{"id":2884,"date":"2013-06-05T05:29:01","date_gmt":"2013-06-05T05:29:01","guid":{"rendered":"http:\/\/cjni.net\/journal\/?p=2884"},"modified":"2013-09-23T05:45:16","modified_gmt":"2013-09-23T05:45:16","slug":"enhancing-orientation-for-graduate-nurses-to-critical-care-through-the-use-of-a-wiki","status":"publish","type":"post","link":"https:\/\/cjni.net\/journal\/?p=2884","title":{"rendered":"Enhancing Orientation for Graduate Nurses to Critical Care Through the Use of a Wiki"},"content":{"rendered":"

by Meaghan MacDonald, RN, BScN<\/em><\/p>\n

Registered Nurse, Queen Elizabeth Hospital, Prince Edward Island<\/em><\/p>\n

MSN Student, Memorial University of Newfoundland and Labrador<\/em><\/em><\/p>\n

Abstract<\/h1>\n

\"wiki\"Registered nurses entering the critical care area after graduation from a baccalaureate program, have many learning needs as they seek to integrate into the nursing workforce.\u00a0 These beginning nurses must continue to refine their basic entry-level competencies while attempting to learn new complex nursing skills and techniques. Critical care presents many challenges even for the seasoned nurse thus orientation to this setting requires a tailored approach for new graduate nurses. A review of the literature demonstrated that the use of computers for orientation and education can be beneficial and cost effective often offering the same value as classroom learning. This proposed nursing informatics project will seek to (a) enhance graduate nurses\u2019 orientation to the critical care setting, (b) support new graduate nurses while supplementing their education and (c) increase professional communication through the use of information technology. These goals will be accomplished by developing a wiki website tailored to the needs of graduate nurses entering the critical care setting.\u00a0 The seven stages of Lippitt\u2019s theory of planned change are explored as they apply to the implementation of the project. The anticipated barriers and facilitating factors associated with implementing a new form of information technology into the workplace of nurses will also be explored.<\/p>\n

Key words<\/h2>\n

Graduate Nurses, Computers, Change Management, Wiki, Critical Care, Orientation, Lippitt\u2019s theory of planned change <\/span><\/p>\n

Introduction<\/h1>\n

Registered nurses entering the workforce today are required to possess a wide array of skills in order to function as beginning professionals.\u00a0 The learning curve is certainly not complete when they receive their baccalaureate degree.\u00a0 In fact, the learning is just commencing for these graduate nurses as they embark on a career path fraught with issues, including nursing shortages, health care reform, advancements in technology and an aging population with increased health care needs. The purpose of this paper is to present a hypothetical nursing informatics project to implement in my workplace to enhance the current orientation of graduate nurses in the critical care setting.\u00a0 I currently work in the critical care setting and act as a preceptor for new employees including new graduate nurses entering this specialised area.\u00a0 I believe that new graduate nurses entering this setting require a large amount of support and guidance to function effectively and safely.\u00a0 Not only do they need to further develop their basic entry-level competencies, but they are also expected to learn many complex nursing skills while functioning under high stress and pressure conditions.\u00a0 I believe the development of a wiki website that is specific to the requirements of working in the areas of intensive care, coronary care and progressive care, may help these beginning nurses to transition more smoothly into the workforce.<\/p>\n

Using Lippitt\u2019s theory of planned change (Lippitt, Watson & Westley, 1958), I explain the proposed project and discuss the anticipated barriers and facilitating factors associated with implementing a new form of information technology into the workplace of nurses.\u00a0 The seven stages of Lippitt\u2019s theory of planned change are explored as they apply to the implementation of the project.\u00a0 The work of Lippitt was greatly influenced by Kurt Lewin and therefore, the key aspects from Lewin\u2019s theorizations are touched upon within this paper.\u00a0 For the purpose of this paper, the term \u201cgraduate nurse\u201d will refer to nurses who have recently graduated from a baccalaureate degree program and are entering the critical care setting as their first position.<\/p>\n

