Preparing Nursing Students for Clinical Reality

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Preparing Nursing Students for Clinical Reality

• Christie Manasco Pawley, MSN, RN
• Rebecca Kossick, RN
• Union University
• School of Nursing

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The original plan..

• Have advanced undergraduate nursing students
  demonstrate how a simulated clinical experience
  can be modified and used to better prepare
  students for clinical reality
• Demonstrate an actual scenario with these
  modifications such as the clinical
  errors/omissions embedded within

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However

• F4 tornados have a way of changing things

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Objectives

• Identify clinical performance needs of advanced
  undergraduate nursing students
• Discuss how simulated clinical experiences can be
  used to stimulate critical thinking and promote
  decision making in these students
• Discuss clinical errors/omissions that can be
  incorporated into a scenario
• Propose scenario adaptations that meet students
  clinical performance needs

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The reality is

• New graduates of today face increasingly complex
  roles requiring a much higher level of critical
  thinking and clinical judgment (1)

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The reality is

• Regardless of education or credentials, only 35
  percent of new RN graduates meet entry-level
  expectations for clinical judgment (2)
• Issues students face in preparing to transition
  from a student to becoming a practicing RN
• Weight of responsibility of being a RN
• Clinical reality versus their expectations (3)
• Reality shock

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Simulation

• Benefits to nursing education
• Realistically simulates the clinical setting
• Provides a safe environment for both the patient
  and student nurse
• Errors can be allowed to occur, corrected and
  discussed
• Promotes active learning
• Specific patient situations can be used (4)
• Provides a new alternative to contextual learning
  (1)

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Simulation at Union University

• 1st semester juniors
• Health assessment
• 2nd semester juniors
• Childbearing
• Skills Practicum
• How instructor facilitates experience depends on
  students learning needs

• 1st semester seniors
• Adult Health I
• Childrearing
• 2nd semester seniors
• Adult Health II
• Community Health

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A different approach

• Integrative nursing care
• Develop a deliberate, purposeful mindset
• Noticer
• Expector
• Decider
• Reconcile initial assessment with the report they
  were given

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Other reasons for change

• Oxygen tanks run dry quicker than we thought
• Oops!!!
• Were waiting for the PE to happen.

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Revising the experience

• Selected simulations corresponding to specific
  course content and/or complex patient situations
  not seen in clinical
• Learner version of SCE not given (2nd semester
  srs.)
• Sets of preparatory questions
• Students get report on arrival to sim lab
• Incorporated clinical errors/omissions
• Start in a later scenario state
• Faculty not present in the room

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Example DIC

• Starts in State 2
• Poor shift report
• Omissions of care
• Embedded errors

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What this experience provided

• Contextual learning experience that actively and
  more independently engages the student
• Integration of the new approach
• Noticer
• Expector
• Decider
• A new strategy to help students critically think
  and make clinical decisions independently while
  fostering development of their clinical judgment
  abilities

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References

• Lasater, K. (2007). High-fidelity simulation and
  the development of clinical judgment Students
  experiences. Journal of Nursing Education, 46(6),
  269-276.
• Del Bueno, D. (2005). A crisis in critical
  thinking. Nursing Education Perspectives, 26(5),
  278-282.
• Cooper, C., Taft, L.B., Thelen, M. (2005).
  Preparing for practice Students reflections on
  their final clinical experience. Journal of
  Professional Nursing, 21(5), 293-302.
• Medley, C.F., Horne, C. (2005). Using
  simulation technology for undergraduate nursing
  education. Journal of Nursing Education, 44(1),
  31-34.