Capstone College of Nursing The University of Alabama


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Capstone College of Nursing The University of Alabama

  1. 1. Capstone College of Nursing The University of Alabama Virtual Nursing/Nursing Clinical Decisions: Patient Outcomes Angela Collins, DSN, RN Associate Professor Becky Edwards, MSN, RN Assistant Professor Marilyn Handley, PhD, RN Assistant Professor Ann Graves, MS, RN Instructor Donna Gullette, DSN, RN Assistant Professor
  2. 2. Discuss the development of a interactive format to teach clinical judgment in complex situations.  Learning Clinical Judgment: Situational Awareness with Virtual Consequences Evaluate the strengthes and weaknesses of this technology format in nursing education. 
  3. 3. Increasing numbers of critically ill patients.  Problem Rising numbers of medication errors. 
  4. 4. Situational Awareness
  5. 5. “Knowledge without experience is just information.” Mark Twain
  6. 6. Nurses make rapid decision with life-affecting consequences in managing critically ill patients.  Challenge 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. 
  7. 7. Challenge Nurse educators Hospital administration How do educators help students apply essential critical care concepts?  How do administrators identify the strengths and weaknesses of nurses’ decision-making skills?  What happens when critically ill patients don’t always fit the text book description?  Could providing documentation to accrediting agencies demonstrate effective learning to ensure patient safety? 
  8. 8. Could both students and nursing staff learn from the consequences of their actions without harm to the patient? This was the question and impetus for the development of a virtual patient case story using interactive technology.
  9. 9. 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 timeframe.  To provide corrective and evaluative feedback. Safe learning environment No harm to patients
  10. 10. Interactive CD
  11. 11. Interactive CD 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. 
  12. 12. Team Members Nursing faculty Hospital nurses Computer programmers Video producers Student actors     
  13. 13. Funding The University of Alabama provided a technology grant for the creation of the first and second nursing CD in this series.
  14. 14. A ticking clock and updated lab results alerts learners about the patient’s deteriorating condition and the need for rapid decision making.  Interactive CD
  15. 15. 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 important cues 
  16. 16. 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. Purpose
  17. 17. 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         
  18. 18. Decision Points 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. 
  19. 19. Decision Points Incorrect Decision • Life-threatening consequences for the virtual patient Correct Decision • Next level of the patient’s care • Program takes learner to a previous decision point
  20. 20. Explanation and Rationale
  21. 21. Documentation Learners‘ actions are logged Final report is generated and can be printed  
  22. 22. Strengths 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.
  23. 23. Strengths Requires learners to integrate symptoms, medications, laboratory findings, and physiological consequences within a realistic timeframe.
  24. 24. Strengths Video footage or animation depict the consequences of decisions made.
  25. 25. Strengths Designed to simulate real world situations and to identify strengths and weaknesses of learners as they progress through care of the virtual patient.
  26. 26. Strengths Emphasizes the importance of clinical pharmacology and the potential harm triggered by medications errors, which is a JCAHO focus.
  27. 27. Strengths CD is designed to work on any Windows- based computer. User-friendly navigation allows learners to progress through care of the virtual patient with ease.
  28. 28. Evaluation Students describe this interactive CD as highly realistic and more complex than other exams.  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. 
  29. 29. Outcomes 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 order clarification. 
  30. 30. Awards 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)
  31. 31. Summary The essence of expert clinical practice is pattern recognition and application of critical thinking as part of the decision-making process. Expert clinical practice is about learning from your patients!
  32. 32. The Nursing Clinical Decisions: Patient Outcomes CD accomplishes all of this: Pattern recognition Application of critical thinking Learning from patients   
  33. 33. To order the Nursing Clinical Decisions: Patient Outcomes CD or to receive a CD demo go to order_form.htm For More Information OR Visit our Web site at