1. Mobile Technology in Higher Education
Claire DeCristofaro, MD
Ashford University, San Diego, CA
Tracy P. George, DNP, APRN-BC, CNE
Francis Marion University, Florence, SC
Thursday, February 22, 2018

2. Objectives Discussion of mobile technology in society.
Discussion of integration of mobile technology in higher education.
Describe examples of mobile technology in teaching innovations.

3. Mobile Technology in Society

4. The “Cell Phone Culture” & The “Personal Communication Society”
Obtaining information
Communication not bound to locality
Entertainment
Interpersonal connectivity
Commerce
Social status
Locating people
Tourism
Discipline specific (healthcare, engineering, etc.)
Education (Goggin, 2006; Campbell & Park, 2008)

5. Interactive Question for Participants: What are the mobile technology apps that are regularly used in your discipline? *Please Type in Chat Box

6. Mobile Technology is Pervasive: Highly Penetrated into Society
The fixed telephone is a bilateral interaction
Mobile technology that includes internet access and web-based applications universal technology can support multilateral relationships – evolution from personal digital assistants (PDAs) to smartphones and tablets that are wireless enabled
Supports the creation of virtual groups, communities & organizations
Strengthens bonds otherwise disrupted by time and distance
Weakening control of formal organizations over its members
Users tolerate the loss of personal autonomy to gain safety, security and direct interaction (Geser, 2006).

7. Examples of Real-world Healthcare Mobile Technology Uses
Delivery of safe, high-quality care to medical patients (Institute of Medicine, 2001); almost 80% of nurse practitioners use smartphones to obtain information about drug therapies (Grabowsky, 2015).
Clinical interventions via smartphone (Fjeldsoe, Marshall, & Miller, 2009)
Charting and documentation, patient portals
Telehealth
Diagnosing illness and provide information in clinical decision making; an example is the LoaScope microscope/smartphone that can determine Loa loa microfilariae parasite blood levels in the field, enabling healthcare providers to determine appropriate antiparasitic drug therapy (Kamgno, et al., 2017).

8. Integration of Mobile Technology in Education

9. mLearning: Mobile Technology in the Classroom
eLearning was transformed by the internet
Now mobile technology gives us mLearning
Smartphone numbers overtook PCs in 2011 (Canalys, 2012).
In 2018 there are anticipated to be 4.93 billion cell phone users, with numbers continuing to rise in 2019 (Statista, 2018)

10. mLearning in the Classroom
There is a need for greater integration of mobile technology into the classroom.
Case studies and group projects that require the use apps will provide students with familiarity with the capabilities of mobile technology (Raman, 2015).
Regular use in the classroom will provide facility with the apps and promote regular use of the apps in the clinical setting.

11. Incorporating Technology in the Classroom: SAMR & TPACK
The SAMR (Substitution, Augmentation, Modification, Redefinition) model has been popularized by Ruben R. Puentedura.
The TPACK (Technology, Pedagogy, and Content Knowledge) model, has been used alone and in combination with SAMR.
However, these two models have mainly been focused on applications in K-12 education (Hamilton, Rosenberg, Akcaoglu, 2016; Koehler & Mishra, 2009).

12. Experiential Learning Novice to Expert
Other similar theory models:
Kolb’s Experiential Learning Theory (Kolb & Kolb, 2005): Kolb initially wrote of experiential learning and learning styles in 1984, with additional refinements in later works; in this view, learning results from interaction of the learner with the world and thus the educator should focus on the best process that enhances learning.
Benner’s Novice to Expert Model (Benner, 1982): a nursing education theory model, based on Dreyfus & Dreyfus that describes stages of proficiency including novice, advanced beginner, competent, proficient, and expert.

