Next Gen Learning on the Fly  Clinical Judgment for all Nursing Students

Next Gen Learning on the Fly Clinical Judgment for all Nursing Students



welcome to sky escapes free webinar series today's topic is next-gen learning on the fly clinical judgment for all nursing students I am Kristin Snowden Smith from skyscape and I will be the moderator today our speaker today is dr. Tim Bristol Tim is a faculty and student success specialist he works with a number of colleges and universities and resides in Minneapolis Minnesota tim has been utilizing technology in the classroom clinical and lab setting for over 20 years his motto is today we will learn how to learn I'll now hand the floor over to Tim thank you so much Kristin I'm really glad to be here today a lot of exciting developments on the front of NCLEX and the whole world of assessing whether or not a person is ready for practice national council State Boards of Nursing and CS bien has been doing a lot of work the past couple years to develop a model of a model of cognitive processing psychomotor processing affective processing that that describes what a nurse truly needs to be able to do and they've been sharing this information with us in a couple of different ways but they've basically come up with this model here in front of clinical judgment is the outcome of critical thinking and clinical decision-making okay you combine these two areas and that and that is where that is where the nurse needs to be okay they kind of say that clinical judgment is the doing part of these these quint these cognitive processes so as you think about as you think about the focus on Pratt's National Council does see a gap between practice and academia they're seeing errors in in novice nurses that indicate a lack of clinical judgment and and there's there's a continuing growth in complexity and the whole healthcare ss so so as we look at the future of NCLEX there's two things that are going to be happening here soon first of all next year 2019 we do expect the difficulty of NCLEX to increase now with just a little bit of terminology here for you a little bit of terminology and background when I say next-generation NCLEX that is not is not what we're going to be seeing overtly in 2019 as the increase in difficulty but what we are going to be seeing is the impact all the research that National Council is doing on clinical judgment we're gonna see that impact the current inflex okay and and we are anticipating an increase in difficulty next year in the NCLEX especially for the RN now in the not too far distant future the not-too-distant future we are going to see some changes in increase we don't know exactly what they're going to be in clicks has given us a few clues they've given us a few ideas but when it comes to assessment they've created a new model that is going to dictate a change in the deep' the progression and the evolution of NCLEX over the next couple of years and so this model you can learn more about it at this website when you go to the national council website you'll see absolutely type in next generation question I think there's like seven or eight documents there that talk about what they've been up to some of the samples that they've been using if you're going to an ink Lex Invitational for faculty they're going to start talking more and more about this and they've been describing what new types of ink Lex questions might look like okay the framework for this change is is what they they call their clinical judgment process and there's five steps here hue recognition hypothesis generation hypothesis evaluation taking action and evaluating outcomes now some of you are sitting here going excuse me isn't this just the nursing process with a new coat of paint was my initial reaction I think what you're gonna what you're going to appreciate as you review some of the documents at their website as we have our discussion today I think what you're gonna appreciate is in the nursing process we talk a lot more about fact okay when we when you look at those five chapters if you will and in the fundamentals textbook on nursing process assess plan implement assess plan analyze implement evaluate when you look at the pie when you look at the AAA pie depending on which one you want to use you're gonna see a lot more talk about fact when you look at this clinical judgment process you're gonna see a lot more talk about processing a lot more talk about higher-order thinking right out of the gate let's go ahead and dive in here first of all queue recognition peer recognition being you do you appreciate what's going on in this clinical scenario can you prioritize the queues can you effectively pick out which queues are of concern and which are not okay we realize that many mistakes are made in the health care system by missing that important queue and when we allow students when we allow students to make a list of 20 things that are important in this clinical picture you know what happens they missed three whereas when we say the students hey what are your top three assessment concerns right now either what are the top three things you have to assess right now or all the assessment data you've collected what are your three most important ones and and so when we when we talk about this it's important that students do a lot of this in class okay what information is an indication of improvement what into what information is an indication of worsening and and the sample of this next generation in clicks the same question looks like this they actually create a chart and I apologize I don't have an image to show you but if you go to their website you'll see some of this um they they have a chart and they list a number of different cues also known as assessment data such as clothing of the feet of the digits vital signs you know a statement by a client okay and so pulse a pulse rate of a heart rate of 80 is this Q unrelated to the to the clients condition or changing condition is it a sign of improvement is it a sign of worsening what does the pulse of 80 mean to this client and then you have a blood pressure of 110 over 70 what does it mean to this patient is it unrelated improvement worse a sign of improvement worsening this patient said I just can't do this anymore is that statement by the patient unrelated to the clients situation is it a sign of improvement in the clients condition is a sign of worsening the students are going to be this is going to be a challenge for them