A clear, all-inclusive definition of e-learning has yet to be established, though research and international collaboration has focused on creating one [10]. Generally, e-learning refers to the use of computers and electronic media and resources in education. It is broadly inclusive of all forms of educational technology, including the Internet, web-based instructional modules, distance education, and reusable learning objects. Distance e-learning is used to describe the integration of available technologic methods for distance education. These methods continue to evolve based on the currently available web resources, information, and communication technologies. The growth and promotion of distance and e-learning education has been attributed to the need to reduce costs, introduce learners to information and communication technologies, and meet the increased demand for this type of learning from consumers [11]. Some also refer to any learning that uses a computer as the main delivery device of education as computer-based learning [12].

Implementing e-learning technology can help meet the needs of learners and create a dynamic and engaging learning environment. The benefit of e-learning is that it is often essentially "on demand" for users, being available anytime, anywhere, and to anyone, especially if the lessons are asynchronous (i.e., can be used without an instructor or immediate communication with others) [13]. One instructor can manage or reach more learners with this type of delivery than traditional classroom instruction, and the resources can often be used repeatedly, making it a cost-effective delivery option [12]. With the rapid growth of this mode of learning, there are a number of premade e-learning tools available for free or purchased use. Using premade materials, educators can supplement pre-existing courses with e-learning tools. The question then becomes how to choose the material appropriately and when to use it in lessons.

Web 2.0 is a term used to describe a group of Internet-based tools that all share a user-focused approach and have an affinity toward user content creation, syndication, and open collaboration between users [19]. Some of the most common Web 2.0 tools include blogs, wikis, rich site summary (RSS) feeds, and social media sites such as Twitter, Instagram, and Facebook. These tools allow users to access information but also to contribute, create, and share. Instead of passively reading or receiving information, learners can collaborate and learn with and from each other, making learning engaging for participants [20]. The use of these tools offers a chance for educators to allow participants to seek out information and learn from each other, helping to construct and grow their knowledge base in an active learning fashion. These tools are particularly helpful when aligned with teaching and assessment exercises that are meant to increase student engagement and/or require students to summarize information or verbalize insight into their conceptual understanding through means other than traditional writing exercises [21].

Using simulation in healthcare education has a variety of applications, including teaching new skills, testing and validating competency, improving team dynamics, and testing of protocol or procedures. It is a valuable tool because it offers a unique, controlled, learner-focused environment that can mimic real-life situations and experiences without risking patient harm [32]. These devices can provide realistic situations and opportunities for hands-on experience of procedures and the practice of professional skills [12]. As such, simulation-based learning can build confidence and improve clinical judgment [33]. Students in the simulation setting are also permitted to practice in their full scope of practice, performing skills they are not permitted to do in their student functions in traditional clinical settings. Creating realistic, student-driven simulation cases can increase critical-thinking skills and promote knowledge retention when correlated with previously learned content [27]. Cases may be adapted to challenge learners and expose them to diverse clinical situations.

Audience response systems (ARS) are a technology that promotes interactive learning by allowing participants to anonymously answer questions in response to a live presentation. This allows the presenter to instantly gather and collect learner feedback to live questions via remote devices and display a graph of the collected data in real time [42]. Students tend to have a strong desire for interaction and engagement in their learning process, and ARS can allow an educator to make traditional presentations more interactive and increase learner engagement [43].

Innovation is simply defined as anything that is new or different from established methods [12]. Regulating bodies in higher education and healthcare agencies recognize the need to integrate technology into the curriculum and have called for innovative teaching strategies as well [32]. Changes in today's learners in conjunction with the difficult and vast material taught in healthcare education require the increased effectiveness of educators [1]. Lecture and discussion are cost-effective means of delivering education and can be useful, but intermittent breaks in content for instructional activities or other types of content presentation can increase retention and comprehension [47]. The overall purpose of innovative strategies is to make learning more memorable and applicable to practice by enhancing knowledge acquisition [12]. There are a variety of innovative strategies educators may use, including problem-based learning, blended learning, gamification, storytelling/journaling, and social network-based learning.

Problem-based learning is a student-centered instructional approach whereby students are exposed to real-life problems or situations as opposed to subject-related courses. Students are then asked to generate learning issues related to what they need to know to solve or understand the problem. They seek out this information either independently or as a group and then reconvene to use their findings to solve the original problem through application [48]. It is a guided learning activity based in inquiry and built upon the foundation of cooperative learning [49]. The major goal of using this approach is to foster critical thinking that relates to professional practice situations. Other goals include helping students to develop flexible knowledge that can apply to various situations, fostering effective problem-solving skills, and increasing intrinsic motivation [50].

Professionals and learners in the healthcare industry require specific clinical and technical skills to practice [54]. Blended learning combines traditional face-to-face instructional methods with online or e-learning techniques with the goals of supporting and enhancing student, educator, and resource interactions and making learning meaningful [55]. Many universities and colleges have turned to blended learning as a means to meet the needs of learners and their current or potential employers [56]. With this approach, educators post course lectures, resources, lecture slides, or other materials in online formats for participants to access as required or needed. It allows the learner more flexibility in using content, as participation in a traditional class setting is not necessary to receive class materials. This appeals to the principles of adult learning, giving learners more flexibility in their educational process [57].

Healthcare education benefits from tools that foster systems thinking and facilitate complex learning [60]. More complex forms of gaming, such as digital role-playing or simulation-based games, can provide immediate or just-in-time feedback, helping participants realize the consequences of their actions in a safe learning environment [49,60]. Educational games can address all levels of learning, including reinforcing content, helping participants with application of content, and employing analysis and decision-making skills [59].

