Since as far back as I can remember I have embraced technology in my teaching – working from the problem to the potential solution. Over the past year, I have been working through the technologist module of the Ontario Extend website in depth – sometimes intentionally sometimes instinctively. 

I updated this post to include this video about the solution to the challenge.

The Challenge

Both my learners and I are challenged by an overwhelming and problematic course. It is a first-year course with a reputation – Students are expected to have difficulty passing. I have been repeatedly been told to be easy on myself because it is not me, it is the course. Well, I do not accept that. Out of uncertainty around how much to disclose about the nature of the course, I will keep this discussion at a high level. After teaching the course similarily to others before me I spend almost 10 months analyzing what was problematic about the course through talking to students, reflecting on course evaluations, reflecting on pedagogical presentations at conferences, and discussing it with students and faculty. The changes made to the course and the technology involved were carefully analyzed prior to implementation.

Student Challenge: To Pass.

Typically I don’t have a high failure rate on assignments because I do my best to support learners in a variety of ways … well, last year … students were at risk. We could debate where the fault in that lies. Some would say it is the student’s responsibility to meet the assignment expectations. However, part of my teaching philosophy is a shared responsibility for ensuring a student’s ability to succeed. Although I had done my best to provide students with the help and resources they needed to succeed, the number of people struggling had me questioning how much of their failure was within my locus of control to change (I was repeatedly told that it was not my fault but I can’t help but feel some ownership). As the technologist module suggests, the best place to start solving a problem is through a lense of empathy. How can I solve the problem if I do not know what the students need or why they are struggling.

Some factors influencing their struggles included:

  • An inability to build on the knowledge that was introduced in the previous term. This may have been due to poor buy-in at the time of initial instruction or poor curriculum continuity. Students needed to be re-taught material from the first term.
  • Difficulty arranging family visits in time. It was challenging to coordinate the schedules of students and faculty advisers (who accompanied students on one of three visits).  Some students did not have a supervised visit before the first assignment was due. Other students ended up not completing visits until too close to the assignment deadline, which disadvantaged them.
  • Challenges with finding a suitable family to visit.
  • Learning the skills required to assess the family. The expectation of a year one student to formulate questions based on an assessment framework, enter a person’s home and conduct an interview of appropriate depth is a tough ask.
  • Partner issues. Some students blamed poor communication or work-ethic of a peer for their struggles in the class. In year one it is difficult to know how to deal with a partner who does not do what is expected.
  • Underdeveloped writing skills. In year one, many students lack basic writing skills. I actually did not realise how much help they needed with this skill until after the assignment was handed in.
  • High-stakes assessment. The first paper based on in-home visits was worth 40% of the final grade (same as the rest of the collaboration).
  • Time-management skills were identified as a challenge by several students.
  • Overwhelming program demands. The workload in the program is heavy and students had long days of classes.
  • Poor attendance. I do not place a lot of emphasis on attendance because I believe that learners can choose to learn course content in a variety of ways. However, in year one it seems as if those that missed class often did not take the time to – perhaps the underestimated the time it would take to develop their knowledge. They also missed some key in-class opportunities for working on the first assignment because they were studying for another class.
  • Too many instructions. Instructions for the assignment could be found in the Syllabus, Moodle, In-class PowerPoint and assigned readings. There were also separate instructions for conducting family visits and completing the assignment.
  • Not following instruction. Several students identified that they did not read the book that walked them through how to do the family assessments. Those that did well indicated the book was essential.
  • A perception that expectations were unrealistic.

Student challenges were multifaceted. As expected, perceptions varied in terms of how realistic expectations were, how approachable I was and how clear expectations were. However, most of the consistent struggles of students seemed to stem from the problematic nature of in-home family visits and essay writing skills. This observation caused me to reexamine what learning outcomes the family visits were intended to meet and think of alternate strategies for meeting them more effectively.

Mine: Workload.

