Innovative Teaching Strategies in Nursing and Related Health Professions:
Practice Giving Empowering and Effective Student Feedback
Summary: The goal of the assignment is expose nurse educator students to a unique type of online simulation environment and provide practice opportunities to assess the results of several example students. Nurse educator students will explore Shadow Health assignments and then assess and evaluate the performance of several example students.
Objectives: Through this assignment, students will:
- Identify strengths and weaknesses in three different students’ work.
- Assess the level of the learner.
- Provide detailed constructive feedback, identifying areas of progress and remediation.
- Recognize the role of the nurse educator in helping to improve student confidence and proficiency.
Example Student Overview:
Case #1: Beginner - In this case, your student is performing an HEENT exam. In the interview, this student asks many good questions, but often fails to ask follow up questions to get pertinent information. She also does not take a full family history that pertains to the HEENT system. This student does perform all of the exam actions, but makes quite a few mistakes when documenting her findings.
Results from Example Student #1
Case #2: Developing - In this case the student does a thorough job of interviewing Tina about her history of present illness, reason for hospitalization, past medical history, family history, and social history. She is also fairly thorough in her documentation. She is so focused on ensuring she asks all the required questions, she skips over all of the privacy and infection control steps. She encounters many opportunities to do patient Empathy and Education, but forgets to follow up and also missed out on performing a complete review of systems.
Results from Example Student #2
Case #3: Proficient - This student is thorough in her interview. She uncovers many pertinent findings, but also misses some key follow up questions about the chief complaint and does not do a thorough psychosocial or family history. Education and Empathy also need to be improved upon. She fails to encounter 2 of the scored areas for Education and Empathy, and in the 6 opportunities she does encounter, she only follows up on one of them. However, she does document her encounter with Ms. Jones thoroughly.
Results from Example Student #3
Providing Student Feedback for a Virtual Patient Simulation
(Student Directions)
Instructions: Prior to completing these assignments, you will need to watch the Shadow Health Introduction video to make yourself familiar with the program. You should also spend a short amount of time (a minimum of 20 minutes in each assignment) in both the Health History exam and the HEENT exam so you have an idea of what you will be giving your students feedback on.
In this assignment you will review the work of 3 different students. After you review their work, you will have the opportunity to provide each student with feedback on their performance. Carefully structure your feedback to be direct, constructive, and encouraging. Your review should include assessments of the following areas:
- Organization of the interview
- Organization of the assessment
- Ensuring patient safety and privacy
- Quality of interaction with the patient
- Overall DCE score, Subjective Data Collection, and Objective Data Collection
- Quality of educational and empathetic statements
Student Work #1: Your student is performing an HEENT assessment on Tina Jones. In this assignment, your students learn that Ms. Jones has a history of headaches, and so the preceptor instructs the students to do a full HEENT assessment. In this assessment, they will find that Ms. Jones reports occasional headaches and blurry vision. You will review the student’s results for both the Subjective and Objective Data Collection, as well as the transcript and give your student detailed feedback on what they have done well and what needs improvement. Results from Example Student #1.
Student Work #2: Your student is doing the Health History with Tina Jones. In this assignment they are meeting Ms. Jones, who is a 28 year old African American woman who presented to the ED because of a painful wound on her right foot that has worsened over the last few days. From the ED she was admitted to the hospital for pain control and IV antibiotics. Ms. Jones has a past medical history of poorly controlled type II diabetes and asthma. You will review the Subjective and Objective Data Collection as well as the transcript and give your student detailed feedback on what they have done well and what needs improvement. Results from Example Student #2.
Student Work #3: You have another student who is doing the Health History with Tina Jones. You will review the Subjective and Objective Data Collection as well as the transcript and give your student detailed feedback on what they have done well and what needs improvement. Results from Example Student #3.
Instructor Model Feedback for Case #1:
●Organization of the Interview: You did a nice job structuring your interview. I like the way you went through each of the parts of the Head, Eyes, Ears, Nose, and Throat individually and asked very thorough questions to determine exactly what was going on with her present illness. However, you missed following up on some questions. For example, you did ask about eye problems, but when Ms. Jones tells you that she has occasional blurry vision and itchy eyes, you did not follow up and ask about aggravating and alleviating factors.