and what I want you to start to is we have this discussion what is so important for you to consider is we're having this discussion not we can't worry about the NCLEX right now okay you you can't worry about it what we're at right now what you have to be thinking about is tomorrow I'm going to be in lecture with 80 students teaching mental health or tomorrow I'm going to be in a clinical agency with 8 students on a telemetry unit I want you to be thinking about tomorrow okay because yes we are concerned about the NCLEX yes our school has to get a certain benchmark pass rate on the NCLEX but in clicks is changing so much fundamentally you have to begin intervening tomorrow you have to begin talking to the students differently tomorrow you have to begin implementing change in the lesson plan tomorrow we're not going to be able to wait and and figure out hey are what kind of questions one of the questions gonna look like on the NCLEX being part of this research let me pause our discussion on the five steps for this puppet part of the research the National Council is doing part of the investment that they're making is that the test taker also known as the candidate will not be able to answer the test at that question using a trick using a test taking strategy they're not going to be able to answer these questions any more with with test taking tips and tricks and test taking strategies National Council wants to actually assess this individual as if they were standing next to a patient as if they were the woman here in the blue scrubs in this picture looking at a patient talking to a patient and they're trying to develop assessment strategies that do just that so so yes I am interested in what these questions are going to look like on the next generation of NCLEX but you have to understand what's going to help your students next time in the next graduating class what's going to help them pass and flex is is actually turning every lecture into a clinical experience is actually taking them deep in every lab experience is actually having these over discussions about priority queues priority assessment in every clinical experience starting from day one of fundamentals we've got to help them train this way practice often practice early starting in fundamentals we can't wait we can't do things like hey I'm gonna I'm gonna wait until they have a bunch of information memorized then I'll start on this cue recognition discussion or this clinical judgment we have to start early we have to start showing them this prioritization early another sidebar here for you National Council does research on on thousands of new nurses every three years and that research every time shows that the most important class in the entire curriculum is fundamentals that's not going to change with the next generation of NCLEX that's not going to change with the doing clicks coming out next year what what you're going to see is fundamentals has to be taught at a higher level okay so so this is why I'm advocating for let's focus on clinical judgment yes even in the first very first nursing class this is a this is an example of what you have three patients here with Crohn's disease for each patient scenario what is most concerning okay you know this is where we create three patient scenarios of patients with Crohn's disease and maybe in one scenario we lists and lab values and a statement by the patient I just can't go on anymore this you see the nurse the nurse has to prioritize is that statement the patient I just can't go on anymore or is the potassium of three point one more concerning you see what I did there I didn't give you a potassium of two point five putting them an imminent danger of a cardiac event I put it on the edge and and that statement I just can't go on anymore that's what's gonna happen here with Q recognition because in the real clinical environment that's what's happening that's the reality our students have to look at a set of data and constantly be in that prioritization mindset but you can't just look at a set of data and go oh there's hypokalemia cool I know what hypokalemia is you can't do that you have to move them beyond that much quicker um when we're talking q recognition and using some of this verbage you need to be overt about it in the lab in the simulation in the clinical as we have our discussion here today I hope to show you some examples of how to do that some tools how to do that but here's one very simple one students I need you to get out of 3×5 card and I need you to actually write these words on this three by five note card for your client today what are three things that you can delegate and why what are three things you cannot delegate and why and I need you to present this to appear for feedback now we're talking about Q recognition we're talking about forming habits being able to manage multiple cues coming at you what does the outcome of that look like well one of the outcomes is delegation are you able to delegate appropriately can you take all these cues in and delegate appropriately and many times in many curricula we treat delegation as a unit to be covered assess address one time in a program or one time in a class you can't do that anymore with a clinical judgment we've got to figure out ways of helping students build habits so for instance they write these words on this note card and then literally during class literally during class idiots with these patients these three patients with Crohn's disease okay you have them treat you have them treat those patients as if they were actually in a clinical setting with those patients and they start having discussions I'm caring for this patient with Crohn's disease on an inpatient unit who has these vitals these lab values has made these statements what can i delegate for their care what can I not delegate for their care and then I talked to appear about that now this note card you created students it's not just for lecture today in GI med surg it's also for this afternoon when you go to your mental health lecture and it's also for tomorrow when you have your simulation and it's also for Monday when you're back in clinical on the telemetry unit you're going to take this card with you all three of those settings all of those settings and be sure to bring it back to lecture next week to this class because we're gonna use it again that's how you build habits of queue recognition I also like to show students how to use these tools in their own study