WEEK 4: TEACHING CLINICAL IN A VARIETY OF SETTINGS
[FOCUSED ON AMBULATORY CARE]
[FOCUSED ON AMBULATORY CARE]
Niederhauser, Schoessler, Gubrud-Howe, Magnussen & Codier (2012) state that stakeholders, faculty members, and nurse educators need to join forces to develop a reality-based educational program that will allow for the graduate nurse transition into practice. As nursing education has traditionally valued the clinical experience as an essential aspect of the learning process for undergraduate nursing students, practicing in the clinical settings allows the opportunity for students to apply what they have learned in the classroom, thus helping to prepare them for the real world of nursing (Ironside, McNelis & Ebright, 2013). By working in clinical settings, this allows nursing students to begin to learn how to organize and prioritize actual bedside nurse care (Ironside, McNelis & Ebright, 2013) in addition to applying their knowledge and skills.
Based on IOM (2010) recommendations, and as health care emerges, it becomes imperative that nurses entering the workforce are prepared to provide patient care to their highest ability within their scope of practice (Ironside, McNelis & Ebright, 2013). Swan (2007) reports that because the healthcare needs of patients and the costs associated with acute care are rising, the need to employ nurses in ambulatory settings has increased in necessity. With the increased need for ambulatory nurses comes the need for introducing ambulatory care into the clinical setting of undergraduate studies. Swan (2007) debunks many myths in her article including the myth that RN’s who work in ambulatory care settings cannot ‘cut it’ in acute care settings because they cannot care for complex patients. She argues that ambulatory care nurses require RN’s to have critical care skills or specialized education and training in order to care for the increased complexity of patient diagnoses and procedures that are being seen in outpatient settings. Swan (2007) also mentions that nurses working in ambulatory settings are required to exhibit critical thinking skills and clinical judgment because they are being required to make rapid assessments of sicker patients in a time sensitive environment. In addition to students learning theoretical and experiential components commonly seen in undergraduate nursing school, collaborative efforts among nursing education and ambulatory care organizations must focus on incorporating components specific to ambulatory care nursing (Swan, 2007). Such components include triage assessment and disposition, decision making and priority setting, care management in clinics, patient and family education, advocacy and health system management, technology applications such as virtual care, and telehealth nursing practice (Swan, 2007).
In my opinion, simulations are one of the best teaching strategies for allowing nursing students to demonstrate their knowledge and skills as well as practicing clinical judgment, clinical reasoning and critical thinking skills. With the difficulty in finding available ambulatory clinic settings that are available to support the learning needs of nursing students, the use of virtual simulation would be beneficial. “Second Life” is a virtual simulation environment that allows nurse educators to develop scenarios and competencies that focus on a variety of real-life situations that are reflective of the type of patients you might see in an ambulatory care setting. One example of virtual simulation in the ambulatory care setting as described by Aebersold & Tschannen (2013) is the education surrounding a patient with type-two diabetes. The authors provide three scenarios; non-compliant patient, the patient requiring medication management, and the patient with psychosocial needs and barriers to effectively manage diabetes (Aebersold & Tschannen, 2013). While managing the three patient scenarios, the students were able to partake in the virtual simulation that afforded them the opportunity to identify underlying issues, discuss mutual goals and develop a plan for future care. This helps the student to learn how to develop a collaborative partnership with their patient’s, use clinical judgment and reasoning for identified teaching needs, as well as develop critical thinking skills. This would also address the cognitive and affective levels of Blooms Taxonomy as students are challenged to recall knowledge of diabetes management as well as their ability to communicate effectively while being a patient advocate and taking into consideration the patient’s needs, values and beliefs.
