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Can nursing skills be taught online?

SDSU finds valuable alternative during forced online learning

Jessica Oye using Shadow Health
Jessica Oye, a fourth-semester nursing student from Luverne, Minnesota, goes through a Shadow Health module. South Dakota State University's College of Nursing started using Shadow Health to train students in March due to the move to online-only course delivery.

Learning online isn’t a big stretch for some subjects—Pythagorean theorem isn’t any easier to learn in person than it is on the internet.

Campuses across the country turned into ghost towns when COVID-19 became a pandemic with cases seen coast to coast. Suddenly crowded classrooms became a thing of the past as all lessons quickly went online. At South Dakota State University, that began March 23 after spring break was extended to two weeks.

But how do you teach a nursing student to know what lungs should sound like, when a heart is beating irregularly or if that lump in the abdomen is normal?

At SDSU, the answer was found in Shadow Health, a Florida-based leader in educational simulation technology. The firm and its programs weren’t unfamiliar to the College of Nursing. Alyssa Zweifel, the college’s healthcare simulation center assistant director, said SDSU was going to implement some of Shadow Health’s modules into the college’s curriculum in the fall. Faculty were to be trained in May.

Coordinating for 550 students
When it was announced that students wouldn’t return to school March 16, all signs pointed to online education when classes resumed.

That included all clinical lessons, whether for first-semester nursing students or fifth-and-final semester nursing students. Matching up the Shadow Health modules with the college’s curriculum was a weeklong challenge, Zweifel said. Working with Cassy Hultman, clinical site manager, Zweifel created a giant spreadsheet to identify where each of the 550 students on four different campuses was at in their clinical hours.

First-semester students hadn’t started clinicals yet while fourth- and fifth-semester students had a good start on their spring semester clinicals, Zweifel said.

That aligning took a week plus faculty training sessions were needed on using the virtual simulation program. It helped that some faculty had used Shadow Health when pursuing master’s degrees. The company offered Zoom training sessions and provided a self-training module for students to prep with before beginning graded activities.

Shadow Health grades students as they progress through the modules, which generally take 60 to 90 minutes to complete, Zweifel said.

“We can offer prompts for beginning students. The module offers a debriefing for students on how they scored and where they need to work to improve. It offers suggestions on what the students could have asked the patient. Also, students can go back and repeat the scenario until they get mastery,” Zweifel explained.

Student, faculty reaction
What do students think of Shadow Health?

Jessica Oye, a fourth-semester nursing student from Luverne, Minnesota, said, “The Shadow Health modules are a good substitute for our clinical experiences. It would be impossible for it to be an exact replacement, but I feel like the modules do a nice job of reinforcing basic skills we learned in the first semester and integrating them with critical thinking and knowledge application that we have acquired.

“It provides a formal opportunity to practice our skills and apply what we've learned, and that's what we need as nursing students.”

Associate professor Becka Foerster, who was part of the committee that had witnessed Shadow Health presentations this winter, said “Since it is an interactive platform, it fosters nursing critical thinking. Students have to prioritize and apply their classroom knowledge to successfully navigate through a patient’s care.

“While similar concepts can be achieved through written case studies, the visuals and audios certainly make the experience much more like real life.”

The program is strong in requiring students to use critical thinking skills. The virtual patient communicates with the student nurse based on questions asked during the assessment. For example, “What makes the pain worse?” can prompt a variety of responses depending on the body system being studied and the patient profile.

Zweifel said the biggest challenge for users is knowing if they are logged in to the standard website or the one that hosts its pilot modules. Shadow Health gave SDSU the opportunity to use it pilot site for specialties such as pediatric modules.

Drawbacks and bonuses
As happy as the college has been with this emergency substitute, there are no plans to drop in-person clinicals after COVID-19 pandemic restrictions end. “We can’t mock up an IV start. There’s just not a virtual simulation for that. It’s the hands-on, tasky skills that we’re missing,” Zweifel said. By fifth-semester, those skills have already been well-drilled, she noted.

One other drawback of internet learning is internet bandwidth. “It uses quite a bit of bandwidth, so it can be slow,” Zweifel said.

A bonus of using a digital clinic experience is that there are always patients with the ailment that students need to learn about, Zweifel said. “Depending on patient load (at hospitals), sometimes we can’t get the experience we wanted to,” she said. Scheduling the clinical experiences between the care provider and the numerous nursing programs in the region also is a major jigsaw puzzle.

Oye added, “All of the patients I have encountered in Shadow Health have been unique just as patients are in the hospital setting.”