NURSING MS C922 EMERGING TECHNOLOGY PROPOSAL Virtual Simulation in Community Health Nursing ,100% CORRECT

NURSING MS C922 EMERGING TECHNOLOGY PROPOSAL Virtual Simulation in Community Health Nursing Virtual Simulation in Community Health Nursing Stephanie M. Gill Western Governors University College of Health Professions 2021 Executive Summary The world is in a current state of chaos with the Covid-19 pandemic. Covid-19 has caused schools to shut down, offices to close, and allotted physicians to refuse patients because of their symptoms. The world has never needed a change in healthcare like it does now. Virtual simulation (VS) technology has evolved and improved over the years, such as the field of healthcare. Utilization of virtual simuation has also grown over the years, especially during the pandemic, and offers several benefits to students, educators, and healthcare professionals. The Covid-19 pandemic has created new challenges and demands for nursing programs, such as limited clinical settings, inability to assess actual patients, and limited or no physical time for instructors to work with their students. The pandemic has forced facilities to identify disparities in technology and education located in healthcare and learning platforms by performing a needs assessment and gap-analysis. A literature review was performed to reveal virtual simulation, particularly i-Human, as a very real and likely solution to the gaps in healthcare and education during the pandemic. Administration, faculty, students, and IT personnel were identified as being the main academic stakeholders in the gap analysis. A force-field analysis is accomplished and incorporated to demonstrate the organizations interest in the use of Zoom for Higher Education and i-Human as a virtual simulation. Also included are forces for and challenges to integrating the proposed change and organizational factors that may enable or hinder change are examined. Using Lewin's Change Theory, virtual simulation can be incorporated into the curriculum and provide students with a safe environment for clinical scenarios and patient interactions. This proposal examines the current gap in nursing education and how virtual simulation can improve the course entitled "The Role of the BSN Nurse in Promoting Community Health". Virtual Simulation in Nursing Education Literature Review Table 1. Literature Review Summary Table First Author (PubYear) Title Purpose Context Findings Relevance Strength of Evidence Chen (2020) “Effectiveness of Virtual Reality in Nursing Education: Meta- Analysis” To assess the efficacy of virtual reality in nursing education, specifically in the areas of knowledge, skills, satisfaction, confidence, and performance time. A meta-analysis of 12 studies that included 821 nursing students or nursing staff as participants using the Cochrane methodology. The study compared traditional education methods to virtual reality simulation. Virtual reality educational methods can enhance nursing student’s knowledge and understanding, as well as improve the teaching process. The study supports that virtual reality is a valuable learning strategy. Level I: Meta- Analysis Strengths: Included students and nursing staff in multiple studies that were reviewed. Weaknesses: The data obtained in the study was collected one year after students received virtual simulation. Jiménez- Rodríguez (2020) “Simulated Nursing Video Consultations: An Innovative Proposal During Covid- 19 Confinement” To find a solution that adapts to simulation- based education that is needed because of restrictions set forth by the COVID-19 pandemic. A cross- sectional study was completed with a mixed-method, quantitative and qualitative methodology, to analyze 48 third year nursing students using video consultation scenarios. Students felt pleased with the simulated experience and developed skills in a physical and psychologically safe environment. This article is relevant to evaluate the use of simulation in enhancing nursing students learning. Level IV: Non- experimental Cross-sectional study Strengths: The study used a 33 satisfaction questionnaire and two open ended questions allowing for precise results. Weaknesses: The study had a very small sample size and most of the participants were women. Liu (2021) “The Effects of Virtual Simulation on Undergraduate Nursing Students’ Beliefs about Prognosis and Outcomes for People with Mental Disorders” To evaluate the effects virtual simulation (VS) has on nursing students’ beliefs on prognosing long-term outcomes for people with depression and schizophrenia. A cross-sectional survey was performed among a group of 153 undergraduate nursing students who were in their final year of nursing school and in a mental health course. Students in the comparison cohort were divided into groups, one group received education via VS and the other did not. The findings of this study support the use of virtual simulation as a learning tool to nurture nursing students’ positive beliefs about attitudes regarding mental illness. This article is relevant to the proposal because it supports the use of VS as a learning tool to enhance nursing students clinical training. Level IV: Non- experimental cohort- comparison study Strengths: Large sample size of 153 students. Weaknesses: Data was collected one year after the VS experience, which can cause skewed data. Padilha (2019) “Clinical virtual simulation in nursing education: Randomized Controlled Trial” To assess the effect of virtual simulation (VS) with concern to knowledge retention, clinical reasoning, self- efficacy, and student satisfaction with learning experiences. A randomized controlled trial comprising of a pretest and two post-tests with 42 Portuguese nursing students enrolled in the course “Corporal Body Responses 1”. The participants split into two