Author Q&A: Stein and Hollen’s Concept-Based Clinical Nursing Skills, 2nd Edition

Stein and Hollen’s Concept-Based Clinical Nursing Skills: Fundamental to Advanced Competencies, 2nd Edition covers more than 250 nursing skills in an innovative concept-based format. Unlike any other text, Stein and Hollen incorporate an overarching framework of seven critical concepts — accuracy, person-centered care, infection control, safety, communication, evaluation, and health maintenance — to drive home the importance of these key themes in performing nursing skills and developing nursing competencies.

In this Q&A, authors Loren Stein, MSN, RNC-NIC, and Connie J. Hollen, RN, MS, share their insights on the landscape of concept-based clinical nursing and important topics covered in their new title.

Q&A with Authors Loren Stein, MSN, RNC-NIC, and Connie J. Hollen, RN, MS

Q: In 2021, the AACN released The Essentials: Core Competencies for Professional Nursing Education. How does this skills book address the changes in nursing education identified in The Essentials?

A: This book goes beyond skill competencies to address many of the domains, competencies, and sub-competencies identified in The Essentials. Some of the clinical skill chapters are organized by content that aligns with AACN domains, such as safety and person-centered care. In order for clinical skill competencies to emerge, the student must also understand competencies related to the knowledge for nursing practice. In order to successfully complete skill competencies, the student must understand the role of the nurse and demonstrate interprofessional partnership competencies, as well as information and healthcare technologies competencies to appropriately document. This book provides concrete competencies within the greater framework of AACN competencies and assists students in understanding and assuming the role of the nurse.

Q: What are the ways that learning clinical skills helps to develop clinical judgment? 

A:  It is important to note that learning clinical skills is not just about memorizing how to perform a psychomotor skill. There is knowledge and clinical decision-making involved in performing skills, as well. This is where the clinical judgment model comes in. The NCSBN Clinical Judgment Measurement Model identifies six cognitive skills required to make appropriate clinical judgments. This text identifies these steps within many skill descriptions, for example the skill identifies key cues to be analyzed prior to initiating a skill. Each skill consistently identifies a concluding step on evaluating outcomes. In addition, each chapter ends with a detailed case study and a concept map that encourages the student to apply the clinical judgment steps to the identified case.

Q: How does learning clinical skills impact the development of the student nurse and their identity as a nurse?

A: When students learn clinical skills, they begin to see themselves as “the nurse.” In order for students to master many of the competencies in nursing, such as clinical judgment and interprofessional partnerships, they must first see themselves as “the nurse.” The development of the student’s identity is critical to their ability to solve problems from the perspective of the nurse. Clinical skills lab is a unique setting that allows students to step into the role and identity of the nurse. Learning clinical skills is an opportunity to begin to develop the competencies for nursing practice.

Q: How is this skills book different from other skills books?

A: This skills book is unique in that it teaches conceptually. The seven critical concepts provide a truly conceptual approach to teaching essential components of nursing practice to develop clinical skills. The critical concepts assist the student in understanding the frameworks of nursing, such as the nursing process, QSEN competencies, and the NCSBN Clinical Judgment Measurement Model. The framework of nursing is consistently identified so that students can learn the context to apply and adapt their clinical nursing practice to different situations, settings, and populations.

Q: How does this book support faculty and facilitate their ability to teach clinical skills with a concept-based approach?

A: This book was written by authors who have taught nursing for decades and provides faculty with clear objectives, including AACN competencies. Vocabulary and acronyms are provided for each chapter. The units identify fundamental, intermediate, and advanced skills that may be needed in many settings, including acute and critical care. At the end of each chapter, there is a case study, practice question for the NCLEX® exam, and a concept map. Online resources for this text include skills videos, PowerPoint® slides of the text content, and more test bank questions.

Q: In the 2nd edition of this book, a new online resource for faculty is 12 NCSBN Clinical Judgment Measurement Model simulations. Tell us more about these simulations.

A: These simulations were developed to promote the application of the NCSBN Clinical Judgment Measurement Model and the demonstration of nursing care. Simulations are in place for twelve of the twenty chapters. These simulations include faculty instructions, equipment needed, and a description of the simulation environment. Student pre-briefing and debriefing questions are provided. These simulations also address specific AACN competencies that are applicable for the scenario, as well as NCSBN Clinical Judgment Measurement Model simulation objectives. Successful completion of the simulation documents the student’s completion of the objectives and competencies.

Q: How can a concept-based approach be incorporated into the evaluation of clinical skills and nursing competencies?

A: Students are encouraged to learn the clinical skills along with the application of critical nursing concepts, such as safety, communication, and infection control. Students can be encouraged to not merely memorize the skills steps, but to demonstrate the competencies that provide the foundation for the practice of nursing. Evaluation of student skill competency can include the identification of concepts. This allows the student and the faculty to quickly see if errors or omissions are predominantly within one concept area, such as breaks in sterile technique falling within the infection control concept.

Q: Many instructors and students are concerned with the changes being made to the NCLEX exam. How does this book address those concerns?

A: As the Preface notes, the language and concepts of this text often mirror those found in the NCLEX exam. The book reflects the content and categories of the latest NCLEX-RN Test Plan. For example, reduction of risk and contributions to a safe care environment are consistently identified as a safety strategy. The organization of the sections and the skill steps reflect the steps of the NCSBN Clinical Judgment Measurement Model, including when to take action. Each chapter provides students with the opportunity to apply the knowledge and skills learned within the case study and the concept map. Each chapter also provides a practice question for the NCLEX exam so that students gain practice with a variety of question types.

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