially be built

importance. The Internet provides opportuni-

upon if their educational character were

ties that cannot be granted by traditional

enhanced instead of merely passing on factu-

methods of education. Participating in regular

al knowledge and information.

Chapter 2 Examples of e-learning in European hospitals

impending danger of death. According to Fischer & Riedesser (1999) life-threatening situations of sickness bring out potentially

The idea of the project The project “ECDL for children and teenagers

traumatic instances which can lead to psycho traumatic symptoms.

with cancer” was started in January 2002 and

Cancer and its therapy have to be seen as a

has been running successfully in several

process which can stretch out from months to

provinces of Austria. This was made possible

possible years, that is why there is documen-

through the cooperation between several part-

tation and literature about chains of trauma or

ners: Österreichische Kinder-Krebs-Hilfe,

complexities of trauma.

(Austrian Children-Cancer-Assistance), differ-

Respect and care are essential in the interac-

ent hospitals and the educational institution

tion with traumatised people. The recovery of

die Berater®, supported by other national

control and meaningfulness is also important

organisations such as Österreichische Com-

for coping with traumatising experiences.

putergesellschaft (Austrian Computer Asso-

These factors were the central focus in the

ciation). Children and teenagers who come

conception of this project.

Chapter 2

2. An Austrian case: ECDL for children suffering from cancer

down with cancer can complete the European Computer Driving Licence (ECDL)14 within the

Initially a pilot scheme which considered the

project. It is the goal to support the healing

mental, spiritual and social consequences of

process positively through new experiences

cancer was designed. The following consider-

and a sense of achievement outside of the

ations were imperative for the conception:

normal course of hospital life.

• External perception, consultation and proj-

The diagnosis cancer normally abruptly

ect support through an educational institu-

releases a flow of an acute imagination and

tion/consultancy

feelings in the affected young cancer patients

• Impact of the environment

and their relatives. The emotional intensity

• Commitment of the hospital staff, the spon-

can be explained through the close connection between the diagnosis cancer and the

sors and the peer group Furthermore the following active-therapy considerations took centre stage:

14

The ECDL is an internationally approved and standardised certificate which confirms to the computer user the basic and practical skills in computer applications.

This certificate includes the common use of the computer as well as the typical office use and the searching through the internet. The ECDL contains 7 modules which can be completed in any order. The schooling conveys the following skills: basics in information technology, computer usage and data management, word processing, spreadsheet, data base, presentation, information and communication.

• Blended learning as an ideal approach of

learning in extreme situations, focussing on the future through learning – focusing on the after, achievement orientation with the option of partial success • Activity as a social anchor • New assignments of tasks as protection of

mental collapse

21

Chapter 2 Examples of e-learning in European hospitals

Chapter 2

The ECDL was considered the central active therapeutic element, which seemed to be especially adequate for the young patients with cancer because of the following considerations: • Technology as positive motivation factor • Egression of the roll as a patient (or to help

step out of the roll as a patient) • Assignation of the personal learning speed • Collective studying in the peer group • Identification with like-minded teenagers

Fig. 9: A participant and her trainer while learning with the computer

• Growing stronger through the feeling of suc-

cess

wards the participants choose a topic they want to start with and then get the CD and

The participants of the project average between 10 and 19 years old. The project is supposed to positively influence the recovery of the children and teenager and to support other therapies, for example: psychological and occupational therapeutic arrangements (such as training brain activity).

Patients’ occupation with a concrete topic, conversation with a person from outside, studying together, staying in contact and the feeling of accomplishment in the exam have a positive influence and allow experiences which are set apart from every day life at the hospital. With the help of the project the

documents for their study from the trainer.

Further work will be done regularly at the hospital, on the premises of the project initiators or at home – depending on the state of condition and therapy. During their stay at the hospital the children and teenagers participate in group workshops or directly at the bedside. Blended Learning leads to application: On the one hand the participants gather content on their own with the help of learning materials, learning CD-Rom or work assignments and in regular intervals also with the especially skilled trainers of the project.

reconstruction of an optimistic perspective and the connection with the life after is being aided.

The exchange in the pee group is another important component. Patients’ social development through the subject matter at the hos-

Individual participants – individual learning

22

pital or over virtual communication such as chatting because through the identification with like-minded people and the collective

An initial discussion is held with the partici-

work on contents which do not have anything

pants about the project which is being intro-

to do with sickness or hospital have a positive

duced and questions are answered. After-

influence. The participants decide on their

Chapter 2 Examples of e-learning in European hospitals

own how fast they want to study. By 2007 the

Experiences and achievements Chapter 2

project is running in several hospitals which, if necessary, work together nationwide on the terms of the patients. If, for example, a teenager starts the project in Salzburg and then spends some time for treatment in Graz the work can be continued smoothly at the hospital in Graz.

Multipliers and trainers: Selection and competence In every region so-called multipliers are trained – people who mostly work directly at the hospital or are constantly in contact with the children and teenagers. These multipliers themselves complete the whole ECDL course including all the tests in order to support the

Fig.10: The first ECDL certificate ceremony 2002

children and teenagers with the accomplished competences. Furthermore they get all the information about the study material and the current level of the project from the trainers.

From the start of the project in 2002 to September 2007 over 213 participants started with the project. There from until now 65

Selection of the trainers for the project runs

children and teenagers achieved the ECDL-

under various aspects. Aside from basic pro-

graduation certificate. Forty-nine participants

fessional applicability (all trainers are certi-

passed away during the project. All together

fied ECDL assessors) in particular the social

over 576 elemental examinations have been

and pedagogical qualifications and the soft

completed so far.

skills of the trainers are being appraised during a preliminary talk with psychiatrists of the hospitals. Regular team meetings and supervision units are a fixed part of the project.

Not only the creativity and flexibility of the participants, but also those of the people in charge of the project has been requested consistently. For example the wish of a participant to arrange himself a web design- course

In regular meetings and reflective discussion

for other teenagers with cancer was organised.

with the people in charge of the hospitals, the

The project shows on many levels a positive

psychiatrists and of course with the partici-

influence on the children and teenagers as

pants the courses are carefully evaluated to

well as on their social surroundings (sib-

assure the highest quality possible.

lings, parents and friends). The communica-

23

Chapter 2 Examples of e-learning in European hospitals

Chapter 2

tion among one another about a topic aside from the sickness as well as the formation of peer groups, the personal meetings and the communication possibilities over the internet are being absorbed positively.

• different target groups (different groups of

adult patients) • different topics (occupational orientation,

language, Soft Skills) • other European countries • a different form of learning.

From ECDL project to eHospital

24

The ECDL project with children and teenagers

Whereas the ECDL project predominantly con-

with cancer gives proof that studying can be a

sisted of intensive face-to face training and

big

long-term

Computer-Based Training (supporting self

patients. These positive experiences gave the

learning periods with the help of CDs)

initiative to the European project eHospital.

eHospital tried and academically evaluated

The latter can be understood as expansion

also more advanced and stronger interactive

and transfer of the Austrian ECDL project on:

forms of e-learning.

motivation

incentive

for

Chapter 3 The eHospital project

Chapter 3 The eHospital project

The idea for the project developed from the coordinating institution’s involvement in a national project which attracted great public

Holger Bienzle, Théo Bondolfi, Marie-Claude

Since 2002 die Berater have provided com-

Esculier, Carmen Fernández Morante, Uwe

puter-based training which prepares young

Hoppe, Maria Jose Rodriguez Malmierca,

patients suffering from cancer for the

Joanna Szczecinska

European Computer Driving Licence (ECDL).

Chapter 3

attention in Austria (cf. preceding chapter).

As this project proved that learning can produce an enormous emotional boost for longThe eHospital project seeks to promote

term patients and was received very positively

e-learning opportunities for adult patients in

by patients, parents, medical and psychologi-

hospitals. The project originated from three

cal hospital staff alike the idea was born to

different roots: the positive experience of the

build on this experience in a European proj-

coordinating institution with ECDL training

ect.

courses for young cancer patients, stakehold-

The eHospital project sought to

er demands for providing adult learning iden-

• transfer the experience from the ECDL proj-

tified by the project partners, and the European Union’s lifelong learning policies. ###################

ects to • other age groups (adults) • other patients groups • other learning topics

1. A short project description

• other countries

eHospital is a transnational cooperative proj-

• react to the observation that in many

ect co-funded by the European programme

European countries there are hospital

Grundtvig. The project was implemented from

schools for school-age children, but there

2005–2008 by a consortium of six partners

do not seem to be any learning provisions

from five countries: die Berater (Austria),

for adult patients.

Donau-Universität Krems (Austria), ORT

• investigate the potential of e-learning for

(France), Bildungswerk der Sächsischen

informal learning activities for hospital

Wirtschaft e.V. (Germany), CESGA (Spain),

patients

Universidad de Santiago de Compostela (Spain) and Spol´eczna Wysza Szkol´a Przedsibiorczoci i Zarzdzania w ´L ´ odzi (Poland).

• scientifically evaluate the effects of the

learning activities by two universities.

Ynternet.org, an associated partner from

The

project’s

intention

coincided

with

Switzerland, complemented the partnership.

European lifelong learning policies and fund-

Each partner cooperated with one or more

ing programme priorities like exploring new

hospitals in their respective country.

places of learning, including hospitals, giving

25

Chapter 3 The eHospital project

access to learning provisions to vulnerable

• to produce guidance materials and tools for

groups, and promoting the use of information

adult educators to enable them to work with

and communication technologies in educa-

hospital patients,

Chapter 3

tion.

• to implement awareness-raising activities

When partners were contacted they immedi-

on e-learning in hospitals among adult edu-

ately reacted positively to the project idea, as

cation institutions, hospital managers,

the need for diverse educational activities for

medical, nursing and administrative staff,

adult patients had been expressed by many

sponsors, authorities and other health care

stakeholders of the health system they had

agents.

been in contact with.

Thus, the overall aim of the eHospital project

The project team wanted to make sure that in

was to promote e-learning activities for adult

the development of the local e-learning proj-

patients in hospitals in order to

ects in hospitals the experience gained else-

• give them access to life-long learning

opportunities while in hospital, • provide them with an educational reference

environment for the acquisition of knowledge and skills, for personal development and social interaction, • ease their pathways back to employment,

learning and society in general, • and thus support the process of physical

where was to be taken into account. Though the project partners were rather sceptical from the start because many examples of elearning offers for adult patients could be found, an initial phase of research and analysis was carried out in order to identify best practice examples from which valuable lessons could be learned.

Putting these elements together the project followed the following intervention logic.

and emotional convalescence.

This aim was pursued by the following operational objectives:

Research in the state of the art in hospital education

Experience of seven local e-learning projects in hospitals

Best practice

Results

• to design and pilot local e-learning projects

for different groups of patients in hospitals, • to evaluate the effects of these learning

activities on the patients’ personal and social development and on the process of convalescence,

eHospital publication: Recommendations Methodological guidance Course designs

• to create and test an e-learning system

with educational resources for learners

Dissemination and awareness-raising

and educators and with collaborative tools for interaction and group learning,

26

Fig. 1: eHospital framework of intervention

Chapter 3 The eHospital project

2. The eHospital partner institutions

personal lives. Around 15,000 people participate in the programmes of die Berater per year.

Contents and methodologies are tailor-made according to the needs of their customers.

Clearly defined training aims and accurate assessment of results ensure the high stan-

die Berater Unternehmensberatungs GmbH

dards of the educational programmes and

Wipplingerstrasse 32

form the basis for continuously improving

1010 Vienna

them. Core learning fields covered are man-

Austria

agement and language skills and compe-

Tel: +43 (1) 732 45 45-0

tences related to the use of information and

Fax: +43 (1) 732 45 45-1145

communication

e-mail: eu@dieberater.com

offered either in face-to-face training semi-

www.dieberater.com

nars or in blended learning courses, a combi-

technologies.

They

Chapter 3

Project coordinator:

are

nation of online learning and face-to-face elements.

die Berater速 are a training and consultancy

In the corporate culture of die Berater fair

company founded in 1998. Today the compa-

play, respect and tolerance are central values

ny employs 400 members of staff who work in

that are put into practice in the relations with

more than 50 locations all over Austria. The

customers, colleagues and partners. For die

core fields of business of die Berater are edu-

Berater, social responsibility means making

cation and training, coaching, outplacement

their core competences available to those who

and consultancy, and EU projects.

are less advantaged in society.

The company develops and organises educa-

It was one of the charity projects die Berater

tional seminars and training courses for indi-

are regularly involved in which gave the idea

viduals, organisations and enterprises. The

for the eHospital project: training leading to

main aim is to motivate and qualify the cus-

the European Computer Driving Licence

tomers to make full use of their potentials in

(ECDL) for young patients suffering from can-

the economy, at the labour market and in their

cer.

27

Chapter 3 The eHospital project

groups of people such as senior citizens, rural areas entrepreneurs, deaf people, etc.

Chapter 3

The core activities focus on the design of new CESGA, Supercomputing Center of Galicia

proposals to apply ICT in innovative and

Avda de Vigo S/N

research projects at regional, national and

15.705- Santiago de Compostela

European levels. Additional to this the latest

Spain

information and communication technologies

Tel:+34 981 56 98 10

applied to the field of e-learning field are

Fax: +34 981 59 46 16

analysed. Design and optimization of distance

e-mail: mjrm@cesga.es

learning classrooms are offered, too. CESGA

www.cesga.es

supplies planning, training and consulting services to ICT users including the deployment of web-based course material.

CESGA also counts on experience in design-

28

Centro de Supercomputacion de Galicia

ing e-learning scenarios and developing web

(CESGA) is a non-profit technological scientif-

based course material for e-learning and

ic institution whose main aim is to promote

blended learning courses. They participate in

knowledge in different areas by offering hori-

Open Source software initiatives, and have

zontal services to satisfy scientific, technolog-

developed a personalized LMS (Aula Cesga)

ical and research interests.

that effectively supports online learning activ-

CESGA has a specific area devoted to e-learn-

ities, as well as blended learning activities.

ing analysis and research and development

Other equipment used for e-learning activities

projects related to information and communi-

are video services which are used for live and

cation technologies applied to learning and

on-demand training sessions and collabora-

teaching processes. Previous to this project,

tive work. CESGA hosts an Access Grid Node

CESGA had participated in other projects

(www.accessgrid.org) with multi-conferencing

which dealt with ICT being used with other

capabilities

Chapter 3 The eHospital project

es. It offers 63 official degrees and 6 own degrees, as well as a significant number of University of Santiago de Compostela

specialisation courses. The USC, which has

Facultade de Ciencias da Educación.

over 2.200 lecturers, is made up of around

Campus Sur. 15782

35.000 students each year.

Santiago de Compostela

The Faculty of Educational Sciences through

Spain

the

Tel: +34 981 56 31 00 Ext. (13749)

Group” has accumulated vast competence in

Fax: +34 981 53 04 94

e-learning over the years. It is composed of 27

e-mail: trek1671@usc.es

researchers from Universidade de Santiago de

www.usc.es

Compostela and professionals from other edu-

“Educational

Technology

Research

Chapter 3

doctoral programmes, masters degrees and

cation institutions in the region of Galicia.

Universidade de Santiago de Compostela

The core activities in e-learning range from

(USC) is an institution of education and

new technologies applied to education,

knowledge at the service of society. It was

design, development and evaluation of multi-

established as a “Grammatik Academy” as

media educational materials, to e-learning

early as 1495 by Don Lope Gómez de Marzoa.

environments and e-inclusion: a core issue is

Nowadays, University of Santiago is organised

to ensure equal access to and participation in

into two campuses: one is located in

the knowledge society.

Compostela and the other in Lugo. Both uni-

This last issue was also the trigger to establish

versity grounds complement each other, aim-

relations to the health sector: The work of

ing to construct a unity despite the different

USC has been centred on promoting access to

specialisations each of them offers.

ICT and digital literacy of different minority

The university is strongly committed to provid-

communities like people with disabilities or

ing high quality teaching, research and servic-

hospitalised children and adults.

29

Chapter 3 The eHospital project

sulting with excellent customer orientation and service. More than 3.500 students from 50 countries are enrolled in over 150 aca-

Chapter 3

demic courses.

Donau Universit채t Krems

The Department for Interactive Media and

3500 Krems

Educational Technology offers master pro-

Austria

grammes in educational technology and e-

Tel: +43 27 32-2340

learning. In addition, it is a partner in numer-

Fax: +43 27 32-4340

ous national and international research proj-

e-mail: birgit.zens@donau-uni.ac.at

ects related to technology enhanced learning,

www.donau-uni.ac.at

most notably in Kaleidoscope, one of only two currently funded FP6 networks of excellence on e-learning. The postgraduate courses in

30

Donau-Universit채t Krems is the only state-

media education and e-learning are designed

funded university throughout Europe which is

for teachers, trainers and educationists who

exclusively dedicated to post-graduate aca-

work with interactive media and new educa-

demic studies. The university offers courses

tion technologies.

in the fields of Business and Management

The Medical Science Department at Danube

Studies, Telecommunications, Information

University Krems is working closely with hos-

and

En-

pitals and medical firms. Furthermore there

vironmental and Medical Sciences as well as

are a number of cross-departmental research

of Cultural Studies. Being a European model

and development projects and study pro-

project, Danube University Krems combines

grammes primarily dealing with health man-

high quality in education, research and con-

agement issues.

Media,

European

Integration,

Chapter 3 The eHospital project

professional qualification. In addition to this Bildungswerk der Sächsischen Wirtschaft Bildungswerk der Sächsischen Wirtschaft

e-business, e-commerce or m-commerce. The

09126 Chemnitz

association contributes to the realisation of

Germany

lifelong learning policy aims.

Tel: +49 (0) 371 53 34 620

E-learning has been an integral part of the

Fax: +49 (0) 371 533 46 29

development, research and training activities

e-mail: uwe.hoppe@bsw-mail.de

of BSW for many years. The institution devel-

www.bsw-ggmbh.de

oped several information, presentation and

Chapter 3

offers its knowledge in e-technologies as

self assessment tools and materials like the Quality Cartoons® for self learning materials.

Bildungswerk der Sächsischen Wirtschaft

All these products can be used as a supple-

gGmbH (BSW) is a non-profit organisation

ment to face-to-face trainings and communi-

with a wide range of educational and voca-

cation platforms in a blended learning form.

tional offers for companies and individual

As it is an important field, the organisation

adult learners who wish to enhance their

has intensive working relationships with dif-

employability through further education for

ferent health-care institutions. Bildungswerk

managers and technical or interdisciplinary

der Sächsischen Wirtschaft designed and

trainings for skilled personnel. Contents

implemented together with some partners

therefore can be chosen from a range of top-

process management systems for hospitals,

ics including languages, human resource

medical practitioners, nursing homes and dis-

development, organisational development or

pensaries.

31

Chapter 3 The eHospital project

and levels of education (high schools, graduate colleges and training centres).

Chapter 3

The Innovation and Development Department ORT France

of ORT FRANCE is dedicated to research,

75116 Paris

consulting and strategies focused on imple-

France

menting lifelong learning through the use of

Tel: +33 (0) 144 17 30 82

ICT: audit of users’ requirements and needs,

Fax: +33 (0) 157 67 13 56

accompaniment to change, training engineer-

e-mail: mc.esculier@wanadoo.fr

ing, expertise and advice in eLearning engi-

www.ort.asso.fr

neering, competencies management, tutoring and coaching, e-services, e-health, apprenticeship, VET strategies, centres of excel-

32

ORT FRANCE is a non-profit organisation

lence, entrepreneurship, advanced systems

member of World ORT UNION, one of the

for education and corporate training, techni-

largest NGO education and training organisa-

cal enhanced Learning applications and

tions responsible for the education and train-

semantic WEB – security applications.

ing of 270.000 people each year through a

Currently ORT FRANCE is coordinating the

global network of schools, colleges, training

HCNV project dedicated to eLearning courses

centres and programmes. ORT FRANCE,

for both social and medical sector in order to

which is an expert in innovative strategies

improve the early diagnosis of the Alzheimer’s

involving IT, gathers 8 training centres and

disease and is partner of METABO, a FP7

schools, 500 experts and trainers and has

project about controlling chronic disease

agreements with French Ministry and public

related to metabolic disorders. Those projects

bodies as well as a close collaboration with IT

have enabled ORT FRANCE to set up a nation-

and Telecom companies, industrial leaders

al and European network of actors of med-

and health professionals. ORT FRANCE edu-

ical/health sectors and users/patients associa-

cates and trains students in different modes

tions.

Chapter 3 The eHospital project

Marketing, International Relations, Finance and Banking, Computer Studies, English Philology. The Academy is also very active in Academy of Management

and international conferences and is publish-

90-113 Lodz

ing scientific books.

Poland

In 2002, Academy of Management created its

Tel: +48 42 632 50 23 54

own e-learning platform. Since then the uni-

Fax: +48 42 636 62 51

versity is developing and providing online

e-mail: jszczecinska@swspiz.pl

courses. This knowledge is adopted in the

www.swspiz.pl

Leonardo project “E-trainer� in which training

Chapter 3

scientific research, organisation of national

on e-learning competence for teachers is created. Students of Computer studies pursuant Academy of Management is a private universi-

to the regulation confirmed by the school sen-

ty situated in Lodz and was established by the

ate can obtain social, scientific, motivational

Association of Polish Educators in January

or international scholarships. Studies at the

1995. Currently there are around 10.000 stu-

Polish Open Academy develop skills in the

dents enrolled in the Academy.

areas of communication with the environ-

The Polish Open Academy, which was found-

ment, doing research, environmental assess-

ed in 2005, is a unit of the Academy of

ment and application of marketing techniques

Management. It is responsible for implement-

in the enterprise.

ing and organising e-learning courses. The

The institution has a strong connection to the

offers for students range from MA and BA

health sector as it provides physiotherapy

studies, post-graduate courses as well as spe-

studies as well as post graduated studies in

cialized training courses on daily, evening and

management for different medical compa-

weekend to extramural basis. At present five

nies. Cooperation partners are four hospitals

departments are available: Management and

in the region of Lodz.

33

Chapter 3 The eHospital project

Associated partner:

The core activities are developing and promoting methodologies and platforms for cooperative projects through the Internet, providing equality of chances, supporting freedom of

Chapter 3

speech and quality standards in the knowlYnternet.org Institute for eCulture 1002 Lausanne Switzerland Tel: +41 213 11 30 47 e-mail: move_at_cooperation.net www.ynternet.org

edge economy and information society.

The institutions offers e-portfolio development processes for individuals and organisations, e-learning programmes for Internet users and trainers, user’s guides and sensitisation campaigns and NGO support in worldwide cooperation on the Internet.

For Ynternet.org the social aspect of information and communication technologies is the

34

Ynternet.org institute for e-culture was found-

key issue. This is why the organisation con-

ed as a non-profit organisation in 1998 on the

centrates on providing training modules,

demand and with support of the Swiss

e-learning tools, virtual community contents

Government. The Organisation is composed of

management, conferences and workshops on

experts in electronic culture and cyberspace

e-culture, articles, publications and others.

behaviour. Its formal mission statement is to

The computer expertise is externalised to high

define and promote e-culture and its links to

school classes, free software movement devel-

free culture communities in the digital envi-

opers and non-profit organisations such as

ronment (free licences, free software, free doc-

Linux Users Groups (LUGs) and Free Software

umentations, free art, free methodologies etc).

Foundation (FSF) network.

Chapter 4 Seven informal e-learning programmes piloted by eHospital

erated with a local hospital, which was interested in making learning offers available to its patients.

DIE BERATER

Universitäts klinik für Kinder und Jugendheilkunde, Vienna

CESGA/USC

Complejo Hospitalario Universitario Juan Canalejo, Coruna

France

ORT FRANCE

Centre d’Accueil de Jour Edith Kremsdorf, Paris

Poland

ACADEMY OF MANAGEMENT

Course 1: Zgierz Centralny Szpital Kliniczny w Lodzi

Austria

Théo

Bondolfi,

Elisabeth

Marie-Claude

Frankus,

Carmen

Esculier, Fernández

Morante, Uwe Hoppe, Maria Jose Rodriguez Malmierca, Joanna Szczecinska

Spain

Chapter 4

Chapter 4 Seven informal e-learning programmes piloted by eHospital

In the framework of the eHospital project seven local e-learning projects were planned, organised and implemented in six European countries. Each of them provided informal learning opportunities to a specific group of adult patients.

The local projects covered a range of different learning topics which were as diverse as the learning interests of the patient target groups in question.

Course 2: Miejski Zespól/ Przychodni Rejonowych w Zgierzu, Lodz

1. Hospitals, patient target groups and learning topics In the eHospital project seven pilot e-learning programmes for hospital patients were planned, organised and implemented in Austria, Spain, France, Germany, Poland, and Switzerland.

In each participating country an education provider, who was a formal partner of the

BILDUNGSWERK Germany DER SÄCHSISCHEN WIRTSCHAFT Switzer land

FONDATION YNTERNET.ORG

Uni Klinikum Dresden

Hopital de Malévoz

European project, initiated the e-learning offer. Each of these education providers coop-

Fig. 1: Tandems in the eHospital partner countries

35

Chapter 4 Seven informal e-learning programmes piloted by eHospital

These pilot programmes, which will be presented below, provided different opportunities of informal learning to different groups of hospital patients. The patient groups as well as the learning topics were selected at the request of the cooperating pilot hospitals. In

Computer and Internet literacy

Computer and Internet literacy Publishing of e-portfolios

Personal development

Modern art and creativity

Employability and professional (re-) orientation

Job orientation

Health education

Maintenance of selfdependence

their diversity they highlight the diverse purChapter 4

poses learning can potentially have in the context of patient education. The unifying element of the seven pilots is informal learning, which, in the definition of the European Commission, takes place alongside the main-

stream systems of education and training and does not typically lead to formalised certifi-

Information management

Fig. 2: Learning topics of the eHospital pilots

cates. Informal learning may be provided in the workplace15 or in other new places of

The choice of topic depended on the patient

learning.

target group (age, health problem, back-

The eHospital pilots demonstrate that engag-

ground) and their particular needs. Other top-

ing in informal learning may have completely

ics might have been equally or even more

different purposes: Adult patients may want

suitable than others. Of course it was impos-

to learn more about their current state of

sible to identify one topic which suited all.

health and how they can improve it. But

Any group of hospital patients, even with a

health education is just one possible domain.

similar health problem and age, are (like

Personal development, the wish to use the

many groups of adult learners)very heteroge-

time in hospital to get to know a new area of

neous with regard to social, educational and

interest or to improve creative skills may be

professional backgrounds and corresponding

another. ICT competences which can be

learning needs and interests. Nevertheless the

applied in professional or personal contexts

programme developers aimed at focusing on a

may be developed. Or patients enhance com-

learning topic which had in some respect or

petences which improve their employability,

other explicit relevance to patients’ current

either in the job previously held or in the

situation.

search for a new one more appropriate to the changed health condition.

Not only the topics, also the patient target groups chosen – or, rather: pointed out by the cooperating hospital as the group preferred to participate in the pilot – cover a wide range in

15

A Memorandum on Lifelong Learning, SEC(2000) 1832.

36

terms of age (from adolescence to senior age) and health problem (from patients with men-

Chapter 4 Seven informal e-learning programmes piloted by eHospital

e-learning programme. Again, this helped to

and victims of accidents who suffered spine

promote the main issue of illustrating the

cord injuries.)

potential of computer-supported learning for

Some target groups were rather extreme for

diverse groups of hospital patients.

piloting e-learning, like Alzheimer’s patients

The seven eHospital pilots will be described

for whom it was already a learning achieve-

in more detail in the remainder of this chap-

ment to remember that they participated in an

ter: Chapter 4

tal problems to patients after brain surgery

Austria Age: 15–25 Health problem: Patients of neurooncology, neuropaediatrics, epilepsy, cardiology, cystic fibrosis, dialysis units Topic: Job perspectives Spain

France

Age: 18+ Health problem: Patients with spinal cord injuries Topic: Digital literacy: computers, office and the Internet

Age: 75+ Health problem: Elderly patients suffering from Alzheimer’s (Memory Cognitive Impairments), early stage Topic: Using computers and the Internet

eHospital patients target groups and course topics Germany Age: 20–60 Health problem: Diverse health problems Topic: Information management

Switzerland Age: 18–45 Health problem: Patients in soft psychiatric treatment (burn-out syndrome, behaviour trouble, anorexia ...)

