Improving Nurse Practitioner Student Confidence and Competency Through Virtual Technology and Distance Education
Background: As part of ongoing AGNP and FNP student program evaluation noting increasing complexity of the primary care older population, NP students need increased exposure to geriatric patients with multiple chronic conditions and polypharmacy. Not all NP students are exposed to these complex patients within clinical experiences in a sufficient manner to promote competency and confidence with synthesis of geriatric prescribing practices.
Methodology: An IRB approved program was developed to address this gap in the clinical educational process. This team developed a comprehensive educational program as part of required curricula in AGNP and FNP programs. This geriatric prescribing program was designed with a focus on the innovative Virtual Clinic (VC) including online lectures and distant education learning activities. The virtual patients simulated the complex geriatric patient commonly seen in primary care with geropsychiatric conditions, multiple chronic health conditions, and polypharmacy. The self-paced VC provides immediate feedback to the student regarding their clinical critical reasoning. The virtual patients presented with post-herpetic neuralgia with chronic pain, dementia with behavioral disturbances, and pneumonia requiring antibiotics, renal dosing, and consideration of warfarin therapy. The didactic component of the series involved three synchronous one-hour distance education sessions with AGNP and FNP students enrolled in their final clinical semester. Each session provided evidence-based practice standards and clinical pearls for managing and reducing potentially inappropriate medications using START, STOPP and Beer's criteria, appropriate use of psychotropic medications in various geropsychiatric conditions, and evidence-based pain management practices.
Results: A paired-t test was conducted to compare pre- and post-summation scores. There was a significant difference in scores for FNP (n=20,M=12.97, SD=3.08) and AGNP (n=12, M=16.81, SD=3.02; t(31) = -7.93, p=.000 two-tailed, Crombach's α =.76. The AGNP students showed more confidence entering the program than the FNP students, but at the end of the program, the difference was negated.