groups with the same lesson objective and timing. One group used conventional learning and the other utilized virtual The findings of the experimental group results indicate that virtual simulation improves knowledge retention, initial clinical reasoning, and student satisfaction with learning. The study endorses that virtual simulation is a useful tool for students with regards to knowledge retention, clinical reasoning, self- efficacy, and student satisfaction. Level II: Randomized Control Trial Strengths: Randomized controlled trial with pretest and two post- tests allows for a very thorough study. Weaknesses: Test group is very small, consisting of only 42 students and there were no statistical simulation. differences discovered in the self- efficacy assessment. Schaffer (2016) “Second Life® Virtual Learning in Public Health Nursing” To evaluate the effectiveness of virtual simulation (VS) in clinical learning, as well as assess student satisfaction in knowledge gained about public health nursing. This article depicts the educational revolution of assimilating Second Life® virtual learning experiences into clinical learning for senior nursing students in a community health course. Nurse educators use the VS program to create opportunities for collaborative learning experiences. This article found that using Second Life® is an effective learning tool for teaching nursing student’s public health nursing when clinical experiences are challenging to find or are in an unsafe area. This article is relevant to the proposal because it supports the use of VS as a learning tool to enhance nursing students clinical training, especially in the public health aspect. Level VI: Single Qualitative Study Strengths: The study tested multiple VS scenarios and changes were made to future simulations as a result. Weaknesses: The study is limited to one school and has a very small sample size of 77 nursing students. Summary of Sources Each article located in the literature review has a common theme, the use of virtual simulation in nursing programs. The argument common throughout each article is that virtual simulation (VS) allows for competency-based education and assessment in a safe environment. When virtual simulation is used in the clinical setting students are enabled to gain a superior level of learning by being immersed in real-world scenarios, situations, and patient-centered challenges in a controlled and secure environment. Students can develop skills such as, patient assessment, critical decision making, and communication, all while in a virtual setting (Padilha et al., 2019). With the use of a meta-analysis, Chen in accompany of multiple other authors, discovered that virtual reality can be more effective in improving knowledge than more conventional methods. The meta-analysis concluded that virtual simulation can effectively improve knowledge nursing education and promote the application of theoretical knowledge in clinical practice (Chen et al., 2020). Virtual simulation has been an excellent tool for nursing students during the Covid-19 pandemic. When facilities canceled classes and clinicals, students were left with confusion and uncertainty pertaining towards graduation. With the use of virtual simulation, students could use digital/simulated patients to develop assessment skills and nursing video consults to improve communication skills (Jiménez-Rodríguez et al,. 2020). Educators and students found the virtual learning platform Second Life® useful when used in place of clinicals. Educators can use Second Life® virtual learning to develop possibilities for collaborative learning experiences. Schaffer et al. (2016), explains that students can use the Second Life® platform to navigate through real-life clinical scenarios in a safe environment and limit harm or risk to students and clients. According to Liu (2021), students can gain from VS in more than just the clinical setting, such as in mental health classes. Mental health can be a challenging subject for students who have no background with mental health or have never experienced mental health issues. Educators must come up with innovative ways to educate their students about the different mental illness they may encounter as a nurse, but also dispel stigmas surrounding mental health. “Nursing students' unfamiliarity with and stigmatization of mental disorders might be dispelled through videos and simulations that portray realistic patient population and clinical environments” (Liu, 2021). Liu (2021) concluded that virtual simulation can be an effective learning tool to promote undergraduate nursing students’ optimistic beliefs and attitudes toward mental illness. Technology Gaps In the recent past virtual simulation has proven to be exponentially important. During the current Covid-19 pandemic virtual simulation has been used in several ways and on multiple platforms to provide education. Modernization in virtual simulation has “made available high- fidelity simulators that have supported the change in the health education paradigm. The use of high-fidelity simulators has improved the acquisition of knowledge and skills and strengthened quality and safety in clinical practice” (Padilha et al., 2019). However, there are limitations and challenges with the use of virtual simulation. Padilha et al. (2019) explains “we have been facing challenges with the increasing cost of simulators, the difficulties of space management, and the low number of clinical scenarios available”. Virtual simulation programs are extremely expensive, students then also must add in the cost of ensuring the device used for simulation can handle the graphics and storage required for VS use. This may require students to update their computers with costly programs or purchase a new computer system entirely. Students may push back when