Orientation Strategies for Critical Care <\/b><\/h1>\n

According to Travale (2007) the area of critical care is most affected by the nursing shortage.\u00a0 By necessity, less experienced nurses are entering this area with little experience in the basics of medical-surgical nursing.\u00a0 They require a creative means of education and teaching tailored to this unique situation.\u00a0 Travale (2007) states: \u201cAn inexperienced nurse\u2019s knowledge is theory based because he or she lacks the wisdom that defines an experienced nurse. Targeted education needs to be progressive to engage this computer-savvy generation in learning\u201d (p. 132).<\/p>\n

Chestnutt and Everhart (2007) also discussed the nursing shortage and the inability to fill positions with experienced nurses. They described these new graduates as \u201cadvanced beginners\u201d in critical care who are often oriented toward completing tasks and find it difficult to adapt to rapidly changing clinical situations (Chestnutt & Everhart, 2007).\u00a0 It is therefore essential that graduate nurses entering the critical care area receive appropriate orientation that meets their needs, provides support and fosters an effort for retention of trained professionals. It is not only new graduates that are affected by the shortage in nursing either. Billings et al. (2006) suggested that the shortage of nurses also spills over into academia and impacts nursing faculty and educators.\u00a0 These authors claimed that a useful way to simplify orientation and capitalize on educator resources, is to offer online courses.<\/p>\n

Enhancing Education through Computer Technology <\/b><\/h2>\n

Travale (2007) advocates that the use of computer assisted instruction (CAI) can be used to bridge the gap for novice nurses between basic curriculum knowledge gained in the university setting and orientation practices, by acting as an adjunct to their knowledge development. The term CAI is used to include a wide array of technologically based tools such as multimedia programs, internet based learning, and chat rooms to name a few (Letterie 2003, as cited in Travale, 2007).<\/p>\n

Nerlich (1995) also discussed the use of computers for learning under the title of computer assisted learning (CAL). CAL is defined as, \u201cAny learning that is mediated by a computer and which requires no direct interaction between the user and a human instructor in order to run\u201d (Nerlich, 1995, p. 23). It can be used as a sole learning tool or in conjunction with verbal and printed learning tools.\u00a0 According to Nerlich (1995), in comparison to alternative education methods, CAL has offered the same degree of knowledge retention and provides easily accessible information that can be obtained 24 hours a day through the use of a computer.\u00a0 Nerlich (1995) suggested that educators can save the expense of commercial CAL packages by authoring their own CAL tools.\u00a0 This is an ideal suggestion and the new era of technological advancements that we are currently experiencing, has brought about the use of social interaction tools including blogs and wikis.<\/p>\n

Wikis <\/b><\/h2>\n

Wikis are defined as: \u201cCollaborative websites, created and maintained by groups of people with specific interests\u201d (Varga-Atkins, Dangerfield & Brigden, 2010, p. 825).\u00a0 The word wiki comes from the Hawaiian word meaning \u2018quick\u2019 and it is estimated that there are several million of these sites although it is not possible to know exactly how many there are due to the lack of an appropriate search engine for this type of site (Sandars, 2006). There is evidence from published research that demonstrates the usefulness of the wiki for educational purposes in undergraduate nursing education. \u00a0According to Morley (2012), 45 percent of nursing students who participated in a wiki that was part of a complementary learning technique, felt that the wiki was a useful way to communicate with other students.\u00a0 Thirty-three percent of nursing students felt that the wiki fostered information sharing among group members.\u00a0 According to Varga-Atkins et al. (2010) the phenomenon of using wikis for educational purposes was found to enhance medical students\u2019 learning in two ways. In the first instance, they were able to use the wiki as a means for information sharing related to professionalism.\u00a0 Second, medical students were able to develop their professional identity through interactions they had with other students.\u00a0 This demonstrated that although many students in today\u2019s era of technology participate in online social media, participating in a wiki dedicated to a professional endeavor held a different meaning to students than participating in social networking sites like Twitter\u00a9 or Facebook\u00a9.<\/p>\n

