Educational Advancements Prevail Amidst Pandemic Challenges

First-year nursing students Berenice Moreno (from left) and Vickie Cuellar-Banuelos discuss the Foundations course simulation with Julie Peterson, MSN, RN, assistant professor/clinical, and Susan Popham, simulation technician.

By DAVID ENDERS

The disruption and apprehension that comes with a global pandemic wreaks havoc on all aspects of our lives. So, it comes as no surprise that college enrollment for first-year students was down by 16.1 percent across the U.S. this past fall, according to the National Student Clearinghouse Research Center. Who would blame these students for weighing health, financial, and travel concerns, along with the value of an education delivered, in large part, virtually, and then choosing to postpone and wait it out?

Berenice Moreno (left) and Vickie Cuellar-Banuelos are using the skills learned during their first year to assess the condition of the medical manikin in the Center for Simulation Innovation at the School of Nursing.

Thankfully, with nurses predicted to be in high demand at least through 2028, the UT Health San Antonio School of Nursing maintained a steady enrollment due to a quick, robust, and resilient response from administrators and faculty, ensuring a fresh supply of well-prepared nurses to see the pandemic through.

David Byrd, PhD, associate dean for admissions and student services, said waiving the TEAS (Test of Essential Academic Skills) exam for all new applicants through the spring of 2022 likely helped to steady the ship. But he credited the success to the teamwork of faculty, administrators, the Center for Simulation Innovation, and the Student Success Center, as they quickly adapted to virtual education when appropriate, while still delivering crucial hands-on learning opportunities in a safe environment.

“Most of all,” Dr. Byrd added, “I cannot understate the students’ role in all of this. They showed resiliency and courage, and they have overcome personal and financial obstacles. I believe that is all going to pay off. If I were a potential employer, I would take a good look at these students and consider what they overcame and sacrificed in dedicating themselves to their profession.”

Applications for the School of Nursing’s traditional BSN program more than doubled, increasing from 258 in the spring of 2020 to 519 by the spring of 2021, said Henry Cantu, MA, director of admissions and special programs. Applications increased from 349 in the fall of 2020 to 625 and counting for the coming fall of 2021. Applications for the accelerated BSN program increased by 102 since last spring.

The long-term impact of waiving the TEAS exam (a measure of academic preparedness for students entering health science fields) remains to be seen. “There are many faculty members who believe the TEAS exam is a strong indicator of success in our nursing program,” Cantu says. At the same time, he notes, many competing schools have done away with the test. Plans are underway to test the first student cohort granted the waiver and determine if there is any decline in academic performance compared to cohorts who were tested.

“Most nursing programs, including ours, use a holistic approach to evaluating applicants where both academic and non-academic factors are used to determine admission. Even with the TEAS in place, the score does not necessarily carry more weight than any of the other criteria. It’s just an additional factor in our consideration.”

As applications for admission increased, the Student Success Center (SSC) helped bolster student retention. The SSC was already in the process of transitioning certain program elements to virtual format even before the pandemic, according to Vanessa Meling, EdD, assistant dean for academic enhancement, thanks to a U.S. Department of Education Title V grant.

The nursing curricula consists largely of didactic and clinical courses posing barriers to academic assistance, so assistance programs like virtual PALS (Peer Assisted Learning Sessions) were already being piloted in 2019 with plans to offer one or two of the virtual sessions by 2020. The pandemic shifted the timeline into hyperdrive, says Dr. Meling. PALS Champion Student Leader and now alumna Julissa Del Bosque, BSN, RN, helped transition all of the learning sessions to virtual format using the popular Canvas interface and helped train PALS and tutor leaders how to conduct the sessions, all within a few days.

“To date, 72 percent of our currently enrolled undergraduate students have participated in at least one virtual academic support program,” Dr. Meling says. PALS remains one of the most popular and effective programs with participants consistently showing higher course grades.
The SSC used Canvas to build virtual support communities to serve as a centralized platform to host all student support content. One-on-one appointments with professional staff, Virtual New Student Orientation, student organization meetings, supplemental instruction and tutoring, and peer mentoring are all hosted using the Canvas video conferencing tool. An early alert management system called Starfish is embedded within Canvas and is used to streamline communication between students and faculty using data analytics to identify struggling students early enough so SSC staff can custom tailor interventions.

“We learned early on you can’t over-communicate during a crisis,” Dr. Byrd noted, and using Canvas allows them to target critical information delivery at just the right times to avoid communication fatigue.

Karen Walker Schwab (left), PhD, APRN, CPNP-PC, assistant professor/clinical, and Jacqueline Villarreal-Leal, a DNP-Pediatric Nurse Practitioner student, treat twin pediatric patients at Wellness 360, the School of Nursing’s clinical practice.

Transitioning all undergraduate coursework to 100 percent virtual was a challenge, says Cynthia O’Neal, PhD, RN, associate dean of undergraduate programs. “While the undergraduate program was considered ‘web enhanced’ pre-pandemic, we were basically a face-to-face program. So, we didn’t really pivot to online learning, but we pivoted very quickly to virtual delivery of a face-to-face program.” Thirteen didactic courses transitioned to virtual delivery within three weeks. Even so, “nursing is a practice profession, and the mode is interaction,” Dr. O’Neal adds. “These students thrive in a face-to-face environment, as do the faculty. We knew that lack of interaction would have a large impact.”

