Advanced Health Assessment Course Research Articles

Adolescent Simulation in a Health Assessment Course for Advanced Practice Nursing Students.

Advanced practice registered nurse (APRN) students face challenges transitioning to practice. They benefit greatly from simulated learning experiences that build confidence and increase competence in the skills needed to perform in an APRN role. The purpose of this quality improvement project was to evaluate the effectiveness of a simulated adolescent well visit in an advanced health assessment course. Using a pretest/posttest design, qualitative and quantitative data were collected from participants. Results included high learner satisfaction, an increase in both self-reported competence and confidence, and an appreciation for the "safe space" of learning.

Trauma-informed care: Insights from a Q-methodology study of advanced practice registered nursing students

BackgroundTrauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing. ObjectivesTo identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course. DesignQ methodology was used to explore student perceptions of TIC. SettingA virtual advanced health assessment course at a large, midwestern university in the United States. ParticipantsNinety-five APRN students from six specialty APRN programs. MethodsStudents completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions. ResultsFour factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners. ConclusionsAll students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

Teaching Nurse Practitioner Students Advanced Health Assessment Skills During COVID-19.

The purpose of this project was to evaluate student outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic in an advanced health assessment course that was offered in the summer semesters to nurse practitioner (NP) students as a hybrid course with online didactic and in-person lab components. Due to COVID-19, the summer 2020 course offering transitioned to being 100% online and innovative strategies replaced the in-person labs. Student outcomes from summer 2019, when the course was hybrid, were compared to summer 2020, when the course was changed to being 100% online. The findings of this project showed somewhat similar learning outcomes on both knowledge and skill acquisition in the 100% online course despite the change to 100% online during COVID-19. In teaching advanced health assessment to NP students, use of videography for skills demonstration, the virtual classroom, and unfolding case studies provided a robust and flexible pedagogy approach for 100% online teaching during a pandemic. [J Contin Educ Nurs. 2022;53(2):83-89.].

Addressing 4Ms of Age-Friendly Health Systems for Older Adults in Family Nurse Practitioner Education through Simulation-Based Learning

The population in the United States is aging, and care of older adults is frequently more complex. Addressing older adult competencies in educational programs provides a foundation in which to assess this population, guide the plan of care and aid in decision making. Using the Institute of Healthcare Improvement (IHI) ‘4Ms’ framework, a family nurse practitioner (FNP) program designed a novel approach using an unfolding simulation to integrate the four elements: (a) What Matters Most, (b) Mentation, (c) Medication, and (d) Mobility. The pilot simulation focused on Mentation and What Matters Most in an Advanced Health Assessment course. Students conducted a comprehensive cognitive assessment for an older patient with memory concerns, providing education and resource referrals. Progressive simulations are planned as the patient's cognition declines, building in complexity to include Medications and Mobility while attending to What Matters Most for the patient and their family in each phase. In designing simulations using the 4Ms framework, the pilot simulation provided a teaching strategy and measurement of performance in caring for older adults, and students reported an increase in confidence in communicating and advocating for this population.

An Online Asynchronous Physical Assessment Lab (OAPAL) for Graduate Nursing Students Using Low-Fidelity Simulation With Peer Feedback

Physical assessment courses typically include a didactic component and a skills laboratory component. It is a challenge to create laboratory components in fully online nursing courses. This article reports on the use of an online asynchronous physical assessment laboratory using low-fidelity simulation with peer feedback to teach physical assessment skills to postlicensure nursing students in a fully online advanced health assessment course within an RN to MS program. Students found the online asynchronous physical assessment laboratory favorable, relevant, and engaging and believed it advanced their current skills.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course.