13. Technology in the Classroom: Simulation and Active Learning (1 of 2)
Another theory model has been described in the context of using simulation as a teaching and learning tool
More accessible in practical application to implementing technology in the higher education classroom (Humphreys, 2013)
Supports course and program learning objectives:
knowledge integration
analysis of data
use of evidence-based knowledge
acquiring skills
understanding how communication methods impact processes
retrieval, evaluation and synthesis of evidence (George & DeCristofaro, 2016)

14. Technology in the Classroom Simulation and Active Learning (2 of 2)
When creating new curriculum or modifying existing learning activities, three themes have been identified to guide implementation: preparedness, activation & reflection
Preparedness includes faculty and student preparation – this can be accomplished with faculty training and access to the devices and software, and facilitated student practice with the required apps.
Activation deploys the use of mobile technology in active learning
Reflection is included in the design of the learning activity. Such reflection can be required of students and also benefit the involved faculty (George & DeCristofaro, 2016).

15. Implementation Using Three Guiding Themes

16. Technology in the Classroom: Here and Now Learning (1 of 2)
Lave & Wenger (1991) described “here and now” learning in a situated framework
Learning is more than the reception of factual knowledge and requires participation in communities of learning and practice, with a gradual increase in engagement and complexity
With mobile technology, the learning environment includes the real world as well as the digital & virtual world, permitting:
Access any time and anywhere
Assignments out of the classroom
Improved situation (less “abstract” and more context- and culture-based learning)

17. Technology in the Classroom: Here and Now Learning (2 of 2)
With mobile technology, students can analyze and create knowledge from access to real-world resources by utilizing:
Up-to-date research and professional guidelines
Access to individual experts
Mobile technology adds elements such as:
geospatial technology (e.g., GPS, radio-frequency)
mobile/visual search
camera image capture
social networking
virtual reality settings (Martin & Ertzberger, 2013; Chu, Wang, & Tsai, 2010).

18. Ubiquitous Learning & Mobile Technology
Learning anywhere, anytime that is situated and immersive
This definition is closely associated with mobile technologies
Learning activities can take place in:
a traditional classroom
an online classroom
a laboratory
a real-world setting
a virtual environment
The teacher selects appropriate situations to support acquisition of knowledge and skills
Permits scaffolding for novices as well as opportunities for experts to learn individually or collaboratively within the context of authentic activities (Chu, Hwan, & Tsai, 2010).

19. Early Adopters? Laggards? (1 of 3)
Rogers Diffusion of Innovation model can be used to describe the adopters of mobile technology in the educational setting (Doyle, Garrett, & Currie, 2014)
This model describes five groups of people:
Innovators
Early adopters
Early majority
Late majority
Laggards.

20. Early Adopters? Laggards? (2 of 3)
Recognizing Rogers’ groups may provide a roadmap to successful implementation of innovation
Innovators introduce new technology to other faculty
Early adopters become champions after being presented with it
The early majority may require instruction and coaching from the innovators and early adopters in order to become proficient in the technology
Late majority members may have skepticism about the innovation, which must be addressed
Laggards may be the last group to accept changes, so may require more encouragement.

21. Early Adopters? Laggards? (3 of 3)
These groups include:
Faculty
Leadership
Students
Staff
Working with all three groups in an appropriate and time-sensitive manner can support successful implementation of this learning strategy
It is also important to identify mobile technology champions who catalyze change (George & DeCristofaro, 2018).

22. Interactive Question for Participants: Are you an innovator, early adopter, early majority, late majority, or laggard when it comes to using mobile technology in teaching? *Please type in Chat Box

23. Mobile Technology and Course & Program Outcome Alignments
Implementing mobile technology can help meet course and program objectives
Sample Course Objectives:
Knowledge integration from the sciences
Advocating for health promotion and disease prevention using risk assessments
Analysis of data and use of evidence-based knowledge
Sample Program Objectives:
Incorporate information management, client care technologies, and communication devices in providing safe and effective client care.
Be able to retrieve, evaluate, and synthesize evidence
Integrate knowledge and skill in the provision of holistic care to individuals, families, groups, communities, and populations with a focus on health promotion, disease and injury prevention (George & DeCristofaro, 2016).