required to pay more for their education. Schaffer et al. (2016), explains that the Second Life® Virtual Learning platform is an effective learning environment for students that are studying public health in nursing and require a clinical experience. This virtual environment allows for students to assess patients and environments without putting themselves or patients at risk. Students found this program to be beneficial in place of clinical, but found the platform limiting and the learning aspects were very limited. The authors further discuss that “…educators may be responsible for costly fees to purchase an island (i.e., a virtual learning environment) and for the annual renewal of Second Life…Nursing faculty ‘also’ need to ensure technological challenges are addressed and that scenarios are realistic and engaging students through interactive collaboration” (Schaffer et al., 2016). Virtual simulation is an exceptional tool for learning enhancement, but it does not come with out flaws or a learning curve for students and staff. Second Life® Virtual Learning only had three learning scenarios/environments when the article was published, which is very limiting for students. Multiple authors have a similar conclusion that virtual simulation is quite beneficial, but there are components, such as cost and limited scenarios, that must be addressed to ensure students have the greatest experience possible. Needs Assessment Need-Gap Analysis Process Across the nation school and universities closed during the Covid-19 pandemic. Students were left home for weeks without any guidance or understanding of the material given to them. A needs assessment, “the process of collecting and analyzing information that can influence the decision to initiate a new program or revise an existing one” (UCLA Health, 2016), was completed to initiate a new technology to incorporate into student learning. Many facilities began incorporating zoom into their online learning, while others incorporated virtual simulation or both platforms into online learning. To proceed with the integration of zoom and virtual simulation a needs gap analysis was performed. A needs gap analysis is “the method of identifying the difference between current knowledge, skills, and/or practices and the desired best practice” (UCLA Health, 2016). To perform a gap analysis of a technology need, the first step would be understanding the current technology being used and identifying the desired technology. The gap must then be identified and followed by the action steps needed to meet the need-gap. Stakeholders Stakeholders must be identified and included in part of the change process. The cooperation and collaboration of academic stakeholders is vital to address the needs-gap among present curriculum technology and desired technology for the program. The stakeholders collaborate by frequently meeting to examine and discuss the action plan for the transfer to the desired technology. The first stakeholder would be the institutions administration, as they have the most pull for change at a facility. The administrations part in the gap analysis is to head the executive functions of the technology proposal. The administration will have the role of providing funding and distribution of key assets, which makes for a crucial partnership. To spearhead the collaboration, the first meeting will be face to face if allotted, this ensures for a thorough discussion of the proposed change. The second stakeholder would be the faculty or educators at the institution. The faculty’s role in the gap analysis is to provide expertise and understanding on the proposed technology. The faculty offer awareness to the other stakeholders about the implementation of the technology proposal. Faculty have the most interaction with students, their buy-in and feedback is crucial to successful implementation. Training the faculty must be included to create awareness of how technology can impact education and provide proof of success. Faculty must know how to use the proposed technology to ensure student objectives and learning outcomes are achieved. The thirds stakeholder would be the student learners. The student learners, much like the faculty, provide insight in the current curriculum and emerging trends in technologies. Most current students were born and are familiar with new and up-and-coming technology that staff, or administration may not be familiar with. The students can provide information or views on specific technology platforms. Their feedback is crucial because the proposed technology will directly affect them and any future student. Student learners’ feedback must be contemplated prior to executing such a significant change in technology. The fourth stakeholder would be Information Technology (IT) personnel. The IT department representative would be accountable for determining the technology that will best suit the virtual simulation needs based on the other stakeholder's evidence-based research. The IT personnel will also be responsible for assessing the equipment needed for the proposed technology change and what the associated cost may be for the product. IT will be responsible for instructing the faculty on how to accurately work the new technology and will be available for any assistance that may be needed by faculty and students. Methods of Collaboration Collaboration between stakeholders is crucial to the change process. Keeping communication open and straightforward decreases confusion and allows for more thorough discussion of the proposed technology. The easiest and most effective way to collaborate with the stakeholders is by holding a bi-weekly meeting and subsequently sending emails. The stakeholders will first be introduced to one another at a meeting, this will encourage partnership and cooperation. This will also allow team