Journaling is simply the process of writing down one's personal thoughts, feelings, beliefs, and/or values related to an experience or situation. It can be used as a tool for healthcare providers to reflect on and review how personal experiences and beliefs influence their professional practice [12]. Storytelling can be used as a way to relate taught material to professional situations and practices, particularly for learners with limited exposure to clinical practice. Educators may also use storytelling to illustrate how course content relates to various clinical situations, thereby enhancing understanding.

Challenges implementing social networking methods are often related to professional boundaries. As noted, most learners are accustomed to social networking sites, but guidelines for professional learning participation should be provided if they are to be used as instructional mediums. The guidelines should include communication expectations and standards and how to represent oneself professionally online. Professional agencies, such as the American Nurses Association, remind healthcare professionals that their participation in social networking and online self-portrayal are reflective of the overall profession [12,70].

Social networking sites can move beyond communities of practice and information sharing. They can be used as way to reflect on topics, debrief events or difficult situations, and work through complex problems by promoting group thinking and collaboration. These applications can also bring students together for emotional and professional support. For instance, first-year nursing students at various colleges could be invited to the same social networking sites to discuss and share opinions or questions uniquely related to their common situation. Remember, any information published on social media should reflect professional standards and best practices, be well vetted for accuracy, and be closely monitored for abusive or misinformative comments or content. The desired outcomes as well as the consequences of a social media post should be considered before publishing [71].

Course assessments should include an opportunity for participants to provide feedback on the innovative strategies or technology, which can then be used to revise and adjust courses. Consider if strengths can be enhanced or shared with other educators to improve courses further. Identify weaknesses that can be addressed with revisions or by adjusting the instructional method or technology used to improve learning outcomes. It is important to embed assessment in courses and to revise periodically and as needed to keep as current as possible with the changes and needs in health care.

When creating or revising a course, it can be difficult to determine where to start, and deciding which new strategies or technology to incorporate can be complex [75]. Learners and instructors have seen trends come and go in technology and innovation use in education [9]. Making strategic decisions regarding the incorporation of innovative techniques requires educators to take on the role of designer and analyzer, which they may or may not be familiar and comfortable with. However, this is necessary in order to create a balanced course delivery. Finding this balance is important to ensuring an efficient mix of conveying class material and providing a means for students to connect with it [76].

The first step in the selection process is considering the specific content of the learning activity and the learning needs of the participants [72]. How do these two items relate and/or support each other? If the current content is not clearly defined, an innovative strategy or technology can be used to help clarify and/or to make information more accessible or applicable to learners. Take time to define the audience, environment, and motivating factors that will engage learners so they are addressed by the choice in innovative strategy or technology [14].

Selected educational strategies should accomplish their purpose for incorporation effectively and efficiently [1]. To ensure this occurs, the final phase of incorporation should be evaluation. Educators should take time to reflect on their personal experiences in order to identify potential areas for adjustment to make the next course or activity more successful. Learner feedback should also be gathered to determine if the strategy enhanced learning, facilitated engagement with the material, or resulted in improvements in application of the information. Learners may also be asked to share their experiences and provide suggestions for improvements. In addition, quantitative course data may be helpful. For example, exam questions related to course content presented using innovative strategies may be assessed to determine if knowledge was retained and appropriately applied.

Although it is possible to incorporate innovative design and implementation strategies without assistance, finding support services to aid in the process increases the chances of success. There are a variety of ways an educator can find sources of support related to their personal projects or interest, including professional development courses, technology training classes, mentoring relationships, support or interest groups, and professional learning communities.

All educators will need help at some point, but they may not have the time, experience, or connections to access the support they need to be successful [79]. Gaining access to materials or people that could be helpful can be a challenge. If available, technical support staff can provide assistance with troubleshooting and questions. However, many educators do not belong to institutions with dedicated information technology staff or access to such staff may be limited. Alternative resources may include the startup guides, troubleshooting guides, and frequently asked questions related to usage of specific technology. Manufacturers or vendors may also have instant messaging services to contact remotely located support professionals. Discussion boards and chat rooms from professional organizations and networking sites can also provide knowledge and insight.

Innovative teaching methods challenge long-held assumptions and standards regarding clinical-based education in nursing and other health sciences [84]. While the use of technology is growing in acceptance and popularity, educators implementing innovative teaching strategies may have more challenges to address. The natural instinct for curiosity and drive to learn seems to be dissipating, especially for students in higher education [76]. Today's learners prefer class information to be given passively through notes and lectures. New strategies require a substantial shift in students' roles and responsibilities [85]. This can translate to negative acceptance or pushback when educators try to employ engaging, innovative, active, and/or new teaching methods. Support for these approaches may be found in empirical research, other faculty members who have or are implementing such strategies, and supervisors (if learner complaints are made). Explaining why certain methods are used and the expectations for learners can improve participation and commitment. When an educator uses a teaching method that may make learners uncomfortable or anxious, time should be taken to explain why [86].

Innovative teaching methods challenge long-held assumptions and standards regarding clinical-based education in nursing and other health sciences [84]. While the use of technology is growing in acceptance and popularity, educators implementing innovative teaching strategies may have more challenges to address. The natural instinct for curiosity and drive to learn seems to be dissipating, especially for students in higher education [76]. Today's learners prefer class information to be given passively through notes and lectures. New strategies require a substantial shift in students' roles and responsibilities [85]. This can translate to negative acceptance or pushback when educators try to employ engaging, innovative, active, and/or new teaching methods. Support for these approaches may be found in empirical research, other faculty members who have or are implementing such strategies, and supervisors (if learner complaints are made). Explaining why certain methods are used and the expectations for learners can improve participation and commitment. When an educator uses a teaching method that may make learners uncomfortable or anxious, time should be taken to explain why [86].