Two Childhood Cancer Survivors Share Unbreakable Bond at Children’s Hospital New Orleans

Two Childhood Cancer Survivors Share Unbreakable Bond at Children’s Hospital New Orleans

Two women battled cancer as kids; one inspired the other to follow in her footsteps to become a nurse. Both are colleagues at Children’s Hospital New Orleans (CHNOLA).

Laura Shinn, RN – Hematology/Oncology/HSCT Nurse Navigator at CHNOLA, says she went into nursing and specifically oncology because she just felt that there was this need to take the medical path. She was diagnosed with embryonal rhabdomyosarcoma in May 1987 and finished treatment shortly before her ninth birthday.

Jenna Cavalero is a nurse technician in her second year at Delgado Charity School of Nursing. She was diagnosed with osteosarcoma in October 2011 and was 12 years old when she went through nine months of chemo and several surgeries and was Shinn’s patient. She knew she wanted to be a nurse since the end of her cancer treatment.

“I feel like I connect more with these kids because of what I went through as a cancer patient. I remember being in their shoes, how I liked to be treated in certain instances, and seeing a little glimmer of light up inside them. It reassures them that they can beat cancer, they can conquer the disease, and hopefully come out on the other side,” says Cavalero

Our interview with Laura Shinn and Jenna Cavalero follows, edited for length and clarity.

Where did you go to nursing school, and why did you become a nurse?

Shinn: Mississippi College School of Nursing. I graduated from nursing school in May of 2005. For the third time, I decided to change my major to nursing because I felt this need to give back and help others in the same position I was in as a child. To show them the caring, compassion, and dedication provided to me as a cancer patient.

Cavalero: I am in my second year at Delgado Charity School of Nursing and will graduate in May 2024. I officially decided to be a nurse when I attended orientation at the first university I attended. Environmental science was my major, and I immediately switched to nursing. However, I knew from the moment I seriously considered career paths in high school. Nothing interested me more, even when I was not fully committed to being a nurse.

When I was going through cancer treatment, so many of the nurses who took care of me became family to me, and I want to be that for the patients I treat in the future. I bonded with many of the nurses and am still in contact with them because of their huge impact on my heart. I have always loved helping people and working with kids, so when I finally sat down and put all the pieces together, the decision to go to nursing school was a no-brainer.

What are your career goals when you graduate? 

Cavalero: After graduation, I would love to start my career at CHNOLA, and from there, I would like to see where life takes me. I would love to be a travel nurse one day, but right now, my focus is on graduation, and I will figure out the rest as I go.

What does working in the same hospital as the nurse who cared for you as a child mean to you? 

Cavalero: The feeling is surreal. The hospital has had a complete makeover since I was treated, so it looks very different, but so much of it feels the same to me. When I first started working at CHNOLA, I had a lot of memories rushing back to me from when I was treated, both happy and sad. I am grateful for the opportunity to have this job that I love, and I cannot wait to be a registered nurse. I used to joke around with some of the nurses I grew close to, saying things like, “You’ll see me here in ten years sitting behind the nurse’s station,” that dream becoming a reality is so exciting.

How does it make you feel knowing you inspired Jenna’s career path?

Shinn: Knowing I had any influence on Jenna’s career path is very humbling. You go into nursing to provide these young patients with the best care possible, but you rarely think of your care impacting and inspiring their future. It motivates me to be the best nurse and example I can be so she can strive for and surpass my illustration.

How did Laura inspire you to follow in her footsteps?

Cavalero: Laura has always been a great representation of how I would like to be as a nurse. She is kind, thoughtful, goofy, and joyful, and many other qualities make her great. Laura is always full of smiles whenever she walks into a room and works hard. Watching the way she takes care of patients and works with other members of staff is something I admire about her.

How is/did your nursing education prepare you for your role as a Hematology/Oncology/HSCT Nurse Navigator?  

Shinn: My nursing education prepared me for the basic, essential tasks of nursing, such as taking vital signs, but the on-the-job experience teaches you how to apply those basic textbook skills to your patient and hour-to-hour activities. In school, you learn how to take blood pressure and what a normal range is, but the on-the-job experience trains you to know when that pressure is life-threatening and requires immediate attention. What you learn in school is very important because it is the base to grow the knowledge that will be imparted to you during your career. But textbooks and clinicals won’t teach you to care and have compassion for your patient. To know what and how to cheer them up or improve their experience and when to sit and be present and supportive.

How is/did your nursing education prepare you for your role as a nurse technician?

