Dedicated time, at the beginning of the year to refresh students’ practical; skills

Written by Linda Bachelor

  Executive Summary

Third year students are placed in to the first placement of the year in their second week back after break. Because the content of the first week is all theory it does not allow time to practice clinical skills in the simulation labs which, depending on what order clinical placements were done in second year, can be a disadvantage to some students who have not been in a hospital environment for many months. This is why in this submission, I suggest that third year students have dedicated time, before theory week at the beginning of the year, in order to refresh their memory of the hands on skills that are required on placement. This will provide students with a safe learning environment, time to discuss scenarios, identify any issues or areas that the student needs to work on before going out on placement.

Recommendations:

  • To have a week in the simulation labs before the first theory week at the beginning of the year as a refresher that comprises structured stations, with lecturers circulating if more information is required.
  • To have set times in each theory week over the course of the year where 3rd year students have access to the labs to be able to practice procedures unsupervised using scenarios designed by lecturers with structured step by step instructions, similar to OSCE marking schedules , to ensure we know we are doing it correctly.
  • To practice more with the manikin that can talk back and receive medications through an IV line.
  Submission

As third year students much more emphasis is put on us to be proactive and take a patient load while on placements. We are also expected to do more patient assessments and tell our preceptor what we think should be done regarding our patients’ care. This can be a challenge for some students particularly when it comes to hospital placements. We are put in groups and your group depends on what rotation your placements take. If the student did their hospital placement at the beginning of year two, then by third year it could be nearly 12 months since they had been in that kind of environment. As with any skills if you don’t use them you lose them, there is only so much you can learn from reading a textbook and going to lectures. The hands on experience helps to bridge the gap between theory and practice (Ballard, Piper & Stokes, 2012) and is what helps to cement it into one’s mind which is where having time in the simulation lab is so important.

Simulation is an effective way of increasing students’ knowledge of health conditions and clinical skills related to those conditions, but is not a replacement for clinical placements. Literature shows that the use of simulations is increasing due to the increasing technical advances (Handley & Dodge, 2013) including the ability to have really life like manikins that can have a palpable pulse, blood pressure and mimic other human characteristics that are controlled by a computer. It also shows that the use of simulation provides an effective learning approach as it allows students to be active and fully participative learners (Lapkin & Levett-Jones, 2011).

Practicing in the simulation laboratories provides a safe environment to learn where mistakes can be made without the repercussions of making a mistake was made on a live patient. When mistakes are made the learner can spend the time to breakdown the situation and figure out exactly what went wrong and why and what could be done better next time to ensure it doesn’t happen again (Traynor, Fallager, Martin & Smyth, 2010). By discussing those simulated situations in this environment, students are also given the opportunity to discuss events that may have happened to them while on placement that they may not have understood. The support from lecturers and other students can provide the confidence to speak up and explain what happened and get a better understanding of a situation. It also allows students to bounce ideas off each other and pass on knowledge to others who may be having difficulty without any fears of being made to feel ‘stupid’ for asking.

Kelly and Wilson (2009) describe nursing knowledge as “an awareness of the reality one acquires through learning or investigation” (p. 181). Simulations give students the opportunity to learn about equipment, procedures and possible situations that might arise while on placements and gain confidence. This means when students are out on placement they have a basic understanding of dressing types and how procedures can be done. Consequently they are more likely to step up and ask to do the procedure to further their knowledge than stand back and watch. It also allows more time to ask questions to ensure better understanding, which can at times be difficult to do when on placement especially during some procedures. In 3rd year of the Bachelor of Nursing Degree all RN preceptors expect that students will do more, but knowing one’s limits and when to ask questions when unsure is also important. Simulations allow us to do a lot of things which, when out on placement, may not be allowed. Students need to remember to work within their scope of practice, and within the guidelines of where they are placed.

The increasing complexity of the clinical context within nursing is “requiring nurses to draw on various types of knowledge to inform their practice” (Lechasseur, Lazure & Guilbert, 2011, p. 1931). Students gain knowledge from lectures, lecturers and the hands on experience learnt while on placement and in simulations. Simulation teaches us how to problem solve situations. The first step to be able to problem solve is recognising there is a problem in the first place. Problem solving is fundamental to ensuring that the process of care is carried out and identifying any problems that may arise and taking steps to resolve it (Dempsey & Wilson, 2009). The experience of problem solving in a simulated environment gives students confidence and as more is expected of third year students this confidence shows when on placement as students are eager to take on any challenge presented to them.

No matter where students go on placement nurse preceptors are there to help the student learn and teach them whatever they can. However, depending on the placement situation this can be difficult if something goes wrong or if it is really busy. The nurse’s main focus is on their patients’ wellbeing and students can often feel like they are on the sidelines ‘looking in’ feel restricted in their “opportunities to develop decision making skills and exercise professional judgement” (Traynor, et al., 2010, p.142). The more the student learns while in simulations means that their registered nurse partner will be more confident to trust them to do things either on their own or with supervision knowing they are not posing a risk to their patient.