members to know one another and feel less impersonal when emailing. In-person meetings may not always be feasible due to the current pandemic. This can be solved by the stakeholders holding a conference on zoom. Zoom allows for real time interaction, can have multiple participants, and is secure. An additional effective method utilized by the interprofessional team is email messages. Email may be the most convenient method of communication for the interprofessional team as it allows stakeholders to connect with one another virtually and at any time. Stakeholders have more time to think about their answers or look up information they must provide to other members of the interprofessional team. Using email as a form of communication allows for plans to be shared, questions to be answered and progress updates to be given. Stakeholders will also be able to have a copy of everything discussed in the emails and use it as a reference. Current Technologies Table 2. Curriculum Technology Need-Gap Analysis Current Curriculum Technology Desired Curriculum Technology Need-Gap Action Steps to Meet the Need-Gap Educational Institution Simulation lab Virtual Simulation Technology, such as i- Human, for skills assessment and clinical scenarios. Simulation training for faculty, students, and IT personnel. Develop student’s clinical skills in a safe environment. Meeting the course objective of completing a community health assessment accurately. 1. Acquire i-Human technology for education software. 2. IT Specialist training 3. Institution-wide training 4. Student training 5. Annual i-Human training for the institution. Textbooks and Journal articles Zoom meetings, webinars, class discussions, and lessons via video Zoom education for faculty, students, and IT personnel. Encourage and facilitate learning. 1. Acquire Zoom technology for education software. 2. IT Specialist training 3. Institution-wide training 4. Student training 5. Annual Zoom training for the institution. “The Role of the BSN in Promoting Community Health”, much like any other course, requires student nurses to acquire knowledge and skills from an instructor and implement that knowledge and skills in the clinical setting. The traditional form of education is the use of textbooks and journal articles and executing skills in a clinical setting such as a hospital or clinic. The education realm changed when the Covid-19 pandemic hit. Students were forced to stay home, courses were put on hold, and clinicals were cancelled. The solution was incorporating Zoom for Higher Education and i-Human. Zoom for Higher Education is a fantastic platform for students and instructors to communicate at a safe distance. In the country’s current state, staying home is highly encouraged to stop the spread of Covid-19. Zoom is convenient for both students and instructors. Students can learn from anywhere and teachers can teach wherever they see fit. With this educational platform instructors can continue to teach their class, as there can be many people in the zoom session at the same time. Students can still interact with one another and have real time learning at home. Instructs are also able to record their classes to students can refer to them. Zoom is also cost effective as it is currently free for users. As with any other form of technology, Zoom for Higher Education is not without its flaws. Zoom meetings must be conducted in a quiet area as sounds can be heard from all participants. Zoom also requires internet, which if the connection is faulty, students may not be able to see or hear their instructor or other participants of the zoom session. Some may also find it hard to adapt to learning through zoom or have difficulty using the application due to lacking in technology experience. A wonderful collaborative to Zoom for Higher Education is i-Human. I-Human is a program created by the company Kaplan. On the website Kaplan (2020) describes i-Human as being a platform that allows students to “…be assigned ‘to’ cases individually, in a lecture, a flipped classroom or in a team-based learning environment. i-Human tracks every click, and every decision the student documents and provides them with instant, expert feedback along the way”. Students can interact with a life-like patients that are symptomatic, can be auscultated, answers questions, and act in response to interventions. Students can perform clinical from home with the use of i-Human for “The Role of the BSN in Promoting Community Health” course. I- Human has more than just virtual simulation, the program also incorporates the use of lessons, exercises, and quizzes. The disadvantages in using i-Human are that the students will not have experience with real human patients and the program is incapable of teaching student’s empathy. Human contact during clinical is very important for students as it encourages growth and expansion of skills. I-Human also requires updated technology an internet source, which may be difficult for students that have little income or resources. Technology Challenges The current state of technology faces several challenges because of the current Covid-19 pandemic. The pandemic has caused school closures or restrictions to the number of students allowed in class. The closures and restrictions limit instructor’s capability of providing education and instruction to their students. This lack of guidance hinders student’s ability to meet course objectives and learning outcomes. Another current technology challenge due to school closures is the inability for students to have access to resources such as libraries, simulation labs, and guidance from their instructor. One final challenge with the current state of technology in “The Role of the BSN Nurse in Promoting Community Health” course is the lack of ancillary resources for clinical sites. With the