Topic: The art of profiling in the web

Poland (Course 1) Age: 18–60+ Health problem: Patients of the psychogeriatric ward suffering from different mental disorders Topic: Significance of motion for maintaining self-dependence Poland (Course 2) Age: 45–60+ Health problem: Patients with advanced age and problems with movement Topic: Modern art

Fig. 3: Patient target groups addressed and e-learning topics selected

37

Chapter 4 Seven informal e-learning programmes piloted by eHospital

2. Austria: Job perspectives for young adult patients

Chapter 4

General information on pilot course

Period of delivery

11/2006 – 04/2007

Number of patients engaged in e-learning

18

Number of drop-outs

4

Reasons for drop-out

Health reasons (3) Unknown (1)

Average duration of course per patient

10 weeks

Number of face-to-face sessions delivered:

Individual sessions: 23 Group sessions: 0

Average e-learning hours (WBT + CBT) completed per patient:

15 h

Staff from education provider involved in the piloting

Total: 4 Trainers (face-to face): 2 Virtual tutors/facilitators: 1 Local project managers: 1 Technical staff: – Other: –

Hospital staff involved in the piloting

Total: 6 Medical doctors: 1 Nursing staff: – Psychologists: 5 Teachers of hospital school: – Administrative staff management: – Technical staff: – Other: –

Certification

None

Nature of patient target group

The patients targeted were young adults (15–25

Group of long-term patients in the following

years) with brain tumour, metabolic disorders,

units:

heart diseases or kidney problems (dialysis).

• Neuro-oncology

The treatment in hospital can take up to one

• Neuro-paediatrics /Epilepsy Monitoring

year, including periods of daytime treatment.

Unit

38

The course supported young adult patients

• Cardiology

with (re-) entering educational or professional

• Cystic Fibrosis

pathways after longer period of disruption due

• Dialysis

to severe illness.

Aims and objectives

Methodologies applied

The group was very heterogeneous as the

Blended learning seemed to be adequate for

patients had different medical and psycholog-

the target group so that is why face-to-face

ical needs. Some patients who have just

units took place regularly.

undergone brain surgery had deficiencies in

The hospital psychologists emphasized the

their ability to concentrate, and problems in

particular importance of personal face-to-face

learning and memory, so individual approach-

contact between learner and tutor. The expec-

es were needed. On the other hand the

tation was that it would be a challenge to

patients were expected to be highly motivated

keep the patients motivated for self-directed

to participate in the learning activities, as

learning between the face-to-face meetings.

they were very keen to explore new career

Group meetings were envisaged, although the

pathways.

patients’ needs and learning rate would differ

A job orientation course meets vital needs of

individually.

young adult patients who were forced to inter-

The learning relied very much on the face-to-

rupt their educational, vocational or profes-

face training and coaching sessions and on

sional career due to long-term hospitalisation.

the resulting personal relationship with the

In Austria and many other European coun-

trainer/coach. A pure e-learning approach

tries, hospital schools for children exist, but

would have been impossible to think of. The

there are no educational provisions beyond

face-to-face sessions had to be individual

the end of compulsory education. Thus, young

rather than group sessions due to different

adult patients are not sufficiently supported

times of starting the course, different health

at the crucial time of transition from school to

situations, and different learning aims etc.

Chapter 4

Chapter 4 Seven informal e-learning programmes piloted by eHospital

the labour market.

Achievements, obstacles and challenges Learning topics

Achievements

The course has eight modules with the follow-

More than three quarters of the participants

ing contents:

completed the course with positive results.

• Introduction to e-learning

This figure is a clear indication that the

• Job orientation

course content was relevant and motivating.

• Work and working life

The therefore important individual learning

• Individual aims and values • Strengths and challenges • Job application documents

aims, individual learning speed and individual learning intensity were agreed on between the patients and the course trainer. Through this approach it could be ensured that most

• Communication

patients had a sense of achievements within

• Presentation

the given time period. The obvious advantage

39

Chapter 4 Seven informal e-learning programmes piloted by eHospital

Chapter 4

Snapshots of the learning activities

Fig. 4: Video: Job interview

Fig. 5: Participant

was that access to the educational content

patients returned. In addition to this some of

was independent form time and space, a flex-

the participants lacked basic IT skills or at

ibility that highly suited the patients’ chang-

least familiarity with computers. For those

ing health and care requirements.

patients even the login into the learning plat-

Furthermore, e-learning also proved to be a

form was a barrier.

suitable approach because many participants

Some organisational challenges were posed

were interested in improving their IT skills.

by the nature of patients in hospital: Many of

Some participants without prior e-learning

them come and go, i.e. periods of hospitalisa-

experience appreciated a CD produced in

tion, treatment at home or as pay-care

another project. It gave an introduction into e-

patients alternate (Patients started the course

learning.

at different times, there were not always

The intensive and frequent communication

enough patients in the age group targeted by

increased considerably between project staff,

the project). These factors lead to the fact

patients and hospital staff involved when

that it was hard to predict the number of

existing hospital meetings were made use of.

patients involved in the e-learning activities at

At the weekly staff meeting the e-learning

a certain point of time. A lot of flexibility on

project was put on the agenda.

behalf of the organising team was needed.

Due to the change of location, the face-to-

Obstacles and challenges

40

face sessions were held only partially in the hospital.

The availability of technical infrastructure

The cooperation with the hospital staff was

sometimes posed challenges: Internet access

not formalised in a contract – this turned out

was not available in all sections of the hospi-

to be disadvantageous. In a large hospital

tal, nor in all homes to which some of the

with corresponding hierarchies and bureau-

Chapter 4 Seven informal e-learning programmes piloted by eHospital

cracy, some organisational matters like joint

developing a personal relationship between

press contacts were rather difficult and time-

patient and trainer should be planned.

consuming without a clear contractual basis.

• It is advisable to have a formal agreement (contract) with the hospital and not only

Lessons learnt

rely on personal contacts to some members

Educational aspects

of hospital staff. (Large) hospitals tend to be rather hierarchical and bureaucratic

patients should reflect the life situation of the patient group concerned. If there is a clear added value of the learning for the patients – like, in this case reflection and soft skills for the (re-) integration into the labour market, the learning offer is likely to be accepted by the target group.

• E-learning elements have a considerable benefit, since they allow independent learning for the patients whenever the hos-

organisations, which requires a top-down approach in some organisational matters.

• Intensive communication and exchange between trainers and hospital staff are

Chapter 4

• The topics of e-learning courses for hospital

vital. As the hospital staffs, often under high pressure, regular staff meetings and other existing communication structures should be used for the project instead of inventing additional forms of communication.

pital routine admits it. If, however, interactive virtual learning (peer-peer, learner-

Technical aspects

tutor) is intended, this requires a lot of time

• The facilitation team should make sure that

and energy to get it going. Interaction will

the participants have the basic computer

probably be intensive only if there is a clear

skills because it could really be a barrier

communication need (e.g. follow-up learn-

and cause considerable frustration and loss

ing groups who have met face-to-face) or

of (e-)learning time.

familiarity with the online trainer.

Organisational aspects • The personal contact to the trainer is indispensable. Enough face-to face sessions for

Contact and further information on the Austrian pilot Stefan Kremser: s.kremser@dieberater.com

41

Chapter 4 Seven informal e-learning programmes piloted by eHospital

3. Spain: Digital literacy: Computers, office and the Internet

Chapter 4

General information on the pilot course

Period of delivery

10/2006 – 07/2007

Number of patients engaged in e-learning

13

Number of drop-outs

3

Reasons for drop-out

Transfer to another hospital in a different city, lack of cooperation between the two hospitals Inappropriate profile of participants

Number of face-to-face sessions delivered:

Group sessions: 21

Average e-learning hours (WBT + CBT) completed per patient:

60 h up to 70 h Calculation method: hours in face-to-face sessions +1 hour average per week autonomousonline work

Staff from education provider involved in the piloting

Total: 24 Trainers (face-to-face, content designers): 7 Virtual tutors/facilitators: 9 Local project managers: 2 Technical staff: 5 Other: Psychologists: 1

Hospital staff involved in the piloting

Total: 6 Medical doctors: 2 Nursing staff: 1 Technical staff: 3 Psychologists: – Other: –

Certification

Official certificate from University of Santiago de Compostela

Nature of patient target group

42

The patient target group were patients

Aims and objectives

between the ages of 18–30 with spinal cord

Training in basic ICT skills is very adequate to

injuries. Many of them are restricted in their

the life situation of these patients, as they

mobility because of an accident (motor bik-

increase

ers) and have lasting impairments that force

patients will be forced to look for a new job

them to change their career plans.

because of reduced mobility.

patients’

employability.

Many

Chapter 4 Seven informal e-learning programmes piloted by eHospital

targeted patients to endure isolation by using

• Introduction to Internet: Web browsing and e-mail

the network as a leisure space. Acquiring

• Information search engines

basic skills in ICT and using Internet as a

• Communication Tools: synchronous and

leisure place can improve the chance to

asynchronous

access the labour market. The courses were

• Office Tools

designed to motivate the patients for studying

• Internet administrative services: e-govern-

through the e-learning process and to provide

ment

them basic contents in learning management

• Ergonomics at the work place

systems.

• The network as leisure space

Specific objectives of the course were:

• Information technologies and the labour

• Help to endure the isolation using the net-

Chapter 4

The main issue of the sessions was to help the

market.

work as a leisure space.

• Provide basic training in ICT skills.

Methodologies applied

• Introduce the patients to e-learning activities.

• Motivate the patients to study by e-learning.

• Provide basic training in learning managements systems.

• Learn to use Internet navigation and e-mail.

• Learn to use search engines.

• Learn to use online communication tools • Learn to use word processor, spreadsheets, database management programmes.

• Know Internet administrative services.

• Basic knowledge about ergonomics in their workplaces.

• Learn to use Internet as a leisure space.

• Improve their chances to access labour market.

The methodology of this course was blended learning with a face-to-face component. In the first month, two tutors introduced the subject, helped with hardware and software and provided tutoring to the students. Then, face-to-face tutoring was provided once every two weeks. Complementary, a daily schedule (6 days a week, two hours a day afternoon – evening) was established to provide flexible online tutoring, by using Yahoo Instant Messenger.

Face-to-face tutoring was given in either small groups or individually.

Some accessibility software and hardware were used to guarantee an access to all students: a virtual mouse, virtual keyboard, accessibility software to facilitate both the use of laptop keyboard and mouse for those

Learning topics

students who had difficulties or the impossi-

The e-learning programme has modules with

bility to move their hands.

the following content:

Although all the material was published

• Introduction to computers

online, some handouts were given to the stu-

• Learning in a virtual campus

dents.

43

Chapter 4 Seven informal e-learning programmes piloted by eHospital

Achievements, obstacles and challenges

Chapter 4

Achievements

Moreover, patients had online access free of charge and even adapted hardware equipment.

The hospital staff was open-minded for the

As doctors play a fundamental role in identi-

pilot because in their opinion e-learning could

fying, motivating and enrolling patients in the

be very good for the patients who stay for a

learning, the scheduling of the training ses-

long period at hospital. During the course the

sions (both e-learning and face to face ses-

patients took advantage of the great flexibility

sions) was defined by the doctors and nurses

in learning time and location. Canalejo

to not interfere with patients’ daily activities

Hospital provided WIFI Internet access and

(training integration in daily routines as one

one laptop or tablet PC for each patient.

activity more for the patient).

Snapshots of the learning activities

Fig. 6: Course homepage

Fig. 8: Discussion forum Fig. 7: Course topics

44

Chapter 4 Seven informal e-learning programmes piloted by eHospital

In Canalejo Hospital there were hardly any barriers for introducing e-learning activities, maybe because the hospital had already tried to introduce it about six years ago.

The learning methodology combined face-toface sessions with virtual sessions for assessment, tutoring, etc. Although the face-to-face sessions were always successful, virtual meetings were doing well for individual tutoring,

In many cases these skills have to be acquired in a pre-training (digital literacy standards as reference) before the actual elearning can start.

• A clear definition of the communication channels is necessary for effective use.

Communication, including periodical faceto-face meetings is essential to keep close contact with the responsible people in the hospital.

but failed in group learning.

Chapter 4

Obstacles

Technical aspects

Lessons learnt Educational aspects

• If needed, specifically designed software for people with special needs has to be offered (voice recognizers, mouse move-

• Characteristics and needs for every patient have to be analysed in order to select and assign hardware and software suitable for each case. Technical needs are very different for each case (it would be desirable to personalize technical resources).

• Frequent face-to-face sessions (both group and individual) are necessary to give sup-

ment emulators, screen amplifiers etc.).

Computers for non-disabled people would also facilitate the work.

• Mobile devices (such as laptops or tablet PCs) are much better for students in hospitals, as they can be used for learning everywhere and enable patients who cannot move form their beds to participate.

port, technical and tutoring, although blended solutions are very adequate for these types of students.

• The learning contents should be structured to form short modules. Thus it can be assured that patients will have some sort of

Contact and further information on the

achievement.

Spanish pilot María José Rodríguez Malmierca:

Organisational aspects • E-learning programmes in hospitals require that patients have some basic digital skills.

mjrm@cesga.es Carmen Fernández Morante: trek1671@usc.es

45

Chapter 4 Seven informal e-learning programmes piloted by eHospital

4. France: How to use a computer and the Internet

Chapter 4

General information on the pilot course

Period of delivery

12/2006 – 04/2007

Number of patients engaged in e-learning

15

Number of drop-outs

3

Reasons for drop-out

Health reasons (3)

Average duration of course per patient

4 months

Number of face-to-face sessions delivered:

Individual sessions: 120 Group sessions: 0

Average e-learning hours (WBT + CBT) completed per patient:

60–70 h

Staff from education provider involved in the piloting

Total: 3 Trainers (face-to face): – Virtual tutors/facilitators: 1 Local project managers: 2 Technical staff: – Other: –

Hospital staff involved in the piloting

Total: 3 Medical doctors: 1 Nursing staff: – Psychologists: 1 Teachers of hospital school: – Administrative staff management: – Technical staff: – Other: 1 (director of the centre)

Certification

None

Nature of patient target group A group of 15 patients suffering from Alzheimer’s Disease (AD) and related illnesses with memory troubles, attention and execution problems presented the patient target group.

• Syndrome disexecutive: destroyed shortterm memory.

46

• Specific problem of this stage of the AD: patients cannot learn by themselves, difficulties to succeed and achieve complex tasks.

• Patients need permanent assistance from a supervisor to initiate the learning process, repeat information and guide the person.

Chapter 4 Seven informal e-learning programmes piloted by eHospital

These illnesses involve problems like remem-

• How to write documents with a computer

bering some memories (especially recent

• How to use the Internet

ones), concentrating (visible with substruc-

• How to find information in the Internet

tion exercises), implementing complex tasks

• How to send an e-mail message

(need to be accompanied), affective problems

Aims and objectives

Methodologies applied The methodology of this leaning programme was blended learning, a combination of

In the advanced stage of the Alzheimer’s

e-learning and face-to-face training. In the

Disease and other related illnesses, the

particular case of Alzheimer’s patients, how-

patients are not able to use new information to

ever, a special kind of e-learning was neces-

go on in learning activities. This would oblige

sary: a tutor was necessary in order to help the

them to use memory, attention, executive

patients to wok with the computer.

functions and proxy. But at the early stage of

The main pedagogical issue was to stimulate

AD, depending on their knowledge and experi-

memory using constant repetition in good

ence, patients with only a small cognitive

emotional conditions.

impairment can learn and remember the new

For this target group it was important to spend

information easily under the condition that

a lot of time on explaining and repeating the

they are technically well coached and that they

learnt contents. In this way, it was possible to

get psychological support with experienced

stimulate the patient’s motivation. Only if the

professionals during the learning activities.

patient felt secure activity with the mouse,

The use of new technologies appears as a

the keyboard and the monitor could take

benefit for the patients to remain active in

place.

Chapter 4

and dealing with financial questions.

the society (especially in regards to the new demographic statistics about ageing).

Achievements, obstacles and challenges

In case of success, the advantage for these

Achievements

patients (delocalised and de-motivated) was to teach them how to communicate with their

Because of the illness the patients learnt

relatives per e-mail and to be informed

every time as if it was the first time. So they

through Internet access. Thus, they got more

could reproduce and got the profit from the

motivation and cognitive stimulation, which

task even if they did not memorise the task in

were the key-issues of the courses.

a long-term sense.

The essential issue was that the patients did not

Learning topics

give up the access to knowledge and that there was enough pleasure to communicate with

The course was formed by 4 modules, with

another person. In case the patients wanted to

the following content:

give up another way had to be searched for

47

Chapter 4 Seven informal e-learning programmes piloted by eHospital

Chapter 4

Snapshots of the learning activities

Fig.10: Game to learn the use of the mouse Fig. 9: Learning content: Use of Internet

Fig.10: Game to learn the use of the mouse

quickly to keep the access to relation open. This was linked to the notion of social relation. A social relation is creative when it appeals the subject himself. This is our conception of care:

Fig. 11: Trainer and patient

to develop such a relationship with patients.

The MUEVE software was used during the

48

Obstacles and challenges

whole session. This tool was very efficient to

The main problems were of a technical

relax the patients, entertain them and thus to

nature. The patients had difficulties while

make them more secure. All these solutions

using the keyboard and the mouse (here espe-

enabled the use of Google to search for infor-

cially the double click). Another problem was

mation, to navigate on the Web and to build a

the platform itself: It was difficult for the

short message for sending via e-mail.

patients to understand what a platform was

Chapter 4 Seven informal e-learning programmes piloted by eHospital

and how to move inside it. Active support was

• Patients have to feel confident and at ease

a pre-requisite so that the patients felt more

to avoid any kind of stress or failure risk.

secure because the technical and specialized why five people gave up).

Organisational aspects • A supervisor (if possible a doctor) is re-

The technical vocabulary turned out to be too

quired throughout the session’s duration. It

unclear or baffling for the patients. It was

enables tailor-made support for each

replaced by everyday language so that the

patient.

terms sounded more familiar to the patients.

It was required to always have a supervisor for initiating the work and for building the “signs or indications” process that will help the person to remember. The patients were not able to go through the learning process on their

Technical aspects

Chapter 4

language was too complex for them. (That was

• It is essential to define the technical requirements for these patients and to choose the most suitable ergonomic options.

own.

Lessons learnt Educational aspects

Contact and further information on the French pilot

• Any kind of software or tool enabling an entertainment and relaxing context is good

Marie-Claude Esculier: mc.esculier@wanadoo.fr

to facilitate the patient to feel secure.

49

Chapter 4 Seven informal e-learning programmes piloted by eHospital

5. Poland: Creative workshops and history of art

Chapter 4

General information on the pilot course

Period of delivery

06 – 07/2007

Number of patients engaged in e-learning

12

Number of drop-outs

2

Reasons for drop-out

Health problems Change of treatment centre

Average duration of course per patient

2 weeks

Number of face-to-face sessions delivered:

Individual sessions: 0 Group sessions: 8

Average e-learning hours (WBT + CBT) completed per patient:

19 h

Staff from education provider involved in the piloting

Total: 3 Trainers (face-to face): 1 Virtual tutors/facilitators: 1 Local project managers: 1 Technical staff: – Other: –

Hospital staff involved in the piloting

Total: 2 Medical doctors: 1 Nursing staff: Psychologists: – Teachers of hospital school: – Administrative staff management: – Technical staff: – Other: 1 (director of the centre)

Certification

Certificate issued by Academy of Management

Nature of patient target group The target group of the programme were patients of the 1st Psychiatric Clinic of the

50

which is the stage of stabilisation of mental condition for people with temporary mental problems.

Central Clinic Hospital (Centralny Szpital

Participants of the training suffered from

Kliniczny – CSK) in ´L ´ ódz´. They were staying at

schizophrenia, clinical depression, nervous

the Psychotic Disorders Ward at the time,

collapse etc.

Chapter 4 Seven informal e-learning programmes piloted by eHospital

Aims and objectives The basic idea of the course was to teach art in a funny and relaxing way in order to awaken creative abilities, to stimulate imagination

The focus of the course was set on the introduction of selected concepts from art history.

Apart from this another concept was to present new plastic art techniques.

creative action.

Learning topics

Teaching of the history of art and artistic cre-

The course consists of the following contents:

ativity is part of the medical treatment called

• Abstract expressionism

art therapy. It is widely understood that art

• Technique frottage and Max Ernst

gives an opportunity to symbolically express

• Collage techniques

difficult experiences and emotions in safe

• Assemblage techniques

conditions, without speaking ‘straight’. It

• Environment Art

releases tension and helps to define prob-

• Opart

lems. By means of individual meetings and

• Installations techniques

group workshops it is possible to establish

• Interactive art

new and different contacts as well as to learn

• Abstract geometric composition-suprema-

to express ideas and experiences confidently.

Chapter 4

and to motivate participants to get engaged in

tism

The purpose of the art-therapeutical activities is to understand every day problems, improve

Methodologies applied

their expression, interpretation and the development of personality. Remedial function of art allows one to step beyond their own perspective and improve the quality of life.

The lectures were shown in a slideshow. The art workshops included visualisation, brainstorming and discussions.

While using the Internet the patients learnt how to take part in interactive quizzes, do

Snapshots of the learning activities

exercises and use e-mail.

The knowledge acquired during lectures was assessed. The second stage included interaction with the computer: Here the participants had to apply the new knowledge on interactive exercises and quizzes.

Contact and further information on the Polish courses Joanna Szczecin´ska: Fig. 12: Course content: art

jszczecinska@swspiz.pl

51

Chapter 4 Seven informal e-learning programmes piloted by eHospital

6. Poland: Significance of motion for maintaining self-dependence

Chapter 4

General information on the pilot course

Period of delivery

05 – 06/2007

Number of patients engaged in e-learning

10

Number of drop-outs

1

Reasons for drop-out

Health problems Change of treatment centre

Average duration of course per patient

2 weeks

Number of face-to-face sessions delivered:

Individual sessions: 0 Group sessions: 15

Average e-learning hours (WBT + CBT) completed per patient:

19 h

Staff from education provider involved in the piloting

Total: 3 Trainers (face-to face): 1 Virtual tutors/facilitators: 1 Local project managers: 1 Technical staff: – Other: –

Hospital staff involved in the piloting

Total: – Medical doctors: – Nursing staff: – Psychologists: – Teachers of hospital school: Administrative staff management: – Technical staff: – Other: –

Certification

Certificate issued by Academy of Management

Nature of patient target group The patients of the course were elderly peo-

chotic and mood disorders) without any clear health limitation.

ple(about 60 years and older) of the Psychogeriatric Ward and Psychiatric Clinic of

52

Aims and objectives

the Central Clinic Hospital (Centralny Szpital

The purpose of this course was to explain to

Kliniczny – CSK). These patients were suffer-

patients how to keep a good physical condi-

ing from different mental disorders (e.g. psy-

tion on the one hand, this included knowledge

Chapter 4 Seven informal e-learning programmes piloted by eHospital

about safe and useful physical exercises, on

• Using relaxation techniques

the other hand, patients learnt how to devel-

• Breathing exercises as part of fighting

op their self-esteem.

stress

In the third age self-esteem is build on independence. If the elder person can walk and do

Methodologies applied

their shopping, and manage their home, then and meaningful life is still possible. But independence requires good physical health at this age, which can be preserved through adequate physical exercise.

Physical activity can enable the improvement of the state of mind, raise agility and maintain

In the face-to face sessions the active methods reached from brainstorming, snowball method, group discussions, case study, calling experience, self-description and self-evaluation to visualisation. Additional to this kinetic and integration-kinetic activities were used.

good health and self-dependence. Therefore it

During the use of Internet the patients got in

is essential to deepen the awareness of one-

touch with (interactive) content material (e.g.

self as the ’main creator of one’s health’, thus

case study), Internet message boards related

raising the consciousness of health control.

to the content and tests. The participants

The aim was to motivate for regular kinetic activities and to help elderly patients to plan

Chapter 4

meeting with friends to lead an independent

learnt to submit their own activity programme to a given e-mail address, too.

their own kinetic activity. The contents were

After the first half of the course the partici-

transferred by different useful forms of kinet-

pants took a test checking to what extent they

ic activity (e.g. breathing exercises, aerobic

acquired the basic knowledge concerning

exercises) as well as relaxation methods

kinetic activity, while at the end of the course,

(Jacobson’s muscle relaxation method).

they prepared an individual program of kinetic activity to realise on their own.

Learning topics The learning programme contains the follow-

Achievements, obstacles and challenges (both Polish courses)

ing subject matters: • Physical Exercises – Introduction • Role of the physical activity in elderly lifecase studies • Influence of the physical activity on health and psychical comfort

Achievements The balance between theory and practice but also between education and fun was very satisfying. It confirmed that of the suitability of the course content.

• Form of the physical activities

To use the potential of computer technology

• Rules of safe physical activity

for learning at hospitals and adequate e-learn-

• Why people do not exercises- doubts, rea-

ing and face-to face methodologies was a big

sons and attitudes

effort. Although it is has to be emphasized

53

Chapter 4 Seven informal e-learning programmes piloted by eHospital

that the face-to-face sessions were absolutely

Lessons learnt

necessary for explaining how to use the equip-

Educational aspects

ment and helping the group to overcome technical problems.

In the course on art and creativity the main issue was to maintain the learners’ attention.

Therefore the diversity of educational tools Chapter 4

and case studies as well as the other elements enabled the learners to feel cared for.

Obstacles and challenges Overall, it was quite a challenge to implement an e-learning course with a group of elderly patients. The group was not familiar with ICT tools, computers or even basic IT definitions.

So before starting the training a short introduction on how to use the computer and Internet was done (2 days). Technical support was also available in the teaching room during the training.

• It is crucial to employ trainers who are particularly skilled in communication. Intense communication between the trainer and the patient is important because the patients have to feel comfortable and trust in the trainer.

Organisational aspects • Access to computers and the Internet was not easy and without the capacity of Academy of Management to provide the equipment the courses would not have been possible. So it is essential that the training organisation checks the availability of technical infrastructure far in advance.

Technical aspects

It was useful to visualise the exercises on the

• Because of technical problems with the

big screen. First of all it was build the educa-

implementation of the Polish language ver-

tional community between participants.

sion the Dokeos platform could not be

Participants could help and correct them-

used. Instead of this, a Moodle-based plat-

selves during exercises in the group (like aer-

form was in use.

obic). Secondly, it was better to see the position of physical exercises in the larger size then PC monitor.

Another obstacle was the fact that the hospital was not equipped with computers. To make the learning activities possible it was necessary that Academy of Management provided the PCs.

54

Contact and further information on the Polish course Joanna Szczecin´ska: jszczecinska@swspiz.pl

Chapter 4 Seven informal e-learning programmes piloted by eHospital

7. Germany: Information management

Period of delivery

01 – 06/2007

Number of patients engaged in e-learning

12

Number of drop-outs

0

Reasons for drop-out

–

Average duration of course per patient

3 weeks

Number of face-to-face sessions delivered:

Individual sessions: 9 sessions, 2 hours each Group sessions: 6 sessions, 2 hours each

Average e-learning hours (WBT + CBT) completed per patient:

35 h

Staff from education provider involved in the piloting

Total: 2 Trainers (face-to face): 1 Virtual tutors/facilitators: Local project managers: 1 Technical staff: Other: –

Hospital staff involved in the piloting

Total: 1 Medical doctors: – Nursing staff: – Psychologists: – Teachers of hospital school: – Administrative staff management: 1 Technical staff: – Other: –

Certification

bsw – certificate of participation

Nature of patient target group

preparation, freelancers, job movers, and

The content of the courses offered within the

prospective users of software such as content

eHospital project by bsw is aligned with pro-

management software, customer relationship

fessional needs in the job. The target group

management systems (CRM), collaboration

addressed consisted of managers from lower

software, or knowledge management software

and middle management, trainees in job

systems. As information and knowledge man-

Chapter 4

General information on the pilot course

55

Chapter 4 Seven informal e-learning programmes piloted by eHospital

agement has become the core of communica-

The topics of the six training sub-modules

tion guidelines in modern competitive enter-

are:

prises, the chosen subject for the course met

(1) Introduction (The value of information)

the needs of the patients.

(2) Target Definition (What is the aim of an

Chapter 4

The health problems the patients suffered

information management system)

from range from mental diseases such as

(3) Analysis of workflow process and informa-

burn-out syndrome, to physical problems or

tion chains (How to analyse the informa-

injuries such as back trauma, up to lung prob-

tion flow?)

lems (as a consequence of poor nutrition).

