Catching Up with Karen Lilyquist, PhD, APRN, CNP, PMHNP-BC, NCLEX Instructor, Case Writer for i-Human Patients by Kaplan
by Karen Lilyquist, PhD, APRN, CNP, PMHNP-BC, NCLEX Instructor, Case Writer for i-Human Patients by Kaplan | October 4, 2021
Last year, we introduced you to our Kaplan experts so that you could learn more about our team and what drives them to stay passionately committed to nursing education. This year, we’re taking an even deeper dive into their insights and opinions about healthcare education and what educators can do to truly help their students not only succeed on their board exams, but also to thrive in their chosen profession in nursing. We’re excited to welcome back Karen Lilyquist, PhD, APRN, CNP, PMHNP-BC, NCLEX Instructor and Case Writer for i-Human Patients by Kaplan.
2020-2021 was a particularly trying time for those of us who work in healthcare and education. If there was a silver lining to the COVID-19 pandemic, what did that look like for you?
Last fall (Fall 2020), I was able to complete behavioral health clinical with my students before the community college for which I work opted to move nursing courses, lab, and simulation experiences online. I appreciated the willingness of our local hospital and our college administration to allow that experience, with restrictions in place. I truly believe that nursing students need in-person learning opportunities to develop skills such as therapeutic communication, patient-client relationships, the ability to pick up on the nuances of tone, infection, and slight body movements, but I recognize the shift to online learning was based on need for safety―for our students, families, patients, and staff.
The silver lining → the resilience of our nursing students. If students had not identified that nursing is a profession of making decisions based on date, they learned quickly, and students demonstrated the ability to shift to a different platform in record time. I won’t say this shift was without stress and distress, but what I saw was amazing.
Students that were familiar with an online platform helped others that were struggling. I didn’t need to ask; the students themselves identified a need and acted. Students that figured out how to video themselves completing a skill, and posted their experience online so others could learn from their mistakes and accomplishments. My students also showed up and were present in the Zoom room where our class was taking place. I believe we had better discussions in that environment than we did in class. That may be because I insisted that all participate, but I believe it to be the level of attention paid to others in the Zoom room as it was the connection that students sought.
I also had students that dropped out of classes because life outside of school was overwhelming, and I acknowledge their ability to understand their own distress and breaking point, and more I respect their recognition that family (in many cases) was more important than schooling at that point in time. I believe our need to shift and need to look at ourselves and others ability to make that shift brought with it a change in behavior―one that focused outside of the student time and time again. I saw anger and defeat; I saw change in attitude; I saw grace; I saw compassion; I saw people meeting the needs of others. I was humbled to be working with the group that I do.
What kept you sane and inspired during the COVID-19 pandemic?
My family and friends kept me going during the pandemic. I, like many others, lost close family members at the start of the COVID pandemic (for issues not COVID related). I believe this was a pivotal point in one’s life. Friends could (1) pick up my spirits, listen, be present or (2) go back to their daily lives. I found many of my close and distant friends opted for the former. They chose to be present in the time of my grief, but more they stay connected with phone calls, text messages, emails, cards as the months past―all just checking in.
I recognize that each of them had home and work lives that changed, yet they continued to include me in their thoughts. Some will just say, “that is what a friend does,” but I know that to be untrue. Lives go on and it is difficult to stay connected. I know it took an added effort on their part. I continue to be amazed by the compassion (I should have known, right?) and I am inspired. I recognize that others need the same connection that I needed. I strive to make those small connections with others. A smile. A text. A nod. You will never know what another is going through―be kind, be thoughtful. You make a difference.
NURSING EDUCATION TODAY
In what ways can early remediation lead to ultimate student success on the NCLEX?
Remediation is where the learning takes place.
Many students review tests by looking at questions they answered incorrectly, and evaluating at the incorrect response. Simply learning why an incorrect answer choice is wrong is not enough to help one succeed on the NCLEX. One must learn why the credited response is correct and the distractors are incorrect. One must look not only at the answers, but the context of the question. The sooner that students incorporate that mindset, the sooner students will learn from mistakes and make behavior changes to be more successful on subsequent tests.