Another great teaching strategy for the use in ambulatory patient care settings is the use or role play. Because ambulatory care nursing requires the nurse to triage patients, this could be a fun and interactive approach that will help to build students clinical reasoning, clinical judgment, and critical thinking skills. This would address the cognitive level of Blooms Taxonomy. The instructor could place students in two groups consisting of 3-5 students each depending on the class size, and students could take turn practicing being the nurse vs. the patients. The instructor could provide the “patients” with cue cards that depict a case scenario in which the nurse will have to telephone triage patients to determine the acuity of their care needs. The students will discuss the reasoning behind their triage decisions during post-conference and further clarification can be provided by the instructor as needed.
Despite the advances in health care, clinical education in nursing has not changed much in order to meet the increased needs of our patients (Ironside, McNelis & Ebright, 2014). As we know, recommendations of the IOM (2010) include the push for nurses to practice to the full extent of their education and training and the need for education system improvement. Nurse educators are being challenged to develop innovative, cost-effective, and high-quality teaching strategies that prepare nursing students for real-world practice. It is our job as nurse educators to ensure that our undergraduate students are reaching their potential and gaining the experiences they need in order transition to practice in a variety of patient care settings (Benner, Sutphen, Leonard, & Day, 2010; Ironside, McNelis & Ebright, 2013; Niederhauser, Schoessler, Gubrud-Howe, Magnussen & Codier, 2012) including that of ambulatory care.
References:
Aebersold, M. & Tschannen, D. (2013). Simulation in nursing practice: The impact on patient care. The Online Journal of Issues in Nursing, (18)2, Manuscript 6. Doi: 10.3912/OJIN.Vol18No02Man06
Benner, P., Stuphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey Bass
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health, Retrieved on March 9, 2017, from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Recommendations.aspx
Ironside, P. M., McNelis, A. M. & Ebright, P. (2014). Clinical education in nursing: Rethinking learning in practice settings. Nursing Outlook, (62)3, 185-191. Doi:10.1016/j.outlook.2013.12.004
Niederhauser, V., Schoessler, M., Gubrud-Howe, P. M., Magnussen, L. & Codier, E. (2017). Assessment of graduate nurses entry level competencies: Expectations of faculty members versus nurse managers. American Journal of Nursing Research, (5)1, 1-12. Doi: 10.12691/ajnr-5-1-1.
Randolph, S., Evans, C. & Bacon, C. T. (2016). Preparing BSN Students for Population-Focused Nursing Care. Nursing Education Perspectives, (37)2, 115-117.
Swan, B. A. (2007, March). Transitioning from acute care to ambulatory care. Retrieved on March 9, 2017 from Thomas Jefferson University website http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1013&context=nursfp
Based on IOM (2010) recommendations, and as health care emerges, it becomes imperative that nurses entering the workforce are prepared to provide patient care to their highest ability within their scope of practice (Ironside, McNelis & Ebright, 2013). Swan (2007) reports that because the healthcare needs of patients and the costs associated with acute care are rising, the need to employ nurses in ambulatory settings has increased in necessity. With the increased need for ambulatory nurses comes the need for introducing ambulatory care into the clinical setting of undergraduate studies. Swan (2007) debunks many myths in her article including the myth that RN’s who work in ambulatory care settings cannot ‘cut it’ in acute care settings because they cannot care for complex patients. She argues that ambulatory care nurses require RN’s to have critical care skills or specialized education and training in order to care for the increased complexity of patient diagnoses and procedures that are being seen in outpatient settings. Swan (2007) also mentions that nurses working in ambulatory settings are required to exhibit critical thinking skills and clinical judgment because they are being required to make rapid assessments of sicker patients in a time sensitive environment. In addition to students learning theoretical and experiential components commonly seen in undergraduate nursing school, collaborative efforts among nursing education and ambulatory care organizations must focus on incorporating components specific to ambulatory care nursing (Swan, 2007). Such components include triage assessment and disposition, decision making and priority setting, care management in clinics, patient and family education, advocacy and health system management, technology applications such as virtual care, and telehealth nursing practice (Swan, 2007).