closure of healthcare sites or restriction of students, there are limited resources for students to practice and perfect their clinical skills. Students without clinical sites have limited opportunities to gain skills required to becoming a nurse. Overcoming Challenges Overcoming the challenges with the current state of technology requires the implementation of Zoom for Higher Education and i-Human. These platforms can tackle the challenges within the current practice. Enacting these educational platforms allows students to attend class from a safe environment, collaborate with their fellow classmates, view lecture material, develop critical thinking skills, perform clinical tasks, and meet course objectives and learning outcomes. Students can view the material in real time and ask their instructor questions with immediate answers with the use of Zoom for Higher Education. With the use of i-Human as a virtual clinical site, students can safely practice necessary skills in a regulated and controlled environment. Students can assess a variety of patients with a multitude of ailments and broaden their patient care experience and have access to resources on the i-Human website. The i-Human platform additionally provides vital feedback instantly and promotes learning and understanding in a safe relaxed environment. Summary of Findings The needs assessment revealed gaps in the current state of technology and areas where improvement may be applicable. Closures and restrictions of schools associated to Covid-19 have required an alternative means for in-seat class and onsite clinicals for both staff and students. The needs assessment uncovered that “The Role of the BSN Nurse in Promoting Community Health” lacks technological developments necessary to provide students with a modern, evidence-based course. Education has begun to transition to a new era because of the pandemic. Classes have integrated remote learning and virtual simulation. The current state of technology is greatly dependent on textbook use and on-site clinicals, which does not allow for a diverse educational program. Technology will continue to advance, which is why nursing education must also advance. The needs assessment demonstrates that the current curriculum should be improved with the i-Human platform and Zoom for Higher Education platform. Zoom for Higher Education aids student learning by allowing learners to partake in real-time online interactions with their instructor and classmates. Many students work while attending school, Zoom allows for time flexibility and ease of access to course content. With the current technology students must attend class at a specific time, with heavy textbooks, and expose themselves to Covid-19 contamination. With the use of Zoom for Higher Education student learners can remain safe, and keep their classmates and instructor protected. The needs assessment found that the current practice is for students to attend clinicals at a hospital or medical facility. Again, with the current pandemic students are finding it difficult to obtain access to a clinical site or be granted access to interact with patients. I-Human provides students with a safe simulated environment to interact and develop necessary skills. Students will be able to perform clinical objective without fear of harming a patient or putting their health at risk from Covid-19. The i-Human platform prepares students for patient assessment and analytical reasoning and allows for a safe and non-judgmental clinical environment. Collaboration with Stakeholders Collaboration amongst stakeholders is vital to secure support for a proposed change. The alliance between stakeholders has shown improved project outcomes and better development toward mutual goals of the proposed technological change. “As evidence-based quality improvement is an iterative strategy requiring alternating action and reflection, it is important for all stakeholders to understand systems and the problems they create, while developing and evaluating solutions to these concerns” (Goodman & Sanders Thompson, 2017). Stakeholder alignment supports a more efficient management of the projected change and provides for a smoother transition of the transformation. The stakeholders convened to review and disclose their findings on the educational technology needs and plan for technological change. The faculty or nurse educators were responsible for researching nursing programs across the state and assessing their adaptations to the current pandemic situation. The faculty then compared the technological changes and how they could be applied or adapted to the school’s current program. The IT personnel were responsible for assessing costs for the implementation of all possible programs, the amount of time needed to train faculty and staff, and support costs. The nursing students were surveyed on their views and comfort level with using technology, such as virtual simulation. Students and staff were questioned about their comfortability with virtual simulation technology in the clinical setting and what experiences they have previously had with the proposed technology. With all this information in place the faculty, IT, and students must bring the technological change proposal to administration. Administration has the final say over the proposed change as they are the main financial source for the change and final authority to approving the change. The closures of schools and lack of clinical sites and resources has schools acknowledging the need for change to the current teaching practice. Students held fears of being unable to graduate on time due to the Covid-19 pandemic. Teachers feared the return of in-seat class because of the deadly Covid-19 virus. It was clear that a solution was needed. Students, faculty, and IT personnel concluded that the use