Journal of Community & Public Health Nursing
Open Access

Gagne theory; Hybrid model; Mental health nursing

Introduction

The global pandemic has strained the healthcare system, resulting in a failure of needed coffers and pressing the systemic sins in the frugality, education, and health sector. Encyclopedically, the check of educational institutions due to COVID- 19 has raised enterprises about the quality and durability of education. The uncertain situation has needed universities to undertake several innovative measures to continue their educational programs and complete them on time without compromising the quality of education in their graduate programs. In this situation [1-3], the traditional face- to- face tutoring strategy was no longer a feasible option. Therefore, preface of effective strategies was needed to insure durability of scholars’ learning and attainment of the intended issues of the course. Nursing education faced analogous challenges.

The reason for closing the schools of nursing was two-fold, that is, scholars ’ enjoy safety and mitigating the chances of spreading the infection. The nursing programs aim to prepare professionals who can give safe holistic care to the cases. Lack of sufficient clinical experience during COVID- 19, in each specialty- based area, was likely to disrupt students ’ learning by creating a proposition- practice gap. This increased the struggle of nursing institutions to give hands- on experience to scholars in patient care, while keeping a balance between their safety and literacy requirement.

Like other specialty areas, constant change in health care demands has made it delicate to give complete in- case clinical exposure for psychiatry to undergraduate nursing scholars. Several psychiatry units are moreover moving towards closure or are considering homegrounded treatment as precedence. A check by the World Health Organization (WHO), conducted in 130 countries [4], to estimate changes in the provision and access of internal health services due to COVID- 19, revealed over 60 disturbances in the internal health services for vulnerable groups, and 67 dislocation in curatives similar as comforting and psychotherapy( WHO, 2020). Also, the internal health demands are yet to increase with the periodic waves of covid cases, globally.

Several national and international studies have unveiled the impact of COVID- 19 on the internal health of people. This increased vulnerability to internal health suffering will bear further trained nurses who have introductory knowledge and chops to fete, alleviate, and relate the high- threat individualities to the psychiatrists. Also, internal health nursing is getting more challenging, since the major focus of health care amid COVID- 19 has placed physical health as a priority. therefore, an innovative approach can be facilitative in bridging the gap between proposition and practice, in order to promote students ’ critical thinking and clinical decision- making and to develop their capability in core clinical skills, particularly with regard to internal health nursing.

The undergraduate Bachelorette of wisdom in Nursing (BScN) is a 4- time program in Pakistan that's offered to students with 12 times of education, with majors in medical sciences. The Mental Health Nursing (MHN) course is offered to the third time BSc students, in agreement with the public nursing class. The MHN is a six- credit hour course, three clinical (153 hours) and three propositions (51 hours). Also, to meet nursing students’ learning requirements, the perpetration of simulation in internal health undergraduate nursing training has been found to be effective.

Duringpre-covid times, students had a chance to witness faceto- face commerce with simulated and factual cases in the lab and the psychiatric wards. still, keeping in mind the current circumstances of the epidemic and complying with the standard operating principles( SOPs), more flexible and innovative clinical tutoring approach was needed to develop nursing scholars ’ clinical competence in internal health [5-6]. Therefore, the epidemic created an occasion for developing a more dependable and sustainable mongrel model that blends both virtual and face- to- face teaching, to maximize the clinical experience.

Taking up the challenge, the MHN course teaching platoon developed a mongrel model( coetaneous and asynchronous) for the clinical element of the course that handed students a step- by- step exposure to help them integrate theoretical knowledge, ameliorate communication skills, enhance critical thinking, and gain confidence to manage clinical scenarios.

This paper aims to present the hybrid approach for teaching the clinical element of the MHN course, based on Robert Gagne's model that was developed for the undergraduate nursing students at a private nursing institution in Pakistan.

Action and Evaluation

Students’ performance was inspired through their operation of the learned knowledge and skills. Students were engaged in part plays to depict a case script, to enhance their assessment skills. Next, a 2- day extended exertion was planned that integrated the learned generalities, the assessment skills, and their integration, to map possible nursing interventions and remedial modalities. Step- by- step guidelines were handed to the students to witness a close- to-real clinical setting. Each exertion in the model was followed by provision of feedback by the facilitator and peers, using a feed-forward approach to enhance students’ learning and successive performance.

Continuous constructive assessment including self, existent, peer, and group feedback during the course helped both the facilitator and the students to identify areas of enhancement and to work to ameliorate the skills further. Also, summative assessment at the end of the course, including assessment of theoretical knowledge and performance through case- based and in clinical setting, helped to determine the overall performance of the students [7-8].

Retention and transfer of knowledge was the step followed intermittently during the entire course. A series of interactions with simulated cases, pre-recorded videos on history taking and internal status examination, and part plays were some of the strategies used to enhance knowledge retention and its transferability. Periodic performance of the students indicated the retention of core generalities and clinical chops. Summative assessment, as mentioned over, also handed substantiation of use of therapeutic communication principles during their encounter with simulated cases and case- based examinations.

Discussion

Millennial- tech expertise individuals are well versed in the use of technology and the rearmost gadgets. They're comfortable and at ease while dealing with this fast- paced digital world. As a result, the increased use of technology during this epidemic period has created an occasion for millennial to profit the most from it. With this transition, the metamorphosis in the tutoring and literacy strategies helped the facilitators give enriching gests for the nursing students in the MHN course [9]. The Gagne model was integrated totally, which handed a clear event of instructions to align the course objects, learning pedagogies, and issues. This model has proven to ameliorate scholars learning experience. The model helped the facilitators to reflect, explain, and conclude for substantiation- grounded practices to negotiate the course objects to continue to deliver quality education to the nursing students.

Likewise, students appreciated the courteously planned conditioning in the constructive evaluation of this course and set up them salutary in adding their confidence to deal with psychiatric cases. Also, it reduced their anxiety and increased their comfort position, before interacting with factual cases in a clinical setting. also, scholars ’ literacy was enhanced by virtually performing different modalities, similar as canvassing standardized cases, developing conception integrated charts from acclimatized scripts, scholars ’ part plays on case studies, and problem- grounded literacy of various internal health diseases. In addition, it was apparent in scholars ’ feedback that they set up history taking and internal status examination with standardized cases, followed by examining sessions, helpful as this advanced and strengthened their interviewing chops. likewise, recorded internal status examinations and live demonstrations by the facilitators were salutary for scholars ’ face- to- face relations with psychiatric cases. All the strategies helped the scholars to restate their theoretical knowledge into practice.

Virtual clinical enhanced the tone- reflection capacities among students, as they were suitable to identify their areas of enhancement after each exertion and showed bettered performance in the successive virtual and face- to- face relations with the cases. Our findings were consistent with earlier studies on university students that revealed reflective conditioning enhances students ’ in- depth tone- perception and critical thinking which enables them to identify sources and ways of problem working in their profession.

Conclusion

Application of Gagne’ theory in hybrid tutoring in the internal health course helped students to understand the internal health generalities and to apply the learnt theoretical concepts during virtual and face- to- face clinical. Virtual clinical through simulation, adopted as an innovative strategy, assured uninterrupted students’ learning and enhanced their clinical experience. The strategy increased scholars’ confidence and bettered their remedial communication skills. This approach aided in having inflexibility in clinical tutoring, considering the current epidemic situation, to develop students’ capability in the core clinical chops required. However, further exploration studies are needed to estimate the connection of Gagne's proposition on other nursing courses that require clinical faculty and knowledge enhancement, following the hybrid tutoring model.

Acknowledgement

None

Conflict of Interest

None

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