Nurse Practitioner Student Perceptions of Face-to-Face and Telehealth Standardized Patient Simulations

Identifying best practices for virtual nursing clinical education: A scoping review

BACKGROUND

COVID-19 forced nurse educators across the world to rapidly shift clinical experiences from face-to-face to the virtual world without identification of best practices to guide this transition.

PURPOSE

The purpose of this review was to identify best practices in virtual clinical experiences for undergraduate and graduate nursing students using the Community of Inquiry model as a framework.

METHOD

A scoping review was conducted using the Joanna Briggs Institute Scoping Review process. Ten databases were searched systematically for literature related to virtual nursing student clinical experiences. The 36 articles retained for review were appraised using evidence-based rapid critical appraisal tools.

RESULTS

The literature suggests virtual clinical experiences may positively impact clinical reasoning and judgement; knowledge gain, retention, and application; affective learning; communication and teamwork; competence; engagement; confidence; and satisfaction. However, increased anxiety, frustration with technology and access, difficulty asking questions, and increased cost were reported. Additional considerations included appropriate faculty training, student support, and accreditation and board certification requirements. Standards related to virtual clinical experiences and simulation for advanced practice registered nurses needs further study.

CONCLUSION

Virtual clinical experiences resulted in positive student learning outcomes. Through the provision of quality virtual clinical experiences, nurse educators have the potential to maximize student learning and professional growth.

Implementing an Experiential Telehealth Training and Needs Assessment for Residents and Faculty at a Veterans Affairs Primary Care Clinic

Background

The transition to telehealth during the COVID-19 pandemic revealed a lack of preexisting telehealth training for clinicians. As a workplace-based simulation methodology designed to improve virtual clinical skills, announced standardized patients (ASPs) may help meet evolving educational needs to sustain quality telehealth care.

Objective

We describe the development and implementation of an ASP program to assess and provide feedback to resident and faculty clinicians in virtual practice, and report on performance, feasibility, and acceptability.

Methods

From June 2021 to April 2022, resident and faculty clinicians at a VA primary care clinic participated in a video visit in which an ASP portrayed either a 70-year-old man with hearing loss and hypertension or a 60-year-old man with hypertension and financial stress. Following the visit, ASPs provided verbal feedback and completed a behaviorally anchored checklist to rate telehealth and communication skills, chronic disease management, and use of resources. Domain summary scores were calculated as the mean percentage of "well done" items. Participants completed a feedback survey on their experience.

Results

Seventy-six televisits (60 primary care residents [postgraduate year 1-3], 16 internal medicine faculty) were conducted from August 2021 to April 2022. Clinicians performed well in communication skills: information gathering (79%, 60 of 76, well done), relationship development (67%, 51 of 76), education and counseling (71%, 54 of 76), and patient satisfaction (86%, 65 of 76). They performed less well in telemedicine skills (38%, 29 of 76). Participants agreed that the experience was a good use of their time (88%, 67 of 76).

Conclusions

An ASP-facilitated training for resident and faculty clinicians assessed telehealth skills and clinical practice and identified areas for intervention. Clinicians responded well to the training and feedback.

While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study

Introduction

Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting.

Aim

To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements.

Methods

Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach.

Results

49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements.

Conclusion

While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.

Exploring the Effectiveness of Telehealth Simulation in a Standardized Patient Scenario

BACKGROUND

This study evaluated transitioning face-to-face standardized patient (SP) competencies for nurse practitioner (NP) students to telehealth SP (TSP) competencies. Given the effects of coronavirus disease 2019 on clinical nursing education, faculty need evidence-based strategies that offer flexibility and high-quality learning experiences for students.

METHOD

SP grade rubrics for NP students (n = 53) who completed either face-to-face or TSP examinations were compared to determine whether there were any differences in overall mean score, history taking, physical examination, final diagnosis, and documentation between the two groups.

RESULTS

A two-tailed independent sample t test examined whether the mean scores for the variables differed between face-to-face SP and TSP competencies.

CONCLUSION

Overall results indicated the SP competencies were similar between the two groups. This confirms that both options of SP competencies for family NP students are acceptable. [J Nurs Educ. 2023;62(3):162-166.].

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

AIM/OBJECTIVE

To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.

BACKGROUND

Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.

DESIGN

A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.

METHODS

The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.

RESULTS

1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.

