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Class is about to start: Please turn on your cell phones: 10 uses for cell phones in nursing education Marilyn Smith-Stoner RN-BC, PhD, CHPN California State University, San Bernardino, Beaumont, CA 92223-1543, USA Abstract Cell phones are among the most common forms of technology in today's college classroom. Although their presence can present problems, banning them is unfeasible. A more effective approach is to take advantage of their potential to enhance the learning experience. This article presents 10 ways in which nurse educators can use cell phones in undergraduate courses. © 2012 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. KEYWORDS: Active learning; Cell phones; Nursing education; Technology Cell phones may be the most ubiquitous technological gadget in today's classroom. After years of trying to limit their use in my nursing classes, I have embraced them as one of the more important learning tools available to me as an educator. The relatively low cost, the near-universal ownership of cell phones by students, and the variety of features make it advisable that nursing educators integrate them into the curriculum (Cell phones do distract in class, 2007). The controversy over cell phones resembles the debate about the appropriateness of calculators in the classroom in the 1970s. Initially, educators were wary of calculators. Following the invention of four-function handheld calcula- tors in the early 1970s, questions arose about their appropriateness in the classroom, and they remained controversial into the 1990s (Klutch, 1991). Now, they are commonplace, and many instructors permit or require them in their course syllabi. Today, many college instructors confront the problem of what to do about cell phones in the classroom. An extensive 2009 study by the EDUCAUSE Center for Applied Research (Smith, Salaway, & Caruso, 2009) reports that a third of students use their cell phones while in class. In my experience, that figure is too low. Almost every student in my classes has a cell phone, and many use the phone while in class for texting and accessing the Internet. That situation in itself can cause problems. Cell phones can contribute to incivility (Clark & Springer, 2007; Nordstrom, Bartels & Bucy, 2009), encourage cheating (Nordstrom et al., 2009), and distract the student and others. However, cell phones are too important to students to make banning them from the classroom feasible. They have become an indispensable part of day-to-day life in the workforce(Cross & Steadman, 1996) and an equally important part of students' daily lives. The solution is to use these ubiquitous devices as learning tools. Even the most basic cell phone provides rich resources to augment all types of instruction. 1. Transitioning to cell phones Before I incorporated cell phones into the curriculum, the problem of managing cell phones in my classes always seemed complicated. Because many students were single parents, caregivers of aging parents (as am I), or employed in www.jtln.org * Corresponding author. E-mail address: [email protected] 1557-3087/$ see front matter © 2012 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2011.09.005 Teaching and Learning in Nursing (2012) 7, 4246

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Page 1: Class is about to start: Please turn on your cell phones:: 10 uses for cell phones in nursing education

Teaching and Learning in Nursing (2012) 7, 42–46

www.jtln.org

Class is about to start: Please turn on your cell phones:

10 uses for cell phones in nursing education

Marilyn Smith-Stoner RN-BC, PhD, CHPN⁎

California State University, San Bernardino, Beaumont, CA 92223-1543, USA

* Corresponding author.E-mail address: [email protected]

1557-3087/$ – see front matter © 2012doi:10.1016/j.teln.2011.09.005

Abstract Cell phones are among the most common forms of technology in today's college classroom.Although their presence can present problems, banning them is unfeasible. A more effective approach isto take advantage of their potential to enhance the learning experience. This article presents 10 ways inwhich nurse educators can use cell phones in undergraduate courses.© 2012 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.

KEYWORDS:Active learning;Cell phones;Nursing education;Technology

Cell phones may be the most ubiquitous technologicalgadget in today's classroom. After years of trying to limittheir use in my nursing classes, I have embraced them asone of the more important learning tools available to meas an educator. The relatively low cost, the near-universalownership of cell phones by students, and the variety offeatures make it advisable that nursing educators integratethem into the curriculum (Cell phones do distract inclass, 2007).

The controversy over cell phones resembles the debateabout the appropriateness of calculators in the classroom inthe 1970s. Initially, educators were wary of calculators.Following the invention of four-function handheld calcula-tors in the early 1970s, questions arose about theirappropriateness in the classroom, and they remainedcontroversial into the 1990s (Klutch, 1991). Now, they arecommonplace, and many instructors permit or require themin their course syllabi.

