Author: David Foley, PhD, MSN, RN-BC, CNE, MPA
Title: Research Associate
Institution: Case Western Reserve University Frances Payne Bolton School of Nursing
Coauthors: Susan Painter, DNP, PMHNP, PMHCNS, BC
Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration
Advanced Practice Providers, Continuing Education, Graduate Students, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development
Classroom, Clinical Setting
As a reflective exercise, this scenario thus promotes affective development by immersing learners in a low-incidence/high-risk clinical scenario involving the discovery of a COVID-19 positive patient in a ‘low risk’ care setting. Three key QSEN Competencies (Patient-Centered Care, Teamwork and Collaboration, Safety) provide the framework for effective development through reflective thought and discussion:
1. Through reflective thought and discussion, the learner will affirm the importance of patient-centered care for patients and caregivers during the COVID-19 pandemic.
2. Through reflective thought and discussion, the learner will identify opportunities to enhance effective teamwork/collaboration within a stressful COVID-19 patient care scenario.
3. Through reflective thought and discussion, the learner will identify patient and caregiver safety as a top priority in COVID-19 related patient care scenarios.
Pre-licensure education is a complex process that involves the acquisition of knowledge, psychomotor skill, and affective ability within the didactic classroom nursing skills lab, and clinical settings, respectively. Although students often clearly recall efforts to assist them with gaining knowledge and skills through classroom exercises and lab ‘test-outs’, they may be less aware of efforts to promote growth within the more nebulous affective domain. Many educators may adhere to tried-and-true pedagogy that focuses on knowledge acquisition and psychomotor expertise, especially since they themselves were not encouraged to utilize reflective thinking as a cognitive analytical tool. The QSEN competencies provide an ideal framework to promote opportunities for effective development through reflection. In the case of this scenario, the lead characters perform in a competent manner as they provide appropriate care for an unexpectedly COVID19 positive patient. Despite the circumstances and their varied reactions, they strive for Safety, as they utilize Teamwork and Collaboration to provide effective Patient-Centered Care. In short, most nurses bring effective knowledge and skill to the workplace but in today’s ‘COVID-19’ workplace, much emphasis has been placed on the only implementation of safety and infection control protocols and psychomotor skills. This scenario focuses more on reflective thought as to the emotional impact of the stress caused by COVID-19 on nurses and their patients. As tips for educators, the mechanics of this unit thus provide opportunities for affective development within the framework of three key QSEN competencies that:
o Learners have the opportunity to read the actions and thoughts/perceptions of two registered nurses presented in hour-by-hour increments within an 8-hour shift.
o Reflective questions are strategically inserted following key events and are intended to be discussed—with corresponding instructor/peer feedback—in a synchronous manner.
o Whether in the classroom or clinical setting, learners should be granted no prior access to the scenario but given approximately one-half hour to read it independently, with peer interaction followed by instructor-facilitated discussion immediately following.
o A written Reflective Journal assignment follows the exercise’s conclusion and should be prepared and submitted to the instructor prior to the next classroom/clinical, or staff development session. The Reflective Journal is completed asynchronously and thus gives students a more discrete format to present the thoughts they might not have felt comfortable sharing in a public forum.
Inpatient Unit COVID-19 Isolation Protocol
Reflective Journal Format
Critical Reflection Journal Template
Oops! My Bad….He’s Positive! Case study
Nursing Self-Help Mental Health Screening and Wellness Toolkit (teaching aid)
1. Written instructor feedback to evidence of affective development in Reflective Journal questions, each of which is tied to a learning objective/QSEN competency.
2. Student to peer and instructor-peer verbal feedback regarding evidence of affective development as tied to learning objectives/QSEN competencies in classroom sessions, clinical pre- or post-conference discussion, staff development, or any other group as facilitated by a nurse educator.