A teaching strategy for Senior Nursing Students:Simulated Nursing Grand Rounds

A Teaching Strategy for Senior Nursing Students:Simulated Nursing Grand Rounds

Abstract
This teaching strategy examined the impact of simulated grand rounds on student nurses’ professional development. Simulated grand rounds were created to enhance nursing students’ ability to understand patients, analyze complex situations, and simulate nurse leaders from practice settings. Twenty nursing students at the City University of New York provided a presentation of a patient they cared for, included the assessment data from admission to discharge. Their experiences were analyzed using a five-item Likert-type scale. Results indicated that nursing grand rounds promote professional development, which helped students analyze complex patient conditions. Helped engage students, and enhanced learning. Results indicated that 20 student nurses, 19 strongly agreed, and one student nurse agreed that NGRs helped analyze complex patients in the fourth question. The second question resulted in 18 student nurses strongly agreeing and two agreeing that feedback received from peers was helpful.

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Keywords: Grand Rounds, Medical Education, Nursing Students, Patient-Centered Care
A teaching strategy for Senior Nursing Students:Simulated Nursing Grand Rounds
The term “grand round” is often referred to as a practice where medical doctors report and review patients’ clinical findings to peers and mentors. In grand rounds, doctors present a position, receive feedback, and explore treatment modalities. It is in this context that simulated nursing grand rounds (SNGRs) were created. These aim to enhance senior nursing students’ ability to understand patients, to analyze complex situations, and simulate nurse leaders from practice settings. Like medical doctors, nurses, too, have rounds. These rounds may be at the patient’s bedside or in small groups. Lyons, Brunero, and Lamont (2015) describe nursing rounds as “a deliberate method to reduce preventable adverse outcomes” (p. 31). The rounds involve nurses proactively attending to the needs of patients at scheduled intervals. According to a study by Sherrill (2012), nursing grand rounds (NGRs) are among the most effective approaches for providing learning and teaching experiences for professional nursing students. Through the rounds, nursing students can collaborate and share ideas related to the current dynamics in healthcare systems as well as other topics that are significant to the practice of clinical nurses (Sherrill, 2012).
NGRs is an approach used to provide an interaction between nurses regarding patients’ plan of care. Gaberson and Oermann (2010) describe NGRs as entailing interviews, observation of patients in the clinical environment, grand rounds multimedia programs, or webcasts of grand rounds conducted elsewhere. Burns, Rosen, Berry, and Smetana (2018) support NGRs as they offer nurses an opportunity to evaluate specific patient conditions and discuss the interpretation of assessment purpose, data changes, and interventions in the plan of care. NGRs may include students of nursing as part of the interdisciplinary team and are considered a valuable tool for evaluating challenges experienced by patients, communities, and families. NGRs also expose nursing students to conditions similar to what they may suffer as clinical staff (Nakhongsri & Crow, 2015). NGRs can be conducted at a patient’s bedside or through presentations via the internet and intranet. No matter the setting, NGRs can highlight a nurse’s clinical expertise as well as promote best practices for nurses (Gibson, Pasierb, Sunday, & Cavlovich, 2014).
Grand rounds for nurses emerged in United States schools of medicine as a central teaching activity in the first half of the previous century. Owing to education moving to the classrooms, NGRs have faded in practice (Nakhongsri & Crow, 2015). Quality and Safety Education for Nurses (QSEN) competencies support evidence-based practices and critical reasoning skills in education. NGR has its foundations in medical residency training as an educational approach for introducing new learning resources as well as improving clinical reasoning through discussion of patient cases. Furthermore, NGR has remained the base of education for decades, but patients’ dignity and confidentiality concerns have resulted in grand rounds being conducted in the absence of patients. In recent years, the format of NGRs has shifted from case-oriented presentations to expert lectures with more emphasis on recent evidence (Burns et al., 2018). Based on current evidence, more than 60% of hospitals engage in NGRs intending to educate the participants, showcasing faculty in hospitals as role models, and enhance the collegial environment for nursing students (Laibhen-Parkes, Brasch, & Gioncardi, 2015).
