Purpose
The purpose of this instructional exercise was to use technology in the nursing skills laboratory to document the time students spent practicing nursing skills and to assess the quality of the student’s practice sessions after initial skills demonstration by lab instructor.
Background
Historically, at our college students wait until one to two weeks before the end of semester practicum to return to the skills lab to practice the skills learned during the semester. Practicum was their time to demonstrate proficiency in the critical clinical. They often lacked the confidence to perform the clinical skills during end of semester practicum. Students often are unable to list the steps of critical clinical skills in the order performed as required by alternate style questions on the National Council Licensure Examination (NCLEX). In like manner, our faculty and the laboratory instructors did not have an effective monitoring system to determine attendance or the quality and amount of time spent students spent independently practicing critical clinical skills in the lab. There was no effective system in place to give feedback on for performance improvement after the initial skills demonstration in the skills laboratory. As a result, many graduates entered the nursing profession with inadequate psychomotor skills and assessment techniques. Nursing faculty are challenged with the responsibility to prepare newly qualified nurses to be clinically competent and confident as clinical competence is directly related to the quality of care for patients
Method
The instructional exercise was administered to one skills lab class containing 15 students registered in the final medical-surgical class. The lab instructors identified three core clinical skills. The skills were (1) insertion of urinary catheter; (2) hanging IV fluids and (3) performing neurological assessments of the 12 cranial nerves. During skills lab, the instructors showed videos of the skills and demonstrated how the skills are performed to the students. The students returned demonstration of the skill immediately after observing the lab instructor. The students were then asked to return to the lab on their own time to practice the skills and create a video selfie performing one of the assigned skills.
In the lab. On the day the students returned to the lab for practice, they checked in with the clinical laboratory technician, signed in and logged in the time of arrival in the skills lab log book. The CLT gave the students a pre-checklist prior to the start of the practice session. The check list contained a scrambled list of the order in which each item on the skill check list is performed. First the students were asked to unscramble the check list and list each item in the correct order. Then the CLT directed the students to the skills lab where they practiced the skills and created the video selfie. After creating the video selfie, the CLT gave the students a post-test identical to the pre-test and requested the students to again unscramble the checklist. The students then signed out and documented the time of departure from the lab. The students were instructed to upload the video selfies to YouTube within one week and send the link to the lab instructor for viewing. After independently viewing the video selfie, the lab instructor noted strengths and areas that needed improvement by the students. At the next skills lab session, the instructor showed the video to the students in the skills lab class and first requested the students in the video to indicate the areas of strengths and the areas that needed improvement. This was followed by comments from the other students in the class.
Findings
The students used deliberate practice and spent greater than four hours practicing the assigned skill to near perfection prior to making the nursing skill video “selfies”. They mastered the performance of the skill. They demonstrated confidence in performing the skills at the clinical sites and during end of semester practicum. The students who were unable to accurately list the skills in the order performed on the pre-test, were noted to be able to correct this on the post-test. On the written reflection, some students remarked that initially they were scared and “camera-shy”. However, ultimately, the nursing skills video selfies facilitated fun while learning practical clinical skills.
Implications for nursing
Nursing Videos “Selfies” encouraged students to return to the lab to practice skills within one week after demonstration of the skill by the lab instructor. NSVS increased students’ practice time as they confidence to perform skills in the clinical setting and during the practicum. The findings suggest that NSVS may be used to across the curriculum to and provide evidence that students are practicing. NSVS may be used by students as a self-assessment that empower them and help them to try harder to achieve higher goals. NSVS helped students to master skills. As a peer evaluation tool, colleagues critique each other in a non-judgmental environment that allows them to refine and master clinical skills. Faculty also benefit from NSVS. Faculty may use NSVS as a monitoring tool to determine the length and quality of time spent by students to practice clinical skills. Faculty may also use the NSVS as an assessment tool to guide instruction and student learning.
Limitations of the instructional exercise
The instructional exercise had some limitations. A small number of students (15) participated in the exercise. The original intent was for students to create video selfies. However, students had difficulty using hand-held smartphones or the I-pads to create the selfies. As a result, they formed themselves into groups of three and rotated between the roles of recorder, performer and narrator.
Conclusion
The instructional exercise of creating NSVS encourages students to practice and master clinical nursing skills. Ultimately the NSVS help students to prepare for the role of a graduate professional nurse. The NSVS may serve as a self-evaluation and peer evaluation tool for students as well as an assessment tool for faculty. Research using this instructional exercise is needed in a larger sample to confirms the findings in the instructional exercise and to allow for generalization of findings.