Culture Shift in Assessment
Training to be a Registered Nurse is incredibly challenging. When students go out into their practicums and start working with patients, they need to be both confident and competent in their skills. The Faculty of Nursing has incorporated new technology and simulation techniques to help their students prepare. Hands-on learning and assessments are crucial. The Clinical Simulation Lab, along with new virtual simulation techniques are instrumental in assessing students in their practical nursing skills before they start working with real patients.
Virtual Simulations
In January 2018, the faculty started using virtual simulations for low-stakes assessments in third year nursing courses. They use the software VSim which has several different topics, including Medical-Surgical, Pediatric, and Perinatal. Each topic has a series of approximately 45-minute scenarios that simulate a hospital environment and patient-care experience as closely as possible.
A scenario starts with an introduction to the patient, their medical records, and some orders from the main provider. The student then has to choose their actions from a series of options, including safety measures, communications, assessments, and administering drugs or treatments. The simulation logs every action that the student does, and they can access the records and patient chart at any time during the process. When something changes or they get new information, they are notified so they can change their interventions. Once they think they have appropriately cared for the patient, they end the scenario and receive instant feedback. A score is calculated based on all of the actions that were (or were not) done. Students also receive extensive, detailed comments about their performance. If they forgot an action, did things in the wrong order, or did something extraneous, the system tells them. There is also a summarized section that shows the five biggest improvements they could make in the future.
Different courses use different scenarios for assessments. Many instructors forgo a day of lecture so that students can dedicate sufficient time to completing the simulation. The usual requirement for passing the assessment is a score of 90%, but students can re-do each scenario as many times as they need. They are also able to work on other simulations in the topic independently.
After using the online simulations for the first time, a town-hall meeting was held so that instructors could collect student responses to the new assessment strategy. Students had overwhelmingly positive feedback about the online simulations. Most found the comments and ability to re-do simulations worthwhile, so they could make note of what went wrong and improve it. Instructors found that the scenarios were quite realistic and that they were great teaching tools that provided hands-on learning in a low-stakes way. Medical-Surgical, Maternal Child and Paediatric simulations have been implemented so far in 2018 with plans to expand into other nursing content areas. Doing these virtual simulations is a good way for students to build on their skills and confidence prior to coming into the high fidelity human simulation lab.
Clinical Simulation Labs
The Clinical Simulation Lab intends to recreate clinical settings as closely as possible. Technology is integrated at every level. Models of patients of different ages are designed to look and feel as life-like as possible. This means that are an appropriate weight and height, their skin has a very similar texture to human skin, and nursing students can feel their “bones”. They are attached to computers that give them the sounds and motions of breathing, medical conditions or other movements. The spaces are made to look like hospital rooms or home settings, and students are expected to conduct themselves as they would in the actual practice area. Students are given lots of opportunities to practice treating patients with these models before they are assessed. There are open lab times, so students can come in and practice difficult skills with an instructor outside of their regular lab times.
Some laboratories are designed to be used specifically for assessments. The control room is adjacent to a room for the simulation instructors, which has a one way window so they can observe the student and computers so they can control the simulated patient. Instructors make it as realistic as possible, even using voice-changing technology to make their voice fit with the patient’s age and gender. These assessments are higher stakes for students. The assessor speaks like a patient would, and reacts to the decisions that students are making. There is a briefing and debriefing before and after the simulation learning activity. Students are encouraged to ask questions and be reflective throughout the process.
Both the virtual simulations and clinical simulation labs feel very realistic and can closely assess students’ skills. They help build both competence and confidence in nursing practices, which are essential when students move into hospital practicums and start working with real patients. Hands-on learning and assessments are key to making sure that students know what to do in real life situations and feel prepared to handle them.
Special thanks to Dr. Sandra Goldsworthy, Associate Dean, Teaching and Learning, Faculty of Nursing, for sharing these assessment methods and for her continued work creating experiential and hands-on learning opportunities for nursing students.
-Ashley Weleschuk