of i-Human as a substitute for on-site clinical would be the most prominent platform for the technological change. This conclusion was drawn from students and staff reporting previous use of virtual simulations for clinical experiences and found it easy to use and valuable to the course. The IT department concluded that though virtual simulation can be costly, i-Human is a very cost effective program that will enable students to continue their education during the pandemic. I-human can give students a “virtual client encounter experience… for as little as $100 per student, per term” (Kaplan Inc., 2020). With change there is often resistance. Faculty are resistant to incorporating the use of i- Human into the clinical setting because it requires training and an adaptation of the course. IT personnel must take the time to create a virtual training video for both students and staff. Without this training students and staff will not be able to use the i-Human platform to its full potential. Administration fear that students will not gain all the skills and proficiencies required to meet the course objectives. Through the stakeholder’s research, the use of i-Human can benefit students by sharpening “their critical thinking, patient assessment, and diagnostic reasoning skills before seeing live patients. There are fewer misdiagnoses, therefore, resulting in less time and stress, better patient care, higher patient satisfaction, and ultimately lower cost” (Benbow, 2015). Students can gain access to tutorials, online help, and approximately 350 case scenarios at any time. This allows for instructors to not be the sole source in assisting with the course material, technical issues, or virtual program support. Students also find the cost of the program is miniscule compared to other costs in the current program. After the administration discovered the prospective benefits to the students and faculty, they agreed to the use of virtual simulation for clinical practice. Force Field Analysis Assessment Table 3. Organizational Readiness for Curriculum Proposal The use of i- Human for virtual simulation in healthcare as a means of gaining clinical skills. Organizational Factors There are a multitude of factors that can promote or impede the integration of virtual simulation into the “Role of the BSN Nurse in Promoting Community Health” course. External factors are actions or “events that take place outside of the organization and are harder to predict and control” (Internal and External Environments of Business, 2016). Internal factors are events that are easier to control than external events because they occur within an organization, such as management changes or employee morale (Internal and External Environments of Business, 2016). Internal organizational factors can facilitate or impede the implementation of a technology proposal, such as the incorporation of i-Human into "The Role of the BSN Nurse in Promoting Community Health" course. An internal factor that can assist in implementing the use of i-Human is student interest. If students show interest in the use of the i-Human platform, the transition of the technology will be much easier. Students will be drawn to technology that they show interest in. An internal factor that may impede the implementation of i-Human as clinical practice is faculty resistance. Faculty may feel that the curriculum is perfect as it stands and should not be changed. Faculty may also have concerns about learning a new technology and the time needed to fully understand the i-Human platform. This leads into a third internal factor that may impede implementation, which is student and faculty training. As previously mentioned, faculty may find the new platform off putting and may find it daunting to have to create a new curriculum because of the change. Students may be unwilling to take the time to learn the new platform or find the new program unbeneficial compared to a real clinical rotation. External organizational factors are much more unpredictable and are difficult to control. An external organizational factor that may impede the implementation of i-Human into “The Role of the BSN Nurse in Promoting Community Health" course is the cost of the program. The program is currently $100 per student per semester, but the $100 does not include the amount of money required to pay IT for their training or assistance in implementing the platform, or the pay to teach instructors and students how to navigate the system. Students never want to pay more money. If the platform must be added to student's tuition, students may push back or look for other schools to attend. Another external organizational factor is school closures and restrictions due to the Covid-19 pandemic. The pandemic is one of those factors that was completely unpredictable and is without control. Though the pandemic is a terrible situation, it has required a need for a technology change and has assisted in the implementation of i-Human. Forces for Integration Numerous forces encourage the integration of i-Human into the “Role of the BSN Nurse in Promoting Community Health” course to embrace an increase for student success and constructive student experiences. Three forces specifically that support the integration of i- Human into the course are convenience and safety, increased comprehension of skill sets, and customizability of the i-Human program. With the use of i-Human as a clinical alternative, students can safely perform skills on faux virtual patients and eliminate the risk of contracting or spreading the Covid-19 virus. Supporting the technological change allows student learners can obtain a greater understanding of skills as well as a better awareness of the outcomes of their actions and the necessity to lessen any errors or avoid them from reoccurring. Students will be