Advanced Emergency Nursing Journal

Vol. 40, No. 2, pp. 127–130

Copyright 
C 2018 Wolters Kluwer Health, Inc. All rights reserved.

An Interprofessional Web-Based
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Teaching Module to Enhance

Competency of the Advanced Practice
Nursing Clinical Education in the
Emergency Department
Kumhee Ro, DNP, ARNP
Christy Weiland, PharmD
Mo-Kyung Sin, PhD, RN

Abstract
Many advanced practice registered nursing (APRN) students struggle to thrive in their clinical
rotation due to the wide variability in their clinical knowledge. To address the variability and gaps in
knowledge, we created an interprofessional web-based, self-directed curriculum for APRN students
that is clinically relevant and specific to the emergency department (ED) rotation. The modules are
a product of collaboration between the medical, nursing, and pharmacy faculty at an academic
medical center. This web-based curricular preceptorship model that incorporates new technology
and innovation in clinical rotations can provide an opportunity to enhance the clinical education of the
APRN students in the ED. Key words: APRN web-based education, clinical education, competency,
web-based teaching strategies

T
HE CURRENT advanced practice reg- complexity of the ED has increased, including
istered nurse (APRN) educational pro- complex patient population, high-acuity pop-
grams are designed to address the ulation, and large patient volume (Jennings,
growing demand to prepare highly skilled McKeown, O’Reilly, & Gardner, 2013; Woo,
graduates of the health care system of the Lee, & Tam, 2017). To better meet the needs
future (Gidden et al., 2014), especially the of the current and future health care environ-
nurse practitioners entering the emergency ment, structured clinical opportunities that
department (ED) workforce. Over time, the can enhance competencies in clinical rota-
tions are essential to the emergency nurse
Author Affiliations: University of Washington Medi- practitioner (ENP) pedagogical paradigm for
cal Center, Seattle (Drs Ro and Weiland); and Seattle teaching and learning (Gidden et al., 2014).
University, Seattle, Washington (Drs Ro and Sin). The primary purpose of the clinical ro-
Disclosure: The authors report no conflicts of interest. tation experience is to provide educational
Corresponding Author: Kumhee Ro, DNP, ARNP, opportunities for APRN students to apply the
University of Washington Medical Center, 1959 NE
Pacific St, Seattle, WA 98195 ([email protected]; rok@ theoretical knowledge and skills necessary
seattleu.edu). for today’s health care environment (Benner,
DOI: 10.1097/TME.0000000000000185 Sutphen, Leonard, Day, & Shulman, 2010).

127

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 128 Advanced Emergency Nursing Journal