Cavalero: My education has prepared me by knowing background information for the different disease processes the patients on my unit have and why they are being treated the way they are.  

How has having cancer as a young child and the kindness you both share for each other helped you forge an unbreakable bond with each other?

Shinn: To see someone you have helped reach a pivotal point in their life, whether it be simply remission or seeing them become a nurse, knowing they went through a similar journey, rewards you in the most significant way possible in this career. It’s a bond that cannot be broken or understood by anyone else. The smile says, “I know, and I know you know,” and fills your heart with warmth and joy. This is the bond Jenna and I will always have.

Cavalero: Deciding to disclose my medical history with a family is something I have yet to do often. I can imagine Laura was the same way when talking about her history. It’s a powerful thing that she shared with me and showed me that my thoughts of wanting to be a nurse when I got older could be a reality. Knowing that our situations were not the same but a little similar made Laura easier to talk to when I was having tough days because I knew that, on some level, she understood.

How does this bond translate to your patients?

Shinn: For me, our bond serves as a reminder to ensure every patient receives the best care possible. Not only physical care but providing the emotional care and support the patient and family need during their journey. One day, no matter what career path they choose, at least one positive thing you provided will remain with them and pass that same care on to the next person.

What is it like giving back to the profession that helped you as children?

Shinn: It is incredibly gratifying to provide care for the current patients in the same institution, with some of the same physicians who cared for me. It has been a dream of mine since I was young to be able to return to Children’s as a member of its staff, and now I can check that one off of my list.

Cavalero: Helping children is all I have ever wanted to do, and getting closer to graduation and being able to do that for my career is very exciting. I love my job as a nurse technician. I love going to work, learning from the nurses, and seeing all the patients. I am excited to be what all of the nurses who treated me were for me to someone else.

How do your personal experiences help you care for your patients?

Shinn: I try to remember how I was treated, how I would have liked to have been treated, and what I would have liked to have known as a patient, and apply it to my daily practice in a manner that is age and learning appropriate for the patient.

Cavalero: My personal experiences help me understand how they feel on good and bad days. A cancer diagnosis is scary for everyone involved, so being able to help in any way that I can is all I have ever wanted to do.

What is the most rewarding aspect of your job?

Shinn: It is one of the most rewarding experiences. All jobs have their good days and bad days, but in the end, seeing a child ring the bell at the end of their therapy or walk out of the clinic’s front door for the last time makes it the best job in the world.

Cavalero: Seeing my patients smile and having a good day while in the hospital is always a good feeling, but the most rewarding is watching them leave the unit when they are discharged to go home because they are always so happy. That makes my heart happy.

Potential for ChatGPT-Assisted Learning in Nursing Education

Potential for ChatGPT-Assisted Learning in Nursing Education

“ChatGPT-assisted learning has the potential to revolutionize nursing education, providing opportunities for enhancing the learning experience and outcomes for nursing students,” says Michael LeTang, MS, RN-BC, CCRN-K, vice president, chief nursing informatics officer for the risk management department at Healthcare Risk Advisors (HRA), a part of TDC Group, and an adjunct professor at New York University in the graduate nursing informatics program.

Daily Nurse spoke with LeTang about the potential for ChatGPT-assisted learning in nursing education.

chatgpt-assisted-learning-in-nursing-education

Michael LeTang, MS, RN-BC, CCRN-K, vice president, chief nursing informatics officer for the risk management department at Healthcare Risk Advisors (HRA), a part of TDC Group

How will AI-powered tools impact nursing education?

Personalized learning is one of AI’s most significant predicted influences on nursing education. ChatGPT could provide students with customized feedback, resources, and learning experiences, ensuring optimal learning outcomes. Additionally, AI-powered tools like ChatGPT could support nursing students in developing their clinical decision-making skills by providing real-time information, evidence-based recommendations, and assistance with clinical scenarios. This can be especially beneficial in developing critical thinking and decision-making skills, which are crucial for success in nursing practice.

AI technology is also predicted to enhance virtual simulation and immersive learning experiences, providing students with practical experience and developing clinical skills in safe, controlled environments. Although not a direct feature of ChatGPT, AI-driven tools could enable the development of virtual simulations and immersive learning experiences, allowing nursing students to gain practical experience.

However, it is important to note that the role of educators remains vital in guiding students to connect course content with real-life situations and ensuring they can effectively apply their knowledge and skills in the context of patient care. Therefore, a balanced approach integrating ChatGPT-assisted learning with traditional teaching methods can enhance nursing education, prepare students for an ever-changing professional landscape, and ultimately improve patient outcomes.