CONCLUSIONS

Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

A systematic review of online education initiatives to develop students remote caring skills and practices

The ongoing COVID-19 pandemic has altered caring professions education and the range of technological competencies needed to thrive in today's digital economy. We aimed to identify the various technologies and design strategies being used to help students develop and translate professional caring competencies into remote working environments. Eight databases were systematically searched in February 2021 for relevant studies. Studies reporting on online learning strategies designed to prepare students to operate in emerging digital economies were included. Quality assessment was undertaken using the Effective Public Health Practice Project Quality Assessment Tool and/or the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Thirty-eight studies were included and synthesized to report on course details, including technologies being used and design strategies, and study outcomes including curriculum, barriers and facilitators to technology integration, impact on students, and impact on professional practice. Demonstrations of remote care, videoconferencing, online modules, and remote consultation with patients were the most common instructional methods. Audio/video conferencing and online learning systems were the most prevalent technologies used to support student learning. Students reported increased comfort and confidence when working with technology and planning and providing remote care to patients. While a recent influx in research related to online learning and caring technologies was noted, study quality remains variable. More emphasis on assessment, training, and research is required to support students in using digital technologies and developing interpersonal and technological skills required to work in remote settings.

Stakeholder perceptions of the efficacy, barriers, and facilitators of telemental health clinical experiences during COVID for nurse practitioner students

BACKGROUND

Telemental health services grew during the COVID pandemic, resulting in psychiatric-mental health nurse practitioner students obtaining clinical hours through this modality. Although patient outcome data demonstrate the efficacy of telemental health services, data on the efficacy of learning through telehealth clinical experiences are lacking.

PURPOSE

To explore perceptions of learning through telehealth clinical experiences by students, preceptors, and faculty and to identify perceived barriers and facilitators to facilitating telehealth clinical experiences.

METHODOLOGY

Mixed-methods exploratory study using web-based, researcher-designed, cross-sectional surveys eliciting perceptions of learning and perceived barriers and facilitators to telemental health clinical experiences sent to current and former PMHNP students and their preceptors of a state university in the southwest along with PMHNP faculty in the National Organization of Nurse Practitioner Faculties. Students and preceptors were offered the option to participate in a semistructured interview.

RESULTS

Twenty students (35.7%), 22 preceptors (24.7%), and 19 faculty (25.3%) participated in the surveys. Three preceptors and three students volunteered for interviews. Telemental health clinicals were perceived by students as equivalent to or superior to in-person learning. Preceptors rated the teaching/learning environment through telemental health as equivalent or better as compared with in-person clinicals with two exceptions. Faculty-rated greatest barrier to telemental health clinicals was telephone visits because of technology issues.

CONCLUSIONS

Telemental health clinicals can provide a high-quality learning experience for students.

IMPLICATIONS

Preceptors should be provided with resources for facilitating telemental health clinicals. Ongoing discussions regarding the number of clinical hours recommended through telehealth are needed.

Development and implementation of virtual clinical skills experiences for psychiatric nurse practitioner students

ABSTRACT

The educational preparation of nurse practitioner (NP) students includes didactic content and clinical experiences. These clinical experiences can be via clinical rotations or simulation. Although there is no specific list of clinical skills to prepare NP students for professional practice, the National Organization for Nurse Practitioner Faculties identifies core competencies for the basic education of NP students. These core competencies can be fulfilled through simulated clinical experiences. However, due to the COVID-19 pandemic, many institutions had to develop alternate methods of facilitating simulated clinical experiences for their NP students. Because of national, state, and university guidelines to transition all face-to-face educational activities to a virtual format, a Southeastern university simulation program developed and implemented virtual clinical skills experiences for psychiatric mental health NP students. Based on student survey results, the utilization of standardized patients in this virtual clinical skills experience proved beneficial and improved NP students' interviewing and communication skills via a telehealth format.

Adapting clinical experiences during a pandemic: One college of nursing's approach

ABSTRACT

Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

Introducing telehealth skills into the Doctor of Nursing Practice curriculum

ABSTRACT

Telehealth training was important for nurse practitioner (NP) students prior to the COVID-19 pandemic, but now it is essential. Training in telehealth allows access to health care for vulnerable populations in rural health areas and beyond. As the future of health care delivery changes, providers will be required to use this technology. Therefore, it is imperative that such training become part of NP education to prepare students to be technologically competent providers in the 21st century. The objective of this educational pilot project was to educate Doctor of Nursing Practice nurse practitioner students to conduct patient interviews and provide interprofessional collaboration using telehealth. The project addressed a gap in the literature on planning for simulations from varying NP specialties and provided feedback from standardized patients on their experiences. A total of 83 students from four specialty tracks received telehealth education. Students then interviewed simulated patients and provided a collaborating report. The students and patients were asked to complete questionnaires to assess the modules and the experience itself. Quantitative descriptive data were gathered, and qualitative themes were obtained from open-ended questions. Both the students and simulated patients indicated that they appreciated the ease and convenience of interviewing patients through technology. Both struggled with issues related to the technology and the need to have backup systems available. The students demonstrated that they were very capable of using telehealth and were generally very positive about the experience.