Informatics Project Vision<\/b><\/h2>\n

As presented in the literature, the use of a wiki can serve a variety of purposes.\u00a0 In the proposed nursing informatics project, I seek to develop a wiki that supplements educational materials that have already been put in place in the critical care setting.\u00a0 Presently, graduate nurses are placed with a preceptor for a minimum of six weeks, attend a three-day cardiac education course, a two- day general nursing orientation, and are given a USB flash drive with pertinent articles and information to review.\u00a0 They must pass a three hour exam based on the information given to them along with an electrocardiogram analysis exam in order to be covered to work in the telemetry section of progressive care.\u00a0 There are a series of modules for the intensive care unit that are completed at the learner\u2019s convenience and once this is accomplished, the graduate nurse is able to attend \u2018code blue\u2019 calls within the hospital as a junior staff member when patients require cardiopulmonary resuscitation.\u00a0 They also require certifications in basic life support and advanced cardiac life support prior to attending \u2018code blue\u2019 calls. Throughout the orientation process, there is ongoing direction from preceptors and patient assignments are coordinated with the skill level of the graduate nurse in mind.<\/p>\n

Recently, within my workplace, there has been a large turnover of experienced staff and an influx of new nurses with a background in medical surgical nursing, and also graduate nurses who are \u2018fresh\u2019 from nursing school education at baccalaureate level.\u00a0 The staff consists of an all RN complement with support staff of ward clerks for clerical duties.\u00a0 The development of a wiki website may provide nurses working within these critical care areas with education material, links to pertinent websites and online audiovisual aids and \u00a0provide a means of interacting with other staff members.\u00a0 The use of a wiki can be protected with password protection or also can be made available to the public (Billings & Kowalski, 2009).\u00a0 For the purposes of this project, only nursing staff working in the areas of intensive care, coronary care and progressive care units would be able to access the information.<\/p>\n

Wiki content can be created, customized, and altered by the participating users (Sandars, 2007).\u00a0 The importance of referencing and providing trustworthy information from respected sites and material would be stressed on the main page of the site.\u00a0 Confidentiality would also have to be addressed with employees.\u00a0 The site would be monitored by myself, the creator and the content would be directed by the nurse educator for the unit in conjunction with the staffs\u2019 identified learning needs. \u00a0This is what makes the wiki valuable, as it provides a means of communication and creation of learning opportunities for everyone involved (Sandars, 2007). \u00a0Another very good advantage of a wiki for health care education is that it offers a means of communication between employees working in the same area who may otherwise never come into contact.\u00a0 For example, the shift schedule is divided into two day shifts, followed by two night shifts, then four-five shifts off.\u00a0 Certain nurses end up working together on an ongoing basis and may not see or interact with other nurses due to scheduling.\u00a0 The wiki would create interaction between the various shifts and foster communication between employees.\u00a0 In contrast to using e-mail to remain in contact with other employees regarding pertinent information for education and updating on policies and protocols, a wiki provides a means of easily storing messages and links to documents by date (Sandars, 2007).\u00a0 The wiki can be set-up free of charge using common software packages such as PBWiki<\/a> (as cited in Sandars, 2007).<\/p>\n

According to Billings and Kowalski (2009) nurse educators can use wikis to facilitate teaching and learning in a wide array of clinical practice settings. For example, a wiki can be utilized to develop an orientation manual with nursing departments contributing pertinent information specific to the area of practice.\u00a0 The authors also described how a wiki can be used for continuing education in the form of a syllabus, research and protocol documents, learning activities and evaluation materials. It is easy to envision that the possibilities are vast and diverse so it is imperative that the wiki be developed with the needs of the staff involved.\u00a0 Sandars (2006) stressed this fact and encouraged users to be clear on why they want to use a blog or wiki to direct learning. The convenience of a wiki according to Sandars (2006) is that it offers a low degree of technology that can be linked to other sources such as websites, text and audio.\u00a0 This is very appropriate for the purposes of this project as the technology should be simple and easy to use while providing optimal learning resources for critical care nursing.<\/p>\n

