Nursing Education Innovations and Obstacles During COVID-19: Lessons Learned and How That Information Will Be Used Post-Pandemic

Background

Before the pandemic, innovative learning strategies, such as simulation in the classroom and virtual reality, began gaining popularity in baccalaureate nursing programs (Aebersold, 2018). However, the mainstay of many programs remained traditional hands-on learning conducted in a face-to-face format. This format is particularly adept at teaching psychomotor skills, which are vital to success in professional practice roles such as nursing (Tabatabai, 2020; Van Horne & Murniati, 2016; Tharayil et. al., 2018). As face-to-face instruction was interrupted due to the COVID-19 pandemic, innovative learning strategies were thrust into the curricula. Many nursing programs quickly implemented screen-based or virtual learning strategies in the classroom, skills, and simulation labs. Hodges et al. (2020) referred to this initial transition to the online learning environment as emergency remote teaching, described as a temporary shift from one educational delivery mode to another due to an immediate crisis.

During emergency remote teaching, courses that were intended to be delivered face-to-face were delivered in an alternate format, but without the typical planning or development time that goes into online learning delivery (Hodges et al., 2020). Also, according to Hodges et al. (2020), the typical planning and development time for a fully online course is six to nine months before course delivery. During the COVID-19 crisis, lead times for nursing programs to transition from face-to-face to remote delivery ranged from one day to a few weeks. Many faculty and students experienced a need for additional education and support for technology; however, the systems that provide those resources were severely stressed due to the scale of need across campus. In turn, faculty were required to rely on accrediting and other leading nursing organizations and publications for guidance on best practices and strategies for transitioning to online learning (Mariani et al., 2020).

A primary concern for nursing educators was how to effectively harness technology and adapt instruction to effectively teach clinical judgment to their students. In healthcare, clinical judgment is the ability to respond to patient cues with appropriate clinical decisions and is regarded as an essential skill for safe and effective nursing practice (Victor-Chmil, 2013). Preparing students to exercise sound clinical judgment begins in the first semester of their nursing program with the development of critical thinking and clinical reasoning. Critical thinking is the intentional, logical thought process intended to respond to and improve patient outcomes (Papathanasiou et. al., 2014). Essentially, critical thinking is knowledge-based. Clinical reasoning is the application of critical thinking to a clinical situation (Papathanasious et. al., 2014). As students progress through a nursing program, they must be challenged to develop a strong knowledge base (i.e., critical thinking) so they can assess a rapidly evolving situation (i.e., clinical reasoning) and generate the best possible evidence-based solution (i.e., clinical judgment) (See Figure 1 and Callout Box 1 in the Appendix). At the senior level, the goal is to provide a curriculum that solidifies clinical reasoning and clinical judgment skills for students who are preparing to enter the nursing workforce.