In response to the Affordable Care Act, the Institute of Medicine (2010) called for the transformation of nursing education and a shift from task-based proficiencies to higher-level competencies. Given changes in the practice environment for nurses, the Institute of Medicine encouraged nursing education to provide entry-level nursing students with experiences in a variety of practice settings, with an emphasis on experiential learning activities in community and public health. Nurse educators can no longer focus learning experiences for students in acute care settings alone.
Brennan and Sullivan-Marx (2012) present a case study of curriculum change at the University of Pennsylvania School of Nursing designed to provide the changing skills needed to practice nursing in the era of the Affordable Care Act. The focus of change includes health promotion with motivational interviewing skills and behavioral interventions, care coordination, and leadership skills in a variety of clinical settings, including settings based in the community. This article presents an innovative strategy for a nonclinical nursing course in an associate degree program: a virtual simulated experiential learning activity involving care coordination.
SIMULATED CARE COORDINATION ROUNDS
According to the Agency for Healthcare Research and Quality (2016), care coordination involves "deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. This means that the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient" (para. 1).
Teamwork and care management are broad approaches to care coordination. Examples of care coordination activities include communicating and sharing knowledge, helping with transitions of care, creating a proactive care plan, linking to community resources, and working to align resources with patient and/or population needs.
To address the call for providing experiential learning experiences in care coordination, a virtual simulated care coordination experience was designed for the online portion of the course. Simulation, the imitation of an action by another, can be met by a combination of role-play and the use of low- and high-tech tools and can occur in a variety of settings (Society for Simulation in Healthcare, 2015). Our virtual simulated experience utilized National League for Nursing (NLN) Advancing Care Excellence (ACE) unfolding cases (NLN, n.d.). Designed to advance health care quality for vulnerable populations, NLN ACE cases make use of storytelling and can be manipulated to be congruent with the learning objectives of a variety of courses. Each case provides subjective data for a simulated patient and family member in audio format; a simulation toolkit and simulated chart documents are provided.
The care coordination rounding assignment utilized a patient from ACE.S (for seniors) and a patient from ACE.V (for veterans), along with each patient's significant other. Audios for both the patient and spouse were uploaded to the learning management system. Students were provided with activities associated with care coordination as follows:
* Teamwork: Care coordination teams of four to five students were tasked to coordinate care and manage appropriate transitions of care for their assigned patient.
* Communicate and share knowledge: Subjective data were collected by students as they listened to the stories of the simulated patient and spouse. Each team member posted initial answers to questions from the ACE instructor toolkit and replied to at least one other team member's post. This provided insight into how others can analyze the same data presenting a different perspective with regard to patient and family needs.
* Proactive plan of care: After a thorough analysis of the collected data, the teams were tasked to identify the patient's priority needs. The teams then developed patient outcomes and planned discharge interventions.
* Care management, care transitions, and alignment of resources: The planned interventions required referrals to community resources to assist in the transition to the community following hospital discharge. The aim was to prevent future hospital admissions and promote patient-family independence and well-being. Each team contacted two community resources to investigate all services available to the patient. Teams were required to provide support for their decision to refer the patient and family to the chosen community agency.
Care coordination rounding culminated in a team-presented voice-over PowerPoint that included the following:
* A transitional report of the situation, background, assessment, and team recommendations related to the simulated patient's needs
* Discussion of community resources identified for the patient, noting the care coordination model that best meets the needs of the patient along with the rationale for the referral
* Creation of a concept map for the team-developed plan of care
Rubrics for the discussion board, collaborative work, and the culminating presentation were provided to guide students through the process.
RESULTS
This innovative strategy was evaluated within the course evaluation at the end of the course. Seventy-five percent of students (n = 40) either agreed or strongly agreed that the simulated care coordination rounds assignment supported their learning. This was 3 percent lower than the acceptable program-set benchmark of 78 percent).
Within the qualitative findings, a common theme was that there were too many projects for a one-credit-hour course. This perception may have impacted the quantitative findings, as students may have rated all projects as not meeting learning needs because of their frustration with the number of projects. Other factors may have influenced the results. This was the first time this strategy was implemented, and the sample size was small. However, missing the target program-set benchmark by only 3 percent warrants further implementation and study of this innovative strategy as an intervention to support student learning of the important initiatives recommended by the Institute of Medicine (2010).
IMPLICATIONS AND CONCLUSION
Ongoing changes in health care are driving forces leading to calls for change in nursing education. Nursing education must incorporate experiences in care coordination and transition care management to better prepare nurses for their future employment. Simulated care coordination rounds are an innovative strategy to provide relevant experiences to nursing students. This strategy can be used for nursing students and can also provide interprofessional collaboration experiences. It can be used in an online learning environment as well as the traditional classroom. Research on the outcomes of this strategy on care coordination competencies is needed.
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