Lesson 1: Basic Clinical Skills for Nursing

Grade Level: First Semester Nursing Students Subject: Nursing Prepared by: Tara Peters Overview and Purpose: All nursing students must demonstrate competency in basic nursing skills prior to attending clinicals and caring for patients. These skills will be taught in the skills lab via review of material covered in lecture, discussion, question and answer, practice and informal simulations. The purpose of this lesson (first in a series) is to provide students with the knowledge and skills they need to competently care for patients. In this lesson students will learn: 1. 2. 3. 4. 5. How the infection transmission cycle theory applies to the clinical setting. Proper hand-washing technique and its importance. The methods and importance of maintaining patient privacy. The importance of proper patient identification and how this relates to patient safety. How to properly identify patients, including patients who may be unconscious or who are unable to assist in their own identification.

Terminal Objectives and Competencies This lesson addresses the following: Terminal Objective 1: Utilize the nursing process and critical thinking skills to provide evidence-based, safe, competent nursing care within the scope of practice for a licensed practical nurse. Competency 3: Performs interventions in a safe and effective manner. The Clinical Competencies are directly tied to the Terminal Objectives and the assignments and skills requirements derive from the Competencies. This process allows us to evaluate students and determine if they can do what we say they can do when they graduate. Objectives: The student will Demonstrate his/her knowledge of the infection transmission cycle by correctly responding to possible infection risks and solutions during skills pass-off simulation testing. Identify common causes of nosocomial infections by correctly identifying a minimum of 6 common causes of nosocomial infections during the assigned Virtual Clinical Excursion. Demonstrate proper hand-washing technique during skills pass-off simulation testing. Identify ways patient privacy can be compromised in the clinical setting during assigned Virtual Clinical Excursion.

Demonstrate methods of maintaining patient privacy upon entering the patients room, while interacting with the patient, and upon exiting the patients room during skills pass-off simulation testing. Identify patient identification issues during assigned Virtual Clinical Excursion. Demonstrate proper patient identification techniques during skills pass-off simulation.

Materials Needed: Basics of Skilled Nursing Techniques text and accompanying videos Videos recorded by nursing faculty, available on disk, flash drive, or YouTube Virtual Clinical Experiences (Disk or online) Access to simulation and skills lab Recording equipment (installed in lab) YouTube videos Computer, laptop, tablet, smart phone or other device capable of accessing the Internet and streaming media Skills checklist Information: Students will be required to master the first skills needed to begin to interact safely and effectively with patients. They need to know why infection prevention is vitally important, how infections are spread, and what they can do about it. Students also need to know why patient privacy is important and what role they play as nurses in maintaining the patients sense of dignity and privacy, and they must demonstrate their understanding of patient privacy by demonstrating proper techniques in this regard. Students must also know that they are interacting with the correct patient, another basic element in patient safety. Students will need to demonstrate their knowledge of how to identify patients in various settings and they will need to apply that knowledge by demonstrating their ability to properly identify patients and to spot issues that can lead to incorrect patient identification. In order to accomplish the objectives, students will have a variety of tools at their disposal for obtaining and reviewing information, demonstrations, and discussions of the lesson materials.
1. Students will be taught about infection control, the infection cycle, hand-washing, privacy

and patient identification during their lab class time. This coincides with similar material delivered in the didactic part of this course and should be a review for students. 2. Students will be able to see live demonstrations of proper techniques and will have the opportunity to ask questions and interact with the instructors. 3. Students will have supervised practice time in the lab where they will be able to attempt skills, and receive help and input from their classmates and instructors. Every student should spend at least 15 minutes in the role of instructor by teaching another student the skills learned in lab, and each student should also spend at least 15 minutes in the role of

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student. This gives students an opportunity to learn by teaching, which is very effective for many students. Students will have access to recorded lectures and skill demonstrations on YouTube. These recordings will each cover just one aspect, question, or demonstration in order to allow students to review only what they need as they study their skills. Students will also have access to Virtual Clinical Experiences (VCE) included on a disk in the back of their textbook. The same VCEs can be accessed online. Students have the option of completing their VCE-related assignments online, by hand-writing the answers on the workbook pages, or by typing them out and sending them to the instructors as an email attachment. The form in which the information is presented is not an issue. The content and legibility of the students work is. Students with Internet or cell phone access can access the content any time from their smartphone, laptop, or tablet. Students without access to a computer or the Internet at home can view the VCEs at school in the computer lab from 0630-2100 Monday through Friday, and on Saturdays from 0630-1700. There is no computer lab access on Sundays. VCEs can also be accessed from public library computers. VCEs may or may not run on all smartphones or tablets, so students are advised to test their equipments capabilities sooner rather than later to guarantee they will be able to have the access they expect in order to complete their work on time. VCEs must be completed prior to the students skills pass-off. Proof of completion must be presented to the instructor as their ticket to the sim lab. Students are encouraged to work together in small groups as desired on any aspect of the assignments. However, each student will turn in and be graded on their own submissions and skills performances.

Verification: Steps to check for student understanding

1. Students will be required to participate in role-play and simulation scenarios during lab

and practice time to help instructors gauge their understanding of the material. They may be asked to take the role of patient, nurse, family member or other so they can see the same process from multiple perspectives. This is important because some students can demonstrate proper technique even though they do not understand the reasoning behind it. In order to participate, students must understand the material, demonstrate skills, and be able to anticipate events during the scenario. Students will need to demonstrate both the physical skills and the ability to apply what they have learned to a variety of scenarios.
2. After lab and simulations on Monday/Tuesday of the first week, the students will

demonstrate their skills in a simulation lab scenario on Friday. Instructors will design a scenario intended to test the students ability to apply what they have learned. Instructors will be provided with a skills check-off sheet detailing the essential elements of each skill. Each student will be assigned a 15 minute time slot and will be evaluated at that time. Students can switch times with one another freely, provided doing so does not cause problems for the instructors or the other students. Students who do not show for their evaluation will be failed.