time okay how to use multiple tools together in their own study time so students I'd like you to go ahead and get out you know your your iPad get out your cell phone we've had you by you're in CLECs review book and skyscape on your phone I'd like you to open that up and and open up your in CLECs review app and click study then go to the case study for that particular area that we're studying in this case it's the prenatal period okay I want you to look at that case study all right now I want you to open up your lab guide and I'd like you to create three lab values that indicates this patient's situation is improving three lab values and then I'd like you to create three lab values that indicates this patient's situation is worsening do you see what I'm doing National Council has said they're going to ask questions similar to that okay I don't look at that and go oh I've got to change my exam I look at that and go oh I've got to show students how to do this repeatedly while they're studying while there unless you're watering lab while they're in clinical I've got to help them start to train their clinical judgment muscle in that way and the students do just that they open up their lab guide and and they you know and sometimes will tell them which labs to create create a potassium create a sodium Curia hemoglobin other times well have them go the step picking which labs they need to create that indicate improvement that indicate worsening this idea of create is a very powerful way to learn and faculty if you're teaching fundamentals think about it think about it students I gave you a 20 minute video to watch before class on on blood pressure how to measure blood pressure what's appropriate for blood pressure blood pressure across the lifespan okay now you're in class and now I've given you this patient scenario and now you students create a blood pressure that indicates the clients condition is worsening you create a blood pressure that indicates the clients condition is improving you see allow the students to create the next step that they talk about is hypotheses generation and again you're gonna see a lot of discussion about prioritize here okay what needs to be done to get the best outcomes for the client here's where we start the planning phase and and we start about what what what actions am I going to take now the examples they talk about is an extended drag and drop and you're no longer going to in the good old days on NCLEX and and the current being clicks we're in a lot of times that drag and drop what we would hear about is I had to put the correct steps in order to doing a particular skill National Council is moving way beyond that now and and this extended drag and drop is is more of a prioritization of concerns more of a prioritization of which patients you're going to see first there's a lot of prioritization here as you're as you're trying to create a list of things that need to be done what our priority needs if in and sometimes it'll be care of one patient sometimes it'll be care of multiple patients sometimes it'll be plans for entire teams faculty I hope you hear me this has got to be done in class this has to be a part of lecture we've got to come up with strategies to do this and and and then we compare okay I've created a list of priority hypothesized my priority list if you will now we have to compare what we've created here with the evidence base we've got to train our brains that I always quickly go to that evidence Basin and in a number of my other webinars I talk a lot about evidence-based practice on the fly if you're with me in a face-to-face conference Vegas Minneapolis Orlando you're actually going to see us using our devices to do this evidence-based practice on the fly you don't just create a list of priority needs and cross your fingers and hope it's part of the up to space you actually check the evidence-base who compared the list you've created of needs with clients needs what are the priorities for the client right now again back to our example with patient with Crohn's disease ulcerative colitis IBS IBD you've got to you've got to say what truly is a priority for this patient right now no longer are we going to be allowed to live inside of one pathology when it comes to prioritizing patient care now many of you are sitting here thinking boy Tim you're nuts you don't know how much information I have to cover in class you don't know how much how much work we have to do to just get through what we're doing already I hear you I hear you we're probably going to run out of time today if you will you've got to allow the students to be receiving feedback multiple times a day in class multiple times a day and lab multiple times a day and clinical and the best way to do this is have them working with peers and giving each other feedback multiple times a day the student should not be surprised when we tell them you're not doing a good job at prioritizing your assessments they shouldn't be surprised when the faculty gives them that feedback either on an exam in a care plan in clinical because daily they're prioritizing assessments and getting feedback from peers okay so we've got to find ways of making that peer interaction a part of this as they're high as they're evaluating this whole process this is an example of another question that national council talks about will be a part of the next generation in CLECs you're there list on the left side of the computers trained three patient scenarios okay and they'll be somewhat related but somewhat different you know maybe it's a a sexually active 21 year old female who smokes maybe it's a of 45 year old female nulliparous whose husband has been a coal miner for many years and maybe you know and then there's a third patient and then on the right side of the screen will be three different target areas one target area is labeled a patient most at risk for cervical cancer a patient most at risk for lung cancer a patient most at risk for ovarian cancer okay and they literally the student literally has to click and drag a scenario or the title of that scenario into the correct target that's an example that's an example of this extended drag and drop this this this national council's attempt to not allow has taking tips test taking tricks strategies to be the focus and as we're looking at the next generation of NCLEX the students have got to be able to create these priorities on their own when we're doing this in class when we're doing