How Screen-based Virtual Nursing Exercises Can Help Students Develop and Improve Clinical Judgement Skills

September 24, 2019

Throughout their training, nursing students are asked, “What do you think is the best course of action?” Problem-solving and prioritizing, whether working on a routine procedure or responding to a complex or critical situation, are part of nursing every day. Nurse educators know that the more meaningful experiences students have, the better prepared they will be. They know that clinical judgment skills can be developed using methodologies, for example Tanner’s Model of Clinical Judgment, which puts a logical framework around what Tanner calls “an essential skill for virtually every health professional.”

(Read Dr. Christine Tanner’s Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing)

Tanner seeks to add layers of insight into what clinical judgment involves, augmenting the traditional teaching model in which clinical judgment is viewed as a systematic problem-solving activity. Why? In her words, “complete reliance on this single model to guide instruction may do a significant disservice to nursing students.”

If you visit the Simulation page on the National League for Nursing Web site, you’ll find this:

From standardized patients, to low and high-fidelity manikins, and now the virtual world (vSIM), each context provides a slightly unique perspective and can facilitate learning and evaluation of patient care situations along the continuum of care.

Nursing programs using blended learning, including virtual clinical scenarios like what Healthcare Learning Innovations and other online learning platforms offer, give students more opportunities to connect what they experience during training to what they will encounter in their career. Furthermore, virtual learning proponents make the case that simulations (including manikins as well as e-learning) address challenges nursing programs face, such as difficulty finding and managing clinical placements, enabling practice in a risk-free environment and offering the flexibility that lets students work while advancing their career.

Various studies evaluating learning preferences of today’s students also point to specific ways virtual nursing exercises help develop clinical judgment skills.

Flips the Classroom
You’ve probably heard about flipped classrooms, where lectures are delivered online as homework and the concepts are explored in class. An article in American Nurse Today by Donna Volpe, RN-BC, MSN, describes her switch to a flipped classroom for first-year nursing students in maternity nursing and senior nursing students in mental health nursing.

Some key points are:

  • First-year students for the fall 2014 semester rated the course a 6.51 on a scale of 1 to 7 (where 7 is the highest score).
  • Teaching a flipped classroom is more demanding than the traditional one, because I have to devise and set up classroom activities. But more and more, I find myself smiling at the end of the day.
  • Of course, the flipped classroom approach isn’t just for nursing schools. Hospitals can use it as an alternative to traditional education for new and current staff members.

Inspires Creative Thinking
Here’s feedback from a student: “The simulation made me think more outside of the box. It made me realize that I need to check out my surroundings more than I do now. Traditional methods are educational as well but don’t make you think the way the virtual city did.” The student was evaluating Sentinel City® community health virtual simulation.

Danni Reinisch, a Public Health Nursing Instructor at Minot State University, has integrated Sentinel City into her curriculum. Reinisch teaches online and in the classroom. She says it engenders “creativity when students are coming up with community interventions and messaging programs.”

Is Effective for Today’s Students
Changing the classroom dynamics can make learning more engaging for today’s students. In 2016, Educause surveyed 183 institutions to collect responses from more than 70,000 undergraduate students in 12 countries to learn what they thought about their technology experiences. You can get a copy of the full report on their website; findings include:

  • 82% prefer a blended learning environment
  • 71% say technology increases engagement while learning
  • 69% agree that technology sharpens focus on learning activities or course materials

Considering that the last time the NLN conducted their biannual survey 75% of BSN students were under age 25, using online virtual nursing simulations is worth considering.

On the Job. Where the Virtual World Meets the Real World
Teaching healthcare professionals always will involve direct experience, lectures and reading assignments, pharmacology exercises and sim labs. There’s no substitute for practice and experience. But there is new technology that adds to those experiences, and help enable the blending of virtual, screen-based clinical simulations and scenarios with traditional methodologies.

Clinical judgment is the sum of experiences, knowledge, common sense and that intangible quality that inspires someone to take on the challenge of nursing. While it’s impossible to anticipate every situation a healthcare professional will face in their career, we can keep digging into how it happens, adapt and improve teaching techniques and use technology to make simulations as real-life as possible.

How have your experiences shaped your clinical judgment skills? Has online learning influenced you? Please share your thoughts!