3. Each element on the check-off sheet will be incorporated into the simulation. Students will

attempt the simulation independently and out of view and hearing of the other students, and will be scored. Students will need to demonstrate 100% proficiency in the essential elements of each skill in order to pass this skills lab unit.
4. Students who do not pass will be told why and what they need to do in order to pass. They

will then be offered the opportunity to review the available materials and try again on remediation day which will be no sooner than 3 days but no later than the day before their next scheduled lab skills or simulation day. Activity: The activities that reinforce the lesson are incorporated into the lesson and practice time, the skills demonstration and written exam and all future sims, labs, and clinicals. These skills must be mastered and consistently demonstrated by nurses at all times. Nurses cannot be considered competent if they fail to consistently exhibit these behaviors. Maintenance of skills is considered a professional nursing behavior. These ideas are taught from the first day of nursing school and are maintained throughout the educational process and into the nurses professional practice. Instructors and supervising RNs at the various clinical sites are aware of this and will monitor these skills and behaviors, making corrections as needed. In addition, subsequent skill sets assume the mastery of the skills taught in this lesson, and students can fail future skills tests or their clinical rotations if they do not properly perform these basic skills. Notes A sample skills check-off sheet is available for download from the programs main drive and is also available for download by the students when they access their classes in the LMS. Instructors can change this form to suit their needs provided all essential elements remain. This lesson can also be broken into parts for schools that follow a 12-month course rather than a 9month course. Diversity Statement We recognize not all students have access to some or all of the technology we utilize in this program. Students who need to find alternate ways of access class material are encouraged to speak with their instructor or the program director to see what options are realistically available to them. While the nursing program and the school recognizes that some unique issues may prove beyond our collaborative efforts to remedy, every effort will be made to accommodate each students individual circumstances. The student and faculty handbooks are excellent sources of information in this regard.

How Technology is Used in This Lesson Plan VCEs online or on disk Virtual Clinical Excursions (VCEs) are digital simulations designed to accompany the material covered in the students textbook(s) and serve the purpose of allowing students to practice their skills and demonstrate their knowledge in the time and place of their choosing. The VCEs can be completed online, and their answers to questions, solutions to problems, and progress can be monitored by the instructor. Students can receive feedback online, via email, or in person depending on their individual access to computers, smartphones and so forth. If a student needs correction or additional practice they can review the material imbedded in the VCE, read their textbook, or view videos on YouTube, and then try again. It is important to allow students as much practice as they need to master the skills without penalty. Once they have met standards, they will be awarded their points and will be given proof of completion, which is required to attend their skill pass-off simulation testing. Textbook Students can decide to purchase hardcover textbook, eBooks, or both at the beginning of the semester. This is entirely up to the student, though the expectation is that students will have access to the text in some form. Students will be assigned readings to accompany the lecture content and the expectation is that they will have done their reading prior to attending class. Videos on disk (accompany textbook) The textbooks have skills videos available on disk (provided with each hardcover textbook) and online. All students will all be provided with a password to access the online content. Skills lab and Simulation lab The nursing program has a skills learning and practice lab and a simulation lab. Instructors will utilize both during skills teaching and skills assessment. Students can expect a mixture of lecture, instructor-led demonstrations and return demonstrations by the students. Adequate time will be given for guided practice, and the lab is available for practice outside of class time. Students are encouraged to work together to learn skills. Students who have already mastered the skills being taught are encouraged to assist and teach others because teaching deepens the students understanding of the material and helps them develop leadership skills while working in a collaborative environment. The simulation lab uses a variety of high tech equipment (Birthing Noelle and Sim Man among others) to teach and test students. This setting is particularly useful in teaching high-risk scenarios in a low-risk environment. Not all skill sets require the use of the sim lab, but the sim lab is the setting for all skills pass-off testing. Recording Equipment (in lab) The lab is equipped with cameras in several locations. These cameras have been located to best capture as much of each skill station as possible. This allows instructors to record demonstrations which can then be posted on YouTube. Students are encouraged to use all available technology, including the recording

equipment. Instructors or staff can assist any interested student to learn to use the recording system. Students could make videos of one another, use them for learning and remediation. For example, a student could be told they made an error, and then asked to watch the video recording of their performance to see if they can identify their error. This should help students become more aware of their own actions and is also intended to help them think critically about their behaviors. While instructors realize that time is limited, students do have this option if they want to make use of it. YouTube Instructors will video-record demonstrations and lectures for YouTube. We have decided to make a series of short videos each one covering specific, limited information or just one specific skill (or aspect of longer skills and scenarios). This will allow students to view only those portions of the skills and lectures they need rather than forcing them to set through an entire lecture to get to the part they need. This method should enhance learning because information is often best absorbed in small chunks, and they can access the information any time and from any location as long as they have access to the Internet and they have a suitable device. The same videos are also available for download for students who may have computer access, for example, but who do not have Internet access. Students can review individually or work collaboratively in a study group. They can use laptops, tablets, smartphones and desktops to access the information. Computers (desktop or laptops), Tablets, Smartphones All of these devices can be used to access the videos or communicate with instructors during the week. Students will be given instructor email addresses and cell phone numbers along with specific instructions about when and how to contact instructors if they have questions. Students will potentially have access to all course materials in one form or another 24 hours a day. Students who do not have access to the Internet at home or who do not have a computer, tablet, or smartphone can use the school computer lab 6 days per week. Training and assistance will be provided to any student or instructor who requests it for any of the equipment, programs, apps or devices used in this program.