Personalized education key to deploying nurses to ICU

Arizona State University has long been a player in the realm of personalized digital education, with a current count of 175 fully online degree programs and 50,000-plus undergraduate and graduate students enrolled from around the world. And it’s no slouch when it comes to preparing students to work in the health care field, with a recent $50 million gift paving the way for a host of new scholarships and degree programs, including one focused on simulation science.

All of this should come as no surprise considering ASU has been hailed as the most innovative school in America for five years running. So when, in the wake of the rapid spread of COVID-19, international educational technology company Sana Labs was tapped to design a training program to transition nurses at New York City’s Mount Sinai Hospital into critical care at a moment’s notice, they knew just who to partner with.

In record time, experts at EdPlus, ASU’s digital teaching and learning unit, and the Edson College of Nursing and Health Innovation joined forces with Sana Labs to produce just such a program. The teams’ first conversation took place on Friday, March 27. Dubbed Project Florence, the training program was initially rolled out to 35 nurses on Thursday, April 9, and it is now available to thousands.

“I think right now, everyone is feeling like what can I do?” said Wayne Anderson, senior director of EdPlus. “We’re dealing with all different levels of stress, concerns and anxieties, and we want to contribute. This was a good opportunity for us to do a small part in contributing to the fight against the virus.”

Ellis Rubinstein, president emeritus of the New York Academy of Sciences and former editor of Science magazine, praised Project Florence in a press release from the Mount Sinai Health System as one of the first online tools capable of responding to a global event of this magnitude.

Joel Hellermark, Sana labs CEO, said two things made him confident ASU was the best partner in this endeavor: “ASU is known to be the most innovative player in this market, and one which is willing to move fast when needed. And second, the quality of the nursing education that they provide today.”

The 12 days between March 27 and April 9 saw a frenzy of activity among the teams at EdPlus and Edson. Within only a couple hours of learning about the project, Heidi Sanborn, clinical assistant professor and director of the RN-BSN and concurrent enrollment program at Edson, had assembled a team of experts that included Aliria Rascon, clinical assistant professor and assistant director of the Edson Global Health Collaboratory, and Debbie Hagler, Edson clinical professor.

In addition to their roles as nurse educators, all three are practicing nurses with decades of hands-on experience in the critical care setting, an invaluable asset when it came to assembling and then paring down the content needed for Project Florence.

Sanborn explained that the typical clinical workflow at a hospital in the event of something like a viral pandemic is to empty the hospital of all nonessential patients and procedures in order to free up every resource to deal with the crisis at hand and bolster their intensive care units.

“With COVID-19, all the hospitals started preparing that way, but at Mount Sinai, they were already living the reality where all of a sudden their ICU was exploding,” Sanborn said.

They had to act fast. Normally, it takes even experienced nurses eight to 10 weeks, sometimes longer, to train to transition to the ICU. Mount Sinai needed their nurses to transition in a matter of days.

Sanborn and her team worked round the clock the weekend of March 28 and 29, combing through the content provided by Sana Labs and Mount Sinai to tailor it for this specific need, then passed the baton to the team at Edson, which worked with Sana Labs to package it into a user-friendly format.

“It was roughly 10 days from when we first connected to when we piloted a nice, clean, well-designed module,” Sanborn said. “I think we’re all quite astonished at what we did. But we knew this was our way to help. It was a labor of love and loyalty to our fellow nurses.”

Nurses can access the Project Florence training program on any digital device — be it smartphone, tablet or computer — and choose from a menu of topics. Each topic begins with a pretest to determine how much they know about that particular area, which in turn determines the type of content they receive. After they review the content, they take another test to assess comprehension.

Nurse managers also have access to the program, and can use test scores to decide which nurses take which patients based on their levels of mastery.

“The goal was to help nurses understand what knowledge they didn’t possess, so they are aware of it, and also learn what they need to learn as quickly as possible so that they can be deployed as quickly as possible,” said Philippos Savvides, assistant director of learning technologies at EdPlus.

“We were trying to create something as lean as possible so they’re not wasting their time,” Anderson added. “The way the personalized education model works is when you know what the goal is, you can assess what someone already knows and then determine what content you need to (enable) that person (to) understand that. So if a nurse already understands mechanical ventilators, they won’t be presented with that content.

“There are a lot of universities trying to respond to the same need of getting skilled workers in place to help with certain demands. I think the differentiator (between ASU and them) is that personalized piece.”

For Project Florence, Sanborn and her team focused on such topics as lung processes, recognizing how pneumonia presents and progresses, then determining treatments.

Much of the content focused on how to use a ventilator, a complicated machine that nurses who don’t normally work in ICU will never have used. They also included content on pulmonary embolism, a blood clot in the lung that can occur as a complication of using a ventilator, procedures that may be done in the event of a collapsed lung, and capnography, the monitoring of levels of carbon dioxide in a patient’s breath.

The feedback from Mount Sinai has been overwhelmingly positive.

“I’m very excited to bring this innovative approach to Mount Sinai hospitals to help advance the skill set of our nurses,” said Diane Adams, chief learning officer of Mount Sinai Health System, in a press release. “Not only are we advancing the essential skills of our staff, but we are also meeting the needs of our community during a particularly critical time across New York City, the United States, and the rest of the world.”

With the Project Florence training program complete, Sana Labs is looking to deploy it in other areas of need around the world, and over a dozen hospital systems have already signed up.

“This is an issue hospitals everywhere are trying to deal with,” Sanborn said. “And I think there would be interest in a broader market if this pandemic continues to develop. In the future, this holds a lot of value in general because I think hospitals are understanding now that with pandemics, based on whatever the virus is and whatever the issues are for the patient, this could be pivoted for any sort of emergency situation.”

What was most clear in speaking with the players involved in Project Florence was how much they appreciated each other’s expertise and willingness to get the job done.

“In some ways, I think we’ve been preparing for this for quite a long time,” Savvides said. “Because our nurses at Edson were so quick to respond, they were extremely knowledgeable and their feedback was extremely valuable. It was amazing to see them work in this capacity, with such a short turnaround in such a high intensity environment. And then there’s the fact that ASU is willing to work with private industry and startups and things like that to help reach goals that potentially save lives.”

“There’s no playbook for how to do this,“ Sanborn said. “And I think it’s just a really good lesson about what can be accomplished in an emergency when multiple teams come together with a common goal.”

Top photo courtesy of Pixabay