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