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‘Hands-on’ experience goes online for nursing students

As featured in The Daily Item

Graduate nursing student Kristi Heiss asked her patient "Danny" about his history of smoking and his past medical history.

Danny, who was looking at her from a computer screen, was trying to quit smoking for his daughter, a single mom, and for her 2-year-old boy, both of whom lived with Danny.

Another graduate student, Tawney Engelberger, had to break the news to "Cynthia" that she had breast cancer.

Heiss, of Bloomsburg, and Engelberger, of Ashland, who already work as registered nurses at Geisinger Medical Center, are graduate students in Bloomsburg University's Nurse Anesthesia program, studying to become nurse anesthetists.

The two 29-year-olds, who both have two more years to go in the program, normally would have been doing their clinical work at Geisinger to get hands-on experience. The COVID-19 pandemic halted that when the state shut down schools, classes went online and hospitals stopped taking nursing students for clinical.

Thanks to an endowment to the university's nursing department, nursing students who are finishing up their required clinical hours are doing so through four different software programs rather than in a hospital setting.

That also is the case for the Central Susquehanna Intermediate Unit (CSIU) Licensed Practical Nurse (LPN) program, said Timothy Campbell, the program's director.

Acting like real patients

The online interaction the BU students participated in was a separate part of their online training. Danny and Cynthia, actually Danny Roth and Cassandra Pisieczko, actors with Bloomsburg Theatre Ensemble, were among the BTE actors playing patients over Zoom, an online version of what they've done face-to-face with the students over the past 10 years.

"We were lucky to have most of our clinical experiences before COVID," Heiss said. "It's nice to compare. It's less stressful than in-person encounters. We can take our time and think how we can more effectively interact with the patient."

"It's definitely a lot different, especially because of how artificial that it is," said Engelberger.

Kim Olszewski, Bloomsburg University associate professor of nursing and graduate nursing program coordinator, said one of four online clinical software programs the students are using, from Shadow Health, uses avatars, electronic images in human form that can be manipulated on the computer. Each software program is for a different nursing program.

According to Susan Fetterman, chair of BU’s Department of Nursing, the programs are a computerized illustration of a patient. The student and virtual patient can both ask and answer questions regarding symptoms and the location of the symptoms. The responses are evaluated as to what is the best response by the student and why.

The system allows faculty to evaluate the student’s ability to take care of a patient and allows students to learn how to interact with patients as well as what symptoms to look for.

Olszewski suggested purchasing the software, with a $1.9 million endowment from Ed and Julie Breiner.

Fetterman said that without the online clinical software, clinical would have had to extend into the summer months for most of the students, versus the few that were extended for clinical currently.

The department purchased computer simulation software for both undergraduate and graduate nursing students to complete their courses and allow seniors to graduate on time. The department could use the computer simulation only because the students had completed 54 to 61 percent of their face-to-face clinical and theory courses.

Computer comfort

Campbell, who said he already was implementing the tools to get students more comfortable with computers and virtual simulation, said that when the shutdown occurred in mid-March, the program easily transitioned to online classes and clinical, which used virtually simulated patient care scenarios.

He said the online clinical programs actually offer an advantage because in clinical rotations, there is no way for a faculty member to be there all of the time with every student. The virtual program reinforces the importance of doing all of the steps.

"Having the virtual program is helping prepare (students), knowledge-wise, a little bit better," Campbell said.

Olszewski said the students interact with the avatar to assess the "patient" and develop a patient history. The program records the dialogue and provides immediate feedback to the patient.

BU has 490 undergraduate students, both in and not in clinical, in the Bachelor of Science in Nursing (BSN) program, and 120 graduate students in programs such as Nurse Practitioner, Nurse Anesthesia and Master of Science in Nursing, Olszewski said.

At the undergraduate level, the program has approximately 300 students in clinical, and at the graduate level, approximately 65 students in clinical.

"At the graduate level, the required clinical hours for the Nurse Practitioner program is 500 hours, however, our program has always required well above that minimum requirement," Olszewski said. "The Adult Gerontology Nurse Practitioner program requires 720 hours, and the Family Nurse Practitioner requires 920 clinical hours. 

"For the Nurse Anesthesia program, the nine seniors getting ready to graduate are required to have a certain number of cases in the OR (operating room) in order to graduate and they were all completed as well," she added.

Preparing for the 21st century 

Campbell said that while there is no substitute for hands-on patient care, computer knowledge is important for nurses, who will use computers in the workplace. 

"I had 40-year-old students who had never used a computer," he said.

Campbell noted a lot of non-traditional students haven’t had experience with electronic health records

When he started at CSIU a little over two years ago, a lot of students were coming out of the program not feeling comfortable with computers.

"I'm student-focused and I'm going to prepare students for the 21st century," he said.

"By luck, when we were shut down, we could go directly online," Campbell said. "We had all the necessary software available to do it."