Today, many college instructors confront the problem ofwhat to do about cell phones in the classroom. An extensive2009 study by the EDUCAUSE Center for Applied

National Organization for Associate Deg

Research (Smith, Salaway, & Caruso, 2009) reports that athird of students use their cell phones while in class. In myexperience, that figure is too low. Almost every studentin my classes has a cell phone, and many use the phonewhile in class for texting and accessing the Internet. Thatsituation in itself can cause problems. Cell phones cancontribute to incivility (Clark & Springer, 2007; Nordstrom,Bartels & Bucy, 2009), encourage cheating (Nordstrom etal., 2009), and distract the student and others. However, cellphones are too important to students to make banning themfrom the classroom feasible. They have become “anindispensable part of day-to-day life in the workforce”(Cross & Steadman, 1996) and an equally important part ofstudents' daily lives. The solution is to use these ubiquitousdevices as learning tools. Even the most basic cell phoneprovides rich resources to augment all types of instruction.

1. Transitioning to cell phones

Before I incorporated cell phones into the curriculum, theproblem of managing cell phones in my classes alwaysseemed complicated. Because many students were singleparents, caregivers of aging parents (as am I), or employed in

ree Nursing. Published by Elsevier Inc. All rights reserved.

Page 2: Class is about to start: Please turn on your cell phones:: 10 uses for cell phones in nursing education

Table 1 Ten uses for cell phones in the classroom

Purpose Notes

Deal with emergencies Students create three phone entries for contacts in case of emergency “ICE” in case of emergencyphone numbers, for example, “ICEDON” for a family member who is the first to be call in an emergency.

Use as a subject to set standards anddiscuss misconduct

Students identify cell phone-related behaviors that support or detract from group motivation.

Replace audience response systemsor clickers

Students can use http://www.polleverywhere.com to respond to poll questions.

Aggregate data collection Collect data: questions from students, answers to questions using aggregate sources such ashttp://wiffiti.com.

Aid time management Students use calendars and other applications to record due dates of assignments, set wake upalarm clocks, and time themselves performing nursing skills as a self-assessment.

Photograph course materials Students can photograph notes written on a board, setups for equipment, for example, isolationprocedures, refer to photos for studying.

Use calculators Students can use calculators for quizzes regarding medication calculations, BMI, etc.In class interviews of people Students can call people and ask questions regarding conditions being discussed in class.Text information to students Instructor can bulk e-mail information to students.Use voice-to-text services Instructors can use http://jott.com or Google Voice to convert voice messages to text or record

lectures and produce transcript.Ask questions via Google text service Students can query information using this free service.

43Cell phones

jobs that required them to be on call outside regular workinghours, turning off phones did not seem to be a reasonablesolution. Instead, I required that all cell phones be turned to“vibrate” and accepted the idea that some phones would bevibrating across the students' desks when their calls came induring class.

Still, that was not an ideal solution. Realizing that cellphones are in my classroom to stay and that most studentsseem happy when they are talking or texting on their cellphones, I decided to take advantage of that engagement inmy classes. As a first step, I accepted the students' need forimmediate access to a cell phone in case of an emergencyoutside or inside the class. This first step helped me toexplore other ways that I could incorporate cell phones intomy lesson plans. I came up with the ideas in Table 1, whichlists 10 common ways I use cell phones in my classes. In atypical quarter-long course, I use cell phone activities in atleast 50% of the class sessions.

2. Instructional planning with cell phones

Incorporating cell phones into a class requires some timeand planning. Redesigning learning activities to incorporate

Table 2 Lesson plan integrating cell phones with end-of-life content

Time Activity

Before class Listen to music related to death or dying while read0–15 minutes Students list the songs they listened to that relate to16–30 minutes Pairs of students think–pair–share on experiences w31–56 minutes Students number a piece of paper 1–10, then list 2 o

the most. When signaled, cross out arbitrary numberminutes, students then share reactions to life withoutheir activity sheet and share their loving feelings du

57–76 minutes Break77–90 minutes Instructor reviews course content related to learning

this technology provides an excellent opportunity tocollaborate with colleagues in completing a classroom actionresearch project (Cross & Steadman, 1996). Becauseimplementing cell phones into a class results in morenoise, movement, and energy than in traditional classrooms,instructors need to overcome three primary challenges: (a)managing transitions between cell phone-related activitiesand class discussion; (b) managing time and designing well-constructed activities; and (c) keeping the phone conversa-tions professional and on topic.

