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Next Generation NCLEX-RN®

and Virtual Simulation

Susan Sanders, DNP, RN, NEA-BCVice President, Kaplan Nursing

David Schultze, EdD, MSN, RN, CNRNExecutive Director of Nursing Simulation, iHuman Patients by Kaplan

Goal of Nursing Education?

➔ Improved Outcomes of Care

Quality & Safety of Care?

➔Depends on the nursing care delivered

NCSBN Research = NCJ cognitive task model● Recognizing cues

● Analyzing cues

● Prioritizing hypotheses

● Taking action

● Generating solutions

● Evaluating outcomes

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Novice Nurses Need to Display...

1. Clinical Judgment

2. Professional Communications

3. Active listening

(NCSBN Job Analyses 2012, 2015)

Next Generation NCLEX® Aligned ExperiencesProvide your students with a realistic clinical day, giving them plenty of

opportunities to think like a nurse, following the NGN model.

3. Prioritize Hypotheses

4. Generate Solutions

5. Take Action

6. Evaluate Outcomes

2. Analyze cues

1. Recognize cues

NCSBN Clinical Judgment Task Model

Group & Prioritize Findings

Select & Prioritize Actions

Document

EHR, Physical Assessment

Top 5 Reasons for Virtual Simulation

1. Failure without consequences

2. Same experience, every time

3. Safe environment for patients & leaners

4. Enhanced clinical judgment

5. Standardized assessment

American Sentinel University (2016)

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Virtual Simulation

Allows Nursing Schools to offer students additional opportunities to practice clinical judgment skills

4 R’s for Educator Support

RemediationReportingRange of Cases & SpecialtiesReclaimed Time

4 C’s for Student Success

Clinical JudgmentClinical ExperienceCompetencyConfidence

Confidence & Competency

Preparing students to gain confidence in their ability to succeed in their clinical judgment.

How do your students prepare for their clinical experience?○Do your students feel confident going into clinicals?○Do you feel confident sending your students into clinicals?

NOTE: Competency is used to describe mastering skills - here, we’re talking about interpretation skills (clinical judgment), NOT psychomotor skills.

Clinical Experience

Offering students 24/7 access to a wide range of cases to develop their clinical judgment skills.

Are your students getting the clinical experience they need to

succeed?○Time and space?

○Specialties? Variety of experiences?

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Clinical Judgment

Assessment of nursing students’ preparedness to enter the field is moving from recall to case-based analysis that measures clinical judgment (ie Next Generation NCLEX®)

➔How do you teach and measure clinical judgment?

➔How do you bring the clinical experience into the classroom?

➔How do you bring the classroom into the clinical experience?

Students develop clinical judgment skills through virtual clinical experiences that follow the clinical task model from patient needs to

patient decisions.

Bring the case-based approach and “at the bedside” mindset into the classroom with i-Human Patients virtual simulation.

Recognize & Analyze Cues: Electronic Health RecordUsing cue recognition, the student will identify the priority problems for this client and compare their answers with those of an expert nurse.

This immediate feedback will guide the student through the remainder of the simulation.

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Instant Feedback for Students

Multiple-choice items will provide additional feedback on the student’s progress within the case.

Detailed, expert feedback is delivered instantly, each step of the way allowing students to work independently.

Recognize & Analyze Cues: Take a History

Vast library of questions gives students practice.● Scaffolding:

○ Category: Directory of questions good for beginning learner

○ Search box: Mostly used by more advanced students

● Efficiency: “Google-like” natural language search allows students get through history quickly○ Speak to text available in the

Chrome browser

Recognize & Analyze Cues: Physical ExamStudents can safely practice a wide range of physical exams

Auscultation of LungsMarkers track movements to

ensure correct patterns are followed.

Assess IV siteDisplays an image from our media library.

Examine PupilsPerform neuro check on patient with

a subdural hematoma.

Take Blood PressureTake blood pressure, document

and assess readings.

