ASET logo
[ EdTech'90 Contents ] [ EdTech Confs ]

Chronic Blood Transfusion: A video and resource book to facilitate teamwork in the treatment of patients requiring chronic blood transfusion

Justus H. Lewis
Chisholm Institute of Technology

Ralph E. Green
Royal Melbourne Institute of Technology

The program, Take Care! Chronic Blood Transfusion was the result of a collaboration between the two authors, one of whom was at that time working in the area of instructional design in the Education Unit at the Royal Melbourne Institute of Technology (RMIT) and the other Lecturing in the Department of Applied Biology there. Other members of the working party included the Director and senior members of the nursing staff at the Red Cross Blood Bank.

Meeting vocational needs

The Blood Banking subject in the RMIT is vocationally oriented and taken by students in the final year of the Medical Laboratory Science course. Blood Banking can be studied at a number of levels. For example, all students have a brief introduction to the topic in their second year. Those who wish to consider Blood Banking as a career option can study it as a one semester subject, and those who are already committed to a career in transfusion science have the opportunity to study the area in depth in the subject Immunohaematology.

Take Care! Chronic Blood Transfusion was designed to be used in this course as an interactive video program in response to the identification of a number of concerns and issues, outlined below, relating both to the educational processes being used in different subject areas in the undergraduate Medical Laboratory Science degree course at the RMIT and also, more generally, to vocational education.

Changes in the funding basis for the course meant that it was necessary to re-evaluate the aims and objectives of many subjects and to determine the most effective way of teaching them. It was decided to employ a multimedia approach and to develop a number of instructional packages. The degree of self learning and student interaction incorporated in each package was determined largely by the aims and content of the subject material being covered. Another concern was the cost in terms of time and materials required to develop and produce each package.

For a first year introductory subject in Haematology it was decided to use a series of self instructional booklets and to follow a Keller plan approach to help students understand and assimilate their laboratory based work. The booklets were produced using ReadySetGo! and make extensive use of graphics. The professional presentation of the booklets will allow cost recovery from students who are required to purchase them as their course text.

A second year subject in Introduction to Immunology requires students to come to terms with many new and often complex concepts. The grasping of concepts is often facilitated by the use of diagrams and figures. Quite often animation is also helpful where there is interaction and subsequent change in the items of interest. The computer program HyperCard® has been used to develop a number of stacks on the various topics in this subject. Extensive use has been made of the graphics capabilities of the program and stacks are printed and provided to students as hand outs during lectures. The stacks are being programmed and will eventually be available for use in Computer Aided Learning.

The vocational issues related firstly to a need to categorise and define the essential elements which students are required to understand to meet their future professional requirements. As medical laboratory scientists they will frequently be operating as part of a team with other members of the health professions such as nurses and doctors. A way had to be found, therefore, to relate concepts and principles learned in the classroom to future on the job training in the laboratory. Another of the authors' concerns was to provide clear guidelines for teachers both of undergraduate and postgraduates as to the level and depth at which it was appropriate to present these topics to students and in what sequence, again with emphasis on the need for students to be able to recognise and apply their knowledge in practical situations. Yet another concern was the need to make more effective use of the limited teaching time available and to present the subject in ways which would encourage students to understand concepts and principles and also to become more self reliant in their approach to learning. The vocational nature of the subject obviously lends itself to the use of a problem solving case study approach and this is the approach that was decided on.

Search for suitable material

An investigation of existing video material in the field of Blood Banking indicated that there were not many programs available and those that were, did not address the issues the authors wished to examine.

The National Heart Lung and Blood Institute in the United States had in 1984, awarded a Transfusion Medicine Academic Award to Brown University to examine the state of transfusion medicine teaching and the application of new teaching technologies. Under this award the Brown University team, led by Dr James Crowley, commenced the production of a number of interactive video programs integrating the use of computers and video. A number of videos in this series were obtained for evaluation, but, once again, the topic material and approach used did not suit our purpose.

The objectives of the program

The program was conceived as having three main objectives. The first was as described above: to show the ways in which the responsibilities of nurses, doctors and laboratory scientists are linked in the treatment of chronic transfusion patients. The other two objectives related to the need to make users aware of the most recent developments in the area of blood products together with some of the dangers inherent in lack of care and attention to detail in using the products. They were, firstly, to show some of the most recent practices and procedures in the treatment of chronic transfusion patients and, secondly, to give information on the composition and storage of red cell products used for these patients.