Table 2 illustrates a successful lesson plan integrating acell phone activity with end-of-life content for a sophomoremedical–surgical course (n = 33–44 students). The learningobjective is to recognize one's own attitudes, feelings,values, and expectations about death (American Associationof Colleges of Nursing, 1998). During the second half hourof class, students call or text loved ones in the middle of theday to say, “I love you.” The activity has been successful inseveral parts of the world, including China, South America,and West Africa. In my experience, this activity always hasthe same positive effect and is delightful to watch studentssmiling and enthusiastically engaged in this class assign-ment. Once students have engaged in an experience to thinkabout their own death and talked to a loved one about their

ing textbook assignment on end of lifedeath on the writing board in classith death of patients and, if none, in personal lifef each: people, possessions, dreams, hobbies, and roles that they cherishof items. After the items have been eliminated, quietly reflect for three

t crossed-out items. Students instructed to call the 2 people they listed onring the break

objectives, question, and answers

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44 M. Smith-Stoner

relationship, the students are engaged to consider moredifficult aspects of caring for patients who are dying.

3. Limitations of cell phones

The chief limitation to using cell phones in the classroomis that not every student has one. Because the few studentswithout cell phones cannot participate in the cell phoneactivities, the assignments are formative and ungraded. Forstudents who do not have cell phones, although a decreasingnumber, they are paired with other students.

Cell phones can pose a significant threat to personalprivacy. For this reason, some health care facilities banphones with cameras. In a classroom, a student video- oraudio-recording can compromise the crucial teacher–studentrelationship, especially when students are sharing personalinformation during a class activity. Awareness of theseconcerns should be part of the learning experience.Consequences for violating standards of conduct related tocell phones must be clear, well publicized, and enforced.

Another limitation is the reluctance of instructors to giveout their cell phone numbers. In the past, I have not given outmy number to students because of the potential lack ofprivacy that might result. However, once I started using mycell phone in community-based courses, I found manyadvantages, especially text messaging, to stay in contact withstudents in the field. I have found that texting questions andanswers is much easier than answering e-mail or phoning astudent, and cell phones are obviously more mobile thancomputers or landline phones. In my view, these advantagesoutweigh the disadvantages. However, instructors whochoose not to give out their cell phone numbers can stilluse the phones in the classroom once they have taken thenecessary precautions to protect their number. Students canstill be given a phone number that is linked to a cell phonethrough a free online service that assigns a number thatforwards calls to any phone selected (http://jangl.com/).

4. Establishing standards of conduct

No matter how cell phones are used, the instructor mustestablish clear guidelines for their use. In my classrooms,some rules are nonnegotiable, such as no cell phone useduring a test. Other important rules are as follows:

• Ringers must be turned off or set to vibrate.• Students must not text during class unless doing so is part of

the assignment.• A student expecting an important call must sit next to the door

and leave class to take the call.• Students must not photograph or record anyone in the class

without permission.

On the first day of every class, I discuss the use of cellphones with my students, along with other expectations for

classroom conduct. I ask students to establish an individualmotivation for being in the nursing program, after which theclass integrates the individual motivations into a singlemotivation for the class. This document is an important stepin helping students understand the professional valuesof collaboration, integrity, and honor. Next, students identifyspecific behaviors that support and detract from themotivation. Then, the instructor posts a copy of themotivation and behaviors statement online and inthe classroom. When students (or the instructor) violate theguidelines, students recall the motivation and discuss theincident in a nonjudgmental way.Most of the infractions haveto do with cell phones. Sharing the responsibility for classconduct enhances the development of professionalism.Encouraging students to discuss issues in nonjudgmentalterms enhances their professional development.

