Rapid Change in the COVID-19 Pandemic: Being Flexible and Innovative in the Wake of Disruption

Patricia Benner, R.N., Ph.D., FAAN

March 26, 2020

Amid this COVID-19 Pandemic, graduating the current senior nursing students and preparing all to graduate on time is critical to meeting health care needs with our current nursing shortage. We pause to reflect on how nurse educators can be innovative when the stakes are so high. I applaud the announcement of the NCSBN for the re-starting of the NCLEX exams. Here is the press release on this:

March 23, 2020
NCLEX Exams to Resume in Limited Capacity March 25, 2020

CHICAGO – NCLEX-RN and NCLEX-PN Examinations testing will resume on a limited basis at 60 Pearson VUE Testing Centers on March 25, 2020, ramping up to additional sites by March 28. These sites were selected to be close to large metropolitan areas in the U.S. and Canada.

The decision to reopen these centers speaks to the unprecedented need for nurses and their importance in the health care system during this time of global pandemic. NCSBN and Pearson VUE know that they have a crucial role in assisting to put more nurses into the workforce.

Following CDC guidelines for social distancing, NCLEX candidates will be screened before being allowed to test. Likewise, testing center personnel will also undergo screening before being allowed to work. The testing centers will be thoroughly cleaned and disinfected between each test taker including all objects that candidates interact with or encounter.

While still maintaining the psychometric integrity of the NCLEX exams, the time limit of the exam will be shortened to four hours to allow the maximum number of candidates to test per day. The pretest items and the special experimental Next Generation NCLEX section will be removed, however, the difficulty levels and passing standards of the exams have not changed.

FAQs can be found on ncsbn.org. Candidates can schedule testing appointments at Pearsonvue.com/nclex.

It is heartening to see all the innovative things that faculty, deans, and schools of nursing are doing in response to the disruptions of nursing education, such as closed or greatly diminished clinical access for nursing students. I highly recommend the March 24, 2020, American Association of Colleges of Nursing outstanding webinar focused on online simulation resources available, found on the AACN website under “Recently Recorded Webinars.” This very highly informative webinar offers faculty resources for gaining skills in learning more about developing online education and clinical simulation:

Aligning Simulation within COVID-19 Contingency Plans
March 24, 2020 at 1:00 pm (E.T.) American Colleges of Nursing
Dr. Carol Fowler Durham, University of North Carolina at Chapel Hill and Dr. K.T. Waxman University of San Francisco and Director of the California Simulation Alliance led the webinar.  Both are outstanding leaders in the development and use of simulation . They provided a comprehensive list of online clinical simulations that catalogue multiple clinical simulations that can be used for clinical replacement resources.  They identified current  online simulation resources that are excellent.

It will be a great source of educational improvement if faculty and students evaluate learning and practice performance outcomes for all these online simulations. Our clinical and classroom teaching would leap ahead as a result of planned learning and formal evaluation of all these innovations. Designs as simple as pre-tests and post-tests could help us move forward with the next generation of online simulation. Imagine the possibilities!

One innovative result could be a movement to high fidelity online clinical simulations. This could become a central part of NCLEX Exams, in order to reliably test situated thinking and clinical reasoning.  A formal hypothesis testing exam approach does not adequately capture the ability to recognize the nature of whole clinical situations (perceptual acuity and sense of salience), which is so central to avoiding failure to rescue. It is a goal of NCLEX to improve the assessment of clinical reasoning, and the best model of the world is the world itself.

Selecting the Most Effective Online Clinical Simulations for High Fidelity Clinical Learning

The AACN Webinar by Drs. Durham and Waxman has guidance and suggestions for selecting the most effective online clinical learning solutions. Online clinical simulation should be rigorous, evidence-based, use real unfolding clinical cases with authentic vital signs and lab, exam data and so on.  Simulations need to be designed to create maximum student engagement and a sense of responsibility. Student engagement is essential for experiential learning (Benner, Hooper, Stannard, 2010; Benner, Tanner & Chesla, 2009). Perceptual grasp of the nature of the whole clinical situation, as in “this is a situation of heart pump failure, or low fluid volume” or a situation of “poor oxygenation” come before formal hypothesis and clinical judgment. Simulations and situated coaching, even in a chat room, or online meeting, can help the student understand the nature and demands of whole clinical situations. Online simulations also need to build-in priority and urgency as evaluation measures for optimal interventions.

The goals of clinical teaching and learning must go beyond teaching facts, principles and theoretical knowledge, i.e. “knowing that and about.”  It should include “knowing how and when” to intervene in actual practice situations. Knowing how and when—situated clinical reasoning and judgment—are more than mere applying principles or application of knowledge, as exemplified by procedural knowledge of how to measure blood pressure. Clinical judgment requires interpreting the meaning of a blood pressure reading in the unfolding clinical condition of the patient. This situated clinical reasoning is a form of higher-order thinking. This situated cognition (Lave and Wenger, 1991) is central to clinical reasoning.  In debriefing sessions, students need to inquire and create a dialogue about the particular case with population statistics and general guidelines. Similar and contrast clinical cases can sharpen students’ learning.

Using this Disruption of the Usual Classroom and Clinical Activities to Innovate

Disruptions can create new levels of awareness, attentiveness, curiosity and openness—all essential ingredients for experiential learning. Make the most of this opportunity to rethink and reconsider new teaching-learning opportunities!  Engage students in sharing newly discovered learning resources, whether online or in videos, Ted Talks, podcasts, websites, print, news and more. Social distancing creates space and time for exploration of rich resources for learning.  For example, the website nCoV2019.live, which is updated every 17 minutes, can help students interpret and discuss what public health measures are working and which are not.  Bill Gates gave an informative and forward-looking TedTalk about global pandemics five years ago that provides an excellent stimulus for discussion of public health responses and public policy:

Deliberately partnering with students to introduce relevant learning resources shifts expectations that teaching and learning come primarily from the teacher rather than being bi-directional, as Paulo Freire so convincingly demonstrated (Freire, Macedro, 2017).

I encourage faculty to describe and assess their innovative approaches to clinical teaching and learning during this major disruption to classroom and clinical teaching.  In this spirit, EducatingNurses.com welcomes faculty to present innovations that are effective and enlivening. Collaborating with local and even distant schools can make our collective response to this crisis more effective.  Practicing collaboration during this crisis, can have a long-term effect of improving and enriching collaborative educational efforts in the future.

We have a lot to do. In the midst of all this doing, let’s make the most of learning and evaluating the outcomes of our efforts, during this time of disruption that calls for innovation and thoughtful evaluation.

An “Inside Higher Ed Webinar” will be held on March 26, 2020 at 2:00 PM (EST) “How COVID-19 is Changing Higher Education.”

 

References

Benner, P., Tanner, C., Chesla, C., (2009) Clinical Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics. (2nd Ed.)  New York, N.Y.: Springer.

Benner, P., Hooper-Kyriakidis, P., Stannard, D. (2010) Clinical Wisdom and Interventions in Acute and Critical Care. (2nd Ed.) New York, N.Y.: Springer.

Freire P. & Macedro, D. (2017) Pedagogy of the Oppressed: 50th Anniversary Edition  New York, N.Y.: Bloomsbury Academic.

Lave, J, Wenger, E. (1991) Situated Learning: Legitimate and Peripheral Participation. New York, N.Y.: Cambridge University Press.

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