Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students

ABSTRACT

This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

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.

Avaliação de uma intervenção educacional (edworkcases) envolvendo casos clínicos e estudantes de Enfermagem: um estudo observacional transversal

Resumo Objetivo: avaliar o impacto da intervenção educacional (edworkcases) nos resultados da avaliação dos alunos em suas práticas clínicas, suas atitudes em relação aos diagnósticos de Enfermagem e sua satisfação. Método: estudo observacional transversal, realizado com 69 estudantes do terceiro ano de Enfermagem de uma universidade pública de Madri, Espanha. Os dados analisados foram obtidos das notas dos alunos em suas práticas clínicas, bem como, os escores pré- e pós-intervenção na Escala de Posições frente ao Diagnóstico de Enfermagem e uma pesquisa de satisfação. A comparação de médias por participação no projeto (sim/não) foi realizada por meio do teste t de Student. A comparação de médias por professor foi realizada por meio de testes de Kruskal-Wallis. Resultados: taxa de participação: 72,4%; 92% dos participantes eram mulheres; mediana de idade de 21 anos. Foram encontradas diferenças estatisticamente significativas entre participantes e não participantes em termos de pontuação média na Avaliação Geral e na Avaliação do Estudo de Caso, com maiores pontuações encontradas entre o grupo de participantes. A pontuação média das atitudes em relação aos diagnósticos de Enfermagem foi de 99,9 (DP=2,8) antes da intervenção e 111,1 (DP=2,9) após a intervenção [IC 95%: 3,3-19,2]. Conclusão: a utilização de edworkcases como parte do treinamento prático foi considerada satisfatória, permitindo a articulação teoria e prática e melhorando as atitudes dos alunos em relação aos diagnósticos de Enfermagem.

Evaluación de una intervención educativa (edworkcases) que involucra casos clínicos y estudiantes de Enfermería: estudio transversal y observacional

Resumen Objetivo: evaluar el efecto de la intervención educativa (edworkcases) sobre los resultados de la evaluación de los estudiantes en sus prácticas clínicas, sus actitudes hacia los diagnósticos de Enfermería y su nivel de satisfacción. Método: en este estudio se empleó un diseño transversal y observacional. Los participantes fueron 68 estudiantes de tercer año de la carrera de Enfermería de una universidad pública de Madrid, España. Los datos que se analizaron en el estudio fueron las calificaciones obtenidas por los estudiantes en sus prácticas clínicas, al igual que las puntuaciones antes y después de la intervención en la Escala de Posicionamiento ante el Diagnóstico de Enfermería y en una encuesta de satisfacción. Se utilizó la prueba t de Student para realizar una comparación de valores medios por participación en el proyecto (sí/no). La comparación de valores medios por profesor se llevó a cabo por medio de pruebas Kruskal-Wallis. Resultados: índice de participación: 72,4%; el 92% de los participantes eran mujeres, con una mediana de edad de 21 años. Se encontraron diferencias estadísticamente significativas entre participantes y no participantes en cuanto a la puntuación media en la Evaluación General y en la Evaluación de Estudios de Caso, con puntuaciones más elevadas en el grupo de participantes. Las puntuaciones medias correspondientes a las actitudes con respecto a los diagnósticos de Enfermería fueron 99,9 (SD=2,8) y 111.1 (SD=2.9) antes y después de la intervención, respectivamente [IC 95%: 3,3-19,2]. Conclusión: se consideró satisfactorio utilizar edworkcases como parte te la capacitación práctica, lo que permitió combinar teoría y práctica y mejorar las actitudes de los estudiantes con respecto a los diagnósticos de Enfermería.

Evaluation of an educational intervention (edworkcases) involving clinical cases and Nursing students: a cross-sectional observational study

OBJECTIVE

to evaluate the impact of the (edworkcases) educational intervention on students' evaluation outcomes in their clinical practices, their attitudes towards Nursing diagnoses, and their satisfaction.

METHOD

this study used a cross-sectional observational design. The participants were 69 third-year Nursing students from a public university in Madrid, Spain. The data analysed in the study were the grades obtained by students for their clinical practices, as well as pre-post intervention scores on the Positions on Nursing Diagnosis Scale and a satisfaction survey. A means comparison by participation in the project (yes/no) was carried out using Student's t-test. A means comparison by professor was conducted using Kruskal-Wallis tests.

RESULTS

participation rate: 72.4%; 92% of the participants were women; median age = 21 years old. Statistically significant differences were found between participants and non-participants in terms of mean score in the Overall Evaluation and in the Case Study Evaluation, with higher scores found among the group of participants. The mean score for attitudes towards Nursing diagnoses was 99.9 (SD=2.8) before the intervention and 111.1 (SD=2.9) after the intervention [95% CI: 3.3-19.2].

CONCLUSION

the use of (edworkcases) as part of the practical training was considered satisfactory, enabling theory and practice to be combined and improving students' attitudes towards Nursing diagnoses.