this in class the students have got to compare what they've discovered with up here when you're talking about evaluating your hypotheses when you're talking about generating a hypotheses and evaluating it the students have got to do it they've got to be about doing it themselves and again and I've mentioned this many times before here's where we use a clinical tool in class here's where they get out their clinical decision support tool in this particular case I believe this is my clinical companion the students open it up and on their phone they evaluate how do they do with planning so they come up they generated some hypotheses and now they're looking at that evidence-based they've actually got to do this when it comes to when it comes to taking notes okay and and we want them to do this process as well when you look at the nurse think notes notebook you're gonna see this process is very overt they're gonna do a lot of harren contrast notebook itself is not going to ask them for what are a bunch of facts what the notebook is going to do is take them into that compare and contrast right away so as they're reading they're they're looking for cues they're looking for priority queues as they're in lecture they're looking for priority queues they're looking for as they're generating their hypotheses what our priority hypotheses they're doing a lot of compare and contrast and when they use a notebook like this and and and you can see this you see the numbers one two three a whole goal here it is not the same what are the assessments that you do for a patient with Crohn's disease the the goal here is to say what are the priority assessments what cues must you look for or if if they have their notebook out when they're looking at those three patients with Crohn's disease they have their notebook out and they're actually going okay you know what for this particular patient I think here's the priorities but it's other patient here's a different set of priorities so that priority assessment priority intervention and if you're not using the nurse think Note notebooks that's not a problem you could create this on your own but the take-home message is we've got to figure out ways of making this doing part that's doing part of the cognitive processing the clinical judgment we've got to make it a habit if you think about taking notes that's where we develop a lot of our habits now a beauty of the notebook it allows them to really develop their habits well in the front of the notebook is a table of contents and an index and the app for this is going to come out here in the next couple of months but the the idea here is because of the table of contents because of the index they keep going back to the same page of notes keep building on what they already have a big barrier to developing your clinical judgment skills is feeling like every time you encounter something you have to start all over or you have to memorize a new list of facts as if if I keep going back for the same page of notes you'll notice this particular is paid 13 and and if you looked at in in the index of the book it would tell you what's on page 13 but the beauty of this is you get to build habits across the curriculum you get to take your notebook to class you get to use your notebook when you're studying you get to use it in lab use it in clinical any time a patient comes across your radar with Crohn's disease you're gonna open up to the exact same page of notes and build on what you already have and that's just a very powerful way to work it's a very powerful way to study it goes right to the heart of this clinical judgment what about taking action okay remember clinical judgment is the doing part of critical thinking and clinical decision-making anytime I'm working with students in an ink Lex review we always we always talk about what is the nurse going to do in clicks has always been a doing exam okay take home message faculty when you're teaching class your students have got to be doing something they've got to be exercising their clinical judgment muscles what is highest priority how do I address the highest priority right now as a nurse faculty let me give you a little word of caution here if you're teaching prioritization with a PowerPoint slide it has the word priorities of care and then there's five ten fifteen bullets on that slide of priorities of care what you've done is you've decreased a student's ability to develop their priority prioritization clinical judgment muscles you've hindered their learning what you need to do is have a PowerPoint slide that says priorities of care it has nothing else written on it and then the students open up their notebook they go to that page of priority I'm sorry they go to that page of priority intervention priority assessment and they create their list of priorities of care priorities of assessment when students are taking action they have to be doing they can't be receiving it can't be listening to you tell them what the priorities are that type of learning will no longer work for students they're gonna have to take it to the next level um in this particular in this particular activity the students or I'm sorry test question example on NCLEX what happens is the students have a series of buttons and it'll say like I believe the example was 11 o'clock 12 o'clock one o'clock two o'clock three o'clock they can click a button and and what they'll see on the computer is what the nurse was doing what assessments they did what interventions they did at that particular time then they'll click on twelve o'clock it'll show them assessments interventions one o'clock assessments interventions then the question actually asks them when it did nurse make a mistake when did the nurse do something incorrect as in did they do an assessment they should have done yet or did they not do an assessment that they should have done at that time what did the nurse do it was incorrect what should the nurse have done what should the nurse have done instead what what should they have been about you see this is all about the doing part of clinic this is that this is clinical judgment and the students aren't looking for what's the correct process in trate trate care what's the correct steps in trigger they're not looking for that you're watching the entire clinical scenario unfold and they have to implement clinical judgment we've got to do this often in class we've got to have class time be less of an emphasis in facts more of an