If you haven’t read my last blog, How to Use KeithRN Unfolding Case Studies to Transform the Virtual (and traditional) Classroom be sure to do so! Today’s blog builds on this content and will empower you to transform the way you teach in both the class and clinical settings!
One of the concerns that many nurse educators and practice partners share is that nurses who have had a significant percentage of clinical experiences via virtual learning will not possess the clinical judgment and overall practice readiness expected for safe practice.
I want to share best practice principles to ensure that your virtual clinical replacement activities meet both student and program outcomes, so your students graduate better prepared for practice and licensure.
Principle #1: Simulate the clinical setting as closely as possible.
To ensure that essential content sticks and is retained by your students, necessary knowledge must be provided in context to the patient’s bedside. The clinical setting must be replicated as realistically and closely as possible with a virtual clinical replacement activity.
This does not necessarily mean high tech and avatar simulation. Clinical realities can also be replicated using realistic unfolding patient care scenarios in a simple unfolding case study that mirrors how a nurse encounters clinical realities in practice.
As a nurse educator who has current experience and who has practiced in the critical-care float pool of a large metropolitan hospital, I have written most of the case studies posted on KeithRN. They are derived from real-world clinical practice.
In the Unfolding Case Study, just as in practice, the nurse will review a set of vital signs, nursing assessment, and lab values. After each collection of clinical data, the same clinical reasoning question is asked,
“What clinical data is relevant, and why is it clinically significant to the nurse?”
Once clinical data has been reviewed, the nurse must put it all together and correctly interpret the meaning of this data and identify the primary problem and the pathophysiology this problem represents.
Students must understand, then state, the pathophysiology of the current problem in their own words to enhance meaningful application and synthesis of pathophysiology to practice.
Medical management and resultant orders are presented that include medications. The student must identify each order’s rationale and expected outcomes, just as a nurse must do in clinical practice to determine if it is expected or unexpected and should be questioned.
The nursing process is concisely contextualized by identifying the nursing priority and priority nursing interventions with the rationale and desired outcome. The importance of holistic care and psychosocial nursing priorities are also addressed in a separate question.
Start Case-Based Active Learning 1st Semester!
Even in the beginning first semester, your students will benefit by using a KeithRN Unfolding Case Study to simulate practice-based realities of how they will experience and use knowledge in practice.
Since fundamental students may not have had fluid and electrolyte content to understand labs, you may skip this content or, better yet, expose students to this important content and have them use their lab manual or textbook to determine relevant lab values in the case study and why.
When students begin to see the “big picture” of patient care through a case study, they will make connections. They will feel better prepared when they experience the clinical setting.
FREE COVID-19 Case Study
I have a free COVID-19 Skinny Reasoning case study that can be used with all levels, but especially fundamental students because it contextualizes fundamental content including isolation precautions, the chain of infection, and the nursing process/priority setting.
Problem recognition is presented in my higher-level Unfolding Reasoning case studies, which use a series of questions that include the importance of identifying the worst possible or most likely complication.
Identification of EARLY assessment findings of this problem is included, so students recognize a problem more quickly and contact the primary care provider sooner if they encounter it in clinical practice.
Principle #2: Contextualize ALL aspects of nursing practice
Case-based simulation such as Skinny Reasoning provides a comprehensive experience of what a nurse must understand and apply to provide safe patient care by addressing the following core nursing content:
- nursing process and care planning
- holistic care priorities
- nursing assessment
- critical thinking that emphasizes understanding and application of essential content
- clinical reasoning that captures the thinking in action required at the bedside
- clinical judgment, which is the outcome when a student can both critically think and clinically reason!
Multiple levels of complexity
Just as any nursing program curriculum is leveled from simple to complex as students progress from novice to advanced beginner in their development, KeithRN case studies have multiple levels of complexity to bring the case study to the level of the student.
For example, Skinny Reasoning is the shortest and most concise level of a KeithRN Unfolding Case Study with only four pages. Still, it captures the essence of a global clinical patient care experience.
Unfolding Reasoning is the most complex KeithRN case study and is 8 to 10 pages in length but provides higher level clinical reasoning questions that emphasize priority setting. Unfolding Reasoning includes an unfolding change of status that must be recognized by the nurse.
Different levels of case studies provide faculty with the flexibility to use the best level based on the student’s semester and professional development.
Principle #3: Emphasize and practice clinical reasoning.
To develop the clinical judgment that students require for safe practice, they must be able to reason in action at the patient’s bedside as new data is collected and correctly interpreted by the nurse.
Tanner’s Clinical Judgment Model
Chris Tanner’s clinical judgment model captures the essence of the four clinical reasoning steps required to make the correct outcome of a clinical judgment and must be understood by every nurse educator to develop clinical judgment in your students.
These four steps are:
- NOTICING. What clinical data is detected as important or significant by the nurse?
- INTERPRETING. What is the meaning or clinical significance of relevant clinical data that was noticed?
- RESPONDING. How will the nurse respond with a nursing priority and plan of care based on the clinical data that was noticed and interpreted?
- REFLECTING. After responding, what is the evaluation, reflecting on the clinical data noticed by the nurse?
Tanner’s clinical judgment model was published in 2006 and remains a research and evidence-based clinical judgment model that every nurse educator must be familiar with. These four steps of Tanner’s framework align with the nursing process to develop the nurse thinking that every student must possess.
It is not a coincidence that Tanner’s clinical judgment model is also the essence of the NCSBN model of clinical judgment that is the basis for Next Generation NCLEX. When Tanner’s model is understood and then integrated into your curriculum using KeithRN Unfolding Case Studies, there is no reason to fear the upcoming Next Generation NCLEX!
Just as the nursing process is a repetitive framework and sequential process that a nurse uses to think like a nurse, the clinical reasoning questions and underlying framework of KeithRN case studies do not change, regardless of the scenario topic.
This is because the essence of clinical reasoning that captures nurse thinking is consistent; it does not change, irrespective of the clinical practice setting.
How to Use in Traditional Clinical Setting
Got downtime in clinical?
Some students get a robust experience, while other students patient was discharged early or is not as busy. Use the concise SKINNY Reasoning format as a resource to provide a meaningful, clinical-based alternative activity!
Print up extra copies of the case study and have an individual or group of two students work through a relevant topic seen most commonly in your clinical and present it in post-conference.
To strengthen and innovate how nursing is taught, it does not require a change in the curriculum but only changing HOW nursing is taught.
By using the educational best practice principles of replicating the clinical setting as closely as possible and utilizing a practice-based framework of clinical reasoning such as Tanner’s clinical judgment model, student learning can be strengthened despite the challenges posed by the current pandemic.
As a result, students will be better prepared for clinical practice and licensure, including the much more difficult Next Generation NCLEX coming in 2023!
Keith Rischer – Ph.D., RN, CCRN, CEN
As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…
The Ultimate Solution to Develop Clinical Judgment Skills
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