Fortunately, faculty had already started down a path of innovative education strategies in the preceding years, Dr. O’Neal adds. “They were already primed to embrace new technologies and products. After all, this is what nurses do. Nurses respond in times of crisis.”

Restrictions on clinical sections with academic-practice partners was certainly understandable. Hospitals and clinics were concerned about student and faculty safety, PPE shortages, and overburdening the system at a time when all hands-on deck were needed to respond to the pandemic. Until pandemic restrictions loosened somewhat by summer of 2020, the School of Nursing relied heavily on the Center for Simulation Innovation (CSI) to fill the clinical gap.

The CSI quickly ramped up its technology, course offerings, and hours of operation to meet the demand, offering more than 200 simulated clinical scenarios including surgical, intensive care, obstetrics, pediatrics and mental health. The center remained face-to-face throughout the pandemic providing a carefully controlled, safe environment for hands-on clinical learning.

“We went from a handful of courses doing simulation the past two years and increased our workload by 120 percent,” says James Cleveland, PhD, MSN, RN, director of the CSI. “Now, every undergraduate course has some form of simulation it.”

Thanks to two grants from the Texas Higher Education Board, the CSI upgraded several simulations as well as video and audio equipment to produce its own simulations including a video on proper PPE donning and doffing during a pandemic which has proven to be a critical factor in reducing transmissions in the health care setting.

Precautions to keep the CSI environment safe include mandated masking, limiting group size, visitor movement tracking, and constant cleaning protocols. The CSI reported not a single case of COVID transmission at the site, and no staff has tested positive. “The team has been extremely professional and remained intact, so we were able to maintain our full academic mission without a stumble,” Dr. Cleveland says.

Sara Gill, PhD, RN, IBCLC, FAAN, associate dean of graduate programs, estimates the BSN to DNP and master’s programs were less than 50 percent online pre-pandemic, and the PhD program was entirely face-to-face.

The CSI again helped fill the clinical gap, and the faculty rallied to shift didactic graduate courses online. “Our faculty members are amazing,” Dr. Gill says. “I’ve been at the School of Nursing for 22 years, and their commitment blew me away. Their main motivation was getting the students what they needed—no complaints. They took it in stride and did what they needed to do, came up with creative ideas, and took additional time to learn new strategies so they could deliver the best education possible.”

The School of Nursing master’s program requires 600 hours with a preceptor in a clinical site. While Governor Greg Abbott’s waiver of the 50 percent limit on simulated clinical experience helped for undergraduate students, it did not pertain to graduate APRN hours. Challenges remained for the graduate program.

“Even as clinical offices began to open up, they were often still reluctant to have students in their facilities, particularly when little was known about the virus,” Dr. Gill recalls. “When we did send them back, we had to handle logistics like providing appropriate PPE at each clinical setting.”

Graduate student enrollment has been down but only slightly since the start of the pandemic. Many practicing RN graduate students were forced to take leaves of absence until their workload decreases. “They are on the front lines, juggling mandatory overtime at the hospitals while caring for their children who are doing online learning,” Dr. Gill says. “Their stories are just heartbreaking.”

A disproportionate impact from the pandemic is borne by Latinx, African American, and other underserved populations in South Texas. Adelita Cantu, PhD, RN, associate professor of nursing, says many students witnessed first-hand the social determinants of health in vulnerable populations. “We had to think about how you get students to learn about population health, as well as social justice, and primary and secondary health promotion, with the same rigor we have always done, all while observing social distancing.”

With clinical opportunities scarce, students made weekly wellness calls to at-risk senior citizens. “They would check in with them, check on meal delivery, answer any questions they may have about COVID-19,” Dr. Cantu says. “Just saying ‘hi’ and giving these seniors somebody to talk with can have an impact on their health as they deal with feelings of social isolation. There is somebody who cares.”

Students also teamed up with Meals on Wheels drivers for socially distant in-person visits with seniors. “This allows them to see that health is not just what we deliver in the hospital, but health is something we deliver in the community as well.” Even the shy students, by the end of the year, Dr. Cantu recalls, “now looked forward to their calls and visits with seniors. The calls had really improved their communication skills and honed their observational instincts that they will continue to use in all aspects of their nursing careers.”

The pandemic challenged academic programs as it has challenged just about everything in our lives, but staff, faculty, and students rose to the occasion, according to Dr. O’Neal. “While students were naturally concerned about their own personal challenges with COVID, they still remained dedicated, committed, and enthusiastic about the profession. I found that really heartening, that’s just what you want to see in the next generation of nurses.”


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In the 2021 issue of Tribute

Tribute is the official magazine for the alumni and friends of the School of Nursing at The University of Texas Health Science Center at San Antonio. Read and share inspiring stories highlighting our alumni, faculty and students who are revolutionizing education, research, patient care and critical services in the communities they serve.

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