(4) Modelling (How to evaluate the results of

The offer was seen by the patients as a moti-

the analysis stage. How to put them into

vational add-on to better cope with the stay in

a model)

hospital and to speed-up and foster the health recovery process.

(5) Realisation and implementation (Conditions and steps of implementation) (6) From information management to knowl-

Aims and objectives The main aim of the course is to enhance patients’ competences of intoducing and maintaining an information management sys-

ment of systems)

Methodologies applied

tem in their companies. Thus, the time at

The course layout was based on experiences

hospital is used to develop professional com-

gathered in the past and was adjusted to both

petences which can be used in many con-

the hospital facilities and capacity, and to the

texts.

patients needs. The whole course covered

The participants familiarize themselves with

approximately 70 units, whereby 30 to 35

the with the following core questions:

units, depending on the patients learning

• How to handle information?

progress were run as face-to-face sessions.

• How to filter information?

The remaining learning units were organised

• How to keep information?

• How to structure information?

Learning topics

56

edge management (lessons on improve-

by the patients themselves, when and how intensively as they wished. The face-to-face sessions were subdivided in individual and in group sessions.

The course itself was opened with a kick-off

The e-learning course consists of one training

group session in which the learners and the

module (72 h) and one examination module

hospital staff were introduced into the basic

(6 h) in which patients are asked to do a case

principles of e-learning, blended learning, the

study (description of the steps of the imple-

organisation of the course, the methodology

mentation of a information management sys-

applied, the aim of the course, the learning

tem in the example of a fictive company).

path, the structure of the course ware and last

Chapter 4 Seven informal e-learning programmes piloted by eHospital

but not least the handling of the virtual learn-

SCORM standard, which means existing

ing environment.

free content can be directly imported and

The course had to be carried through as an

enlarges herewith the variety of courses

off-line course as the bandwidth of the hospi-

that can be offered by the hospital and can

tal’s internet access did not allow use of mul-

attract a wider public and larger group of

timedia based web content such as video

interested patients.

on a specially prepared intranet server hosting the virtual classroom.

Obstacles and challenges • A crucial point is the place of learning. It is

Achievements, obstacles and challenges

not good to learn in a room where they are

Achievements

other patients. Some might feel disturbed

• The motivation of participants was high as

by the sound of the multimedia content.

the learning path/curve was clearly defined.

• It was also hard to find enough patients

The chosen methodology (blended learning

who were really interested in the education-

with a 50/50 ratio of virtual and face-to-

al aspects and of the provided content

face elements) was suitable.

itself. Some felt under pressure just like in

• The patients themselves delivered suitable

Chapter 4

streams. For this reason the course-ware ran

school.

proposals for the course structure in the

• A crucial point was to find the right trainer.

future, and gave valuable advice concern-

Ordinary trainers who are not prepared for

ing possible content.

the target group do not run the course inter-

• The selection of Dokeos was a brilliant

actively enough, they more or less simply

choice as it is built according to the

provide knowledge (from the evaluation: THEY TRY TO TEACH!!). This turned out to

Snapshots of the learning activities

be a decisive factor for patients’ motivation. Patients want edutainment.

• The use of wireless technology was forbidden due to radiation. Only in some special areas and only for special patients who didn’t belong to a so-called risk group (e.g. suffering from heart diseases, heart flickering) was it possible to set up work places.

Another problem was the bandwidth in the initial trial of running the course, it was too low. E.g. multimedia content such as video

Fig. 13: Patient and trainer

streams were transmitted in a bad quality.

57

Chapter 4 Seven informal e-learning programmes piloted by eHospital

Lessons learnt Educational aspects

be intense. The formation of an e-learning team consisting of members of the hospital staff, the training provider and if applicable

• First, more content must be produced. The

of prospective sponsors is a fruitful

content should not only cover professional

approach to support the sustainability of

topics, but areas of the daily ordinary life

this new way of learning as a part of the life

should be provided. Areas which interest

long learning process.

Chapter 4

many patients are sports, hobbies, travel, languages, and foreign cultures. For this

Technical aspects

reason the content should be clustered, aligned to the patients’ interests and provided.

• It is essential to provide an extra class room. Having a sponsor for the equipment

• Second, the content should be designed

and the connectivity costs would be per-

with many opportunities of interaction,

fect, as it turned out the cost factor was

using all kind of communication channels,

underestimated (direct cost for the hard-

especially up-to-date information should be

ware and the line). Furthermore, it would

provided. Therefore the trainers are respon-

be much better to have a separate network

sible for regular content checks.

with direct Internet access, as herewith the access to content provided in the Internet

Organisational aspects

is given, and especially when it comes to maintenance questions (hardware, soft-

• Concerning the training schedule the number of learning hours should be reduced, as it quite often interfered with by the doctor’s visits and the time when the patients get visits from relatives or friends. The best time seems to be between 14.30 and 16.00.

ware) this work can be done much quicker.

• As a substitute solution for the connectivity problems an offline, locally operating network was installed. On the offline server an instance of the virtual learning environment was running. So also the (a) security and (b) costs concerns were met. For (a) there

• Regarding the recruitment of the patients it

was no interference or link to the hospital

would be good if the hospital management

network and no link outside from where

would implement the offer of e-learning

possible threats could come such as virus-

courses into their service catalogue. In this

es, Trojans etc.

case the patients can inform themselves about the additional services of the hospitals provides before choosing the hospital where they will get their treatment.

• Cooperation between the training provider and the management of the hospital should

58

Contact and further information on the German course Uwe Hoppe uwe.hoppe@bsw-mail.de

Chapter 4 Seven informal e-learning programmes piloted by eHospital

8. Switzerland: The art of profiling on the web

Period of delivery

06 – 10/2007

Number of patients engaged in e-learning

11

Number of drop-outs

1

Reasons for drop-out

Emotional instability

Average duration of course per patient

6 weeks

Number of face-to-face sessions delivered:

Individual sessions: 8 Group sessions: 8

Average e-learning hours (WBT + CBT) completed per patient:

20 h

Staff from education provider involved in the piloting

Total: 3 Trainers (face-to face): 1 (pedagogical coach) Virtual tutors/facilitators: – Local project managers: – Technical staff: – Other: 1 project manager – 1 president

Hospital staff involved in the piloting

Total: 5 Medical doctors: 2 Nursing staff: – Psychologists – Teachers of hospital school: 1 Administrative staff management: 1 Technical staff: 1 Other: –

Certification

e-culture certificate level 1 (e-portfolio)

Nature of patient target group

Chapter 4

General information on the pilot course

develop abilities in social relationships as well as their self-esteem.

The patient target group consisted of women and men between the ages of 18 to 45 years.

Aims and objectives

These people, who were selected by hospital

As the patients already decided voluntarily to

psychologists, were located in soft psychiatric

receive treatment, they are globally motivated

treatment as they were suffering from anorex-

for personal development.

ia, behavioural problems or burn-out syn-

The main issues of the sessions were to adopt

drome. Patients of the target group needed to

new practices in lifelong learning and to feel

59

Chapter 4 Seven informal e-learning programmes piloted by eHospital

integrated into an informal society. Apart from those patients who participated in the piloting were reducing the digital gap with their relatives, friends and colleagues as some of them rarely had used a computer before the eHospital training. In this way, the participants built a capacity in self-promotion on the Chapter 4

web to reinsert themselves in social and professional life.

Methodologies applied The main method of this course was blended learning, a combination of individual assessment of competences, collective training (face-to-face) and online training on the elearning platform.

Each participant received an ECO-PC which is an economical, ecological, ethical, confidential and practical USB key. It contains person-

With the idea of individualising the learning

al applications and documents of its owner

effect, trainers organized private lessons with

and can be used with any PC (home, office,

each participant aiming to produce an initial

laptop, Internet cafe etc.)

diagnostic and define specific needs.

Achievements, obstacles and challenges Learning topics The programme called The Art of Profiling on

the Web consists of the following four learning topics:

The main output was a series of e-portfolios.

Their volume and quality depended on the motivation and pleasure of the participants.

• Identifying the Internet

Sustainability has been accomplished: the

• Publication on the web

same course will be implamentnted again by

• Writing one´s personal site (e-portfolio)

the hospital. The hospital’s occupational ther-

• Legal and confidential aspects of the Inter-

apist will be trained in order to build up the

net

Snapshots of the learning activities

Fig. 14: Pages of the e-portfolio (website)

60

Achievements

know-how within the hospital institution.

The eHospital experience will be capitalized

hospital staff present the learning pro-

with the partner hospital in an adult master

gramme to them.

level training programme. The e-learning pro-

• The occupational therapist and other hospi-

gramme will be presented to students as well

tal staff should be incorporated in each

as teacher and the hospital covers all expens-

step of the process for validating the prac-

es for this regular training eHospital pro-

tical feasibility in terms of schedules, tools,

gramme from their own budget.

motivating of patients, etc.

Obstacles and challenges Some of the participants lacked basic IT skills or at least familiarity with computers. For those patients even the log-in into the learning platform could be a barrier but most participants managed to use DOKEOS with the help of a short, explanatory user manual.

Organisational aspects • Concerning the organisation of e-learning

Chapter 4

Chapter 4 Seven informal e-learning programmes piloted by eHospital

courses full cooperation with the management of the hospital is important.

• The intensity and frequency of communication with the hospital staff involved increased considerably when the e-learning project was put on the agenda of the week-

The main challenge was to motivate the hos-

ly staff meetings.

pital staff to inform the patients about the elearning opportunity. The hospital contact personel had an immense work load and were

Technical aspects

under tremendous mental stress, since many

• For a well working course, good cooperation

patients were in a critical state of health there

with the computer staff of the hospital is

were communication problems and long wait-

vital.

ing periods in organisational matters.

An occupational therapist gave the training after receiving a training ba a trainer. In this

• Regular technical and organisational support during the course is vital for the success of any e-learning activity in hospitals.

context, co-workers of this therapist unfortunately did not have a lot of time for the followup of the eHospital programme. Consequently, some patients missed a few training sessions.

Lessons learnt Educational aspects • It is important to convince patients individually by talking to them or by having the

Contact and further information on the Swiss course Théo Bondolfi: move@cooperation.net

61

Chapter 5 Life in hospitals

framework of statuses, roles and controls

Chapter 5 Life in hospitals

which orders the lives of the people who work within it.16

Beatriz Cebreiro López, Carmen Fernández

Historically, the institution hospital has gone

Morante, Marie-Claude Esculier, Elisabeth

through an upward socialisation process: from

Frankus, Stefan Kremser, Corinna Reisner

the asylum for the poor to the widely acknowledged centre of medical treatment in the

Informal e-learning in hospitals differs sub-

Chapter 5

stantially from other contexts of education.

This difference is to do both with the setting in which takes place, the hospital, as well as with the recipients of the learning, the patients.

These variables are in some cases of an objective nature, which have to do with organ-

present. Nowadays hospitals are generally understood as enterprises providing personal services, where efficiency means to ensure high-quality medical service with the available resources17,18,19. This service-orientation entails a new view of the patient as customer.

The patient/customer normally goes through this process chain:

isational conditions and mark the day to day life in hospital .Others are of a more subjec-

Care

tive kind which have to do with the experience

Admission

of illness, with its emotional impact on the

Diagnosis

Discharge Therapy

patient concerned, and with the support on which patients can count to succeed in the

Fig. 1: Basic patient processes in hospital

learning process.

It is crucial that the whole process of teaching

A hospital is a health service institution which

and learning be subordinate to the specifics of

offers diagnosis, therapy, care, and isolation

hospital life, which should be present when

of their patients to their own benefit and to

designing the learning offer as well as when

that of the society at large.

putting it into practice.

16

1. Structural characteristics of a hospital There is an enormous amount of writing about hospitals, of a polemic, apologetic, fact-finding, problem-solving, or pedagogic nature, but none which studies the way in which the institution provides a social

62

Smith, Harvey L. (1944). The Sociological Study of Hospitals. Chicago 17 Rohde, Johann Jürgen (1974). Soziologie des Krankenhauses. Zur Einführung in die Soziologie der Medizin. Stuttgart 18 Eichhorn, S. (1975). Krankenhausbetriebslehre.

Theorie und Praxis des Krankenhausbetriebes. Bd.1.

Stuttgart 19 Eichhorn, S. (1987). Krankenhausbetriebslehre. Bd. 3. Theorie und Praxis der Krankenhaus-Leistungsrechnung. Köln

Chapter 5 Life in hospitals

These four substantial purposes of the hospi-

the care aspect. Part of this role is to give

tal result in two general fundamental circles,

emotional support to the patients, whereby at

the medical and the nursing function circle. A

the same moment the nurse has to remain

third function circle which includes the man-

emotionally neutral. The execution of various

agement tasks makes sure that the material

administrative tasks belongs likewise to the

and organisational conditions that are needed

areas of activities of a nurse.

for the first function circles are given to satis-

The main task of the management function cir-

20:

fy the institutional needs

cle is to ensure the existence of the institution, its equipment as well as the material and staff infrastructure. The management funcNursing function circle

tions can be differentiated into four groups: 1) administrative-personnel tasks 2) administrative-material tasks 3) operational-personnel tasks

Patient

Chapter 5

Medical function circle

4) operational-material tasks

Norms shared by the Three circles

Management circle

Medical Function Circle

Nursing Function Circle Management Function Circle

Fig. 2: Hospital function circles Fig. 3: Overlapping of the three hospital function circles

The three function circles roughly correspond with professional groups which cooperate for the benefit of the patients.

The medical function circle covers the medical staff, above all the various specialised medical doctors. It is responsible for diagnostic and therapeutic services of the healthcare institution.

The nursing function circle consists of the nursing staff. The nurse has to satisfy the basic needs of patients and is responsible for

While in theory these three functions can clearly be distinguished from each other, there is also considerable overlapping between the three sectors: A nurse, for instance, also has to do a considerable amount of administrative work: There are sometimes tensions between the three professional groups as a result of differing norms and aims related to their function, and, of power struggles.

Hospitals are hierarchical organisations, as a traditional representation of five different sta-

20

Rohde, Johann J端rgen (1974). Soziologie des Krankenhauses. Zur Einf端hrung in die Soziologie der Medizin. Stuttgart

tus groups within each of the three professional circles demonstrates:

63

Chapter 5 Life in hospitals

Status

Medical Function Circle

Nursing Function Circle

Management Function Circle

I

Medical Director, Chief Physician, Deputy

Hospital Matron, Nursing Sister (Head nurse)

Administrative Director

II

Ward Physician, Intern

Nursing Sister, Trainer of Nurses, Surgical Nurse, Staff Nurse

Deputy Director, Chief Superintendent, Superintendent

III

Medical Assistant, Clinic Clerk, Assistant medical technician

Nurse

Accountant General, Secretary, Technical Supervision

Assistent Nurse, Nursing Student

Office staff, Mechanic, Cook, Driver

Chapter 5

IV

V

Porter, Messenger, Nonskilled worker

Fig. 4: Status relations of different professional groups in hospital21

The structural and social conditions in the

instead of the object of medical treatment

health system have been transforming in the

and care. Other factors that are currently

past years. We already mentioned the new

determining the health sector are described in

perspective on the patient as customer

a recent PHD thesis:22

■

■ ■

Demographic and epidemiological development Change of patient structure due to elderly patients, long-term patients, multimorbidity Technological development Medical technology: new possibilities for diagnosis and treatment ICT: Potential for innovation and economisation

■ ■

Changing values and demands Patients as customers Demands of staff on the quality of their work

■ ■

Legal framework and growing competition Priority of cost efficiency and reduction Increasing pressure of competition in the health sector

Fig. 5: Changing determining factors in the health system

22

21

Based on Rohde, Johann Jürgen (1974). Soziologie des Krankenhauses. Zur Einführung in die Soziologie der Medizin. Stuttgart

64

Pflueglmayer, Martin (2002). ‘Informations- und Kommunikationstechnologien zur Qualitätsverbesserung im Krankenhaus’ (Quality improvement in health care through information and communication technology): Linz. Medizin. Stuttgart

It is under these organisational and social/

Patients’ experience of completing a mean-

political conditions that any proposal to intro-

ingful e-learning course while at hospital can

duce e-learning for hospital patients will be

be an important factor of the touch dimen-

received. Some of these conditions are not par-

sion: The hospital proves that it is up to

ticularly favourable (complex hospital hierar-

recent information and communication tech-

chy, financial pressure) to this new idea, others

nologies and is able to use their potential for

do open opportunities (patient-centred health-

the well-being of the patient (tech dimen-

care, pressure for innovation due to market sit-

sion). Sensitive and committed face-to-face

uation). The idea of e-learning for hospital

trainers and online tutor contribute to the

patients fits for instance very well into a new

patients’ impression that they are cared for in

type of assessing the quality of a health care

a comprehensive way that exceeds their

institution which introduces a touch dimension

expectations.

in addition to the traditional tech dimension: The technical (tech) dimension describes the volume and content of the services from the point of vie of the patient. It is the technicalmedical core service, whose quality can only be evaluated by experts. The tech dimension is the most important result the patient expects, but cannot assess in a qualified way.

On the other hand, the functional (touch) dimension comprises how the tech services

2. Health – illness – hospitalisation

Chapter 5

Chapter 5 Life in hospitals

About health and illness In 1946 the WHO defines health as the state of complete physical, mental and social wellbeing and not only as the absence of illness, taking into account for the first time the social aspects of the concept of health. The factors determining health are:

are delivered. It relates to the way the patient perceives the medical services and is therefore determined by the subjective view of the patient:

Quality of structure

Quality of process

Quality of results

23

Gorschlüter P.( 1999): Das Krankenhaus der Zukunft, Integriertes Qualitätsmanagement zur Verbesserung von Effektivität und Effizienz. Stuttgart.

Tech dimension

Touch dimension

Facilities/infrastructure – Medicaltechnical equipment Number and qualification of staff Process organisation Type and duration of diagnosis, therapy and care Process organisation Waiting times Patient's state of health (effects and sustainable impact of therapy) Costs, duration

Hospital culture orking climate Reputation of hospital Ambiance of premises Contacts to and communication with staff (empathy, friendliness, considerateness) Health perception of patient Complaint behaviour

Fig. 6: Quality matrix of hospital performance23

65

Chapter 5 Life in hospitals

• Biological or internal factors

The functioning components (corporal, activi-

• Factors related to the setting

ty and participation) will also be influenced by

• Factors related to life habits

contextual factors: environmental and person-

• Factors related to the sanitary system

al, at the same time as the contextual factors will be also influenced by the functioning

In 2001, the Executive Board of the WHO

components.

approved the International Classification of Functioning, Disability and Health (ICF), understanding health as a key element which relates to functioning (generic term that indiChapter 5

cates all bodily functions and structures, the capacity to undertake activities and the possibility of social participation of the human being), and disability (generic term that includes all the deficiencies in the bodily functions and structures, limitations in the capacity of carrying out activities, and restrictions in social participation of the human being).

Illness from this perspective is understood as

Emotional impact of the illness on patients Illness is a special situation that presents itself as a state in which the physical, emotional, intellectual, social, or spiritual functioning of a person is altered or diminished in comparison with their previous experience.

The diagnosis of illness supposes an emotional impact both for the patient and their social setting which is conditioned by a series of factors as can be seen in the following diagram.

The individual

a loss of health, to a greater or lesser degree,

Each person experiences illness in a personal

and will have consequences for the function-

manner, according to their own personality,

ing of the person who suffers from it. In this

social and cultural environment and their

way a person who is ill can have limitations at

ability to cope with the illness. The emotional

three levels:

impact of being ill is conditioned by:

• bodily functions and structures

It is well known there are no illnesses but peo-

• ability to undertake activities

ple who are ill. Therefore, the characteristics

• possibilities of social participation

of the person who is ill need to be taken into account. Subjective aspects are involved in

Emotional impact of the illness

The individual

Fig. 7: Emotional impact of illness

66

Characteristics of illness and hospital

Patient-health staff relations

Support networks

the way one experiences health or illness. It is

regard to structure, functioning and organisa-

necessary to consider how each patient expe-

tion.

riences their illness, and how the experience

This situation demands to adapt oneself to a

of the illness is influenced by their own per-

temporary setting which seems at first

sonality and by the support and help on which

unknown and different form normal life. Or,

they can count.

depending on the illness, people are forced to

Individual perceptions of the concept and

alternate between their homes and the hospi-

experience of an illness are determined by

tal, which means a temporary break of habits

physical (state of the illness, pain, treat-

that can produce alterations in behaviour, par-

ment...), psychological (cognitive level, previ-

ticularly with hospitalised children.

ous experiences, expectations...), and exter-

When an illness is diagnosed, and more so in

nal factors (family attitudes, environment,

the case of chronic illness, an emotional

sanitary staff, support group....).

process often occurs which is in some

People suffering from an illness face the tran-

respects similar to coping with the grief after

sition from an ’independent to (temporarily)

the death of a loved one:

Chapter 5

Chapter 5 Life in hospitals

’independent person’. A situation of dependency is given with regard to • access to information about one’s own illness: diagnosis, prognosis... and the knowledge of others…

• aspects which are related to daily routines: timetables, meals...

• the social environment: contacts, social activities…

The illness

Fig. 8: Stages of a patient ‘s emotional process

At the first stage, when the diagnosis has been

An illness is characterised by its symptoms,

communicated, the patient has a feeling of

severity, character (acute or chronic), the

helplessness, accompanied by rage, distress

prognosis and the treatment that is necessary

and uncertainty.

as well as the consequences and the possibil-

At the second stage, which often coincides

ities of recovery and social rehabilitation.

with hospitalisation, often feelings of sadness

We must also have in mind that part of the

and dejection appear, sometimes leading to

process of the illness will take place in a spe-

depression and isolation. This is a phase in

cific context, the hospital, which shows

which it is crucial to have a support network

marked differences from the usual context in

to help the patient leave this state of isolation

which the life of the patients takes place with

and share what is happening to them.

67

Chapter 5

Chapter 5 Life in hospitals

At the third stage, there is an adaptation to the

team routines at the hospital should be care-

illness, to a new life situation which, in many

fully analysed and a personalised learning

cases, differs considerably from previous life.

programme established accordingly. During

At the first stage it is necessary to assess indi-

the implementation of the programme the

vidually whether starting an e-learning pro-

facilitation team should always be alert to

gramme is appropriate.

possible crisis situations that can arise during

In some cases to start any intellectual or

the hospitalisation period and may influence,

leisure activity would help the patient to get

disrupt or even stop the learning process.

over this stage and also to reduce the possible

Figure 9 sums up the main factors to consid-

tendency to psycho-emotional isolation.

er when assessing whether an e-learning pro-

Patients’ attitude and their desire to engage

gramme should be started:

in learning activities will be key elements for introducing the programme, as well as the physical impairments the illness entails.

STAGE 1:

In other cases the emotional and/or physical impact of the illness puts patients in a critical situation in which it is not advisable to involve them into a learning programme until they adapt to the new situation (difficulty of con-

factors to consider

Assess each case in an individual way

tions and daily activities 1997

In such sit-

uations it is necessary to postpone the start of

Start always

+ Positive attitude Wish to participate Relevance of developing supportive networks - Difficulties of concentration Physical limitations Inability to maintain daily RISK FACTOR: Don´t start functions/ routines

centration problems, inability to keep func24.

STAGE 2:

STAGE 3: Start always

Fig. 9: Factors to consider when assessing the appropriateness of learning during hospitalisation

the learning programme until the patient is physically and emotionally stable and has at least a minimal chance of success.

Patient-professional relationship

At the second and third stages, it will always

On many occasions the relationship hospi-

be recommendable to involve a patient into an

talised people may develop with health or

e-learning programme. The flexibility that

indeed education professionals is an impor-

characterizes this type of learning allows

tant one and influence the patients’ emotion-

adaption of the programme to the different

al state for the better or worse. It is therefore

rhythm and healthcare necessities of the

important to think about patients’ expecta-

patient. At any rate, prior to the start of the

tions from educational staff and how the rela-

programme, the patient’s needs as well as

tionship they have with them may affect their health state and how they perceive it.

24

Moro Gutierrez, L. (1997): Variables que influyen en el aspecto psicológico del diágnístico de cáncer, en Iberpsicología, 2.1. http://www.fedap.es/IberPsicologia/ iberpsi2-1/moro.htm (27-11-07)

68

Patients tend to look to these professionals as competent people, but above all they expect a relationship built on trust. Two main require-

Chapter 5 Life in hospitals

ments may be pointed out that the educational personnel must meet to make this relation-

3. Consequences of the setting for the educator role

ship effective and help the patients during the process of their illness:

Organisational conditions that are characteris-

1. Empathy: What is needed is that the edu-

tic for hospitals include issues related to hos-

cational professionals are capable of feel-

pital routines (timetables, medical calls,

ing and sharing the patient’s pain.

tests...) as well as aspects of hygiene and

subjectivity with which the patient experiences the illness and the objectivity that the health staff try to implement.

health prophylaxis which need to be kept in mind

when

working

with

hospitalised

patients.

Life in hospital means the entrance into a new institutional context that involves changes in

Emotional support and help Until recent times the relationship between medical doctors or healthcare staff and the patient was practically the only one that came into play at hospital, but nowadays the framework of relationships is wider. We can now talk about support networks which every per-

the usual daily routines, in the underlying rules that govern these routines and in the behaviour of the people taken into hospital.

The now patient has to stay in a strange and unknown world, because to have some knowledge of hospitals it is different to live there as a patient.

son can count on during the process of their

On occasions this strange world may become

illness and stay at hospital.

a strain, because of the progress of the ill-

These networks range from healthcare professionals to the family, friends, teachers, or members of voluntary associations. All of them should be able to keep stable and handle patients’ emotions, to help them acquire the attitudes and basic skills needed to face and accept the new life situation as a conse-

ness, because of the loss of control on what is happening, or because it is necessary to adapt to changes which arise from the hospital’s own dynamic: changes of staff because of work shifts, regulations that limit or restrict visits in certain periods, breaking of routine timetables...

quence of the illness, during their stay in hos-

The organisational setting does not only exert

pital as well as after their return home.

an influence on the patient, but also on the

Emotional support means:

educator who undertakes to work in a hospital

• To accompany and spend time with the

environment. Working in a multidisciplinary

patient • To listen to and share the patient’s daily

experiences with the illness • To strengthen communication and get

involved in joint activities

Chapter 5

2. Reduction of the distance between the

team is essential for several reasons: Educators do not know the organisational logic and processes of healthcare institutions, nor can they assess complex aspects of diverse pathologies.

69

Chapter 5 Life in hospitals

From an educator’s point of view, to work in

For example: to comment on patients’ med-

hospitals often implies direct contact with

ical diagnosis or treatment, to interchange

extreme situations of life like a degenerative

medical information, to respond to ques-

illness (e.g. Alzheimer’s), dramatic changes of

tions about medical matters the patient or

the life situation (e.g. loss of mobility after a

their family may ask because they find the

spinal cord injury), fatal situations (e.g. repet-

educator more approachable than the

itive infections, breathing complications or

healthcare staff.

Chapter 5

multi-organ failures, neurological syndromes

• Never reinforce pessimistic behaviour in the

in childhood, ...). In such context the learning

patient or their family.

offer should contribute to the improvement of

For example: Educators should not involve

the patient’s quality of life and their personal

themselves in situations of crisis, patient’s

and emotional growth.

uncertainty or fear that can provoke auto-

Needless to say the educator’s role is extreme-

limitations (couldn’t-care-less attitude of

ly difficult in such serious cases because the

responsibilities), feel sorry or even reject

patient goes through different stages with

systematically any type of professional

fluctuations in the evolution of the illness that

help.

may relapse or even lead to death. These situations are not always easy to cope with as they demand a large extent of emotional control. On some occasions it can also be necessary to seek some type of psychological support or mentoring.

• Never identify with the patient.

While the profile of a hospital educator’s requires a good deal of empathy, personal involvement should not be so strong that the educator is not able to keep an emotional distance and cope with the situation.

Tolerance to frustration and emotional bal-

An educator ought to motivate and encourage

ance are key characteristics of a hospital

the patient but

educator.

