Capstone College of Nursing The University of Alabama
Capstone College of Nursing
The University of Alabama
Virtual Nursing/Nursing Clinical Decisions:
Angela Collins, DSN, RN
Becky Edwards, MSN, RN
Marilyn Handley, PhD, RN
Ann Graves, MS, RN
Donna Gullette, DSN, RN
Discuss the development of a
interactive format to teach clinical
judgment in complex situations.
Learning Clinical Judgment:
Situational Awareness with
Evaluate the strengthes and
weaknesses of this technology
format in nursing education.
Increasing numbers of critically
Rising numbers of medication
“Knowledge without experience
is just information.”
Nurses make rapid decision with life-affecting
consequences in managing critically ill
Practice in such decision-making is often either
not available for all students or, often, cannot
be entrusted to students.
Very few new graduates are prepared to care
for severely ill patients, yet many new
graduates find themselves in this situation.
Nurse educators Hospital administration
How do educators help
students apply essential
critical care concepts?
How do administrators
identify the strengths and
weaknesses of nurses’
What happens when
critically ill patients don’t
always fit the text book
documentation to accrediting
effective learning to ensure
Could both students and nursing staff
learn from the consequences of their
actions without harm to the patient?
This was the question and
for the development
of a virtual patient case story
using interactive technology.
To improve learners clinical decision-making skills.
Virtual Teaching Method
To require learners to integrate patient’s
symptoms, signs, medications, laboratory findings,
and to apply pathophysiology within a realistic
To provide corrective and evaluative feedback.
Safe learning environment No harm to patients
Uses a virtual patient.
Requires learners to apply advanced medical
concepts to make key nursing decisions within
a realistic timeframe.
Provides individualized branched feedback
about the effects of each decision.
Simulated patient can live or die based on
nursing decisions made.
The University of Alabama
provided a technology grant
for the creation of the first and second
nursing CD in this series.
A ticking clock and updated lab results alerts
learners about the patient’s deteriorating
condition and the need for rapid decision
Uses a realistic clinical simulation
Principles of Learning
Presentation of visual and auditory content
through both digital and animation
Presentation of information about the
consequences of incorrect decisions
Reinforcement of correct decisions
Repetition of the entire sequence when
incorrect decisions are made provides
opportunity for further investigation of
By actually seeing the consequences of
nursing decision making
when caring for critically ill patients
in a virtual setting,
learners can clearly associate cause and
effect on patient outcomes.
Nine Decision Points
Time to recheck blood glucose after IV titration
Rate calculation relevant to IV KCL administration
Physician or NP clarification of orders
Acid-Base effects on electrolytes of glucose and potassium
Electrolyte shifts that occur with acid-base changes
Choice of fluid when administering different medications IV push
Rate of glucose, electrolyte shifts when DKA is treated
Rate calculations of concentrated electrolyte solution
Glasgow Coma Scale Assessment Scoring
At each of the 9 decision points
the learner selects among the choices presented.
Each time a learner makes a decision a sequence of
events is set into motion.
Learners see the consequences of their decisions
unfold in live video footage or animation.
the virtual patient
• Next level of the
• Program takes learner
to a previous decision
and can be
The CD is a visual story of one critically ill virtual
patient’s experience during a critical situation in his
life when he was brought unconscious to the ED.
Requires learners to integrate symptoms,
medications, laboratory findings, and physiological
consequences within a realistic timeframe.
Video footage or animation depict the
consequences of decisions made.
Designed to simulate real world situations and to
identify strengths and weaknesses of learners as
they progress through care of the virtual patient.
Emphasizes the importance of clinical
pharmacology and the potential harm
triggered by medications errors, which is a
CD is designed to work on any Windows-
User-friendly navigation allows learners to
progress through care of the virtual patient
Students describe this interactive CD as
highly realistic and more complex than other
Hospital users like the CD’s diagnostic
capacity for areas of clinical weakness.
One student wrote on her evaluation
that the CD was the hardest test she
had ever taken.
Students are motivated to review acid-
base and electrolyte imbalance.
Out of 114 senior baccalaureate
nursing students, only 5% were able to
navigate through the case study
without harm to the patient.
The greatest obstacle to success was
Recipient of the 2004 Excellence in
Teaching Award from the Alabama
League for Nursing. (May 2004)
Recipient of the Computer-Based
Professional Education Technology
Regional Award from the International
Sigma Theta Tau. (November 2004)
The essence of expert clinical practice is
pattern recognition and application of critical
thinking as part of the decision-making
Expert clinical practice
is about learning from your patients!
The Nursing Clinical Decisions: Patient
Outcomes CD accomplishes all of this:
Application of critical
Learning from patients
To order the Nursing Clinical Decisions:
Patient Outcomes CD or to receive a CD
demo go to
For More Information
Visit our Web site at http://nursing.ua.edu/ncd.htm