●Organization of the Assessment: The assessment was well structured. I like that you did the entire interview first so you could do both a general assessment, but also use what you learned in the interview to focus on certain areas.
●Patient Safety and Privacy: You did a very nice job in performing all of the nursing tasks pertaining to patient safety and privacy.
●DCE Score: There are 2 areas where you lost the majority of the points on this assignment. The first area for improvement is in the interview. You did not address any family history in this exam. Family histories might indicate a genetic predisposition to some illness, so for example, asking Tina if she has a family history of migraines can reveal generational patterns. The second area for improvement would be in the assessment. You were able to perform each of the components of the physical assessment, but you did not accurately identify some of the findings when you were documenting. Take your time and ensure that you are really looking at the finding while you are documenting to improve accuracy.
Model Feedback for Case #2:
●Organization of the Interview: You did a very nice job of asking many follow up questions, but you did miss a couple of opportunities to follow up on Ms. Jones’ allergies and her family history. You also neglected to perform a complete review of systems, which is where you missed a lot of points.
●Organization of the Assessment: There was no assessment component to this assignment.
●Patient Safety and Privacy: I noticed that you did not perform any of the nursing tasks that are associated with patient safety, privacy, and infection control. It is always important to perform these tasks, even on virtual patients, because these tasks are so vital to taking the highest quality of care of each of our patients.
●DCE Score: Overall, I would say you did a nice job. The one area for improvement would be to be sure to complete a full review of systems any time you are doing a complete health history for each of the body systems. Although most of the answers to a thorough review of systems will be “no” from your patients, asking these types of questions can uncover additional problems not discovered during the discussion about the patient’s chief complaint.
●Quality of Educational and Empathetic Statements: You encountered 7 out of 8 of the possible situations for education or empathy over the course of your interview. You did not follow up on any of those opportunities. As nurses, it is our job to educate our patients to the best of our ability about their disease process, and about the plan of treatment while they are in the hospital and beyond. You had opportunities to teach Tina about her diabetic diet, glucose monitoring, treatment with a diabetes medication, and asthmatic control, but you did not follow up with an educational statement. You also had the opportunity to empathize with Tina and let her know that you understand that she isn’t feeling her best. Empathy for our patients is an important part of our role, and humanizes them in a sometimes difficult situation. In this assessment, you had the opportunity to empathize with Tina about her physical pain and a loss of a family member, but you did not follow up on that.
Model Feedback for Case #3:
●Organization of the Interview: I would suggest that in the future after you introduce yourself to your patient you start with an open ended question like “what brings you to the hospital” instead of asking about pain right off the bat. You bounce around a little bit from topic to topic, I would try to stay focused and ask every question you have on one topic before moving on. It will be less confusing for your patient, and for you as the interviewer.
●Organization of the Assessment: There is no assessment component of this assignment.
●Patient Safety and Privacy: You did a very nice job in performing all of the nursing tasks pertaining to patient safety and privacy.
●DCE Score: Overall your score is very impressive. You did a very thorough job with the interview, and your overall score shows that you are proficient at taking a health history. You did miss asking so key follow up questions, for example you asked Tina about any drainage from the wound on her foot, but you did not ask a key follow up question about the character of the drainage. You also missed taking a thorough psychosocial and family history. Asking these types of questions may not directly pertain to the chief complaint, but they will give you a broad view of your patient’s lifestyle and help you to build a rapport.
●Quality of Educational and Empathetic Statements: You encountered 6 out of the 8 areas in your interview where you had the opportunity to provide either an educational statement or an empathetic statement to our patient. Of those, you only chose to follow up on one opportunity. You followed up empathetically on the loss of a family member, but did not follow up on her expression of pain. Empathy for our patients is an important part of our interactions with our patients, and humanizes them in a sometimes difficult situation. You miss the opportunity to follow up with an educational statement when Tina showed gaps in her knowledge base on a diabetic diet, diabetes medication, lack of blood glucose monitoring, and counseling about past drug use. As nurses, it is our job to educate our patients to the best of our ability about their disease process, and about the plan of treatment while they are in the hospital and beyond.