What are the potential misuses of ChatGPT in nursing education?

While ChatGPT can serve as a valuable supplementary resource in nursing education, potential misuses, such as overreliance on AI-generated information, inadvertent neglect of human interaction, fostering complacency, or misinterpreting knowledge, could hinder nursing students’ learning process and professional development.

Nursing education emphasizes theoretical and practical knowledge, so students must apply AI resources like ChatGPT responsibly and cautiously.

A few potential misuses and their possible consequences:

  1. Overreliance on AI-generated information: Students may excessively depend on ChatGPT to answer questions or provide insights without cross-referencing the information with other reliable sources. This could lead to misconceptions, misinformation, and poor decision-making, potentially harming patient care in the long run.
  2. Inadvertent neglect of human interaction: The convenience and immediacy of ChatGPT may inadvertently lead to students favoring digital interactions over human connections. This could impact their interpersonal skills and empathy, essential in nursing. Maintaining a balance between AI assistance and personal communication with educators, mentors, and peers is crucial.
  3. Fostering complacency: The ease with which students can obtain answers from ChatGPT might foster a sense of complacency, reducing the motivation to delve deeper into complex subjects or develop critical thinking skills. Students should always be encouraged to explore beyond the information provided by AI and strive for comprehensive understanding.
  4. Misinterpreting knowledge: AI-generated information may occasionally be ambiguous or misleading, resulting in students misinterpreting the content. Students should be taught to critically evaluate the information they receive from AI sources and cross-check with authoritative references to ensure accuracy.
  5. Ethical concerns: Using AI tools, such as ChatGPT, in nursing education raises ethical concerns around data privacy and security. Students should be aware of these concerns and adhere to guidelines and best practices when using AI technology.

How can educators maximize ChatGPT in nursing education?

To maximize the benefits of ChatGPT in nursing education, educators must guide students on how to responsibly utilize AI as a supplementary tool while emphasizing the importance of critical thinking. This will ensure that future nurses are well-equipped to provide high-quality patient care while responsibly embracing AI technologies.

Using AI to Transform Nursing Education 

Using AI to Transform Nursing Education 

Big data and machine learning already impact most aspects of modern life, so there is growing optimism about using artificial intelligence (AI) to transform health provider education.

Cristina Lussiana  is a senior program manager of digital health and monitoring at Population Services International (PSI) and an expert in the health applications of AI.

Daily Nurse spoke with Lussiana about using AI to transform nursing education.

What follows is our interview, edited for length and clarity.

using-ai-to-transform-nursing-education 

Cristina Lussiana is a senior program manager of digital health and monitoring at Population Services International (PSI) and an expert in the health applications of AI.

How has AI integration become more prevalent with technological advancements in the healthcare field?

Recently, progress in digital health has led to larger medical-related datasets, and technological advancements have made it possible for these larger datasets to be processed quickly. At the same time, there has been an increased awareness of AI’s potential to sustain and accelerate positive health outcomes. Think of electronic medical records (EMRs), medical imaging, and genomic data and how AI algorithms might identify patterns and trends faster and more accurately than human analysis. AI algorithms can quickly provide insights to help prevent, diagnose, and treat—leading to better health outcomes!

How can AI be used to improve health on a global scale?

In some countries, public health resources are scarce, and it’s mandatory to target these resources where they are more effective. This is where AI can play a role: helping to identify areas that we can invest in to build stronger and more resilient health systems. For example:

  • Through personalized medicine based on an individual’s medical history and lifestyle, AI can support health practitioners in developing tailored screening and treatment plans. For example, in Kenya, we partnered with Audere on a research project to assess HealthPulse AI, a suite of AI-powered tools for clinicians, Community Health Workers (CHWs), and health consumers. We studied whether the tools could improve the accuracy of administering and interpreting malaria Rapid Diagnostic Test kits (RDTs) by CHWs and health workers in private clinics. HealthPulse AI uses machine learning and computer vision to improve the accuracy of rapid diagnostic test kit results. It requires only an image of the RDT captured by the user’s smartphone to interpret the results of the RDT and can read even the faint test result lines that expert test readers may miss. This pilot project demonstrated that AI-powered tools in health workers’ hands and CHWs’ hands could improve the accuracy and interpretation of rapid diagnostic tests and positively impact the quality of care consumers receive. Additionally, it holds potential as a mobile tool that can be scaled up for use in low-resource settings with potential benefits as a supportive supervision, diagnostic, and surveillance tool. The project also confirmed that health facilities and CHWs would accept and welcome such a tool.
  • When accessing health-related information, AI-powered chatbots can provide accurate information and direct consumers to relevant health facilities, even in areas with limited resources. For example, in late 2022, PSI and Babylon launched AI OI, a new digital health service focused on supporting people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system. Piloted in Vietnam, the new, free 24/7 service gives users more control over their access to healthcare, triages users to the appropriate level of care, and signposts to high-quality providers in their local area. And it saves people time and subsequent loss of income from taking time off work and paying unnecessary out-of-pocket expenses.
  • By analyzing large datasets and identifying patterns, AI algorithms can support governments and public health implementers in predicting outbreaks, playing an important function in health security.
  • For research and development, AI has the potential to advance progress in medicine by, for example, identifying potential drug targets and improving the sensitivity and specificity of diagnosis.