• Never adopt a paternalistic or over-protective

Educational work in hospital requires taking

Examples for such an attitude: to prema-

care of hygiene in two ways:

turely express statements that a patient can

• Personal hygiene, but this of course refers

give by themselves, to take over necessary

to the daily healthy habits of every profes-

work routines that the patient must develop

sional: cleanliness of body and clothes

and train until they become an autonomous

(hospital equipment, uniform).

person again (e.g. to switch on/off the computer, to walk to the seminar room).

• Never move apart from the role of educator.

70

4. Demands of hygiene in hospitals

attitude which inevitable leads to a limitation of the patients’ capabilities for action.

• Measures to avoid infections: Caps, masks, shoe covers, gloves, robes etc. which are used for sanitary reasons may be pre-requi-

Chapter 5 Life in hospitals

sites to facilitate the contact with the

It’s fundamental to settle preventive measures

patient.

aimed at avoiding a patient’s risk of contract-

Therefore, an educator has to know and

ing some bacterial agent or infection. Specific

respect the protocols of fundamental asepsis

measures for vulnerable patients may also be

which the health personnel generally follow

necessary as they could have serious immuno-

with certain types of patients. These protocols

logic alterations or repetitive infections.

depend on the sort of illness, and sometimes

Some basic protocols exist in asepsis that are

even on the hospital ward or individual

always demanded in a hospital and they must

patient, as a hospital educator illustrates:

apply to all type of in-patients.

A trainer’s account of changing hospital hygiene requirements In our e-learning project we worked with patients from five different wards at different floors of the building. Each ward gave me different detailed instructions about the sanitary requirements.

Moreover, these requirements were handled very individually, even for the same patient. I had to wear robes, gloves and masks in every session. I forgot to put them on once or twice, and was gently reminded of my mistake by the patient. At the same time the patient’s mother who was present in some sessions never seemed to wear any protection. She told me that in the two hospitals her daughter had stayed the hygiene regulations were less strict….

make a lot of noise, clothes that can expel substances or scents, hair products that can affect to patients’ breathing, etc.

Chapter 5

1. Use appropriate clothes: Avoid shoes that

2. Don’t take food to the patients’ rooms or eat in them.

3. Follow the instructions of the hospital personnel, respect routines and schedules and hospital equipment (serum feeding dispensers, etc.).

4. Avoid unnecessary noises (don’t rise your voice).

5. Avoid contact with the patient if you feel sick or you think you might be incubating an infection.

6. Don’t make any indications or recommendations of medical character to the patient and in the event of being asked about anything of this nature, direct the patient to the medical and healthcare personnel.

Be it as it may: If you work as a trainer in hospitals you must be flexible and adapt

There are also occasions where patients are

to varying hygiene regulations. For each of

under special conditions of strict isolation or

your learners different rules might apply,

in a specific unit with certain restrictions

and these may even change in the course

(coronary unit, dialysis unit, etc.).

of the learning programme.

In the case of isolation the patient is in a room with some special aseptic rules that vis-

71

Chapter 5 Life in hospitals

iting relatives and educators must follow. In general the following measures should be

Chapter 5

respected:

Learning activities in a transplantation unit: A trainer’s account

1. Careful hygiene.

In the transplantation ward the rules are

2. To provide the healthcare staff in advance

very strict and must be followed at any

with all learning materials and technologi-

rate. Some patients’ immune system is so

cal tools required for the work with the

weak after the transplantation of an inner

patient (pens, books, laptop, accessories

organ that they need what they call “ster-

like webcams, digital tablets, accessibility

ile care”.

tools like punches, mouth sticks, etc.) so

Each time I came to the ward I went to the

they can be sterilized before being handed

nurses’ office to find out which hygiene

over to the patient. The use of e-learning

regulations were necessary for each partic-

platforms facilitates the exchange of docu-

ipant. On top of that there are signs at the

ments and activities, as this can be done

door of each room which explain what you

virtually. The patient can download the

have to do before entering the room.

learning materials to their computer and work with them in the isolated situation

Every time before I went to into Mrs T.’s

without risking infection. Interaction with

room I had to think whether I was allowed

an educator and other patients can also be

to bring learning documents, and whether

done virtually with the help of Internet-

I was allowed to take them out again. The

based communication tools.

standard routine consisted of taking off all

3. To use barriers to avoid infections and, at the same time, to facilitate the contact between educator and patient: Surgical wash and brushing of hands and arms required to access to the room, use of

on a mask, robe and gloves. All my personal belongings (bag etc.) I had to leave behind lest they could transfer spores or germs.

gloves, robe, cap, mask and shoe covers

One thing is extremely important if you are

provided by the medical centre.

not a hundred per cent sure of the proto-

4. To dispose of the used sanitary material

col: Ask the nurses – better you get on

(gloves, dressing gown, cap, mask and

their nerves by asking the same thing too

shoe covers...) into the corresponding con-

often rather than ask too little!

tainers at the exit of the isolated area.

72

the jewellery, disinfect my hands, putting

Chapter 6 Profile of e-learning facilitators in hospitals

Chapter 6 Profile of e-learning facilitators in hospitals

For Kempe26, facilitation is also a pedagogical

term that applies to student-centred approaches to teaching as opposed to teacherdriven – the teacher’s role moving from expert to one of facilitation – ‘sage on the stage’ to ‘guide on the side’.

Regarding the facilitator definition in e-learn-

Clara Barrafranca, Holger Bienzle, Marie-

ing you can read The online course instructor

Claude Esculier

who aids learning in the online, student-centred environment.

27

Other experts stress that the facilitator has

patients does not require a traditional teacher.

It needs facilitators who introduce the educational offer to the patient, make largely self-

more than one area of responsibility. The facilitator does not hold the answer but helps learners acquire knowledge and develop skills • providing information to help learners complete assignments

directed learning possible, and give personal and virtual support when needed. The facilita-

• suggesting ideas or strategies for learning

tion role is multiple: pedagogical, social,

• helping learners connect content with prior

Chapter 6

Providing informal e-learning for hospital

knowledge

organisational and technical.

It is quite rare that all of these functions are

When the Leonardo da Vinci project EFL28

united in one person. Normally a facilitation

asked learners What is an e-learning facilita-

team of complementing professionals from the

tor? their answers: were: e-learning facilitators

education provider and the hospital will be

are tutors, e-tutors, or e-professors.

formed.

To understand the roles and profile of facilitator it is useful to consult the work done by Berge29. Berge did this work for e-tutors,

1. What is a facilitator?

The literal meaning of facilitator is one who

makes things easy.

Educational research distinguishes different facilitator roles and competences in an e-learning context.

Hootstein25 proposes a model in what an e-learning facilitator wears four pairs of shoes-

acting as instructor, social director, programme manager, and technical assistant.

25

http://www.learningcircuits.org/2002/oct2002/elearn. html 26 Kempe, A. and team (2001), Putting the Teacher Online – TEC’s Learnscope Project, paper presented at NET*Working 2001 Conference. http://flexible-learning. net.au/nw2001/01_attending/papers/4_6Kempe.doc 27 http://www.learnigcircuits.org/glossary.html 28 http://conseil-recherche-innovation.net/download/ELF/ ELF%20-%20facilitators%20roles%20report%20-%20 Greta%20du%20Velay.pdf 29 Berge, Z.L. (1995) Facilitating Computer Conferencing: Recommendations from the field. Educational Technology, 35(1), 22–30.

73

Chapter 6 Profile of e-learning facilitators in hospitals

which is only one part of facilitation, but it is

facilitation situations in e-learning context.

in fact valid for describing the overall role of

Berge defines four main facilitation roles of

facilitator, appropriate even for face to face

an e-tutor:

Advisor/counsellor

Metacogniton facilitator Process facilitator

Content facilitator Social role eTutor

Pedagogical role

Organisational role

Technical role

Chapter 6

Assessor Technologist Resource provider Fig. 1: Facilitation roles 30

Before facilitation roles can be specified it is

interpreter and guide through the concepts

necessary to highlight that in the hospital

of study.31

environment a pure e-learning approach would not be feasible. The eHospital experience shows that only a blended learning sce-

2. Facilitation roles in a face-to-face context

nario with intensive face-to-face-contacts supporting the e-learning activities can be successful. This entails two basic modes of facilitation for the facilitator as a professional who • Helps and guides the learner in face-to-face sessions in the patient’s rooms or seminar/ social rooms of a hospital. This person does

The pedagogical role This role includes the function to motivate the learner for the learning process. This is particularly important at the beginning of the learning activities. Beside this the facilitator has to support the patients in their learning activities as well as to help the learner to understand

not have to be necessarily a content expert. • Coaches and trains the learner during the elearning session in a collaborative distance learning context. The facilitator intervenes sometimes as project expert, sometimes as

74

30

http://www.iode-conseil.com/temp/e-package/guidelines_multiformat/index.html 31 http://www.if.insa-lyon.fr/projets/etutor/guidelines/content. html

Chapter 6 Profile of e-learning facilitators in hospitals

the course instruction. Part of the pedagogical

The technical role

role is also to encourage and guide the learn-

This role contains personal user support in

ers on how to approach the learning materials

cases of technical difficulties as well as guid-

and e-content. Another facilitation role con-

ance on how to use the e-learning environment

cerns the knowledge construction process.

and other virtual tools. The technology must be made transparent for the learners so that they

The social role

feel comfortable with the system and software

The facilitator builds bridges between cultur-

For this it is vital to ensure a functioning infra-

al, medical, social and learning environments.

structure and continuous access to the

To develop, encourage and maintain commu-

Internet, as well as access to the hospital infra-

nication between learners and their distance

structure like computer and seminar rooms.

tutors is another crucial task of the facilitator.

It is in fact the most difficult part to achieve.

Psychological assistance in stressful situa-

3. Facilitation roles in an online context

tions arising from the learning is also required

The virtual facilitator functions are often sum-

from a facilitator.

marized or labelled with the term e-tutor:

Chapter 6

and can concentrate on the e-learning content.

The e-tutor role relates to activities involved in facilitating and preparation of

The organisational role

materials for synchronous and asynchronous learning events. It also involves sup-

The facilitator has to provide a schedule for

porting learners, building online communi-

the face-to-face and online events of a blend-

ties and using collaborative technologies

ed learning programme. This includes organi-

confidently and efficiently to deliver effec-

sation of individual and group sessions,

tive learning. The e-tutor role is an exten-

e-tutoring times, synchronous virtual meet-

sion of the traditional role of a trainer or

ings etc.

facilitator within VET. The roles of trainer,

The facilitator observes the effects of learning

facilitator and e-tutor may be combined

and e-learning on the patient, gives feedback

and

to the other team members including sugges-

trainer/facilitator roles will still apply. It

tions for the course improvement. Part of the

should be noted that the role of e-Tutor

organisational role is to report on every ses-

varies between and within organisations. 32

sion.

In a hospital context the organisational role also includes the overall management of relations between the educational provider and hospital.

the

competences

relating

to

To fulfil this roles an e-tutor has a number of tasks to do, which requires specific competences: 32

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75

Chapter 6

Chapter 6 Profile of e-learning facilitators in hospitals

Facilitate a synchronous learning event

Support online learners

Use collaboration technologies

Evaluate and monitor online collaboration

Plan for online collaboration

Prepare for online collaboration

Conduct e-learning administrative tasks

Faciitate an asynchronous learning event

Understand basic information technology

Appreciate e-learning tools and technologies

Knowledge of e-learning industry

Experience in e-learning basics

Apply learning principles

Establish learner engagement

Use e-learning development tools

Test e-learning content

Plan and monitor an e-learning pilot

Develop e-instructional strategy

Develop technical specifications

Design e-learning content

Understand online assessment

Appreciate challenges and issues with online assessment

Reduce plagiarism and cheating in online assessments

Fig. 2: E-tutor tasks and competencies33

33

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76

Manage e-learning documentation and resources

Develop e-learning content

Chapter 6 Profile of e-learning facilitators in hospitals

4. Formation of a team of facilitators

gle educator, but by a team of facilitators with complementary professional expertise.

The team of professionals who are to facilitate

The preceding description of the numerous

blended learning projects for hospital patients

and varied face-to-face and online tasks

should combine the competence areas neces-

makes clear that facilitation of blended learn-

sary for the face-to face and the online ele-

ing activities is normally not done by one sin-

ments of the programme:

Pedagogical staff

Face-to-face trainer

Programme developer

E-content producer Pedagogical staff

Evaluator Technical staff

Chapter 6

E-tutor

Course organiser E-tutor

Technican

Fig. 3: Facilitation team of blended learning projects

Learner-centred training methodologies and e-learning pedagogy • Motivation, follow-up and encouragement of the patient learners, • Understanding and communication of blended learning concepts and the role of different members, in particular that of the facilitator • Animation of pedagogic face-to-face and online sessions • Collaborative learning and communication • E-tutoring competences (cf. above) • …

Social and psychological competence • Understanding of learning in the context of illness and hospital • Basic knowledge about health and hygiene and their impact on the learning process and the facilitator work • Identification of the learner’s aspirations and potential barriers to learning • Knowledge how to give emotional support in stress situations arising from the learning • Awareness of limitations of professional action: Who to ask in case of psychological

77

Chapter 6 Profile of e-learning facilitators in hospitals

or medical problems what process and action to made

Organisational and management skills • Planning an (e-) learning project

• …

• Organising and leading a project team of diverse • Documentation and reporting

Technical skills

• Evaluation and corrective action process • Installation of a PC and accessories (print, scan) in different environments (room, learning centre etc.)

• Promotion, marketing, and recruitment of participants • …

• User support with hardware and software

• Access to Internet

5. Involvement of hospital staff in the facilitation

• Adaptation and maintenance of e-learning

If the e-learning programme is offered by an

Chapter 6

problems

external education provider the facilitators are

platform • Practical induction to the use of the platform and collaborative tools (chat, forum, virtual classroom)

not in every-day contact with their learners.

Nor do they know the rather complex institution hospital, its regulations, routines and processes from the inside. Cooperation

• Collaboration with the technical hospital

between educators and various groups of hos-

staff: define the collaboration modes and

pital staff is therefore fundamental. At least

processes, reporting of problems

six categories of hospital staff are potentially involved:

• …

Medical Doctors

Psychological Psychologists

Healthcare Nurses Physiotherapists

Involvement of hospitals staff

TECHNICAL Network engineers IT user support

Pedagogical Hospital school teachers Social workers

Fig. 4: Hospital staff potentially involved in the facilitation of blended learning projects

78

Administrative Managers Administrators

Chapter 6 Profile of e-learning facilitators in hospitals

Members of these groups of hospital staff undertake important functions without which e-learning courses cannot be organised and implemented. These functions may include:

Supporting the learners • Motivation (The doctor’s word is the bible!)

• Encouragement • Psychological assistance in stressful situa-

Providing educators with information on the target group • General state of health • Medical, therapeutic, and hygienic needs • Definition of learning needs

Ensuring a functioning infrastructure

tions arising from the learning

Observing and giving feedback • Regular observation of effects of learning on patient • Feedback to the tutor, assessment, evaluation

• Technical assistance with PC problems

• Suggestions for improving the course

(limited) • Access to the hospital, and to computer and seminar rooms

Not all of the groups of hospital staff mentioned will be involved in all e-learning proj-

Chapter 6

• Access to the Internet

ects, and the degree of involvement in the

Recruiting course participants • Promotion and information • (Pre-)selection of potential participants • Introduction of the tutor

facilitation will vary. In the eHospital project some pilots cooperated predominantly with the team of psychologists, others with nurse or medical doctors. This depends on the patient target group, on previously existing contacts, and, of course, on individual enthu-

Organising face-to-face sessions

siasm for the learning project. The important

• Day-to-day organisation of the course

thing is to cooperate closely with some mem-

• Scheduling of face-to-face sessions

bers of staff who are in touch with the

• Communication of changes in the schedule

patients daily, and can act as a door-opener to

to the tutor

the hospital.

79

Chapter 7 Management of e-learning projects in hospitals

Chapter 7 Management of e-learning projects in hospitals

by people, constrained by limited resources, planned, executed, and controlled.34 It is therefore advisable to take a project management approach at such a cooperation venture. It is not an easy undertaking, either, as partners from two completely different sectors – education and health – will have to cooper-

Holger Bienzle, Uwe Hoppe

ate closely in all main phases of the e-learning project.

In most cases an organisational precondition

Phase 1: Preparation

for e-learning projects for adult patients in

Phase 2: Development

Phase 3: Implementation

hospitals is the cooperation of education Phase 4: Promotion

providers and healthcare institutions. At the personal level this is necessarily the cooper-

Chapter 7

ation between team members coming from dif-

Phase 5: Evaluation

ferent professional fields, with working experiences in quite different institutional con-

Phase 6: Project management

texts. This constellation poses a challenge, but also has a great potential for the professional development of the staff involved.

Fig. 1: The main phases of an e-learning project in hospitals

Preparation In the first step a suitable hospital needs to be

1. The main phases of an e-learning project for hospital patients

contacted and convinced of the benefits of

To work together with a hospital to plan,

their patients. A thorough analysis of the

organise and implement informal, comput-

patient learners’ needs, the hospital infra-

er-supported learning activities for patients

structure and the organisational preconditions

is far from being a routine job for an educa-

needs to be carried out. Methods of financing

tion provider. On the contrary, it is some-

the learning activities need to be found. As the

thing out of the ordinary, which probably

last step the cooperation ought to be for-

informal (e-) learning for a specific group of

has not been done before. In other words: a project, i.e.

a temporary endeavour undertaken to create a unique product or service. It is performed

80

34

PMI (1996), A Guide to the Project Management Body of Knowledge, p.10.

Chapter 7 Management of e-learning projects in hospitals

Course development

Preparation First contact

Patient needs

Hospital Patient target group

Medical Emotional Hygienic Educational

Financing

Cooperation

Costs Fees Sponsoring Funding

Contact persons Facilitation team communication contracts

Infrastructure PCs/laptops Internet access Seminar rooms

Course design

LMS

Aims Content/modules Methodologies Volume

Selection Adaption Virtual tools

Learning materials Search Purchase Creation

Fig. 3: Development phase of an e-learning project in hospitals

Information Patients Hospital staff Management

Fig. 2: Preparatory phase of an e-learning project in hospitals

materials can be selected and modified if necessary.

Course implementation The implementation phases starts with the plays an important role in identifying suitable

malised in a written agreement, and all stake-

patients and ensure that they can take part in

holders in the hospital informed of the project.

the learning. Those working in the hospital on

Chapter 7

recruitment of participants. Hospital staff

a daily basis are as important in the day-to-

Course development

day organisation of the face-to-face and online learning activities, can give information

The experience gained in the eHospital proj-

about changes in patients’ needs and rou-

ect strongly suggests that e-learning for hospi-

tines. Moreover, it is desirable that hospital

tal patients will only be successful if the

staff also take over a pedagogical role: to sen-

course offer reflects the life situation of the

sitively observe the learning process, to

learners and takes into account the specific health requirements and the environment of

Course implementation

the particular hospital concerned. It is therefore extremely helpful to regularly consult

Recruitment

Face-to-face

Markteting Recruitment Breaks Continuation

Group Individual Support

Online

hospital staff in the development or adaptation of the design of the e-learning programme. A suitable Learning Management System must be selected and adapted. In most cases it will be financially impossible to create much e-content, but existing learning

Synchronous Asynchronous

Fig. 4: Implementation phase of an e-learning project in hospitals

81

Chapter 7 Management of e-learning projects in hospitals

encourage and support learner, and to give valuable feedback to the educators.

Project management, promotion and communication

Evaluation

Project management

Communication

Promotion

All phases of the e-learning project should be subject to careful evaluation. The aim of all evaluation activities should be to improve the

(Re-) Planning Organisation Controlling

Target groups Channels Frequency

Internal visibility External PR

learning programme and provide the basis for feedback to those who commission it.

Fig. 6: Management of an e-learning project in hospitals

Evaluation should involve the main stakeholders: patients, their friends and families as well as the facilitators from the education provider

2. Formal or informal cooperation?

to the hospital involved.

In the eHospital project different cooperation approaches have been practiced in the local e-learning pilots. While in some cases the

Evaluation

Chapter 7

cooperation between educators and hospital Evaluation plan

Data collection

Scope Objectives Target groups Methods

Patients Hospital staff Traniers Friends & family

Conclusions

staff was informal and only at the operational level, in other projects formal contracts between the hospital and the education

Reports Feedback

provider were signed by the respective top management.

The experience clearly indicates that formal

Fig. 5: Evaluation phase of an e-learning project in hospitals

agreements with the hospital management are necessary. Even if interaction and communication between educators and highly motivated hospital staff have been carefully planned

82

Project management, communication, and promotion

there will always be critical phases in the

A thoroughly planned project management

Lack of resources may endanger a smooth

approach ensures smooth cooperation in the

information flow and course organisation. Or

phases mentioned above and in the promotion

collaboration with other units of the hospital

of the e-learning programme inside and out-

(Marketing, IT department etc.) proves to be

side the hospital. The key management issues

difficult because of complicated internal reg-

which have to do with the specific conditions

ulations.

of hospitals will be discussed in some detail

In such cases it is extremely helpful if a for-

in this chapter.

mal agreement was signed at the beginning of

implementation of the e-learning project:

Chapter 7 Management of e-learning projects in hospitals

the project and the management of the hospital can be reminded of its commitment.

• Conditions to extend the agreement, and to terminate it prior to that date.

Essential elements of such a contract

• Annexes may follow this agreement (educa-

between the education provider and the hos-

tional project description, timetable, etc.]

pital are: • Partner institutions (hospital and education providers) and their legal representatives • Scope of educational project and declaration of common interest in providing a tangible benefit for the patients who participate in the learning activities

3. Visibility and promotion of the e-learning project An important task of a project manager is to make the e-learning project visible in side and outside the hospital concerned. hospital staff as well as at the patients and

• Responsibilities of both parties in the proj-

their families.

ect. (educational design, tutoring, techno-

It is essential that everybody working in the

logical infrastructure, selection of patients,

hospital knows about the e-learning project in

promotion, etc.)

order to

• Budget and sources of financing. Terms and conditions of payments and contributions.

• recognize the tutors and grant them access to wards, rooms, and patients • promote the e-learning programme among

• Facilitation team, roles and responsibilities. Name and role of main contact persons and other the responsible actors from both parties.

Chapter 7

Internal visibility aims at the various groups of

• Duration of the project.

suitable patients • support the patients in their learning activities • to reassure patients’ friends and families

• Communication procedures, details of com-

that the e-learning project is fully support-

munication channels and procedures to

ed by the hospital and not an alien ele-

ensure effective communication between

ment.

partners.

• Confidentiality.

Information

disclosed

To reach visibility of the e-learning project is

between both parties will be confidential /

not an easy task:

not confidential. Confidential treatment of

Several wards of a hospital may be involved in

data referring to patients and compliance

an e-learning project. They may be in differ-

with national regulations of personal data

ent buildings of even locations. Another

protection.

aspect to be considered are the diverse groups

• Promotional measures (external): Rights to

of staff concerned, who work in shifts and

use the learning project for marketing pur-

therefore may have different levels of informa-

poses.

tion.

83

Chapter 7 Management of e-learning projects in hospitals

There are various ways to make the e-learning

activities in an extremely sensitive manner.

project visible in the hospital. They should be

This can be best done by people to whom they

carefully considered and selected according

have already started to develop trust. In many

to a clear internal communication strategy:

cases, this is the medical doctors, nurses, or hospital psychologists.

It needs to be taken into account that in a

Elements of an internal communication strategy

medical environment the person many

❑ Visual identity: logo and title

doctor. Therefore, this channel of communi-

❑ Promotional items: posters and infor-

cation with potential course participants

mation fliers, give-aways (ball pens,

might be most successful for recruiting

notebooks etc.)

patients.

patients view as the authority is the medical

❑ Blackboards ❑ Presentations at hospital meetings ❑ Information in the hospital intranet ❑ Regular hospital publications for staff Chapter 7

and / or patients ❑ Hospital radio broadcasts ❑ Informational events for staff and / or patients and their families

Establishing individual contact with the patients and providing them with basic information on the e-learning course requires personal face-to-face conversations. It is, however, not only a question of providing information about the course, its aims, content and organisational frame, but at least as much about encouraging patients to participate in the course. It is likely that people will get involved in an activity if they deem that the

Recruitment of participants Organising the recruitment among patients who are under health care requires thorough understanding that patients are individuals who may be waiting for medical care, may be receiving it or may have already undergone medical treatment and now are in the process of recovery. Their health condition may affect their interest in taking any initiative not directly related to the improvement of their medical condition such as an e-learning course. They are therefore particularly vulnerable and need to be approached for learning

84

activity will bring benefits to their situation or will be stimulating to them. Therefore, to increase motivation, it is essential for the project team or participating hospital staff to stress the aspects which are most meaningful and valuable to a particular individual. They should stress the potential benefits of patient’s participation in the e-learning course regarding their skills, learning competences and health condition, as well as other reasons such as leisure, entertainment or socialisation.

Such benefits could include the following:

Chapter 7 Management of e-learning projects in hospitals

Good use of time during hospitalisation

Connection to society

Entertainment and fun

How patients can benefit from e-learning

Personal development

Acquisition of new competences

Enhancement of employability

Ultimately, the learning activities may lead to

tion of the hospital concerned. This might be

increased self esteem and emotional well-

particularly welcome to the growing number

being, which will contribute to patients’ con-

of hospitals which are forced to compete for

valescence and successful reintegration into

public health funding or even operate in a

their normal professional and social lives after

market situation.

leaving the hospital.

Most hospitals have a PR department. They

The question of what happens if the learning activity is interrupted or suspended due to

should be consulted early on to develop an adequate promotional strategy.

their health condition turns up repeatedly during

the

recruitment

conversations.

Obviously, many patients are reluctant to make a commitment in a situation of unstable health condition. Course facilitators need to be prepared for that question and make clear to patients that the individual learning pathways e-learning offers allows for taking up the course after a break again, and for finishing parts or the whole course in their own time – in hospital or back at home.

Chapter 7

Fig. 7: Potential benefits of e-learning for patients

4. Communication as a key challenge To ensure intensive and continuous communication between educators and hospital staff is critical for the success of an e-learning project.

There are two different levels of communication.

The strategic communication partner is the management of the hospital. It is the hospital

Visibility of the e-learning project also has an

managers who make the final decisions about

external component. To run an e-learning proj-

e-learning courses in the hospital. The man-

ect for adult patients is still a very unusual

agement should therefore be regularly

thing to do for a European hospital. So many

informed about the achievements of the

journalists can be expected to be willing to

learning project and, if necessary, of desirable

report about such activities. This fact should

improvements of the organisation. Normally,

be fully exploited for the sake of the reputa-

communication with hospital management

85

Chapter 7 Management of e-learning projects in hospitals

will focus on milestones in the project and take place over longer intervals.

Definition of communication needs It is essential to define at the outset of the e-

Once this is achieved, it is necessary to estab-

learning course the information needs of each

lish a direct and more frequent channel of

stakeholder. This definition should be orient-

communication with the people the e-learning

ed towards minimum requirements rather

facilitators will be dealing with when working

than maximum wishes.

in the hospital. These will be the operational communication partners: medical doctors,

Appointment of contact persons

nursing staff, psychologists, teachers of hos-

From the beginning one main contact person

pital school, and technical staff. The hospital

in the hospital for the day-to-day management

staff is directly involved in the treatment

of the e-learning should be appointed. Even

process, therefore communication with them

so, the experience form eHospital shows that

determines the actual realisation of the

it can be extremely difficult to reach that one

course.

person when needed, so one or two additional contacts should be listed.

The key challenge in the interaction with hos-

Chapter 7

pital staff as identified in the eHospital project must be highlighted:

Agreement on most suitable communication media

Hospital staff normally works under extreme

The most appropriate communication medi-

pressure of time and emotional strain.

um differs from hospital to hospital, and for

Hospital staff is often overworked and their

one member of staff to another.

working time is organised in a shift system –

Does the working routine recommend asyn-

this means that it is difficult to plan regular

chronous virtual communication via e-mail,

interaction with staff members. Moreover: The

synchronous distance communication on the

idea of patient education may be welcomed as

(mobile) phone, or face-to-face contacts?

beneficial for patients, but is not the core business of hospital staff and therefore not

Establishment of basic communication rules

very high on their agenda. This needs to be taken into account when planning the communication system.

Whichever communication channels have been chosen an agreement should be sought about the reaction time to messages, times of

The project-related communication ought to

notification about organisational changes etc.

be integrated in the existing hospital routine

86

and should not produce additional strains.