Other Activities for Nurse Educator Students to Explore Instructional Methods and Curriculum Design
Integrating Shadow Health into a Syllabus
Imagine that you are faculty in a brand new program. You are being put in charge of the 16 week face to face Health Assessment course, and you will be integrating the Digital Clinical Experience into your curriculum. There are many things to consider, such as which assignments you should use, when you should use each assessment, what other assignments should be utilized in addition to the Digital Clinical Experience, and how to meet the learning objectives that you have set for your students. In this assignment, you will be making all of these decisions as you work to integrate Shadow Health into the syllabus and course calendar.
Determine Meaningful Use of Shadow Health as an In-class Activity
Using virtual patients in your classroom is not just for solo learning done while sitting at your computer. There are many innovative ways that you can utilize the Digital Clinical Experience to provide unique and memorable learning experiences for your students to learn from one another as well as from Tina Jones. For example, you may decide to pair up your students and have them do a full head to toe assessment on one another to get an idea of what their skill set is, and follow that assessment up with the comprehensive assessment on Ms. Jones. After they complete the comprehensive assessment and review their feedback, you could then have them perform another live assessment on their partners so they can see their improvements. Feel free to be creative, think about how you would like to learn, and how you could meet the outcomes you have set up for your course in a meaningful way for your students.
Creating a Grading Rubric based on a Shadow Health assignments
Rubrics are an essential part of any course, and learning how to create a rubric is a skill that you will carry through your teaching career. By creating a rubric, you will be explicitly representing your expectations for your student’s performance on an assignment. In this exercise, you will be creating a rubric for the Health Assessment assignment that your students will review prior to completing the assignment themselves. For you to be able to do this successfully, you will need to first familiarize yourself with the Health History assignment. In order to do this, you will need to spend about 20-30 minutes in the assignment and carefully review all of the feedback after completion of your attempt. Your rubric will likely have many components, which will include each of the objectives your students will be meeting, the range of points that they could receive, and a detailed description of each objectives. Here is one line of an example annotated rubric:
Examples of Excellent, Satisfactory, and Unsatisfactory Work
Categories / Excellent / Satisfactory / UnsatisfactoryDocumentation / Complete Detail
Allergies: Codeine: rash. Latex: rash. Strawberries: tongue swells. Denies all other environmental allergies. Notice that all categories are reported and reaction is recorded in depth.
Complete Organization
As needed for constipation: Colace 100mg 1-2 tabs by mouth daily. Notice that the indication leads the medication. This is an improved method of reporting medications.
Professional Language
Denies substance abuse: alcohol, tobacco, illegal drugs. Notice there is excellent categorical information followed by information.
20 PTS / Complete Detail
Allergies: Codeine: rash, Latex: rash. Strawberries Notice that all allergies are reported and most reactions are recorded as well, but the documentation does not include all information.
Complete Organization
Colace 100 mg tabs by mouth,
1-2, as needed for constipation. All pieces of drug data are here, but the reporting could be improved by starting with the indication leads.
Professional Language
Colace 100 mg tabs by mouth,
1-2, as needed for constipation. All pieces of drug data are here, but the reporting could be improved by starting with the indication leads.
15 PTS / Complete Detail
Allergic to strawberries. Notice no reaction reported and drug allergies are not documented.
Complete Organization
100 mg constipation medicine 1-2 tabs. Reporting is disorganized and missing the drug name.
Professional Language
Said that she doesn’t use pot. Unprofessional language. When discussing substance use, the student should have referred to specific substances professionally and avoided using slang.
0 PTS
Review / Initially patients may ignore and tolerate symptoms of enlarging prostate. As the prostate grows in size, symptoms become severe such as hematuria and urinary tract infection. Citation: Chang, H. S., Park, C. H., Kim, D. K., Park, J. K., Hong, S. J., Chung, B. H., ... & Kim, J. C. (2010). Assessment of patient-reported outcome of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and treated with tamsulosinHCl in Korea. Urology, 75(5), 1156-1161. Complete evidenced based information with citation.
5 PTS / It is common for patients with enlarged prostate to complain of a urinary tract infection. This is basically true; however, it lacks the clinical reason and background for the information. Also there is no citation.
3 PTS / Urinary tract infections are caused by drinking too much soda. This is incorrect. This lacks clinical reasoning and is unrelated to the assessment. There is no citation to back up the claim.
0 PTS