Author: Robin Arends,
Institution: South Dakota State University
QSEN competencies are utilized daily in the clinical setting. Each decision the clinician makes in the clinic setting utilizes the competencies of safety and patient centered care. Informatics is integral in the clinic setting to document and share pertinent patient information. Each clinician works as a member of the healthcare team and needs to understand group dynamics and communication styles. It is a challenge to educate future clinicians on these important concepts as they learn by working with real patients in real clinical settings. By providing assignments that utilizes these concepts so the students are able to practice in a safe environment prior to real patients, nurse faculty are able to promote safe and effective care.
Approach: Problem based learning scenarios (PBLs) were developed to be utilized in two consecutive semesters in a Nurse Practitioner program. QSEN competencies were interwoven throughout the PBLs with increasing complexities as the student progressed through the program. A patient scenario based in a “real life” setting was presented to the students. In the first semester, the history and physical of the patient were supplied to the students. In the second semester, the students interviewed a “patient” for the history and physical exam. The students in both semesters were responsible for ordering diagnostic testing for this patient. To accomplish this, they utilized informatics to work as a team and collaborate on necessary and patient centered diagnostics through a discussion board. Each student contributed ideas to the group discussion. Then, individually each student would apply evidence based guidelines and research to recommend a treatment plan for the patient. Each student needed to script the dialogue they would use in the clinic setting to educate the patient to accomplish mutual goals. Patient centered care was utilized as the patient may have additional medical history, have religious beliefs that limit treatment options, be from another culture, or have low education or socioeconomic resources. Safety was interwoven as the students needed to order appropriate diagnostics as well as treatment plan and evaluate the patient for adverse effects.
Please see attachments for an example. The first attachment is an example of the patient’s chart that would be supplied to the students. The second attachment is the rubric and explanation for the students. The third attachment is an example of the H & P for the “patient.” In the first semester, this can be given to the students. In the second semester, the faculty would be able to answer questions from the student for the H & P based off this scenario.
Students were evaluated through the use of a rubric. Points were achieved for determining the correct final diagnosis as well as other diagnoses present in the patient. Students needed to describe the pathophysiology of the final diagnosis. Students were then evaluated on the treatment plan. The treatment plan was evaluated on the correct treatment taking into account patient characteristics that would influence treatment choice. Interactions with current or other prescribed medications were evaluated. Follow up recommendations which included when the patient would follow up and lab testing ordered for that visit were also described. The student needed to write as if he or she was talking to a patient to describe the diagnosis, treatment and follow up plan. If technical or medical words were used or if this was not clear to the patient, points were deducted.