Web-Based Virtual Patients in Nursing Education: Development and Validation of Theory-Anchored Design and Activity Models

Abstract

BackgroundResearch has shown that nursing students find it difficult to translate and apply their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as a learning activity that can support nursing students in their learning of scientific knowledge and help them integrate theory and practice. Although VPs are increasingly used in health care education, they still lack a systematic consistency that would allow their reuse outside of their original context. There is therefore a need to develop a model for the development and implementation of VPs in nursing education.ObjectiveThe aim of this study was to develop and evaluate a virtual patient model optimized to the learning and assessment needs in nursing education.MethodsThe process of modeling started by reviewing theoretical frameworks reported in the literature and used by practitioners when designing learning and assessment activities. The Outcome-Present State Test (OPT) model was chosen as the theoretical framework. The model was then, in an iterative manner, developed and optimized to the affordances of virtual patients. Content validation was performed with faculty both in terms of the relevance of the chosen theories but also its applicability in nursing education. The virtual patient nursing model was then instantiated in two VPs. The students’ perceived usefulness of the VPs was investigated using a questionnaire. The result was analyzed using descriptive statistics.ResultsA virtual patient Nursing Design Model (vpNDM) composed of three layers was developed. Layer 1 contains the patient story and ways of interacting with the data, Layer 2 includes aspects of the iterative process of clinical reasoning, and finally Layer 3 includes measurable outcomes. A virtual patient Nursing Activity Model (vpNAM) was also developed as a guide when creating VP-centric learning activities. The students perceived the global linear VPs as a relevant learning activity for the integration of theory and practice.ConclusionsVirtual patients that are adapted to the nursing paradigm can support nursing students’ development of clinical reasoning skills. The proposed virtual patient nursing design and activity models will allow the systematic development of different types of virtual patients from a common model and thereby create opportunities for sharing pedagogical designs across technical solutions.

How to tell a patient’s story? Influence of the case narrative design on the clinical reasoning process in virtual patients

“…However, we found a significant difference in the actual level of difficulty based on the number of attempts needed to provide a correct final diagnosis. VP difficulty for education or research is often assessed as the perceived level of difficulty of students, case authors, or educators (Botezatu et al 2010;Georg and Zary 2014). However, based on our findings, we see a discrepancy between estimated and measured level of VP difficulty; therefore, we suggest considering the actual and individual VP difficulty as a more accurate measurement before providing VPs to learners.…”

A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients

“…As in patient encounters, the students can carry out their assessment in any order they choose. Both systems were exploratory and semi-linear in design which means that they enable free navigation between the different sections for data collection (for example patient interview, physical examination and diagnostic tests) Zhou et al, 2018).The design of the virtual patient cases used in the different studies was based on the on the virtual patient Nursing Design Model (vpNDM) (Georg & Zary, 2014). This model is described in greater detail in Section 6.1.…”

“…The data consisted of summary statements and reflections that students produced during a learning activity including virtual patients. The learning activity was based on the virtual patient activity model and included two different virtual patients ( Figure 6) based on the virtual patient nursing design model (vpNDM), developed in study I (Georg & Zary, 2014) and is described in greater detail in section 6.1.…”

“…clinical reasoning in nursing education (Georg & Zary, 2014). The vpNDM model is based on the Outcome-Present State-Test model (OPT).…”

Desenvolvimento e avaliação de curso on-line sobre suporte avançado de vida em parada cardiorrespiratória para enfermeiro

“…As Diretrizes Curriculares (116) O uso da simulação virtual permite agregar novas abordagens para o ensino em enfermagem, valorizando a aprendizagem centrada no aprendiz, em que o mesmo atua como participante ativo do processo de construção do seu próprio conhecimento e, consequentemente, resulta em retenção do saber (118) .…”