Computer Assisted Instruction (CAI) is a legitimate method of instruction, equal to other traditional types of teaching in terms of learning and time involvement (Jelovsek & Adebonojo, 1993). Kohl & Su (1995) reported two studies that showed small but significant achievement gains in the average examination scores of CAI classes as compared to traditional classes. In six studies, retention of the information showed no significant difference between CAI and conventional methods of instruction. The time required to learn from CAI compared to conventional methods also was not significantly different.

The past decade has seen a growth in the number and quality of available instructional software packages for nursing education, which have many advantages: flexible, self-paced, easily monitored and updated, and provide feedback on progress. CAI is useful in teaching decision making; developed on a case simulation approach, it can assist the student in the steps of the nursing process. The findings of a study conducted at the University of Texas Health Science Center in San Antonio showed that CAI was at least equivalent to the traditional nursing process strategy in terms of critical thinking outcomes and was demonstrated to have some advantages over traditional nursing process in terms of student satisfaction and time efficiency, which could make it a superior strategy. Another study found that students using computer based instruction had higher examination averages and they had more positive attitudes toward their instructional method than conventionally taught students (Saucier, Stevens, & Williams, 2000).

Some faculty members may find it hard to locate good case materials and others are not sure how to go about teaching a case study. A potential fear is that the discussion will degenerate into a "pointless exchange of personal opinions." Dowd and Davidhizar (1999) suggest that this can be prevented by careful case preparation:

• Review the problem-solving objectives for the class session.
• Prepare the materials the students will read.
• Consider critical issues and topics yet to be covered.
• Make notes after each class session, and use them to review.
• Hypothesize how the case will develop.
• Consider each student's background and experiences.
• Considering your personal attitude toward the case study issue to prevent biases from emerging.
• Developing opening comments and closing summaries for each case.

Dowd and Davidhizar (1999) warn that instructors must be willing to relinquish control over the learning process when they implement student-centered strategies like the case study approach. Both successes and failures will occur; both should be used as feedback in developing subsequent learning experiences. The danger when student-centered approaches fail is that instructors quickly return to more familiar teacher-centered approaches such as lecturing. Dowd and Davidhizar see this as "a retreat to surface rather than deep learning."

Students in both traditional classroom settings and online courses frequently request access to CAI programs from home. Recently, CAI software vendors have added web-based delivery options, which facilitate use in online courses. Other vendors have student pricing for individual programs available through college bookstores. Here are some examples:

• EDGT Tutorials
• Graphic Ed Course Demos
• College of DuPage Demos
• New York Emergency Room RN

Maybe you want to develop your own computer assisted instruction from one of your favorite case studies. Here are some simple steps from Danette Wood, RN, MSN, EdD, CCRN, to help you design the CAI:

1. Write goals and objectives.
2. Frame the story and develop the patient scenario storyboard or script.
• A storyboard provides sketches of frames or scenes, with accompanying information regarding dialog, setting, and or transitions. The strength of the storyboard lies in its ability to give a visual representation or overview of what the scene should look like (usually through cartoon or stick figure diagrams). To see an example of a storyboards click here. To print out a blank storyboard click here.
• The script is a paper version or outline of your video. It contains dialog characters, plot, and can be broken down into parts called, scenes or acts. To see an example of a script click here. To print out a blank script click here.
• Answer: Who, What, When, Where, How and Why?
3. Develop critical thinking questions, include:
• Correct answer with rationale.
• Incorrect answers with rationale.
4. Include copyright statement
   • The United States copyright law protects this product. Copyright law (17 USC section 117) protects computer software and duplication or distribution of copyrighted software violates the law.
5. Include disclaimer:
   • Nursing is a constantly changing field. New research has increased nursing knowledge and changes in nursing practice occur daily. Although attempts have been made to consistently update and provide the newest and most current information, readers must be advised that errors may occur. The information contained in this scenario is a synopsis of ideas from the literature. The recommendations included in the scenario about the care of patients are opinions formed from this information. The author assumes no responsibility or liability. Before acting on any of these suggestions, the reader should obtain and review detailed current information about these different treatments and medications.
6. Remember the following tips:
   • Content (function) is more important than style (fashion).
   • Beware of bells and whistles:
     • Design for the lowest common denominator - students often do not have the latest technology and may be connecting to the Internet with dial up connections rather than DSL or cable.
     • Large images and audio files may take a long time to load and may frustrate the end user.

(For more information contact Education Support Services, Danette Wood, PO Box 1517, Statesboro, Georgia 30459 or dmwood@pineland.net)

After completing this module, you will have the basic tools you need to create all of the different components: scenario, interactive questions, post test, etc.

References:

• Dowd, S.B., & Davidhizar, R. (1999). Using Case Studies to Teach Clinical Problem-Solving. Nurse Educator, 24(5), pp 42-46.
• Jelovsek,F. R., & Abebonojo, L. (1993). Learning principles as applied to computer-assisted instruction. MD Computing, 10, 165-172.
• Kohl, J.E. & Su, M.C. (1995). Computer Assisted Instruction: Implications for Achievement and Critical Thinking. University of Maryland. [Available Online: http://www.nursing.umaryland.edu/students/~jkohl/cai.htm]
• Saucier, B.L.; Stevens, K.R.; Williams, G.B. (2000). Critical Thinking Outcomes of Computer-Assisted Instruction versus Written Nursing Process. Nursing and Health Care Perspectives, 21(5), pp 240-246.
• Wood, N. (Undated). Develop Course Specific Interactive Software: Techniques for Development of Computer Assisted Instruction. Presentation handout.