Nurse educators, many of whom had no prior experience with online teaching, had to adopt technology when delivering content during the pandemic. While some had previously incorporated technology into their teaching activities, many had never relied solely on technology to facilitate student learning. Puentedura's1 model for applying technology to substitute, augment, modify, or redefine (SAMR) learning activities may be used to assess teaching practices and ascertain whether technology-enhanced teaching should be sustained (Figure). Select examples of efforts to integrate technology into nursing education are presented and examined by corresponding constructs of the SAMR framework.
SAMR Model
Puentedura's1 model does not describe how technology is applied to facilitate learning but, instead, offers educators a framework for integrating technology into their teaching activities to promote student attainment of intended curricular outcomes. Lower levels of the SAMR model (ie, substitution and augmentation) denote ways that technology is used to enhance learning, whereas the upper levels (ie, modification and redefinition) represent ways that technology is applied to transform learning. Puentedura's1 framework is often referenced in K-12 literature and has been growing in popularity within the higher education community. Although an abundance of information about technology-enhanced teaching strategies has been published, few authors have applied the SAMR model to describe their motivation or rationale for choosing specific technologies to influence learning. This has resulted in missed opportunities to expand the evidence base for employing technology in nursing education.
Substitution
According to the SAMR model, substitution involves exchanging traditional practices for technology-enhanced ones that do little to change the functionality of the experience. Many publications emphasized the use of web-based meeting spaces (eg, Zoom, WebEx, Google Meet) to facilitate didactic learning, a simple replacement of a physical classroom with a virtual environment. Some educators opted to provide asynchronous lectures using recorded PowerPoint presentations. Web-conferencing platforms were also used to proctor examinations and facilitate clinical skills practices that would ordinarily take place in laboratory settings. Educators turned to technology to overcome the challenge of teaching physical assessment skills in remote settings. In one instance, the substitution involved using Easy Auscultation, a freely available website, to help students differentiate normal and abnormal breath and heart sounds in the absence of having actual patients to evaluate.2
Augmentation
Augmentation occurs when the application of technology allows for functional improvement to previously employed teaching/learning strategies. Hassler et al3 described converting clinical evaluation forms to portable document format (PDF) to facilitate students' ability to share their progress with their instructors online. Other examples of augmentation include creating technology-enhanced presentations with web-based apps, such as Canva, Prezi, and Google Slides, to highlight students' work. The simple act of placing a hyperlink to a website in the chat box of a web-conferencing platform so that students can access additional information on a topic is another example of using technology to augment learning.
Modification
Modification involves the application of technology to redesign traditional teaching practices. A collaborative learning activity described by Konrad et al,2 in which students deconstructed nursing care plans to promote their clinical reasoning abilities, can be used to illustrate the modification construct of the SAMR model. The authors created small groups (after reviewing students' previously completed care plans) to facilitate peer-based learning. Learners were moved into breakout rooms to critically appraise information included in the care plans according to specific assigned topics (eg, laboratory values, pathophysiology, nursing interventions). The instructor rotated through the breakout rooms to offer feedback as students worked collaboratively to prepare a presentation on elements of the care plan that were pertinent to their assigned topic. This involved using technology for a learning experience that would have been logistically cumbersome in a traditional classroom. Furthermore, having the students create a presentation on their topic to share with their classmates afforded an opportunity for technology-enhanced social learning.
Redefinition
Puentedura1 suggested that technology can ultimately be used to redefine how learning occurs. Learning activities that would not otherwise be possible without technological enhancement fall into this category of the SAMR model. Hassler et al3 described 2 technology-driven teaching activities used for clinical learning. In the first, students generated public service announcements (PSA) designed to educate patients, caregivers, or health care providers about select geriatric conditions. This effort included using graphics embedded into the free version of Adobe Spark along with voice-over commentary to create the PSA and culminated with presentations to faculty and peers that enhanced learning for all participants. The second activity involved creating educational materials to address learning needs of undomiciled pregnant mothers and their children. Students created teaching modules on several topics (eg, circumcision care, infant bathing, recognizing symptoms of postpartum depression) that were reviewed by educators to ensure accuracy and published as videos using web-based tools such as iMovie and Powtoon. This learning experience was well received by students, faculty, and the community practice partner who requested access to the modules for their continued use.
Summary
Nurse educators experienced challenges as many were accustomed to using traditional models of nursing education that are overly reliant on face-to-face lectures, clinical rotations, and issues of overburdened curricula. When faced with finding creative ways to facilitate remote learning experiences for students, nurse educators intuitively turned to situations they were most comfortable with-the context of providing actual nursing care to patients. In reimagining their usual teaching strategies, many educators moved out of their comfort zone and applied technology to illustrate clinical application of learned concepts.
Examining teaching and learning practices using Puentedura's1 framework illustrates how higher-order learning outcomes (ie, analyzing, evaluating, creating) of Bloom's revised taxonomy are evidenced within the modification and redefinition constructs of the model. The use of innovative strategies, integration of classroom and clinical concepts, and enhanced student engagement helped promote student development of critical thinking and clinical judgment skills. Moreover, this provided opportunities for students to explore the meaning of nursing. The nature of the learning activities referenced in this article exemplifies ways in which educators can work to bridge the academic-practice gap.
A wealth of informative literature that detailed technology-enhanced approaches used to educate nurses has been published over the past 2 years. The adoption of newer technologies during this time was rapid and constantly evolving, and few empirical studies emerged. Applying the SAMR model as a framework for future research that expands upon what educators achieved may help foster sustainable change in nursing education.
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