Nursing students and advanced practice registered nursing (APRN) students must demonstrate competency in a variety of skills when preparing for their clinical rotations and practice. Prior to their first clinical rotation, one of the required clinical skills taught to health care providers and to adult gerontology acute care nurse practitioner (AGACNP) students is basic suturing. This skill is taught to APRN students in nursing programs across the United States and internationally to prepare them for encounters in the clinical setting (Ramponi & Ross, 2015). Although suturing is a hands-on skill usually taught in person by faculty prior to beginning the clinical rotation, an innovative approach to suturing through a virtual suturing skills lab proved to be beneficial to students and faculty. This was evidenced by the students' abilities to demonstrate competency of their skills during a virtual suturing training and checkoff.
Face-to-face, hands-on skills training is taught in many universities and colleges of nursing across the nation. Hands-on training is necessary for APRN and AGACNP students to acquire specific skills prior to their clinical rotations. Supervised, basic suturing sessions improve the confidence of students as they aim to provide safe care for their patients (Gonzalez-Navarro et al., 2021). Today, hybrid and online nursing programs offer opportunities for faculty to initiate innovative approaches to teach skills that were traditionally taught in person (Alanazi et al., 2017). An innovative approach allows students to demonstrate competency of their skills during their clinical checkoff as evidence of meeting expected course outcomes.
PLANNING CONSIDERATIONS AND SKILLS OBJECTIVES
The strategy to adequately teach and demonstrate the skill of basic suturing in a virtual, nontraditional setting was composed of three key components. First, our AGACNP students were given access to prerecorded videos. Second, students received suturing kits to practice their skills early in the semester. Finally, it was important to ensure the provision of proficient faculty who could teach, monitor, and validate students' demonstration of the required suturing techniques.
The goals of the virtual suturing skills lab were to: 1) provide an opportunity for students to practice their suturing skills in the presence of a faculty member through distance learning, 2) give students an opportunity to ask questions regarding proper suturing techniques and other questions related to suturing, and 3) ensure students successfully completed the skills checkoff prior to their upcoming clinical rotation. The objectives were to: 1) identify wound injuries that required application of sutures, 2) review analgesia and dosage calculations needed for specific wound injuries that required application of sutures, 3) discuss appropriate suturing materials and instruments used for specific wound injuries, 4) demonstrate proper hand techniques of basic suturing, and 5) perform foundational suturing skills for beginning providers (Hu et al., 2013). Foundational skills include, but are not limited to, correct threading of the suture needle, completion of suturing techniques (simple suture, instrument tie, interrupted suture, running simple or uninterrupted suture, and correct suturing technique for V and Y flaps), and correct tying of the suture knots.
IMPLEMENTATION OF THE PROCESS
Implementation of the virtual suturing skills lab began by providing professional prerecorded videos for the course at the beginning of the semester. The six instructional videos remained available, allowing unlimited access for students to view and ask questions prior to the virtual suturing session. The process continued with mailing students their suturing kits, an expense already included in their tuition. The suturing kits contained suture materials, suturing needles, needle drivers, and an instructional suturing pad with preprinted insertion sites and exit sites. The suturing pad was identical to the pad used in the instructional videos.
Dates on which the faculty and students would normally meet for skills lab on campus were instead reserved for the virtual skills lab. This eliminated any further disruption in the students' schedules. The process facilitated self-directed training for AGACNP students to use their suturing kits and practice their suturing techniques throughout the semester with the guidance of the prerecorded instructional videos (Denadai et al., 2012). Self-directed teaching through prerecorded videos and simulation had previously been implemented to develop a virtual skills lab (Hu et al., 2013; Ramponi & Ross, 2015).
The virtual skills lab involved 29 students and five AGACNP faculty. One faculty presented a brief PowerPoint presentation and demonstrated the various suturing techniques. The instructor of record assigned virtual breakout rooms and managed the schedule for the virtual classroom and the breakout rooms. The virtual skills lab continued with a question-and-answer period. After this, students were divided into the virtual breakout rooms where they practiced suturing in small groups with designated faculty. Students practiced suturing for approximately one hour and completed their skills checkoffs at the end of the session. The presenting faculty and instructor of record rotated through the four breakout rooms, assisting faculty and students who had questions or needed further guidance.
EVALUATIONS AND OUTCOMES
Faculty utilized a basic rubric provided to them prior to the virtual session. The rubric consisted of categories for competence in three areas (completing the simple interrupted suture, the simple running suture, and the basic suturing technique) as well as comments regarding general skills performance. The rubric also functioned as an attendance roster for faculty. Upon completion of the individual breakout suturing sessions, all students and faculty returned to the main virtual meeting room for further questions, debriefing, and discussion.
This virtual suturing session gave students the opportunity to adequately meet course and program outcomes necessary to progress and continue in their learning. Although this virtual session was an untraditional method, students were able to engage successfully with faculty, prepare for their upcoming clinical courses, have assurance they were being exposed to the skill of basic suturing, and be evaluated with a competent score by their faculty. The students were also provided with resources to become more proficient in their suturing skills with additional guidance from expert faculty.
Along with faculty assessments of students, the success of the virtual suturing skills lab was also evidenced by students' course evaluations. Students expressed that the ability to prepare for clinical through video instruction and self-directed teaching was beneficial. Students specifically stated that they felt confident in performing the suturing techniques and more prepared to begin their clinical rotations. Acknowledgments and gratitude to faculty for being innovative during a time when in-person training was not available was expressed in the students' evaluations.
CONCLUSION
Nurse educators must continue to strive for innovative methods to meet the needs of nursing students on every academic level when teaching face-to-face or distance learning. Video assessments and simulated suturing skills can be innovatively utilized in a virtual suturing lab. Incorporating competent faculty and providing students with the necessary resources can ensure course objectives are met in hybrid and online nursing programs.
Students look to nurse educators to fill the gap when traditional methods of teaching are not successful or possible. A virtual suturing lab proved to be a practical and innovative approach in nursing education. We must continue to discover novel ways to educate our nursing students and prepare them for the tasks that lie ahead. In doing so, this gives students a sense of confidence to be the nurses and providers our health care system needs.
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