5. Using cell phones in the classroom

Once nursing instructors have followed the necessaryprecautions, such as establishing a code of conduct andpreparing workable lesson plans, they can use cell phones ina variety of ways. The following suggestions, all of which Ihave used in my own classes, are relevant for all types ofbasic cell phones. Internet-enabled smartphones can dofar more.

5.1. Dealing with emergencies

On the first day of each class, I require students to createphone entries for two or three contacts in case of emergencyand to add the university emergency response phone number(which is not 911) to the contact list. Many emergencyresponders are trained to look in cell phones for “ICE” or incase of emergency phones numbers. These numbers savetime in contacting friends and family to obtain medicalinformation when there is an emergency. Emergencypreparedness is an important part of a nursing curriculum,and adding ICE phone numbers to each student's cell phoneis the first step for students to participate in planning for apossible emergency in the classroom or other location.

5.2. Time management

Students can use the cell phone's calendar and otherapplications to record due dates of assignments and assistwith basic project management, such as setting smaller goalsfor completing larger assignments. Most cell phones alsohave a stopwatch, and students can time themselves incompleting activities/skills. I encourage students to setalarms to take breaks while studying, especially whenusing the computer for more than 30 minutes. Students canalso time themselves when giving presentations, whichincreases their accountability for assignments.

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45Cell phones

5.3. Using calculators

Almost every cell phone contains a calculator. For manystudents, the calculator and the phone are one device. Studentscan use the built-in cell phone calculator to determinemedication doses, compute body mass index (BMI), and soforth, in homework assignments or during quizzes. Moststudents already use a calculator for these computations ratherthan doing them by hand, and using the cell phone calculatormeans one less device to buy or carry to class.

5.4. Photographing course materials

Students can photograph notes written on a board andsupply setups for skills and other technical tasks for futurereference. Visual cues, especially for students who may beleft handed or color blind or possess some other variation inlearning can easily develop their own learning tools withphotographs. Obviously, students should not use the cellphone cameras for photographing classmates without theirpermission or refer to photographs at inappropriate times.

5.5. Replacingaudience responsesystems(“clickers”)

Before I began using cell phones in the classroom, theaudience response system (a computerized system thatallows students to respond to questions using handhelddevices known as clickers) provided an effective andexciting tool to check students' understanding of a conceptduring class (Meedzan & Fisher, 2009). For example,students can use their cell phones for immediate responsesto poll questions (Meedzan & Fisher, 2009). My studentsalways responded positively through comments on curseevaluations when I introduced clickers, which I requiredthem to purchase along with their textbook. They had veryfew complaints about the modest cost, and after a short time,they considered any class session that did not include clickerquestions incomplete. Despite the overall enthusiasm,however, some students often forgot their clickers, no matterhow I tried to encourage or admonish them.

Because students were much less likely to forget their cellphones, the answer seemed to be to use a Web-based mobilephone application in place of the clickers. Several models areavailable, but the best I have found is at http://www.polleverywhere.com (see Table 1). There is a free trial and asmall fee for use in larger classes, which may be paid by theuniversity or faculty member, but students always findassessment activities using cell phones engaging.

5.6. Interviewing

Students can call people and ask questions regardingconditions related to material covered in class (Bransford,Brown & Cocking, 2000). Integrated activities work bestwhen student responsibilities are clear. For example, I oftenhave students call someone they know who has had a specific

problem, such as experiencing unrelieved pain while apatient. During these conversations, students must useprinciples of therapeutic communication to elicit informa-tion. They must record their notes in data sheet and use thosenotes to create a plan of care for my review. Every part of theactivity is central to the course objectives, and students areaccountable for showing their professional work.

5.7. Asking questions via Google text service

Google text service (466453, the numeric equivalent of“Google”) is a free service that allows students to queryinformation, such as metric equivalents or translations, bySMS-capable cell phones. This is a quick and preliminarysource of information; responses must be verified if used informal assignments.

