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A simulated nursing grand rounds for senior nursing students

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Introduction

The term grand rounds are often referred to a report of patients’ clinical findings by medical doctors to a room of their peers and mentors. In such grand rounds doctors defend a position, receive feedback and explore treatment modalities. It is in this mode of grand rounds that a simulated nursing grand rounds (SNGR) was created to enhance senior nursing students’ ability to understand the whole patient and increase the ability to analyse complex patient situations and care. Like medical doctors, nurses too have rounds. These rounds may be at the patient’s bedside or in small groups. (Lyons, Brunero, & Lamont , 2015 ) describe nursing rounds as a deliberate method to reduce preventable adverse outcomes. These rounds involve an approach to patient care where nurses proactively attend to patients needs at scheduled intervals. According to a study by Sherrill (2012), nursing grand rounds (NGR) similar to medical grand rounds are among the most effective approaches for providing learning and teaching experiences for professional nursing students. Through nursing grand rounds, nursing students are able to share and collaborate ideas related to the current dynamics in healthcare systems as well as other topics that are significant to the practice of clinical nurses (Sherrill, 2012).

Background

Similar to grand rounds by medical doctors, nursing grand rounds is an approach used to provide an interaction between nurses regarding patients’ plan of care. As described by Gaberson and Oermann (2010), nursing grand rounds entail interviewing and observing patient(s) in the clinical environment, a multimedia program of grand rounds or Webcast of grand rounds conducted elsewhere. (Smetana et al., 2018) supports, nursing grand rounds as it offer nurses an opportunity to evaluate specific patient conditions, discuss the interpretation of assessment data and propose changes and interventions in the plan of care. NGR may include nursing students as part of the interdisciplinary team and is considered a valuable tool for evaluating challenges experienced by patients, communities, and families. NGR also exposes nursing students to common situations that they might not experience in their clinical experience (Nakhongsri & Crow, 2015). NGR can be conducted at a patient’s bedside or by presentations via the internet and intranet. No matter the setting, NGR can highlight a nurse’s clinical expertise as well as promote best practices for nurses (Sunday & Cavlovich, 2014). Nursing grand rounds emerged as a central teaching activity in United States medical schools for the first half of the past century but faded as education has moved to the classroom (Nakhongsri & Crow, 2015). Development of activities with the structure of Quality and Safety Education for Nurses (QSEN) competencies supports evidence-based practice and critical reasoning skills (Sunday & Cavlovich, 2014). NGR have its foundations in the medical residency training as an educational approach for introducing new learning resources as well as improving clinical reasoning through discussion of patient cases.In addition, NGR has remained a staple of medical education for decades, but patient’s dignity and confidentiality concerns has resulted in the practice of conducting grand rounds in the absence of patients. In recent years, the format of NGR has shifted from case-oriented presentations to an expert lecture with more emphasis on the recent evidence (Smetana et al., 2018). Based on the recent evidence, more than 60% of hospitals engage in NGR with the objective of educating the audience members, showcase faculty in hospitals as role models and to enhance the collegial environment for nursing students (Laibhen-Parkes, N., Brasch, J., & Gioncardi, L. (2015) Another important aspect of NGR is that it enhances learning related to characteristics of common health challenges and emphasis on teamwork (Smetana et al., 2018). A case for simulated nursing grand rounds (SNGR) is supported by Smetana et al.,2018) that further states NGR is an example of creative teaching strategy which is critical to engaging students. In addition, through NGR presentations, nursing students are able to develop presentation skills, increase their knowledge of signs and symptoms of diseases and how diseases’ effect patients. Nursing students can enhance their learning ability such as critical thinking. They can also understand how sharing ideas with their colleagues enhance collegiality which in turn provide for better collaboration when caring for patients. students (Laibhen-Parkes, N., Brasch, J., & Gioncardi, L. (2015) Through utilization of NGR nursing students are able to identify patients health issues, and factors that inhibit or promote health. They can address challenges in the clinical setting, share their personal experience, and identify gaps in their own understanding.


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Activity

To create an opportunity for senior nursing students to engage in a simulated nursing grand rounds activity and study, permission was requested from the City University of New York Institutional Review Board (IRB) It was determined that this activity did not require IRB review. Twenty students enrolled in the final Medical Surgical course at an associate degree nursing program were selected. A total of three clinical groups participated. Students were given clinical assignments that included patients with complex conditions and co-morbities. Students were instructed to prepare a power point presentation of the patient that they cared for in the clinical setting. The instructions were to include assessment data from admission to discharge planning. A date was selected on campus for the simulated NGR. Students from other nursing classes were invited to attend. Faculty members were also invited to serve as experts for the simulated nursing grand rounds presentation. Each student had an opportunity to present their patient case to the audience of peers and faculty, similary to medical grand rounds. The student presenters answered questions from both faculty and their peers. A post nursing grand rounds survey was sent via Survey Monkey to glean the students’ feelings about the experience of this simulated experience.

Results

A total of 20 student nurses from three clinical groups responded to the six question survey following the simulated nursing grand rounds. See Table 1. The table shows a six-item Likert-type scale where participants rated from a 1 ‘strongly disagree’ to a 5 ‘strongly agree.’ All twenty student nurses strongly agreed that the nursing grand rounds helped promote professional development, would recommend nursing grand rounds to other students, and the program incorporated previous semester course objectives. A total of 19 student nurses strongly agree and 1 student nurse agreed that nursing grand rounds help analyze complex patients and feedback from faculty was helpful. The last question resulted in 18 student nurses strongly agreeing and two agreed that feedback received from peers was helpful.

Conclusion

Nursing grand rounds offer nursing students an opportunity to evaluate the specific conditions of patients’, discussion of assessments data and then propose any changes in the plan of care. A simulated NGR is an opportunity to comprise nursing students and faculty to increase understanding of the roles of interdisciplinary. Nursing grand rounds provide an excellent opportunity for exchanging ideas related to patient’s care conditions which may comprise of staff, students, and the entire clinical faculty. The benefits of a simulated NGR helps to promote professional development and increase their abilities to analyse complex patient situations and collaboation The benefits of SNGR are in line with QSEN competencies of teamwork and collaboartion and patient cetered care. The results from this SNGR suggests further inquiry. The sample size was small; however, the responses support further SNGR. An aspect that wasn’t measured was the responses of a and faculty participants. As nursing grand rounds are conducted in various forms, so too can nursing school create various ways to engage students and enhance learning and SNGR is one way to do this.


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