• Hayley Sayre

Putting the Pieces Together: An Original E-Learning Design

Updated: Jun 21

Patient Conversations

The e-learning object I'll be sharing with you today, Patient Conversations, was designed to support a hospital's goal of improving communication between nurses and patients. The hospital I am working with is proud to maintain its Magnet status, a competitive certification earned by only 8.9% of hospitals in the country that designates it as an exceptional clinical setting for its nursing staff. Maintaining this status in part requires data supporting positive patient experience and care outcomes, so one of the hospital’s goals is to improve these scores.

At times nurses must navigate challenging interactions with patients where patient satisfaction may seem to be at odds with hospital policy compliance or ensuring the best possible patient outcomes. Helping the patient feel respected and in control of their body cannot come at the expense of maintaining their safety. Management would like the nursing staff to practice developing communication skills that balance empathy, education, and positive patient care outcomes.

Getting Organized

Every year during the holidays my family loves to work on jigsaw puzzles. It's delightfully relaxing to work together with the holiday music in the background, a cup of hot chocolate in hand, and of course to eventually see the beautiful finished product! Even with a simple task like this, beginning with a plan makes the entire process easier and more enjoyable. Whether your personal strategy is to first find all the edge pieces, flip over all the pieces to reveal their picture, or sort by color - nobody begins trying to jam random pieces together.

Designing an e-learning course is not so different! While it can be exciting to jump head-first into a new project, it's critical to get your ducks in a row before getting started, and to keep the design grounded in evidence-based practices to ensure its efficacy. My design document below outlines the principles behind this course in great detail, but here are a few highlights:

  • Trigger Event: All branching scenarios should start with a trigger [1]! This should be a realistic event that engages the learner with the story so they understand the setting and context for upcoming decisions. In my course, the learners begin by meeting Kim, their charge nurse, who sends them to meet their first patient. This establishes the familiar workplace setting, prepares them to meet their first patient, Mr. Davis, and establishes their relationship with Kim, who will be providing feedback throughout the course.

  • Feedback: Throughout this course, the learner is helping the main character navigate interactions with patients and select the best response. After each decision point and at the culmination of the training the learner receives both intrinsic and instructional feedback. Intrinsic feedback is provided when a realistic consequence occurs based on the learner's decision [1]. For example, when the nurse dismisses a patient's concern, the patient becomes angry and requests a different provider, while an empathetic decision results in a calm and compliant patient. Instructional feedback helps the learner understand the consequences and provides guidance on how to improve [1]. In this course, Kim provides direct feedback and reminds the learner of hospital policies and best practices in nurse-patient communication.

  • Learning From Mistakes: One hallmark of scenario-based learning is allowing the learner to make and learn from mistakes [1]. In this course, the learner can make decisions leading to good, bad, and okay outcomes. However, when a mistake is made resulting in a consequence or an endpoint, all is not lost! They receive feedback on why the decision was less than ideal and are immediately offered the opportunity to try again, whether by moving forward in an alternative pathway or by going back to the beginning to restart. The freedom to explore all possible actions and make mistakes is, in my opinion, the beauty of branching scenarios!

E-Learning Design: A Brick by Brick Approach

  • Drawing the Blueprints: Designing a branching scenario course begins with mapping out the scenes. What is the trigger event? What decisions will the learner need to make, and where will each choice lead them? One of the most valuable instructional design strategies I used in designing this course was creating a branching flowchart. If you are new to creating these, I highly suggest Lucid! After drafting ideas with a pencil and paper, this program makes it easy to map out your course, and going back to make inevitable revisions is a snap. You can also see below that color coding your flowchart will help your development team to easily differentiate between the good, bad, and okay decision points and outcomes.

  • Complications: No project moves from start to finish without a few hiccups! For this project, I wanted to create my storyboard visuals using a program I haven't tried before, "StoryboardThat". I enjoyed it and would recommend it to others who are going for a similar look in their design prototypes. While creating the desired image was easy, there was a learning curve in some of the program features such as getting the scenes to 'lock' for future reference. I handled this frustration by rapidly creating and downloading a library of character poses to pull from as I constructed my storyboard. As you're designing your project remember that snags like these are inevitable, but there is no hurdle you can't overcome. Remaining flexible and patient is key!

  • A Light Bulb Moment: As I've mentioned in previous posts, eLearning templates are profoundly helpful in saving you time and energy. You've got enough on your plate when trying to hammer out details in your course outline, set up a meeting time with your SME, and keep your ever-growing number of tabs under control - there's no reason to reinvent the wheel. Rather than creating my own templates for the design document and storyboard I adapted pre-made ones. My project was fairly bite-sized but with 21 slides to map out, having a high-quality template and using the copy-paste command with wild abandon cut my work time in half.

"Have no fear of perfection - you'll never reach it." - Salvador Dali

  • Never Stop Improving: A final lesson learned from this project is that a design may never truly feel complete. But there is wisdom we can take from both Dali and the nature of branching scenarios - perfection is not the goal, instead there is value in making mistakes and improving! If I were starting this project over again, I think I would improve my organization by having a home-base Doc with links to all of the project components. There are many pieces to manage, including external research, a design document, the storyboard, SME meeting notes, and a dozen more! Having all of these anchored in one spot will help cut down the endless clutter of open tabs and keep the chaos to a minimum. A designer's skills of creativity, organization and flexibility are muscles - the goal is to keep building them over time!

Without Further Ado: Enjoy "Patient Conversations"!

External URLs: Design Document, Storyboard & Script, "click through" prototype

Storyboard & Script

"Click-Through" Prototype: Give Patient Conversations a try!

Design Document

Patient Conversations_ High Level Design Document
Download PDF • 1.35MB


[1] Clark, R. C., & Mayer, R. E. (2012). Scenario-based e-learning: Evidence-based guidelines for online workforce learning (1st ed.). Pfeiffer.

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