emphasis on concepts and actions when it comes to the learning part of this you've got to get the students up out of their seats okay be cautious watch a clock set an alarm on your phone if those students are sitting for more than 15 minutes for more than 20 minutes if they're sitting in one place just being a passive recipient you gotta set that alarm off you got to say okay it's time to get up out of your seats pair up take your phones and open up your clinical companion review what you wrote in your nurse think notes go to those priority nursing interventions and talk about did you did you come up with the same priorities as appear did you come up with the same priorities as as what you see in your clinical companion or what your clinical companion has guided you to do after reviewing your opinion do at least two assessments on your buddy perform at least two interventions on your buddy on this peer that you're working with no don't sit down students nurses don't get to sit down you see where I'm going with this right even in a lecture hall where I've got nine students sitting theater-style with those little pizza desk things you know I'm sorry it is so important that they get up out of their chair and do something yes you're gonna have to hold up your laptop stick it back in your backpack walk out to the aisle walk down to the front walk to the back of the room you've got to do something and you're thinking oh my gosh how am I going to bring all these skills supplies to class and on and on it goes guess what you don't have to use your clinical imagination students use your clinical imagination and guess what students you've also got to find a new buddy each day now think of what I just talked to you think of the chaos as a part of this you've got to make some choices are you going to continue to just feed facts to the students or are you going to allow them to engage clinical judgment while they're there with peers while they're there with you you've got to go to that clinical judgment piece and notice I keep trying to use tools here they're their med surg clinical companion that's the book that they're supposed to have with them when they're in the clinical setting okay and if you know the clinical agency doesn't let them get out their phone or their iPad or whatever that's okay go to the break room or they you maybe you bring one iPad that you share with the students on the clinical unit that's okay we've got to build these habits during lecture and we got to replicate we've got to use these clinical tools use these tools that they're going to use in other places here's another example this is a this is a tool that students use in skills it's called skills hub and basically for each of the skills it walks them through you know what's the what's the current evidence base on performing this skill it'll link them to some video I'll you know and the other thing I want to point out here when you're looking at tools like this and I'll talk about it here in just a moment one of the biggest reasons students don't use their tools to their fullest capacity is because they don't see faculty using their tools and this is any kind of tool whether it's the nursing notebook weather it's the whether it's the adaptive quizzing whether it's the NCLEX review book whether it's case studies that they've purchased number one reason students don't use those tools is because they don't see you using them so here's an example students get out your skills hub in class let's talk through this for a moment now you just cared for you just cared for a patient if you will and I want you to find a skill in your skills hub that addresses that oh look as you're looking at your skills hub your your practicing your you're looking through some of the information there in the learn component and look you have not yet checked off on that skill or maybe it says yes you have checked off on that skill oh this reminds me we did do this skill last semester you see what I'm doing I'm trying to I'm trying to trigger their memory I'm trying to make learning enduring acrost learning environments across the curriculum by using tools that they've used in multiple places okay never get a to life skills having oh that's only for the lab in fundamentals no I look at skill so I look at the clinical companion I look at the notebook I look at note cards a three by five card that you just created and I focus on how can I use this in multiple environments so one example here one example is is you know using the skills hub here they're going through they're like oh yeah and maybe they're reviewing some of the processes on a skill they just completed as part of that clinical judgment activity in class maybe they give each other a little bit of feedback because they're practicing a skill in lecture and then the skills hub walks them in to collect style questions that refer to that skill okay and this is this is powerful this is a good way for them to a good way for them to learn it's very powerful and maybe that you can see over here they got some of the questions wrong well that's good that's a good thing because now what's gonna actually happen is the students are going to be like oh that's right I remember missing that quest they're gonna have some and the faculty at the front of the room they actually the faculty can open up the dashboard the faculty dashboard for this this is a good way to see what students are doing here in class or what they have done and you can customize the lesson plan you can say wait a minute hey let's back up for a moment even though yes we're in GI med surg let's go back to this particular fundamentals skill because i see a number of you had some trouble with it or haven't completed as many of the modules or maybe you got a lot of the quiz questions wrong and i can apply it to what we're learning right now right here today you see what the pickles is the most important class in the curriculum as I mentioned before now you've got data on different parts of fundamentals that they might be we can our fundamental skills that they might be weakened and you can emphasize how do i how do I incorporate that in the big picture here I've just hey today we're gonna memorize all the facts you need to know Crohn's disease the students can do the same thing the students can open up their own personal report and they can focus on their weaknesses they can focus on questions in this particular example the green check mark shows that they got