By: Catherine Hillberry, DNP, RN, CHSE, Marymount University; Melody Bethards, EdD, RN, CNE, CHSE-A, Des Moines Area Community College; and Jenny O’Rourke, PhD, APRN, CHSE, Loyola University Chicago
In March 2020, the COVID pandemic caused many schools of nursing in the United States to shut down or severely limit student engagement in the classroom, simulation center, and clinical facilities. While programs were able to move theory courses to virtual online presentations without too much difficulty, face-to-face practicum and simulation experiences presented a larger problem: Could online simulations be used as replacement for clinical and simulation hours?
To support nursing programs in addressing this question, the NLN pulled together a small group of simulation leaders. Our inspiration was work begun by Dr. Melody Bethards of Des Moines Area Community College.
Melody had already compiled a small list of available, free web-based resources for use as virtual clinical or simulation experiences to share with colleges in Iowa. We decided to expand on this work and create resource lists for undergraduate and graduate nursing programs and a separate list specific for COVID training. Melody, along with Dr. Jenny O’Rourke, graduate faculty at Loyola University Chicago, scoured the web and developed a robust list of virtual resources that could be used for clinicals and simulations across the curriculum. The resource lists were vetted by a larger group of simulation educators, alumni of the NLN’s Leadership Development Program for Simulation Educators, then shared on the NLN website and updated weekly.
Nurse educators expressed appreciation for the resources and reported that they were using them to replace clinical time, but anecdotal evidence indicated that not all schools were using course outcomes to guide the experience, and best practice simulation standards were not being applied. To aid nursing programs, the developers provided examples of how resources could be incorporated into specific courses. This work focused specifically on mapping learning activities to course outcomes and incorporating INACSL Standards of Best Practice: SimulationSM (INACSL Standards Committee, 2016). Following are some exemplars.
For Dr. Catherine Hillberry of Marymount University, the most pressing concern was to provide clinical experiences for graduating seniors. Catherine found that the detail and accuracy of ATI Real Life Scenarios, screen-based simulations, allowed seniors enrolled in a clinical reasoning course to continue to present clinical case studies and meet course objectives. Using course outcomes as a guide, she also evaluated several options from the undergraduate list to replace 155 clinical hours across the curriculum, selecting the Virtual Healthcare Experience from Ryerson University and the George Brown College to enable students to meet their clinical hours. As an outcome of the implementation and evaluation of these virtual simulations, the school, starting this fall, will substitute up to 25 percent of clinical hours with simulation across the curriculum. Half of these simulation hours will be virtual simulations with debriefings conducted via a video-conferencing platform, such as Zoom.
The family nurse practitioner program at Loyola University Chicago created telehealth simulations using a virtual COVID case followed by a synchronous standardized patient experience. These experiences bridged the loss of clinical hours and followed accreditation standards. Loyola also reports innovative interprofessional experiences. Some programs used a hybrid model that enabled nursing, medicine, and pharmacy students to participate remotely in TeamSTEPPS simulations. Additionally, several programs trialed asynchronous and self-debriefing to accommodate the large number of students in their programs.
Des Moines Area Community College used some of the Global Network for Simulation in Healthcare (GNSH) 30-minute team engagement patient stories in a virtual simulation learning experience with health care students from different programs and institutions. Based on positive feedback from students and faculty, the college plans to continue to use this experience.
To assist faculty who were struggling through their first experience teaching online, the NLN began a series of webinars. Taking Aim: Addressing Online Teaching Challenges and Taking Aim at Good Teaching focused on learning from experts who successfully implemented remote teaching strategies. The webinars continue to be available free of charge on the NLN website at http://www.nln.org/enterprise-development/nln-center-for-innovation-in-education-excellence/center-for-innovation-in-education-excellence-webinars.
As COVID restrictions have eased and clinical opportunities have slowly resumed, programs indicate that they will continue to use virtual simulation as a teaching tool. Research is underway at several schools to determine how the use of remote teaching has impacted course and program outcomes and the performance of new graduates. Dissemination of these research findings will add to our body of knowledge on virtual simulation.
The NLN has posted the virtual resources mentioned here on our SIRC site where they will remain through the end of 2021, but since pandemic restrictions are now lifted, we will no longer update them.