Authoring and implementation of virtual patients in nursing and obstetrics

– the new challenge at the Jagiellonian University Medical CollegeA. Stachoń, E. Walewska, L. Ścisło, D. Matuszyk, M. Dziedzic, A. Kononowicz

Jagiellonian University Medical College

International Conference of Virtual Patients 5-6.06.2009 Kraków

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■ Repurposing (language, culture and discipline)

■ Creating original cases

AUTHORING OF VIRTUAL PATIENTS

Authoring tool of CASUS® system – Ludwig Maximilian University

in Munich

eViP Project = electronic Virtual Patients

3-years project co-funded by the European Union

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Presentation of

patient’s problem

Anamnesis

Physical

examinationOther medical tests Therapy

Classic linear model of virtual patient

Presentation of

patient’s problem

Anamnesis

and physical

examination

Purpose of nursing interventionPurpose of nursing intervention

Purpose of nursing intervention

Purpose of nursing intervention

Nursing diagnosis

Nursing interventions

Nursing interventions

Nursing interventions

Nursing interventions

Patient’s condition

estimation

Nursing model of virtual patient

Diagnosis

AUTHORING OF VIRTUAL PATIENTS

Solution of diagnoses

Nursing diagnosis

Nursing diagnosis

Nursing diagnosis

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VIRTUAL PATIENTS IN NURSING

CASE TYPE SOURCE STATUSMr Myszkowski

77 yr old patient with bloody vomiting: Part 1

Nursing diagnostics and interventions in gastric ulcer

Repurposed

case

Mr Meissner

77 yr old patient with

bloody vomiting

Diagnostic and treatment in gastric ulcer/lymphoma

(CASUS® case for physicians)

- ready, in CASUS® system,

- media and nursing

documentation added,

- implemented into Surgical

Nursing course

Mr Myszkowski

77 yr old patient with bloody vomiting: Part 2

Nursing procedures in gastric lymphoma (surgery)

Repurposed

case - translated,

- in discipline repurposing

Mr Andrzejewski

A 48 yr old male with severe chest pain

Nursing care in myocardial infarction

Repurposed

case

Mr Angermeier

A 48 yr old male with severe chest pain

Diagnostic and treatment in myocardial infarction

(CASUS® case for physicians)

- translated,

- in discipline repurposing,- media and nursing

documentation added

Mr Sobczyński

A 38 yr old male with haemophilia A

Home care in haemophilia

Original

case

---

- created, - media and medical/nursing

documentation added,

- in amending

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VIRTUAL PATIENTS IN OBSTETRICS

CASE TYPE STATUS

Mrs Miłowicz 19 yr old pregnant patient

Obstetric care of patient in danger of premature delivery

Original case

- ready, in CASUS® system

- media and obstetric documentation added

- implemented into Obstetrics course

Mrs Iwanowska41 yr old pregnant patient

Obstetric care and procedures in premature delivery

Original case

in creation

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AUTHORING OF VIRTUAL PATIENTS

Repurposing workflow – VP Meissner/Myszkowski

Creating workflow – VP Miłowicz

contentculture

adaptationtranslation media ready

implementation

disciplineadaptation

draft of patient’s history

broadening of particular aspects media

ready

patient’s documentation

10 hmedia

ready

34 h5 h

45 h

implementation

49 h

57 h

evaluation

evaluation

2 h

10 h

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IMPLEMENTATION OF VIRTUAL PATIENTS

~ 100 students (3rd year)

~ 50 students (1st year)

~ 50 students (2nd year)

Faculty of Health Sciences JUMC

scenario: self-study, invitation students by e-mail

Surgery and Surgical Nursing

VP Myszkowski

Obstetrics Care

VP Miłowicz

purpose:

teach students define nursing

diagnoses, purposes of

interventions and plan

nursing procedures.

purpose: familiarize young students with reality of obstetrics care in case ofendangered pregnancy.

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ELEMENTS VP MYSZKOWSKI VP MIŁOWICZ

PAGES

WORDS

33

~ 4830

41

~ 7031

CARDS 25 29

PICTURES 13 + 5(series gastroscopy pictures)

21

HIPERLINKS 10 17

EXPERT COMMENTS 4 16

QUESTIONS 21(15 MCQ + 5 free + 3 others)

24(18 MCQ + 6 free)

LINK TO ONLINE SOURCES

--- 1

VP’s MARK(by students)

4,3 4,5

COMPARISON OF IMPLEMENTED VPs

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Online student questionnaire concerning their learning and clinical reasoning experiences with virtual patientsSören Huwendiek, Bas de Leng et al. 2008

STUDENTS EVALUATION OF VPs

0

10

20

30

40

50

PE

RC

EN

TA

GE

S

TOTALLY DISAGREE

DISAGREE NEUTRAL AGREE TOTALLY AGREE

LIKERT SCALE

While working on this case, I felt as if I were the nurse/obstetrics caring for this patient

VP MIŁOWICZ VP MYSZKOWSKI

N = 13

N = 14

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VIRTUAL PATIENT

N SCENARIO OF IMPLEMENTATION

QUESTIONS(AVERAGE MARKS IN LIKERT SCALE)

Q1AUTHENTICITY

Q4MOTIVATING

Q9COACHING

Q10EFFECT

MYSZKOWSKI 14 sefl-study 3,6 4,3 4,2 4,1

MIŁOWICZ 13 sefl-study 3,8 4,1 4,6 4,2

Q1 - While working on this case, I felt as if I had to make the same decisions a nurse/obstetrics would make in real life.Q4 - While working through this case, I was actively engaged in revising my initial image of the patient’s problem as new information became available.Q9 - The feedback I received while working through this case was helpful in enhancing my diagnostic reasoning in this case.Q10 - After completing this case, I feel better prepared to confirm a diagnosis and exclude differential diagnoses in a real life patient with this complaint.

well present reality of work in hospital ward mobilize to thinking of patient’s problem and finding solution expert comments were very helpful, especially when I didn’t undrestand more complicated issues some questions were too difficult and too detailled I would like to solve more virtual medical cases It was hard to motivate myself to go through all at home

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Repurposing and creating VP is time-consuming Difficulties with creation of new media Additional elements activating and

coaching students are helpful Troublesome implementation (lack of

computer lab, low motivation of students)

Student like this new educational tool …

SUMMARY & CONCLUSIONS

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Thank you for your attention