Implementing Clinical Skills and Clinical Simulation Across the Lifespan: Impactful Nursing Education Design and Delivery
Presentation
Overview
Overview
Description
escription/Purpose: Nurse Practitioner graduates have knowledge, skills, and abilities essential to autonomous clinical practice (National Organization of Nurse Practitioner Faculties, n.d.). In a large southeastern university hybrid Doctor Nursing Practice (DNP) program, we conducted two separate on-campus intensive days: clinical bound and clinical skills day. Each of these intensives catered to students at different stages of their clinical education journey. While clinical-bound students are about to embark on their initial clinical semester, attendees of clinical skills day were enrolled in their second clinical rotation. Through immersive simulation experiences facilitated by standardized patients and expert clinical faculty, students engage in hands-on learning within a safe, supportive environment. The clinical bound intensive focuses on fortifying foundational skills necessary for forthcoming clinical rotations and encompasses history taking, physical examinations, and critical thinking competencies. Conversely, clinical skills intensives offer opportunities for students to refine their procedural skills through teach-and-return demonstrations and case scenario reviews. The primary goal of intensives is to provide students with essential knowledge and clinical expertise, setting them up for success in their DNP journey.
Pediatrics: Health history, physical examination, differential diagnosis coupled with essential skills of the pediatric patient is a critical process for advanced practice registered nursing students. Supported by elements from the Healthcare Simulation Standards of Best Practice (2021) and recent evidence centered on pediatric healthcare, Family Nurse Practitioner students engaged in two on campus learning intensives: (1) essential skills related to advanced pediatric health supervision, and (2) a simulation case revolving around the management of a 4-day-old neonate with jaundice and breastfeeding concerns. At the skills day intensive, students engaged in microteaching sessions on approaches to pediatric physical exam, manipulation of the stethoscope, otoscope, and ophthalmoscope, and common pediatric screenings. During the simulation intensive, learners participated in small groups aimed at collecting subjective and objective data from the mother of a newborn and neonate, followed by a rigorous active simulation debrief centered on diagnostic reasoning of the newborn with physiologic hyperbilirubinemia.
Women’s Health: The Women’s Health skills session and simulation sessions align with Advanced Family Nursing III Women's Health goals by providing a scaffolded learning environment where students can become proficient in caring for female patients. Each on-campus intensive includes pre-session resources for the student to review before the interactive learning experience. The Women’s Health skills day intensive runs concurrently with the didactic Women’s health course. The small group sessions utilize a pelvic trainer manakin to identify external and internal anatomy and speculum use. Demonstration and return demonstration are used to teach proper collection of specimens like a pap smear, std screening, and wet mount preparation. Students also have the chance to practice bimanual examination and discuss possible pertinent findings of the entire exam. The Women’s Health simulation session allows the student the opportunity to interact with standardized patients in a mock clinic setting and work through a simulated women’s health symptom complaint of dysuria. The students work together to gather subjective and objective data and develop a care plan for this patient.
Procedures: Two common procedures for FNPs to perform are incision and drainage of simple abscesses and suturing of skin lacerations. These specific stations were designed to teach students proper techniques for completing these procedures. Students were given resources to review before the skills day event. Pre-session resources included a training video, review of the procedure, and other treatment considerations (antibiotic usage, wound care, and follow up). The faculty demonstrated the procedure first, then intentionally lead students though each step, checking student technique and ensuring mastery of each step prior to moving forward and practicing the procedure. Incision and drainage procedure was demonstrated using a simulated abscess of a chicken thigh injected with Greek yogurt. To best simulate human tissue, students practiced suturing using pigs’ feet using simple interrupted sutures. The students were then given a chance to practice these procedures several times, with faculty members observing and providing constructive feedback and guidance.
Critical Thinking: Ordering laboratory testing and analyzing lab values is an essential role for the FNP. The lab interpretation session utilized case studies commonly seen in primary care that placed the student in the scenario. Students had to work together as a group to determine which labs were relevant to order based on the patient's presenting concern and exam findings, interpret the labs, and develop a plan based on the results using evidence-based practice recommendations. Additional components of the plans included discussion of imaging, medications, and social determinants of health, which could affect a patient's care plan. This discussion was part of the clinical skills day intensive to increase students' comfort and confidence in ordering and interpreting common labs they were likely to manage as nurse practitioners.
Learning Objectives: By the end of this presentation the learner will be able to explain how on- campus clinical skill building can enhance the advanced doctoral FNP students' understanding and confidence with hands-on skills practice and critical thinking scenarios. By the end of this presentation the learner will be able to explain how on- campus simulation scenario practice can enhance the advanced doctoral FNP students' application of learning in preparation for clinical rotations.
Conclusion: We aim to explain the implementation of each of our on-campus clinical bound intensives and clinical skills days which were tailored for our doctoral Family Nurse Practitioner (FNP) students as they advance through their DNP program. By integrating simulation-based learning and targeted skills development, we strive to foster the holistic growth and preparedness of our future nurse practitioners for the diverse challenges of clinical practice.
