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Pandemic highlights need for nurses, but hampers hands-on career training for future healthcare workers

When Portland Community College announced it would close its campuses and move all of its classes online for the rest of the semester, it put nursing students in a bind.

How would they learn a hands-on trade like health care from their couches at home?

The solution? A nursing simulation software that allows users to work on actor patients in different scenarios.

SCREENSHOT COURTESY OF PCC/ATI - In this virtual simulation, a nursing student guides patient care decisions via a software program. This semester, as Portland Community College campuses were shut down due to COVID-19, nursing students had to shift their hands-on training to the web.With a web program called Real Life Clinical Reasoning, students respond to video scenarios with medical actors, then make decisions about patient care. If they make decisions that jeopardize the health of the virtual patient, the program alerts them.

It's the first time the nursing program, which is located at PCC's Sylvania campus in Southwest Portland, has used simulation software.

"We were sort of able to take this term and shift it into the virtual environment," said Heather Reynolds, director of the nursing program at PCC. "They don't get that hands-on practice, but what it does allow them to do is focus on the other portion, which is clinical judgment and decision making."

The program is offered by Assessment Technologies Institute, which specializes in educational products and tests for nursing students and instructors. ATI's scenario software is somewhat self-guided, and responds to user input. Nursing students get a hand-off report from an emergency department, inpatient unit or clinic, then the simulation video will pause at various points and ask students to make a decision. The student's response will trigger the next scenario. If enough non-ideal decisions are made, a user will be directed out of the scenario.

Nursing students are in a unique predicament. The same global pandemic that highlighted the critical need for health care workers has prevented them from getting the training they need to enter the profession.

Not all facets of the nursing program can be moved to a virtual experience. Clinical training, which sees students observing and learning at various healthcare sites in the region, is a fundamental part of PCC's two-year program. Crucial skills, like inserting an intravenous needle, or a urinary tract tube, can't be practiced on a computer.

"You could not do an entire nursing program remotely," Reynolds said. "You definitely need that hands-on care and patient access."

For students like Lynn King, having the ability to adapt and still graduate meant the realization of a life-long dream, and the promise of economic security for his family.

King said he's eager to join the workforce.

 "As an 'older' non-traditional student, surviving on a tight budget with a spouse and three young children, we didn't have some of the resources I needed to learn remotely," King said. "Our director Heather Reynolds personally coordinated a solution to help my family keep going until graduation. I am truly grateful."

This year, half of the college's nursing students are set to graduate from the program in a few weeks. Reynolds said the spring graduates got lucky, and were still able to complete the required clinical hours to graduate, despite the shift to virtual learning. Things aren't as certain for the next round of nursing grads, as COVID-19 threatens to keep some college campuses closed well into the fall. Pandemic or not, nursing graduates still need a minimum level of in-person training to meet the requirements for exam and licensure, Reynolds said.

She and other PCC staff are awaiting guidance from the state about how in-person classes could resume.

Despite the shortcomings of virtual learning, there are advantages to the software, Reynolds said, noting the cause and effect learning style allows students to train in a lower-pressure environment with more autonomy and decision making.

"The students that I met with, they said they like engaging in the scenarios, because it felt like there was less hand holding. They felt like they were more independent and it was easier to be wrong (and correct course.)," Reynolds said. "We know that sometimes you learn better when you're not in that stress brain mode, and they get to not be so stressed and hopefully are able to learn and process things a little bit better in these scenarios."

She also points to a study from the National Council of State Boards of Nursing, which found "substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses under conditions comparable to those described in the study."

Reynolds said PCC might end up integrating the simulation software it into its future classes.

"Another thing that's required of nurses is adaptability and flexibility," Reynolds said. "Our students have shown that this semester."


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