HealthMay 26, 2023

Help your students prepare for NCLEX® with immersive experiences

When this year’s nursing graduates take the Next Generation NCLEX® exam (NGN), they won’t just be tested on what they know — but on how they think. The new test is focused on evaluating the learner's ability to demonstrate the use of clinical judgment when responding to clinical questions.

Ensuring that graduating nurses have training and proficiency in clinical judgment is key to patient safety. Research by the National Council of State Boards of Nursing (NCSBN), which oversees the NCLEX exam, shows that 65% of nursing errors result from poor clinical decision-making, with 50% of novice nurses involved in those errors in nursing care.

Of course, teaching nurses clinical judgment skills is nothing new, says nurse educator Michelle Moulton, DNP, RN, CHSE, CNE, Senior Manager for the Division for Innovation in Education Excellence at the National League for Nursing (NLN). “Nursing education has always focused on developing nurses who are good thinkers and decision-makers,” she explains. “The issue now facing nursing education is the need to shift ‘how we teach’ to best prepare learners to develop their clinical judgment skills. Nursing education is challenged to be more thoughtful and strategic in preparing our learners,” which includes leveraging promising immersive technologies like virtual reality (VR) to enrich the learning experience.

Measuring clinical judgment

To better assess a nursing student’s decision-making capacity, Dr. Moulton says NCSBN’s new measurement model focuses on clinical reasoning to make sound clinical judgments, which is an abstract concept for most learners. “Clinical reasoning is all about the thinking process and how we interact and engage with the environment where thinking happens. “Engaging learners to ‘think’ on paper is challenging. The thinking happens at the bedside while doing care, with alarms going off, phone calls coming in, all while multiple patients require varying degrees of care complexity.”

Framed around patient cases, Moulton says the NGN clinical reasoning questions are much more detailed, mirroring the complexity of real-world clinical practice settings where new nurses will be challenged to make decisions. “The learner needs to sort through more clinical cues, which is why learning in VR is more robust. For instance, learners are given a list of provider's orders and they need consider each one for relevance, safety, and priority – many more decision points. Here, the learner needs to be more discerning, pulling out the most relevant pieces of information. That's thinking in action."

vrClinicals for Nursing
A virtual reality solution that prepares your students for the real-world pressures of nursing practice with evolving, multi-patient, clinical experiences

Walking in a nurse’s shoes

Because learners are likely to struggle with the clinical judgment portion of NCLEX, at least initially, Dr. Moulton believes educators have to better understand and support their thinking process. “Our job is to look under the hood, so to speak, seeing how our students think, understanding the processes that guide them to good decision-making. To do this, there’s got to be more opportunities for them to practice their thinking in context.”

Although today’s students are exposed to some hands-on training through simulations and live clinicals, she says it is not enough to build enough experience. “You may only have one mega multi-patient simulation in your entire program. In clinicals, students may not be getting good educator time — especially with high student-to-faculty ratios. During live clinicals, students are also limited in what they can do because they are interacting with real people.”

Taking technology to the next level

Technology has long been considered a viable alternative to help nursing students hone their clinical judgment skills, with virtual reality (VR) of particular interest due to its immersive qualities. In a research study conducted by Wolters Kluwer and NLN, 91% of respondents said they were currently using some form of virtual simulation, with 48% saying they planned to invest more in virtual simulation over the next two years, anticipating full adoption by 2025.

To address the need for VR in nursing education, Wolters Kluwer, Laerdal Medical, and the NLN collaborated to develop vrClinicals for Nursing, a virtual reality solution currently in beta testing and expected to be launched in summer 2023. The solution immerses students into peer-reviewed scenarios adapted for the modality. Explains Dr. Moulton, a member of the development team, “We had to be very thoughtful, staying true to the learning outcomes we wanted to accomplish.”

The team scaled the VR scenarios to ensure the experiences were appropriate for learners throughout their education. With this approach, she explains that learners progress in a leveled manner, with the patient scenarios advancing in complexity as students become more proficient.

Virtual reality in action

What does a student experience with VR? How does it help build clinical judgment?

Unlike any other simulation modality, VR provides students with a sense of immediacy and realism from being in the moment. “It’s a game changer. Your senses are engaged. It’s remarkable,” observes Dr. Moulton. “vrClinicals for Nursing engages learners to provide nursing care for multiple patients. The multi-patient care experience requires that learners recognize and analyze several clinical cues, making the decision-making process more complex.

“The complexity of managing the care of multiple patients provides opportunities for learners to prioritize nursing care in a way that cannot be easily done in the clinical setting while caring for high-acuity patients,” Dr. Moulton continues. “The opportunity for learners to practice and receive feedback on these high-level skills is critical for the new NCLEX but is also an invaluable bridge to their nursing practice,” Dr. Moulton explains.

She sees VR being used in combination with other simulation capabilities, including mannikins and computer-based solutions like vSim® for Nursing. “As an educator, you’ve got to decide, ‘what am I trying to achieve?’ and strategically place the experiences throughout the curriculum to create a holistic student experience.”

Building a repository of knowledge

Ultimately, Dr. Moulton says the end game is to provide students with more clinical training, helping them build a mental repository of experiences they can draw on in actual practice. “Instead of being reactive, we need to shift to making immersive experiences a more proactive, thoughtful integration. In all cases, students should be entering into an experience with a learning outcome and the goal of gaining experience practicing and demonstrating clinical reasoning,” she adds.

Learn more about vrClinicals for Nursing and how it can be incorporated into nursing programs.

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