How many college students can fit into a telephone booth or a car? And why would they even try? For some reason, this seems to be a popular college pastime. On a similar note, trying to fit 40 students into a cramped intensive care unit room is no laughing matter, and until recently, an impossible and impractical task.
Last week at Walter Reed Army Medical Center, Maj. John Nerges managed to do just that. While taking care of a Medical Intensive Care Unit patient, he led a class of about 40 nursing students through every step of a typical morning shift.
The MICU head nurse's actions didn't compromise patient safety with an overcrowded room, though. He was conducting a "virtual clinical" for nursing students at Mount Aloysius College in Cresson, Pa. -- about 170 miles away from Walter Reed.
Over the last four months, Walter Reed has participated with the college in the congressionally-funded Nursing Telehealth Applications Initiative.
For this part of the four-year NTAI study, researchers, educators and medical professionals teamed up with telemedicine experts to address the nursing shortage problem.
To help deal with a national nursing shortage, education programs have been in high gear. But finding room for all the students to observe and participate in real-world ICU settings has been a challenge, said Dr. Janet Grady, the project's lead researcher and Mount Aloysius' nursing division chairperson.
"We hope to harness the best technology and the best practices to help reduce the nurse shortage," Grady said.
"We approached Walter Reed because they are the flagship of nursing research," added Loretta Schlachta-Fairchild, co-researcher and iTeleHealth, Inc. president.
Telehealth technology used in the study includes computers, the Internet, television, voice and video capability, and distance-learning technologies to provide patient care, education and health-care provider contact.
During the virtual clinical, a computer and internet-connected camera at the doorway of one of Walter Reed's MICU rooms allowed nursing students at the college to see a patient, an ICU nurse and all of the life support and monitoring equipment in the room.
For close-up shots, a second nurse used a hand-held digital video camera. The close-ups allowed the students to read labels on medications, see Nerges' hands as he worked, and to see vital sign displays.
As Nerges monitored and checked his patient's condition, he used a wireless lapel microphone to explain ICU patient care and to answer student questions. A few times, Nerges tested the students' knowledge by asking them what particular drugs or devices are used for, or what actions might he take next. It was as if the students were by Nerges' side for his morning shift.
"I learned a lot about teaching from this virtual clinical," he said. "Nursing on camera is like narrating everything you do when you drive a car: turn the key, hit the blinker, honk the horn ... All that stuff is natural until you have to describe it."
Mount Aloysius's faculty, through student focus groups, found that students felt they had a lot of one-on-one interaction with Nerges. The technology allowed the students to focus more on the nurse-patient interaction without distraction, Grady said.
Nursing students rarely see the type of cases Walter Reed's ICUs treat, Grady said. She and Schlachta-Fairchild hope that taking advantage of telehealth technology will enable nursing education graduates to be more prepared and confident when they enter the workforce.
"With the nursing shortage [being] a potentionalcatastrophe for American health care, new and innovative methods have to be found to educate those going into nursing to the highest standards possible," said Col. Michael Custer, Walter Reed's Nursing Research chief.
Besides addressing possibilities to help minimize the national nursing shortage, the project is comparing options to improve patient outcomes. "If this technology proves effective, the possibilities are endless," Grady said.
Using virtual clinicals, nurses might be able to manage high-risk patients who undergo in-home care. Instead of traveling to every in-home patient, nurses may be able to just dial into patients' homes to check their health. This would effectively let patients see nurses more often.
"This is truly a landmark event in nursing education's use of technology, and Walter Reed and Mount Aloysius College are taking a technology 'leap' that we all believe will impact the current nursing shortage dramatically," Schlachta-Fairchild said.
"At first I was sure virtual clinical had no value, but I had to think outside the box," Nerges said. "Maybe they have incredible value and I think we should explore virtual nursing from the combat support hospitals in Iraq and Afghanistan. Imagine beaming nursing care from Iraq?"
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