Yes, AI can potentially improve health globally – but only once we have determined who leads and how we implement it.

Does ChatGPT provide nursing students with a convenient and accessible way to access information and practice clinical skills? Talk about the potential for ChatGPT-assisted learning in nursing education.

ChatGPT provides students with a wealth of information that can fit their educational needs.

  • ChatGPT offers students a variety of case scenarios and medical questions for research and practice.
  • ChatGPT can also facilitate group work – students can work on similar case scenarios and exchange ideas.
  • Students can stay current on the latest guidelines and best practices in medicine and have access to nursing education materials for free, even from low-resource areas.

But it does not, and should not, replace in-person training. With ChatGPT, students won’t have the in-person experience to treat patients, including emotional intelligence development and hands-on clinical care.

What are the potential misuses of ChatGPT in nursing education?

ChatGPT can be a valuable tool in nursing education; however, there are some misuses that students need to be aware of, namely:

  • AI-related bias: AI algorithms are based on the type of data they are fed. Despite technology advancements to ensure a great deal of variety in datasets, there are limitations to the accuracy and usefulness of AI technology in contexts and scenarios that represent a case for a bias, resulting in inaccurate or unfair recommendations.
  • Lack of domain-specific knowledge: In some cases, ChatGPT might not be up to date on emerging diseases and changing patterns in specific health-related topics or specialized medical fields.
  • Lack of or limited understanding of context: This might quickly change even when trained in a specific context. ChatGPT might not always correctly understand the context where its answers should operate, resulting in inappropriate responses.
  • Overreliance on technology: Similar to how calculators can limit mental math abilities, there is the risk that ChatGPT users over-rely on the technology and don’t train their clinical memory and critical thinking muscles. These are skills for nurses to make decisions adequate to their patient’s unique needs and contexts.

As AI continues to develop, will it replace educators in the future?

According to Oxford Languages, education can be defined as an enlightening experience. This goes beyond transferring knowledge and skills from one human being (or an AI) to another. AI technology cannot offer the level of human interaction, debate, discussion, and involvement needed to spark a rich learning experience. Also, because of the limitations of AI technology listed above, it is unlikely that the role of educators will be replaced by AI technology. AI has the potential to complement and enhance education. Still, it cannot replace what educators offer regarding human interaction and soft skills like critical thinking, understanding of the context, empathy, communication skills, and creativity.

If acquiring knowledge becomes increasingly accessible, what will be the role of higher education in an AI world?

Assuming that in the next ten years, knowledge will be increasingly accessible through AI technology for free, the role of higher education might evolve to concentrate on skills and competencies that cannot be learned via AI, like emotional intelligence, critical thinking, interdisciplinary learning, contextualization, and prioritization. Furthermore, highly specialized education in medical fields requires education that is not AI-based.

What kind of education and training do we need to provide our nursing students so they become highly qualified geriatric nursing professionals?

The world population is getting older, and we know this trend won’t reverse. Hence, nursing needs highly qualified professionals who confidently and competently manage geriatric patients. This entails offering students a comprehensive package of educational knowledge and skills that prepare them to care for an aging population in different aspects, from the medical to the mental one. Specific education topics include geriatric diseases, management of chronic diseases, mental health, palliative care, emotional intelligence, and ethics. This ensures geriatric nursing professionals have diverse skills that equip them to deal with older adults who might experience chronic or aging diseases, mental health issues, and emotional burdens related to loneliness, isolation, and anxiety due to a fast-changing world where it’s difficult to catch up. Furthermore, we want to ensure we equip geriatric nursing professionals with the tools they need to support older adults in making life/death choices in an ethical way.

