Integrative Online Learning for Nurses in "The Neighborhood"

Virtual community is a teaching tool developed by RWJF Executive Nurse Fellow to promote concept-based learning in nursing schools.

    • May 29, 2012

There’s a growing recognition that nursing students are better able to learn and apply concepts in real-life, clinical settings where they can understand why they’re meaningful. The notion, called integrative learning, has been championed by leading nursing educators like Patricia Benner, RN, PhD, FAAN, professor emerita at the University of California, San Francisco, one of the nation’s leading nurse educators, and author of a major national nursing education study. It’s also the basis for The Neighborhood, a unique and innovative online teaching application developed by Jean Giddens, RN, PhD, FAAN, professor and executive dean at the College of Nursing, University of New Mexico and a 2011 Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow.

“The trigger point for The Neighborhood was working with faculty who had adopted a concept-based curricula and were trying to figure out how to teach that curricula in a meaningful way,” Giddens said.

The idea for The Neighborhood came to Giddens while walking in her own neighborhood, when she realized that all the health conditions and clinical situations that nursing students must learn about are present in their own communities. Even more importantly, she realized, one’s own community influences personal histories, living situations, and daily lives in important ways. By creating a virtual community, or neighborhood, Giddens could provide her students with an opportunity to learn in a setting that was close to real life.

She began working on the concept while working full time at the University of New Mexico. It took about 18 months to fully complete. “Before I had characters, I had to think about the conditions and situations that students should be exposed to,” she said.

Giddens began by creating a table of health conditions to address, several of which are co-morbid. “Then I thought about who would have that condition or those conditions—how old they would be, whether they would be men or women, where they would live, what they would look like, how they would behave. Then I grouped them into families.”

The Neighborhood includes diverse 48 “patient” and “health professional” characters, each with his or her own medical history and biography (including relationships to others in The Neighborhood, work, hobbies, and other pertinent information). These characters are diverse and include children, older adults, a gay couple, an American Indian couple, Filipinos, Hispanics, African Americans, and others. Giddens wrote storylines for each character and then gathered feedback from members of the representative racial and ethnic groups (including some of her students) to ensure the stories were culturally accurate. She also interviewed experts on various health conditions to help her fill out the details of people’s biographies and the storylines she developed. The stories in The Neighborhood are written from the patients’ perspectives through narratives and video vignettes posted online, which help bring the characters’ stories more vividly to life.

“Studies conducted have shown that there’s a level of student engagement that happens when you use stories,” Giddens said. “Stories provide context for the information students are learning. We all know someone with a health condition. When someone has a close family member who has a health condition, they learn about it. They’re engaged in that learning because they have a context for understanding the condition. This works in the same way. The stories provide context for learning about health conditions.”

The Neighborhood is being used in schools across the country to teach nursing students at BSN and MSN levels. It’s intended to be used for a semester and can be used in any course. “The Neighborhood can be used in an endless number of teaching applications” said Giddens. “It can be used for games, concept papers, debate learning activities, clinical, nursing theory. I’ve even seen it used as a basis for a health fair learning activity for students.”

Reactions to The Neighborhood from students and faculty vary. Evaluations show that students’ perceptions of the application are correlated with the expertise of the faculty using it. To be most successful, faculty need to learn to use The Neighborhood and to do it consistently, but students’ learning styles also play a role. Students who prefer reading to hands-on learning tend to like The Neighborhood less than students who enjoy active learning. Giddens has also discovered that students from cultural groups that embrace story-telling are more likely to enjoy using The Neighborhood as a learning tool.

Giddens recently completed an evaluation of the impact of The Neighborhood on faculty work-life as the principal investigator for an RWJF Evaluating Innovations in Nursing Education project. She also recently gave a presentation on The Neighborhood at an RWJF New Jersey Nursing Initiative Collaborative Learning Community session for students preparing to become nursing faculty.

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