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Capstone College of NursingThe University of Alabama
Capstone College of NursingThe University of Alabama
Virtual Nursing/Nursing Clinical Decisions: Patient Outcomes
Angela Collins, DSN, RNAssociate ProfessorBecky Edwards, MSN, RNAssistant ProfessorMarilyn Handley, PhD, RNAssistant Professor
Ann Graves, MS, RNInstructorDonna Gullette, DSN, RNAssistant Professor
Discuss the development of a interactive format to teach clinical judgment in complex situations.
Learning Clinical Judgment: Situational Awareness with
Virtual Consequences
Evaluate the strengthes and weaknesses of this technology format in nursing education.
Increasing numbers of critically ill patients.
Problem
Rising numbers of medication errors.
Situational Awareness
“Knowledge without experience
is just information.”
Mark Twain
Nurses make rapid decision with life-affecting consequences in managing critically ill patients.
Challenge
Practice in such decision-making is often either not available for all students or, often, cannot be entrusted to students.
Very few new graduates are prepared to care for severely ill patients, yet many new graduates find themselves in this situation.
Challenge
Nurse educators Hospital administration
How do educators help students apply essential critical care concepts?
How do administrators identify the strengths and weaknesses of nurses’ decision-making skills?
What happens when critically ill patients don’t always fit the text book description?
Could providing documentation to accrediting agencies demonstrate effective learning to ensure patient safety?
Could both students and nursing staff learn from the consequences of their actions without harm to the patient?
This was the question and
impetus
for the development
of a virtual patient case story
using interactive technology.
To improve learners clinical decision-making skills.
Virtual Teaching Method
To require learners to integrate patient’s symptoms, signs, medications, laboratory findings, and to apply pathophysiology within a realistic timeframe.
To provide corrective and evaluative feedback.
Safe learning environment No harm to patients
Interactive CD
Interactive CD
Uses a virtual patient.
Requires learners to apply advanced medical concepts to make key nursing decisions within a realistic timeframe.
Provides individualized branched feedback about the effects of each decision.
Simulated patient can live or die based on nursing decisions made.
Team Members
Nursing faculty
Hospital nurses
Computer programmers
Video producers
Student actors
Funding
The University of Alabama
provided a technology grant
for the creation of the first and second
nursing CD in this series.
A ticking clock and updated lab results alerts learners about the patient’s deteriorating condition and the need for rapid decision making.
Interactive CD
Uses a realistic clinical simulation
Principles of Learning
Presentation of visual and auditory content through both digital and animation
Presentation of information about the consequences of incorrect decisions
Reinforcement of correct decisions
Repetition of the entire sequence when incorrect decisions are made provides opportunity for further investigation of important cues
By actually seeing the consequences of
nursing decision making
when caring for critically ill patients
in a virtual setting,
learners can clearly associate cause and
effect on patient outcomes.
Purpose
Nine Decision PointsTime to recheck blood glucose after IV titration
Rate calculation relevant to IV KCL administration
Physician or NP clarification of orders
Acid-Base effects on electrolytes of glucose and potassium
Electrolyte shifts that occur with acid-base changes
Choice of fluid when administering different medications IV push
Rate of glucose, electrolyte shifts when DKA is treated
Rate calculations of concentrated electrolyte solution
Glasgow Coma Scale Assessment Scoring
Decision Points
At each of the 9 decision points
the learner selects among the choices presented.
Each time a learner makes a decision a sequence of
events is set into motion.
Learners see the consequences of their decisions
unfold in live video footage or animation.
Decision PointsIncorrect Decision
• Life-threatening consequences for the virtual patient
Correct Decision
• Next level of the patient’s care
• Program takes learner to a previous decision point
Explanation and Rationale
Documentation
Learners‘ actionsare logged
Final report is generated and can be printed
Strengths
The CD is a visual story of one critically ill virtual patient’s experience during a critical situation in his life when he was brought unconscious to the ED.
Strengths
Requires learners to integrate symptoms, medications, laboratory findings, and physiological consequences within a realistic timeframe.
Strengths
Video footage or animation depict the consequences of decisions made.
Strengths
Designed to simulate real world situations and to identify strengths and weaknesses of learners as they progress through care of the virtual patient.
Strengths
Emphasizes the importance of clinical
pharmacology and the potential harm
triggered by medications errors, which is a
JCAHO focus.
Strengths
CD is designed to work on any Windows-
based computer.
User-friendly navigation allows learners to
progress through care of the virtual patient
with ease.
Evaluation
Students describe this interactive CD as highly realistic and more complex than other exams.
Hospital users like the CD’s diagnostic capacity for areas of clinical weakness.
One student wrote on her evaluation that the CD was the hardest test she had ever taken.
Outcomes
Students are motivated to review acid-base and electrolyte imbalance.
Out of 114 senior baccalaureate nursing students, only 5% were able to navigate through the case study without harm to the patient.
The greatest obstacle to success was order clarification.
Awards
Recipient of the 2004 Excellence in Teaching Award from the Alabama League for Nursing. (May 2004)
Recipient of the Computer-Based Professional Education Technology Regional Award from the International Sigma Theta Tau. (November 2004)
Summary
The essence of expert clinical practice is
pattern recognition and application of critical
thinking as part of the decision-making
process.
Expert clinical practice
is about learning from your patients!
The Nursing Clinical Decisions: Patient
Outcomes CD accomplishes all of this:
Pattern recognition
Application of criticalthinking
Learning from patients
To order the Nursing Clinical Decisions: Patient Outcomes CD or to receive a CD demo go to http://nursing.ua.edu/ncd_demo_ order_form.htm
For More Information
OR
Visit our Web site at http://nursing.ua.edu/ncd.htm