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Faculty Research Spotlight

Regina Jillapalli, St. David's School of Nursing

Rising to the Challenge: Creating Meaningful Learning Experiences for Nursing Students in the Era of COVID-19

“Our NIGP grant research will enhance clinical judgment acquisition, skill competency evaluation, and psychosocial integrity in an altered COVID-19 learning environment.”

Dr. Regina Jillapalli
Dr. Regina Jillapalli

Every day I challenge my students to be competent and compassionate nurses. This involves appropriate leveled clinical experiences and participation in real-life rigorous simulation scenarios. We carefully select clinical sites and units to ensure the best clinical experiences. To help achieve comparable outcomes for all students, I created many simulation scenarios and activities that engage students to help them develop clinical judgment. Clinical judgment refers to the thought process (clinical reasoning) that allows healthcare providers to arrive at a conclusion (clinical decision-making) based on objective and subjective information about a patient.

In March 2020, a mid-semester switch to online and virtual clinical learning was necessary because of facility, university, and community COVID-19 restrictions. Our clinical partners denied student access to live patient care opportunities due to limited personal protective equipment (PPE) and many unknowns about COVID-19. In summer 2020, our student nurses had limited access to hospital facilities as well. To ensure the safety of our students and faculty, the School of Nursing purchased and distributed N95 and KN95 masks, face shields, and goggles to use in the clinical facilities and simulation labs. In the simulation labs, we restricted the use of medication carts and access to supply rooms in compliance with social distancing guidelines. As a course coordinator, I faced challenges creating online clinical activities that continued to meet the course outcomes and support clinical judgment acquisition.

A Johnson in sim lab with students
Dr. Johnson in Sim Lab with students

In fall 2020, the Texas Higher Education Coordinating Board (THECB) announced a Nursing Innovation Grant Program (NIGP), titled “Supporting Clinical Learning Experiences to Mitigate Impediments due to COVID-19”. My colleague, Dr. Alisha Johnson (Co-PI), and I (PI) applied for this grant to support clinical courses in the nursing program. We were awarded $120,000 through this 2-year grant. Dr. Marla Erbin-Roesemann, Director, School of Nursing; Dr. Chris McClanahan, Director, Simulation and Interprofessional Education; and Dr. Star Mitchell, Undergraduate Program Director, helped us identify curriculum needs. Dr. Erbin-Roesemann guided the budget, and Dr. McClanahan helped identify appropriate equipment for our study.

We identified several challenges:

  1. Increased threat to meeting course outcomes, leading to potential delay in student progress through the curriculum
  2. Lack of hospital access for in-person skills acquisition practice and verification, including PPE utilization and psychosocial interactions
  3. Lack of opportunity for clinical reasoning to prioritize and balance care among multiple patients
  4. Lack of real-time ability to respond and plan care for patients from various cultural backgrounds during COVID-19 patient access restrictions
  5. Restricted access to patients, such as those in isolation; limited interaction with families, incorporation of psychosocial dynamics into the plan of care, medication administration opportunities; and increased reliance on simulation/virtual scenarios to achieve course/program outcomes
R Jillapalli in Sim Lab with Students
Dr. Jillapalli in Sim Lab with students

Given these continuing threats and to ensure our students achieve program outcomes, either through distance or face-to-face learning, we proposed the following:

  1. Hire a training and professional development consultant for simulation instruction and distance education to promote clinical learning
  2. Modify curriculum, design lessons, and develop scenarios to help students meet specific clinical objectives, including distance education
  3. Use GoPro HERO 8 videos, medication scanners, and AV recordings to facilitate faculty debriefing with students for clinical and simulation lab learning experiences, including online formats
  4. Have students participate in simulated high fidelity virtual clinical learning experiences that include realistic or interactive patient scenarios
  5. Demonstrate and evaluate skills and competencies, synchronous or asynchronous
  6. Provide hands-on practice and demonstrations on campus

Our NIGP grant research will enhance clinical judgment acquisition, skill competency evaluation, and psychosocial integrity in an altered COVID-19 learning environment. We were awarded this grant because we focused on the whole curriculum versus individual clinical courses. We seek collaborations with faculty experienced in virtual reality platforms to ensure the capture of clinical judgment, acquisition of skill competence, and improvement of psychosocial integrity outcomes.