24. Barriers and Advantages (1 of 3)
Cost of device and software (Raman, 2015).
Many students already own smartphones.
However, devices may be different platforms/OS
Consider choosing apps that are cross-platform
Consider choosing free apps
Lack of technology literacy
Issues with internet connections
Small screen size (Martyn, Larkin, Sander, Yuginovich, & Jamieson-Proctor, 2014).

25. Barriers and Advantages (2 of 3)
Although many advocate for continuing to use print textbooks, these can be heavy and may become obsolete quickly – mobile technology is portable and current
Younger learners typically seek information using web-based technologies (Williams & Dittmer, 2009)
Millennials expect learning activities to mirror lived experiences (Gambo, Bahreman, Watties-Daniels, Neal, & Swoboda, 2017).
Students can highlight & make comments in eBooks (Bristol, 2013).

26. Barriers and Advantages (3 of 3)
Interference with other equipment in the field
studies have shown that use of mobile technology such as smartphones is safe in most hospital and clinical areas (van Lieshout, van der Veer, Hensbroek, Korevaar, Vroom, & Schultz, 2007)
Faculty resistance (Raman, 2015):
Faculty should role-model the use of mobile technology
Faculty training and access to the software is essential.

27. University Library Integration of the Innovation
Wider university integration of teaching innovation via library services to create a library page with smartphone/tablet apps for use in undergraduate/graduate nursing.

28. Examples of Mobile Technology in Teaching Innovations

29. Mobile Point of Care Technology in Healthcare
Earlier research looked at personal digital assistants (PDAs), however smartphones are becoming more prevalent in American society and are also well accepted by older patients (Care Innovations, 2015).
It is important for nursing students to become comfortable with accessing point of care (POC) technology.
Many clinical smartphone applications (apps) are widely used by health professionals and patients as useful tools in evidence-based practice at the point of care, for patient education, disease self-management, and remote monitoring of patients (Mosa, Yoo & Sheets, 2012).

30. Selected Uses of Smartphones in Nursing Education
Students can remotely communicate with a nursing instructor from the clinical setting.
Students may access internet resources, including videos, podcasts, practice guidelines, and pharmacology resources to enhance safe care (Phillippi & Wyatt, 2011).
Smartphone apps and internet access can support application of health promotion knowledge in the field, including recommended patient screenings (Phillippi & Wyatt, 2011).

31. Mobile Technology in Nursing Education: in the Clinical Setting
The use of mobile technology has been studied more in the clinical setting (Raman, 2015); used for drug references, clinical logs, faculty-student communication, and peer support (Doyle, Garrett, & Currie, 2014).
Use of smartphones improved undergraduate nursing student performance in the clinical setting (Wittmann-Price, Kennedy, & Godwin, 2012)

32. Many Compendiums of Clinical Apps
Mobile clinical apps are available as free downloads, web based, and for purchase
Example MD Linx:
Enter keyword to search for apps

33. Examples of Free Online Pharmacology Apps
EMPR: Medscape: Drugs.com:

34. Blending Technology in the Simulation Laboratory
Blending technology with PDA and simulation mannequins in a graduate nursing health assessment lab allowed students to mimic an actual patient encounter
Immersive and engaging
Translates to real-world expectations of skills and proficiencies
In the unfolding case scenarios all program functions of the POC app were used in the standardized patient encounter, increasing comfort levels regarding the transition to clinical site activities
Faculty training with the software enabled successful role-modeling in laboratory sessions with students (Elliott, DeCristofaro, & Carpenter, 2012).

35. Mobile Technology: Nursing Education in the Field
Requiring BSN nursing students to use smartphone applications (apps) in community during service learning field activities:
ePSS app from AHRQ to determine individualized recommended preventive care clinical screening
Body Mass Index (BMI) app
Results:
increased engagement with patients
improved comfort level of students in regard to taking health histories and asking sensitive questions
Helping to apply classroom history-taking skills to a real-life setting (George & DeCristofaro, 2016).

