Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences.     

Building psychiatric advanced practice student nurse competency to conduct comprehensive diagnostic interviews using two types of online simulation methods

BackgroundThrough innovative use of established technologies, online nursing programs can provide psychiatric mental health nurse practitioner (PMHNP) students with robust virtual experiences for learning professional competencies, including those involving psychomotor and affective domains.PurposeTo describe a virtual simulation teaching methodology using online text-based simulations of patient visits prior to a virtual standardized patient (SP) encounter in an asynchronous online course for PMHNP students.MethodStudent learning experiences were framed by the Framework for the 21st Century Learning. Two types of online simulations were employed: (1) four text-based exercises, created with a testing tool in a learning management system, allowed students to practice the critical thinking processes behind diagnostic interviewing, and (2) a telehealth simulation with an SP, where students engaged the patient, conducted a diagnostic interview, and discussed the treatment plan with the patient. Following the telehealth simulation, students completed self-assessments, received individual feedback from the SP and clinical faculty, and discussed experiences in small groups.ResultsStudents demonstrated professional competencies and developed self-awareness and self-efficacy through reflection and discussion.ConclusionThis teaching approach can potentially enhance learning and build greater career skills including conducting diagnostic interviews using therapeutic communication skills for patients with stigmatizing mental health conditions.     

Interpreting the NLN Jeffries Framework in the context of Nurse Educator preparation

The NLN Jeffries Framework describing simulation in nursing education has been used widely to guide construction of human patient simulation scenarios and serve as a theoretical framework for research on the use of simulation. This framework was developed with a focus on prelicensure nursing education. However, use of human patient simulation scenarios is also a way of providing practice experiences for graduate students learning the educator role. High-fidelity human patient simulation offers nurse educator faculty a unique opportunity to cultivate the practical knowledge of teaching in an interactive and dynamic environment. This article describes how the components of The NLN Jeffries Framework can help to guide simulation design for nurse educator preparation. Adapting the components of the framework-which include teacher, student, educational practices, design characteristics, and outcomes-helps to ensure that future faculty gain hands-on experience with nurse educator core competencies.     

Emotional connection and integration: dominant themes among undergraduate nursing students using a virtual community

The use of virtual communities is an emerging pedagogical application that enhances student learning in nursing education. This study involved a sample of 40 undergraduate students enrolled in a baccalaureate nursing program using The Neighborhood as a teaching application across the curriculum. The students were followed over three successive semesters. Using the qualitative method of content analysis, student responses generated by open-ended questions were grouped and analyzed to identify major themes. Analysis of the data revealed two primary themes: (1) an emotional connection to specific characters or families, and (2) integration of characters and events into learning activities. Student feedback indicated that virtual communities provide a viable strategy for teaching nursing concepts and their application.     

A case for learning-centered curricula

Nurses must be able to anticipate and manage the care of patients with complex conditions in a rapidly changing, highly technological health care environment. Yet many of today's nursing programs are failing to provide curricula to meet the changing needs of students who will work in that environment. Typical teacher-centered programs are content heavy and focus on what faculty want to teach, not what students need to learn. Learning-centered education shifts the focus from teaching to student learning. Learning-centered programs identify student learning outcomes that are reflective of current nursing practice, use authentic assessment, and provide learning experiences that move students toward the achievement of outcomes. This article describes the major benefits of a learning-centered curriculum, and a model depicts the dynamic relationship among learning experiences, assessment, and student learning outcomes. We also offer suggestions for nursing faculty who are considering the move from teacher-centered to learning-centered curricula.     

An Educational Strategy for Teaching Standardized Nursing Languages

PURPOSE.  The aim of this paper is to describe an educational strategy for teaching standardized nursing languages (SNL) used in both the classroom and clinical components of a psychiatric–mental health nursing course at the associate degree level.
DATA SOURCES.  Data included a review of the relevant literature, teaching experiences, and faculty and student experiences.
DATA SYNTHESIS.  Enhancing associate degree student nurses' competency regarding diagnosis and interventions is essential to influence positive health outcomes. Use of diagnostic, outcome, and intervention classifications for learning nursing care promotes critical thinking, individualization of nursing care, and students' fluency with SNL. One possible teaching strategy to assist students to learn and use SNL was implemented through the use of a faculty-developed Student Nurse Documentation Packet.
CONCLUSIONS.  The educational strategy provided students opportunities to enhance their experience with the SNL to plan and document care of individuals experiencing psychiatric–mental health problems.
IMPLICATIONS FOR NURSING.  The educational strategy used in this program was judged to be successful. Research is needed to provide empirical evidence of the efficacy of this pedagogical strategy for increasing knowledge and enhancing students' competency.     