It was exhausting and emotionally draining to support the number of students who were struggling – Particularly when some of them perceived me as heartless. It feels horrible when students are not successful in a course and I am unable to fix the problem. After it was clear that students were struggling we took a reactive approach and offered additional supports through the Library, learning centre and additional meetings with me. It was honestly difficult to keep up. Thankfully, they were successful in helping the majority of students who were struggling. Some of the problems from my perspective included:

  • Difficulty discussing families during class time as each student had different families. I also had no way of knowing what students were doing in the class.
  • An inability to identify struggling students until it was too late.
  • Uncertainty if students were doing visits correctly.  
  • Scheduling challenges with a lack of availability of people to supervise visits.
  • The semester was compressed and it was my first time teaching it.
  • Time. Last year I also tracked my hours. Thankfully, doing so helped me negotiate for some additional support for this year’s course delivery. Two major sources of time spent included meetings (137+ hours) and marking (213+ hours).

The Solution 

Last year I also started planning a proactive approach to prevent future students from experiencing the same struggles. Solving this problem is not easy. Several strategies are being implemented this term to improve the student experience. In this post, I will focus on describing one of them. If you are curious you can explore and compare last year’s syllabus to this year’s syllabus.

In planning for this term I started with carefully identifying the learning outcomes and objectives that this course is intended to address. From there I was able to assess more effective ways to help students meet the learning outcomes. I sought input from former students, colleagues, my Dean, future students and anyone who would listen.

I was able to change a critical aspect of the course: family visits. Several of the challenges faced by students stemmed from difficulty preparing for, scheduling, and conducting these visits. Also, if I am completely honest, students could have fabricated much of the assessment in their essays and I would have no idea.

One could argue that the exercise of going into a home and conducting the visits is useful for building communication skills. I would agree. However, that is not one of the outcomes of this course. It is an outcome of another course they are taking at the same time. Having taught that other course I feel students need more time to learn communication skills before being expected to perform well in a real-world setting.


Simulated family visits was one idea that seemed to solve many of the challenges with sending students to family homes. In the past other strategies have been tried to replace the visits, but the decision was made to return to doing visits. I tried to find existing simulations but was unsuccessful. In the end, I negotiated for the supports to create my own. The work associated with developing these simulations was extensive but worth it. Ethically, I have an issue with forcing students to pay out of pocket to replace the visits. Creating my own was the best solution I could think of.

Scenario Development

I am extremely grateful for the volunteers who helped to make this endeavour a success. It would not have been possible to save the students thousands of dollars without their support. I ended up being both a nurse and a wife in two of the scenarios. Our cameraman, Jeff, became a good fill-in nurse by the end of the scenarios. Recruiting actors and developing the scenarios involved a lot of advanced planning.

We recorded responses to correct, incorrect and not the best options for questions. The inspiration came from a combination of Ryerson’s work as well as conversations and presentations at Online Learning 2018. My goal was to have a clean design, approximately three options for students to choose from for each interaction. I also wanted to have the option of editing the text over the videos in the simulations.

Selecting a Technology

With the support of management, I set out to create my own simulations. However, they were really a collaborative team effort. I spoke with as many people about the options as I could. It was quite timely that I got to attend Online Learning 2018 and was exposed to many options and some theoretical foundations for serious game development. As the recordings were being done and we got closer to developing them I started working very closely with Jeff (Multimedia Specialist and Video editor extraordinaire) and Sarah (Instructional Designer and mastermind of organization and project planning). Sidney (extremely helpful colleague/Professor) also helped to problem-solve what technology would be the best fit. Below are a few notes on the pros and cons of developing the simulations using the technologies outlined below.


Initially I had been planning on editing the video into individual segments and uploading each one as an individual video on YouTube. I was planning to use end cards to allow students to choose the next question. One of the major disadvantages to using YouTube was the inability to track if students had completed the simulation. In addition, I did not like the distractions on that platform and wanted to be able to layer text and other interactions on the videos. Due to YouTube’s limited interactivity I wanted to try something else. That meant learning how to use something else.

Articulate Story line 

This program may be powerful, but it requires an instillation on my computer and was less familiar to some of the team members who were inputting the simulations. It would have taken more time to learn how to use it and seemed to limit my ability to make it openly licensed. It was the team’s desire to openly license the work when completed. I was also told it would be more difficult to edit.