Although these objectives may appear to be mainly concerned with the giving of information, the authors were also concerned to influence the attitudes of students towards their responsibilities. Studies in the United States (Sazama, 1988; Honig & Bove, 1980) have indicated that most fatal transfusion reactions result from the transfusion of ABO incompatible blood. In the vast majority of cases the cause behind the transfusion of ABO incompatible blood was shown to be human error involving mistakes in patient, blood sample and donor unit identification. All participants in the transfusion of blood (medical scientists, nurses and doctors) were guilty of such errors.

A practical guide to current procedures and practice had recently been produced by the Red Cross Blood Bank (Blood and its Products), and it was felt that it was desirable to reinforce and promote vigorously the positive attitudes to good professional practice outlined in this manual. This could be done by presenting some of the content of the manual within the context of a case study which would demonstrate the practical application of the principles.

A joint venture

It was decided, therefore, that there was a need for a new program to be developed. Because of the nature of the proposed content (depicting a team situation involving nurses and doctors as well as medical laboratory scientists, it was realised that this program would be potentially as useful to these professionals in their on the job and continuing education as it would be to undergraduates. Consequently the Director of the Red Cross Blood Bank was approached and he and senior members of his nursing staff agreed to become part of a joint working group with the authors. This meant that from the start, there was input from all three groups and the development of the program became itself another exercise in cooperation and understanding between members of the three professions.

Development issues and their resolution

In developing the present program the authors encountered a number of problems and dilemmas. Some of these were of a practical or pragmatic nature, such as arranging suitable common meeting times for a group of diverse professionals. Some were more technical in character, such as finding a speedy and cost efficient way to collate and integrate the diversity of inputs from these groups. This was greatly facilitated by a member of the working party inputting material directly into the computer.

The issues that concern us here, however, raise questions regarding the design of instruction. Although in hindsight, many of these matters appear clear cut, the working party experienced them at the time as complex and unclear. This is scarcely surprising since the processes of design fall into the category of problem solving processes and these are frequently ill structured in the case of complex and 'real life' problems (Jackling et al, 1990, in preparation).

  1. One of the most difficult decisions concerned the amount of information which should be included in the program, whether that information should be given in the video or the resource book, or in both, and how the information should be presented. This is a classic teaching issue: how can we 'cover' all that students need to know within a limited time frame? In this instance, the problem was compounded by the need to ensure that the material would be relevant to three distinct groups of professionals, who although they clearly had a common interest in the material, were involved in the situation in different roles and to varying degrees of depth.

    For example, it was desirable that the nurses should have some understanding of what the scientists were doing with the blood samples in the laboratory but it was not necessary for them to have detailed knowledge. The doctors, on the other hand, would need a certain amount of detailed knowledge of these procedures, but not to the degree required of the practising scientist. Similarly, the scientists and doctors should be aware that there existed detailed procedures for setting up the equipment for transfusion without requiring to know the precise nature of the details.

  2. Another related decision concerned the relationship between the video and the resource book. Should the program be conceived as video led or as print led? Was the printed page an adjunct to the video or was the video to be seen as a practical illustration of the basic principles explained in the resource book? If the case study in the video was the central focus, then did this imply that the video could be viewed as a 'stand alone' program?
From the start it was decided that a resource book as well as a video was essential to the success of the program. If, however, the video were to be viewed on its own, by someone who did not consult the resource book, if the video appeared superficially to be a 'stand alone' program, would this reflect adversely on the program if the viewer(s) decided that insufficient or misleading information was presented? Conversely, what if the resource book were studied without reference to the video? What steps might be taken to forestall the possibility of students being frustrated or misled?

Practical solutions

Let us begin with the second problem. It was decided at an early stage that the program should be video led on the grounds that one of the major reasons for making it was to promote attitude changes in the three groups of users and the printed word by itself was insufficient to ensure this. By developing a case study which showed the progress of a patient from the start to the end of an episode involving transfusion procedures, it would be possible to represent the most important issues in a real life situation with which students could identify.

Having made the decision to create a real life situation, the next decision was whether to recreate this with the help of actors or to use actual patients and medical personnel. The choice of the latter was made on the grounds both of cost and that the professional audience for whom the video was intended would be more likely to respond positively to a real patient and real personnel. Further, the program was conceived as a teaching performance rather than a dramatic re-enactment, and for this purpose, 'real people' were considered more likely to convince learners.