Scheduling of meetings

Here are some measures which may help to

The most difficult part is often to find time for

ensure successful communication between

regular meetings with key people in hospitals.

educators and hospital staff:

Such meetings should be very well structures

Chapter 7 Management of e-learning projects in hospitals

to keep them short and efficient. Wherever

Who owns an e-learning project for hospital

possible, regular hospital staff meetings

patients? This question should be answered

should be used for the purposes of the e-

quite independently from the question where

learning project instead of creating an addi-

the money comes from. In a wider sense own-

tional one. To keep a larger number of person-

ership can be described as the degree to

nel updated about the learning project, it is,

which cooperation partners feel themselves

for instance sufficient to reserve a short item

owners, actors and decision makers in a joint

on the agenda of such meetings every fort-

activity.

night.

On the background of the experiences gained in the eHospital pilot projects it is a key success factor that the hospital wholeheartedly

Elaboration of a communication plan

supports the learning activities. From the top Communication needs should be documented in a concise communication plan which gives an overview of the crucial aspects:

management to the various groups of staff who are in daily contact with the patients. organising learning activities for their patients

• Who are the communication partners?

is likely to increase when they fully identify

• How is communication to take place?

with the undertaking. The impetus for the e-

• When / in what intervals is the communica-

learning project may have come from the outside: a training organisation, the sponsor or a

tion planned?

Chapter 7

Their commitment to the additional task of

• What needs to be communicated?

health authority. It is nevertheless crucial that the manager of the e-learning project makes

5. Whose e-learning project?

an effort to transfer it into the project of the

Key success factors for organisation of e-

hospital concerned.

learning courses in hospitals are trust

As in any other form of cooperation there are

between the partners and identification of the

various ways to enhance such sense of owner-

hospital with the learning offer.

ship on behalf of the hospital:

Acceptance of motives for project

Early stakeholder involvement

Full information, transparency

Measures promoting a sense of ownership

Written agreements

Integration in hospital PR

Experience of joint achievement

Fig. 8: How the e-learning project can be owned by the hospital

87

Chapter 7

Chapter 7 Management of e-learning projects in hospitals

88

The best way to develop a sense of ownership

which hospitals are forced to compete for

on behalf of the hospital is to actively involve

patients and funding.

relevant representatives as early as possible.

Such motives are to be respected, and ways

A team of hospital staff should be given a

have to be found on how corresponding pub-

platform to bring in their expertise of and

licity aims can be met.

experience with the patient groups concerned:

In one of the eHospital pilots, for instance, it

Doctors, psychologists, or hospital peda-

proved helpful that the hospital was allowed

gogues are the experts to know if the learning

to publicise the e-learning project under their

topics, training modes, methodologies etc. are

own logo and visual identity. In another pilot,

best suited to the needs of the patients they

joint press conferences of the hospital and the

have to work with everyday – and this expert-

cooperating training organisations created a

ise should be appreciated.

win-win situation.

Not only the complementary expertise of the

In any case it is crucial that the cooperation

health professionals need to be appreciated,

is fixed in a written contract which specifies

but also the reasons why the hospital engaged

roles, rights and obligations, as well as

in the learning activity in the first place.

resources of both sides involved. By that the

Motives may vary and are not always predom-

project will get the priority it deserves and the

inantly educational. It can also be important

momentum it needs in times where problems

to distinguish themselves from other hospitals

occur and perhaps overworked hospital staff

in an increasingly fierce financial situation in

need to make an extra effort.

Chapter 8 The preparatory phase

Chapter 8 The preparatory phase ´ ukasz Nowak, Maria Jose Rodriguez ´L Malmierca, Malgorzata Marciniak, Joanna Szczecinska

Educational needs of patient target group

Financing mechanisms of the course offer

Criteria for cooperation with hospital

Organisational capacity and technologigal infrastrcture

Commitment of management and staff

Fig. 1: Identifying suitable hospitals

tals needs thorough preparation. In many

the latter to promote the idea of patient learn-

cases it will be a true project, i.e. something

ing and to identify and convince cooperation

unique that has not been done before, and

partners in the health system.

something players from different backgrounds

As the most relevant criteria for selecting a

have to learn to do together.

suitable healthcare centre the actual organi-

The first step for education providers will be to

sational capacity of the institution and its

identify suitable partner hospitals and suc-

commitment to the project realisation should

cessfully argue the case of e-learning for their

be taken into consideration:

patients.

A profound analysis of the needs of the patient target groups, the infrastructure and of organisational aspects will follow.

This chapter presents experiences and recom-

A first, short listing of suitable institutions can be based on generally accessible data from journals, rankings of medical institu-

Chapter 8

Providing e-learning to adult patients in hospi-

tions, lists provided by health ministries or local governments.

mendations for the preparatory phases which are based on the experience gathered in the eHospital project.

The next step would be the analysis of the internal environment of the institution to check on the corporate structure, organisational and communication culture. The final choice is determined by face-to-face negotia-

1. First contacts with hospitals

tions with the management of the institution

Patient education is not a core business of

that offers best conditions for project realisa-

hospitals (yet). Therefore the most likely sce-

tion.

nario of providing e-learning for hospital

Such a rather formal approach, however, is

patients will be cooperation between hospitals

not the only possible way to select a hospital.

and institutions or practitioners from the edu-

Other less formal pathways may be taken in

cational field. In most cases it will be up to

order to successfully introduce an e-learning

89

Chapter 8 The preparatory phase

initiative in a hospital. Sometimes previous

To make use of existing contacts proved

contacts with some members of the hospital

extremely helpful in all cases, no matter what

staff (medical, directive, technical...) can

these contacts were. It is much easier to

facilitate the process. Such key contacts can

argue the case of patient education with sup-

later become strong internal supports of the

port from an internal co-promoter who is

project.

equally convinced of the idea and trusts the

In the case of the eHospital project different

educational partner.

door-openers have been used to get in touch with hospitals. The e-learning projects were introduced through existing contacts with • hospital psychologists, with whom the education provider had cooperated in an ECDL project before

it should lead to direct negotiations with the hospital management and the staff to be involved in the learning activities.

The idea of e-learning in hospitals is still new

• the hospital management

and needs active promotion among stakehold-

• medical doctors

ers of the health system. There are several

• the hospital ICT support unit with which

strands of arguments in favour of informal

one partner had previously cooperated.

Chapter 8

However the first contact may be established,

Best use of time

New competences

patient (e-)learning.

Support of convalescence

Emotional well-being

Enhancement of employability

Entertainment & fun

Patients Hospital

High patient satisfaction

Image and reputation of hospital

Distinction from competitors

Fig. 2: Arguments in favour of e-learning in hospitals

90

It is needless to stress that a professional

Sometimes, it may be helpful to present the

form of presentation improves the quality of

initiative as born from a successful European

the discussion and adds to its potential suc-

project, being tested previously in several hos-

cess. Therefore, it is recommendable for plan-

pitals in Europe. It may help to stress that get-

ning the presentation, its logic and array of

ting involved in patient e-learning would work

arguments to be used.

very well for the reputation of the hospital as

Chapter 8 The preparatory phase

an innovative institution which is open-mind-

sense to engage in e-learning when patients

ed for international developments in patient-

stay in hospital only for a few days.

care. Advertising the e-learning course and its

• Patients should be likely to benefit from the

potential benefits for the patients might be of

offered course programme. The course

strategic importance for the hospital manage-

offers should ideally have some connection

ment. More and more hospitals are forced to

to the life situation of a particular patient

operate in a market situation, and the addi-

target group, and there ought to be a real

tional offer of e-learning might be a decisive

educational need.

factor in the competition for patients. Such

• Patients should be pointed out by the med-

arguments might be appreciated by the man-

ical and/or psychological staff as an appro-

agement of a hospital and its marketing and

priate target group for participating in the

PR officers.

course.

The management of the hospital makes the

Organisation of e-learning in hospitals is

decision to get involved in the project, but it

dependent on the specific demands and con-

is the doctors, nurses and other medical staff

straints of patients. Therefore, it is essential

who will be working with the patient learners

to gather the following information on the

on an everyday basis. Therefore appointing

patients before the learning activities actually

the staff collaborators and forming clear

start:

with them is of crucial importance and also requires a clear decision of the management as participation in the project means additional duties in their everyday routine.

• Patients’ interests – this information helps to adjust the content of the course and make it more interesting for the patients.

• Length of patient’s stay in the hospital – this affects the planning of the duration of

Chapter 8

organisational and communication patterns

the whole course. It is not a good idea to

2. Identification of patient target groups and their needs

plan a long (more than 50 hours) training if

Identifying suitable groups of patients creates

out of the hospital before they are able to

a different kind of challenge because it

finish the training activities.

this means that most of the students will be

requires insight into the nature of their illness

• Concentration capacity of the patients –

and the medical treatment, their emotional

this information influences the planning of

situation, and their resulting educational

the duration of an individual class.

needs and requirements. When deciding on

• Technical skills of patients – there is a need

the patient target group the following criteria

to find out how they handle ICT, how much

should be borne in mind:

assistance and technical support/ tutoring

• Patients ought to remain in hospital for a

they require.

period allowing successful completion of

• Diversity of competence levels – it will be

the e-learning course. It will hardly make

possible that the course will have to offer

91

Chapter 8 The preparatory phase

different activities and learning proposals

to continue using medical care services and

to accommodate to all students previous

stay within a given health provider.

competences and skills.

The needs of patients are defined both by the

• Mental condition – for example patients

patients themselves and by the medical doc-

from France had problems with short-term

tors who keep track of the patients’ condition.

memory that was why each lesson needed

Therefore planning an e-learning course

to be organized as a separate unit, not

requires the confrontation of patients’ desires

requiring knowledge from the previous one.

and doctors’ advice. Such an approach leads

• Physical condition – for example in Poland

to setting three basic categories of needs:

it was necessary to survey the actual physical condition of the patients to create a set of exercises that would be suitable for

Patient needs

them.

• Motivation level – it was proved that a positive attitude to participation in the course

Medical needs

Hygienic needs

Emotional needs

is a crucial success factor. Therefore, some additional motivational actions can be planned accordingly.

Fig. 3: Types of patient needs to consider before starting an e-learning course

• Organisational issues, as some learning Chapter 8

proposals could be provided for group

92

learning environments, and some others will only be possible in one-to-one level, or

Medical needs

even for self study with online tutoring (if a

Each patient is subject to an individual med-

patient is isolated, for example).

ical treatment plan which defines the overall

One of the biggest challenges of e-learning in

treatment goals, the length of stay and specif-

a hospital environment is to identify and tar-

ic clinical and rehabilitation goals and out-

get patients’ genuine needs.

comes. Therefore an e-learning course must

Satisfaction can be defined as the extent of

be planned in a way that would not interfere

an individual’s experience compared with his

with the patients’ ability to attain these goals.

or her expectations. Patients’ satisfaction is

In case a patient has to suspend participation

related to the extent to which general health

in the course because of their medical condi-

care needs and condition-specific needs are

tion there should be arrangements in place to

met. Provided that e-learning services

ensure that the educational activity can be

improve the level of patients’ satisfaction they

taken up again at a later stage. The continua-

may be clinically relevant, as satisfied

tion of the course and achievement of its final

patients are more likely to comply with treat-

objectives is of a crucial importance for the

ment, take an active role in their own care and

final satisfaction of the patients.

Chapter 8 The preparatory phase

Emotional needs

Hygienic needs

Many patients staying in the hospitals are suf-

Many patients in hospital become dependent

fering from chronic illnesses. A chronic illness

on staff to care for their hygienic needs. They

is an illness that lasts for a long time and usu-

often need extra help with bathing, washing

ally cannot be cured completely. Examples of

and toileting routines. Therefore, the role of

chronic illnesses include diabetes, heart dis-

the healthcare staff is to support the patients

ease, arthritis, kidney disease, HIV/AIDS,

in daily activities in order to maintain the

lupus, and multiple sclerosis. People diag-

atmosphere conducive to treatment and com-

nosed with chronic illness must adjust to the

fortable for patients. The healthcare-staff per-

demands of the illness itself, as well as to the

forms everyday duties such as taking temper-

treatments for their condition. The illness may

atures, measuring pulse rates, blood pressure

affect a person’s mobility and independence,

and respiration rate. They help with the trans-

and change the way a person lives, sees him

portation of the patients, sometimes together

or herself, and / or relates to others.

with specialized patient monitoring and treatten to patients and respond by encouraging

or sadness is normal. In some cases, a chron-

them to cooperate and participate in treat-

ic illness may actually cause depression. It is

ment activities in order to help patients

estimated that up to one-third of the individ-

achieve attitudes conducive to treatment and

uals with a serious medical condition experi-

rehabilitation.

ence symptoms of depression.

For these reasons, the role of healthcare staff

E-learning can contribute to reducing the dis-

in e-learning projects is of vital importance as

tress, as well as the risk of complications

they not only assist in mobility of patients and

related to a long and fatiguing treatment.

control their health condition on regular basis,

Among the most valuable effects for the psy-

but they also play an important part in moti-

chology of the patients who are participating

vating the patients for participation in the

in an e-learning project the following can be

course. This is the type of support the facili-

mentioned as the most important:

tator of the e-learning course requires on an

• Learning how to live with physical effects of the illness

Chapter 8

ment devices. What is more, they talk and lisFor these reasons, a certain amount of despair

everyday basis, therefore close cooperation between the course facilitators and the healthcare staff is highly recommended.

• Improving communication with the doctors • Gaining emotional balance to cope with negative feelings • Gaining confidence and a positive selfimage

3. Analysis of infrastructure Health-care institutions do not always offer ideal conditions for implementing e-learning.

Sometimes a critical constraint is that the

93

Chapter 8 The preparatory phase

hospital infrastructure is inadequate to cope

they are. Only in this case they can fully ben-

with the rising number of patients. In many

efit from the potential freedom e-learning

cases it takes some effort to create a proper

offers as compared to traditional forms of

learning environment.

education.

As far as the infrastructure for e-learning

But the availability of mobile devices cannot

courses in hospitals is concerned there are

be taken for granted in hospitals across

three main elements to consider:

Europe. It heavily depends on the country, the

• rooms for face-to-face sessions

region and the social background of patients.

• availability of computers

If a patient group in a particular hospital can-

• access to the Internet

not be expected to bring their own laptops, other solutions must be sought.

Rooms

• There might be classrooms in a hospital school for children which are equipped with

In order to provide a location offering good infrastructural conditions for an e-learning course the following factors should be taken into account: • It should be located in close proximity to the hospital ward where patients receive

Chapter 8

their medical treatment.

• It should minimize distraction for learners as much as possible so they can concen-

one or more PCs. • Perhaps the PC in the patient library can be used for the e-learning.

• It might even be possible to approach a computer business to donate hardware as an act of sponsorship.

• In some private hospitals patients can even be encouraged to rent a laptop for the learning activity.

trate on the training.

• It should provide enough room to accommodate the whole group of patients partici-

Access to the Internet

pating in the same course for the social

Widespread usage of the Internet cannot be

aspect and the possibility of exchanging the

taken for granted in hospitals in Europe yet. The

experiences.

hospital offices are likely to have Internet access, but in other parts of the hospital build-

Availability of PCs

94

ing it might be problematic.

An ideal and relatively cheap way to provide

Obviously the availability of computers is a

Internet connection at the hospital is the

condition sine qua non for implementing e-

implementation of a wireless network. A big

learning in hospitals. It is, however, often a

advantage of using a wireless network is its

major challenge to be solved in the preparato-

increased mobility – patients can move

ry negotiations with hospitals.

around from one room to another without

Ideally patients have their own laptops which

being tethered to a network. But some hospi-

they can use whenever they like and wherever

tals might have reservations about a possible

Chapter 8 The preparatory phase

interference of wireless technologies with medical equipment.

• Funding by hospital in order to increase its attractiveness

In case there is no possibility of building a

• Fees paid by patients

connection to the Internet setting up a Local

• Mixtures of these options

Area Network can be an alternative solution. A

The selection of the appropriate financing

Local Area Network (LAN) supplies network-

mechanism for patient education is a highly

ing opportunities to a group of computers in

sensitive issue, particularly as far as the

close proximity to each other such as in an

option of financing through the patient is con-

office building, a school, or a hospital. It

cerned. In principle there are two opposing

means that the participants of an e-learning

views:

course can be connected to each other within

Some educators insist that educational offers

a local network of computers. A LAN provides

which may support emotional well-being in

almost the same options of interaction and

the very vulnerable life situation of being in

communication as a regular Internet connec-

hospital with a severe health problem should

tion.

be free of charge. No additional pressure or

4. Financing of the e-learning offer Providing tailor-made blended learning to hospital patients is rather expensive: High fluctuation of patients

Need for individualisation of the learning offer

Cost factors

measures to should be built up.

The contrary position is, however, that e-learning in hospital could be seen as an additional – payable – service a lot of patients would be willing to pay for. A fee would also increase the value subscribed by the patients to their e-learning course (What is offered for free, has no value!).

Chapter 8

barriers for patients to access such relieving

There is probably not one definite answer to this question. Different solutions will be ade-

Usually small numbers of participants at a time

Time-intensive face-to-face contacts

Fig. 4: Cost factors of blended learning for hospital patients

quate in different contexts. The nature of the health problem of the target groups concerned may be as relevant for the decision as their social background. To give an example from the eHospital piloting: a manager in pulmonary treatment in a private sanatorium

Different financing models appear adequate

might be well inclined to pay for an e-learning

in different contexts:

course on information management, while it

• Sponsoring through patients’ associations

is hardly imaginable to ask a fee for a job-ori-

or companies

entation programme from a 17-year old

• Public funding

patient with an immigrant background who has just undergone brain surgery.

95

Chapter 8 The preparatory phase

5. Establishing an organisational basis for cooperation If education providers are to work together with hospitals in an e-learning project it is essential that the nature of the cooperation is defined at the outset of the project.

One of the biggest challenges to successful cooperation is the workload of hospital staff.

Chapter 8

It is therefore essential that the hospital man-

96

Hospital staff can only fulfil their functions if they are fully informed about the e-learning project. The experience from the eHospital project shows that an initial informational meeting for hospital staff is essential.

Participants of this meeting should exceed the narrow core group of collaborators and include multipliers in all groups of staff who might get involved in the e–learning project:

agement appoints a main contact person and

The information session introduces the e-

a core team of collaborators. The roles and

learning projects and explains the additional

tasks of each of these collaborators need to be

functions and tasks to the hospital staff. The

precisely defined and ensured that sufficient

agenda for the information meeting should be

time resources will be allocated.

communicated well in advance in order to

When selecting the staff it has to be taken

give people time to sort out basic questions

into consideration that most groups of staff

before the meeting starts.

additionally have to work in shifts.

It could look as follows:

Chapter 8 The preparatory phase

Agenda of a staff information meeting Presentation of the education partner Hospital staff should know about the institution their hospital cooperates with in the implementation of the e-learning project. They should develop trust that the education partner will act in the interest of the patients and the hospital.

Presentation of the people involved It is very important that many hospital staff know at least their key personnel of the education partner by sight. This eases later communication and helps avoid embarrassing situations (e.g. a nurse asks a trainer who he is in front of a patient).

Aims and objectives of the e-learning project Hospital staff should have an idea why the course content was chosen for a particular patient group and which benefits are expected from the learning.

Basic introduction to e-learning

Introduction of the e-learning platform If there is time for a longer meeting, or perhaps a follow-up, it might me worthwhile to present the learning platform and some of the e-content to the hospital staff, as this gives a much more

Chapter 8

Many staff members may not have had any experience with e-learning yet.

vivid impression of the e-learning course than merely talking about it. Even short hands-on sessions have an added value.

Organisational cornerstones of the course offer Staff members should be able to communicate the duration and the main conditions for participation in the e-learning course to patients and their families. Or they should at least know where to get this information quickly.

Role, function and tasks of the hospital staff It should be clearly communicated which – additional – tasks related to the e-learning offer are expected from each group of staff (e.g. promotion, recruitment of participants, support etc.).

97

Chapter 8 The preparatory phase

6. A checklist for the preparatory phase Issues to address in preparatory negotiations with hospitals Type and requirements of the patients to be involved ❑ Which group(s) of adult patients are most suitable for the e-learning project? ❑ Are they long enough (= at least 1–2 weeks) in hospital to engage in e-learning? ❑ What exactly are their ❍ medical ❍ hygienic ❍ psychological needs? ❑ How fit are they for learning (attention span, energy level etc.)? ❑ Are they mobile? ❑ Schedule of the daily routine (doctor’s visits, meals, visiting times etc.)

Content of the learning activities ❑ What topics could be of special interest / relevance to the target group? ❑ Are there any topics to be avoided (for psycho-medical reasons) Type of learning activities ❑ How often/long should face-to-face activities be planned?

When (cf. daily routine of the hospital)? ❑ Are face-to-face meetings in groups possible?

Chapter 8

Infrastructure ❑ ❑ ❑ ❑ ❑ ❑

Are there PCs and / or seminar rooms available? When can they be used for the project?

What type of hardware / software can be expected?

Do patients have their own lap-tops?

Does the hospital provide access to / Internet / W-LAN? Is the Internet access free of charge?

Are lap-tops allowed in the bed-rooms? If not, where can patients (e-)learn?

Financing ❑ Who will finance the e-learning offer? ❑ Are there any potential sponsors? ❑ Can patients be expected to pay for the e-learning course?

Cooperation with hospital staff ❑ In which way will the e-learning facilitators cooperate with ❍ Doctors ❍ Hospital psychologists ❍ Nursing staff ❍ Administrative staff ❑ What kind of preparation of / induction to the e-learning pilots do these groups need? ❑ Appointment of official contact persons for each staff category / formation of a hospital project team

98

Chapter 9 Educational strategies of e-learning activities

Chapter 9 Educational strategies of e-learning activities Carmen Fernández Morante, Beatriz Cebreiro

characteristics and needs of the potential group of patients to which it is directed. That is why the first step will be to have an interview with the medical team to know the patients’ profile: age, sex, professional and educational background, impact of the illness on each person, and possible educational needs derived from the new situation.

López, Malgorzata Marciniak, Maria A. Muñoz

This first contact will offer the programme

Cadavid, Isabel Porto Golpe, ´L ´ ukasz Nowak

developer important clues to determine the patients’ fields of interest and detect the existence of specific needs which the programme

ological issues which should be reflected on when designing and implementing informal elearning offers for hospital patients.

Principal characteristics of the patients as a specific group of adult learners are reviewed.

Particular emphasis is put on the necessity to adapt any learning programme to the individual characteristics, rhythms and needs of the patients concerned. Information and communication technologies have much to offer in this regard, but e-learning facilitators should

should give an answer to. An example of this could be the case of people with marrow injuries who, because of mobility limitations, need a change of profession and, therefore, the development of new competences. The learning programme offered to this type of patients should respond to this need. At the planning stage it is necessary to take into consideration: 1. The training needs resulting from the impact of the illness on the patients, which may demand the redefinition of their professional career.

be aware that this potential can be fully used

2. The opportunities for updating professional

only if they are supported by active, participa-

competences which arise during convales-

tive and flexible learning methodologies.

cence and can range from the improvement

Chapter 9

This chapter discusses didactic and method-

of specific knowledge or skills, to the development of transversal competences like ICT or foreign languages.

1. Definition of the aims and contents of the e-learning programme

3. The personal interests of the patients and/or inclinations of a social nature (hobbies, cultural and artistic preferences,

Providing informal e-learning programmes

etc.), because they involve a component

that can be of interest to hospitalised patients

with a high motivation level.

or day-patients linked to a hospital unit

A second necessary step in the development

requires detailed previous knowledge of the

of the e-learning programme is an interview

99

Chapter 9 Educational strategies of e-learning activities

with the selected group of patients with the

Moreover, the e-learning programme should

intention of adjusting the learning proposal.

guarantee the principles of continuity in

The interview can be conducted with a sam-

learning, gradually incorporating different lev-

ple of patients. The trainer should bring a

els of learning and offering opportunities of

flexible proposal to consider together with the

studying in depth when the level of knowledge

patients to this session. This session with the

of the patient is greater.

group of patients allows to complete the infor-

In the design of learning content a combina-

mation gathered previously: group character-

tion of obligatory units (related to the mini-

istics (age, sex, professional profile, family

mum achievements required in the pro-

situation...), previous knowledge, expecta-

gramme) with optional units (dealing with

tions and level of social interaction within the

related subjects, allow patients to go into

group.

more depth or progress in their level of com-

As in all forms of adult learning and particularly in informal learning contexts any group of adult patients will show a high degree of heterogeneity. The only characteristic they can be sure to have in common is a similar health problem. Many of the other departure points for their learning activity are likely to be diverse, and this heterogeneity will have to be taken into due consideration.

plexity) is advisable. These units and the possibility of choosing between them give each patient the opportunity of creating their individual learning pathways. This didactic strategy takes into account individualised learning processes and combines individual needs with the development of a (virtual) community of learners.

To take the actual situation and needs of the target group into consideration is one key fac-

On the other hand, it will be not possible to Chapter 9

offer all kinds of learning subjects at the same time, due to limited resources. It is a challenge to deal with this dilemma.

tor of its being received favourably by the patients concerned. Another is the capacity of the team of facilitators to communicate to the patients the benefits which participation in

A programme developer can only try to find

the learning activities can create. It will be of

some common ground as to the topic of the e-

great importance to discuss how the learning

learning proposal, which will probably be

activities will contribute to patients’ personal

related to the health situation which affects

development during the phase of illness or

all of them.

convalescence.

Interviews with hospitals staff and sample of patients

Definition of aims and contents

Knowledge of characteristics and needs of the patient target group

Fig. 1: Key elements of the planning stage of an e-learning programme for patients.

100

Communication of the expected requirements and benefits to patients

Chapter 9 Educational strategies of e-learning activities

The hospital as the institutional context of the learning activities has considerable influence on the actors of the programme. The patients

point the learner establishes their own needs. For that the programme offers the possibility to select one’s own learning pathway.

must be regarded as adult learners influenced

• Individual differences increase with age,

by variables like the development of the ill-

that is, adults have more defined learning

ness, emotional fluctuations, social support

styles, they have acquired some intellectu-

available during the illness, routines derived

al working competences and have therefore

from treatment and hospital processes. These

more clearly defined preferences and

variables exert a considerable influence on

expectations. Autonomous learning should

the teaching-learning process.

therefore be a priority.

To address the patients as adult learners,

• One of the first barriers to overcome in the

basic principles of adult learning should be

programme is the erroneous belief of many

taken into account (Peterson, Clark, Dickson,

adults that one can only learn at certain

35.

Based on these principles and on

ages. Some adults have doubts whether it

the experience gained in the eHospital pilot

will be worth the effort to invest in the

projects carried out, the following recommen-

learning process at this time of their lives.

dations can be established:

They may also be worry whether they will be

• Adults are motivated to learn when they

capable of learning new concepts, handle

discover the needs that can be satisfied

new technologies and break with the habits

through learning. This is why it is important

acquired in other educational experiences.

to base the e-learning programme on the

These barriers have a high relevance in the

needs expressed by the patients.

envisaged e-learning activities because in a

1990)

• The course of adult learning should be

great number of cases adult patients have

directed towards real situations, that is why

not had any previous experience with tech-

new knowledge and skills should be

nology-supported learning. Moreover, some

acquired through activities that demand

might even have negative attitudes towards

problem-solving in the day-to-day context of

these new technologies. It is necessary to

the patient.

anticipate this reluctance using, on the one

• The analysis of one’s own experience is a

hand, functional and simple technologies

valuable resource for learning. As from this

and, on the other hand, designing initial

Chapter 9

2. Patients as adult learners

learning units which give an introduction to 35

Peterson, P.; Clark, C., Dickson W. (1990). Educational Psychology as a Foundation in Teacher Education: Reforming an Old Notion, in Tozer, S., Anderson, T., Armbruster , B. (Eds): Foundational Studies in Teacher Education. A Re-examination, New York, Teacher College Press, 24–48.

technological tool handling. This ensures the elimination of any barrier caused by ignorance or negative prior experiences with ICT. Before starting the experience an assessment should be done to determine

101

Chapter 9 Educational strategies of e-learning activities

learners’ competences in the use of tech-

tion and activities provided in a virtual envi-

nologies as didactical resources.

ronment. On some occasions, in this experi-

The hospital trainer should keep in mind that

ence of hospital training some variables of the

the relationship with the patient is an educa-

patient’s situation are going to condition this

tional relationship. It is directed to facilitation

teaching role and can eclipse or divert the aim

and guidance in the teaching-learning process

of the e-learning proposal which is the train-

based on e-learning and aims at enabling

ing of the patient during convalescence.

patient learners to learn to a large extent

The process of learning in hospitals can be

autonomously in work processes with informa-

influenced by five variables:

Arrangement with hospital system

Affective support networks

Development of the illness

Factors influencing patients’ learning process

Expectations and learning rhythm

Acceptance of the illness

Chapter 9

Fig. 2: Factors influencing patients’ learning process

Arrangement with the hospital system The hospital is the principal reference context for the patient and it is necessary to establish communication and coordination channels with the medical staff (doctors, nurses, health

daily; interns who always remain in hospital; patients who combine hospitalisation with stays at home; or patients in isolation units.

technicians, orderlies, psychologists, thera-

• To identify the professionals of the medical

pists...). The work with them allows the e-

centre with whom the teacher should coor-

learning facilitators:

dinate the patients’ learning sessions: need

• To know the routines of each professional.

to enter specific wards, to obtain materials,

• To know the different situations in the hos-

102

patients who come and go to the hospital

to ask for sanitary and/or technical help.

pital system and the conventional way to

The forms of interaction of educators with

interact with the patient in each case: day-

healthcare staff necessary to create as much

Chapter 9 Educational strategies of e-learning activities

synergy as possible in the interest of the

tual learning environments foresee, can be a

patient learners are described in more detail

considerable source of motivation.

in Chapter 6 of this publication.