Too often in nursing school, we (instructors) give students a test and then provide a grade. Instructors are so worried about test integrity that test review is seldom an option. I believe we are missing a teaching opportunity for our students. We can use test review as a time to teach the action of remediation and discuss its importance. We can build knowledge, skill, and value of the experience.
Remediation is twofold. The first is to consider the test itself. By looking at the experience, students can learn from timing cues (spending too much or too little time) and runs of incorrect responses (did the student lose focus, did the student need a break), and students can learn to sense anxiety and try different techniques to quiet that anxiety. With this, students learn behaviors that work well and those that do not and make changes to increase the odds of a better score on the next exam. The second part of remediation is review of the question. Students need to understand the question to respond correctly. Test review allows that practice. Students need to learn to eliminate wrong answer choices (for specific reasons) and then trust in the response that is left.
Taking a well written test is both an art and a science. Knowledge of facts is important as is understanding the why behind a given action. Decisions are based on this knowledge. Yet, this is not enough for the NCLEX. The NCLEX will ask the student to make sound clinical decisions in a new situation. For the student that has learned a comprehensive remediation process, that student has learned about questions themselves, has learned how to systematically think through a question using a framework that follows the nursing process. This student has learned to apply knowledge rather than recognize correct facts. This student has learned to confront a new situation and logically determine the safest, most effective response.
Beyond clinical replacement, what’s the most exciting aspect of integrating virtual simulation into nursing curricula?
I shy away from using the term “clinical replacement” when talking about virtual simulation. I believe simulation is a tool that augments the learning process. The patient encounter is a small part of the virtual simulation, the experience is the learning that takes place before, during, and after that encounter.
By nature, simulation learning is a controlled environment. Students can practice skills and with that develop communication and technical skills with a safety net. Simulations can push students outside of their comfort zone, but there is access to resources. The most exciting aspect of simulation is collaboration and active learning. Students experiencing the same encounter have a common frame of reference which stimulates discussion. Students learn from explaining their ideas to others, from collaborating with others, from giving and receiving feedback from others. It does not matter the platform of virtual simulation, it can be an online game, augmented reality, or a case study. The value of simulation is the discussions that take place throughout the experience that push students to think about their thinking. In this aspect, virtual simulation can augment the didactic classroom, lab, or in person simulation.
Why is it critically important to address diversity and inclusion in nursing education?
Nursing education must include diversity and inclusion to provide the opportunity to administer quality care, meeting cultural, social, and language needs, of all patients. Introducing the concepts within the nursing curriculum leads to cultural competency. To understand another’s culture is to acknowledge values, attitudes, beliefs, traditions that may be unique to that individual and that improves communication with that individual, and that builds trust and respect, and likely better outcomes.
Are there any Kaplan webinars or resources that you’d recommend for educators seeking to learn more about a trending topic in education?
Kaplan has so many great resources for nurse educators, including:
- The Nurse Educator Blog You will find the Educators for Educators series as well as a series in which you meet the Nurse consultants. More, you will find topics ranging from best practices with simulation, test writing, preparing students for the NCLEX, incorporating technology into education, boosting clinical judgment, just to name a few.
- Shannon Meijer, DNP, RN, Nurse Consultant did a great webinar on Clinical Judgment on Next Generation NCLEX.
- And a panel discussion Prepping for NGN doesn’t mean reinventing the wheel, found here.
- A full menu of Nurse educators videos can be found here.
ADVICE & TIPS
What are your top tips for helping to build student confidence?
Confidence is a belief in oneself. A confident person takes risks, learns from mistakes, and among other things, is optimistic.
Nursing school can be overwhelming. Students are asked to perform skills that are new, take part in group presentations, and take test after test on new information. Not always does the outcome go as planned, which allows self-doubt and questioning set in. So, how does one build confidence?
