Challenge accepted! Addressing the clinical practice gap during the pandemic

Wow, 2020 was rough! Not only did it affect our everyday way of life and how we manage contagious viruses, but it also put our educational system on notice that we need to be flexible and able to change up our teaching methods on a dime. Luckily for nurses, flexibility is our middle name, and we can embrace new modalities both in our bedside practice as well as in our classrooms.

We saw this happen in the early days of the pandemic. Nurse educators put their heads together to create meaningful assignments to fill the gap created by the loss of clinical practice for students. Some were better than others, which left us searching for new innovations in the tech world. Enter Kaplan i-Human. Kaplan i-Human is a highly interactive application designed to help students master patient assessment and clinical reasoning. In the application, students can provide care to virtual patients who blink, answer questions, and respond to interventions.

The application has a wide range of patient ages as well as quite a variety of diagnoses to work with. After viewing a demonstration of the product and gaining access to the application for trial, the Healthcare of Children faculty concluded the application was a good fit in our course and would address the loss of clinical practice better than additional written assignments. We introduced i-Human to our students during the second half of the spring 2020 semester.

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We assigned our students four separate patient scenarios that ranged from a baby with hyperbilirubinemia to an adolescent with Post streptococcal glomerulonephritis (PSGN). Each scenario included a detailed history, physician orders, medications and interventions required for the patient. The data was presented in an Electronic Health Record (EHR) format to facilitate charting in the real world. Students were required by the app to interact with the patient or family member (scenario dependent) by asking pertinent questions, performing a physical assessment, taking vital signs, and applying necessary interventions appropriate to the patient's condition. They were also asked to determine which actions were of the highest priority and write up nurse’s notes and as a Situation, Background, Assessment, Recommendation (SBAR) communication about the overall encounter during the simulated experience. Students were graded on their performance in several areas and given an overall score. After each scenario was completed, the program provided students with feedback pertaining to health history information that was important for them to have noticed, abnormal physical assessment data that should have been obtained and the priority nursing interventions that should have been initiated.

Initially, we ran the assignment without any additional course work but found that although the students stated they were learning from the experience, we didn’t have a good way to evaluate due to the extensive feedback provided in the application. After incorporating i-Human into their courses for a few semesters, faculty developed a written assignment that required students to do prework which included specific readings from their text, along with answering questions about their primary concerns for the patient in the scenario, including medications the patient may take at home, physical assessments that should be conducted, anticipated medical orders, and homegoing instructions. Upon completing these steps, students then moved into the simulation exercise. Afterward, students wrote a focused assessment of the patient in the scenario, prioritizing abnormal assessment findings and identifying appropriate nursing/medical interventions, including an appropriate SBAR communication. Use of the literature and in-text citations were required to support their healthcare decisions. Each student also had to include a written reflection of what they did well, where they could improve, what they could do differently and how the exercise improved their ability to think critically. The students’ reflections, along with the feedback from i-Human, were both taken into consideration when the faculty graded these assignments.

Feedback from students has overall been very positive. While they state the assignment was challenging, they were able to see how their critical thinking has improved with each scenario. They also identified specific areas of practice they personally need to improve on, such as reviewing health history data more thoroughly or asking specific questions to gain pertinent patient care information.

While simulations can never replace robust clinical practice experiences, especially in the care of children, this i-Human application and associated assignment have become a valuable tool to help address practice gaps. The use of this app was born out of the challenge of the pandemic but has become a staple in the ever-changing world of evidence-based practice nursing education.

Students are now completing the i-Human experience at home on their own time as classes are back to in-person simulations in addition to bedside practice in the hospitals.