question one a chest physiotherapy or or question one of incentive spirometer correct question three on incentive spirometer they got it correct after multiple tries okay so they can look through this that gives them feedback and it reminds them of what they've already learned but it also shows them what their gaps might be very powerful way to learn again just pulling it out a few times in class in it weekly is going to help them tremendously and then again doing similar activities obviously using it in lab think about post conference think about post conference and clinical that's gonna start tying all these pieces together that allows them to move through the clinical judgment process better more effectively okay final part of the clinical judgment the final step in the clinical judgment process is evaluate outcomes what cues does the nurse look for and pair those outcomes against what was expected is this outcome what you expected start to train your brain to think that way and and here's where you see a lot of different types of questions when they talk about when you read national councils data and you look at this evaluate outcome they're going to talk about different types of questions and then here they talk about a lot of the ones we've already covered such as the extended drag and drop it's not a list anymore you literally could put two items next to each other as in which two patients are gonna go in this room together extended multiple response this is where it moves through a scenario so it's not just one so multiple response is national councils way of describing select all that apply in this particular in this particular situation it goes through a scenario that's unfolding and keeps out and asking select all that apply questions and this is where you might say what are the priority assessments what are the priority interventions going through that scenario so these are just a couple of a couple of the examples of what that might look like what those questions might look like as I wrap up this part of our discussion though I really hope that you see this is way more than a discussion about what next-generation in Flex is going to look like or about the difficulty increasing on the in clicks in the near future this is a discussion about how you can change your class change your lab change your clinical experience tomorrow I really hope you'll consider that helps students take ownership okay you know and and a lot of times this we need to do some role modeling here okay a lot of times we need to do some role modeling I hear it a lot Tim I can't teach this way because the students are not prepped for class okay or the students didn't do their homework so I can't each this way well we've got to do two things first of all we can't enable that behavior and when you say things like I know you guys didn't have time to prepare for class so I'm gonna start with a brief overview of the pathophysiology of Crohn's disease what you've just said to them is prep for class really isn't that important really doesn't matter a whole lot because I'm gonna fill in the gap for you anyways and now because we're spending 20 minutes covering the pathophysiology of Crohn's disease do you know what's gonna be you know what's gonna be lacking you're just takin away 20 minutes from those students developing their clinical judgment skills so we've got we can't enable them we've got to be careful with that and when we expect them to prepare for class you know so for instance what I will tell my students is hey we're doing GI med surg next week and in lecture I'd like you to open up your inquest review book before you come to class next week and take that practice quiz on GI med surg you need to know what you don't know before you get here because when you come to class you will get a patient assignment and you've got to be ready to start caring for that patient so that's what I say to the students but what do I do what do I do I say go use that in CLECs review tool go do those NCLEX questions and and they've got it they've got to see that I really value that I mean taking some time in class to show them exactly what I'm talking about and this you know and this really helps the students save time studying too when you do this for them when you open up those tools in class because a lot of times they'll sit at home to waste a lot of time studying doing things that don't work for them you are or thinking yeah he mentioned that in CLECs review book but he never uses it in class so I shouldn't waste my time using it well guess what had they used the unclicks review book had they used the be adaptive quizzing that came with their med surg textbook they would have saved so much time studying then they would know what they don't know they know how to study more effectively and when you when you ask students you know how do you know what you don't know they're like well maybe I'll do bad on the exam next week look students don't wait you've got to start practicing now you've got to create your you you've got to start creating assessments that focus on your areas of weakness you can't just you can't just assume you need everything that you're looking at and this really empowers the students because as you're showing them how to do this practice how to practice this know what you don't know with their tools it really allows them to go right to their areas that they need to spend time on your students don't have a lot of time to sit around and guess okay maybe I should just read for two more hours for many of your students reading is not effective studying because their reading comprehension skills are so poor and so we've got to show them how to get to that information that they need so that when they come to class we can go right to that clinical judgement and there's a lot of tools out there even now in the in the testing the practice testing that we have in skyscape they can actually ask an expert and if they get a question wrong and get get feedback from an expert on you know hey maybe maybe you'd misunderstood the question or maybe you misunderstood this part of the question it's a very powerful way to learn as we go through these five steps of clinical judgement again I hope you reflect on what you can do in class what you can do in lab what can be done in clinical what can be done in multiple semesters okay when it comes to learning and building habits especially habits a clinical judgment it does help if there's some