Change Management Theory<\/b><\/h1>\n

The change management theory that will guide the implementation of the proposed informatics project is Lippitt\u2019s theory of planned change (Lippitt et al., 1958).\u00a0 According to Geraci (1997), Lippitt\u2019s model builds on the work of Kurt Lewin by concentrating on problem solving and interpersonal domains of the change process. Lippitt et al. (1958) claimed that Lewin was a pioneer in change theory with his development of the three phases of the change process. These stages are described as unfreezing, moving and freezing (Lehman, 2008). The criticisms of Lewin\u2019s theory have been that it is incomplete and it relies heavily on upper management carrying out a change and further, that is does not involve key stake holders in the process of change (Tiffany et al. as cited in Lehman (2008).<\/p>\n

Geraci (1997) defined the seven phases of Lippitt\u2019s theory as:<\/p>\n

(a) diagnosing the problem;<\/p>\n

(b) assessing the motivation and capacity for change;<\/p>\n

(c) assessing the change agent\u2019s motivations and resources;<\/p>\n

(d) selecting progressive change objectives;<\/p>\n

(e) choosing the appropriate role for the change agent;<\/p>\n

(f) maintaining the change once it has started; and<\/p>\n

(g) ending the helping relationship.<\/p>\n

 <\/p>\n

In Lippitt et al.\u2019s (1958) book The dynamics of planned change, <\/i>the stages are referred to as:<\/p>\n

(a) development of a need for change,<\/p>\n

(b) establishment of a change relationship,<\/p>\n

(c) working toward change,<\/p>\n

(d) the clarification or diagnosis of client systems problem,<\/p>\n

(e) the examination of alternative routes and goals\/establishing goals and intentions of action,<\/p>\n

(f) transformation of intentions into actual change efforts, and<\/p>\n

(g) the generalization and stabilization of change and achieving a terminal relationship.<\/p>\n

There is some discrepancy between how Geraci (1997) and Lippitt et al. (1958) chose to refer to the nonclementure of the seven phases of change. Based on my assessment, the phases appear to be the same and entail similar objectives but are described using different terminology.\u00a0 Gercaci (1997) offered that the seven step process of Lippitt\u2019s theory aligns well with what nurses know as the nursing process for problem solving and that the theory can be applied to just about any setting in nursing practice. This was the main motivation for choosing the theory to guide the current project. To explain the process of change for the purposes of this paper, Lippitt\u2019s original work and terminology will be used.<\/p>\n

The Development of a need for change <\/b><\/h2>\n

This stage of the change process can occur in a few different ways.\u00a0 According to Lippitt et al. (1958) this stage will align with what Lewin described as \u2018unfreezing\u2019.\u00a0 More specifically Lippitt et al. describes three ways in which this first phase might occur.\u00a0 In the first instance, a change agent may notice that an intervention or change would benefit the system or person and offers assistance or opens a dialogue to make others aware of the situation.\u00a0 Second, a third party that is related to the change agent and the potential group affected by the change brings the two parties together.\u00a0 Third, a person or group in need of assistance seeks help from an outside source.\u00a0\u00a0 In the case of the present project proposal, the first scenario would most closely coincide with the situation since I am the change agent hypothesizing about the change I would like to put in place. According to Lippitt et al. (1958) a change agent is simply defined as an individual from any type of system who seeks to help a situation by offering their skill set. As the change agent I will have to be aware of the forces that influence the process of change.\u00a0 Lippitt et al. (1958) refers to the forces that resist change or favor change respectively as, resistance forces and change forces.<\/p>\n

Lippitt et al. (1958) stated, \u201cMaintaining a favorable balance of forces is a continuous job for the change agent and client system, beginning with the initial decision to undertake a change project or helping relationship and continuing until the project has been completed\u201d (p. 73).<\/p><\/blockquote>\n

The goals of the project would be to (a) enhance graduate nurses\u2019 orientation to critical care setting, (b) support new graduate nurses while supplementing their education, and (c) increase professional communication through information technology.\u00a0 This initial stage would involve approaching the department nurse educator and nurse manager to discuss how this proposal could be integrated into the current orientation of new graduate nurses to critical care.\u00a0 Their support and awareness of the benefits that this project could offer to new graduates and staff would be the primary focus of the unfreezing phase as they manage this process for the most part.\u00a0 After the support of the key stakeholders is obtained (nurse educator and nurse manager), I would then move on to the second stage of the change process.<\/p>\n

