Development of an Electronic Virtual Acute Care Hospital to Cultivate Decision-Making

According to the Institute of Medicine (2004), a preponderance of medical errors occurs in hospitals and the root cause of many of these mistakes is attributed to ineffective decision-making.   A wide range of decisions impacting the assessment, diagnosis, and treatment of patients with acute, critical, and chronic illness constitute some of the most challenging problems for Acute Care Nurse Practitioner (ACNPs) students and contribute to high levels of decisional uncertainty in practice.  To cultivate effective decision-making, an intraprofessional team of experts in simulation science, informatics, and acute care advanced nursing practice has developed a web-based virtual hospital called “Acute General Hospital”.  Consistent with Kolb’s Theory of Experiential Learning (1984) signifying that learning evolves from interactions among cognition, experience, and perceptions, we have “brought to life” four virtual patients through the use of Standardized Patients (SP’s).  Students followed these patients in the virtual hospital from admission to discharge.  To fully engage the different perceptual and emotional senses of ACNP students, we have incorporated the use of multimedia technology.  Students viewed patient videos, diagnostic tests, and audio recordings of heart sounds, lung sounds, and bowel sounds.  To convey the emotional aspects of the illness experience, we have produced videos involving SP’s (actors) who describe their history, chief complaints, and medical problems.  The SP’s tell the patients’ stories and capture the human perspectives defining each person and the emotions associated with the illness experience.  Students viewed SP’s videorecording, interpreted multiple sources of visual, sensory, and verbal information to enhance their decision-making skills.  Using a free inquiry approach, groups of students worked together to pose differential diagnoses and generate treatment decisions according to the best evidence using a discussion board. 

During this presentation, we will describe how collaboration fostered the development of this innovative teaching method.  Strategies for developing the electronic hospital, creating virtual patients, and devising scenarios will be illustrated.  We will present examples of the hospital replete with “virtual patients” and provide examples of student discussions and use of evidence for decision-making.