In my opinion, simulations are one of the best teaching strategies for allowing nursing students to demonstrate their knowledge and skills as well as practicing clinical judgment, clinical reasoning and critical thinking skills. With the difficulty in finding available ambulatory clinic settings that are available to support the learning needs of nursing students, the use of virtual simulation would be beneficial. “Second Life” is a virtual simulation environment that allows nurse educators to develop scenarios and competencies that focus on a variety of real-life situations that are reflective of the type of patients you might see in an ambulatory care setting. One example of virtual simulation in the ambulatory care setting as described by Aebersold & Tschannen (2013) is the education surrounding a patient with type-two diabetes. The authors provide three scenarios; non-compliant patient, the patient requiring medication management, and the patient with psychosocial needs and barriers to effectively manage diabetes (Aebersold & Tschannen, 2013). While managing the three patient scenarios, the students were able to partake in the virtual simulation that afforded them the opportunity to identify underlying issues, discuss mutual goals and develop a plan for future care. This helps the student to learn how to develop a collaborative partnership with their patient’s, use clinical judgment and reasoning for identified teaching needs, as well as develop critical thinking skills. This would also address the cognitive and affective levels of Blooms Taxonomy as students are challenged to recall knowledge of diabetes management as well as their ability to communicate effectively while being a patient advocate and taking into consideration the patient’s needs, values and beliefs.
Another great teaching strategy for the use in ambulatory patient care settings is the use or role play. Because ambulatory care nursing requires the nurse to triage patients, this could be a fun and interactive approach that will help to build students clinical reasoning, clinical judgment, and critical thinking skills. This would address the cognitive level of Blooms Taxonomy. The instructor could place students in two groups consisting of 3-5 students each depending on the class size, and students could take turn practicing being the nurse vs. the patients. The instructor could provide the “patients” with cue cards that depict a case scenario in which the nurse will have to telephone triage patients to determine the acuity of their care needs. The students will discuss the reasoning behind their triage decisions during post-conference and further clarification can be provided by the instructor as needed.
Despite the advances in health care, clinical education in nursing has not changed much in order to meet the increased needs of our patients (Ironside, McNelis & Ebright, 2014). As we know, recommendations of the IOM (2010) include the push for nurses to practice to the full extent of their education and training and the need for education system improvement. Nurse educators are being challenged to develop innovative, cost-effective, and high-quality teaching strategies that prepare nursing students for real-world practice. It is our job as nurse educators to ensure that our undergraduate students are reaching their potential and gaining the experiences they need in order transition to practice in a variety of patient care settings (Benner, Sutphen, Leonard, & Day, 2010; Ironside, McNelis & Ebright, 2013; Niederhauser, Schoessler, Gubrud-Howe, Magnussen & Codier, 2012) including that of ambulatory care.
References:
Aebersold, M. & Tschannen, D. (2013). Simulation in nursing practice: The impact on patient care. The Online Journal of Issues in Nursing, (18)2, Manuscript 6. Doi: 10.3912/OJIN.Vol18No02Man06
Benner, P., Stuphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey Bass
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health, Retrieved on March 9, 2017, from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Recommendations.aspx
Ironside, P. M., McNelis, A. M. & Ebright, P. (2014). Clinical education in nursing: Rethinking learning in practice settings. Nursing Outlook, (62)3, 185-191. Doi:10.1016/j.outlook.2013.12.004
Niederhauser, V., Schoessler, M., Gubrud-Howe, P. M., Magnussen, L. & Codier, E. (2017). Assessment of graduate nurses entry level competencies: Expectations of faculty members versus nurse managers. American Journal of Nursing Research, (5)1, 1-12. Doi: 10.12691/ajnr-5-1-1.
Randolph, S., Evans, C. & Bacon, C. T. (2016). Preparing BSN Students for Population-Focused Nursing Care. Nursing Education Perspectives, (37)2, 115-117.
Swan, B. A. (2007, March). Transitioning from acute care to ambulatory care. Retrieved on March 9, 2017 from Thomas Jefferson University website http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1013&context=nursfp