Author: Crista Reaves, PhD, RN
Title: Assistant Professor
Institution: Michigan State University College of Nursing
Coauthors: Michael Martel DNP, APRN, AGCNS-BC
The learner will:
Identify the need to activate the emergency response system in critical situations (PCC – knowledge)
Identify risk factors for an acute ischemic stroke (PCC – knowledge)
Evaluate and apply critical thinking to determine expected assessment, laboratory, and diagnostic findings for a patient with an acute ischemic stroke (PCC – skills)
Design a plan of care, including prioritizing nursing interventions, and modify as the scenario unfolds (PCC – skills)
Demonstrate effective therapeutic communication with the patient and family member while respecting the patient’s values and autonomy (PCC – attitudes)
Address and support the patient and caregiver’s emotional well-being (PCC – attitudes)
Compare and contrast the roles and responsibilities of the interdisciplinary team in emergent situations (T&C – knowledge)
Explain when to collaborate with the provider regarding patient’s care (T&C – skills)
Articulate risk factors and safety considerations for commonly prescribed thrombolytic medications for patients with acute ischemic stroke (safety – knowledge)
Identify safety concerns for the patient when they return home and design a plan of care to reduce safety risks to improve patient outcomes (safety – skills)
This specific unfolding role-playing case study allows ADN or BSN undergraduate nursing students and faculty the ability to focus on the QSEN competencies of patient-centered care, teamwork and collaboration, and safety. The nursing students will role-play the nurse, while the educator is the facilitator and/or patient. If additional faculty are available, supplementary roles may be assigned such as provider, EMT, and the patient’s family.
The students are provided with a brief history of present illness and must use their communication, critical thinking and reasoning, and judgment skills to ask the patient additional questions to obtain a complete history. The students will also use their critical thinking and reasoning to verbalize the components of an assessment that would need to take place and the expected findings with rationale. Students will use the information provided to collaborate with one another to determine their next steps of care. The nursing students will prioritize care and create a plan (including assessments, interventions, medications, and education) for the patient as the scenario unfolds. In addition, they will identify key safety concerns and the education and/or interventions needed to promote safety as they learn new information from the patient, the patient’s provider, and/or from labs and diagnostics.
This unfolding role-playing case study will challenge the students to apply their critical thinking, reasoning, and judgment skills to translate content learned to a simulated patient encounter.
Newly graduated nursing students are finding themselves ill-prepared to manage their patient’s convoluted care, with many new nurses demonstrating limited ability to critically think to make appropriate clinical decisions (Benner et al., 2015; Goode et al., 2016; Wotton & Gonda, 2004). The lack of inability to critically think and reason may lead to adverse patient outcomes and safety concerns (Good et al., 2016; Saintsing et al., 2010). Nurse educators have failed to prepare nursing students for the changing healthcare environment by educating students through passive lecture-based learning (Hammand & Khalaf, 2020). Passive learning impedes the ability for students to translate knowledge learned to a practice setting. The QSEN competencies of patient-centered care (PCC), teamwork and collaboration (T&C), and patient safety must be presented through active learning activities to develop competent nursing students who are equipped with the tools needed to manage their patient’s care. Nurse educators must bridge the transition gap from school to practice by including active learning strategies encompassing QSEN’s core competencies during the didactic portion of each nursing course to improve students’ critical thinking and problem-solving skills (Duta, 2013; Powers, et al., 2019). One way to do this is through the incorporation of unfolding role-playing case studies (Hammad & Khalaf, 2020).
Unfolding role-playing case studies encourage student participation, critical thinking, and reasoning (Dutra, 2013), and can enhance peer communication and collaboration (Gropelli, 2010). Unfolding role-playing case studies allows the students the ability to interact with the simulated patient (the faculty teaching the course) to analyze the situation and apply key concepts learned to improve patient outcomes (Lee et al., 2003). Students can gather the pertinent history, verbalize an assessment and expected findings, prioritize problems, identify nursing interventions, and provide education to the patient all within a simulated environment. In addition, role-playing engages the students in therapeutic communication while having real-time feedback on how the communication is perceived (Powers et al., 2010). Students leave lectures having learned the rationale behind the care provided, and the critical thinking needed to care for a patient with a specific condition. This active learning translates into clinical practice when the student is presented with a similar patient situation.
Ensuring students are engaged in active learning through role-playing case studies promotes retention and translation of knowledge learned in the classroom setting. This will assist in developing competent nurses who are readily able to apply critical thinking and reasoning to provide safe, evidence-based care to the diverse patient population they serve (Hammad & Khalaf, 2020).
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Summative Case Study Evaluation Questions:
1. How did this unfolding case study make you feel?
2. Reflect and evaluate the care provided throughout the scenario:
– What went well?
– What did not go as expected?
3. What opportunities for improvement can you identify?
4. What were some of your strengths and weaknesses throughout the scenario?
5. How did this unfolding case study contribute to your learning?