Adaptation: A Strategy for Long-Term Success

The College of Nursing at Brigham Young University has overcome many challenges to continue its mission during the past year of the pandemic. The use of technology and other resources required flexibility and unique approaches to networking, clinical, and didactic work.

“While our response was to establish a method to complete tasks, many of them proved to be a valuable approach for students not only during a crisis but as a way to educate students in the future,” says Dean Jane H. Lassetter (AS ’81, BS ’98, MS ’01).

A few of the approaches that were originally implemented as short-term fixes will be used by the college long after the coronavirus threat is gone. Here are a few examples.

College Podcast

With the COVID-19 restrictions implemented this school year, the College of Nursing could not sponsor any in-person events. To fill this void and provide students with information, the college created The College Handoff, a weekly podcast series devoted to sharing career knowledge and nursing insight.

The project began by surveying undergraduate students to understand their podcast listening habits and discover how each show should be structured. We learned the ideal length (22 minutes), the main day to release new shows (Tuesday), and what components to include (career information, recruiter tips, and nursing how-tos).

The show is produced by college communications manager Jeff L. Peery and is cohosted by Corbin Smith (a public relations major) and Adia Hansen (a fourth-semester nursing student). Behind the scenes, Donovan Kelly (a photography major) works as the production sound mixer, and Alex Coleman (an English major) helps write episode talking points and scripts. Each person’s unique talents and skillsets combine to produce a new production each week.

By the end of the fall semester, 17 shows had aired, with over 2,000 downloads. While BYU nursing students are the main audience, additional listeners can be found in 28 states and five countries. All episodes are available wherever you can download podcasts, including Spotify, Google Podcasts, Amazon Music, and Apple Podcasts (or online at https://thecollegehandoff.podbean.com).

Lasseter says, “While COVID is not allowing us to be together in person, we hope this podcast will help you feel connected to the College of Nursing wherever you may be. Alumni looking to transition into a new branch of nursing, or even those who just want to learn about what other nurses and professionals are doing to share the Healer’s art, will find that The College Handoff is the perfect way to relax and learn each week.”

Shadow Health & Mentoring

For nursing students, the N292 class (clinical practicum of older adults) is their first clinical experience. Before COVID-19, students complete this clinical in a skilled nursing facility for gerontology patients. However, the pandemic forced these facilities to close their doors to visitors.

Second-semester students now receive their first experience with older adults through an online program called Shadow Health. The digital clinical experience gives students feedback and suggestions based on their care disparity with professional care.

One way to support this learning type is through a unique College of Nursing mentoring program that pairs N292 students with students in N492 (the nursing capstone class).

Feedback on mentor/mentee relationships has been beneficial. N292 student Olivia Snow comments, “I love the mentorship program. I only know nursing students in my cohort semester, and so I wouldn’t have anyone to ask questions if I didn’t have a mentor.”

She meets with her mentor once a week to talk over any questions she has about clinicals, class, registration, or whatever has helped her mentor throughout Olivia’s upcoming semesters.

After the first semester of use, faculty members found that students did much better in the computerized simulations if they had conversations with senior nursing students about each scenario and reflected on their first attempt and outcomes.

Several studies exist to support student/professional relationships. However, college faculty could not find research about mentoring relationships between students. “The research surrounding student mentor/mentee relationships is limited,” says assistant teaching professor Petr Ruda (BS ’09, MS ’15). “We are eager to finalize our data and share the results in a future journal article.”

It can be valuable to draw new teaching methods from within the college. “I don’t see this as a one-time alternative to clinicals,” says Ruda. “After COVID-19, these types of learning experiences can supplement the clinical course, become a refresher between semesters on how to do assessments, or remind students how to be empathetic; this system can be very useful.”

The hope is that the students, both mentors and mentees, will take all that they learn from these relationships with them into the workforce. It will make them better new nurses, prepared to ask the right questions and receive instruction, and more willing to guide in the future when a new nurse comes along and needs their help.

Rural Clinicals

With many of our partner facilities not allowing clinical placement during the pandemic, BYU College of Nursing administration had to consider alternative locations, especially for capstone students. One solution was to think outside of the box or, in this case, outside of Salt Lake and Utah Counties.

Associate dean and associate professor Dr. Julie Valentine arranged for a few nursing students to complete their clinical rotations in rural locations such as Vernal, Fillmore, and Panguitch, Utah. “Starting in the 2020 fall semester and expanding during the 2021 winter semester, a dozen students had the opportunity to participate in clinical work outside of the greater Salt Lake City area,” says Valentine. “These locations provided unique learning for students as they got to experience smaller hospitals, work with a variety of staff, and spend time on multiple units within those facilities, encounters not usually available in urban settings.”