The Establishment of a Change Relationship<\/b><\/h2>\n

This second phase involves the change agent (myself) gaining the trust of the group at my work setting in order to proceed with the project.\u00a0 According to Lippitt et al. (1958) an important aspect of this stage is how the group perceives the change agent and the potential change.<\/p>\n

\u00a0\u201cWhat the client system really wants is two change agents in one. It wants an agent who will identify himself with the client system\u2019s problems and sympathize with the system\u2019s needs and values, but who will at the same time be neutral enough to take a genuinely objective and different view of the system\u2019s predicament\u201d (p. 134).<\/p><\/blockquote>\n

I believe that this stage needs to be approached in a sensitive and appropriate manner.\u00a0 Due to the fact that I am a nurse and able to identify with the work setting and also that this change is meant to enhance learning and support workers, I anticipate being able to gain access and trust from the group quite readily.\u00a0 The recipients of this project – new graduate nurses, will hopefully be open to acquiring the best possible orientation and take advantage of the resources being provided.\u00a0 The one barrier that I foresee here is potential information overload as they are given a wealth of information related to their new nursing positions.\u00a0 This will have to be considered in respect of the optimal timing to introduce the wiki to their practice and education in the critical care setting.<\/p>\n

Clarification or Diagnosis of the Client System\u2019s Problem<\/b><\/h2>\n

According to Lippitt et al (1958), working toward change encompasses stages three, four and five, which coincides with Lewin\u2019s second stage labelled \u2018moving\u2019.\u00a0 For the purpose of this third stage, information must be collected regarding the situation in the workplace and why the project would benefit staff.\u00a0 It has already been identified that there is plethora of very junior staff in the unit and that support and ongoing education is a priority.\u00a0 Being a staff member and acting as a preceptor for some of these employees puts me in an ideal position to interact with and obtain information about what their needs are.\u00a0 A meeting to discuss what staff would like to have offered within the wiki would be beneficial so that they feel they are participants in the process.\u00a0 If a meeting were to take place I believe a brief presentation on what a wiki is and how it works would be beneficial for staff.\u00a0 This would give me the opportunity to provide rationale and state the benefits of its use.\u00a0 The meetings would be targeted towards new graduates but all staff would be welcome.<\/p>\n

Examination of Alternative Routes and Goals<\/b><\/h2>\n

Within this phase the group will begin to formulate ideas about the change.\u00a0 Lippitt et al. (1958) cautioned that problems related to motivation may arise when the group starts to formulate actual intentions and specified actions.\u00a0 These problems with motivation occur in many cases due to anxiety about the change or fear of failure.\u00a0 The authors offered that a trial procedure involving the change may help to alleviate these anxieties and foster the adoption of the idea.\u00a0 In the case of the informatics project of developing a wiki to enhance orientation, it is my hope that once staff members become aware of how this new way of learning can enrich their practice and increase their knowledge base that they will be more willing to accept it.\u00a0 Also, recent graduates may have experience with the technology already and be able to offer information on past experiences, and assist in helping with the implementation of the project.<\/p>\n

\u00a0 The Transformation of Intentions into Actual Change
\n<\/b><\/h2>\n

During this phase, the change agent works to ensure that the staff feel supported and encouraged to work towards actual efforts based on their intentions.\u00a0 For this project it would be the actual creation of the wiki, followed by an active demonstration of an activity that could be performed on the site.\u00a0 An example activity could be to provide a link to a website where answers to clinical practice questions are found.\u00a0 It would be very brief but informative in order to display simplicity and applicability to the work setting. I envision providing links to pertinent clinical skills or techniques as well as links to articles for current practice that will provide best practice guidelines and evidence for clinical interventions. Links to visual aids and websites are possible when using a wiki (Sandars, 2006). Videos of procedures would also be helpful for new graduates who do not get to experience assisting with a procedure during their orientation. For instance, it is possible to view procedures such as innovative surgeries or insertion of a central lines and temporary pacing wires on websites such as Youtube\u00a9.\u00a0 This can give the learner a visual aid so that when they are faced with this in practice they at least have the knowledge and visual recall of what takes place during a procedure though they may not have the hands on experience.<\/p>\n

