DURING GRAND rounds, healthcare professionals report and review their patients' clinical findings and outcomes to their peers and mentors. They present a position, receive feedback, and explore treatment modalities. In this context, simulated nursing grand rounds (NGRs) were created at the authors' institution to enhance senior nursing students' ability to understand patients and analyze complex situations in a practice setting. This article provides background on the role of grand rounds in healthcare environments, discusses the benefits of NGRs for nursing staff and students, and offers an example project to incorporate simulated NGRs for nursing students.
Background
Grand rounds emerged as a central teaching activity in US medical schools during the first half of the 20th century. The concept was founded in medical residency training as an educational approach to introduce new resources and improve clinical reasoning through discussion of patient cases. The practice has remained a staple of healthcare education for decades; however, Health Insurance Portability and Accountability Act concerns related to patient dignity and confidentiality in hallways or rooms with multiple patients have led to conducting grand rounds in more confidential environments.
Similar to other healthcare professionals, nurses also have rounds at the patient's bedside or in small groups as case presentations. In one 2015 study, nursing rounds were described as "a deliberate method to reduce preventable adverse outcomes."1 NGRs can be conducted at the patient's bedside (provided the patient is in a single room), in health facility conference rooms, or through presentations via the internet and intranet to highlight clinical expertise and promote best practices.2
Today, nursing education has moved primarily to classrooms and online education.3 The format of NGRs has shifted from case-oriented presentations to expert lectures with an emphasis on recent evidence. Approximately 60% of hospitals still conduct NGRs to educate participants, showcase faculty as role models, and enhance the collegial environment for nursing students.4 Quality and Safety Education for Nurses (QSEN) competencies support evidence-based practices and critical reasoning skills in education.5,6
When NGRs are performed at the bedside, nurses have the opportunity to interact with, learn from, and discuss plans of care with colleagues, as well as to cultivate nursing skills and promote professional development.7 Nurses can also evaluate specific patient conditions, assess changes in patient data, and plan interventions.5 Additionally, NGRs are a valuable tool for evaluating the challenges facing patients and their families.
NGRs are one of the most effective educational approaches, as they provide opportunities to collaborate and share ideas related to clinical nursing and the current dynamics of the healthcare system.8 NGRs may involve various healthcare professionals as part of an interdisciplinary team, which exposes nursing students to a range of conditions that they may experience in their career.3
NGRs also represent a creative teaching strategy that is critical for engaging students, enhancing education related to common healthcare challenges, and emphasizing teamwork.5 NGRs help nursing students develop presentation skills, improve critical thinking, and increase knowledge of disease processes. Additionally, NGRs teach the value of sharing ideas with colleagues to improve collegiality and collaboration in patient care.4 By utilizing simulated NGRs, nursing students can identify patient health concerns, address clinical challenges, share personal experiences, and identify gaps in clinical understanding.
Student practice
An educational project at the City University of New York aimed to create an opportunity for senior nursing students to participate in simulated NGRs. After discussing the opportunity with their clinical professor, 20 students who were enrolled in the nursing program volunteered to participate. The project was exempted by the Institutional Review Board.
Three clinical groups participated, and presentations were not graded. Students were given clinical assignments on patients with complex conditions and comorbidities in a medical-surgical clinical setting.
Participants first observed NGRs in a clinical setting with nurses and other healthcare professionals. They were then instructed to prepare presentations on specific patients, including admission assessment data, prescribed medications, lab results, consultations, discharge plans, and any discussion of provider involvement from the multidisciplinary team.
The nursing students presented on real patients under their care in a format similar to the NGR presentations they had previously observed. Instead of doing so in the healthcare facilities, however, the presentations were simulated in the classroom. Other nursing students were invited to attend, and faculty members served as experts. The participating students answered questions from both the faculty and their peers, simulating professional NGRs. After the presentations, a six-item online survey was distributed to all participating students to determine their satisfaction with the experience (see Survey responses). They rated their answers on a five-point Likert scale, with 1 representing "strongly disagree" and 5 representing "strongly agree."
All 20 participating nursing students from the three clinical groups responded to the six-item survey:
* All 20 strongly agreed that the NGRs helped promote professional development and recommended simulated NGRs for other students.
* All participants either agreed or strongly agreed that the simulated NGRs had helped them analyze complex patients.
* All participants either agreed or strongly agreed that the feedback they received from faculty and peers was valuable.
* All participants also agreed that the program incorporated the previous semester's course objectives, which detailed the role of nurses in medical-surgical units.
Summary
Simulated NGRs offer nursing students an opportunity to evaluate patients, discuss assessment data, and propose any changes to the plan of care. Through participation, nursing students and faculty members can increase their understanding of the roles of the multidisciplinary team. Simulated NGRs give students an opportunity to exchange ideas related to patient care with staff, other students, and the clinical faculty. It also promotes professional development, encourages collaboration, and improves clinical assessments in accordance with the Quality and Safety Education for Nurses' competencies of teamwork, cooperation, and patient-centered care.6
The project had several limitations. Although the results point to the potential benefits of simulated NGRs, the sample size was small. Additionally, the survey questions were subjective and faculty responses were not taken into account. Simulated NGRs represent one way to engage students as future healthcare professionals and enhance nursing education, but the outcome of this project suggests a need for further research.
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