36. First Free App Selected for Project: ePSS
Electronic Preventive Services Selector (ePSS) app uses patient information, such as age, sex, and smoking status, to display recommended screenings based on the United States Preventive Services Task Force (Agency for Healthcare Research & Quality [AHRQ], 2013):

37. Second Free App Selected for Project: BMI
Second App: Body Mass Index (BMI) for adults: For Android: For iPhone:

38. Learning to Use the Apps
Both weekly classroom and laboratory sessions (first semester, traditional BSN program).
Week 1: Students downloaded apps
Weeks 2 & 3:
Practice data entry using mock cases in the laboratory
Students switched roles from student to patient
Instructor support facilitated learning how to obtain patient histories and integrate the apps into this process
Week 4: Students used the apps in community screenings at a variety of settings.

39. Student Feedback
Students thought it was “fun” to use the apps in the lab and community.
“Less bulky” than using a textbook.
Students felt that the apps made the content from the text more “interesting.”
Said they had “better recall” of didactic health promotion subject content.
Students stated that while taking objective assessments (exams) they realized they were recalling what they had learned in the case study activities (George & DeCristofaro, 2016).

40. Case Studies – Active Learning
In active learning learners and faculty construct knowledge, attitudes, and skills collaboratively (Cheng et al., 2015).
Using apps in solving case studies and applying these to actual patients in service learning community screenings reinforced health promotion content including concepts of primary, secondary, and tertiary prevention and enhancing clinical reasoning skills.
Using POC apps in simulated patient encounters involving unfolding case studies and role modeling improves nurse practitioner student’s critical thinking skills and comfort levels with complex patient encounters in multidisciplinary team settings.

41. Smartphone/Tablet Apps in the Online Advanced Pharmacology Classroom
In a fully-online advanced pharmacology class for MSN/DNP nurse practitioner students a clinical database app is used to complete unfolding pharmacology case studies (LexiComplete®)
Basics such as dosing and how to calculate
Higher-order decision-making based on clinical considerations
Real-world aspects such as length of time to take the drug
Real-world considerations such as herbal therapies
How to manipulate the software using a standardized patient encounter
Students then use the app in clinical practicums
Student acceptance is high – most renew their subscription annually after the course is ended and continue to use it in clinical settings (DeCristofaro, 2017)

42. Using Case Studies
Interactive Question for Participants: Are you using case studies in the classroom or laboratory setting, or do you prepare students for real world application of your discipline in other ways? * Please Type Your Answer in the Chat Box

43. Engineering Education (1 of 4)
Twitter can be used in large engineering classroom settings:
Students submit answers to surprise questions during lecture via a smartphone response system using Twitter.
Improves academic achievement and students’ concentration in class (Kim et al., 2015).

44. Engineering Education (2 of 4)
Template-based learning can be used to teach mobile phone programming with Android phones (Akopian, Melkonyan, Golgani, Yuen, & Saygin, 2013).
Content about sensor technologies can be integrated into a hands-on robot project (Deal & Hsiung, 2017).

45. Engineering Education (3 of 4)
Formulas
E-books
Apps for design of circuits
Apps to transform ipad into a graphing calculator
Unit conversions (Shepherd, 2015)

46. Engineering Education (4 of 4)
Computer aided design applications for technical drawing
Smart tools that permit measurement of distances, magnetic field, angles, slopes, sound & vibrations
Reference library
Evernote for note taking (Shepherd, 2015)

47. Mobile Technology Translates Classroom and Lab Learning to the Real World
Smartphone apps are already familiar to most students and are more convenient than textbooks.
Translational learning allows students to apply content from class and lab to community and clinical settings.
Many free reference apps are available.
Engages students in active learning and promotes long-term retention of content.
This innovation supports nursing practice leadership for health promotion, disease prevention, and achieving health equity in the community.