Two of the capstone students were also roommates and shared an apartment. Lauren Schagel and Jamie Valentine (no relation to Julie) volunteered to spend time in Vernal, a community 150 miles east of Provo. “We would travel there on Wednesday, complete three 12-hour nightshifts, then return home on Saturday,” says Schagel. “We did that for a month. The situation offered great outcomes, as we were able to see the same patients from day-to-day, help with treatment evaluations, and work on different units of the 39-bed hospital.”

The logistics to accommodate rural clinical shifts came with an unexpected price. However, with a generous college donor’s help, the additional expenses for transportation, lodging, and meals were covered.

“The list of rural hospitals that are eager to allow undergraduate and graduate nursing students is expanding,” says Dr. Valentine. “We will continue to find ways to make the situation beneficial to students, the hospitals, and the faculty members that must also support these visits.”

The college also needs to find permanent funding to support such measures on an ongoing basis, as donor support should also be used in other areas (scholarships, mentored learning, and global health practicums).

Safety Measures

COVID safety measures were implemented throughout all buildings on campus, but a few of the safeguards that occurred in the College of Nursing will continue.

Starting in the fall semester, the college implemented a lab uniform that was different from clinical scrubs. Students must wear ceil blue scrub bottoms with a white top without a logo while working or practicing in the nursing learning center.

“The NLC scrubs provide a visual signal and assurance to faculty that students did not wear those same scrubs to clinical that week,” says Lassetter. “Then, when they go to clinical wearing their traditional navy scrub bottoms and white top with the BYU emblem on the sleeve, clinical faculty members know this set of scrubs was not worn on campus, potentially collecting the COVID-19 virus for transportation into the clinical facility.”

This simple action allows us to assure our clinical partners that we are doing everything we can to keep their employees and patients safe, helping them feel more comfortable with students in their facilities learning to provide patient care.

“We cannot determine if a student has washed scrubs in between wearing if we have the same set of scrubs for both clinical and the NLC. Previously, we allowed lab coats to be worn over students’ clothing, but this is no longer possible with COVID precautions,” says Lassetter.

Another precaution makes students responsible for cleaning their lab space before use. Using sanitizing wipes provided in the classrooms and labs, students can disinfect their desks, table, keyboard, and manikins before instruction. Pre-COVID measures relied on custodial staff or lab employees to clean surfaces as their schedules or routines allowed.

Other measures that will likely continue include wearing safety goggles during hands-on labs, having temperatures taken before entering the simulation lab, completing a health screening questionnaire, and, like any nursing professional, the continuation of hand hygiene upon entering or exiting any room.

Telehealth Training

Last year, the College of Nursing introduced standardized patients who “have been trained to answer questions for a particular condition,” says associate professor Dr. Neil Peterson (BS ’07), coordinator for the graduate program. This allows students to have similar experiences, because scenarios are scripted; patients can present the same symptoms for each student.

To keep the cases consistent, patients are trained in their ailments and may wear earbuds during their exams to receive real-time coaching from a faculty member on what to say, or they may refer to script cards during the process.

Because of COVID-19, part of the student’s learning also included treating standardized patients through telehealth sessions.

“Assessment via telehealth is something that every practitioner needs to know how to do now,” says Peterson. “Applying the techniques of telehealth and consulting via one-on-one video conferencing gives students the most realistic experience for what they will see in the clinical setting, preparing them to leave the graduate program confident in their ability to administer high-quality treatment.”

Peterson realizes that there is a need for ongoing refinement of the nurse practitioner training, including instruction on following proper video etiquette, collaborating with colleagues and other healthcare professionals, and upholding the standards of ethical conduct, privacy, and informal consultations with patients.

Summary

Most nursing schools significantly changed their curricula as they navigated the complexity of educating students during a pandemic. Some of the modifications were temporary safety measures, while others were significant improvements to training the next generation of nurses. The BYU College of Nursing will continue to evaluate its teaching methods and course outcomes and apply key evidence-based practices of peers and industry research. Besides the changes with networking, peer mentoring, rural clinical work, and the increased use of technology in patient care, we are likely to see an expanded role of simulations in nursing education, more ways to learn in smaller group settings, and an increased acknowledgment that lectures and learning can occur both in-person and online.

Corbin Smith, Alex Coleman, and Jeff L. Peery contributed to the writing of this article.

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