Baccalaureate nursing students' experiences with multi-patient,standardized patient simulations using telehealth to collaborate

BackgroundNurse faculty must utilize teaching strategies that promote student achievement of essential competencies, and simulation can provide experiential learning to help prepare students for professional practice.PurposeThe purpose of this phenomenological qualitative study was to explore baccalaureate nursing students' experiences with multi-patient, standardized patient simulations that used telehealth to provide opportunities to learn and practice intra- and interprofessional collaboration. Student perceptions of their ability to utilize lessons from the simulations in clinical practice were also examined.MethodsFocus group interviews were conducted with 27 final-semester baccalaureate nursing students after they had participated in two telehealth-enhanced simulations.ResultsAnalysis revealed five themes: Anxiety due to lack of experience, Improved clinical reasoning, Real world practice, How to communicate effectively, and Application to clinical practice.ConclusionThe use of telehealth helped overcome barriers to implementing collaborative simulations and provided students with experiential learning that addressed essential competencies for safe and effective professional nursing practice.     

Using Feedback to Improve Clinical Education of Nursing Students in an Academic-Practice Partnership

There is growing evidence to support partnerships between academic and practice institutions. In one of the Veterans Affairs Nursing Academic Partnerships (VANAP), nurses supervised undergraduate nursing students during the clinical practicum of acute care courses. To evaluate the partnership, faculty solicited feedback from nurses, clinical site leaders, and students. In this quality improvement project, feedback, in the form of written questionnaires and informal debriefing, was collected over four years at the end of sophomore and junior courses. Six site leaders, 71 students, and 34 nurses provided feedback. Common themes were: (1) all participants valued faculty presence during the clinical day, (2) students benefited from being paired with the same nurse throughout the course, (3) clinical teaching associates and site leaders suggested students be present for entire 12-hour shifts, and (4) clinical teaching associates, desired more training to address student needs. Several changes were made using this feedback: piloting a 12-hour shift and providing nurses with in-services on strategies to coach nursing students. Follow-up feedback showed high levels of satisfaction with these changes. Collecting feedback from students and staff provides guidelines for changing educational practices. Implementing changes based on the feedback strengthens partnerships, supports student learning needs, and improves student experiences.     

Increasing competence in wound care: A cross-sectional study to evaluate use of a virtual patient by undergraduate student nurses

Concerns have arisen internationally over the competency of student nurses to perform wound care. A global shortage of nursing faculty and clinical practice opportunities is regarded as a contributing factor. Virtual simulation offers a possible solution.The aim of this study was to describe the development and educational evaluation of a virtual patient to supplement undergraduate learning of wound care. The National League for Nursing Jeffries model informed the design of the media. Evaluation of the virtual patient by penultimate year nursing students (n = 148) was conducted using a survey design. Findings are presented from statistical and directed content analyses.Most students rated the educational value of the virtual patient and its support of learning highly. They reported a perceived increase in confidence and ability to meet wound care competency outcomes. The virtual patient also provided students with opportunities to develop their clinical reasoning skills.This study provides evidence that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care. It allows nursing students the opportunity to practice skills and utilise theory repetitively in a safe environment, unhampered by a lack of resources such as clinical placement availability and a declining faculty.     

Innovations in virtual education for clinical and simulation learning

The global impact of COVID-19 forced nursing education to provide an alternative for scheduled clinical experiences during the Spring and Fall of 2020. Many programs selected the pre-packaged, web-based solutions at the onset of the pandemic due to the uncertainty and recommendation of social distancing. Clinical and simulation faculty began to look for educational alternatives to provide meaningful learning experiences that more closely replicated clinical learning because students expressed displeasure with the asynchronous web-based options. This article outlines how an innovative partnership between clinical faculty, simulation faculty, and the Theatre Department modified an in-person simulation activity designed for groups of two students into a web-based “clinical” experience that included the assigned clinical faculty, eight nursing students, and one simulated patient. This active learning strategy was able to meet the course objectives, required little additional resources, and most importantly, underwent positive evaluation by the weary, screen-based learners.     

Creating and sustaining an academic‐practice Partnership Engagement Model

Public health clinical educators and practicing public health nurses (PHNs) are experiencing challenges in creating meaningful clinical learning experiences for nursing students due to an increase in nursing programs and greater workload responsibilities for both nursing faculty and PHNs. The Henry Street Consortium (HSC), a collaborative group of PHNs and nursing faculty, conducted a project to identify best practices for public health nursing student clinical learning experiences. Project leaders surveyed HSC members about preferences for teaching‐learning strategies, facilitated development of resources and tools to guide learning, organized faculty/PHN pilot teams to test resources and tools with students, and evaluated the pilot team experiences through two focus groups. The analysis of the outcomes of the partnership engagement project led to the development of the Partnership Engagement Model (PEM), which may be used by nursing faculty and their public health practice partners to guide building relationships and sustainable partnerships for educating nursing students.     

Service learning: a strategy to develop group collaboration and research skills.