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care. Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD. This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions. Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD. The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

Improving lesbian, gay, bisexual, transgender, and queer/questioning health: Using a standardized patient experience to educate advanced practice nursing students.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons account for 3.5% of the population. Nursing programs in the United States provide a median of 2.13 hours of formal content regarding LGBTQ health, which contributes to iatrogenic barriers to care. Patient experiences related to inadequate provider preparation include misguided treatment strategies, impedance of communication, and abuse. A pilot educational project was developed to provide advanced practice nursing (APRN) students meaningful clinical interactions with LGBTQ-identifying standardized patients (SPs) to better prepare them to care for LGBTQ patients with cultural humility. This project was determined to be Exempt by the Institutional Review Board at the University of Michigan. Implemented in an advanced health assessment course with 99 APRN students, components of the project included course readings, lecture content, laboratory activities, an SP experience, and both large and small debriefing sessions. The SP experience itself was a 15-minute clinical encounter with a patient presenting with "abdominal pain," with an emphasis on history-taking, communication, and cultural humility. Qualitative data analysis was performed using the constant comparison method to interpret the results from student evaluations and other written feedback. This pilot project has promise to inform future educational offerings and set the standard for LGBTQ health content and application for APRN students. Further research is needed to evaluate the quality of LGBTQ content in APRN curricula to improve the ability of APRN students to provide care to LGBTQ patients.

Promoting Collaboration in Undergraduate Nursing Students.

The role of the nurse educator is to prepare students to collaborate and practice competently and safely. One way of promoting collaboration is with the use of students as standardized patients (SPs). This exercise used undergraduate nursing students in collaboration with graduate nurse practitioner (NP) students in an advanced health assessment course. Undergraduate students were assigned a specific disease process to review, then as SPs were asked to describe symptoms and answer questions regarding the disease by the NP students. At the end of a combined group debriefing, a survey was given to evaluate the process. Analysis of the survey identified the following themes: Positive Learning Method, "Aha" Moments, Improvement in Critical Thinking, and Communication. Using undergraduate nursing students as SPs helped create real-life scenarios for both the undergraduate and graduate nursing students to learn from. [J Nurs Educ. 2019;58(11):657-660.].

Physical examination competence as a predictor of diagnostic reasoning among new advanced practice nurse students: a cross-sectional study

Aim: To investigate levels of diagnostic reasoning among new APN students as well as students’ characteristic affecting such reasoning levels.Design: a descriptive correlational design.Methods: One hundred fourteen APN students in an advanced health assessment course self-assessed their competene in performing examination. The students’ self-reported Diagnostic Reasoning Assessment scores were used to categorize them into pre-novice, novice, advanced beginner, and competent levels. Ordinal logistic regression analysis was used.Results: Only physical examination competence significantly predicted the students’ diagnostic reasoning levels. Being in a higher diagnostic reasoning level relative to being in a pre-novice, novice, or advanced beginner level was 16.1, 2.6, and 1.9 times greater in the physical examination competence, respectively.Conclusions: Promoting physical examination competence can be an effective teaching strategy for enhancing the diagnostic reasoning of newly enrolled APN students, especially for students who have poor diagnostic reasoning performance.

Seeing From the Eyes of the Beholder: A Pilot Program for Learning Through Reflection in Graduate Nursing Education.

A key element in the comprehensive physical exam is the patient interview in which the nurse practitioner (NP) elicits information from the patient to help guide in the discovery of a health issue. Technologies that allow the NP student to view patient interviews from the patient's perspective may enhance interviewing techniques and promote therapeutic interview behaviors. We report the results of a pilot program for NP students enrolled in an advanced health assessment course. Student volunteers conducted interviews with patient actors. Actors wore Google Glass®, an optical head-mounted device with video-recording capabilities.

Using specialized standardized patients to improve differential diagnoses.

A Specialized Standardized Patient (SSP) is a standardized patient who has advanced nursing education. This article describes an experience of introducing advanced practice registered nurses as SSPs into an advanced health assessment course. The article also discusses the simulated clinical experience and the desired course outcome that the student will be able to merge the patient history and physical exam findings to develop differential diagnoses.

