West Virginia Nurse - January 2022

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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. You have the power to do even more amazing things. Cal U has the keys to unlock your potential, dreams and abilities through RN-to-BSN and MSN programs for nursing leaders. Unlock your story and build your future at Cal U. calu.edu/nursing
January, February, March 2022 West Virginia Nurse Page 5 Facilitated debriefing Facilitated debriefing is done immediately after the scenario (Macdiarmid et al., 2020). This is when the faculty evaluates the students’ critical thinking strategies while participating in the scenario. The faculty allows the students to explore their feelings of the scenario and the actions made by the students. Students are asked: How do you think that went in your patient’s room? After that question, students are asked: Can you tell me what was going on with your patient? What did you do for the patient? Would you do anything differently after thinking about it for a little bit? These questions allow students to evaluate their strengths and weaknesses and enable the faculty to determine student gaps in knowledge. After debriefing, sometimes students may need a skills refresher after identifying a knowledge deficit (Hanshaw & Dickerson, 2020). Simulation in Nursing Education During the Pandemic Nursing education had some challenges facing the pandemic in March of 2020. Students were sent home from universities and had no clinical. Creating learning activities in the virtual world to simulate clinical experiences was a challenge. Faculty were able to utilize videos of patient situations/simulations and use this for critical thinking exercises to immerse the student in realistic situations that needed prompt action. This experience allowed for facilitated discussions regarding the patient’s safety, and in the “live” virtual simulations, students were able to interact with the standardized patient via a telehealth visit. Videos Clinical faculty created videos to play for students during a clinical day; the SON simulation team created virtual charting capabilities. Videos were created for instruction and demonstration purposes for class orientation in the summer and fall semesters of 2020 by the director of nursing simulation at WVU and posted on the learning management system. The students replayed the videos throughout the semester. Faculty also created videos for the simulation elective course. The purpose was to generate discussion among students on the discussion board about appropriate prioritization patient care. Here is a collection of five video clips that formed one day’s assignment. https://youtu.be/IzGZtok-E-o (shortness of breath) https://youtu.be/vHjH9CxDo4A (pain complaint) https://youtu.be/KnLJR4oovj0 (fall) https://youtu.be/3CRCo-IpO8Y (needs to go to the bathroom) https://youtu.be/ORm6qtrtjNo (bleeding) After viewing the scenarios, students answered the following questions: 1. Who is your priority, and why? 2. List – in order of importance – which patients you will see from 1-5 and give rationales. 3. Do you anticipate any issues with any of the patients? 4. Is there anything that you can delegate? To whom? The Use of Technology to Engage Learning In conclusion, the use of technology to engage learning is effective. The pandemic allowed for WVU School of Nursing to increase the use of technology. These new or additional uses of technology opened the door to possibilities for the future of simulation education. Now faculty has more options to offer learners different methods of learning new information. Maybe this will be the end of any “off days” for students, which could prevent them from missing important course material and clinical experiences. Faculty can video their lectures and post them for students. Clinical faculty can have video modules for students who miss clinical. Nursing education can be evolving, adaptable, and advancing, which in the long term can positively affect patient outcomes by making our students more prepared. References Agency for Health care Research and Quality. (AHRQ). (2018, July: last review). TeamSTEPPS essentials course. https://www.ahrq.gov/ teamstepps/instructor/essentials/slessentials.html. Hanshaw, S. L., & Dickerson, S. S. (2020). High fidelity simulation evaluation studies in nursing education: A review of the literature. Nurse Education in Practice, 46, 102818. https://doi. org/10.1016/j.nepr.2020.102818 Macdiarmid, R., Neville, S., & Zambas, S. (2020). The experience of facilitating debriefing after simulation: A qualitative study. Nursing Praxis Aotearoa New Zealand, 36(3), 51–60. https://doi. org/10.36951/27034542.2020.015 Mitchell, A., & Assadi, G. (2021). Using simulation exercises to improve student skills and patient safety. British Journal of Nursing, 30(20), 1198–1202. https://doi.org/10.12968/ bjon.2021.30.20.1198 Weberg, D., Chan, G. K., & Dickow, M. (2021). Disrupting nursing education in light of covid-19. OJIN: The Online Journal of Issues in Nursing, 26(1). https://doi.org/10.3912/ojin.vol26no01man04 Wolters Kluwer. (2017, January 15). Nursing landscape. Up to 50% of clinical hours can be replaced by simulations. https://www. wolterskluwer.com/en/expert-insights/up-to-50-of-clinicalhours-can-be-replaced-by-simulations Virtual “Live” Simulations Virtual telehealth visits became another method of facilitating nursing students to care for a patient’s problem differently. A standardized patient is an actor trained to portray the role of a patient and patient condition. The students would attend these sessions via Zoom and would go through the pre-briefing and debriefing process as they would if they were attending an in-person session. The feedback from the students was positive and proved to motivate them to learn.
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West Virginia Nurse - January 2022

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