Running head: INTERGRATING TECHNOLOGY INTO MALIGNANT HYPERTHERMIA

TRAINING

Integrating Technology into Malignant Hyperthermia Training

Application of the SAMR Model

Melissa Purchacki

SUNY Delhi

NURS 602 CRN 11217, Curriculum Development and Instructional Design

Katherine Quartuccio

Month Day, Year

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Abstract

Recently the educators of the post anesthesia care unit in a hospital in New York decided to

change the way they educated nurses on malignant hyperthermia (MH). Using the SAMR model

as a framework, they introduced new technology to change the way nurses completed their

annual MH competency. First, they substituted a pen and paper exam and transitioned the

content to the hospitals learning management system. They augmented the content by adding

more information to the module such as links to websites. Educators modified the program when

they introduced a virtual MH code cart for the nurses to use and finally redefined the current

education by introducing mock MH codes in a simulation environment. While there are many

advantages to the use of technology it is important to note some of the disadvantages such as

learning how to use the simulation lab and educating nurses to new technology. While all steps

of the SAMR model were used, the educators found the redefinition classification to be the most

beneficial for helping nurses learn more about caring for the MH patient.
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Malignant Hyperthermia Mock Codes

Malignant hyperthermia (MH) disorder where the body enters a hypermetabolic state

after exposure to volatile anesthetic gases or succinylcholine (Rosendberg, Pollock, Schiemann,

Bulger, & Stowell, 2015). The incidence of MH reactions is 1:10,000 to 1:250,000 anesthetics

administered. Before the 1970s, the mortality rate of MH was 70% but with the introduction of

dantrolene, a drug that counteracts the reaction, the mortality rate has dropped to 8 percent

(Shick & Windle, 2014).

The Malignant Hyperthermia Association of the United States suggests hospitals that use

volatile inhalation agents and succinylcholine have MH carts readily available in areas such as

the operating room, post anesthesia care unit (PACU), and intensive care units who recover

patients from the operating room (Malignant Hyperthermia Association of the United States,

2018). The carts are stocked with the supplies necessary to combat this potentially deadly

condition.

The PACU in a busy privately-run hospital in New York requires nurses in the PACU to

complete a yearly competency on MH. The competency consists of a printed article on MH and

a post-test. The article focuses on signs and symptoms of MH and treatments. Unfortunately, the

nurses are not given to opportunity to run a mock MH code or have access to the MH cart. Many

nurses expressed concerns about no knowing what to do in the event of the MH code.

The hospital recently acquired a simulation lab to help with yearly competencies as well

as new nurse orientation. One of the competencies is running mock codes. To address the

nurses concerns and increase awareness of what to do during an MH code. Before attending the

simulation lab students will have access to and MH tutorial on the hospitals existing learning
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management system. This tutorial will include relevant articles about MH, and interactive MH

cart, as well as link to important websites.

Utilizing the SAMR Model to Change Current Teaching

According to Romrell, Kidder, and Wood (2014), the SAMR model is a framework that

can be utilized to introduce technology to enhance learning. This model consists of four

classifications: substitution, augmentation, modification, and redefinition. Substitution and

augmentation are used to enhance learning while modification and redefinition are used to

transform learning (Romrell et al., 2014).

Substitution is the easiest way to implement technology into a course. For example, this

year the yearly MH competency was transitioned onto the hospitals learning management

system. Instead of using a pen a paper to take the test, students completed the task online. The

task remains the same, and there is no functional change (Romrell et al., 2014).

Augmentation is the next level of the SAMR model where functional change occurs

(Romrell et al., 2014). Educators created and MH module that includes more information than

the original competency. Within the module students will complete the yearly competency, have

links to the Malignant Hyperthermia Association of the United States website, as well as

hospital-based MH protocols.

Modification occurs when technology is used to redesign a task (Romrell, et al., 2014).

The education department found a program that allowed them to create a virtual MH cart, this

can be found on MH module. Nurses on the unit expressed concerns that in the event of an MH

code they wouldn’t know where everything was in the cart. This program allows them to go

through each draw and see where the drugs and supplies are without having to open the locked

MH carts on the unit. The education department also created a Popplet that lists where the
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supplies are as well as links to the Malignant Hyperthermia Association of the United States

website.

The final classification in the SAMR model is redefinition where technology can be used

to create new tasks (Romrell, et al., 2014). An example of redefinition is the creation of a mock

MH drill in the simulation lab. Nurses were now able to participate in hands on learning that

would not be possible without the use of this technology (Romerll, et al., 2014).

Advantages and Disadvantages of Technology

There are many advantages to using technology in nursing education. For example, with

the use of the simulation lab, nurses were able to get hands on experience with treating a patient

who has malignant hyperthermia. This drill will allow nurses to become more comfortable with

caring for this patient population. Transitioning to an online module for MH allowed educators

to present more information to nurses as well as provided them with easy links to important

websites to help increase their knowledge of MH. Another advantage for educators is they can

easily track who completed their yearly competencies and reach out to nurses who need to

complete them.