6. Using cell phones outside the classroom

6.1. Texting information to students

Cell phones can also aid instructors outside class hours.Multiple applications that the instructor can use to bulke-mail information to students are available. Universities usethese bulk texting services to alert students to emergenciesand to provide other important information. Instructors canuse them to make announcements on changes to meetingplaces and times of activities.

6.2. Using voice-to-text services

Instructors can subscribe to voice-to-text services such ashttp://jott.com/ and Google Voice (http://google.com/voice/),both of which offer a free trial. The instructor can request acaller to leave a message, which the service converts to textand sends out as bulk message to students as the instructordirects. Faculty members can record their lectures andproduce a transcript using these services or ask patients tocall to a specific phone number and leave feedback onstudent performance.

7. Evaluation

Evaluating the effectiveness of cell phones in nursingeducation is difficult, in part because students have deepattachment to cell phones and their features and in partbecause the near-universal presence of cell phones makescomparing classes with and without them challenging since itcan be very difficult to get students to refrain from accessingtheir cell phones during class. However, the level ofengagement of students and their recall of important coursecontent suggest that incorporating them into the curriculum isbeneficial to the students themselves. I teach the first requiredcourse of our nursing program, nursing fundamentals, and

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46 M. Smith-Stoner

one of the last courses, nursing research. In the 2 years since Iincorporated cell phones into these classes, the level ofengagement has improved, along with the satisfaction ofstudents. Student ratings of teacher effectiveness have movedbeyond the department mean to above, and narrativecomments also include comments about the use of cellphones and other technology.

8. Future plans

I look forward to the day when I tell students, “Take outyour smartphones! Let's begin class.”When that time comes,the instructional possibilities will be even more exciting andrelevant to the lives of my students and the patients they arelearning to care for (New Media Consortium, 2011). Thereare significant barriers to overcome before cell phones can befully used, for example, ensuring students are clear (honest)about sources of content they acquire, but the potential toexpand learning in meaningful ways is an importantmilestone in education.

References

American Association of Colleges of Nursing. (1998). Peaceful death:Recommended competencies and curricular guidelines for end-of-life

nursing care http://www.aacn.nche.edu/publications/deathfin.htm.Accessed January 29, 2011.

Bransford, J. D., Brown, A. L., & Cocking, R. R. (Eds.). (2000).How peoplelearn: Brain, mind, experience, and school Washington, DC: NationalAcademy Press http://www.nap.edu/openbook.php?isbn=0309070368.Accessed February 20, 2011.

Clark, C. M., & Springer, P. J. (2007). Incivility in nursing education: Adescriptive study of definitions and prevalence. Journal of NursingEducation, 46(1), 7−14.

Cross, K. P., & Steadman, M. H. (1996). Classroom research: Implementingthe scholarship of teaching. Jossey Bass Higher and Adult Education,2nd ed. San Francisco, CA: Jossey-Bass.

Cell phones do distract in class. Teaching Professor [serial online]. March2007;21 (3):4–6. Available from: Academic Search Premier, Ipswich,MA. Accessed February 25, 2011.

Klutch, R. (1991). The calculator crutch, New York Times. http://www.nytimes.com/1991/09/29/opinion/the-calculator-crutch.html. AccessedNovember 27, 2009.

Meedzan, N., & Fisher, K. (2009). Clickers in nursing education: An activelearning tool in the classroom.Online Journal of Nursing Informatics(OJNI), 13(2), 1−19. http://ojni.org/13_2/Meedzan_Fisher.pdf.Accessed January 12, 2011.

New Media Consortium. (2011). The horizon report. http://www.nmc.org/publications/2011-horizon-report. Accessed March1, 2011.

Nordstrom, C. R., Bartels, L. K., & Bucy, J. (2009). Predicting and curbingclassroom incivility in higher education.College Student Journal, 43(1),74−85. http://findarticles.com/p/articles/mi_m0FCR/is_1_43/ai_n31415093/. Accessed January 21, 2011.

Smith, S. D., Salaway, G., & Caruso, J. B. (2009). The ECAR study ofundergraduate students and information technology. Boulder, CO:EDUCAUSE Center for Applied Research.