These clinical experiences are crucial for ability and gaps in knowledge, the model was
progress of students from novice to prepared created in a series of web-based, self-directed
clinician (Benner et al., 2010). One of the clinically specific modules that are integrated
challenges facing current nursing clinical ed- into the ED clinical rotation.
ucation is lack of sufficient clinical rotations The modules are a product of interpro-
with qualified and willing preceptors for fessional collaboration between the medical,
more structured learning (Cronenwett et al., nursing, and pharmacy faculty at the medi-
2011). In addition, inadequate collaboration cal center. This was used as a supplemental
and coordination by academic faculty and teaching tool while the students were in their
preceptors in the design of the clinical clinical rotation. The APRN students partic-
educational experience, leading to a lack of ipated in this 9-week preceptorship, afford-
curricular coherence, have been identified ing them much more than bedside teach-
as a challenge (Roberts, Wheeler, Tyler, & ing. The web-based ED curricular module
Padden, 2017). Perhaps, of most concern is contained comprehensive learning objectives
that the clinical rotation experience model is that aligned with the learning objectives of the
inconsistent, primarily because students can- clinical courses. The learning objectives in-
not be assured that they will all acquire high- cluded translational research, leadership, and
quality clinical skills and knowledge due to clinical practice components with specific
significant variability of the quality of the sites goals that were measured at the end of the
and preceptors (LeFlore & Thomas, 2016). quarter.
Therefore, transformation in APRN clin- The content on the website was divided
ical education emphasizing an interprofes- into two areas: self-directed modules and
sional team approach focusing on rigorous skills curriculum. Self-directed modules of-
evaluations, seamless academic progression, fered weekly video-captured didactics by the
and clinical competency is needed. The pur- emergency medicine faculty in the School of
pose of this article is to describe unique Medicine. The lectures and articles covered
clinical teaching strategies through a web- the essential evidence-based theoretical
based, self-directed curriculum that integrates content of emergency medicine. The topics
technology to facilitate experiential learning. included abdominal pain, altered mental
The web-based module provides pedagogy in status, chest pain, OB/GYN complaints, phar-
nursing that enhances the overall learning ob- macology case studies, shock, trauma, basics
jectives of clinical education. of ultrasound, and toxicology. All lectures
and case studies were entirely online and
asynchronous. The skills curriculum included
DEVELOPMENT OF INTERPROFESSIONAL
history taking, physical examination, docu-
WEB-BASED ED CURRICULAR MODULE
mentation, clinical reasoning skills, and oral
The web-based, self-directed curriculum for case presentations. In addition, it included a
APRN students evolved from medical, phar- 2- to 3-hr session with radiologists to allow
macy, and nursing faculty members at an aca- APRN students to practice reading plain
demic medical center ED who recognized radiographs focusing on the chest, muscu-
the need for APRN students to have APRN- loskeletal system, and abdomen. This session
specific content for improved efficiency and was supplemented by a radiology resource
competency in their rotations. Although sim- that the students reviewed prior to the ses-
ply having a traditional preceptorship model sion. Finally, there was a 4-hr session offered
can help students transfer theoretical learning by certified registered nurse anesthetists
into practice, many APRN students struggle in the operating room focusing on airway
to thrive in the rotation due to the complex management. The website also included
nature of the ED and the wide variability in rotation requirements, student expectations,
their clinical knowledge. To address the vari- and common procedural resources.

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 April–June 2018 r Vol. 40, No. 2 Web-Based Teaching Strategies in the Emergency Department 129

STUDENT ASSESSMENT AND EVALUATIONS ED nursing experiences. Although these stu-

dents with ED or critical care nursing experi-
Currently, there are no ENP educational pro-
ence had a higher baseline knowledge level of
grams in Washington State nursing schools.
emergency medicine, they also demonstrated
A total of eight APRN students from two
posttest improvements following this web-
nursing schools participated in this precep-
based ED curricular module.
torship model between 2015 and 2017 over
Institutional review board approval was not
six academic quarters. The students’ spe-
required for this education quality evaluation.
cialty tracks included Adult/Geriatric Primary
The students evaluated both their precep-
Care, Adult/Geriatric Acute Care, and Family
tors and the clinical experience through qual-
Nurse Practitioner. The initial assessment in-
itative interview evaluations through their
cluded a pretest of emergency care knowl-
schools. Through implementation of this pre-
edge and skills with 10 multiple-choice case-
ceptorship model, the faculty members were
based questions. The questions were created
able to identify the knowledge gap and ad-
by the interdisciplinary faculty members in-
dress the clinical needs of the students. To
volved, and the questions stemmed from the
that end, the students’ descriptive feedback
topics students were expected to have partic-
on this preceptorship model has been over-
ipated in during the preceptorship. The test
whelmingly positive and well received. Stu-
was given prior to and at the end of the pre-
dents appreciated the carefully structured
ceptorship. In addition, each didactic that was
clinical rotation, which they found to be
presented was followed by four to five on-
meaningful and mentally challenging.
line posttest questions. Assessment also oc-
curred throughout the 9-week preceptorship
through direct clinical observation and ver-
IMPLICATIONS FOR APRN EDUCATION
bal feedback. Written assessment was given
to students using a structured feedback form Although many aspects of this preceptorship
created by the School of Medicine. These eval- are innovative, what is truly unique about this
uations were based on the following: data- ED preceptorship model is that the students
gathering skills, knowledge of subject, clini- were given standardized learning materials,
cal reporting skills and communication skills, supplemental web-based learning, and oppor-
educational attitude and documentation, es- tunities for interdisciplinary learning. At the
pecially medical decision making. core of this preceptorship model is an empha-
Of note, the overall mean pretest score was sis on integrating unique educational strate-
49.5% and increased to 75% on the posttest gies that enhance students’ critical think-
assessment. These were average percent cor- ing abilities in clinical rotations. There are
rect over the six academic quarters since fall many benefits to creating a web-based cur-
quarter of 2015. The pre- and posttest scores ricular preceptorship model as described ear-
were lowest in diagnostic interpretation and lier. First, the web-based curriculum can en-
pharmacology questions whereas highest in sure that the preceptorship is designed to
approach to abdominal pain test questions. bridge the gap between practice and edu-
The students were given an optional survey cation so that all students acquire consistent
to evaluate the experience about the pre- fundamental clinical skills and knowledge that
ceptorship. The students surveyed reported they will need in their future practice. Second,
that their comfort level increased in proce- it can ensure that preceptors are appropri-
dural skills and communication with the in- ately recognized for their knowledge as they
terprofessional team. Three of the master’s in are active participants in the design of the
nursing students had no prior nursing expe- preceptorship. Third, the assessment of the
riences. Of the five students seeking doctor students’ knowledge at the beginning of their
of nursing practice (DNP) tracks, almost 60% rotation can help identify any deficiencies and
of the DNP students had prior critical care or allow for development of individual learning