48. Thank You! Any Questions?

49. References (1 of 4)
Agency for Healthcare Research and Quality. (n.d.) ePSS electronic preventive services selector. Retrieved from
Agency for Healthcare Research & Quality. (2014a). Men: Stay healthy at any age. Retrieved from
Agency for Healthcare Research & Quality. (2014b). Women: Stay healthy at any age. Retrieved from
Akopian, D., Melkonyan, A., Golgani, S. C., Yuen, T. T., & Saygin, C. (2013). A Template-Based Short Course Concept on Android Application Development. Journal Of Information Technology Education: Innovations In Practice, Retrieved from
Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), Retrieved from
Bristol, T. J. (2013). Tablets in nursing education. Teaching & Learning In Nursing, 8(4), doi: /j.teln
Campbell, S.W. & Park, Y.J. (2008) Social Implications of Mobile Telephony:
The Rise of Personal Communication Society, Sociology Compass, 2(2), DOI: /j x Retrieved from
Canalys (2012) Smart phones overtake client PCs in Retrieved from
Care Innovations (2015). Older populations have adopted technology for health. Retrieved from
Centers for Disease Control and Prevention. (n.d.). Measuring blood pressure. Retrieved from
Centers for Disease Control and Prevention. (2015a). About adult BMI. Retrieved from
Centers for Disease Control and Prevention. (2015b). Health equity. Retrieved from
Cheng A, Morse KJ, Rudolph J, Arab AA, Runnacles J, & Eppich W. (2016). Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development. Simulation In Healthcare : Journal Of The Society For Simulation In Healthcare, 11(1), doi: /SIH Retrieved from

50. References (2 of 4)
Chu, H-C., Hwang, G-J., & Tsai, C-C. (2010) A knowledge engineering approach to developing mindtools for context-aware ubiquitous learning, Computers and Learning, 54, 289–297. Retrieved from
Deal, W. I., & Hsiung, S. C. (2017). Sensors Expand the Capabilities of Robot Devices. Resources in Technology and Engineering. Technology And Engineering Teacher, 76(7), Retrieved from
DeCristofaro, C. (2017) Unfolding Case Studies with Point-of-Care Technology in an Online Graduate Nursing Advanced Pharmacology Course [poster]. Best Practices for Promoting Engaged Student Learning, 2017 University System of Georgia Teaching and Learning Conference, Athens, GA (April 5, 2017). See:
Online Graduate Nursing Advanced Pharmacology Course [poster]. Best Practices for Promoting Engaged Student Learning, 2017 University System of Georgia Teaching and Learning Conference, Athens, GA (April 5, 2017). See:
Doyle, G.J., Garrett, B., & Currie, L.M. (2015). Integrating mobile devices into nursing curricula: Opportunities for implementation using Rogers' Diffusion of Innovation model. Nurse Education Today, 34, Retrieved from
Elliott, L., DeCristofaro, C., & Carpenter, A. (2012). Blending technology in teaching advanced health assessment in a family nurse practitioner program: Using personal digital assistants in a simulation laboratory. Journal of the American Academy of Nurse Practitioners, 24(9), 536–
Fjedlsoe, B.S., Marshall, A.S., Miller, Y.D. (2009) Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service, American Journal of Preventive Medicine, 36(2), Retrieved from
Gambo, J.M., Bahreman, N.T., Watties-Daniels, D., Neal, M., & Swoboda, S.M. (2017) Can Mobile Technology Enhance Learning and Change
Educational Practice? CIN Plus, 35(8), DOI: /CIN Retrieved from
George, T.P., DeCristofaro, C. (2016) Using Smartphones with Undergraduate Nursing Students. Journal of Nursing Education, 55(7), DOI: doi: / Abstract retrieved from
Geser, H. (2006) Is the Cell Phone undermining the Social Order? Understanding Mobile technology in a Sociological Perspective, Sociology of the Internet. Retrieved from