able to enact real life situations but not feel as much pressure as if they were on a real clinical site, saving students and patients from errors that may occur. The third force of integration of the use of i-Human is the customizability of the platform to the school’s program or course. I-Human simulations can be tailored to suit beginner, intermediary, and expert learners. Students who may be just starting the program can learn the basic assessment skills, while the more advanced students can practice their critical thinking skills and enhanced assessment skills. Challenges to Integration Not everyone loves technology, there are multiple forces that can impede the implementation of i-Human into the “Role of the BSN Nurse in Promoting Community Health” course. Three forces that hinder the integration of i-Human into the course are resistance to change by staff, training for all factions, and inability of the platform to generate accurate patient situations. Staff may be resistant to the technological change because the virtual simulation platform will require a restructure of the curriculum. This will require more time and energy the instructors must pour into the course. Training for students, staff and IT personnel may be time consuming and expensive. The institution will have to pay IT personnel for the extra time worked when training the staff and the students. Students may be more technologically savvy compared to the instructors and not require as much training, but there may be a learning curve for the older students in the course. Staff may also argue that the virtual simulations in the i- Human program do not always generate real-life situations. The students will not be accustomed to the fast thinking required when a patient begins to decline, or the adrenaline that forms as you perform CPR on a patient. If a student does not perform the accurate skill or administer the correct medication during the program, they are given feedback but do not feel the emotions tied to giving a real person the wrong medication or performing the wrong skill. Students are not exposed to legitimate consequences for errors during the simulation, which may result in students under performing and not fully engaging in the clinical experience. Change Theory Identification of Change Theory A change theory is an unambiguous statement depicting an organization’s approach to creating change. “A strong theory of change requires surfacing hidden assumptions and challenges from people in different roles, levels, and perspectives within the nonprofit, facilitating agreement between them, and negotiating shared commitment among them” (Capacity Institute, 2017). In nursing, Lewin’s change model is often used to implement change. Kurt Lewin, the father of social psychology, created a three-stage change model known as the unfreezing-change-refreeze model that requires prior learning to be rejected and replaced (Nursing Theory, 2020). Healthcare and education are ever changing with the advancement of technology. With the use of Lewin’s change theory and a collaboration between the interprofessional team, the implementation of technology can be successful. Justification of Change Theory Various forces drive change in health care, which is why Kurt Lewin identified three stages through which change agents must continue before an implementation of change becomes part of a system. Lewin’s three stages of change are “unfreezing (when change is needed). Moving (when change is initiated). Refreezing (when equilibrium is established). He also discussed how certain forces can affect change, which he called force-field analysis” (Mitchell, 2013). The use of Lewin’s change model and force-field analysis will decrease the likelihood of challenges during implementation of the new technology platform i-Human. The three stage change theory is warranted in its ability to allow stakeholders to unite and collaborate early in the process of change. In Lewin’s second stage problems and solutions are identified, which allows participating parties in the change process to effortlessly see the advantages of the proposed change. In the final phase or stage the change becomes routine, and results are observed and assessed. Potential Resistance to Technology As previously respected, there are potential barriers and resistance to the implementation of i-Human in the “Role of the BSN Nurse in Promoting Community Health” course. Faculty and staff may be resistant to the technological change because the use of i-Human as a clinical simulation will require a restructure of the course curriculum. This will require more time and energy from the instructors. Training for students, staff and IT personnel will also be expensive and time consuming. The faculty may also resist the change because they may feel students will not be prepared to care for a patient in real life if their only clinical time is virtual simulation. Educators may also contend that the i-Human program does not always create genuine situations. Students may feel comfortable with textbook symptoms and clear assessment findings, where in a real clinical setting the assessment findings may be more difficult to evaluate. Students are not exposed to genuine consequences for errors which may result in students under performing and not fully participating in the clinical experience. Potential barriers to the implementation of i-Human into the “Role of the BSN Nurse in Promoting Community Health” course are significant costs for application of the platform and lack of technology or resources to support the use of i-Human at home. The cost of the platform per student is infinitesimal compared to tuition costs, but add the cost of the technology, training, and updating hardware and students may look for other sources of learning. Students may also feel uneasy