"Perioperative Unfolding Case Study"-A Lesson in Quality and Safety

Unfolding case studies present the opportunity for learners to develop and improve their critical thinking and problem-solving skills to deliver safe patient care. The structure of an unfolding case study actively engages learners to determine and customize nursing care based on the patient's changing situation. In addition, this type of case study supports development of knowledge, skills, and attitudes consistent with the Quality and Safety Education for Nurses (QSEN) competencies. During the student session at the AORN Global Surgical Conference & Expo 2019, the author gave attendees the opportunity to participate in the "Perioperative unfolding case study" that was framed in the QSEN competencies. Session evaluations indicated that participants found the process provided a thorough overview of perioperative nursing and emphasized safety-focused initiatives that protect patients undergoing operative and other invasive procedures. This article offers an in-depth discussion of the "Perioperative unfolding case study" and its implementation.

The validity and reliability of clinical judgement and decision-making skills assessment in nursing: A systematic literature review

OBJECTIVES

To appraise the validity and reliability of approaches to assessing the clinical decision-making skills of nurses, and use findings to inform the assessment of students as they transition to newly qualified nurses.

DESIGN

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct the review.

DATA SOURCES

Medline, CINAHL and the British Nursing Index were searched from inception to November 2019.

REVIEW METHODS

Studies were grouped according to their assessment approach following a competency framework with findings presented as a narrative synthesis.

RESULTS

38 articles were included in the review which assessed clinical decision-making in a variety of settings; clinical practice, simulation, written examinations and self-assessment. Multi-level rubric and checklist approaches demonstrated good validity and reliability in practice and simulation settings, and the former was effective at differentiating between students at different stages of their training. Written, case study examinations were also effective at assessing clinical decision-making, although an optimum structure for their presentation was not possible to discern. Students tended to score themselves more highly than faculty staff when undertaking rubric-based self-assessments.

CONCLUSIONS

Findings suggest that the best approach to assess clinical decision-making for final year students is to use several low-stakes, snap-shot summative assessments in practice environments, which are marked using a multi-level observational rubric. To assure reliability, it is recommended that a small team of expert practice assessors undergo regular training and peer review, have protected time to complete their assessor role and are appropriately supported.

NLN Core Competencies for Nurse Educators: Are They Present in the Course Descriptions of Academic Nurse Educator Programs?

AIM

As an initial approach to determining representation of the NLN Core Competencies for Nurse Educators in Master's of Science in Nursing Education and Post-Master's Certificate programs, the study identified the presence of the competencies in course descriptions.

BACKGROUND

The competencies are the gold standard to ensure academic nurse educators have the knowledge and skill to teach, assist learners, develop curricula, and implement effective evaluation methods.

METHOD

A descriptive design that applied web scraping techniques was used to collect data from school web pages, including course descriptions, credit hours, practica information, distance accessibility, and Certified Nurse Educator exam preparation.

RESULTS

Four competencies were well represented (≥85 percent), and four competencies were poorly represented (<50 percent) in a sample of 529 schools.

CONCLUSION

Programs should review courses and course descriptions for inclusion of all competency areas that prepare nurse educators and make revisions to address poorly represented competencies.

Case-Based PowerPoint to Improve Knowledge and Comfort of Having Code Status Discussions by Physician Assistant and Nurse Practitioner Students

BACKGROUND

Little is known about how certain educational interventions may improve informed code status discussions by physician assistant (PA) and nurse practitioner students.

METHODS

This is a prospective, prospective, single academic center pilot study utilizing a short case-based PowerPoint that reviewed the differences between code status choices and the likelihood of survival to hospital discharge of attempted resuscitation after a cardiac arrest. Training occurred between September 1, 2017, and May 31, 2018. The study population included PA and adult gerontology acute care nurse practitioner (AGACNP) students during their inpatient internal medicine rotation (n = 9) and preclinical PA students (n = 5).

RESULTS

After training, there was a significant increase in knowledge in the likelihood of survival to hospital discharge (P = .01) and comfort level in having an informed code status discussion (3.36 ± 0.81 vs 4.10 ± 0.80, P = .02). For questions related to identification of the correct code status, there were no significant differences before and after the intervention.

CONCLUSION

A short case-based PowerPoint viewed by PA and AGACNP students increased the knowledge about the likelihood of survival to hospital discharge of attempted resuscitation after a cardiac arrest and increased the comfort level of having code status discussions with patients by PA and AGACNP students.

Improving Family Nurse Practitioner Students' Confidence for Clinical Decision Making and Presenting Patient Information to the Preceptor

BACKGROUND

Family nurse practitioner (FNP) students often lack the confidence to develop diagnostic skills and convey patient information to their clinical preceptor. Preparing FNP students for these tasks is essential to their clinical success.

OBJECTIVE

To describe the adequacy of interactive case studies to increase confidence in making clinical decisions and presenting patient information to the clinical preceptor.

METHODS

The authors developed three interactive case studies for student analysis during an on-campus intensive week prior to the students' first clinical rotation. Student confidence was examined pre and post to determine if the interactive cases had any effects on their diagnostic reasoning and skill in presenting patients to the preceptor.

RESULTS

The pretest survey found that students were least confident in presenting a patient to the preceptor (21% not confident). After the three interactive case studies, students demonstrated a significant increase in confidence.

CONCLUSION

Interactive case studies and role-playing the patient presentation prior to an initial clinical rotation is a successful educational methodology for improving FNP students' confidence for the clinical environment.

IMPLICATIONS FOR NURSING

Faculty can implement interactive case studies in traditional and online courses to foster student confidence.