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Prioritize Hypothesis: Client Problem Categories

Moving from assessment to analysis

Guard rails: In “learning mode”, we start by providing full list of correct findings from assessment sections.

Task is to group findings into system/concept

Generate Solutions

Ultimately, i-Human Patients encourages students to think like a nurse:

applying clinical judgement to analyze, categorize, and prioritize findings, followed by steps to take action and evaluate outcomes.

Evaluate Outcomes

● This is the final step of the task model

● Students wrap it up here in the nurse notes -documenting their key findings - assessment, SBAR, SOAP note

● Then they review the summary of the case

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Instant Feedback for StudentsDetailed, expert feedback is delivered instantly, each step of the wayallowing students to work independently.

Individual Student Report Students receive detailed reports at end of the case

Faculty Reports

Faculty have access to the same reports to assess individual student and chort preparedness for Next-Generation NCLEX®.

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Faculty Reports: Different aspects of the case

Stop by the Kaplan Booth & ask us about our special i-Human Patients promotion for COADN attendees!

Questions?

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Thanks!

Susan.Sanders@Kaplan.com

David.Schultze@Kaplan.com

References• American Sentinel University. (2016). Technology to watch: Virtual simulation. The Sentinel Watch.

https://www.americansentinel.edu/blog/2016/03/29/technology-to-watch-virtual-simulation/

• Ballard, K., Haagenson, D., Christiansen, L., Damgaard, G., Halstead, J., Jason, R., … Alexander, M. (2016). Scope of nursing practice decision-making framework. Journal of Nursing Regulation, 7(3), 19-21.

• Bearnson, C.S., Wiker, K.M. (2005). Human patient simulators: A new face in baccalaureate nursing education at Brigham Young University. Journal of Nursing Education, 44(9), 421-425.

• Benner, P., Sutphen, M., Leonard, V., Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.

• Dickison, P., Luo, X., Kim, D., & Woo, A. (2016). Assessing higher-order cognitive constructs by using an information-processing framework. Journal of Applied Testing Technology, 17(1), 1-29.

• Duff, E., Miller, L., Bruce, J. (2016). Online virtual simulation and diagnostic reasoning: A scoping review. Clinical Simulation in Nursing, 12(9), 377-384.

• Gaba, D. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, Oct: 13(Suppl 1): i2-i10. doi: 10.1136/qshc.2004.009878.

• Georg, C. & Zary, N. (2014). Web-based virtual patients in nursing education: Development and validation of theory-anchored design and activity models. Journal of Medical Internet Research, 16(4), doi: 10.2196/jmir.2556.

• Healthcare Innovations. (2016). Top 5 reasons simulation is better than reality In healthcare education. https://healthcarelearninginnovations.com/top-5-reasons-simulation-better-than-reality-in-healthcare-education/

• Liaw, S.Y., Chan, S. Chen, F, Hooi, S., & Siau, C. (2014). Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performance in assessing and managing clinical deterioration: randomized controlled trial. Journal of Medical Internet Research, 16 (9)

• Muntean, W. J. (2012). Nursing clinical decision-making: A literature review. https://www.ncsbn.org/Clinical_Judgment_Lit_Review_Executive_Summary.pdf

• Muntean, W. J. (2015). Evaluating clinical judgment in licensure tests: Applications of decision theory. Paper presented in the annual meeting of the American Educational Research Association in Chicago, IL.

• National Council of State Boards of Nursing (NCSBN). (2018). The Next Generation NCLEX® Usability Studies. https://www.ncsbn.org/NGN_Spring18_English.pdf

• Tschannen, D., Aebersold, Mi., McLaughlin, E., Bowen, J., & Fairchild, J. (2012). Use of virtual simulation for improving knowledge transfer among baccalaureate nursing students. Journal of Nursing Education and Practice, 2(3), 15-24.

• Saintsing, D., Gibson, L.M., & Pennington, A. W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19(3), 354-359, doi: 10.1111/j.1365-2834.2011.01248.x.