Although it has more limited features than articulate storyline, H5P was easy to learn and quite versatile. I also did not need to install anything on my computer. Since learning to use it I am completely sold. In this particular application a mixture of branching logic and multiple choice questions is being used.

A screenshot showing the timeline of interactions along the bottom of the video.
A screenshot showing what a question looks like. Each interaction asks students to “Choose the most appropriate response. Take note of any questions you wanted to ask that were not asked.”

Each correct and incorrect response was also accompanied with a rationale.

Digital Literacy

My digital literacy skills are high, which is an advantage for me as an educator. However, when selecting a technology to use in the classroom it needs to be extremely easy to use as my learners come from a variety of backgrounds with varied levels of technological skills. That was another thing that drew me to H5P over other options like Moodle lessons or anything that required some kind of external account.

Innovative Thinking

To my knowledge this approach is unique. I borrowed ideas from a variety of sources and put creativity into action. There were three parts to the simulations. Students are guided through part one and two of simulated visits. Both part 1 and 2 were developed using H5P technology.

The opening question in one of the scenarios.

Part 1 made use of branching logic. Branching logic made sense for the assessment of a family’s chronic health challenge as there were a variety of paths that students could logically take to ask relevant questions. Students were not permitted to skip forward or backwards in the timeline. Each option the student choose provided them with feedback on their choice.

This feedback shows that the best response was selected and why it was the best response.

This screenshot shows an example of some feedback for when a student selects a less than optimal response.

Part 2 used linear logic. The assessment framework was more linear in nature. In addition, I was unsure how much time the branching logic would add to a student session. Again,
students were not permitted to skip forward or backwards in the timeline. They were able to retry questions until they answered correctly.

A screenshot showing the H5P retry button.

They were then asked to identify any missing information. Part 3 was a live in-class discussion with the simulated families. Students had the opportunity to ask probing questions directly or through typing them in a Google document.

How the simulations are organized inside of Moodle.


To integrate the simulations into the curriculum I clearly outlined for students how it would help them meet the learning outcomes for the course. Instructions were concisely outlined in class, the syllabus (page 10) and inside Moodle. Completion of the simulation was evaluated on a pass/fail basis two weeks before the paper on the simulation was due (in order to encourage adequate time to complete the assignment). In addition, the course schedule (page 6) identified optimal weeks in which to complete the simulations. Assessment of the simulations continues to be discussed during class.


Students appreciate that simulations can be done independently, as many times as they want. It allows them to review the assessment frameworks and figure out what the best path through the assessment is. It also prevented issues with finding a suitable family, scheduling visits and dealing with partners. I was able to reinforce a schedule with students, which hopefully helped with time-management skills. In my opinion, this year’s experience was superior for students.

Image by DarkAthena on Pixabay

Once created, the H5P objects require no ongoing maintenance, which means they can be used in the future with little work. Faculty in the Hub have since been inspired to use H5P technology in a variety of interesting ways for simulation development. As we continue to develop our capacity to support simulation development in H5P the impact of this strategy will grow beyond the nursing program. In future years these family assessments can be used across the collaboration to promote student assessment skills and prevent the challenges inherent with in-home family visits.

It would not have been possible to develop such a robust activity for students without access to the free and open-source H5P software from MIT. Hopefully, we can openly license these materials once institutional policies are in place to permit it. Currently, the resources can be shared on a by-request basis.

What is Next?

As a member of the Hub team, I hope to be able to encourage and support more faculty who want to try this appraoch (or a variation of it). Student feedback has been positive, which means that if I continue to teach this course I will advocate for the continued use of this approach. I would like to add additional simulations for the next iteration of the course. Coupled with ongoing use will hopefully be a formal evaluation in the form of research. This blog post has been months in the making. For pragmatic reasons I was unable to go into as much depth as I wanted here but hope to turn this into a publication or research project one day. Gamification and simulation are two major interests of mine. The principles of both aid in creating immersive and engaging student learning situations.

Update: H5P just released some new updates that makes doing what I did so much easier. I can’t wait to try it.

Laura Killam


Laura Killam is an experienced nursing educator from Northern Ontario with a keen interest in improving student learning through innovation. For more information please visit


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