Using Story-Guided Online Deliberate Practice to Develop BSN Students’ Critical Incident Reporting Skill

The use of stories in healthcare education is a teaching-learning strategy used to provide the context of a clinical situation in a way that learners can relate the facts with the concept (Billings & Kowalski, 2016). Listening to stories, as opposed to reading a clinical case presented in a third-person view with objective clinical values, encourages learners to think critically while allowing them to react with emotions (Billings & Kowalski, 2016). The nature of stories brings the context to a person level and links actions with consequences as the stories unfold (Sherwood, Durham, & Zomorodi, 2016). Without visual cues, audio stories decrease the introduction of preconceived assumptions and free the learners to use their imagination. For these reasons, stories present a unique way to introduce and simulate clinical scenarios. Deliberate practice (DP) is an intentional, repetitive practice that is performed with the goal to improve a skill from the current level and has been identified as a critical activity to excel in a given skill (Ericsson, Krampe, & Tesch-Romer, 1993). Its use in simulation-based medical education suggests that DP is more effective when compared to the traditional “see one, do one, teach one” approach (McGaghie, 2011). The key components of DP include 1) practice, 2) feedback, 3) self-reflection, and 4) repeat practice (Ericsson, 2008). This study uses story to guide pre-licensure nursing students as they engage in online DP sessions in reporting a patient critical incident using SBAR (Situation, Background, Assessment, Recommendation), a standardized communication tool, to another healthcare provider (Kaiser Permanente).

Purpose: The purpose of this study is to evaluate pre-licensure nursing students’ experience in completing story-guided online DP sessions to practice reporting a patient critical incident using SBAR to another healthcare provider. Main topics evaluated include students’ 1) feedback on using story to introduce clinical scenario, 2) perception of the helpfulness of different components of the DP session, and 3) overall satisfaction in completing the story-guided DP sessions. The reported preliminary results are a part of a pilot experimental study measuring the impact of the online DP sessions on students’ critical incident SBAR reporting performance.

Methods: Eighty-one pre-licensure nursing students completed a minimum of two (mean=2.6) story-guided online DP sessions as a summer course requirement. To simulate clinical scenarios, audio case stories provided by StoryCare®, Eefform, LLC were used to introduce scenarios with a patient critical incident that required calling another provider for his/her immediate attention. The online DP sessions were accessible to students on an educational platform used by the University. In each session, students listened to an audio story and then constructed and recorded a verbal SBAR report to a provider. Subsequently, students completed a self-assessment checklist (Foronda et al., 2015) and four self reflective questions before recording a refined SBAR report. At the end of each session students listened to an example of a good SBAR report recorded by an experienced clinician. Each session had a 45-minute time limit. Upon IRB approval and after the summer session ended, an online evaluation survey was sent to all students to evaluate their experience in completing the story-guided online DP sessions.

Results: Forty-six students (56.8%) completed the online evaluation survey. In using story to introduce a clinical scenario, survey results revealed that students rated the audio stories to be realistic (100%). They also indicated that stories help them establish the context of how clinical situations develop (93.3%) and see different perspectives of other healthcare team members (93.3%). Among different components of a DP session, the most highly rated elements were: actually recording a verbal report, completing the self-assessment checklist, and listening to the example SBAR report provided. Overall, students reported the DP sessions were helpful in developing critical incident reporting skills using SBAR. All but one student perceived some level of improvement in their ability to use SBAR in communications and 30.4% stated they have made significant improvements throughout the summer session. Despite the overall satisfaction of the experience, 40.0% of the students experienced technical difficulties in recording their verbal reports directly on the educational platform and 15.6% wished they had more time to complete each session.

Conclusion: Results of the evaluation study suggest that using story is an effective teaching-learning strategy in providing the context of a clinical situation and further guiding a DP learning experience to report a patient critical incident. These preliminary results supported the use of audio stories to simulate clinical scenarios. Analysis of students’ verbal reports and a study of a larger scale are needed to further assess students’ actual performance change in relation to completing the DP sessions. Modifications to overcome technical difficulties associated with the educational platform are necessary to provide students an improved learning experience. Online DP for skill development can be an efficient teaching approach to meet both students and faculty time management needs.