West Virginia Nurse - January 2022

Page 4 West Virginia Nurse January, February, March 2022
Innovative Thinking: Where Necessity
Requires New Methods of Teaching
Christy Barnhart, DHSc, MSN, RN, CHSE
Introduction
This article looks at the challenges in nursing schools
everywhere when the pandemic began in March of 2020
and how simulation helped meet the learning needs
of the nursing students at the WVU School of Nursing
(SON). Nursing schools everywhere were sending the
students home to complete the semester virtually
online. This change was a sudden shift from “normal”
to one that no one was expecting to occur. How do we
finish clinical hours? How will the seniors complete the
needed hours to graduate in May?
With so many uncertainties of the who, what,
why, when, and where, it was time for simulation in
nursing education to shine and lead the way for use
in technology to engage learning throughout the
pandemic. These new changes/adaptations were
enlightening to new methods to be useful now and for
future learning sessions. Learning management systems
helped optimize learning, which enabled faculty and
students to think outside the box.
Simulation is used for nursing education whether
or not there is a pandemic because it is a safe place for
students to learn by making mistakes. Students can
make mistakes, learn from them during the simulation,
and use guided reflection to evaluate their strengths
and weaknesses. Simulation education allows for
safe patient outcomes because the students correct
mistakes before the mistakes reach the patient (Weberg
et al., 2021).
Simulation in Nursing Education
Simulation and skills training occur throughout the
curricular progression of nursing school. Nursing schools
can use simulation education to substitute for clinical
learning, up to 50% (Wolters Kluwer, 2017). Students can
learn new nursing skills in the skills lab before practicing
these skills on the patients at the hospital. Some of the
learned skills are tested in the lab to ensure student
competency levels before practicing on the patients.
Nursing students are placed into a realistic situation
where the application of the learned skills is evaluated.
The realistic situations or simulations are to be treated
as a typical clinical day. Students are prebriefed before
going into the room with peers. During pre-brief, the
faculty discusses broad objectives, role assignments, and
scene/scenario-patient information/room orientation.
After the students see their simulated patients, they
return to the classroom for a facilitated debriefing
session (Hanshaw & Dickerson, 2020).
Broad objectives
Some broad objectives include patient safety,
critical thinking strategies/actions, and communication.
Patient safety consists of a discussion about falls
prevention, medication safety, and infection control
(Mitchell & Assadi, 2021). An example of a question
for students is “When you think about patient safety,
what are some things that come to mind?” Students
typically mention side rails, a clutter-free environment,
bed in the low position, the six patient rights, and hand
hygiene.
We discuss using critical thinking while providing
care and appropriate nursing interventions for the
presenting patient problem. The faculty discuss the
importance of communication with the patient and
family and the health care team and how conversations
can differ. References are made to government resources
such as those from Agency for Healthcare Research
and Quality (2018) and how/when the nurses use SBAR
(Situation Background Assessment Recommendation)
and IPASStheBATON (Introduction, Patient, Assessment,
Situation, Safety Concerns, Background, Actions, Timing,
Ownership, and Next).
Students face different patient situations when
entering the simulation room. Beforehand, it is
important to discuss the functionality of the manikins
(pulses, pupillary response, chest rise and fall, heart
sounds, lung sounds, abdominal sounds, etc.) and
the limitations of the manikin (can’t walk or move
extremities).
Patient problems require nursing interventions,
and students are expected to utilize critical thinking
strategies to apply to the given situation. An example of
using critical thinking is that the manikin patient has a
blood pressure of 100/50 and a heart rate of 58 beats per
minute; they are due for metoprolol 50 mg by mouth.
The student should retake the vital signs and call the
lead clinician if the heart rate isn’t greater than 60 bpm.
The student would be expected to use SBAR when
communicating a patient problem to the clinician.
Communication is an essential skill to practice
while in the lab, as it is essential to relay important
patient information to get prompt and effective
treatment for the patient. Using SBAR is a vital student
goal in the simulation lab and beyond. Students use
SBAR to relay patient problems to the lead clinician,
pharmacist, and other health care team members.
When educating patients regarding the plan of
care, students need to be aware of the patient’s
comprehension of the plan and provide information
that can be understood by the patient and family (in
layperson’s terms).
Role assignments
Students are broken into groups and assigned roles.
The roles consist of an assessor, medication administrator
(intravenous and oral medications), and communicator
(educates the patient and family members and calls the
lead clinician or other health care team members regarding
patient issues). Different roles can involve students
outside the scenario (parent, respiratory therapist, or the
rapid response team). Some nursing students who are
not participating in the simulation are observers and are
expected to participate in a debriefing. These observers can
participate in the second simulation scenario, wherein the
first group has a chance to observe and then participate in
the debrief.
Scene/scenario-patient information/room orientation
Setting the stage for the student helps to give the tools
needed to have a successful learning experience. The scene
involves the location of the scenario (hospital room, clinic,
home visit, health care provider’s office, emergency room,
telehealth, etc.). This information is vital for the student to
prepare for patient care.
Providing the scenario to the student, not only by
reading it like a hand-off report but also by going over
the information on the computer and how to access
information when the faculty member steps out of the
room, can be helpful and create a successful experience.
Orienting the students to the information and where to
find the labs, medications, history and physical, etc., can be
helpful information to make decisions within the scenario.
An orientation to the patient’s room lets the students
know where to find essential equipment needed for the
scenario. Teaching the student communicator how to use
the phone can allow the students to make appropriate
phone calls while in the simulated experience. Showing
the student how to move the bed/stretcher up and down
and where the IV line is located on the manikin can allow
the students to enter the simulated patient’s room with
confidence to provide safe and effective care.
Your Story.
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and build your future at Cal U.
calu.edu/nursing