The Generalization and Stabilization of Change<\/b><\/h2>\n

During the implementation of the informatics project the focus will be to target new graduate nurses entering critical care to enhance their orientation.\u00a0 If the project is well received it is my hope that the inclusion of this piece of information technology into the orientation could also be useful for other employees entering the critical care setting with no prior critical care experience.\u00a0 It may also benefit existing staff as a resource to review material and use audio visual aids to review a procedure that they have not encountered in quite some time.<\/p>\n

According to Lippitt et al. (1958), “One critical factor in the stabilization of change is the spread or non-spread of change to neighboring systems or to subparts of the client system\u201d (p. 140).<\/p><\/blockquote>\n

If the use of a wiki in my workplace spreads from the target group of new graduate nurses to other staff members, this would signify to me that stabilization of the intervention is occurring.<\/p>\n

Achieving a Terminal Relationship <\/b><\/h2>\n

According to Lippitt et al. (1958) the termination of the change agent\u2019s involvement in the change process can end as early as the third phase of the change process.\u00a0 Therefore the issues that may arise during this phase are dependent on when the relationship ends.\u00a0 Many of the issues that are able to occur within phase two (establishment of a change relationship) may occur, taking into account that the goal of a project is for the group to become completely independent of the change agent or to continue to be in consultation with the change agent.<\/p>\n

For the purposes of this project, and taking into account that I am a staff member as well as the creator of the site, I will have to have an ongoing involvement and relationship with \u00a0the group\/staff as well as nurse educator and nurse manager.\u00a0 However, the goal behind a wiki is that it becomes a way to contribute to discussion and share knowledge.\u00a0 According to Sandars (2007) a wiki allows content to be directly altered or edited by users of a site.\u00a0 As time goes on, and staff members become more comfortable using the wiki, I envision nurses contributing their knowledge and participating more readily in discussion about ways to enhance education and practice in critical care nursing.<\/p>\n

Conclusion<\/b><\/h1>\n

According to Bozak (2003) in order to decrease resistance and favour adaption to change, a well formulated strategy is essential.\u00a0 In the proposed project, I discussed an endeavor to encourage staff involvement in the process and offer opportunities to enhance learning during the challenging time of orientation for new graduate nurses in critical care.\u00a0 Lippitt\u2019s model offers a comprehensive seven stage process that closely aligns with the nursing process and is appropriate for a variety of settings.\u00a0 Being astute to the needs of staff as well as the barriers and facilitators to change that may be encountered is paramount for moving this initiative forward.\u00a0 Adapting to these factors during the change process will be an ongoing endeavor that requires a constant interaction with key stakeholders in the work setting.\u00a0 As a staff member, I am already in a position to be able to interact with staff regarding the project.\u00a0 I foresee that this project may be a valuable learning opportunity for new graduate nurses that could enhance their orientation experience and promote a smoother transition in a challenging practice area.<\/p>\n

References<\/h1>\n

Billings, D. M., Jeffries, P. R., Daniels, D. M., Rowles, C., Stone, C. L., & Stephenson, E. (2006) Developing and Using Online Courses to Prepare Nurses for Employment in Critical care. Journal for Nurses in Staff Development, 22 <\/i>(2), 87-92. Retrieved from http:\/\/journals.lww.com\/jnsdonline\/abstract\/2006\/03000\/developing_and_using_online_courses_to_prepare.8.aspx<\/a><\/p>\n

Billings, D. M., & Kowalski, K. (2009) Wikis and Blogs: Consider the possibilities for continuing nursing education. The Journal of Continuing Education in Nursing, 40 <\/i>(12) 534-535. doi: 10.3928\/00220124-20091119-10<\/p>\n

Bozak, M. G. (2003) Using Lewin’s Force Field Analysis in Implementing a Nursing Information System. Computers, Informatics, Nursing, 21<\/i>(2), 80-87. Retrieved from http:\/\/journals.lww.com\/cinjournal<\/a><\/p>\n

