Advanced Health Assessment in Nurse Practitioner Programs: Follow-Up Study

Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education

AIMS

Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education.

DESIGN

We conducted a scoping review on DR-related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis-directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence-based, patient-centred management plans.

DATA SOURCES

N = 1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005-2021. Forty-one scholarly articles met inclusion/exclusion criteria.

REVIEW METHODS

Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures.

RESULTS

Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR.

CONCLUSION

The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature.

IMPACT

Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches.

Physical examination competence as a predictor of diagnostic reasoning among new advanced practice nurse students: a cross-sectional study

Aim: To investigate levels of diagnostic reasoning among new APN students as well as students' characteristic affecting such reasoning levels.Design: a descriptive correlational design.Methods: One hundred fourteen APN students in an advanced health assessment course self-assessed their competene in performing examination. The students' self-reported Diagnostic Reasoning Assessment scores were used to categorize them into pre-novice, novice, advanced beginner, and competent levels. Ordinal logistic regression analysis was used.Results: Only physical examination competence significantly predicted the students' diagnostic reasoning levels. Being in a higher diagnostic reasoning level relative to being in a pre-novice, novice, or advanced beginner level was 16.1, 2.6, and 1.9 times greater in the physical examination competence, respectively.Conclusions: Promoting physical examination competence can be an effective teaching strategy for enhancing the diagnostic reasoning of newly enrolled APN students, especially for students who have poor diagnostic reasoning performance.

Using Standardized Actors to Promote Family-centered Care

PURPOSE

The purpose of this study was to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation. This study was considered an innovative approach within our undergraduate program because the use of standardized actors (SAs) was new to the program and had only previously been used in our graduate program.

METHOD

This study used a mixed method design of descriptive comparative data and content analysis to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation.

RESULTS

There were 146 students who participated in this study. Thematic analysis indicated that empathy needs to extend beyond the patient to the family. A comparison of the standardize actors' and peer assessment of student empathy was significant.

CONCLUSIONS

Nurse educators can use standardized actors as caregivers in simulation as an effective teaching strategy to connect theory and the philosophy of family-centered care to its application in pediatric nursing practice.

PRACTICE IMPLICATIONS

Family-centered care is a key philosophy in pediatric nursing. Students report that there is a significant gap between family-centered care theory and its application to practice. Few baccalaureate nursing students receive experience in family interactions during their clinical time. Therefore, this research supports the need for incorporating family-centered care simulation practices in nursing education to increase student nurses' readiness to practice in specialty settings such as pediatrics.

Improving Physical Assessment Observational Skills in the Community Setting: An Experiential Exercise

To become skilled providers, nurse practitioner students are required to expand observational skills and develop acumen in differential diagnosis. Good observational skills are essential for developing differential diagnoses, which are narrowed through diagnostic reasoning to reach an accurate final diagnosis. Teaching observational skills and differential diagnosis methods to nurse practitioner students can be challenging for nurse educators. The goal of an experiential assessment exercise (EAE) was to breathe life into an online course and have fun while learning to gather data about the health status and risk factors of people in the community environment.

The Impact of Team-Based Learning on Nervous System Examination Knowledge of Nursing Students

INTRODUCTION

Team-based learning is one of the active learning approaches in which independent learning is combined with small group discussion in the class. This study aimed to determine the impact of team-based learning in nervous system examination knowledge of nursing students.

METHODS

This quasi-experimental study was conducted on 3(rd) grade nursing students, including 5th semester (intervention group) and 6(th) semester (control group). The traditional lecture method and the team-based learning method were used for educating the examination of the nervous system for intervention and control groups, respectively. The data were collected by a test covering 40-questions (multiple choice, matching, gap-filling and descriptive questions) before and after intervention in both groups. Individual Readiness Assurance Test (RAT) and Group Readiness Assurance Test (GRAT) used to collect data in the intervention group. In the end, the collected data were analyzed by SPSS ver. 13 using descriptive and inferential statistical tests.

RESULTS

In team-based learning group, mean and standard deviation was 13.39 (4.52) before the intervention, which had been increased to 31.07 (3.20) after the intervention and this increase was statistically significant. Also, there was a statistically significant difference between the scores of RAT and GRAT in team-based learning group.

CONCLUSION

Using team-based learning approach resulted in much better improvement and stability in the nervous system examination knowledge of nursing students compared to traditional lecture method; therefore, this method could be efficiently used as an effective educational approach in nursing education.

