Linda Gibson-Young, Assistant Professor, College of Nursing
NGR 5003: Advanced Health Assessment and Diagnostic Reasoning. This is a core, foundation-level, required course for graduate nursing students in the nurse practitioner or nurse educator curriculum. Typically, the course is offered in a mixed-mode format and meets face-to-face for two (2) hours every other week, while the rest of the content is taught online through Canvas.
In this course, we flip the classroom. In this flipped classroom, graduate students read required assignments, then complete modules and quizzes in the online environment. This typically requires students to practice each system assessment in the home on a spouse or family member. Concurrently, there are 30 mandatory hours in a face-to-face laboratory allowing independent practice of assessment skills, and students receive feedback from adjunct faculty members in the College of Nursing. However, this lab time is limited to 30 hours total.
Increasingly, this face-to-face laboratory time has validated the need for more intensive instruction in the online environment to ensure students accurately learn advanced health assessment skills and diagnostic reasoning techniques. Because of this need and because of mobile accessibility, we have implemented the use of a digital clinical patient experience web-based technology as an innovative teaching strategy for use in this graduate nursing course. In a recent study, we have examined the feasibility of utilizing Shadow Health’s Digital Clinical Experience (DCE) with graduate nursing students in our health assessment course.
Examining TINA: A Standardized Digitalized Patient For Advanced Health Assessment And Diagnostic Reasoning on a Mobile Platform
Numerous advances have been made in graduate nursing education curriculums across the United States including: greater prevalence of online nursing education, laboratory implementation of high fidelity simulators, and increased faculty and student interest in web-based technologies. While there are numerous instructive products to educate undergraduate nursing students on health assessment, we lack material for advanced practice graduate nursing students. Students are required to have computer accessibility with this online classroom, so we aim to include a new and innovative technology.
Shadow Health’s Digital Clinical Experience™ (DCE) to provide students with a dynamic and immersive experience through a clinical examination of a digital standardized patient. TINA is a computerized patient and the experience is standardized.
1) To examine student perceptions when using digital standardized examinations, history and assessment findings, and documentation and
2) To explore relationships between student use of digital patient with learning style, exam grades, and SOAP note scores.
To examine the effectiveness of the DCE we utilize a mixed method design with qualitative focused semi-structured interviews, along with descriptive and correlational analyses with the sample of graduate nurse practitioner and nursing educator students. Each term, we explore student perceptions pre and post intervention within an advanced health assessment course in an online environment. We collect demographic data, learning styles, and curriculum data for descriptive purposes.
Student learning styles assessed prior to course.
- Visual 70%
- Auditory 30%
- Kinetic 50%
NOTE: percentages exceed 100% r/t multiple learning styles
We found students positive with this mobile technology, but did identify students were overwhelmed prior to TINA use.
- “I like the idea of Tina, but not sure how many questions to ask.”
- “Tina is only one patient, I would like to work with many different patients using this one software system.”
- “I am older, and Tina is hard to learn. I want the patient to be live.”
- This was a new experience for students; no student had used a mobile clinical patient with previous coursework.
- Student perceptions changed with use. Students were open to learning new technology.
- Students worked with Tina throughout semester, even without prompting. Students practiced with Tina outside of required activities.
Themes obtained post-TINA:
1. Comprehensive understanding of content
2. Practice collection of history
3. Documentation feedback
No significant relationships between learning style and TINA modules: History, HEENT, or GI. Since we expect to use TINA with all learning styles, we expected a non-significant correlation.
Faculty perception significantly better with use of TINA. Students perceptions improved throughout use.
Application of Mobile Technology in Course:
By incorporating this innovative teaching strategy using a mobile delivery system, we seek to promote interventions that will promote successful teaching in the online environment. Students have access to technology and successfully manage the use of a digital clinical patient. Use of this immersive experience with a digital standardized patient will add strength and substance to this course.
This information has been submitted to Computer, Informatics, and Nursing journal. Expect publication 2014.
Any questions or comments about this Faculty Spotlight? Please contact Dr. Linda Gibson Young at firstname.lastname@example.org.