Deliberate Practice: An Online Method to Develop Students' Interprofessional Critical Incident Reporting Skill

Saturday, 29 July 2017

Jen-Huei (Vicky) Yeh, BSN
Gwen Sherwood, PhD, RN, FAAN, ANEF
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Ineffective interprofessional communication contributes to treatment delays and can result in serious patient harms (The Joint Commission, 2015). Communication skills are a part of every nursing curriculum; however, opportunities for students to practice communication with providers of another profession to achieve proficiency are limited (Bartges, 2012; Guhde, 2014). Practice opportunities are compounded by competing priorities and time constraints in teaching essential hands-on nursing skills. Students are rarely provided opportunities to engage in critical conversations with providers in their clinical learning experiences even though evidence indicates ineffective communication increases safety risks, particularly for new graduates transitioning into the workforce. The theoretical framework of deliberate practice (DP) has been used to effectively provide health affairs students intentional, repetitive practice to develop psychomotor skills (McGaghie, Issenberg, Cohen, Barsuk, & Wayne, 2011; Oermann, et al., 2011). This study used an innovative approach in applying DP online to help students develop proficiency in reporting a patient critical incident to a provider.

Purpose: As a part of a pilot experimental study, the purposes of this study were to 1) design the online DP sessions based on the theoretical framework of deliberate practice and 2) explore the feasibility of using these sessions to develop pre-licensure nursing students’ communication proficiency in giving a verbal report on a patient critical incident to a provider.

Methods: The online DP sessions used audio recorded clinical stories produced by StoryCare®, Eefform, LLC to simulate clinical encounters. Five stories that included a patient critical incident which required the primary nurse (the student) to report to a provider were selected and developed into five stand-alone practice sessions. Based on the four key components of DP, each practice session was composed of four sequential steps to be completed by students: 1) perform initial practice: record a verbal report to a provider using SBAR (Situation, Background, Assessment, Recommendation), a standardized communication tool (Kaiser Permanente), 2) receive immediate feedback: compare own performance with a standard SBAR checklist (Foronda et al., 2015), 3) self-reflect on the performance: appraise own performance by answering four self-reflection questions, and 4) repeat practice: record a refined SBAR report. Each session had a 45-minute time limit and were offered through an online educational platform used by the University to support its academic programs.

To explore the feasibility of using online DP sessions to develop pre-licensure nursing students’ interprofessional critical incident reporting proficiency, following IRB approval, senior pre-licensure nursing students from one University were recruited by email to participate in this study. Over a two-week period, each student completed two online DP sessions. At the end of the second week, students were invited to participate in a one-hour focus group to provide feedback on the acceptability, clarity, and potential burden of completing the practice sessions. Ways to improve the DP sessions were also discussed in the focus group.

Results: Seven senior pre-licensure nursing students participated in the testing of the online DP sessions and five attended the focus group discussion. Students described the sessions to be well-formatted and beneficial in improving their critical incident reporting skill. They further identified the sessions as valuable practice opportunities that were time efficient and convenient; and they recommended offering them to all BSN students. To improve the DP sessions, the students recommended making the online experience more realistic, such as to provide an electronic chart-like patient profile. Although no technical difficulty was reported during the two-week study period, one student’s verbal reports did not record. To address this issue, students recommended offering a recording tutorial prior to completing the first DP session.

Four major themes were identified in the focus group discussion: 1) Lack of opportunity to practice interprofessional critical communication: students collectively expressed having limited opportunity to practice interprofessional communication and that they had never reported a critical incident. 2) Difference between knowing and being able to do: by having to give a verbal report, students realized giving a focused report was more difficult than they had anticipated. One student stated part of the learning experience will be lost if they did not need to verbalize the report. 3) Wanting to practice interprofessional communication early in the program: students described feeling apprehensive about reporting to a provider as a shortcoming for most new graduates and that students would really benefit from start practicing this skill before their first clinical rotation. 4) Realness of the experience was important: students thought the audio recorded stories provided valuable reality, but real-world experience was most valued.

Conclusion: Student feedback indicated that the online DP session provided a well accepted approach for pre-licensure nursing students to practice reporting a patient critical incident in a safe environment without jeopardizing current class time. While the sample size was small, participating students affirmed the need to create deliberate practice opportunities and that pre-licensure students were motivated to improve their interprofessional communication skills. The DP sessions were then modified accordingly to use in future studies. Results from these studies provide guidelines for developing an education methodology to enable pre-licensure nursing students develop critical communication reporting skills that can have a direct impact on patient outcomes.