familiarity across the curriculum and the students you know when the students go from my med surg class to your mental health class do they feel like they let just left one planet and went to a different planet if we're doing if we're doing using similar tools okay if we're using similar tools in these classes a lot of times it helps build in so much comfort that the student is able to get closer to their clinical judgment goals much quicker okay it's a very powerful powerful way to learn and I really hope that you'll consider that all right I apologize went a little over there but questions thoughts ideas concerns if you have questions anyone in the audience please post them in the chat window and we will answer them quiet audience today no I'm just trying to um let's see what do those that are using other services like ATI or Kaplan or has they need to change or add our students preparation before the graduation other words how do we simulate the NCLEX test experience how do you simulate the inquest test experience well okay I'll I'll give you some pointers on that but I want it I want to make sure you understand first no matter what you're using a TI Kaplan hesse no matter what tools you're using it in clicks the direction Inc likes is headed and what we're gonna see even next April when we get a new in clicks implemented it's more about what happens in the classroom so if you're using for instance ATI and there's the ATI skills modules you need to use those in class and use them often and make sure that the students are doing clinical judgment with those tools they're doing things with those tools in class you know so that's really important it's it's really important that the activities that the students are doing in class to passing and click cuz whether you have a TI Kaplan se using the NL n tools for standardized testing it's it's about learning it's it's not about testing and national councils doing a pretty good job they're doing a pretty good job now of creating more and more test items that really assess that at a deeper level now back to preparing them for the testing experience the best way to prepare for the testing experience is to do that practice quizzing often if it's the testing experience that you're you're truly focused on is in the day that they arrive to the Pearson VUE testing center and and check in and do the palm vein scan it's down to the computer and use the whiteboard you know I have an inkless update where I talk about some of that you can access but the best the best thing to do for them is to have them assessing themselves using tools that they're using so I really prefer the the testing experience with that the Saunders NCLEX out that does a great job truth be known they can do it with just about anything now when we're practicing to take NCLEX a mistake that many students make is put the testing tool in study mode as in I answer the question and I instantly get feedback on that question that's a problem that's a problem because you're training your brain automatically find out how it did how did I do how brain how did I do on this question I'm gonna get instant feedback the NCLEX is not like that and you have to be careful studying in study mode you want to study more in exam mode where it gives you 20 questions then you hit submit then you only focus on the questions you got wrong or it gives you 50 questions or 100 questions or whatever it doesn't give you the answer every single time because that trains your brain and then what happens you're sitting in the NCLEX you answer a question and you're like oh my gosh I don't know if I got a right or wrong and then you answer another question your stress level goes up even more and the third question and a fourth and a 75th question and they question number 125 and all this stress has built up in you because you're used to hitting submit and getting instant feedback so I would say that that would be one caution that I do see good question though another question we have is if teaching an online program that doesn't meet for lecture how do you recommend implementing these strategies into practice this is where this is where them creating priority lists comes very very important I mentioned the nursing notes notebook you can take a look at that you can have them create priority lists in your discussion boards any of your discussion boards have a feature where they can't see other people post until they post their own and that's important to enact that feature and then I think that when you have online classes it's okay it's okay to say to the students students you have to meet with another group of students on the phone on skype here's three options per week or per two weeks you've got to meet and have some verbal discussions about this that is okay especially if it's a pre licensure experience I think it's really important and the pre-licensure experience that is fully online you've got the lab experiences that you come together face to face you have the clinical experiences that you come together face to face the instructors the faculty the preceptors in those environments need some needs some queuing on how to do some of this but the students have got to have these in depth prioritization discussions okay thank you another one is if you are a graduate from years ago where learning was done in the clinical setting and you were in clinicals for two to four days a week maybe you weren't good at test taking but you were really great at prioritizing and delegating do you think it's a good practice for a program to maybe add more clinical time to the curriculum versus classroom work we have stuck on PowerPoint lectures what are you sure you have to help encourage them to move towards interactive learning yes yes I totally hear you I get where you're coming from I am always an advocate for more clinical time whenever possible my son just graduated with his BS and I was just I couldn't believe a lack of clinical time and you know and it's in its constraints I know that in some states your curricula your your Board of Nursing your Department of Ed is cutting credits out of your program and we've got all kinds of constraints in academia to deal with so yes if possible that additional clinical time as long as your your additional clinical time these faculty are having overt discussions about key recognition prioritization priority assessment priority intervention the students should hear those words in their sleep because so many