Rising to the Challenge

clinical professor assisting nursing student in simulation lab

Teaching Hands-On Nursing Skills During the Time of COVID-19

How do you create an appropriate learning experience when teaching students hands-on nursing skills at a distance?

With proper planning, support and ingenuity!

As the COVID-19 virus continued to spread throughout the spring and early summer, it was apparent that in-person learning at Duquesne University would have to be adapted for the Fall 2020 semester, including in the School of Nursing Learning and Simulation Center. Often referred to as simply “the lab,” the 7,000 square-foot space provides hands-on clinical training to roughly 400 undergraduate nursing students each year.   

Rosanna Henry, assistant dean for Clinical Skills and Simulation Education, who oversees all aspects of the lab, knew all learning would be impacted. Henry along with a small team of faculty and staff quickly got to work. They began planning in early summer, and soon realized one of their greatest challenges would be to identify how to move an estimated 260 Fundamentals of Nursing and Health Assessment students through the lab safely without impeding the needs of other lab courses and simulations.

“Once Duquesne announced plans to adopt a HyFlex educational strategy, my team had to move fast in order to ensure proper social distancing without sacrificing student learning,” shares Henry. “Regardless of whether we are teaching online, in person or a combination of both, our goal to provide high quality lab and simulation instruction remains consistent. We knew we had to get creative, and to develop and implement new strategies and activities quickly and effectively in order to support faculty and students,” she says. “This past year has really shone a light on the hard work and dedication of our nursing community.”

Fall 2020 Lab Offerings

Some of the adaptations implemented include:

More Lab Sessions with Less Students

Henry and others worked to socially distance students, which meant that they had to offer more sessions with less students. For example, if a room would normally hold 16 students, it would now only allow six.

Open Lab Hours

Daily open lab hours were available between the hours of 2:30 – 7:30 p.m. Students could sign up for lab time to practice patient care skills. Graduate students, without whom these lab hours would not have been possible, according to Henry, mainly staffed these sessions.

Virtual Skills Chat

Students could join this chat via Zoom and connect with faculty, and other students, to ask questions and learn skills remotely.

Quarantine Skills Kit

Developed by faculty, mainly adjunct clinical faculty member Christina Ruchka, MSN, RN, this kit consists of:

  • Trach with faceplate: The “trach” is actually a 3cc syringe that was cut at the end to simulate a tracheostomy cannula. The syringe is pushed this a cardboard faceplate.
  • Trach ties
  • Salem Sump tube for NG insertion
  • Surgi-lube
  • Tape
  • Two blunt tip syringes
  • Vial of saline

Faculty created written instructions (with photos) and supplementary videos to help students understand how to use the kit and its content to practice some basic skills.

Skills and Assessment Videos

Over the course of the semester, faculty recorded numerous skill sessions and health assessment videos to assist students with their virtual learning.

Faculty Development Video for Adjunct Faculty

Henry and lab staff also recognized a need to help support faculty, So, Henry developed a recorded presentation, “How to Conduct a Virtual Simulation,” for adjunct faculty. This helped ensure that all were knowledgeable and teaching in a standardized way, as some faculty were new to the University and others were new to simulation.

Further Flexibility

Due to an increase in positive COVID test results among School of Nursing students at the end of October, instruction shifted back to all virtual—and the lab was prepared to make the switch immediately.

“With the help of our lab faculty, new strategies were put in place to complete the semester in a completely virtual format,” explains Henry. “These included the Quarantine Skills Kit as well as skills competency assessments that transitioned to an online live Zoom session for the remaining students who were unable to complete this competency in person. The simulations that remained were originally planned as virtual activities, so no changes were necessary.”  

The spring semester will begin at the end of January. Henry and colleagues are already revising and developing schedules, simulations and all learning stations to incorporate faculty and student feedback via simulation evaluations and lessons learned. She also foresees some of these newer learning methods remaining once things are back to “normal.”

“I would like to see us utilize many of the newly developed strategies, such as the virtual skills chat, as it allowed students one-on-one private consult with a faculty member. I can also envision returning to in-person simulations while still implementing some of the virtual activities to allow students additional opportunities for learning.”

A Team Effort

Henry credits this semester’s success to the team effort between faculty and staff.

“I credit our Dean and Associate Dean for the foresight to think ahead and help us prepare. Our technology team is phenomenal and were so vital during this time,” Henry says. “I also think the dedicated faculty, staff and adjunct faculty played an impressive role in making the SON so successfully during this period. A great team effort!”

A Typical Day in the Lab for Professor Rosanna Henry, MSN, RN, CHSE

First, I would like to say that I lead a great team of faculty and staff. All that happens in the lab is a team effort. I couldn’t do it without Bernadette Clark, Susan Williams, Josh Calvetti, Joe Seidel and Gail Hric.

I will also say that every day is different depending on what group of students are in the lab and what specific activities are planned. I could be overseeing Fundamentals skill stations, Health Assessment, or a variety of simulations. I might be working with adjunct faculty or observing student learning activities. I am also involved in planning and revising simulation activities and related faculty and student materials.

The lab has been involved with telehealth strategies, simulations with our disability consultants, Augmented Reality projects along with small research pilot study with the developer. In addition, I coordinate with vendors to order equipment/supplies and ensure our technologies are running smoothly, as well as continue to explore new technologies for future endeavors.

Attending various webinars sponsored by organizations such as the Society for Simulation in Healthcare (SSH), and the International Association for Clinical Simulation and Learning (INACSl) AACN is vital to my role. The information gleaned from these sessions not only improve learning activities at Duquesne, but I share my knowledge with colleagues. For example, I was asked to develop and present a webinar on best practices in virtual simulation to a large audience with SSH members, and I did this with the assistance of the lab faculty.

I also work with the graduate faculty to assist with virtual campus visits, and I helped transition this in-person lab experience to a virtual format this year.

In addition to overseeing all open lab encounters and communicating with the graduate assistants, who staff the lab, I provide oversight for HESI exams, coordinate efforts for custom HESI exams and revisions, and provide input and advice as needed.

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