If you missed part I Why KeithRN Unfolding Case Studies Can Transform the Virtual (and Traditional) Clinical, take a minute to review this blog, then put it all together with today’s blog post which is part II!

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Still in need of supplementing your clinical day or replacing it with a meaningful clinical replacement activity?

Today, I will keep it practical and share a couple of strategies to mix up your virtual clinical and get your students’ nurse thinking using KeithRN Unfolding Case Studies!

Strategy #1: Creating a Virtual Clinical Day using KeithRN Case Studies

How many hours are needed for your virtual clinical to satisfy the Board of Nursing requirements in your state? Since some states allow a 2 to 1 ratio of simulation to clinical experience and will need a 3 to 4-hour activity to provide a virtual clinical replacement activity.

If your state offers a one-to-one ratio of simulation, you will need a more extended virtual clinical experience of 6 to 8 hours to replace your clinical day.

The table below will guide you in selecting the best level of a KeithRN unfolding case study simulation for your students:

KeithRN Case Study Level:	Hours to Complete:
SKINNY Reasoning	2-3 hours
RAPID Reasoning	3-4 hours
UNFOLDING Reasoning	4-5 hours

Synchronous or Asynchronous?

The student version of any KeithRN case study is a writable PDF document that can be posted in your LMS prior to clinical. This gives you flexibility as an educator.

One of the benefits of transitioning clinical to the virtual online space is that it no longer requires students and faculty to be together for a 6-8 hour clinical day. To leverage this online learning aspect, allow students to work on the unfolding case study asynchronously and provide a time where it must be completed and submitted.

Then have a faculty-guided discussion as an entire clinical group to ensure that everyone is on the same page. Any errors in thinking in the case study can be addressed at this time.

You can also use the case study synchronously and be available to answer questions as they come up. The choice is entirely up to you!

Individual or small group?

Once the writable PDF document is posted, students can access and begin to work on it. Because of the Unfolding Case Study’s complexity and feelings of isolation many students experience because of the pandemic, I recommend small groups of at least two and no more than three students to work through the case study together and submit a single case study to faculty.

Consider trying both approaches and identify what works best with your students.

Structure of the Virtual Clinical Day

KeithRN case studies capture the essence of clinical reasoning using salient scenarios. They are not just a case study, because they realistically simulate clinical thinking are really a low-fidelity simulation.

Applying best practices of simulation, structure the virtual clinical using an unfolding case study by including the following components:

1. Identify, then post the unfolding case study. Use the most common scenarios seen in your current clinical setting to inform your choice. With more than 110 case-based simulations across the curriculum in the all-inclusive membership, you will be able to provide your students with the typical patients cared for in the practice setting your activity needs to replace and simulate.
2. Pre-briefing. This is done BEFORE the case study simulation. Review and highlight important content that the case study will review and incorporate. Be sure students UNDERSTAND what is most important. Identify what students know about this content or any prior exposure to patients with this problem that will be presented.
3. Guided faculty discussion of the case study with the clinical group. Once students have completed and submitted the unfolding case study simulation, the case study should be reviewed together with all students to enhance student learning and understanding. Ensure that students are on the same page and can answer questions, or provide clarification if needed.
4. Debriefing. Debriefing afterward is essential just as it is in high-fidelity simulation because it provides a chance for group reflection, which facilitates the development of clinical judgment. What was done well? What would you do differently? How will you transfer learning to future patients in your care? These and other questions are essential to have a robust and engaging dialogue as a clinical group.
5. Individual student reflection. Tanner’s clinical judgment model emphasizes the importance of the fourth and final step of reflecting ON action, which is the reflection after patient care or a virtual case study simulation. Additional reflection questions can be assigned to students and then submitted to faculty within a designated time frame.

When these constructs of the virtual clinical are used by nursing faculty, the following table provides the actual length of time that a KeithRN unfolding case study takes to ensure that clinical hours that need to be replaced are provided:

KeithRN Case Study Level:	Prebriefing:	Hours to Complete:	Faculty Discussion:	Debriefing:	Student Reflection	TOTAL Time:
SKINNY Reasoning	1-2 hours	2 hours	1 hour	30 minutes	1 hour	5.5-6.5 hours
RAPID Reasoning	1-2 hours	3 hours	1.5 hours	30 minutes	1 hour	6-7 hours
UNFOLDING Reasoning	1-2 hours	4 hours	2 hours	30 minutes	1 hour	7.5-8.5 hours

Strategy #2: Students Create a Virtual Clinical Learning Experience

Instead of giving students an unfolding case study simulation already created, have students work in small groups of 2-3 to CREATE their unfolding case study based on their knowledge of the topic you assign for the virtual clinical experience!

This alternative strategy is called a reverse case study in the nursing literature and takes student learning straight to the top of Bloom’s taxonomy by creating and constructing knowledge in your virtual clinical!

Get started using the following steps:

1. Provide the first sentence of a case study simulation scenario by giving the patient’s name, age, ethnicity, and relevant past medical history. Let students develop the remainder of this scenario based on their knowledge of the topic you are teaching.
2. To successfully implement this strategy, I provide a template of both a concise Skinny Reasoning case study format or a more complex template for advanced students in the all-inclusive membership. If you are already a member, go to the classroom tools button on the homepage, click on the classroom tools button, and download this document and put it to use!
3. Once students have developed this opening scenario on a typical presentation of sepsis, have them continue to work through an unfolding case study by creating expected normal and abnormal vital signs, nursing assessment findings, diagnostic lab results, and nursing priorities, and the plan of care.
4. Alternating your virtual clinical with a reverse case study that students create with an already completed scenario in a KeithRN unfolding case study provides a way to easily mix it up and keep students engaged in the learning process.
5. Use the same principles of prebriefing of essential content before, then debriefing afterward, with individual student reflection, when students create a case study.
6. Instead of a guided faculty discussion, each student’s clinical group presents their unfolding patient care scenario on the assigned topic. Allow other students to provide feedback. Guide if students get off track or have questions.

Strategy #3: Supplement the Traditional Clinical Day

One of the downsides of clinical teaching is that not all students receive a comparable experience. Some students receive an assignment that is challenging, while another has a patient who goes home early.

When downtime is present for any reason, use the concise SKINNY Reasoning level to have a student work through and complete as part of the clinical assignment when a supplemental resource is needed.

This assignment will provide a rich application of essential content, plus practice the nurse thinking skill of clinical reasoning.

In Closing

Using case studies as low fidelity simulation provides a comprehensive clinical experience that applies essential content and provides a comprehensive clinical experience.

Developing clinical judgment is the most important skill your students must possess to be safe in practice.

Using KeithRN case studies that emphasize clinical reasoning and practice realities provide practice of nurse thinking in both the classroom and clinical settings, so your students get a relevant learning experience and can graduate better prepared for both real-world practice and licensure!

Relevant Blogs

• Part I: Why KeithRN Unfolding Case Studies Can Transform the Virtual (and Traditional) Clinical
• Case Studies: An Underutilized Strategy to Develop Nurse Thinking & Improve Practice Readiness
• How to Create Case Studies that Bring Clinical to Class!