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HealthJanuary 05, 2021

Teaching clinical skills via an online platform

By: Shena Williams, MSN, RN
The pandemic has created several unique challenges for colleges and universities and especially, Schools of Nursing.

Nurses are needed more than ever at this moment, making “halting” nursing schools and nursing education something that frankly has not even been a thought within the nursing community. While it was an easy switch over for lecture, thanks to the availability of programs like Zoom and MS Teams, the challenge was definitely having the ability to teach clinical skills to large groups of students.

Clinical skills are one of the most important things that nurses learn in nursing school. Often first-semester nursing students enter programs in groups of upwards of 100 students. Many nursing students do not have the means to purchase expensive equipment that is marketed to help in situations where students will primarily have to practice at home instead of using the school lab equipment daily. This is where it is important to become creative while still ensuring that you are providing the best possible alternatives to clinical skill instruction. This blog will discuss some of the key lessons learned while teaching clinical skills to first semester students not going to clinical sites in a hybrid course.

Clear instruction

When tasked with coming up with ideas for students, there are an endless number of options that may initially run through your mind. It is important to remember that students require clear instruction and guidance. Therefore, providing students with structure is the single most important aspect to successfully teaching students skills.

When one thinks of Zoom and Microsoft Teams (MS Teams), you normally would think of a lecture. However, these platforms have proved to be very helpful when teaching skills to a large class. Each student ultimately has a front-row seat to the skills demonstration when utilizing these online tools.

Another form of instruction for students is video demonstrations. There are a wide variety of videos of skills available on the market. Often the students’ textbooks come with several online videos that can be utilized. The instructor needs to view the videos and make sure that they are clear, easy to understand, and teach the skills correctly. It is also important when using videos that the instructor provides clear instructions on which videos students are to watch. It has been found that many students, despite being told which videos they need to watch, often veer to YouTube, which provides several videos, however they are often not the most reliable.

Live-online instruction

So, we are in a pandemic, need to socially distance, how on earth can we teach 100+ students skills reasonably? Live-online instruction has been the best method. This simply means using an online platform to demonstrate in real-time.

The easiest tools for this method was a smartphone, a subscription (usually available via the school) to Zoom or Teams, and at least two additional clinical instructors. The subscription is key as it will allow you an unlimited amount of time on the platform without it cutting you off. Before beginning the demonstration it’s always good to have a dialogue with the students. Our dialogue often included normal findings pertaining to the skill, what equipment they would need, when would the skill be performed on a client and a brief run-through of the instructions in their skills book. Since they are getting live demonstrations this way, we did make sure they had their skills book on their person, so that they can follow through with the instructions as well as read the rationales when they did not understand a step. It is also vital to make sure that students know they are welcomed to ask questions during the demonstration. This gives them the feeling of being in person and allows them to have their questions addressed in real-time, as it would be in the normal clinical setting. One of the instructors who is assisting should be designated to hold the camera or smartphone device that is being used to show the demonstration. The other instructor should be nearby on a separate device, handling the chat as well as addressing the questions as the demonstration is going on. Upon completion of the skill, all instructors can take a moment to address any questions, as well as share personal experiences with the skill. This tactic often draws in the students, as they are always excited to hear “real-life” stories. It also gives them a moment to “recharge” between demonstrations. It’s important to have moments where they can “recharge’ as learning several skills along with being on the computer for an extended period can cause overload.

Video demonstrations

Demonstrating skills to students is vital in them learning how to perform the skills correctly. Investing in quality videos can be a key component of ensuring students understand how to perform them. The students’ books and other resources often come with numerous online tools. These tools usually include a series of “watch and learn” videos. While these videos are tailored for the book, it’s highly suggested that the instructors take a moment to review them, as they may skip some points that are important for students to think through. They are often minor points, however when the student performs their “check-off”, if it was not corrected on the video, or discussed prior to the checkoff by the faculty, it would not be fair to hold the student accountable.

Checkoffs

Many skills can be performed at home by the student. It was extremely important to explain the checkoff procedure well in advance, as there were many questions even after providing a thorough explanation. It was found to be a good idea to record example snippets of “acceptable” and “unacceptable” submission. These snippets should demonstrate unacceptable camera angles, voiceover skill videos and videos that were “cut-and-paste”. We found it useful to explain that we would not accept “YouTube” type videos. Many students are savvy and would perform the skill and just provide a “voiceover” explaining what they were doing, this defeats the purpose and therefore is unacceptable.

A needs survey could be carried out and if your facility has the capability, students can take home certain equipment. Any skill that was to be performed at home was explained thoroughly. The video of the faculty demonstration was included as a “link” and they were instructed on how to upload their return demonstration. While many of the skills were able to be recorded, there were several, such as Blood Pressure, and vital signs that students were required to come in person for. This was done in pre-assigned clusters. The use of these “clusters” allowed for easier checkoff as well as in-person demonstration/clarification of skills, while also allowing for easier “contact tracing” if necessary.

The take-home message

The pandemic has called for all nursing instructors to become more creative in every approach. The lecture portion of courses has been easier to adapt thanks to various online platforms. Skills, on the other hand, is one portion of the courses that have called for instructors to think completely outside the box at times. While there are many ways to teach skills, keeping it as close to the normal has proven to be effective for not only the sanity of the instructors but the benefit of the students.

Keeping the instructions clear and concise is perhaps one of the most important steps of the entire process. Making sure students have a clear understanding and you are putting instructions where students can see them easily and not have to search will help keep confusion minimal. Try to stick to one platform for the delivery of content to students. If you lecture utilizing Zoom, it is advised to teach skills on the same platform. This way students are not scrambling to figure out where lessons will be held.

Live-Online instruction is a team effort that can be very rewarding to the students. Having a plan ahead of time is vital for the execution of this method. A few minor supplies, set meeting times, and allowing times for discussion. Video resources can also add to the online skills demonstration. These videos can be made by faculty or from resources such as those included in the students’ text. The key is for instructors to take time to view the videos to ensure they are exactly what they are teaching.

Many skills can be checked off remotely, however, it will be necessary for students to come on campus occasionally. Providing clear instructions early in the semester will keep confusion to a minimum for students. When needing to check off on the school’s campus, putting the students into pre-assigned groups “clusters” and designated the exact time and location that they are to meet will help create a sense of normalcy as well as help the instructors and school in the case the contact tracing is needed.

The pandemic has created a situation that nursing instructors never imagined. We have become more creative in the past few months than we ever could have imagined. While many methods can be used to teach skills online, my hope is that those organizations that cater to a population who may not be able to afford the most expensive resources, will not be left behind, but instead encouraged and recognize that “where there’s a will, there’s a way.”

Shena Williams, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
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