(1) Surround yourself with positive people. These folks are optimistic, see the good in themselves and others. These people, by association, will lift you up.
(2) Work on weaknesses. Listen to feedback, verbal or written, from peers or instructors. Identify areas of weakness and practice (over and over again). Prepare (learn what is going well, keep doing it. Learn what did not go well and change your behavior). and Perform (act as if) and confidence will come. Look at what you have achieved and remind yourself of the good that you have done.
(3) Find a mentor. Mentors can help students transition from acquisition of knowledge and skills to application. Use these individuals as a role model, ask questions of them, and allow them to guide you through the few years of being a nurse.
Is there a tried-and-true strategy that you could recommend for nursing students to manage their stress and mental health around their board exams?
Stress happens when we lose control over a given situation, when our usual means of coping no longer work. A little stress can be a motivator. For example, it can make you more alert (envision yourself taking the NCLEX, a little stress makes you sit on the edge of your seat, open your eyes, be aware of your breathing, read every word carefully). A little stress shows that you care about outcomes. A lot of stress (distress) can create an overwhelming flood of disbelief. It can create irrational thoughts and questioning of your ability. The latter can have a devastating effect on your NCLEX experience.
You want to identify what stress looks like for you and practice ways to manage those feelings. Each of us has one or two unhealthy ways to manage stress, which may include (but not limited to) distracting ourselves from the situation, use of drugs or alcohol, binge eating, binge TV watching, binge sleeping. Be aware of these behaviors and minimize them. Consider more healthy ways to manage stress: exercise, eat a balanced diet, meditate, connect with friends, and breathe. Recognize triggers and do what you can to minimize them.
Specific to the NCLEX, stress can cause you to question your confidence. In addition to managing stress, you can increase your confidence by setting a study schedule, practicing questions and remediation, building on your strengths and making changes to alter your weaknesses. With behavior change, you will see scores change over time, which will lower your stress as well.
What tips would you recommend to educators to help their students achieve that “ah-ha!” moment when it comes to studying for the NCLEX?
I view the “ah-ha” moment as recognizing that the ability to pass the exam lies with the student. Taking control over studying, making a schedule and sticking to it, remediating every question, acknowledging what is not working for the student and making behavior changes. Seeing that these changes impact ultimate test scores is that “ah-ha” moment.
Educators can help students recognize this intrinsic control. Talk about study plans, ask students how they are doing, ask about what is working and what is not, ask about anxiety and what is working to lessen it and ask what steps the students are taking to rectify these issues. Talk about taking control and learning from past outcomes.
The COVID-19 pandemic changed the world of education. What advice would you give to nursing educators about teaching online?
Teaching online is different from teaching in the classroom. You can no longer chat informally with students before or after class, answer pressing questions, or notice the subtitles of body language. If left to chance, online learning is less personal and less effective.
While it is important to prepare content, it is equally important to deliver that information. Key to online teaching is your presence (your tone, your facial expression, your facilitation of discussion, and your organization of the course).
Connect with your students―not just facilitating the class, but setting up the course, providing instructions for assignments.
Focus on the asynchronous presence as well – struggling to find files, links, drop boxes, etc., can cause stress. Practice moving through your lessons in student mode and use that experience to alter your design as needed. Be active – define active for yourself, but let the students know that you are reading posts, available to answer questions, and available to talk. Let them know you care and appreciate their work.
Create a sense of human connection, even in the virtual world. Check in with students, allow them to check in privately to identify accomplishments and concerns. Let students talk with one another for a short time before and after class.
Get student feedback; respond to it. Teaching can be a work in progress. Ask for feedback and analyze that data and make appropriate changes. Do this each semester. Communicate to students that their input matters.
I wear multiple hats: besides working for Kaplan, I work as a FNP at a dual diagnosis (CD-MI) treatment center, a prescriber of psychiatric medications, and teach nursing at a community college. There is a method to my madness: all my roles involve teaching, science, and caring for others. My career choices allow me to help others, in that moment, be the best that they can be.