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Stilwell - A Virtual Community

Stilwell is a health sciences virtual learning tool, consisting of a series of videos, blog posts and online newspaper articles all pertaining to the characters of the fictional city of Stilwell, Ontario. Designed to represent a typical Canadian neighbourhood with a wide social and cultural demographic mix, the health, social and personal problems of the residents are situated, contextualized, and followed. Their stories are brought to life and embedded in the community with the aid of multimedia.

Learners (both students and practicing clinicians) from different disciplines work through the cases over time to respond to health related issues and to create dialogue around the roles and responsibilities of providers. Participants experience greater engagement in the lives and events of the people in Stilwell than in a typical case study.

A Brief Description of Stilwell, the Community

Situated in a picturesque lakeside community, Stilwell is a vibrant neighbourhood located within a large urban area. Built in the 1960’s as a planned community, several thousand homes are nestled into lovely tree lined streets. St. Peter’s Lane is a middle to upper income area where most residents are well educated and employed as professionals. To the south is Dale road, where million dollar homes with high level security systems line the waterfront. Most residents have their roots in the UK and Europe, however, cultural diversity is increasing. Just north of the railway tracks, a different picture presents itself in Stilwell. Crowhill Road is a busy thoroughfare of high-density social housing, high-rise apartments, and homeless shelters. The gap in socioeconomic status between the two sub-communities creates significant tensions at times. Like many urban areas in Ontario today, Stilwell is a cultural mosaic with social and health issues commonly found everywhere.

Bringing the Community to Life

A variety of media are used to bring the residents’ stories to life including:

  • An introductory video tour of the neighbourhood Photographs and audio diaries from the area
  • Professionally acted and produced video clips of critical incidents
  • Electronic health records from clinic and hospital visits
  • The front page of the local newspaper Narrative devices such as blogs kept by both residents and health care professionals working in Stilwell
  • A facilitator’s guide is provided to help direct discussion

male and female student looking at computer screen

Case Study

Stilwell, the learning tool, is an amalgamation of the many stories of the residents who make up Stilwell, the neighbourhood. The following is an example of how one such story can be used to facilitate a discussion on patient safety.

Young man

Nurse looking at incubator

Two nurses

Police talking to doctors

The Context

The Montoya’s story represents a simulation of a near miss event in the emergency department. Participants would be shown the first video clip of the Montoya’s in the emergency department. Here, the day is busy with many people waiting and only one inexperienced triage nurse.

Issues raised include:

  • Distraction and the impact on their ability to do their job
  • How best to work with unfamiliar clinical situations
  • Asking for help
  • The impact of cultural assumptions on patient safety
  • What is available to you to learn new things as your role expands - clinical competency

Solution and Debriefing

Learners are shown the video clip of a more experienced nurse discovering the sick child and bringing her for immediate treatment. Subsequently the learners discover that the child was septic and immediate treatment was needed to avoid a catastrophic event. The triage nurse is then shown with a clinical educator debriefing.

Debriefing allows:

  • Educators to have students talk about what they might do in this situation
  • Students to learn what they would need to prevent this
  • Discussion on what mechanisms need to be in place

Learning Objectives

  • Inter-professional collaboration
  • Cultural awareness
  • Language barriers
  • Role awareness
  • Paediatric assessments
  • Difficult conversations
  • Contributing to a culture of patient safety
  • Recognizing, responding to, and disclosing adverse events
  • Communicating effectively
  • Managing safety risks

Testimonials

"Stilwell serves to illustrate both the physical and emotional components of a client and his/her family, when faced with challenging, and life altering events."

Jackie Galea, RN
Professor, Nursing 

"Stilwell has been an excellent adjunct to my classes. As a continuing education instructor, I have used cases related to the presentation of the cardiac client to allow students to analyse and gather important data. The students then apply critical thinking strategies to each case/scenario to interact with the content during class. For my online classes, the paediatric cases in the Stilwell neighbourhood assisted in giving students specific examples of critical decision points made when nursing paediatric patients and their families. Stilwell allows for interaction and active learning to support understanding, application and critical thinking in my students."

Barb McGovern, RN, BScN, ENC
Professor, Nursing 

 


"I had the recent opportunity to apply the Stilwell virtual community to an online course, NURS 466, Communication in Nursing. The episode I referred to as a teaching tool was the Armstrong Family. 

I had the students answer questions regarding the communication skills, to include body language as well, between the health care professionals and the family members in each case scenario. The students stated that they enjoyed exploring the Stilwell virtual community and that they liked the idea of watching health care professionals in action with family members in various situations. The online discussion was interactive between students and myself and proved to be a good learning tool.

I believe this teaching strategy added variety to the content of this online course.  I was happy for the opportunity to apply this strategy in this course."

Eva Hearn,  RN, BN
Professor, Nursing 

"I have had the opportunity to introduce case studies from the Stilwell community in two courses in the Part time Practical Nursing program over the past year and the student response was very positive. I utilized one of the case studies, the Armstrong Family, to stimulate a discussion related to communication and the health care team. This scenario was used very effectively in NURS 466-50, an online semester 4 theory course. The case study scenario stimulated an engaging conversation with the students and provoked further debate and discussion with the entire class. In NURS 260-50, a semester two theory course, the case scenario involving Isabelle who was inflicted with Alzheimer’s disease was very helpful in providing the students with a realistic perspective of the disease. Each episode encouraged further discussion and helped to reinforce the theory content related to Dementia and Alzheimer’s disease. I look forward to having the opportunity to introduce more members of the Stilwel community in the classroom and online in the future."

Judy Martin RN BHScN 
Professor, Nursing 

"I have had great results utilizing Stilwell in an Ethics course designed for Paramedic students. Stilwell facilitates the use of a ‘real world’ case scenario methodology into an Ethics course. The video cases within Stilwell contain many interprofessional ethical dilemmas. These cases immerse the student in a virtual environment that creates student attachment to the characters. I feel the discussions that ensue are richer and truer because of this virtual patient relationship. This engages the student to have a client focus in the application of ethical frameworks to resolve the many dilemmas. I have used Stilwell for the past couple of years and with each course preparation I find new ways of utilizing the many cases found within the virtual learning environment. Additionally, the informal comment sections in the SFQs for the Ethics course reveals that students enjoy and would like to see more of Stilwell incorporated. I would recommend Stilwell to anyone that is looking to bring a patient/client’s story to life."

Craig MacCalman, ACP, BScN
Professor, Paramedic Program