51. References (3 of 4)
Goggin, G. (2006) Cell Phone Culture: Cell Phone Use in Everyday Life. London and New York: Routledge. Retrieved from
Grabowsky, A. (2015). Smartphone use to answer clinical questions: A descriptive study of APNs. Medical Reference Services Quarterly, 34(2), 135–148.
Hamilton, E. R., Rosenberg, J. M., & Akcaoglu, M. (2016). The Substitution Augmentation Modification Redefinition (SAMR) model: A critical review and suggestions for its use. TechTrends, 60(5), Retrieved from
Humphreys, M. (2013). Developing an educational framework for the teaching of simulation within nursing education. Open Journal of Nursing, 3, doi: /ojn Retrieved from
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from
Institute of Medicine. (2015). Assessing progress on the Institute of Medicine report: The future of nursing . Retrieved from
Kamgno, J., Pion, S.D., Chesnais, C.B., Bakalar, M.H., D’Ambrosio, M.V., Mackenzie, C.D., …, Boussinesq, M. (2017). A test-and-not-treat strategy for onchocerciasis in Loa loa – endemic areas, New England Journal of Medicine, ePub ahead of print. DOI: /NEJMoa Retrieved from doi/full/ /NEJMoa
Kim, Y., Jeong, S., Ji, Y., Lee, S., Kwon, K. H., & Jeon, J. W. (2015). Smartphone Response System Using Twitter to Enable Effective Interaction and Improve Engagement in Large Classrooms. IEEE Transactions On Education, 58(2), Retrieved from
Koehler, M. J., & Mishra, P. (2009). What is technological pedagogical content knowledge? Contemporary Issues in Technology and Teacher Education, 9(1), Retrieved from
Kolb, A.Y. & Kolb, D.A. (2005) Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education, Academy of Management Learning & Education, 4(2), Retrieved from
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. New York: Cambridge University Press.
Levine, D.M., Lipsitz, S.R. & Linder, J.A. (2016) Trends in Seniors’ Use of Digital Health Technology in the United States, JAMA, 316(5), Retrieved from

52. References (4 of 4)
Martin, F. & Hertzberger, J. (2013) Here and now mobile learning: An experimental study on the use of mobile technology, Computers and Education, 68, Retrieved from
Martyn, J., Larkin, K., Sander, T., Yuginovich, T., & Jamieson-Proctor, R. (2014). Distance and devices — Potential barriers to use of wireless handheld devices. Nurse Education Today, 34(3), 457–461.
Mosa, A. S. M., Yoo, I., & Sheets, L. (2012). A Systematic Review of Healthcare Applications for Smartphones. BMC Medical Informatics And Decision Making, 12(1). doi: / Retrieved from
National Heart Lung and Blood Institute. (n.d.). High blood cholesterol: What you need to know. Retrieved from
National Heart Lung and Blood Institute . (n.d.). NHLBI BMI calculator. Retrieved from
Phillippi, J., C., & Wyatt, T., H. (2011). Smartphones in nursing education. CIN: Computers, Informatics, Nursing, 29(8), 449–454.
Raman, J. (2015). Mobile technology in nursing education: Where do we go from here? A review of the literature. Nurse Education Today, 35(5), 663–672.
Shepherd, M. (2015). 25 apps every engineer should download. Retrieved from
Spain, M. P., DeCristofaro, C., & Smith, C. A. (2004). Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team. Journal of the American Academy of Nurse Practitioners, 16(12), 535–46. Retrieved from
Splend Apps. (n.d.). BMI calculator. Retrieved from
Williams, M. G, & Dittmer, A. (2009). Textbooks on tap: Using electronic books housed in handheld devices in nursing clinical courses. Nursing Education Perspectives, 30(4), 220–225. Retrieved from
Wittmann-Price, R., A., Kennedy, L., D., & Godwin, C. (2012). Use of personal phones by senior nursing students to access health care information during clinical education: staff nurses’ and students’ perceptions. Journal of Nursing Education, 51(11), 642–646.