Introducing the Nursing Process Through e-Learning and Serial Virtual and Manikin Simulations

The pace of an accelerated prelicensure program requires students to rapidly develop clinical skills and reasoning to be successful. Evaluation identified the need to modify existing teaching and learning strategies in a Nursing Fundamentals course to enable students to build a better foundation for applying the nursing process in patient care. A new hybrid unit designed to introduce the nursing process as the critical-thinking framework for patient care was implemented over the first six weeks of the program. The hybrid unit featured a “flipped” technology-enhanced presentation of a step of the nursing process with a multimedia virtual patient simulation, and a short manikin simulation with debriefing, each week for six weeks. Team-based learning (TBL), a student-centered active learning strategy, was threaded through the unit to facilitate student engagement, enhance peer-to-peer collaborative learning, and stimulate readiness to engage in patient care in the co-requisite clinical course (Hallin, Bäckström, Häggström, & Kristiansen, 2016; Whitaker, 2015). Integrating interactive e-learning with unfolding case simulations was selected for the unit to enhance clinical reasoning development, and to satisfy student preference for independent, asynchronous learning (Njie-Carr, Ludeman, Lee, Dordunoo, Trocky, & Jenkins, 2017; Saunders, Green, & Cross, 2017). The multimedia virtual patient unfolding case simulation was developed by the faculty using standardized patients, a film crew, a video-editing software suite, and an interactive software package. Virtual unfolding case simulation allowed students to explore each step of the nursing process and connect clinical decision-making concepts at an individual, self-learning pace (Donovan, Argenbright, Mullen, & Humbert, 2018; Peddle, Bearman, & Nestel, 2016). Manikin simulation was subsequently conducted as a team-based learning activity with a different unfolding case scenario (Cant & Cooper, 2017; Hallin, Bäckström, Häggström, & Kristiansen, 2016). The virtual simulation incorporated an Individual Readiness Assurance Test, and the manikin simulation prebrief to the team included a Group Readiness Assessment Test, integral components of TBL (Mennenga, 2013). Ideally, students identified concepts and processes during the virtual simulation to apply to a different patient in the manikin simulation. Following the manikin simulation, the team added data derived from the current week’s step of the nursing process to an evolving care plan. Course evaluations of the unit indicated student learning outcomes and faculty objectives for the unit were achieved. All students completed two, and half the students completed three e-learning with virtual and manikin simulations prior to the first hospital-based clinical experience. Clinical faculty noted increased critical thinking across the cohort during the Nursing Fundamentals clinical rotation of the program (Georg, Karlgren, Ulfvarson, Jirwe, & Welin, 2018). Complementing flipped e-learning with simulations catalyzed the application of the nursing process by new nursing students in an accelerated prelicensure programs.