Virtual simulation and electronic medical records: Can we work smarter, not harder? Lessons learned
Nursing education organizations, including the NLN and ANA, and initiatives such as TIGER and QSEN, are among the first to outline definitions and standards surrounding informatics. Each day nurses use information technology to make critical decisions surrounding patient care. As educators we need to ensure that our students are prepared to use the data at hand to think critically and use clinical reasoning.
As nurse educators, we all face similar challenges. We all struggle to implement accreditation standards while educating our students to care safely for patients, show compassion, and prepare to pass the NCLEX. We are all confronted with a shortage of clinical sites, whether we teach in rural or metropolitan areas. And we all want to know: How can we integrate informatics into the nursing curriculum in a meaningful way?
With the increased use of manikin-based simulation and standardized patients as teaching strategies, the validation of simulation standards, and virtual reality beginning to augment or replace clinical teaching, educators are also asking: Can we work smarter, not harder? Can we integrate information technology and virtual reality? Can we incorporate virtual simulations and electronic health records together in a dual assignment?
Let me share with you an example of how my colleague at Belmont University, Dr. Angela Lane, approached these questions. Angela's students in Belmont's Child and Family Nursing course complete 10 virtual simulations (vSim® for Nursing): 5 core and 5 complex cases. For each of the cases, students must also complete documentation in an electronic medical record (EMR) (Lippincott DocuCare). The simulations, and the subsequent documentation, count toward their clinical placement. According to Angela, one advantage to the virtual simulation platform is the immediate feedback students receive based on their clinical decision-making. Once they complete the simulations they must go to a new "platform," open the EMR, and chart their assessment, medications, and patient teaching.
How many hours should we attribute to this work? If we are truly replacing clinical hours with virtual simulation, how should we evaluate the student's work?
These are just a few of the questions Angela has faced during her journey as an early adopter. This journey has lasted several semesters, and this spring she asked clinical faculty to take on some of the grading of the EMR. Angela also communicated some lessons learned: Treat student preparation as clinical orientation. Have the company representative come in and ensure that each student can access the virtual simulation. Be sure each student understands the assignments associated with the clinical.
One plan for the upcoming semester includes the use of "guided reflection" questions that are included with the virtual simulation. These will be part of a live postconference, while also reviewing the EMR. Angela and her team have participated in training for "debriefing with good judgment" and are well prepared to help students use the virtual simulation and EMR documentation to impact their clinical reasoning and practice. Other nurse educators currently combining the two types of platforms have noted that they have their students provide rationales around their documentation within the EMR. Providing rationales could also be part of the Socratic questioning during debriefing sessions. Having students comment on the diagnostic data in the patient records and expand on assessment findings helps confirm their understanding of information relevant to the patient case.
It is important to emphasize that research on the impact of virtual simulation is essential to ensure that documentation is meaningful.
And such simulation technology is available right here at home for today's nursing students, to better prepare them for direct patient care. Designed to simulate real nursing scenarios, Lippincott's vSim for Nursing, co-developed with Laerdal Medical, allows students to interact with patients in a safe, realistic environment, available anytime.
Based on simulation scenarios developed jointly with the National League for Nursing (NLN), each course area includes a variety of patient diagnoses and situations requiring complex decision-making and reasoning.
Discover the following available course areas for vSim for Nursing: