The Episodic Tool: An innovative approach to teach clinical decision making in advanced health assessment

Advanced health assessment (AHA) serves as the foundational course in advanced practice nurse education in which students apply clinical decision-making skills to gather appropriate subjective and objective data and to begin to formulate diagnostic hypotheses. Summative objective structured clinical exams (OSCEs) have been used in AHA courses to evaluate students' clinical competence. After implementing summative OSCEs in AHA, we found that students struggled with evaluations requiring critical thinking skills and subsequently designed a teaching tool to address this gap. An Episodic Tool was created for the six main body systems with a chief complaint and three age and gender combinations. In small groups, students used the tool to identify pertinent history and physical exam components for a specific age and gender. A faculty-facilitated group discussion followed. A pre/post design was used in this quality improvement project to compare OSCE and oral clinical exam (OCE) scores. OCEs were used in 2020 due to COVID-19 limitations. There was a statistically significant increase of 7 % in the mean OCE/OSCE scores after implementation of the tool (p < .001). Qualitative feedback from students and faculty suggested the tool effectively enhanced students' critical thinking and clinical decision-making skills and promoted consistency across course sections.

An Innovative Ultrasound-Guided Approach: Stimulating Student Query in Advanced Nursing Health Assessment

An ultrasound curriculum was developed to enhance advanced health-assessment delivery of didactic and laboratory content to advanced practice nursing students. Ultrasound (US) focused on cardiac, pulmonary, and abdomen image acquisition and interpretation. A convenience sample of 80 advanced practice nursing students from the nurse anesthesia program and the family nurse practitioner program were enrolled in the study. Time frame coincided with their Advanced Health Assessment and Diagnostic Reasoning course program curriculum. Utilizing a survey, self-reported data were obtained for measures assessing the curriculum and confidence levels pre and post implementation. Survey data indicated students felt the US curriculum improved their understanding of anatomy (n = 76; 98.75%) and more effectively helped them learn physical exam skills (n = 75; 97.4%). When comparing confidence levels (M = 5.62, SD = 1.71) from before the health-assessment course to confidence levels (M = 2.82, SD = 1.19) following the US curriculum, a significance difference was discovered, t(77) = 14.99, P < .001. The physical examination is a key component of the patient-anesthesia provider interaction. With the use of US technology, students can learn in a positive environment, while improving their physical health-assessment skills.

Using Objective Structured Clinical Examination (OSCE) as Education in Advanced Practice Registered Nursing Education

Approximately 3 million nurses make up the U.S. health care workforce. The Robert Wood Johnson Foundation and the Institute of Medicine (2011) supported the call to strengthen the nursing profession by establishing global standards of educational criteria and outcomes. Throughout the world, health education is affected by fundamental inadequacies related to static, fragmented, and content-oriented curricula. There are inadequacies in our curricula, and nursing faculties are facing challenges with clinical placements (both the number and quality of these placements); therefore, alternative methods of providing practice to students need to be considered. A transformative agenda comprising changes in the way students are taught fully harnessing the potential of information and communications technology (i.e., simulation) is necessary. Simulated patient encounters and Objective Structured Clinical Examinations are 2 means to achieve needed practice in a safe environment. The purpose of this article is to show, by using simulation, how students can practice and be evaluated within their clinical practice role in a safe, controlled environment. In addition, this practice can (a) enable students to increase the complexity of their understanding and their autonomy and (b) educate students about social accountability, health and gender equity, social justice, and human rights.