when learning that the new i-Human platform has specific requirements that their current computer does not meet. This may mean that students must spend more money on a new computer to enable the use of the simulation platform. Again, causing frustration and concern regarding the cost of the BSN program. Plans to Implement Change Theory Lewin’s change model will be used to implement the use of the i-Human platform as a clinical experience in the “Role of the BSN Nurse in Promoting Community Health” course. The first stage in Lewin’s change model is unfreezing. The unfreezing phase includes the assessment of the program, identification of the need for change, and identification of stakeholders needed to implement the change. Lewin’s change model also includes the completion of a force-field analysis to identify forces that can affect the desired change. The unfreezing phase would identify the need for the i-Human platform as a source for clinical experience, due to the Covid- 19 pandemic causing school closures and restrictions. The next phase of Lewin’s change model is identified as the moving stage. This stage combines the process of taking action, making the change or changes, and involving the stakeholders. In this stage the change agent and stakeholders plan the implementation of i-Human into the “Role of the BSN Nurse in Promoting Community Health” course, educate the faculty and students on the new platform, implementing i-Human into the clinical development, and testing the technology to ensure readiness for use. The third and final stage of Lewin’s change model is refreezing. “The refreezing stage is establishing the change as the new habit, so that it now becomes the ‘standard operating procedure.’ Without this final stage, it can be easy for the patient to go back to old habits” (Nursing Theory, 2020). This stage incorporates continued management of the use of i-Human to support and foster the idea that the proposed platform is beneficial and valuable to the clinical experience. This stage also includes incentives that ensure faculty and students continue with the use of i-Human. Conclusion Rationale and Purpose of Proposal The Covid-19 pandemic has caused schools to shut down, offices to close, and physicians to refuse physical patient interaction. The pandemic has forced facilities to identify disparities in technology and education located in healthcare and learning platforms by performing a needs assessment and gap-analysis. Utilization of virtual simulation has expanded and offers several benefits to students, educators, and healthcare professionals. Specifically, the use of i-Human has been discovered to be a likely solution to the newly discovered gaps in healthcare and education. New challenges and demands for nursing programs, such as limited clinical settings, inability to assess physical patients, and limited or no substantial time for instructors to work with their students allocates the use of i-Human as a clinical alternative. Explanation of Proposal and Needs Gap The need-gap analysis recognized the need for improvements to the “Role of the BSN Nurse in Promoting Community Health” curriculum. Due to the Covid-19 pandemic restrictions students require an alternate means to clinical experience. A literature review revealed virtual simulation to be a prospective solution. The proposed technology demonstrates that “clinical virtual simulation enabled 20.4% improvement in students’ knowledge retention and clinical reasoning” (Padilha et al., 2019). With the use of i-Human, students will be provided with opportunities for development of clinical skills, critical thinking, and the conversion of theory to practice. The i-Human platform fulfills the curriculum gap by providing student learners with virtual simulations that mimic patient scenarios. These scenarios provide students with a clinical alternative and a safe access to patient care practice. Importance and Impact of Proposal Virtual simulation and the use of i-Human relieves the gaps in education created by the Covid-19 pandemic and does so in a creating and fun way. Virtual simulation brings together strategies such as “gaming and problem-based learning, using an interactive and dynamic 3- dimensional technology that encourages active and critical action-based learning” (Padilha et al., 2019). These strategies incorporated into the i-Human platform provide students with the resources and self-confidence to practice safely and competently before attempting the skills gained on real patients. Incorporating the i-Human platform allows students to perform clinical skills in a safe environment, develop critical thinking skills, and meet course objectives and learning outcomes. The demand for competent and qualified nurses is only increasing. This increases the demand for schools to produce prepared and skilled nurses. Enhanced learning from the i-Human platform allows for “a competency-based education and assessment that consequently enables a deep level of learning and the development of clinical expertise. Clinical virtual simulation can contribute toward reducing clinical error and improving the safety and quality of health care” (Padilha et al., 2019). The incorporation of virtual simulation in the clinical environment prepares students for work with patients and the interdisciplinary team. References Benbow, P. (2015, December 8). i-Human Patients Announces i-Human Expansion. Retrieved from Capacity Institute. (2017, May). What Is a Theory of Change and Why Is it Important? Retrieved from Chen, F.-Q., Leng, Y.-F., Ge, J.-F., Wang, D.-W., Li, C., Chen, B., & Sun, Z.-L. (2020). Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis. Journal of Medical Internet Research, 22(9), 182–190. Goodman, M. S., & Sanders Thompson, V. L. (2017). 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