A critical aspect of NGR is that it enhances learning related to the characteristics of common health challenges and emphasizes teamwork (Burns et al., 2018). Burns et al. support a case for SNGRs that further states that NGR is an example of a creative teaching strategy, which is critical for engaging students. Through NGR presentations, nursing students can develop presentation skills, increasing their knowledge of the signs and symptoms of diseases, and how these affect patients. Besides, nursing students can enhance their learning abilities, such as critical thinking. They also learn to understand how sharing ideas with their colleagues can improve collegiality and, in turn, provide better collaboration when caring for patients (Laibhen-Parkes et al., 2015). Through the utilization of NGRs, nursing students can identify patients’ health issues and the factors that inhibit or promote health. They can address challenges in a clinical setting, share their personal experiences, and identify gaps in their understanding.
To create an opportunity for senior nursing students to engage in SNGRs, permission for this intervention was requested from the Institutional Review Board (IRB) of the City University of New York. It was determined that this intervention did not require IRB review and was deemed exempt. A total of 20 students enrolled in the nursing degree program participated voluntarily. Overall, three clinical groups participated. Students were given clinical assignments that included patients with complex conditions and comorbidities. The intervention started with students being instructed to prepare a PowerPoint presentation concerning the patient that they cared for in the clinical setting. The instructions were to include assessment data from admission, medications ordered, laboratory results, consults, discharge plans, and a discussion of multidisciplinary providers’ involvement. Students from other nursing classes were invited to attend, and faculty members were invited to serve as experts for the SNGR presentations. Each student then presented the SNGRS. They offered a patient case to an audience of peers and faculty at the college to simulate nurses from the clinical setting during NGRs. Subsequently, the student answered questions from both the faculty and their peers, affecting nurses in clinical practice during NGRs. A six-item survey was sent out via Survey Monkey to determine the students’ opinions of the SNGR experience. The students rated their answers on a five-point Likert-type scale from 1: “strongly disagree” to 5: “agree.”Through guidance the students were able to record all observations from the patients as per guide from the senior nurse in charge of the department.
Overall, 20 student nurses from three clinical groups responded to the six-item survey following the simulated nursing grand rounds. All 20 student nurses strongly agreed that the nursing grand rounds helped promote professional development and stated that they would recommend NGRs to other students Answering the third question, they all agreed that the program incorporated previous semester course objectives. Of the 20 student nurses, 19 strongly agreed, and one student nurse agreed that NGRs helped analyze complex patients in the fourth question. The second to last question resulted in 18 student nurses strongly agreeing and two agreeing that feedback received from peers was helpful. In the previous question, 19 strongly agreed, and one decided that input from the faculty was valuable.

Conclusion

NGRs offers nursing students an opportunity to evaluate the specific conditions of patients, discuss assessment data, and propose any changes in the plan of care. SNGR is an opportunity for nursing students and faculty members to increase their understanding of the roles of interdisciplinarity. NGRs provides an excellent opportunity for exchanging ideas related to patients’ care conditions, which may comprise staff, students, and the entire clinical faculty. The benefits of SNGRs are that they help promote professional development and increase students’ ability to analyze complex patient situations and to engage in collaboration. These benefits are in line with the QSEN competencies of teamwork, cooperation, and patient-centered care.
In this intervention, the sample size was small. However, the intervention points to the beneficial consequences of conducting SNGRs. Furthermore, the responses of faculty participants were not measured, and survey questions were subjective, not objective. Overall, the results show that doing SNGRs is one way to engage students as future professionals and enhance learning in healthcare communities. However, the effects of the present SNGR intervention suggests that there is a need for further research in this area

References

1. ?Gaberson???????????????, J., and Oermann? M.???? (2010). Clinical teaching strategies in nursing (3rd ed.). ???New York, NY: Springer Publishing Company.

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