In the light of the experience gained in the eHospital pilot projects, however, it is evident

Affective support through family and friends

that triggering and maintaining this process of

The support networks on which the patients

virtual collaboration is a big challenge for the

can count during convalescence is one of

e-learning facilitator. Many patients seem to

their principal motivation factors: their friends

be much more willing to use a virtual learning

and family. Family involvement in the e-learn-

environment to access information rather than

ing process stimulates the learner and

to engage in intensive communication. It will

strengthens the continuity of the process and

only work if carefully reflected educational

the link with the teacher. Family participation

strategies ensure that interaction with peer

in group sessions of patient learners con-

learners create and immediate added value

tribute to generating a learning atmosphere of

for the patient concerned.

confidence and stimulates the patient to do independent work, especially during periods

Development of the illness

from this relationship it will be necessary to

The physical and emotional development of

establish a fluid relationship with the families

the patient during hospitalisation is some-

that provide valuable information to the train-

times subject to severe fluctuations (critical

er about the patients’ situation, their anxi-

situations, regression, medical complica-

eties, the problems and needs they have expe-

tions...), and in particular with chronically ill

rienced.

patients the dynamics of recovery are often

A strong personal support network eases the

slow. This dynamics have repercussions on

continuity of the learning- programme

the learning process, the learners’ motivation

between hospital and home. Although, need-

and their inclination towards learning. This is

less to say, the absence of a family bond will

why the learning in this context has to be seen

mean difficulty for the follow-up at home that

as a long-term process which often takes an

will have to be taken into account by the edu-

irregular course. Trainers and tutors have to

cator who will have to draw up a special strat-

pay close attention on these fluctuations and

egy in this case through a virtual environment.

adopt a position that permits them to recog-

Another network of social support that can

nise the patient’s capacities at any given

play an important role in the learning process

moment of the learning process. Flexibility is

is the peer group of other patient learners. In

a must, and trainers must be ready to change

the design of the programme social learning

the learning activity when it is appropriate

strategies should form an integral part.

and necessary, or postpone it to a more oppor-

Collaborative forms of e-learning, as many vir-

tune moment.

Chapter 9

of discouragement or apathy. To benefit most

103

Chapter 9 Educational strategies of e-learning activities

Respect of the students’ rhythm and needs is fundamental for the continuation of the course. A lot of sensitivity and empathy is needed. It is crucial in situations when the continuation of the course is at stake that hospital trainers take a real interest in the development of their learners, encourage them to take up their learning rhythm again and offer flexible learning alternatives.

Learners‘ expectations and learning rhythm The decision of taking part in an e-learning programme at hospital should be made by the patients themselves and it should only be them who ask for participation in the course.

In many cases the experience of the illness completely absorbs the patients and that is the reason why the deliberate decision to get involved in an e-learning activity is often a big step.

Acceptance of the illness

Consequently, the facilitators should seek to find out and meet the expectations of the patent learners. This of course applies to all

Illness implies a process from experiencing its symptoms to accepting it (cf. chapter Life in

hospitals) In the initial stages of the health problem patients often experience negative feelings like rage, rejection, or even face depressive

forms of adult education, but needs to be particularly stressed in this context with a view of the vulnerability of the target group.

Participation in e-learning activities is likely to be felt in accordance with patient expectations if

spells. These strong feelings can determine the patients’ inclination toward learning, the relationship between educator and learner Chapter 9

and thus make the task of the educator very difficult. In these cases the strategy is to respect the negative experiences of the illness and maintain permanent face-to-face and virtual contact with the patient.

• patients are encouraged to express their personal learning goals before they engage in the course, • the learning offer is adjusted and modified according to the individual needs and demands of the patient, • the design of the digital contents is userfriendly,

In the further stages of regret and eventually acceptance of the illness as well as the

feed-back and a follow-up,

limitations it imposes, the trainer will focus

• there is intensive interaction between the

on working closely with the learners until

tutor and other learners by means of all the

the learning is fully integrated into the

available channels of communication,

patients’ daily routine. Learning will then be

• sufficient guidance, counselling, and sup-

a source of motivation and recovery which

port is provided to ensure learning progress

may lead to a more positive experience of

and eventual achievement,

convalescence.

104

• the e-learning programme foresees regular

• the patients’ learning rhythm is respected.

Chapter 9 Educational strategies of e-learning activities

The experience that the learning activities

(week-ends, free intervals between thera-

respond to the patients’ expectations, and,

pies, free spaces between the centre rou-

where necessary, advice on how to learn and

tines, hospitalisation periods or recovery at

progress are likely to favour successful com-

home,…) making use of asynchronous (e.g.

pletion of the course.

forum, messages, dropbox) and synchronous communication tool (e.g. videoconfer-

3. Strategies to exploit the potential of ICT for patient learning

ence, chat, webminars,...) that online sys-

The introduction of technological support to

media resources centre, database and

learning creates without doubt added value,

links)allow learners to work with the infor-

as it provides an opportunity for flexible learn-

mation on demand at any moment of the

ing during the course of an illness. The use of

day.

tems offer. Using such tools when asking for digital information (document folders,

ICT as learning tools offers several advantages compared to other types of training, most notably: individual adjustments and flexibili-

Open nature of the online learning systems

ty, open nature of the learning content and

Internet-based learning allows for

group, and high accessibility of the learning

• Constant updating of the information and

offer.

access to contents and learning materials that are distributed in the web and that

Flexibility to adjust to the needs, rhythm and situations of each student

enormously enlarge the offer of contents and the possibilities of construction of one’s own learning paths.

• Diverse learning contents, with different formats and with different levels of learning to respond to the requirements and heterogeneousness of a specific group of patients.

• Work in different physical spaces (isolation

• Introducing new learners, trainers and tutors at any time of the process: This is particularly suitable in the hospital context because it allows the patients to join a pro-

Chapter 9

E-learning offers

gramme as they come into the hospital or when their health state allows it.

rooms, specific units, classrooms, home, other hospital centres which the patient attends to undergo a specific treatment)

Accessibility

and thus guarantees continuity of learning

• ICT allow finding a solution to a great part

and support and avoids the interruption of

of the difficulties that arise from the physi-

the process patients have to face when

cal limitations resulting form certain ill-

there are changes in their routines.

nesses (mouse emulous to improve mobili-

different

ty and work in different positions – in bed,

moments or with different timetables

lying down, sitting up,… –; adapted periph-

• Learning

opportunities

at

105

Chapter 9 Educational strategies of e-learning activities

eral that makes easier interaction; voice

ditional methodologies that reduce the oppor-

recognisers that substitute mouse and key-

tunities of virtual learning to the methods of

pad; screen and keypad amplifiers that

conventional classroom teaching (old prac-

resolve motor and visual difficulties, etc.)

tices for new resources). Such approaches do not constitute any pedagogical progress, on

Didactic strategies and methodological recommendations

the contrary: they create static settings where the learner works alone and the success of training depends exclusively on the learner’s

ICT-supported learning offers a lot of advan-

capacity and initiative, which might not be at

tages for patient education, but only if it is

its strongest in times of illness.

accompanied by the application of innovating

One of the keys to the success of e-learning

teaching methodologies. One of the most

lies in its interactive potential, that is, its

common errors in e-learning is the use of tra-

capacity to mobilize the learners and stimu-

Chapter 9

Teaching-learning methodology

Active

Participative

Contextualized

(Learning by doing)

with ( Learning others )

from ( Learning experience )

Practical

Learning by ( problem solving)

Fig. 3: Principles of adequate teaching-learning methodologies

106

late them to interact with the other learning

problem solving strategies and social interac-

agents and elements (tutors, peers, contents,

tion.

technological system). That is the reason why

In practical terms the design of the e-learning

the design of a proposal of these characteris-

programmes for hospital patients will benefit

tics requires active and participative teaching

from taking into account the following recom-

methodologies based on significant learning,

mendations:

Chapter 9 Educational strategies of e-learning activities

Analyse possibilities and didactical use of virtual tools

Modular design of contents and flexible navigation system

Respect patients’ rhytms and real dedication to training

Didactical recommendations

Foresee different activities: Individual – pair – group

Combine face-to-face and virtual work

Develop global tutorial action

Fig. 4: Didactical recommendations on the design the e-learning programme

Analyse all the possibilities of the tools and services that will be necessary for the virtual setting and define their didactical functions.

• Progressive incorporation of contents to avoid cognitive overflow.

• Prediction of individual space needed to organise the learners’ productions.

Communication tools

Tools for group work

• Selection of different modes of asynchro-

• Promotion of activities that involve team

nous and synchronous communication.

• Definition how to use certain tools in certain situations: for tutoring, for formal and informal communication between students, support between equals, etc.

work between learners and joint problem

Chapter 9

Recommendation 1:

solving.

• Provision of spaces and tools which allow information sharing and collaboration among the members of the team.

Information management tools • Careful selection and organised presentation of the documentation.

Follow-up tools • Knowledge of the possibilities of continu-

• Individualized route design to direct the

ous evaluation with the quantitative and

students in the use of the available infor-

qualitative follow-up of the students’ activ-

mation (learning pathways).

ities in the system (statistics of access to

107

Chapter 9 Educational strategies of e-learning activities

the tools and contents, recording and supervision of the activities, etc.).

• Implementation of a systematic and individualized follow-up of the patients, offer-

Recommendation 3: Introduce different activities in the contents which require the working out of individual knowledge, in pairs, and/or in groups.

ing feed-back (reminders of pending activities, getting in touch to ask about their general condition, comments about the quality of their productions for improvement, …)

• Basic activities (obligatory or optional): small tasks that compel, step by step, to validate or put into practice the expected knowledge or abilities. They will be of pro-

Recommendation 2:

gressive difficulty and their formulation should be clearly related to the course con-

Modular design of contents and of flexible navigation system that allows learners to locate information and move freely around.

tents, i.e.: practice a technique, use a tool, complete a test, etc …

• Assessment activities (obligatory) that require a higher level of complexity and the

Avoid linear navigation designs by means of: • Distribution of contents in short modules that do not include too much information but have a clear formative unity and can be articulated with others to generate a more complex knowledge.

Chapter 9

• Combination of obligatory and optional

108

modules allowing the student to choose according to his preferences and the configuration of an individualized and flexible curriculum.

combination of different skills and knowledge previously acquired. Interaction between learners can be encouraged by means of introducing proposals that require pair or group work in combination with individual tasks (e.g. solving a practical case or problem or developing a product). This can on many occasions avoid that especially insecure learners be discouraged or mentally blocked by the need to take an assessment or test.

• Further activities (optional) that should be

• Presentation of the information in an inter-

included to give an option to students with

connected manner in hyper-textual and

a faster progress or greater previous knowl-

multimedia formats that combine different

edge. By this it will be avoided that more

resources and languages.

capable learners will resign because the

• Organisation of contents in learning paths

course is not challenging enough. These

and not exclusively in a logical hierarchy

activities should not be closed, but that the

and similar structure. This possibility is not

students can redefine them according to

offered by all platforms and it should be

their interests and daily experiences.

taken into account when choosing the

Methods like projects, cooperative work or

resources.

research are particularly suitable.

Chapter 9 Educational strategies of e-learning activities

Recommendation 4: Combine face-to-face and virtual work.

centration. It is therefore helpful to offer work alternatives that require a high level of intellectual effort. Leisure proposals, “light” or funny bits, or even agreed interruptions of the

E-learning in hospitals should always be

learning activities that can last weeks. During

blended learning. Face-to-face meetings of

these pauses the trainer should keep in touch,

learners and trainers are crucial for the suc-

show interest in the patients’ development

cess of the learning programme. The experi-

and remain alert for the right moment to

ence gained in the eHospital pilot pro-

restart the learning activity. It is of vital

grammes confirmed that regular personal

importance to maintain a balance between

meetings are an indispensable source of

the effort demanded from the learners and

patients’ motivation to pursue their learning

their real capacities for and commitment to

goals. It is also in these meetings where they

the learning. This balance requires continu-

can receive direct and immediate support for

ous assessment of the patients’ situation and

their learning. This is a pre-requisite for the

according adjustment of the demands with

virtual interaction, which will furnish the con-

regard to learning aims and activities.

tinuous support and advice that the individual work of the learner requires.

Face-to-face sessions should be more fre-

Recommendation 6:

quent at the beginning of the programme and

Evaluate carefully and appreciate fully learning

gradually give way to a more prominent use of

achievements of patients.

online interaction, when the learner gains the virtual learning platform. Nevertheless, it is essential that the personal contact is maintained throughout the whole course in order to ensure its continuity.

One of the fundamental indicators of the success of an e-learning course is the individual learning achievements of the patients.

In the context of patient education “learning

Chapter 9

more and more autonomy and experience with

achievements“ can mean much more than in traditional classroom activities, where indica-

Recommendation 5:

tors like completion of the programme or suc-

Respect the learner’s rhythm and actual dedica-

cessful tests are still common. In informal

tion to learning that can be changeable and

learning activities of hospital patients, howev-

irregular.

er, achievement can occur at completely different levels:

Daily routines and therapy at hospital require a great effort that in many occasions reduces

• acquisition of new skills improving patients employability

the patients’ energy and restricts their abili-

• sense of personal fulfilment

ties and possibilities of performance and con-

• increase of motivation and mental strength

109

Chapter 9 Educational strategies of e-learning activities

• diversion of attention from the illness to

Chapter 9

something else

110

by his family, and the patient’s father regularly accompanied him to the face-to-face ses-

Each of these types of learning achievement

sions. At the end of the course the partici-

is equally valuable.

pant came to each meeting alone, and obvi-

One illustration of what learning achievement

ously enjoyed the direct contact with the

can mean in this context:

trainer without any mediation. This achieve-

In one of the eHospital pilot projects one par-

ment may have contributed to his gaining

ticipant was not really convinced of the job

enough confidence to decide to attend a

orientation course at first. The trainer had the

vocational college at the end of the hospital-

impression that he was more or less pushed

isation period.

Chapter 10 Hospital-specific e-learning know-how

Chapter 10 Hospital-specific e-learning know-how Manuel Gromaz Campos, Maria Jose Rodriguez Malmierca, Uwe Hoppe

Technology provides the learner with the flexibility of accessing learning materials, online tutoring or support from other students at any time, regardless of their hospital schedule or own preferences.

The general concept of e-learning comprises several modalities, depending both on the pedagogical approaches and on the technology involved. Several years ago it was expected that e-learning would revolutionize learning

Technology is a key element in every e-learning project. This chapter discusses some general questions related to online tools, network structure, and the hardware and software required to set up and support elearning activities in hospitals.

Some of the most frequent technical problems occurring are addressed, as well as security concerns and usability and accessibility aspects.

and teaching and give a boost to further education and training. The reality shows another picture though. Given the special conditions of learning in hospitals, it seems that pure online learning, with no face-to-face sessions, is not an adequate model, as most learners in hospitals require a strong degree of personal contact, help and support from their tutors before they can benefit from the distance part of the learning activity. Otherwise, they might feel too isolated and not have enough motivation to be able to deal with such an e-learning

1. Two modalities of e-learning in a hospital context

course.

Learning in hospitals can benefit from the use

modalities in a blended learning context,

of technology, as the individual circumstances

which seem appropriate for patients at hospi-

of every learner may improve or even require

tals, highlighting their advantages and disad-

some technological support to their learning.

vantages:

Chapter 10

Here, we explain two different e-learning

Possible types of blended learning in hospitals

M-learning E-learning with mobile computers

T-learning Learning with TV

Fig. 1: Two possible e-learning modalities for informal patient education

111

Chapter 10 Hospital-specific e-learning know-how

Mobile-Learning or M-Learning has proven to

ous situations. T-learning is an e-learning sub-

be very useful in hospital context. Mobile

set and consist to learn trough interactive dig-

learning is understood as learning that hap-

ital TV.

pens across locations, or that takes advantage

The term T-Learning has been adopted as

of learning opportunities offered by portable

shorthand to mean TV-based interactive learn-

technologies. The term covers learning with

ing. T-Learning is about having interactive

portable technologies, such as Personal

access to video-rich learning materials prima-

Digital Assistants (PDA), laptops or tablet

rily within the home, through a TV or a device

PCs, UltraMobile PCs (UMPC), mobile phones

more like a TV than a personal computer. Like

or similar devices, where mobility and tech-

the TV, the device would have to be a so-

nology play an important role in facilitating

called consumer device – which is easy to use

learning activities.

and as reliable as a television, a microwave or

Learners in hospitals may have reduced

a refrigerator.

mobility and/or be isolated for medical reasons and not be able to leave their rooms, or even need to change very often (from their

2. Technical infrastructure in hospitals

room to a specific hospital ward, or even the hospital cafeteria). M-learning is, therefore, very relevant, as it means:

Hospitals are known as places with a lot of technology inside, but this does not mean that all hospitals have a ready-made infrastructure

• learning across contexts, where the focus is on the mobility of the learner, interacting

Chapter 10

with portable or fixed technology;

112

to

host

e-learning

activities.

Furthermore, not every hospital is willing to allow the use of technology that has not very clear medical purposes (for example WI-FI

• learning in a mobile society, with a focus on

connectivity). Analysing available infrastruc-

how society and its institutions can accom-

ture in the selected hospital is one of the first

modate and support the learning of an

tasks that should be addressed.

increasingly mobile population

Hospital infrastructure availability is a key element in an e-learning project success, and

Although related to e-learning and distance

it may be a relevant factor in deciding which

education, it is distinct in its focus on learn-

hospital to work with, in order to implement

ing across contexts and learning with mobile

an e-learning proposal. Working with a hospi-

devices.

tal that provides most or all the infrastructure

In a hospital context T-Learning could be an

makes all the process easier for organization-

appropriate medium/device for teaching and

al purposes and, of course, cheaper.

learning purposes to support lifelong learning

Regarding Internet access, the most desirable

by acting as a vehicle to learning at various

situation would be broadband WI-FI access,

ages, and in physical and psychological vari-

which would allow configuration to a very flex-

Chapter 10 Hospital-specific e-learning know-how

Checklist for technical infrastructure in the hospital ❑ Does the hospital have an Internet connection? ❍ How fast is it? ❍ Is it available for patients? ❍ Is there a wireless connection to the Internet? ❑ Can the hospital provide computers for the patients? ❍ Are they stationary devices in a common room? ❍ At what times can they be used? ❍ Can the hospital provide laptops to patients? ❍ Is the use of laptops/PDAs, etc. allowed in the rooms? ❍ Does the hospital provide accessibility equipment for patients (headsets, input devices...)?

selves. Internet connection is now possible almost everywhere thanks to mobile Internet technologies such as UMTS and GPRS (by using PCMCIA cards or USB devices) which can be used together with any PC.

3. Virtual tools for learning and communication Once the basic infrastructure at the hospital has been established it is time to decide on the online tools to be used and the individual adaptations which might be necessary.

The term online tools refer to software needed to support the e-learning activities, such as a virtual campus, communication tools, social software, etc. These tools provide a virtual learning environment, which can be accessed and used by the learners in hospital at the

ible scenario, where patients could be learn-

their learning objectives, to work on their own

ing anywhere with their PCs and/or laptops. In

or collaboratively, or to get support form a

any case, broadband Internet access is

tutor.

strongly recommended, as it ensures full

One of the key decisions to be taken concerns

access to the online tools you plan to use

the selection of a suitable online platform for

(web browsing, e-mail, videoconferencing,

the e-learning activities.

streaming, etc.) in the e-learning offer.

There are many options when it comes to choose the right virtual environment. First, it

Some hospitals have rooms with PCs available

should be determined:

for patients. These areas could be a good option to be used as training rooms, or places where the patients can come together for (face-to-face or virtually) group learning sessions.

• What is it intended for (online teaching, group work, online tutoring, project management, storing materials, teachers’ area...)?

However, if there is no possibility of having

• Who will use it (teachers, students, e-learn-

the basic network and hardware structure in

ing project managers, hospital’s staff...)?

the hospital, in some cases laptops may be

• What requirements should it meet (techni-

expected to be provided by the patients them-

Chapter 10

time of their choice in order to accomplish

cal, economical, security...)?

113

Chapter 10 Hospital-specific e-learning know-how

There are many software solutions which will

Each LCMS or LMS has its own characteris-

meet almost any requirement. Besides, some

tics, some offering more tools and functional-

of the best options are for free, under an Open

ities than others and relying on different

Source License.

learning philosophies. However, most of them offer the following tools to allow for different

Open Source is a set of principles and prac-

learning activities:

tices that promote access to the design and production of goods and knowledge. The term

• Information and content creation tools:

is most commonly applied to the source code

Document

area

(access

to

training

of software that is available to the general

resources), links, learning path, blog, wiki,

public with relaxed or non-existent intellectu-

etc.

al property restrictions. This means that we

• Interaction/communication tools: Calendar,

can not only install and use certain software

Discussion forums, Announcements, Chat,

for free, (for example a Learning Management

audio/videoconference, webminar.

System) but we are also allowed to modify it, adapting it to better suit our needs or our students’. This fact makes Open Source tools extremely useful and advisable for learning

• Evaluation tools: online test manager, tasks manager, user reports.

• Course management tools: user management, course statistics, etc.

proposals in hospitals.

Chapter 10

Regarding its technical requirements, a LMS There are several terms in use for such online

generally requires installation in a dedicated

platforms:

and powerful server, which can deal with

Learning Content Management

Learning Management System (LMS)

Virtual Campus

E-Learning Platform

Fig. 2: Terms used for online platforms

114

Virtual Environment for Learning

Chapter 10 Hospital-specific e-learning know-how

many students and teachers working at the

and share data with one another. Examples

same time in the platform. Ideally, an experi-

of social software are tools like wikis, e-port-

enced technical department from either the

folios or blogs, and services like YouTube,

hospital or the education provider should take

Flikr or MySpace. These kinds of tools can

care of the server, its maintenance and sup-

provide a creative support for learning activ-

port.

ities.

It may be difficult to select one LMS among

Other free services and tools, such as the new

the many options available, and they usually

generation of instant messengers, provide a

look similar. However, it should be consid-

good support for communication. Tools such

ered what features may be needed for a cer-

as Skype (www.skype.com) can provide an

tain learning scenario, or how accessible the

easy way to provide videoconferencing to

platform

concerned.

facilitate tutoring or one-to-one communica-

Important elements to check out when

tion, as well as multipoint audio-conference

choosing an LMS are functional require-

to organize group sessions.

is

for

all

users

ments, interface requirements and accessibility requirements.

As it was said before, it is essential to analyse the needs of each e-learning course in order

The documentation for learners, trainers and

to select the most appropriate tools.

course developers must be personalized. It is of particular importance that the user’s (learnexplain step by step how to use the system

To give an example for the selection of an online platform:

using screen shots and examples. If it is pos-

In the eHospital project Dokeos (www.

sible it could be a good idea to design an ani-

dokeos.com) was used as both online

mated documentation (flash or video).

Learning Management System and collaborative platform.

Although the focus of this chapter is on

Dokeos is a European Open Source e-learning

LMS, as it presents a popular and compre-

and course management web application,

hensive tool to support online learning, this

translated into 34 languages and installed in

is not the only tool that may be useful to

more than 1.000 organisations worldwide to

support an e-learning experience in hospital.

manage e-learning and collaboration activi-

Social software (or Web 2.0 applications)

ties.

present other interesting approaches to

Dokeos proved to be a versatile, flexible and

design a learning scenario. Social software is

stable platform that complied with the

generally known as a set of web-based pro-

learning programmes developed in the

grammes which allow users to easily interact

eHospital project.

Chapter 10

er) documentation is simple. It ought to

115

Chapter 10 Hospital-specific e-learning know-how

Checklist: Choosing a Learning Management System Functional requirements ❑ Does the LMS provide the tools needed regarding: ❍ User management: roles, inscriptions, ordering,... ❍ Content management and authoring: multimedia resources allowed, online editing,... ❍ Communication tools: asynchronous or synchronous ❍ Information tools: agenda, announcements... ❍ Evaluation tools: task handling, online testing, assessment ❍ Collaboration tools: group tools ❍ Tracking tools: statistics, reports ❑ Do you have a list of these teaching and learning management requirements? ❑ Does the LMS comply with standards enabling course material to be exchanged with other systems (e.g. AICC, IMS, SCORM)? ❑ What level of customization is required in course design, individual tools or overall branding?

Interface requirements (Usability) ❑ Is the interface easy enough for all users (administrators, students and teachers)? ❑ Does it have an intuitive navigation scheme? ❑ Does the LMS require a short/long time to learn how to use it? ❑ Does it provide user manuals in your language?

Chapter 10

❑ Languages: Is it translated to all the languages you may need?

Accessibility requirements (Hardware/Software) ❑ Does your LMS comply with WAI accessibility rules? ❑ Do your students face any problems (visual, motoric) to access the LMS? ❑ Do your learners/trainers have to use a high-speed connection or a brand new PC in order to access the platform? ❑ Do they have to have a certain operative system and/or certain browser to be able to use all the resources in the online platform? ❑ Costs: Is the LMS total cost (license, installation, maintenance, support) in line with your budget?

116

Chapter 10 Hospital-specific e-learning know-how

order to plan and organise support resources

Main features of Dokeos:

accordingly:

• Open Source.

• Available in 44 languages.

Technical problems with Internet access

• Usability as its main philosophy.

Sometimes Internet access fails, or the con-

• Very easy to use for teachers, students,

nectivity is very slow. Also, some software may

administrators.

• Suitable for e-learning and blended learning proposals

change the network configuration in the PC resulting in the users’ impossibility to connect their PC with Internet. For this kind of prob-

• It can be use as LCMS or Workspace.

lem, it is essential to be in a position to count

• It has a stable development community.

on a direct contact with the support desk at

• Stable

the hospital, (or external, if that is your case)

• Scalable, modular.

to solve this issue quickly. In such cases alter-

• Information management tools:

native communication channels should be

Agenda, documents, course descrip-

used to inform the patients on the issue and

tion, links.

the date/hour when this will be solved.

• Asynchronous communication tools: Forums, announcements, internal webmail.

• Synchronous communication tools: Chat, live conference.

• Evaluation tools: online tests, task storing tool.

• Group work tools: area for sub-groups

Technical problems with the platform: Most technical problems related with the platform have to do with their login access data retrieval, instructions to perform certain tasks, etc. A help-desk should answer these questions as soon as possible.

of students/user to work together. settings, user management, backup, etc.

• SCORM compliant: learning path builder.

Technical problems with PC When novice users browse the Internet, sometimes they may install some applications which may cause their PCs to run slowly,

Chapter 10

• Administration tools: tracking, course

sometimes crash, etc. Help desk staff should deal with this issue and give some advice on safe installation procedures.

4. Common problems When patient learners use ICT for learning

Security problems

they may face some technical problems.