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 130 Advanced Emergency Nursing Journal

plans. Finally, this preceptorship model can REFERENCES

prepare ENP students to perform at a higher Benner, P., Sutphen, M., Leonard, V., Day, L., & Shulman,
functioning level during their rotations by re- L. S. (2010). Educating nurses: A call for radical
inforcing important concepts taught in the transformation. Philadelphia, PA: Jossey-Bass.
classroom setting or adding content not pre- Cronenwett, K., Dracup, K., Grey, M., McCauley, L.,
viously covered. If the effectiveness of this Meleis, A., & Salmon, M. (2011). The doctor of nurs-
ing practice: A national workforce perspective. Nurs-
preceptorship model is evaluated further, it ing Outlook, 59(1), 9–17.
can later be replicated in other clinical site ro- Gidden, J. F., Lauzon-Clabo, L., Morton, P. G., Jeffries, P.,
tations. This novel preceptorship model de- McQuade-Jones, B., & Ryan, S. (2014). Re-envisioning
scribes how graduate clinical rotations can clinical education for nurse practitioner programs:
be carefully developed to focus on clinically Themes from a national leaders’ dialogue. Journal of
Professional Nursing, 30(3), 273–278.
relevant materials and resources, with new Jennings, N., McKeown, E., O’Reilly, G., & Gardner, G.
strategies to help APRN students learn about (2013). Evaluating patient presentations for care de-
evidence-based emergency patient care. livered by emergency nurse practitioners: A retro-
There is increasing need to investigate and spective analysis of 12 months. Australasian Emer-
evaluate the quality of clinical education for gency Nursing Journal, 16(3), 89–95.
LeFlore, J., & Thomas, P. E. (2016). Educational changes
APRN students (Gidden et al., 2014). Reen- to support advanced practice nursing education. The
visioning the clinical nursing education of Journal of Perinatal & Neonatal Nursing, 30(3),
APRN students is an important challenge that 187–190.
deserves full attention. This novel preceptor- Roberts, M. E., Wheeler, K., Tyler, D. O., & Padden, D.
ship model that incorporates new technol- L. (2017). Precepting nurse practitioner students: A
new view—Results of two national surveys of nurse
ogy and innovation into the teaching process practitioner preceptors. Journal of the American As-
in clinical rotations may provide an opportu- sociation of Nurse Practitioners, 29(8), 484–491.
nity for successful collaboration between aca- Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017).
demic nursing programs and their respective The impact of the advanced practice nursing role
community preceptor partners to enhance on quality of care, clinical outcomes, patient satis-
faction, and cost in the emergency and critical care
the clinical education of the APRN students settings: A systematic review. Human Resources for
in the ED. Health, 15(1), 63.

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.