Blending technology in teaching advanced health assessment in a family nurse practitioner program: Using personal digital assistants in a simulation laboratory

This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. Review of the evidence-based literature, including peer-reviewed articles and reviews. Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article.

Effectiveness of a Low-fidelity Simulation Experience in Building Confidence among Advanced Practice Nursing Graduate Students

Background Human patient simulators are increasingly being integrated into nursing curricula; however, there is a gap in the literature supporting the use of human patient simulators among advanced practice nursing students. Objective The objective of this study was to determine whether student confidence with heart and lung assessment would increase following a simulation experience. Method The 18 advanced practice nursing students in the experimental group received a 1-hour simulation experience focusing on cardiac and respiratory assessment, and 14 students in the control group received the usual course lecture and laboratory material. All students then completed a survey to assess confidence in assessment skills prior to starting clinical. Results A significant difference was found between the groups. Conclusions Results provide support for integration of simulation into an advanced health assessment course, even for practicing more basic skills. Future studies need to measure confidence before and after a simulation experience and compare simulation outcomes against traditional teaching methods.

Advanced Health Assessment in Nurse Practitioner Programs: Follow-Up Study

The increase in advanced practice graduate programs and the inclusion of content and skills related to advanced health assessment as a core competency for practice served as the impetus for a 5-year follow-up study to track the changes, methodologies, and integration of technology into practitioner programs. The questionnaire was mailed to the faculty/schools listed as current members in the National Health Service Corps Nurse Practitioner Faculty Advocate Network. The number of responding schools was 135 (44%). The family nurse practitioner program continues to be the most offered advanced practice nursing program. Nearly all institutions offer a post-master's program and an advanced health assessment course to their clinical graduate students. Health assessment is usually taught concurrently or as a prerequisite for clinical experiences; there continues to be a strong emphasis on the physical examination component. Ethnic and cultural assessment and gerontological assessment content increased since the original study. Both class and laboratory class sizes decreased. Qualitative data that centered on differences in graduate versus undergraduate health assessment revealed a shift in focus in several areas: differential diagnoses, abnormals, and the inclusion of advanced skills. There was an emergence of more creative strategies: the use of standardized patients, online coursework, videotaping, "live" patients, and simulations.

Graduate students’ experiences with standardized patients as adjuncts for teaching pelvic examinations

To explore graduate nurse practitioner students' perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). Surveys with open- and closed-ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost-effective, voluntary peer examination was a less effective teaching method.

Enhancing diagnostic reasoning skills in nurse practitioner students: a teaching tool.

The Advanced Health Assessment course provides an opportunity to focus on critical thinking and diagnostic reasoning skills as students transition to the nurse practitioner role. The authors describe a structured teaching tool designed for faculty to use in facilitating diagnostic reasoning and clinical judgment. This tool gives faculty a format to use in the classroom or online for helping students decide which data to collect and which data are important in developing hypothesis driven differential diagnoses.

Improving the advanced health assessment course.

Improving the advanced health assessment course.

Evaluation of an Advanced Health Assessment Course for Acute Care Nurse Practitioners

The Acute Care Nurse Practitioner (ACNP) role is being implemented in many centres in Canada. Administrators need to be aware there are very few universities in Canada that prepare ACNPs for advanced health assessment. Therefore, a need may exist for continuing education in the work environment. The ACNPs in London, Ontario recognized such a need, and developed and implemented an Advanced Health Assessment Course using available resources, and administrators supported participation in the course. A pre-post course evaluation based on Bandura's Self-Efficacy theory (1997) was performed. From pre-test to post-test there were significant increases in: (a) the use of health assessement skills; (b) confidence in performing these skills; and (c) confidence in recognizing abnormalities on health assessment. The reasons most often cited for infrequent skill use were "inappropriate to clinical setting" and "used only if problem suspected". The majority of participants agreed that the course met their needs. Implications for practice include administrative support for continuing education at other centres to enhance health assessment skills of ACNPs.