Many colleges and universities currently are implementing service learning as an educational strategy into their curricula. The goal of service learning is a dynamic partnership between educational institutions and communities resulting in the mutual benefits of service and learning. Although service learning has significance for teaching nursing students, educators must differentiate service learning from clinical practicum. This article provides a definition of service learning, identifies the relevance of service learning for nursing education, presents an example of service learning integrated into a nursing course, and evaluates service learning as a methodology for teaching group collaboration and research skills. Student surveys, a focus group, and community partner evaluations indicated service learning contributed to the development of group collaboration and research skills among baccalaureate nursing students. To enhance faculty, student, and community partner satisfaction with service learning, instructors should clearly define service learning experiences for a specific setting and offer structured guidance that does not interfere with student decision-making.     

Comparison of the effectiveness of the virtual simulator and video-assisted teaching on intravenous catheter insertion skills and self-confidence: A quasi-experimental study

BackgroundWith the advancement of technology, methods such as clinical scenarios, role playing, video demonstration and simulation are now used to develop psychomotor skills in nursing education. Virtual reality and video-assisted teaching are useful technologies for the development of skills and self-confidence. In the literature, there is a lack of studies comparing the effects of the two methods.ObjectivesThe aim of study is to compare the effect of the virtual simulator and video assisted teaching on the level of intravenous catheterization skills and self-confidence of nursing students. Thus, students are enabled to develop skills and work efficiently without the need for an instructor.MethodsThis study was a randomized controlled quasi-experimental study. A total of 60 students was included in the study (30 in the virtual simulator group and 30 in the video group). In the virtual simulator group, each student performed an intravenous catheter insertion in the virtual intravenous simulator. In the video group, each student watched a training video on the peripheral intravenous catheterization skill in a classroom setting. Each of the students' level of intravenous catheterization knowledge, psychomotor skill and self-confidence score was evaluated.ResultsPost-test knowledge scores was higher than pretest knowledge scores for both groups. There were no significant difference between the groups in terms of post-test scores. Students' scores of psychomotor skills were found to be higher in the virtual simulator group and self-confidence scores were similar in both groups.ConclusionTeaching with the virtual simulator contributed to the students' skills more than the method used in the video training. Both methods are effective in the development of knowledge and self-confidence related to intravenous catheterization.     

Pediatric clinical simulation: a pilot project

With increased enrollment, nursing faculty are finding clinical placement for students more difficult, especially in clinical areas such as child health. Simulation using moderate-fidelity and high-fidelity manikins offers evidence-based and innovative approaches to augment traditional clinical experiences. However, few studies quantitatively examine student outcomes associated with clinical simulation. This article describes student learning outcomes related to traditional and hybrid (part simulation and part traditional clinical) undergraduate clinical experiences in a baccalaureate nursing program. In addition, the use of faculty-developed simulation scenarios integration of Quality and Safety Education for Nurses (QSEN) competencies into four pediatric scenarios, as well as the educational development of faculty at a simulation center, are presented.     

Using simulation to promote effective communication with a diverse student population

Because of language barriers and cultural differences, effective oral and therapeutic communication remains a challenge to the linguistically diverse student. The purpose of this article is to introduce high-fidelity patient simulation (HFPS) as a teaching/learning method to develop and practice therapeutic and oral communication skills with a diverse student population. A newly established HFPS communication exercise was introduced to associate degree registered nursing students in their psychiatric–mental health nursing course. Students participated in unrehearsed interactive interviews with simulated clients in an effort to improve their verbal and therapeutic communication skills. Feedback on whether this was a successful strategy was sought from the students by means of reflective papers.     

Pandemic Crisis: Simulation Contingency Plans

BackgroundThe COVID-19 pandemic has disrupted the typical delivery of nursing education. Multifactorial issues related to the pandemic and clinical placements have forced nurse educators to employ innovative strategies for content delivery.MethodsThis article is an accounting of a simulation team response to the move to all remote or virtual simulated learning experiences over a two-week period and lessons learned on how to move forward with simulated learning contingency plans.ResultsLearning outcomes were achieved via the delivery of online commercial and faculty made experiences to simulate clinical practice. Simple and easy to use guides assisted both students and faculty for a positive experience.ConclusionCreating a detailed formal contingency plan for emergencies is essential for nursing programs. Additionally, the pandemic highlighted the importance of continuing faculty development and education in online, virtual, and simulation pedagogy. Finally, it is recommended that schools of nursing implement formal policies for replacement of clinical hours with simulation.     

Simulated experiences: Nursing students share their perspectives

In an attempt to address a shortage of clinical nursing placements, the rising complexity of care and to increase preparedness of students entering clinical settings, the provincial government of Ontario invested significant funding for the purchase of simulation equipment in undergraduate Schools of Nursing. What students believe about simulation and learning can influence how it is used and can also provide faculty with a better understanding of how it can best be implemented. This study explored nursing students’ viewpoints about the use of simulation in their nursing programs. Q-methodology was the research approach used. In total, 24 students from 17 universities and colleges participated in the study. Although all students felt that simulated experiences could support learning overall, four groups of students were identified who had differing viewpoints. Described as reflectors, reality skeptics, comfort seekers, and technology savvies, these four groups of students require unique approaches to better engage them in learning with simulation. This study provides recommendations for faculty to consider, taking into account these varied viewpoints regarding simulation in nursing education.