  Recommendations

1. To have a week in the simulation labs before the first theory week at the beginning of the year as a refresher that comprises structured stations, with lecturers circulating if more information is required.

Rationale: This gives students who have been on holiday for many weeks to go back over the basics and refresh their memories. For instance taking manual blood pressures, going over drug calculations and doing patient assessments are easy things that can be done with peers. While it should be fairly well known by third year it gets the students out of holiday mode and into the nursing mode. As the current timetable is organised now, students are straight into placement in their second week after a week of what can be tiring theory lectures. A refresher before this theory week prepares students for getting up early again, and organising themselves and prepares them for placement.

2. To have set times in each theory week over the course of the year where 3rd year students have access to the labs to be able to practice procedures unsupervised using scenarios designed by lecturers with structured step by step instructions, similar to OSCE marking schedules , to ensure we know we are doing it correctly.

Rationale; By having time on our own in small groups with step by step instructions means we can practice and make mistakes without feeling like we are being ‘watched’. There is more pressure on students when in the lab with lecturers present as we feel we must always get things done correctly even though they tell us that it is not the case. If we are there with other students we spend more time doing each step correctly and talking about it with each other and a lot can be achieved. We don’t feel as bad when we make a mistake. The scenarios need to be varied to include emergency situations, life threatening medical conditions and what is involved in dealing with patients in those situations plus what to do with people who have chronic medical conditions or who have recently been diagnosed with a particular condition.

3. To practice more with the manikin that can talk back and receive medications through an IV line.

Rationale : Technical skills like giving medications through an IV line have the potential to go very wrong and are hard to practice on a real person. Being able to practice setting up IV lines and injecting the manikin gives students the confidence to be able to do it for real, and that confidence will show to the patient which ensures that the patient has a good experience. A good patient outcome and patient satisfaction is what students strive for and the knowledge gained through simulation shows when out on placement.

Simulation is an important part of the learning experiences that gives students time to practice in a safe environment and learn from each other. The equipment, scenarios and manikins are realistic and make students step out of their comfort zone in order to problem solve and assess their patient and come up with a plan of care. It gives students the chance to practice and make mistakes without having to worry about the consequences of hurting a real patient. The chance to discuss any mistakes that may have been made in a non- judgmental setting ensures confidence is gained, the gap between theory and practice is bridged and things start to make sense and come together. The benefit of having time in the simulation labs before going back out into placements means students get time to practice skills they already know well and know what skills they need to focus on and research about before going into their specific placement. It also allows the student to identify what areas they would like to concentrate on with help from their preceptor while on placement. Setting goals at the beginning of each placement ensures the student has something to work towards and can make the most out of their time there, and gives them a sense of achievement if they succeed.

  References

Ballard, G., Piper, S., & Stokes, P. (2012). Effect of simulated learning on blood pressure measurement

skills. Nursing Standard, 27 (8), 43-47.

Dempsey, J., & Wilson, V. (2009). Thoughtful Practice: Clinical Reasoning, Clinical Judgement, Actions

and the Processes of Care. In Dempsey, J., French, S., Hillege, & Wilson, V. (Eds.), Fundamentals of nursing & midwifery a person centred approach to care (pp. 258-275). NSW: Lippincott Williams and Wilkins Ply Ltd.

Handley, R., & Dodge, N. (2013). Can simulated practice learning improve clinical competence? British

Journal of Nursing,22(9), 529-535.

Kelly, M., & Wilson, V. (2009). Inquiry, Research and Evidence-Based Practice. In Dempsey, J., French, S.,

Hillege, & Wilson, V. (Eds.), Fundamentals of nursing & midwifery a person centred approach to care (pp. 180-195). NSW: Lippincott Williams and Wilkins Ply Ltd.

Lapkin, S., & Levett-Jones, T. (2011). A cost-utility analysis of medium vs. high-fidelity human patient

simulation manikins in nursing education. Journal of Clinical Nursing, 20(23/24), 3543-3552. doi:10.1111/j.1365-2702.2011.03843.x

Lechasseur, K., Lazure, G., & Guilbert, L. (2011). Knowledge mobilized by a critical thinking process

deployed by nursing students in practical care situations: a qualitative study. Journal of Advanced Nursing,67(9), 1930-1940. doi:10.1111/j.1365-2648.2011.05637.x.

Traynor, M., Gallagher, A., Martin, L., & Smyth, S. (2010). From novice to expert: using simulators to

enhance practical skill. British Journal of Nursing, 19(22), 1422-1426.