Following on this point, was the question of how to ensure that teaching (and learning) were, in fact, occurring? It would be easy for a group to view the case study in a fairly superficial way. It was decided to identify a series of crucial moments in the course of the patient's history. These might be 'critical incidents' or relate to important procedural questions. At these points, the action would 'cut', and with the signal Take Care! a question would be posed for the student(s) to discuss or take a decision on before proceeding to the next segment of the video.

This leads us back to the first design question. How much information should be included in the program? As the focus was on facilitating cooperation amongst the three groups, it was inappropriate to include large amounts of scientific and technical information, although it was recognised, that particularly for the scientists, the knowledge component was of central importance. Scientific and technical information, however, is better presented and learned through the printed word. So should additional information relating to transfusion be presented in the resource book?

The decision taken by the team, after considerable discussion, was that it would be inappropriate to burden the resource book, which was intended to be used as a work book by those using the program, with an excess of technical information. It was decided that the important focus of the program, was to trigger discussion within local settings of the issues highlighted in the video. The function of the resource book was to remind students of these questions and to provide a series of ancillary questions for discussion relating to these issues. Although the importance of the technical knowledge was fully recognised, it was seen as being the responsibility of whoever led the discussion groups, to provide access to such information within the local setting.

One of the interesting features of the experience of developing this program was the movement from the concept of a self instructional package to an open learning program or module. The main features of a self instructional package relate to its self contained nature. It offers instruction in a specific area, and it provides all the information required for the student to acquire the relevant knowledge and skills without recourse to outside resources. A self instructional package addresses itself to each unique individual and takes little or no account of the individual's environment. The very term 'package' suggests strongly that all that the learner needs is provided within the package.

Open learning, on the other hand, addresses itself to the learner within his or her environment and, equally, to groups of learners within specific environments. For the learning to be complete, the learner must use the information provided within the context of the environment. In the case of this program, the environment may be the undergraduate classroom where the student will have the benefit of the teacher's experience and learning. But it may also be the clinical setting of the hospital where it may be used by clinical teachers and supervisors who draw on their particular expertise and specific 'local knowledge' to encourage the students to develop their own structures of learning which internalise the concepts and principles in the context of the real needs of patients and the organisational pressures to cooperate with others to achieve the best outcomes in patient care.


The program has been trialed with a group of final year Medical Laboratory Science students who have had limited exposure to blood banking practices.

Student feedback was very positive with respect to the case study approach employed. They found the program of value in showing some of the practices that take place in the ward at the time of a blood transfusion being given.

Their main interest was directed to the segments of the program which entailed activities in the blood bank. They responded well to the open learning environment created by the video as it allowed them to put much of their theoretical knowledge into a practical situation.

Because of class timetabling, there was a relatively short time available in which to use the program with students and it was only possible to view part of the program. To view the entire program would probably take at least three separate sessions for Medical Laboratory Science students. This time requirement may not apply to nurses or doctors who are viewing the program to gain different information. Using the program on a number of different occasions may be a distinct advantage and permit issues to be discussed again after time for reflection on various aspects of the case study.


Crowley, J. (1987). Interactive Video Technology in Transfusion Medicine, in Summers S. H., Macpherson, C. R. and Kennedy, M. S. (eds), Alternative Educational Methods for Continuing Education. Arlington, VA: American Association of Blood Banks.

Editorial Panel (1987). Blood and its Products. A practical guide to handling and usage. Red Cross Blood Bank. Melbourne.

Honig, C. L. & Bove, J. R. (1 980). Transfusion associated fatalities: Review of Bureau of Biologics Reports 1976-1978. Transfusion, 20, 653-661.

Jackling, N. et al, Problem solving in the professions (in preparation).

Sazama, K. (1988). Transfusion-associated fatalities reported to the FDA between 1976 and 1985. American Society of Clinical Pathologists Teleconference Series. March 8.

Please cite as: Lewis, J. H. and Green, R. E. (1990). Chronic Blood Transfusion: A video and resource book to facilitate teamwork in the treatment of patients requiring chronic blood transfusion. In J. G. Hedberg, J. Steele and M. Mooney (Eds), Converging Technologies: Selected papers from EdTech'90, 152-157. Canberra: AJET Publications.

[ EdTech'90 contents ] [ EdTech Confs ] [ ASET home ]
This URL:
© 1990 The author and ASET. Last revised 15 May 2003. HTML editor: Roger Atkinson
Previous URL 2 Aug 1998 to 30 Sep 2002: