Increasing Student Competence and Clinical Confidence Using a Multimodal Approach Poster

Monday, 9 November 2015

Cynthia Denise Bain, MSN, RN, CNE
Nancy McMenamy, MS, RN, CNE
Deborah A. Tapler, PhD, RN, CNE
Nola Schrum, MS, RN, CCRN
College of Nursing, Texas Woman's University, Dallas, TX, USA

First level nursing students are often overwhelmed with the demands of nursing school. They are taught introductory clinical skills that are basic to a solid foundation for clinical practice. To increase competency, confidence and continuity between all nursing instructors, including adjuncts, as well as decrease student anxiety; the course team developed a multimodal approach to ensure student success. The purpose of our approach was to improve first level student competence, confidence, and continuity and decreased anxiety through using a multimodal approach to teaching skills.  4 modes were utilized to achieve this.  The first mode was use of a Faculty Skill Demonstration Video which was available on blackboard for student viewing.  Each lab practicum skill was demonstrated and videotaped by a seasoned faculty member. These videos provided a resource that the student could access at any time with an internet connection. The videos reinforced the skills learned in lab. Promotion of continuity between instructors and students was enhanced by a single, correct skills procedure for validation in check-offs.  The second mode was utilizing consistent Standardized Practicum Skills Check off Sheets for students that matched the faculty video.  Each lab practicum skill was incorporated into a standardized check-off form with specific evaluation criteria including critical behaviors. The check-off forms stipulated the steps of the skill and the grading criteria. Both the students and faculty now had matching expectations for a passing score. Another method used was practicing of the skills using Simulated Experiences.  Simulated case studies with the skills integrated were developed to improve the students’ psychomotor aptitudes. The experiences provided opportunities for critical thinking with faculty guidance. Important safety procedures were demonstrated by the students when giving medications including the “5 Rights.” Lastly, we utilized Supervised Open Lab Practice Times for students to practice in a nonthreatening environment. This extra time afforded opportunities to acquire reinforcement of correct technique or remediation for incorrect techniques.  At the conclusion of the experience, students were surveyed about their experiences utilizing the various modalities. They were asked if they accessed the skills videos produced by the faculty and if they thought the videos contributed in their success. Ninety-four percent of the responding students accessed the online videos and attended the simulation. Student comments regarding the faculty skills demonstration videos were collected and were overwhelmingly positive. Eighty-six percent of students stated that the demonstration videos reduced their level of anxiety about check-offs. Eighty-two percent of students attended an open lab session for practice of skills outside of scheduled course lab time. The future recommendations of the project were that the skills demonstration videos should consistently follow the check-off procedures exactly. The fundamental scientific principles should be consistent between lab sessions and between the nursing faculty. Students now knew what the skills performance expectations were so they felt less stressed and therefore more confident during check-offs. The faculty were encouraged to stress the importance of the fundamental principles of safety and sterility in response to dynamic clinical situations.