By: Beth Hallmark
The IOM has challenged health care to examine systems and human factors that impact the safety and well-being of our patients. Informatics is one way nurses and caregivers can work together more effectively to bridge gaps in communication and achieve better patient outcomes. Nursing education organizations, including the NLN and ANA, and initiatives such as TIGER and QSEN, are among the first to outline definitions and standards surrounding informatics. Each day nurses use information technology to make critical decisions surrounding patient care. As educators we need to ensure that our students are prepared to use the data at hand to think critically and use clinical reasoning.
As nurse educators, we all face similar challenges. We all struggle to implement accreditation standards while educating our students to care safely for patients, show compassion, and prepare to pass the NCLEX. We are all confronted with a shortage of clinical sites, whether we teach in rural or metropolitan areas. And we all want to know: How can we integrate informatics into the nursing curriculum in a meaningful way?
With the increased use of manikin-based simulation and standardized patients as teaching strategies, the validation of simulation standards, and virtual reality beginning to augment or replace clinical teaching, educators are also asking: Can we work smarter, not harder? Can we integrate information technology and virtual reality? Can we incorporate virtual simulations and electronic health records together in a dual assignment?
Let me share with you an example of how my colleague at Belmont University, Dr. Angela Lane, approached these questions. Angela’s students in Belmont’s Child and Family Nursing course complete 10 virtual simulations (vSim®): 5 core and 5 complex cases. For each of the cases, students must also complete documentation in an electronic medical record (EMR) (Lippincott’s DocuCare). The simulations, and the subsequent documentation, count toward their clinical placement. According to Angela, one advantage to the virtual simulation platform is the immediate feedback students receive based on their clinical decision-making. Once they complete the simulations they must go to a new “platform,” open the EMR, and chart their assessment, medications, and patient teaching.
Working through the logistics of this complicated project, combining two platforms to meet the needs of clinical placement and informatics standards, Angela is a trailblazer. During the development of this project, she had to consider many details, and during implementation she had to answer a number of questions: How do we grade such an exercise? Some students can complete their virtual simulation in as few as 30 minutes while others may take a couple of hours, and then we add the charting component. How many hours should we attribute to this work? If we are truly replacing clinical hours with virtual simulation, how should we evaluate the student’s work?
These are just a few of the questions Angela has faced during her journey as an early adopter. This journey has lasted several semesters, and this spring she asked clinical faculty to take on some of the grading of the EMR. Angela also communicated some lessons learned: Treat student preparation as clinical orientation. Have the company representative come in and ensure that each student can access the virtual simulation. Be sure each student understands the assignments associated with the clinical.
One plan for the upcoming semester includes the use of “guided reflection” questions that are included with the virtual simulation. These will be part of a live postconference, while also reviewing the EMR. Angela and her team have participated in training for “debriefing with good judgment” and are well prepared to help students use the virtual simulation and EMR documentation to impact their clinical reasoning and practice. Other nurse educators currently combining the two types of platforms have noted that they have their students provide rationales around their documentation within the EMR. Providing rationales could also be part of the Socratic questioning during debriefing sessions. Having students comment on the diagnostic data in the patient records and expand on assessment findings helps confirm their understanding of information relevant to the patient case.
It is important to emphasize that research on the impact of virtual simulation is essential to ensure that documentation is meaningful.
Working smarter, not harder, is not always easy, but combining two platforms and thinking outside the box is a win for nursing education. When I began my career as a nurse educator more than 20 years ago I never would have imagined that we would be using virtual simulation to replace clinical hours. We must not forget the goals that stimulated the use of simulation and the informatics movement – patient safety!
Please share with us how you are using virtual simulations. Are you having your students document their findings in an EMR? What barriers have you faced and what solutions have you developed?
This is a very timely article. We have just integrated the EMR in our simulations. The students have happily accepted the change. As nurses and educators, we can appreciate the words of wisdom you left us with. Our goal should always be patient safety in EVERY scenario! Thank you for sharing your information and experience. Happy New Year!
I was initially using a mock paper chart for simulation and requiring the students to do their documentation in it since they often are not allowed or don’t have access to document in either a paper record or EMR. Using a paper chart worked well in terms of the students trying to practice documentation while performing patient care, but since I do simulation in groups, they had to share access to the chart or take the documents out of the chart binder and would scatter them, not taking note of where they came from or even asking where to put them back. Then we started using SimChart and I managed to get computers installed in the sim lab for them to use to document on that platform. That worked better but I had institutional problems getting the students access to it: the chain of possession of the access codes was too long making it nearly impossible to get the students access to it, and the other instructors didn’t want to try to incorporate its use into other areas of instruction. Now I’m told we’re going to adopt DocuCare as our EMR. That hasn’t come about yet, but we really need it.
Whatever the platform, the students need to learn to document as they provide patient care because that’s what they’ll be doing once they get their license and a job. In my mind, documentation should always be part of simulation the same way it is part of clinical nursing care. If nothing else, the students learn how much documentation there is to do and how they’ll need to manage their time to provide patient care and document everything they need to.