UArizona Nursing Creates New Virtual Clinical Concept to Mitigate Changes due to COVID-19

Oct. 23, 2020

When the COVID-19 pandemic struck the United States, the rapid shift from physical to online interactions changed the way Americans shopped, worked, played, and schooled. Along with every other institution of higher learning, The University of Arizona College of Nursing had its share of challenges as it transferred from in-person classes to online instruction. But one of its greatest success stories in this pixilated new environment is its utilization of Zoom for standardized patient (SP)/student intake interviews during Clinical Concept Days.

Held for the last five semesters for 3rd semester nursing students enrolled in Mental Health Nursing 471, the academic exercise is intended to prep students for their behavioral health clinical rotations. The concept is straightforward: volunteers – often retired nurses with direct experience with mental illness – pose as patients suffering from a variety of psychiatric issues and interact with students, enabling them to practice and refine their interviewing skills. The first iterations of Clinical Concept Days were held in-person at the UArizona College of Nursing building, as well as in the new Health Sciences Innovation Building.     

“All our volunteers are extremely dedicated to providing educational experiences for our nursing students. It's been well worth the effort. Without geographic limitations, we have an opportunity to expand the volunteer base and provide each NURS 471 student opportunities for skills practice,  ~ Morgan Stock, MSN-Ed, RN, CNE

After significant time investment in training and support, the revised and revamped Clinical Concept days kicked off in August to resounding success. All told, 36 students were afforded the opportunity to practice psychiatric interviewing, and an additional 18 students benefited by observing their peers during the process.  Students reported feeling safe and supported in the virtual environment and described the experience as very valuable. “All our volunteers are extremely dedicated to providing educational experiences for our nursing students,” Stock says. “It's been well worth the effort. Without geographic limitations, we have an opportunity to expand the volunteer base and provide each NURS 471 student opportunities for skills practice.”

The experience of working with those students virtually allowed instructors Morgan Stock, MSN-Ed, RN, CNE and De Anne Nichole Dwight, MSN, RN, to quickly pivot, post-COVID, to make the interviews an entirely online experience. Since most of the standardized patient volunteers are retired, they had the time and flexibility to participate in the program. While some volunteers initially left over concerns about the virtual environment, the shift enabled the instructors to recruit a wider variety of volunteers from all across the country, including Kansas and Wisconsin. ”By this point in the pandemic, a lot of them had learned how to use zoom on some type of device, because that's how they were staying connected,” Dwight says. “We just needed to get them used to a more than just one-on-one zoom, since Clinical Concept Days involves moving from virtual room to virtual room seeing multiple groups of students.”

The new process involves virtual rooms occupied by a group of students, and then moving the SPs from group to group to interview in-character about such issues as dementia, PTSD and schizophrenia. “We kept the same students in the same room and then we would move the standardized patients from room to room,” Stock says. Students had eight minutes per interview, followed by a five-minute discussion session before the standardized patient was moved to the next group. “We were able to manage all these rooms simultaneously and it was actually more much efficient than having the physical environment,” Stock says.

“Morgan was like the air traffic controller keeping track of this chart where everyone was moving,” Dwight says. “And I was just popping in and out of the rooms to make sure things were running smoothly. Sometimes I’d hear something happen in the middle of the interview where you could tell something wasn’t going to go well. I would make sure that I snuck back in later to see if they had discussed that in debrief.”

The instructors and the SPs have always striven to make the interviews as accurate and realistic as possible. Dwight never fails to be amazed by how committed the SPs are to verisimilitude. “It’s amazing to see the students’ jaws drop when they encounter an SP who has taken on their patient persona,” Dwight says. “It’s almost the way they would be if they had experienced that patient in a day room for the first time. After the interview we would invite the SPs to a debriefing, where the students could see them out of character. They almost had the same expression of amazement. ‘Oh. Rita can talk. She doesn't have dementia.’” The sessions were so successful that in a post-Clinical Concept Days survey, more than 90% of students said the interviews were the most valuable part of their experience. “Talking to the volunteers was so helpful for them,” Dwight says. “They said they felt like they were actually able to receive practice, similar to an in person clinical, and gave them so much insight on therapeutic communication.”

As educators, Morgan and Dwight were equally impressed by the process. “At the beginning of the day, we’d ask the students what they were most concerned about,” Dwight says.  “What they’re truly concerned about is saying the wrong thing.  This structure allowed us to practice without serious consequences, such as saying something wrong or upsetting.” Dwight and Stock especially appreciated watching the SPs and students give one another feedback. “By the end of the day they were getting better,” Dwight says. “It was really neat to watch them teach each other. Plus, the SPs are very gracious and merciful with their feedback.”

Not only is the complex process easier for instructors to moderate, but the students exhibited far less anxiety about psychiatric interviewing, not to mention the added benefit of having access to a  much broader array of SPs. “It was very effective,” Stock says. “And we continue to see increased confidence in our students because of it. We've been pushed because of COVID as far as instantly coming up with other ways to meet with our students and to address and to use the technology creatively. Initially it was a matter of expedience, but now we see it as another tool that we will have after COVID. Once it’s settled, I'll still be using a tool like this.”