The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students

The purpose of this qualitative study was to examine the impact of standardized patient experiences (SPE) in the education of the Advanced Practice Nurse (APN). The education of the APN requires educators to make every attempt to promote competency in the areas of communication and clinical-decision making. SPE programs have been found to improve the interpersonal, problem solving, and critical thinking skills of nursing students. For this research twenty-nine APN students participated in SPEs over the course of two semesters. Fifteen student volunteers of those 29 participants were then interviewed three months after the experience. Results revealed that having an expert in the field of communication studies increased awareness of communication skills and how to improve nurse-patient encounters in the clinical setting. The interprofessional collaboration during the SPEs assisted in facilitating the application of learned communication skills into patient-centered care of the APN student.

Using specialized standardized patients to improve differential diagnoses

A Specialized Standardized Patient (SSP) is a standardized patient who has advanced nursing education. This article describes an experience of introducing advanced practice registered nurses as SSPs into an advanced health assessment course. The article also discusses the simulated clinical experience and the desired course outcome that the student will be able to merge the patient history and physical exam findings to develop differential diagnoses.

The teaching of physical assessment skills in pre-registration nursing programmes in Australia: issues for nursing education

Health assessment is a fundamental aspect of the professional nursing role. The teaching of skills in physical assessment is therefore a large component of pre-registration nursing programmes. As the nursing curriculum becomes more crowded with what is deemed to be essential content, there is a need to rationalise what is taught in preparatory nursing programmes to ensure readiness for practice. The study outlined in this paper, as part of a larger project, explored the teaching of physical assessment skills in pre-registration nursing programmes across Australia. Fifty-three academics completed the 121 item online survey, indicating whether each skill was taught with practice, taught with no practice or not taught at all. The results suggest that only half the skills were being taught by more than 80% of the academics and 23 skills (19%) were taught by more than 90%. Of the 121 skills commonly taught--69 skills (57%) were taught with student practice and 29 (24%) were taught with no student practice. The results of this study raise questions about the teaching of physical assessment in pre-registration nursing programmes. The suggestion is not that skills that are used regularly or infrequently should be removed from the curriculum, rather, the authors propose that consideration be given to whether the teaching of skills that are never likely to be used is occurring at the expense of comprehensive mastery of core skills.

A pilot project in distance education: nurse practitioner students' experience of personal video capture technology as an assessment method of clinical skills

This paper reports on a pilot project aimed at exploring postgraduate distance students' experiences using personal video capture technology to complete competency assessments in physical examination. A pre-intervention survey gathered demographic data from nurse practitioner students (n=31) and measured their information communication technology fluency. Subsequently, thirteen (13) students were allocated a hand held video camera to use in their clinical setting. Those participating in the trial completed a post-intervention survey and further data were gathered using semi-structured interviews. Data were analysed by descriptive statistics and deductive content analysis, and the Unified Theory of Acceptance and Use of Technology (Venkatesh et al., 2003) were used to guide the project. Uptake of the intervention was high (93%) as students recognised the potential benefit. Students were video recorded while performing physical examinations. They described high level of stress and some anxiety, which decreased rapidly while assessment was underway. Barriers experienced were in the areas of facilitating conditions (technical character e.g. upload of files) and social influence (e.g. local ethical approval). Students valued the opportunity to reflect on their recorded performance with their clinical mentors and by themselves. This project highlights the demands and difficulties of introducing technology to support work-based learning.

Case histories in the education of advanced practice nurses

Case histories--rich, anecdotal narratives--are theorized to support the acquisition of cognitive, social, cultural, and emotional knowledge and motor skills through active learning. This manuscript focuses on the value of case histories in teaching and evaluating acute and critical care advanced practice nursing students. Information about the use of case histories in advanced critical care education and clinical practice is limited. Case histories support student-centered learning and development of clinical reasoning. An exemplar of a case history is provided, and application of case histories to both electronic and classroom settings is explored.

Evaluating high-fidelity human simulators and standardized patients in an undergraduate nursing health assessment course

BACKGROUND

An undergraduate nursing health assessment course provided three experiential modalities for practicing health assessment skills: high-fidelity human simulators (HFS), standardized patients (SP) and community volunteers (CV). Previous research has examined the impact of each distinct modality on learning outcomes. However, few studies have compared these learning strategies. This study investigates learners' satisfaction, self-efficacy and performance behaviors among three learning approaches.

METHOD

Forty-four undergraduate nursing students were randomly assigned to perform focused respiratory assessments on a HFS, SP or CV. Participants completed the Health Assessment Educational Modality Evaluation (HAEME) survey to assess self-efficacy and modality satisfaction. A performance checklist evaluated assessment skills.

RESULTS

Performance behaviors were significantly greater with HFS, but learners were significantly less satisfied with this modality. Significant differences in students' self-efficacy were not found across the three modalities.

CONCLUSIONS

Significantly lower satisfaction with HFS may reflect learners' perceived lack of realism. However, HFS may provide a low-stress opportunity for novice learners to practice skills. Results support the integration of distinct experiential learning modalities in an undergraduate nursing health assessment course.