Chesnutt, B. M., & Everhart, B. (2007) Meeting the Needs of Graduate Nurses in Critical Care Orientation: Staged orientation program in surgical intensive care. Critical Care Nurse, 27 <\/i>(3), 36-51. Retrieved from http:\/\/ccn.aacnjournals.org<\/a><\/p>\n

Geraci, E. P. (1997) Computers in Home Care: Application of change theory. Computers\u00a0 Nursing, 15 <\/i>(4), 199-203. Retrieved from http:\/\/ovidsp.tx.ovid.com.qe2a-proxy.mun.ca<\/a><\/p>\n

Lehman, K. L. (2008) Change Management: Magic or mayhem? Journal for Nurses in Staff\u00a0 Development, 24 <\/i>(4), 176-184. Retrieved from http:\/\/search.ebscohost.com.qe2aproxy.mun.ca\/login.aspx?direct=true&db=rzh&AN=2009999650&site=ehost-live&scope=site<\/p>\n

Lippitt, R., Watson, J., & Westley, B. (1958) The Dynamics of Planned Change: A comparative study of principles and techniques.<\/i> New York: Harcourt, Brace & World Incorporated<\/p>\n

Morley, D. A. (2012) Enhancing Networking and Proactive Learning Skills in the First Year University Experience through the Use of Wikis. Nurse Education Today, 32 <\/i>(3), 261-266. doi:10.1016\/j.nedt.2011.03.007<\/p>\n

Nerlich, S. (1995) Computer-assisted learning (CAL) for general and specialist nursing education. Australian Critical Care, 8 <\/i>(3), 23-27. Retrieved from http:\/\/www.sciencedirect.com.qe2a-proxy.mun.ca\/science\/article\/pii\/S1036731495702867<\/a><\/p>\n

Sandars, J. (2006) Twelve Tips for Using Blogs and Wikis in Medical Education. Medical Teacher, 28 <\/i>(8), 680-682. doi: 10.1080\/01421590601106353<\/p>\n

Sandars, J. (2007) The Potential of Blogs and Wikis in Healthcare Education. Education for Primary Care, 18 <\/i>(1), 16-21. Retrieved from http:\/\/search.ebscohost.com.qe2a-proxy.mun.ca\/login.aspx?direct=true&db=rzh&AN=2009524560&site=ehost-live&scope=site<\/p>\n

Travale, I. L. (2007) Computer-assisted Instruction for Novice Nurses in Critical Care. Journal of Continuing Education in Nursing, 38 <\/i>(3), 132-138. Retrieved from http:\/\/www.healio.com\/journals\/JCEN\/%7BD3810DFC-BDC5-44B7-AC0F-D80A6979C58A%7D\/Computer-Assisted-Instruction-for-Novice-Nurses-in-Critical-Care<\/p>\n

Varga-Atkins, T., Dangerfield, P., & Brigden, D. (2010) Developing Professionalism through the Use of Wikis: A study with first-year undergraduate medical students. Medical Teacher,\u00a0 32 <\/i>(10), 824-829. doi:10.3109\/01421591003686245<\/p>\n

 <\/p>\n

\u00a0Author Biography
\n<\/b><\/h2>\n

Meaghan MacDonald is a registered nurse working in the critical area at the Queen Elizabeth Hospital in Charlottetown, PEI.\u00a0 She pursues part-time distance education at the Masters level through Memorial University of NewFoundland.\u00a0 Her long-term goals are to complete her master degree and eventually become a Geriatric Nurse Practitioner.<\/p>\n

 <\/p>\n

 <\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

by Meaghan MacDonald<\/p>\n

Vol 8 No 1 & 2
\nWinter\/Spring 2013<\/p>\n","protected":false},"author":1,"featured_media":2930,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[736],"tags":[36,338,63,782,784,58,569,8,62,55,65,786,752,59,43,785,204,32,132,64,48,783],"_links":{"self":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2884"}],"collection":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2884"}],"version-history":[{"count":43,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2884\/revisions"}],"predecessor-version":[{"id":3124,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2884\/revisions\/3124"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/media\/2930"}],"wp:attachment":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2884"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2884"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2884"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}