faculty are talking about it I have I do a lot of clinical observations of faculty and the word priority assessment priority intervention these do not come up a lot you'll have students randomly rattle off a hundred things thinking if I just give this instructor more words and instructors accept that sometimes so so yes more clinical would be wonderful but reality is you're probably not going to get it what has to happen the discussions we have to start having is that class time needs to become clinical time your classroom time your classroom lecture time the students have got to get patient assignments during lecture and care for patients during lecture and the model that I just walked you through gives you a lot of framework for doing that I get it it's easier to be attached to my powerpoint and just talk through it I've got it I understand where you're headed with that and sometimes that's a problem and sometimes faculty have trouble with that it's not going to work and if if that's the students primary mode of learning with you your students are going to struggle mightily with the new NCLEX comes online and they're gonna struggle even more when the next generation of NCLEX becomes integrated so thank you Tim I another question we have is how would you correlate the lab in the clinical into online didactic can you repeat that I'm not sure I follow the question is how would you correlate the lab and clinical into online didactic well is so I'm going to answer what I think you're asking I apologize it not okay see in my examples here I used clinical tools as learning activities during lecture okay and you saw those tools and I use the lecture tools like the nursing notes in clinical and lab as well it's a way street three by five no card we created early on when I was talking about hue recognition we're using that in lecture lab and clinical why do we do this we do this because the student is going to learn better when we show them what they already are familiar or comfortable with okay the sooner we can get some familiarity and comfortableness or comfort into the mix here the the more permission they have to increase the higher-order thinking also known as clinical judgment okay this is really important I can't overemphasize this enough when a student says clinical has nothing to do with lecture what that means is that of everything they did in clinical today they didn't recognize anything you and I both know your lecture was all over that clinical experience so what do we do we take a tool that they're using and clinical like med surg clinical companion life skills hub like that three by five note card and we use them in lecture now when they use that note card that clinical companion again that skills hub in the clinical experience they're going to it's going to memories of the clinical exercises during lecture that bridging a crossover is a key component to developing what we call in the concept based world enduring learning and it's very very important especially with the way the inquest is going you've got to promote that enduring learning by showing them that crossover does that help I hope it does yeah I think the questioner said you answered his question okay so thank you you one other question here how do you get faculty on board with these types of teaching and learning strategies and when will the next gen and cliques take effect okay the best way to get faculty on board I have many discussions about this and what I hear from schools that I work with nationwide all types of schools the number one strategy it helps you get get get your your team on board is you guys come together and come up with a plan that you all can implement fairly easily and call it a pilot study okay so here's an example of a pilot study faculty we all have this med surg clinical companion that we've adopted that students have on their phones can we agree in every lecture no matter what the lecture is about you're gonna get at least one patient assignment okay so that patient assignment might be patient at the end of a chapter in a textbook they're gonna get a patient assignment and they have to pull out their clinical companion and prioritize care for that patient based on what they see in that book okay and we all do that just once a week for the next five weeks and then come back together and talk about how it went okay that's one example of how you get faculty on board with this because once they start seeing the power of this type of learning it's gonna really help another way is Dean's directors coordinators you ask you ask you say okay we agreed we to have more clinical judgment more taking action more doing in every lecture so what I'm gonna do faculty we've got we've got nine months of faculty meetings ahead of us whoo time to look forward to nine months of faculty meetings ahead of us I'm an assignee each of you a faculty meeting what I want you to do during your five minutes is turn us all into students and show us all an activity where the students are doing clinical judgment learning about it reading about it not hearing you talk about it they're doing it and this gives everybody buy it because everybody knows they're gonna at some point have to present they're getting some point have to share it's a very powerful way to keep all the faculty moving in one direction sorry a long-winded that's okay that's all the questions we have for today I just wanted to say thank you everyone for attending our webinar if you have any questions on the solutions that were referenced in this webinar you can email sales at skyscape comm some of the resources referenced in the member webinar where the skills hub app which can be found in the app and Google Play stores you can look at 25 free skills there's also a saunders and comprehensive review for NCLEX bundle with the nurse think note book you can go to skyscape comm and search nurse think for that more tips on the nurse think notebook going to nursing comm if you want to learn more about the offerings at skyscape go to skyscape dot-com slash education this webinar will be available on demand in the coming days and we will email all attendees if you have any additional questions once you think about it or look at the webinar for a second time or any of your faculty you can contact our sales department or email webinar at skyscape comm and we'll try to get those answered thank you and have a great day thank you bye


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