An Online Learning Approach to Teach and Successfully Deliver Asthma Guideline-Based Care

In 2015, Stony Brook Children’s Hospital embarked on a quality-improvement project to update the institution’s asthma protocol, which had been in place since 2007. The former protocol had been based mostly on scores and pathways. For the revision, initiative leader Lisa Romard, RN, MS, CPNP, ANP, AE-C, of Stony Brook Medicine, planned to focus on asthma education for patients and families.

“That requires making sure staff was competent to provide that education,” Ms. Romard said. First, the project team would have to design and implement an asthma education component for healthcare and allied health professionals, particularly nursing staff.

“Nurses can empower themselves with knowledge,” Ms. Romard said, but they usually don’t have time or funding to attend educational conferences. The institution clearly needed an educational format that nurses could complete incrementally on their own time. Ms. Romard preferred to avoid the common solution of PowerPoint slides loaded with educational content and instead sought a format that would better engage the learners, keep them motivated, and help improve their health teaching and promotion for the benefit of patients.

At the 2018 AAAAI Annual Meeting, Ms. Romard and colleagues shared how they implemented an interactive, engaging, and fun online learning tool to teach practitioners about guideline-based asthma care.

Theoretical Framework and Models for Development

“When we teach something, especially those of us in healthcare, we want to teach for enduring understanding,” Linda Cimino, EdD, RN, MS, CPNP, ANP, CCRC, CHSE, also of Stony Brook. “We don’t just look at what we want to teach, we look at what the learner needs to understand,” such as the big ideas, the must-know and -do items, and core tasks.

She described the frameworks and models the team applied, including:

  • The journalistic framework: who, what, when, where, why, and how
  • Curriculum Development for Medical Education: A Six-Step Approach, as developed by David E. Kern, MD, MPH
  • Understanding by Design® framework
  • A goal to gather enlightening evaluations rather than standard evaluations that do not provide rich, usable data for improvement
  • Adult-learning concepts, which posits that adult learners are different because they are self-directed, draw on experience, and need to know why
  • Engagement Theory
  • Problem-Based Learning
  • Learning styles (e.g., visual, auditory, kinesthetic/active)
  • Bloom’s Taxonomy
  • Meta-cognition

With those frameworks in mind, the team aimed to follow an outline; present information in various formats; keep information to basic literacy levels so that nurses could use the information directly with patients; use expert review and validation; and provide learners with deliberate and repetitive practice.

The 3D Trigger House

The crown jewel of the new protocol is a 3D Trigger House, which was demonstrated by Anne Little, MPH, AE-C, of the Asthma Coalition of Long Island in New York, and Claudia Guglielma, MPA, AE-C, of the Asthma Coalition of Queens in New York.

The interactive online tool displays four household rooms (i.e., kitchen, living room, bedroom, and bathroom) containing various objects that learners can click to learn about asthma triggers and how to mitigate or eliminate them. For example, in the bedroom, when a user clicks on a cat, they hear a sound effect and see a text box that explains how cat hair and dander can affect asthma symptoms. Another click prompts another popup box that offers tips on reducing cat hair and dander. When the user clicks on the bedroom’s open window, they learn about pollen and how to minimize its effects. In the bathroom, learners can click on mold in a bathtub, bleach, and more. The kitchen displays allergens like pests such as rats and roaches, candles, and smoke from frying food. In the living room, a man is smoking, and a nearby gym bag represents exercise as a possible trigger.

In each room, a counter lets visitors know how many triggers are left so that users don’t miss any, and users cannot move to another room until they review them all. The content was based on guidelines and reviewed by experts.

The nurse team is particularly proud of how the Trigger Room achieves many of the goals outlined in the National Action Plan to Improve Health Literacy, and they hope to implement it beyond their institution in the near future.

Presentation 1552: AH: An Innovative Online Learning Approach to Teaching Healthcare and Allied Health Professionals to Successfully Deliver Asthma Guidelines-Based Messages