When users download software applications,

Knowing them ahead of time is important, in

from the Internet, it may happen that they

117

Chapter 10 Hospital-specific e-learning know-how

also download unwanted spyware, malware,

information society data has become a valu-

etc. It is then very advisable to install some

able good, and, consequently, stealing data

anti-spyware software in the patient’s comput-

has become the target number one for cyber-

er to avoid this issue.

criminals.

As in the case of e-learning in hospitals Internet technology is in use as well we are

Accessibility problems with ICT

actually facing two possible threats: the theft Some pupils may need software or hardware

and misuse of data (e.g. personal data of the

adaptations which enable them to use a PC. If

patients) and the misuse or attack of the tech-

this is so, it is necessary to determine what

nical communicational infrastructure and

kind of adaptation they need, test the best

additional follow-up damages.

options with the student and choose the pre-

Being aware of some possible security threats

ferred one. Sometimes it may just be a minor

will make the introduction of e-learning into

change in the operative system accessibility

hospitals a safer and more satisfactory experi-

options, but in some other cases, it may be

ence.

necessary

to

install

screen

readers,

mouse/keyboard emulators, etc. In extreme

Four scenarios should be taken in close con-

cases, hardware adaptations may be needed

sideration:

to allow the student use the computer on his/her own.

(1) Using the Internet as it is, but provided in a classroom through a network physically sep-

5. Security concerns A crucial point sometimes underestimated is

arated from the hospital network to avoid interference.

the question of security including infrastructure and data security. The more the use of Chapter 10

Internet for nearly all information related processes has become an integral part of daily life the more dependent people have become on the properly functioning technical infrastructure. This is obviously the case in patient e-learning activities, too.

And that strong dependence indeed bears a great risk and has become a weak point, too.

Fig. 3: Network architecture36

With the beginning of the era of the information society a new kind of crime has been developed: the so-called cyber-crime. In the

118

36

Network Dictionary, http://www.networkdictionary. com/

Chapter 10 Hospital-specific e-learning know-how

Architecture of a virtual machine

Virtual infrastructure based on a set of several virtual machines

Fig. 4: Network architecture38,39

(2) Using the Internet as described in (1) but

(e. g. software update, patch management)

based on the thin-client-server principle

becomes easier and also more cost-effective.

in comparison with solution (1) the advan-

Furthermore, as the users have restricted per-

tages lie in the security area besides a save in

missions on what concerns the installation of

costs due to less investment into hardware

software, which could be the host for malware

equipment.

(viruses, worms, rootikits, or trojans), risks are minimized.

tion:

(3) Using the Internet but accessing the

The system may be threatened if de-central-

Internet only via a virtual machine following

ized desktops are in use and self-administrat-

the sandbox principle.

ed by the users, especially in the case of

Virtualisation is an upcoming and very pro-

Windows-based systems. Microsoft Windows

gressive technology. On the client PC a spe-

is the operating system with most attacks

cial software solution, such as VmWare, Moka,

faced and security holes discovered. Even

or Virtual PC to name only the most popular at

with huge investments into security software

the moment, has to be installed this kind of

the problems cannot be solved. New infra-

software enables the creation of so-called vir-

structural concepts are needed to increase

tual machines, the work space itself. Any

the security. One of the concepts is based on

operating system (e.g. Windows, Linux) can

the centralisation of applications which run

be installed on a virtual machine being the

on the server only. Software maintenance

basis for all of the other applications (e. g.

37 39

www.vmware.com http://www.networkdictionary.com

Chapter 10

Background for the selection of such a solu-

browser software) necessary to access the Internet.

119

Chapter 10 Hospital-specific e-learning know-how

(4) Using the LMS on a locally installed serv-

side (server security, patch management)

er as a kind of off-line version

should be applied.

LAMP-Server with LMS without Internet access

6. Usability and accessibility aspects It is crucial to take into account the requirements of patient learners in hospital (as well as all other users) in terms of their possibilities to access and use all the learning resources proposed. Therefore, this is something that should be analysed when choosing

Clients with any operating system plus browser

Fig. 5: Network architecture39

the platform and configuring all the course elements: learning scenario, online tools and contents. Having an accessible e-learning course does not only have benefits for some

It is obvious that scenario (4) is the safest but

users with specific problems: it is better for

it has some drawbacks:

all users, improving the course design and

• It needs more resources for a local server

interface usability.

must be placed at the hospital, with the LMS installed in it.

• Students lose the possibility of accessing Internet resources, other than those installed on your local server.

• Lack of interaction with other learners • Usage of communities for interaction is impossible Chapter 10

• Limited opportunities may influence the learners motivation • Additional members of staff are needed, involvement of external training provider

To start with, you should answer some questions: • Hardware: Can your students use a regular PC easily? Do they need adaptations?

• LMS: Is the interface easy enough for all users (administrators, students and teachers)? Does it have an intuitive navigation scheme? Does the LMS require a short/long time to learn how to use it? Does it provide user manuals in your language?

Besides that the common rules for using the

• Online Tools: Are all the tools selected for

Internet which concern the user side (e.g. not

the course easy to use? Does the bandwidth

to trust occurring unknown applications), and

needed for all tools meet the reality of the

administrative tasks concerning the provider

connection available?

• Learning contents: Are learning contents designed following usability and accessibil-

38

Network Dictionary, http://www.networkdictionary. com/

120

ity principles? Do they require high bandwidth, extra plug-ins or software installed?

Chapter 10 Hospital-specific e-learning know-how

When choosing an LMS and designing the econsider if any of the patients face some type of disability: visual (blindness, low-vision, colour-blindness), motoric (traumatic injuries, congenital disorders and diseases), auditory (full or partial loss) or cognitive (attention, comprehension, memory, problem-solving, math or graphic comprehension deficits) in order to make sure they can all access all the course contents. Pupils with physical disabil-

Usability rules • Assignation of the personal learning speed.

• Provide equivalent alternatives to auditory and visual content.

• Don’t rely on color alone to comply meaning.

• Use markup and style sheets and do so properly.

ities should be able to use speech recognition

• Clarify natural language usage.

software to access platform resources, emula-

• Create tables that transform gracefully.

tion software like visual mouse, virtual key-

• Ensure that pages featuring new tech-

boards, etc.

There is a strong concern about most LMS not complying with all WCAG (Web Content Accessibility Guidelines) published by the international reference Web Accessibility

nologies transform gracefully.

• Ensure user control of time-sensitive content changes.

• Ensure direct accessibility of embedded user interfaces.

Initiative http://www.w3.org/WAI/ . However,

• Design for device-independence.

there are some LMS that do take most of

• Use interim solutions to cope with old

these rules into account, as well as web

user agents (like screen readers, etc.).

usability rules (as specified in Jakob Nielsen’s

• Use W3C technologies and guidelines.

usability page: http://www.useit.com/ ).

All elements should be accessible to the

• Provide context and orientation information.

patient learners in order to be successful: the

• Provide clear navigation mechanisms.

computer, e-learning platform, tools, con-

• Ensure that documents are clear and

tents, learning proposal. A LMS is only as

simple.

accessible as the content that goes in it...

A key element in accessibility is information redundancy (information appearing both in

tool and content proposed, without having to

text and pictures/colours, or audio and text),

spend a long time deciding where they should

so it is easy for all learners to access the dif-

click to get where they want, and have no

ferent sections and contents.

problem in using their PCs or mobile devices

The bottom line of making your course usable

(with or without accessibility helpers, such as

and accessible is to guarantee that the learn-

screen readers, specific pointing devices,

ers can easily access all and every learning

etc.)

Chapter 10

learning course content, facilitators should

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Chapter 11 e-Culture for patients and facilitators

Chapter 11 E-culture for patients and facilitators

• perhaps how to play computer games (if you didn’t, learners will certainly have!)

• how to use basic office software, such as a word processor and a spreadsheet However, when using the Internet (whether it

Théo Bondolfi, Raphaël Rousseau

is via e-mail or web pages) teachers will be interacting directly with other users. The par-

As the Internet is a young medium, some of the learners may not understand the differences between older media and the more recent electronic ones, such as e-mail, navigating on a web platform for e-Learning etc. In this chapter we will try to help the teachers understand these differences, so that they can then support learners in doing the same.

ticipants of a distance learning assisted class will automatically become content producers, while accessing a learning management system (LMS), because they will be able to edit (create/modify) contents (texts, images, videos...). Therefore teachers need to know the basics about how things work as a publisher, in order to act appropriately.

Moreover, this chapter intends to help trainers or training project managers in developing a lifelong training programme including e-learn-

Teachers should practice the Internet code of conduct:

ing for the patients of Hospitals.

To reach this goal of including e-learning

Informal guidelines called ’netiquette’ exist

training sessions for patients into a hospital,

for web users and may be useful for you,

we will present the main issues about digital

before giving any class and managing the

environment.

course, mostly while using e-mails to inform

It deals with the ability to develop skills in the

partners, colleagues and participants. More

way of profiling oneself on the web and help

about the rules of the netiquette can be found

learners to do the same afterwards.

in Wikipedia at the following links:

We call this “the art of profiling”.

http://en.wikipedia.org/wiki/Netiquette

or

Chapter 11

www.albion.com/netiquette/corerules.html

122

1. Codes of conduct for communication and e-learning in the Internet

Netiquette is a list of simple rules whose most important ones are explained below. For more details, go to the links referenced at the end of this chapter. Print out the guidelines and

The first things that should be probably learnt

try to explain them to your learners and

when using a computer are:

encourage them to follow them – and of

• how to use the keyboard and the mouse

course, you should practice what you preach!

Chapter 11 e-Culture for patients and facilitators

Stay simple, fun and practical Some participants might have good e-culture skills beforehand, but not all of them.

Participants can quickly feel lost in a new learning environment. This is why, like when visiting a new country, they should have a very positive feeling at the beginning. Teachers should always start with simple things that create trust and motivation for using the tools: a very simple exercise, something funny, and then a step by step guided tour for logging &

unnecessarily with messages. They should also understand that not all viewers of their emails will have a high bandwidth, so they should try not to post large files (usually maximum 500KB) that will take someone with a dial-up connection a long time to download.

Hospitals may have good Internet connections for professional activities related to medicine.

That doesn’t mean that the recipient of the messages will have such a high bandwidth capacity.

using the e-learning system.

Culture of knowledge sharing Cultural differences

Teachers shouldn’t hesitate to share their

It should be necessary to remember that cul-

knowledge. If someone has a particular

ture of the participants to an e-Learning pro-

expertise or knowledge, they should be

gramme may be very different from the teach-

encouraged to share it with other netizens

ers’ ones. For instance, they may be members

(net-citizens), via the e-learning system.

of different religions, genders, ethnic origins,

Discovering the ability to publish information

nationalities, or sexual orientations. They may

during the Hospital staying can be motivating

speak a different language, or belong to a dif-

to start contributing to collective online proj-

ferent age group. They may perhaps have

ects, like to Wikipedia, the free encyclopae-

some physical or mental disabilities. Teachers

dia, on subjects one is a specialist. One can

should take these factors into consideration

join communities of practice about a specific

when putting content on the web (i.e. a web-

music band or any hobby.

page teachers might publish to present themselves) and be sensitive to the feelings of oth-

Respect privacy

ers. Be particularly careful with humour. What insulting or disrespectful by others.

We all should respect other people’s privacy.

People’s private information shouldn’t be namely published in an e-learning platform,

Respect time and bandwidth

without asking adequate permissions beforehand. Publishing content on a web page, any

As learners will interact with other Internet

type of content (quiz, images...)means devel-

users (through chat tools, forums etc), teach-

oping a consciousness of the boundaries

ers should encourage them to respect other

between private and public life. Anyone in the

people’s time and not to disturb other people

Hospital can know a lot about others’ disease,

Chapter 11

one regards as a joke may be considered

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Chapter 11 e-Culture for patients and facilitators

but nobody should ever talk about it to anybody, in everyday life nor on the web. It is possible to anonymize the person (by omitting one’s name and/or giving a nickname) but it should be done with care!

Context Special care should be taken when giving context around information (i.e. author, date, location, targeted audience). Some words are to be avoided like tomorrow or next weekend, which in fact are flexible data. The year

Traceability

should appear in the dates; it’s such a shame to read outdated content speaking about next

As Words Fly Away and Writings Remain, any-

month when this refers to events of several

thing on the Internet can be recorded or saved

months/years ago.

(cached), so words should be chosen carefully. Deleting text and files does not guarantee that they have not been saved somewhere else

Use the web, but don’t duplicate it.

on the web – do be careful! Even if one’s con-

When one can, they shouldn’t copy and paste

nected from a public access to the Internet in

content from the web, but make links in order to

the Hospital, there often exist means of find-

avoid duplicating information. It is one way to

ing people who did punishable things.

avoid becoming outdated, while the original

References The Core Rules of Netiquette, Virginia Shea (1994): http://www.albion.com/netiquette/corerules.html RFC1855, Netiquette Guidelines: http://www.faqs.org/rfcs/rfc1855.html Internet and Web Glossary: Internet and Web Essentials (ISBN 1887902460) by Ernest Ackermann and Karen Hartman (2000): http://www.webliminal.com/essentials/glossary.htm#asynchronous

Chapter 11

The Jedi Master Speaks: Asynchronicity (August 15, 1999): http://www.dreamagic.com/jedi/article5.html Asynchronicity: Distributed Learning Communities: http://www.wsu.edu/vwsu/direction/DirectPapers/Asynchronicity.html Asynchronous Learning: http://www.wsu.edu/vwsu/RFP9631/WP1101496.html Ubiquity in the Internet Age: http://jeremy.zawodny.com/blog/archives/002931.html

124

Chapter 11 e-Culture for patients and facilitators

could be updated. In documents that one

Of course, trainers and tutors should also ver-

wants to create for the e-learning curriculum

ify that they have these e-culture compe-

there is not the necessity to save pages to put

tences themselves, so that they are able to

them into the e-Learning environment used

accommodate learners’ questions adequately.

for the courses. Links are sufficient most of the time.

A simple and informal way of doing such an assessment could be a casual conversation at

2. Assessment of existing ICT and e-culture skills and experiences Some adult patient who gets engaged in informal e-learning activities in hospitals will likely be rather heterogeneous with regard to their educational backgrounds and learning needs in general, and also as to their level of experi-

the start of the programme, focusing on questions like: A more systematic assessment would concentrate on two competence areas: general ICT skills and electronic culture and networking skills.

ence with information and computer technologies and networked communication and learning. It is therefore very advisable that e-

• Did you ever use a word processor on a computer?

learning facilitators make an assessment of existing skills and experiences at the start of the e-learning course.

Here are some key issues that might be addressed in such an assessment. They will help facilitators to get a more precise idea of

• Do you have an e-mail address?

• A computer at home?

• Tell us one of your favourite websites?

• Have you ever produced an electronic CV?

the learners’ knowledge and practice of networked ICT.

• Did you subscribe to newsletters?

• Did you ever use a pen-driver?

In a lot of cases, some of these elements will learner:

• Have you got an account on a web platform (such as a Learning Management System, or Content Mana-

If the learner seems really at ease, it would be

gement System, or any type of web-

of no use to bother them with such matters.

interfaced tool)?

Chapter 11

be skipped, depending on the profile of the

On the contrary, if it is obvious that the competence level is very low, it would be useless if not discouraging to demonstrate in detail

• Have you ever published a web page or a blog? etc…

what is missing.

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Chapter 11 e-Culture for patients and facilitators

Operating system Basic set-up Documents saving Searching Printing

Office applications Word processor Spreadsheet Other application

General ICT skills WWW Web navigation Interface edition Search and manage information

E-mail E-mail management Mailing lists

Cooperation Discussions Network of contacts Contributions to virtual communities

ICT maintenance Keep up to date Prevention of e-pollution

Culture & networking skills Content production Information writing Content licenses Other applications

Further learning Feature vs product Network ecosystem Strategic search

Fig. 1: ICT and e-culture skills and experiences

General ICT skills

everyday information management: make one single directory structure with sub-directories

Operating system: Basic system set-up The learners should be able to analyse and use the basic features of the majority of the desktop applications: menus, task bar, multiple-window, file explorer, network neighbourhood... They should also be able to handle

for personal and professional activities, themselves subdivided into subdirectories for each activity/project. In the same way, trainers could check that the learner feels comfortable with documents’ properties like versions, naming, and appropriate formats to use.

autonomously the computer’s basic configuration (sound, screen resolution ...) and handle

Operating system: Search

applications related to available peripherals of Chapter 11

their system: floppy, keyboard, CD-ROM/DVD

126

drive, USB key etc.

Even if data is well organised in the computer, it is sometimes useful to interrogate the available databases of ones’ system depend-

Operating system: Documents saving

ing on the needs: web bookmarks, e-mail address books, personal computer, remote

Trainers should have a quick look at how the

computers, database, document, removable

learners design and manage their directory

peripherals... The trainer should make sure

structure to store and save files. Otherwise,

that the learner knows how to interpret results

advice could be given to help them in their

given by these tools.

Chapter 11 e-Culture for patients and facilitators

Operating system: Documents printing Paper prints should be reserved to important

multimedia presentation tool, address book managers, mailing ...

steps in the making of a document. Learners should be careful with the quantity and print

World Wide Web: Web navigation

quality for a particular document (re-use old

Even if it can be seen as the major Internet

prints, using the draft mode ...). Some docu-

application, the web browser should be used

ments should also be specially designed for

by learners easily. Some common notions are

printing (header, footer, layout, adapted

well understood: links, windows, tabs, book-

image resolution, page numbering, table of

marks, pop-up menus ...). Moreover, learners

contents ...).

should know how to download and manage files available on the web, and how to read,

Office applications: Word processor

understand and use the URLs (protocol, serv-

Word processors can be very useful, but they

er name, resource name, parameters).

are sometimes used when a simple text editor (notepad, under Windows, for instance) would

World Wide Web: Web interfaced edition

be sufficient. Trainers should ask the learner

A lot of interactions in Internet-based courses

the differences between a text editor and a

are linked to the subscription to personalised

word processor in terms of available features

services. Trainers should make sure that

and if the learner agrees using the appropriate

learners are comfortable with the fundamen-

tool. The learner should be able to build a

tal operations of this kind of procedures:

structured text in a word processor (using

choose an account name, a good password,

templates, styles, align options, regular sav-

manage preferences, etc. and edit contents

ing, automatic table insertion ...).

through a web interface in virtual communities. So they will have to manage concepts

Office applications: Spreadsheet

like formats, naming, version, size ...

be able to use some features of a spreadsheet

World Wide Web: Searching and managing information

application: text insertion, simple computa-

To attend online lessons is linked to relating

tions, table layout ...

to online resources. Trainers will have to make

application can be useful. The learner should

sure that learners will can easily:

Office applications: Other applications Depending on the courses, some other specif-

• make searches on the Web (several search engines),

ic applications or features can be regularly

• identify sources and relevance of each one,

used. Trainers should check if these tools are

• collect found information and present it in

known by the learners: PDF files generator,

Chapter 11

Even for some basic usage, a spreadsheet

a proper way.

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Chapter 11 e-Culture for patients and facilitators

E-mail: E-mail management with a desktop application or though a web-mail interface

Cooperation: Discussions

E-mail is at the same time wide-spread and a

conduct generally referred as Netiquette

source of confusion for many people.

should be respected. For instance, exchanged

Facilitators should be aware of the ease of use

files should comply with appropriate stan-

that learners have of e-mail management on a

dards: a version number will indicate the evo-

desktop application (e-mail client). Learners

lution of a document, files sent by e-mail

should be able to configure their identity

should not be too big, the file format should

(name, surname, and signature) and corre-

be negotiated beforehand as well as the sup-

sponding servers: incoming and outgoing

porting medium (e-mail, USB key, mobile

e-mail servers.

disk ...).

When they are far from their personal computer, learners will sometimes have to manage

In Internet-based cooperation, basic codes of

Cooperation: Network of contacts

their e-mail through a web interface, a web-

As many contacts will be done by e-mail,

mail (identity configuration). They should

address books have to be managed so that

manage it autonomously. Learners should also

contacts can be quickly found (trainer, mail-

know how to create filters to directly store

ing lists addresses). In the same way, book-

messages in the proper folders.

marks of the web browsers should be managed to reach important URLs easily. Such

E-mail: Mailing lists Coordination in online courses if made often

key URLs may be: mailing lists archives, search engines, e-learning environment, portals ...

with mailing lists. Learners should be able to ters, forums, projects. They should be able to

Cooperation: Contributions to virtual communities

subscribe and unsubscribe from mailing lists

Trainers could verify that learners already par-

with e-mail interface and web interfaces.

ticipate to the Internet ecosystem by asking

identify the different mailing lists: newslet-

Chapter 11

them the web forums or mailing lists they

128

Culture & networking skills

already contributed to. It is interesting to remember that those groups generally publish

Being at ease with the Internet means not

their editorial line and it is useful to find and

only being able to browse the web and send e-

read it before posting anything (ask the learn-

mails. Being able to respect generally recog-

ers if they did).

nized rules when contacting people is crucial

Learners could also give their sources of infor-

to have a viable long-term presence on the

mation (blog, book, encyclopaedia, newslet-

Internet.

ter ...).

Chapter 11 e-Culture for patients and facilitators

ICT maintenance: Keeping up to date Keeping ones computer software up-to-date is

content depending on its usefulness, source and license.

a common task that trainers could verify the learner is able to do.

Other tasks that patient learners should be able to handle by themselves: keeping one’s computer ready to use for the day to day tasks. It means being able to monitor disk space, install/uninstall programs, backup data at the proper rate (daily, weekly, monthly) ...

Further learning: Distinguishing between features and products As confusion is widespread between (vendor-) products and (general) functions, the trainer should make sure that the learner can identify similar features of different products (for instance, between two web browsers) and can use manuals and online help features. A sim-

ICT maintenance: Prevention of e-pollution

ple test could be a demonstration of how he

Trainers could verify if learners can define and

uses at least two different web browsers and

give examples of spam and viruses, and that

two different word processors.

they are able to protect their computer from them. On the other hand, learners should avoid producing noise (useless information) in

Further learning: Open communication network ecosystems

their electronic communications. This means (among others): avoiding to forward chain let-

Being an Internet historian is of course not

ters, rumours or jokes, avoid making inappro-

mandatory for using computers properly, but

priate contributions in the different media

some knowledge of the recent past of comput-

provided by each community.

er networks and the current trends of the information society can be considered neces-

It ought to be assessed whether participants can produce a well-structured document with clear and short title, structured body with visual illustrations. It is important to have clearly identified sources of information and

sary to have a wider perspective on ICT. Knowing the major current Internet actors (companies, people & groups) and having a general understanding of free vs. proprietary management models of the information society can be really useful.

other references (web, books, and other readings).

Further learning: Strategic search If the learners are going to make strategic

Content production: Content licenses

Chapter 11

Content production: Information writing

decisions – at a personal or professional level

The learner should have minimal knowledge

– they should be used to searching valid infor-

about different legal options to publish con-

mation on the web before making them. To

tent and to be able to decide how to deal with

keep up to date about those matters, teachers

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Chapter 11 e-Culture for patients and facilitators

should ask the learner if he’s subscribed to

important to get right to the point without

lists and bulletins that he regularly reads.

too many useless details

3. E-mail – some elements of good practices

E-mail body: one topic for one message Sometimes, learners will have several matters

Since lots of communications are made

to discuss with their trainers: various aspects

through e-mail messages during the learner’s

of their curriculum, problems with some

stay in the hospital, and rules related to e-

aspects of the online applications etc. Only

mail are the same in or outside the hospital,

one subject should be dealt with in each e-

this specific topic should be covered, even

mail, so that each subject can be discussed

quickly, to ensure successful communication.

properly and is not forgotten due to other topics. Hospital connections may not be more

Subject choice: short, clear and specific E-mails are first seen in a short form, with sender’s name, date and subject. So, if one

expensive for sending two e-mail messages for two topics as compared to one message covering two topics.

wants his e-mails to be read with appropriate attention, one should take care in the wording used in this field.

Subjects like How are you?, Important, the sender’s or recipient’s name or, even worse, empty subjects should be avoided.

E-mail answers: use the original message words Trainers will generally have little time to answer each learner’s messages: either because they have a lot of learners or because they have other tasks to do at the same time.

E-mail body: simple, direct and clear The main part of the e-mail should be written in a simple, direct and clear language, • e-mail is an asynchronous media (writing Chapter 11

centration difficulties or memory disabilities during their stay at the hospital. For these reasons, when replying to e-mails:

because:

• The “Reply to” feature of e-mail applica-

different

tions should be preferred to composing a

moments), so there a loss of time for it may

new message, because following discus-

take several e-mail exchanges to make a

sions is eased by this kind of programme,

specific point clear

which

and

reading

are

made

at

• people reading their e-mail messages can have lots of messages to read. For instance, trainers may have a lot of learners to manage, and other tasks to complete. So it is

130

Learners, on the other hand, may have con-

can

show

related

messages.

Moreover, it is easier than copying the original message into a new one.

• The text of the original message should be

kept in the body of the reply message.

Chapter 11 e-Culture for patients and facilitators

E-mail replies: answer between the lines

porary) disabilities which make it more difficult than in their everyday life to write long

Answers to specific questions should be put

messages. Trainers may have a lot of tasks

in the line right below the question (cf.

to do and lots of messages to answer. For

example in the box below). Why? Beginners

these reasons, answering to messages the

in general have difficulties to type on the

proper way can be a gain of time and

keyboard, but patients may even have (tem-

efforts.

Answering between the lines To answer to a message, the most appropriate way is to insert a new line just after the one you want to answer to, remove the inappropriate content of the original message, e.g.: Original message: Hi Greg, I’ve been really busy these days because if the launching of our new product in My Dog Food Company, but now I can (at last) send you this message quietly!

How are you in the hospital? Are the e-culture classes interesting?

I hope to see you soon!

Cheers, James Answer: > Hi Greg, Hi James, It’s good to have news from you!

> Are the e-culture classes interesting?

They are great, yes! Everyday I learn new things that I couldn’t even imagine! You should attend some yourself! If you wish to come and see me, take a look at my e-portfolio first (http://www.greg-athospital.org) and look at the map to find me more easily!

Greg — Greg Doe – greg@greg-at-hospital.org 12, Hospital Road 90019 Nice City e-portfolio http://www.greg-at-hospital.org

Chapter 11

> How are you in the hospital?

Fine thanks. I’d be better at home, but I’ve made friends among other patients.

Life is an incurable disease. – Abraham Cowley

131

Chapter 11 e-Culture for patients and facilitators

E-mail replies: remove the noise When answering to a message, one should remove inappropriate parts of the original message (see feature box). Then, only interesting information is put into the answer.

E-mail forwarding: beware of privacy When forwarding messages to non-original recipients, one should be careful on privacy matters. If learners send information to the trainer, it doesn’t mean that doctors or family should be authorised to read it.

Attachments: limit their number and size When possible, attachments should be avoided, since it means having to launch other applications to manage them, and to stop the e-mail management session. Other possible problems with attachments are:

When re-using information given by a third party, one should remove information that can make others recognize the original author.

One should modify: names, places, dates, pictures, to make them unrecognizable.

• Reading e-mail on a public access plat-

form, and then not being able to store them

Spam: never answer them

or having to remove them before leaving the computer.

Even if one receives a large number of spam

• A lot of attachments aren’t needed when

messages one should never answer, not even

they consist of formatted text which could

to ask for it to stop. Senders are often forged,

simply be integrated into the message body.

which means that answers wouldn’t even be

• Each attachment means storage spent to

received by the real sender.

keep it into the mailbox and on the hard drive.

Verify information before forwarding it

Chapter 11

• Big attachments (several GB) can lead to a

132

long time to download e-mails and prevent

Some e-mails are sent so to help somebody

other messages to come quickly.

with diseases of difficulties, and one should

• Attachments force the recipient to use

forward the message to all the contacts of his

some other applications he’s sometimes not

address book. The vast majority of these mes-

used to deal with.

sages are urban legends. Some of them are

• Attachments sometimes force the recipi-

several year old and continue to be forwarded

ents to use programmes he doesn’t neces-

by people willing to do the right thing. Some

sarily have.

websites deal with urban legends that circu-

Instead of attachments, links to online

late on the net, like http://urbanlegends.

resources should be preferred. If those aren’t

about.com/library/blxnew.htm. In any case,

publicly available, one should store them on

before forwarding such alarming e-mails, one

password-protected parts of their websites (or

should take the minimum care that it’s not an

of document sharing platforms).

urban legend.

