While the COVID-19 pandemic was the catalyst for many institutions to introduce virtual simulation (VS) into their undergraduate nursing curricula, educators are discovering that there are many uses and benefits to VS beyond clinical replacement. Recently we caught up with Adrien Gupton, DNP, APRN, CNM, FNP-C, Assistant Clinical Professor, Northern Arizona University, to learn more about her experience with VS and i-Human Patients by Kaplan.

VIRTUAL SIMULATION AND YOUR INSTITUTION

How long have you collaborated with Kaplan, and when did you start incorporating virtual simulation (VS) into your curricula? 

I have collaborated with Kaplan since spring 2017. The maternal-child nursing team has incorporated virtual simulation as part of the didactic course since 2017. In the FNP program, i-Human Patients was incorporated as part of both the didactic and clinical courses in 2018. During the pandemic, both the undergraduate and graduate programs used virtual simulation in order to meet the clinical requirements outlined by the Arizona Board of Nursing. 

What was the biggest challenge of incorporating VS at your institution and how did you overcome it? 

The biggest challenge of incorporating VS in the undergraduate maternal-child course was the students’ access to good Wi-Fi and the student’s perception of the value of the VS. Some students initially thought that VS was “busy work” and did not feel that the exercises would be helpful to prepare for exams. I overcame the situation by consistently incorporating the VS in the didactic setting and asked students to complete exercises that forced them to compare information learned from VS with other assignments and resources. After the student performance on the second exam (which is very rigorous-focuses on intrapartum, postpartum and newborn topics), the students realized that the way the i-Human Patients forced them to use clinical nursing was valuable in helping them to be successful on their exam.

Were you using VS before the pandemic or did the rapid transition to online teaching inspire you to seek out an alternative to in-person clinical experience? 

i-Human Patients VS was used in our clinical and didactic family nurse practitioner courses before the pandemic. We just increased the use of i-Human during the pandemic to meet our clinical requirements. We also used i-Human Patients as a clinical make up assignment if students were not able to attend a scheduled in-person clinical rotation.

Please share how VS helped you manage the COVID-19 crisis at your institution. 

VS helped us to manage the lack of in-person clinical placement due to the pandemic. This was especially true for our undergraduate maternal-child nursing students. The local hospital stopped all clinical rotations on the OB and pediatric floors. i-Human Patients VS was used to replace the clinical rotations for two student cohorts (Spring 20, and Spring 21) for the entire semester; which was in alignment with the emergency pandemic protocols outlined by Arizona Board of Nursing.

THE IMPACT OF VIRTUAL SIMULATION ON STUDENT LEARNING AND RETENTION

What is the aspect of VS that has the greatest impact on student learning and retention?

The clinical nursing judgment and diagnostic reasoning aspects of the i-Human Patients had the greatest impact on student learning and retention as evidenced by at 10-20 percent improvement on assignments and examinations

How can VS help students learn to “think like a nurse?”

The platform provides a clinical scenario that allows the student to organize and pick the pertinent information over time. Also, i-Human Patients allows students to change the patient status over a course of time and place. For example, have the nursing students follow a medical-surgical patient from pre-op to discharge giving the student an opportunity to implement the nursing process to solve various scenarios over a course of time.

In what ways does VS help students build clinical judgment skills? 

The interactive ability of the client with the nursing students has helped build clinical judgment skills. The way VS is set up encourages the student to use clinical judgment in order to ask and tease out the pertinent information in order to proceed to the next step. The scenarios also allow students to provide information that they believe to be pertinent before the clinical scenario begins. Then the clinical instructor can show the Kaplan expert’s answer and facilitate student learning and engagement surrounding the comparison.