There are some disadvantages to using technology for both nurse educators and students.

On major disadvantage that is discussed in a variety of scholarly articles is lack of formal

training in the simulation lab. Many educators feel like they are not adequately trained to use the

mannequins and run the simulations (Janse van Vuuren, Seeko, & Goon, 2018). Another

disadvantage to using simulation in teaching is lack of time and inadequate staffing.

The disadvantages of using simulation for students is also lack of training. Many nurses

who have been practicing for a while are not familiar with using the mannequins and may find it

challenging (Janse van Vuuren, Seeko, & Goon, 2018). Some students may also struggle with
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using the online modules as they are used to completing their competencies on paper. As long as

the students have proper training on how to navigate the simulation lab and online modules, they

should be able to learn using these new technologies and hopefully improve their confidence in

caring for a patient with malignant hyperthermia.

Self-Evaluation of Redefinition Classification

As I worked on this transition I noted that all the classifications in the SAMR model help

enhance student learning by introducing technology into teaching plans. I think redefinition is

the element I would most likely adhere to because it allows educators to both enhance and

transform learning. Redesigning the way we teach nurses about MH in the hospital setting

should help increase their confidence in caring for the MH patient.

One of the benefits of using simulation in nursing education is it allows nurses to practice

in a safe environment (Al-Ghareeb & Cooper, 2016). Because the incidence of MH is so rare,

nurses might never encounter this type of emergency in their practice but, they need to know

what to do if it happens. While reading and article about MH is beneficial, getting hands on

experience caring for a patient with this condition is critical. Utilizing a simulation lab to run an

MH drill is a great way for nurses to become proficient in providing care to this patient

population. Focusing on redefinition allows educators to create new tasks that transform how

students learn (Romrell, et al., 2014).

Integrating the New MH Education into Practice

It is always challenging to introduce new methods of teaching as many people are

resistant to change. The staff will be given a quick read and sign explaining the transition to the

online module as well as the requirement to participate in the yearly simulation lab. As of now,

nurses are required to participate in a yearly mandatory education day where they run a mock
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code, perform blood sugars, and other competencies. The MH simulation will be built into this

day, so the nurses do not have to complete another day in the simulation lab.

If nurses vocalize concerns about this transition, I will explain the advantages of

participating in this new learning. For example, a study was conducted where anesthesia

residents used simulation labs to run a mock MH drill. At the completion of the simulation, the

students filled out a survey about the experience and the responses were positive. The students

said that the drill made them feel more confident about taking care of an MH patient in the

operating room and the simulation allowed them to improve their skills (Jenkins et al., 2017).

The hospital has been using a learning management system for a few years but not every

competency is online. The nurses should be familiar with using this program and if they have

difficulty with the content the nursing education department will help guide them. Finally, with

positive reinforcement and encouragement the education department can help get the use of this

new technology underway.

Conclusion

Using the SAMR model is an effective way to utilize technology to transform learning. It

can be as simple as introducing a new way to complete the same task or as advanced as using

new technology to complete new tasks. Introducing a simulation lab to complete mock MH

drills gives nurses the ability to use hands on experience to learn how to treat a patient with

malignant hyperthermia. Hopefully, this will increase their confidence in taking care of this

patient population and improve the outcomes of these patients.

These are the link to the Popplet and Glogster I designed for the students and educators. The

Popplet is available as an online module and the Glogster is for instructors in the simulation lab.

http://popplet.com/app/#/4932531

https://edu.glogster.com/glog/summertime/38lama0dg16
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References

Al-Ghareeb, A. Z., & Cooper, S. J. (2016). Barriers and enablers to the use of high-fidelity

patient simulation manikins in nurse education: an integrative review. Nurse Education

Today, 36, 281-286. doi:10.1016/j.nedt.2015.08.005

Janse van Vuuren V, Goon DT, Seekoe E. The perceptions of nurse educators regarding the use

of high-fidelity simulation in nursing education. Africa Journal of Nursing & Midwifery.

2018;20(1):1-20. doi:10.25159/2520-5293/1685.

Jenkins, K. D., Stroud, J. M., Bhandary, S. P., Lynem, L., Choi, M., Quick, J., ... & Papadimos,

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Malignant Hyperthermia Association of the United States (2018). What should be on a MH cart.

Retrieved from https://www.mhaus.org/healthcare-professionals/be-prepared/what-

should-be-on-an-mh-cart/

Romrell, D., Kidder, L., & Wood, E. (2014). The SAMR model as a framework for evaluating

mLearning. Online Learning Journal, 18(2). Retrieved October 6, 2018 from

https://www.learntechlib.org/p/183753/.

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