Beware of the security of your e-mails

Don’t feed the troll

A common mistake is to believe in the sender

According to Wikipedia:

field of e-mails, which can lead to catastro-

An Internet troll, or simply troll [...] is some-

phes. Anyone can write a message which pre-

one who intentionally posts controversial or

tends being sent by Bill Gates, the hospital

contrary messages in an online community

director or anybody else, even yourself.

such as an online discussion forum or

Nowadays, there is nothing in the electronic

group with the singular intention of baiting

messaging system to deal with identity.

users into an argumentative response. It

In the same way, e-mails are not a safe way of

often has a broader meaning referring to

sending sensible data on the network. The

any shady trouble making Internet activity.

protocol doesn’t encrypt conveyed data, not

When an e-mail evokes a strong emotional

during the storage nor on the Internet route.

reaction in the recipient it should not be

Solutions exist to have secure e-mails and to

answered immediately. A trick that works well

be sure of the sender’s identity, which are

is to delay the answer for a few hours and

called encryption and electronic signature.

think about something else during this time.

They are not so popular as they could be, but

Then the reply is often less aggressive and the

one shouldn’t hesitate to use them when nec-

discussion can become constructive instead

essary.

of becoming a battle.

Chapter 11

Chapter 11 e-Culture for patients and facilitators

Chapter 12 Evaluation of e-learning activities in hospitals

Chapter 12 Evaluation of e-learning activities in hospitals Birgit Zens

sible for the programme and for upper-level decision makers, such as the management of a hospital and those who decide upon financial resources and personnel.

Fig. 1 presents an illustration of the circle of planning, developing, and implementation of curricula and the role of evaluations in this process.

Evaluations are important instruments for assuring and improving the quality and effec-

Evaluation

tiveness of curricula. Evaluations are essential decision-making instruments that accompany the planning, development, and implementation of programmes. The challenge is

Planning of a curriculum

Development of a curriculum

how to approach and execute this task. When Implementation of a curriculum

can we state with confidence that a programme has proven itself to be effective? This chapter provides an introduction on how to conduct evaluations of e-learning activities in

Fig. 1: The role of evaluations for planning, developing, and implementation of curricula

hospitals by focussing on four steps: defining goals, determining the evaluation design, selecting the target groups, and selecting methods and developing appropriate evaluation instruments.

Chapter 12

1. Reasons for conducting evaluations

134

2. The four main steps of planning an evaluation When planning an evaluation, the first and crucial step is to concrete and specify the

goals of a given course and define tangible

Evaluations are conducted in order to assess

evaluation objectives. It is essential that this

and to improve the quality and effectiveness

step is done in collaboration with those

of programmes, e.g. e-learning curricula in

responsible for the programme. When defin-

hospitals. Evaluations can accompany the

ing the evaluation goals the information needs

planning, development, and implementation

of the involved parties and the subsequent

of a given curriculum and are an important

use of the results need to be taken into

decision making instrument for those respon-

account.

Chapter 12 Evaluation of e-learning activities in hospitals

Dependent on the objectives of a given evalu-

ods must be appropriate for answering the eval-

ation, one has to determine the evaluation

uation questions. What kind of information do

design and decide on a point in time when the

the users of the evaluation results need? Do

evaluation should be conducted. Will the eval-

they need detailed insights based on verbal

uation be conducted prior to the implementa-

data, or do they need quantified figures?

tion of a curriculum, concomitant, or after ter-

Limitations of financial resources and available

mination of a course?

time must also be considered. Finally, one develops the evaluation instruments, or selects

The next step is to select the target groups of

existing instruments. Quite often, such instru-

the evaluation. Who will provide information

ments need to be adapted for their intended

for the evaluation? Will the participants of the

use. The selection, adaptation, and develop-

course? Will the hospital staff? Will the train-

ment of the instruments are crucial for the

ers? Generally, in order to ensure the validity

quality of the data. Hence, this step must be

of the data different target groups should be

prepared carefully and accurately.

taken into account.

In the following sections, the four steps are

After deciding which target groups to focus,

discussed in more detail and practical exam-

one selects the methods for the evaluation, e.g.,

ples for evaluating e-learning courses in hos-

interviews, questionnaires, or tests. The meth-

pitals are provided.

what

when

who

how

define goals & objectives

determine evaluation design

select target groups

select methods develop instruments

Fig. 2: The four main steps of planning an evaluation

in the position to state that the quality of a programme is satisfactory? When are we able

The purpose of an evaluation is to assess the

to state with confidence that a programme

quality and effectiveness of a given pro-

has proven itself to be effective? Therefore,

gramme. The challenge is how to approach

specifying tangible goals and objectives is a

and execute this essential task. When are we

crucial step in planning an evaluation.

Chapter 12

3. Defining goals: four golden rules

135

Chapter 12 Evaluation of e-learning activities in hospitals

Evaluations should answer tangible questions Frequently, evaluators are facing the situation that programme developers have only vague ideas about what they actually intend to achieve and which aspects exactly should be evaluated. Thus, an essential first step for evaluators is to define tangible programme goals in conjunction with all parties involved in the programme development. Based on these goals, the objectives of the given evaluation should be specified. A highly recom-

the results of the evaluation be used to provide information on whether to continue a programme? Or, is it the goal of the evaluation to justify the incurring expenditures? Depending on the purpose of the evaluation, the tangible goals will differ: • Will the evaluation be used to improve a programme?

• Will the evaluation be used to justify the incurring expenditures?

• Will the evaluation be used to determine whether to continue a programme?

mended method is to organize a joint workshop in order to discuss and subsequently

Evaluations should be feasible

specify the information needs of the involved

Another important aspect to consider is the

parties.

feasibility of a given evaluation. The effort of the involved parties in the evaluation must be

Evaluations should target the information-needs of the user The concrete evaluation goals should be specified in conjunction with all parties concerned as the information needs may differ. What does, for instance, effectiveness mean to the

appropriate in relation to the anticipated utility. The estimated cost-benefit ratio should be adequate. With regards to costs, it is frequently necessary to compromise on a comprehensive and systematic data collection and to reduce the scope of the evaluation.

developers of a programme? What does effectiveness mean for the management of a hospital or a financial sponsor? There are several perspectives and concrete informational needs that must be clarified prior to planning

Defining goals: four golden rules

the evaluation.

• Evaluations should answer tangible

Chapter 12

questions!

Evaluations should consider the subsequent use of the results

• Evaluations should target the informa-

When planning an evaluation, it is also essen-

• Evaluations should consider the subse-

tial to take into account the subsequent use of the results. Will the results of the evaluation be used to improve the programme? Will

136

tion needs of the user! quent use of the results!

• Evaluations should be feasible!

Chapter 12 Evaluation of e-learning activities in hospitals

4. When to conduct the evaluation: the evaluation design

its expenditures, or to decide on whether to continue the programme, an ex post evaluation is required. The results of an ex post eval-

Depending on the goals and objectives, evalu-

uation can also be used to improve the subse-

ations are conducted at different points in

quent implementation of the given course.

time. To improve the development of an elearning curriculum, an ex ante evaluation is recommendable. This kind of evaluation is performed in order to assess the needs of the target group prior to the development and

5. What and when to evaluate Assessing the patients’ needs and the conditions in the hospital

implementation of the given course. The needs of the target group for e-learning curric-

Prior to the development and implementation

ula in hospitals are, e.g., the requirements of

of an e-learning curriculum, assessing the

the patients, their physical and psychological

needs of the target group is important, e.g.,

conditions, their motivation for learning and

the requirements of the patients, their physi-

their content-related needs. An example of a

cal and psychological conditions, their moti-

detailed checklist is presented below.

vation for learning and their content-related

During the implementation of the course, a

needs.

concomitant evaluation is useful to collect

Moreover, the conditions in the hospital are

intermediate results and to reveal unexpected

crucial for the delivery and success of e-learn-

problems. The results of a concomitant evalu-

ing courses and have to be considered care-

ation are directly used for improving the run-

fully in the run-up to programme development

ning implementation of the course. An ex post

and implementation.

evaluation assesses the effectiveness of the

A check-list for the ex-ante assessment of an

given course. In particular, if the purpose of

e-learning project in the preparatory phase

the evaluation is to justify the programme and

has been presented in Chapter 8.

Concomitant Evaluation

Development of the Programme

Ex Post Evaluation

Implementation of the Programme

Chapter 12

Ex Ante Evaluation

Fig. 3: Conjunction of evaluation and programme development

137

Chapter 12 Evaluation of e-learning activities in hospitals

Assessing the patients’ computer skills

adapted to the patients’ level of computer

To achieve a high level of satisfaction of the

skills. Example questions assessing the

participants and successful course comple-

patients’ computer experience are presented

tion, the course requirements should be

in the following box.

Assessment sheet of participants’ computer skills In general, how often do you use a computer? ❑ Every day ❑ Several times a week ❑ Once a week ❑ More than once a month ❑ Less than once a month ❑ Never

What do you use the computer for (e.g. word processing, games, e-mail, searching for information, downloading music, etc.)?

Not

Insuffi-

at all

ciently

Some- Sufficiwhat

ently

Very confident

How confident do you feel about using a computer?

❍

❍

❍

❍

❍

How confident do you feel about using the Internet?

❍

❍

❍

❍

❍

Tick any of the following you are sure you can do ❑ Use a word processing tool (e.g. MS Word) ❑ Save a file ❑ Print out a file ❑ Switch between application windows Chapter 12

❑ Use a scroll bar

138

❑ Search the Internet ❑ Read, write, and send e-mails ❑ Send an e-mail with attachment ❑ Write an entry in a discussion forum

Chapter 12 Evaluation of e-learning activities in hospitals

Assessing and improving the quality of an e-learning course

Assessing the effectiveness of an e-learning course

To gain information on how to improve a run-

The evaluation of the effectiveness of a given

ning curriculum, one conducts the evaluation

learning activity is done after termination of a

concomitant to the implementation of the

course. Therefore, one first has to define

course (see Fig. 3).The purpose of a concomi-

which

tant evaluation is the direct use of the evalua-

Depending on the target group of a pro-

tion results for improving the quality of the

gramme, the desired results differ. By and

running course. Hence, it is important that the

large, we can summarize the results on four

evaluation results of concomitant evaluations

levels:

results

one

wants

to

achieve.

are available rapidly after the data collection.

Questions for assessing and improving the quality of a course are presented below.

1. Distraction from health problems, i.e., direct the patients to something useful 2. Support of psychological well-being

• To what extent does the subject content meet the needs of those attending?

• Is the leader the one best qualified to teach?

• Does the leader use the most effective methods for maintaining interest and teaching the desired knowledge and skills?

• Are the facilities satisfactory?

• Are the aids effective in improving communication and maintaining interest?

• Was the coordination of the programme satisfactory?

• What else can be done to improve the programme?

3. Decrease of social isolation 4. Acquisition of new knowledge and skills For example, a programme for Alzheimer’s patients will focus on the first and second level, while a programme for Burnout patients or patients with cancer might aim at all four levels. Hence, the first step when evaluating the effectiveness of a programme is to consider which results are desired. Depending on the concrete objectives, the applied methods and instruments differ.

6. Target groups In most cases, evaluations of learning activities focus on the feedback of the participants.

Without doubt, the reactions of the participants are very valuable and important for assessing the satisfaction with the course.

Satisfaction is salient as it is the basis for

40

Kirkpatrick, D. L. & Kirkpatrick, J. D. (2006). Evaluating Training Programmes: The Four Levels. San Francisco.

successful learning. Subjective assessment of

Chapter 12

Questions for assessing and improving the quality of a course40

benefit is also valuable. Obviously, no one

139

Chapter 12 Evaluation of e-learning activities in hospitals

else than the participants themselves can pro-

of the programme, and the communication

vide better information on the personal bene-

and cooperation of all parties involved.

fit derived from the programme.

However, evaluations should not only focus on

7. Methods and instruments

the patients’ reactions, but also take into account other target groups. Generally, taking

Feedback by the patients

into account different target groups is a high-

In most cases, evaluations of learning activi-

ly recommended method for ensuring the

ties only use so-called reaction sheets or satis-

validity of the data.

faction sheets that are completed by the par-

The hospital staff involved in the care of the

ticipants after termination of the course.

patients is a valuable source of information.

These reaction sheets are very valuable for

For example, nurses, doctors, hospital psy-

collecting information about the satisfaction

chologists, and all hospital staff concerned

of the participants with the course, e.g. its

with the care of the given patient should be

schedule, content, or satisfaction with the

involved. The hospital staff can also provide

trainers. An example of a reaction sheet for

valuable information on the implementation

the participants is presented below.

process of the programme and on the communication and cooperation among the parties

Reaction sheets should always contain closed

concerned.

and open questions. Closed questions can easily be analyzed using computerized statistical

Trainers, facilitators, or tutors of the learning activity also provide information about the learning progress of the participants, their learning outcomes, and the obstacles and challenges that had to be faced.

data analysis. In contrast, the analysis of open questions is time-consuming, as the verbal data has to be adequately summarized (e.g. using categories). Nevertheless, the gathering of verbal data is essential for obtaining indepth information.

Chapter 12

With some groups of patients, however, it is

140

Those responsible for the management of the

difficult or even impossible to work with writ-

implementation of the programme will provide

ten evaluation forms. In such cases, written

valuable information on the entire process of

feedback needs to be substituted by face-to-

programme implementation, the management

face interviews.

Chapter 12 Evaluation of e-learning activities in hospitals

Patients´ Feedback Sheet Dear patient, We kindly request your participation by completing a short survey in regards to the e-learning course that you participated in. The results will help us to meet the patients’ needs even better in the future. Thank you for completing this survey!

For each of the following questions, please mark the circle that best describes your answer.

Not at Insuffi- Some- Suffici- Comall ciently what ently pletely Did the course meet your needs?

❍

❍

❍

❍

❍

Did the course help you to gain new knowledge or skills?

❍

❍

❍

❍

❍

Did you benefit personally by taking part in the course?

❍

❍

❍

❍

❍

Please specify in what way you benefited from the course:

Not at Insuffi- Some- Suffici- Comciently what ently pletely all Did you enjoy taking part in the course?

❍

❍

❍

❍

❍

Do you think it is beneficial to learn while in hospital?

❍

❍

❍

❍

❍

Were the following aspects beneficial?

Not at Insuffi- Some- Suffici- Comall ciently what ently pletely

Presentation / explanation by the trainer(s)

❍

❍

❍

❍

❍

Coaching by the trainer(s)

❍

❍

❍

❍

❍

Peer-to-peer discussion online (e.g. discussion forum, chat)

❍

❍

❍

❍

❍

Peer-to-peer discussion face-to-face

❍

❍

❍

❍

❍

Assignments

❍

❍

❍

❍

❍

Materials

❍

❍

❍

❍

❍

Other elements

❍

❍

❍

❍

❍

Weak

Satisfactory

Good

Very good

❍

❍

❍

❍

How do you rate the schedule of the course?

Comments

What would have improved the course?

Chapter 12

Comments

141

Chapter 12 Evaluation of e-learning activities in hospitals

Feedback from trainers and hospital staff Reactions of the participants are salient; how-

Examples of questions for trainers

ever, they provide limited information. Thus,

• How do you assess the communication

the evaluation should not only focus on the

and cooperation with the hospital staff /

patients’ reactions, but also include other tar-

programme members / other parties

get groups such as trainers and the hospital

involved in the project?

staff.

• Were the learners encouraged by the

Depending on the availability and time

hospital staff to participate in the

resources of the hospital staff, questionnaires

course? If so, in what way?

or interviews may be used. Interviews provide

• Was the infrastructure in the hospital

valuable and comprehensive in-depth infor-

satisfactory (technical, organizational)?

mation. Interviews are the favourite method

Did the participants have easy access to

for discovering unexpected positive or nega-

computers and Internet in the hospital?

tive effects of the programme and for becoming aware of unforeseen problems, challenges, and obstacles. Determining standardized guiding questions is useful and recommendable for focussing the interview on the questions of interest. However, it is important not to reduce the interview to a question and answer session, but to encourage narratives of the interviewees while maintaining the focus of the interview.

• Were there any problems with hardware or software?

• How would you describe the participant’s motivation in general?

• Are you satisfied with their learning progress and learning outcomes?

• How do you rate the benefit for the patients?

• Were there any obstacles or difficulties

Whenever possible, interviews should be

due to the participants’ state of health?

recorded on audio tape, transcribed and sub-

If so, of what kind?

sequently analyzed by summarizing or categorizing the responses. If the interview cannot be recorded, at the very least a third person is needed to take comprehensive notes for subsequent analysis. Hence, conducting and anaChapter 12

lyzing interviews is time consuming and thus more cost-intensive than closed questionnaires and short verbal feedback sheets.

In the following boxes, you find examples of questions for trainers and hospital staff.

142

Chapter 12 Evaluation of e-learning activities in hospitals

Examples of questions for hospital staff • How do you assess the communication between the hospital staff and the programme managers / trainers / other parties involved work?

Psychological tests For the target group patients in hospitals, psychological health-related aspects play an important role. In some cases, one wants to know more about the psychological well-being of the patients and whether this improved over time. Therefore, psychological tests are

• Were the learners encouraged by the

an appropriate instrument. Psychological

hospital staff to participate in the

tests assess latent psychological potentials of

course? If so, in what way?

individuals, clinical syndromes (e.g. depres-

• Was the infrastructure in the hospital

sion), or attitudes. However, one has to con-

satisfactory (technical, organizational)?

sider that administering and interpreting psy-

Did the participants have easy access to

chological tests are the domain of trained psy-

computers and Internet in the hospital?

chologists.

• How would you rate the benefit for the patients / for the hospital?

A well-known and well-tested example of a psychological test is the SF-36 Health Survey, or its short form, the SF-12. The SF-36 (or its

• Do you perceive any problems and chal-

improved version SF-36v2) is a 36-item sur-

lenges regarding the use of e-learning in

vey and measures eight domains of health,

hospital?

which are based on the two factors physical

health and mental health:

Items SF-36

Items SF-12

• Physical functioning • Role limitations due to physical health (role-physical) • Bodily pain • General health perceptions

10 Items 4 Items

2 Items 2 Items

2 Items 5 Items

1 Item 1 Item

• Vitality • Social functioning • Role limitations due to emotional problems (role-emotional) • Mental health

4 Items 2 Items 3 Items

1 Item 1 Item 2 Items

5 Items

2 Items

• Self-reported health transition

1 Item

Factor

Physical Health

Mental Health

Chapter 12

Health Domain

Fig. 4: SF-36 and SF-12 – Health Domains

143

Chapter 12 Evaluation of e-learning activities in hospitals

The survey has been adapted for the use in

Defining the goals of the programme and

more than 60 languages and can be self-

specifying tangible evaluation objectives is

administered to persons ages 14 and older.

the first and foremost step for an evaluation.

The SF-12 (or its improved version SF-12v2)

In doing so, four golden rules need be taken

is a 12-item subset of the SF-36 and meas-

into account:

ures the same eight domains of health.

Because of its brevity, the SF-12 is frequently used as a screening tool.

• Evaluations should answer tangible questions • Evaluations should target the information

The SF-36 and SF-12 survey includes general norms for the US population, by sex and age group, and norms for several clinical syndromes and diseases. As the survey is very

needs of the user • Evaluations should consider the subsequent use of the results • Evaluations should be feasible

sensitive to change, it can be used as a pre and post measure of change after an intervention, e.g. to measure the impact of an e-learning course in hospital. For interpreting the results, both the single scales (domains of health) and the summary measures of physical and mental health can be used. When interpreting single scales, preferably, the SF36 should be used.

Depending on the goals of the evaluation, the second step is to decide upon the evaluation design, i.e., the point in time at which the evaluation is to conduct. Will an evaluation be used to improve the development of the programme? Is the evaluation be used to improve the implementation of a curriculum? Or, is it the goal of an evaluation to assess the effec-

The survey can be obtained from http:// www.qualitymetric.com/. Specific scoring software for easy interpretation is also available.

tiveness after termination of the course?

Accordingly, one conducts an evaluation prior, during, or after the implementation of a given curriculum.

The third step of planning an evaluation is to

Chapter 12

8. Summary

144

decide

which

target

groups

to

focus.

Generally, it is recommended to select multi-

This chapter provided an introduction on how

ple target groups in order to get comprehen-

to conduct an evaluation of e-learning curric-

sive information and to improve the validity of

ula in hospitals based on four steps: defining

the results. The target groups for evaluating e-

goals, determining the evaluation design,

learning activities in hospitals may be the

selecting the target groups of the evaluation,

patients who participated in a given course,

and selecting appropriate methods and devel-

the trainers, the hospital staff involved in the

oping evaluation instruments such as ques-

programme, and finally those responsible for

tionnaires or interview guidelines.

the programme.

Finally, another crucial step is to select appro-

validity of the data, the instruments must be

priate methods and develop evaluation instru-

developed carefully and accurately.

ments. The methods must be appropriate for

As evaluations are an essential decision-mak-

answering the evaluation questions and

ing instrument and intent to assess and

should take into account the subsequent use

improve the quality and effectiveness of pro-

of the results. What kind of information do the

grammes, they need to accompany both the

users of the evaluation results need?

development and the implementation of

Limitations of financial resources and avail-

e-learning curricula in hospitals. Thus, evalu-

able time must be considered. Methods for

ations can not only assess the quality and

evaluating e-learning activities in hospitals

effectiveness of programmes, but can also

are, for example, questionnaires, interviews,

support the achievement of a programme’s

or psychological tests. In order to promote the

goals.

Chapter 12

Chapter 12 Evaluation of e-learning activities in hospitals

145

Chapter 13 Success factors of informal e-learning for hospital patients

Chapter 13 Success factors of informal e-learning for hospital patients Holger Bienzle

jointly provided by a partnership of education provider and hospital. It is essential that this partnership is not only based on the acting professionals, but on a clear commitment of both institutions involved. With a view of the high work pressure in hospitals it is highly recommendable that the commitment to patient learning is fixed in a bilateral contract signed by the top management, which ensures sure that the necessary resources, especially staff time, will be provided.

As already stated in the Introduction this publication does not claim to pave a safe way to tals. For doing so the basis of experience

2. Performance of a multi-player team

gained in one European pilot project is by far

Planning and implementing e-learning in hos-

not sufficient. Having stressed this, however,

pitals requires smooth cooperation within a

the eHospital experience highlights ten key

team of experts with complementary expert-

factors to successful e-learning projects in

ise: education professionals are needed as

hospital. Some of them confirm already pub-

well as technical staff, managers and, most

lished, more general findings with regard to

importantly, healthcare professionals who are

blended learning41, and put them into the

in daily contact with the patients. It is crucial

specific educational context of this publica-

to define precise roles and tasks of these pro-

tion.

fessionals and to plan their interaction for the

successful e-learning programmes in hospi-

benefit of the patient learners.

1. Commitment of the institutions involved If informal e-learning is to be introduced in European hospitals, it will in most cases be

3. Integration into hospital routine Learning is certainly not a core activity of hospitals, which are designed for other purposes and therefore developed processes and regu-

Chapter 13

41

146

Baume, M.; Hummel, S.; Krcmar, H. (2004). Factors for Success for Blended Learning – Concepts.

Experiences gained in the evaluation of Webtrain: http://www.winfobase.de/lehrstuhl/publikat.nsf/intern01 /7E2D04A6544CE5D0C1256F5500497087/$FILE/04 -17.pdf, and Scholze, T. (2005) The Role of e-Learning for Training in Institutions of The Third Sector, http://www.e-learningeuropa.info/directory/index.php? page=doc&doc_id=5992&docIng=6

lations which are not always supportive of elearning activities. Any newly introduced learning programme needs to acquire a basic knowledge and understanding of how hospitals function and seek to integrate the learning activities into existing routines rather than try to change them.

Chapter 13 Success factors of informal e-learning for hospital patients

4. Identification of needs People suffering from severe illnesses are a particular and vulnerable target group with specific emotional and educational needs. It is indispensable to thoroughly analyse these

vated to get and remain engaged in e-learning. It is important for learners to be able to reach their tutors/trainers via familiar communication channels like e-mail or telephone.

needs in advance in order to develop learning topics, aims, content, and methodologies

7. Frequent face-to-face meetings

which are adequate for a specific patient group. To this end, patients, their friends and families, as well as medical, psychological

In the hospital context e-learning should always be understood as blended learning.

and healthcare staff should be involved in the

Frequent and intense face-to-face-meetings

planning process where possible.

of patients and their trainers are vital and cannot be entirely substituted by computer-

5. Creation and communication of benefits

mediated communication. In the eHospital

To get engaged in e-learning while at hospital

tionship was the motor of the whole learning

cannot be an end in itself, nor is it the normal

activity. It is in these meetings where patient

thing to do. Patients will only show interest in

learners can receive much of the necessary

the learning programme if they can see con-

support in their learning process, feedback

crete benefits which support them in a rather

and motivation to go on.

pilots for many patients the personal encounters with their trainers and the evolving rela-

difficult life situation. These benefits may range from improvement of their employability to mere diversion from the illness. E-learning facilitators need to make sure that these benefits are communicated and marketed to the patients.

8. Simple, usable and accessible technology It cannot be taken for granted that all hospitals provide the technical infrastructure nec-

6. Guidance and support

(mobile) computers, or fast and accessible

Learning with the help of information and

Internet connection. Facilitators should make

communication technologies cannot succeed

sure that all learners really have sufficient

without guidance and support through peda-

possibilities.

gogic professionals. The different pilot cours-

All hardware and software used should be as

es have shown that learners appreciate the

simple as possible, have a high degree of

support by trainers, tutors or counsellors very

usability and comply with basic accessibility

much. It is through these contacts that

standards. Moreover, frustration of patients

(patient) learners feel encouraged and moti-

through technical problems should be avoided

Chapter 13

essary for patient e-learning, availability of

147

Chapter 13 Success factors of informal e-learning for hospital patients

at any rate, as they might crush patients’ learning motivation altogether.

9. Enhancement of patients’ ICT competence

10. Evaluation of impact Nowadays all forms of education should have an element of evaluation. Since informal, computer-supported learning of hospital patients is quite a novelty it is particularly

The acceptance of e-learning highly depends

necessary to evaluate carefully the impact of

on how familiar with computers the patient

the learning activities on the patients. Also

learners are. It can only be successful if the

the process of implementing e-learning in

learners accept the media computer or

hospital needs to be scrutinised in order to

Internet. The skills and attitudes necessary

learn from achievements and shortcomings

cannot be taken for granted with all patients.

and thus improve the e-learning offer the next

As a consequence facilitators will in many

time it is implemented.

cases have to check patients’ basic ICT skills

How significant the impact of e-learning

before the actual e-learning can start. A thor-

activities during hospitalisation can be is

ough introduction to the learning management

illustrated by a statement of a male quadriple-

system and other technological tools to be used

gic participant – who can’t move his hands- in

is indispensible at the beginning of the course.

the Spanish eHospital pilot:

Chapter 13

The benefits of e-learning according to an eHospital course participant:

148

In my opinion the experience has been great, it has been a huge alternative to allow us to go on doing things. [Before the course] I had no idea of computers, and thanks to you I can now do countless things: read a newspaper, watch the news, communicate with other people through the Net...well, so many things...but the most important for me, as you know is to be able to learn through the Net. I, In my situation, and so many other people [who suffer from quadriplegia] are quite [physically] limited- we are not going to renounce to our expectations. For example I am trying to learn about architecture, topography, CAD, etc. Anyway, I need to master a drawing program for that. I was trying with AutoCAD, but it is very difficult for me due to the tools I have to use, and because of the complexity of the program itself. I have now downloaded another program, which is a little easier to use, and I have managed to make small plans.

I am still a newbie in computers, at the beginning everything was so complicated, but little by little I am getting pretty good results. Everything requires a long time, there are so many combinations you have to do for any simple task, but it is just about learning the easiest shortcut to get things done. [...]

Summarizing, I think it [the course] has been wonderful, I believe every person in this situation should have the right to do a similar course, as it opens the door to be able to do countless things [...]

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Seite 3

Engagement in learning activities while at hospital can have a positive effect on hospital patients and eases reintegration into their professional and social lives.

Computer-assisted learning has a great potential in this specific educational context. Hospital patients are restricted in their mobility and can therefore profit from being independent on the time-space coordinates of conventional face-to-face learning.

The publication promotes cooperation between education providers and hospitals to introduce e-learning opportunities for patients.

ISBN 978-3-9502335-3-7