How will incorporating i-Human Patients into your curriculum help to prepare your students for the Next Generation NCLEX? 

i-Human Patients will force students to ”read into” the clinical scenario and learn how to successfully answer unfolding case studies, stand-alone case studies and bowtie questions. The scenarios presented within i-Human allow for client-student interaction in real life situations over time. Next Generation NCLEX will be asking questions that are associated with clients over time. Introducing i-Human Patients VS early in the nursing programs will provide the student with frequent opportunities to develop clinical nursing judgment over time. It will also allow students to incorporate the nursing process as they are learning clinical nursing judgment (i.e. learning how to identify, analyze and apply pertinent information from the scenario to successfully answer NGN NCLEX questions). Lastly, i-Human provides the foundation for students to apply what they have learned in all of the nursing courses to address client issues. For example, students will have to apply what they have learned from pathophysiology, pharmacology, and physical assessment courses in order to successfully address the NGN-NCLEX questions. Previous NCLEX questions would focus on each of these courses independently.

THE VALUE OF VIRTUAL SIMULATION BEYOND COVID-19

Beyond simply being a replacement for in-person clinicals/simulation labs, what is the most important way that virtual simulation can benefit your students?

Educators can use innovative ways to increase student engagement using VS by incorporating i-Human Patients in a scrambled classroom setting. For example, for postpartum hemorrhage, I converted the classroom into a virtual hospital ward. I divided the class into groups and assigned them to a certain part of the VS. Their task was to apply the nursing process to identify and analyze the pertinent information and use the information to develop and implement nursing interventions and present their findings to the class.

How does virtual simulation increase student’s exposure to diverse patients and cases? 

According to the American Association of the Colleges of Nursing (AACN) and the Commission on Collegiate Nursing Education (CCNE), one of the focus areas of the new essentials is the incorporation of diversity, equity and inclusion into nursing curriculum. VS has the potential to introduce the student to a wide variety of clients and their families/caregivers that cover topics and situations that include ethnicity, gender identity, culture, LGBTQIA+, homelessness, and health policy.

How do virtual patient encounters effectively prepare students for real-world scenarios? 

The VS patient encounters force  the student to follow the case to resolution. It also provides students with wonderful feedback to help them improve the areas that were associated with moderate to low performance. As an advanced practice registered nurse, it is imperative that client cases are approached using sound nursing clinical judgment and diagnostic reasoning. Cases must be followed to resolution (i.e. cured, referral etc). The nurse must have alternative hypotheses in mind in the event that their leading diagnosis does not work out. The VS patient encounters provide many opportunities for the nursing student to safely make and learn from their mistakes. Lastly, I had a family nurse practitioner student to share with me that one of the virtual patient encounters prepared her for a patient that they saw during their clinical rotation. They were able to correctly recognize and diagnose the problem and were an active part in contributing to the treatment plan. The preceptor was not familiar with the diagnosis and credited the student with the successful client outcome.

VS SUCCESS STORIES

Can you share an example of how VS helped a student increase their confidence and/or success on their exams? 

During the pandemic, I had several students in both the undergraduate and graduate programs to struggle with clinical nursing judgment. In the undergraduate program, two students had a low B average in the maternal-child course. The students and I met and developed a study plan to help improve their performance in the course. As part of their study program, students were encouraged to incorporate i-Human Patients VS scenarios (at least 1-2 per week). Both students improved their exam average. One student went from a low B average (84 percent) to a high B average (90 percent). The other student went from a low B average (84 percent) to an A average (93 percent). 

In the graduate program-family nurse practitioner cohort, I had a student struggle with using diagnostic reasoning to develop differential diagnoses. The student reviewed some videos on the i-Human VS discussing the steps to implementing diagnostic reasoning before delving into the scenarios. The student applied the information from one of the videos when answering questions within the cases. Their score improved dramatically at the end of the scenario with the highest scores being in differential diagnosis.

ADVICE

Can you share any tips for getting students excited about using virtual simulation? 

My advice for educators is do not be afraid of incorporating i-Human Patients virtual simulation into both the didactic and clinical settings. VS is an excellent way to reinforce learning from lectures and clinical experiences. Studies have shown that students learn best from a variety of methods and they learn best from each other. VS encourages student engagement and offers a variety of cases to choose from.

i-HUMAN PATIENTS BY KAPLAN

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