Does this mean that training critical thinking, rather than delivering the content of the class materials, becomes more important than ever?

Absolutely, and this is not just about AI! Knowledge and information have been broadly available and accessible since the world wide web. Now, AI technology presents this information in a tailored and targeted way. However, the need to develop critical thinking and emotional intelligence is still there. Problem-solving, debating, collaboration, coordination, prioritization, evidence-based decision-making, making assumptions, and contextualization are soft skills that allow students to apply knowledge and information, regardless of where they have acquired these from (classroom training, AI chats, etc.).

How should we evaluate students’ competency in acquiring knowledge in the classroom? Should we start implementing traditional paper and pencil formats for exams?

Traditional paper and pencil formats are still very effective for evaluating students’ competency. These can be complemented by other assessment methods like practical skills assessments, where students are required to prove their competency on a case scenario (real or simulated), or project-based assessments, where students are required to develop a specific project to demonstrate the knowledge and skills acquired (i.e., a literature review, a group project, etc.).

While we are making concerted efforts to address health disparities and promote equity globally, do you see the advancement of technology further widening the digital divide across populations with various socio-demographic characteristics (e.g., age, socioeconomic status, and geographic locations)?

Digital health and technology, in general, have the potential to improve healthcare even in low-resource settings. However, it is widely accepted and recognized that technological advancements can widen the digital divide across socio-demographic groups because not all groups have equal access to technology. There is the risk that technological advancements benefit only some of us, leaving behind people with specific socio-demographic characteristics.

There are disparities in the data used to train AI algorithms because underserved populations often lack access to digital health, and their data is not represented in these datasets. This can result in health disparities because AI algorithms do not represent diverse populations, leading to inaccurate or discriminatory results, particularly for those living in low-and-middle-income countries.

As we work toward Universal Health Coverage, it is important to design technology in a way that takes equity and inclusion into consideration, and that is freely available and accessible to all population segments, like zero-rate or low-cost internet access, digital training, language-inclusive content, inclusion of technology elements for people with disabilities, and so on.

Anything else to add?

We now collect data while we offer services like diagnostic, triaging, and signposting. That is because of Fast Healthcare Interoperability Resources (FHIR). This standard describes how to collect, store, use, exchange, and distribute workforce-related information and patient and health data, regardless of the application used. By implementing FHIR and consumer-facing data, we can identify patterns in digital health that point to causalities the human brain cannot quickly identify.

ChatGPT and Its Potential in Nursing Education

ChatGPT and Its Potential in Nursing Education

Artificial intelligence (AI) offers incredible potential to improve health on a global scale, and ChatGPT, an artificial intelligence chatbot developed by OpenAI, shows great promise as a convenient and accessible way for nursing students to access information and practice their clinical skills using ChatGPT-assisted learning in nursing education.

Cara Lunsford , RN, CPHON, is the vice president of community at Nurse.com, where she fosters a community where nurses can find peer support, allies, professional opportunities, resources, and education. Lunsford has 16 years of experience in acute care, home health, and home infusion settings. 

Daily Nurse 
spoke with Lunsford about using ChatGPT in nursing education, the role of nursing educators in an AI world, and lessening the digital divide to make technological advancements accessible for all.

What follows is our interview, edited for length and clarity.

How has AI integration become more prevalent with technological advancements in the healthcare field?  

AI supports simulations to give students and clinicians more practice in safer environments before they begin working with human beings. AI also can bring a broader range of knowledge together more quickly for potential further exploration of the best course of action. Additionally, as ChatGPT becomes more accurate and reliable, students can use it on their own time and in a private setting. They’ll likely feel more comfortable asking questions without fear of judgment from instructors or other students.

How can AI be used to improve health on a global scale?

The demand for healthcare will only continue to increase across the globe as the population ages. However, with challenges related to staffing for both nurses and physicians, AI presents opportunities to reduce costs for organizations and limit exposure to contagious diseases, especially in underserved areas of the world.

Patient populations are also becoming more complex, and we will continue to face increasing global health challenges, such as COVID-19. People will continue to travel more than before. Viruses will spread more quickly than we can keep up with. However, we can provide global health equity with immediate access to evidence-based best practices that will eventually be available through AI. As a result, we can save hundreds of thousands of lives.

Does ChatGPT provide students a convenient and accessible way to access information and practice their clinical skills?   

As ChatGPT becomes more reliable, it will allow nursing students to build clinical and interpersonal skills in a more controlled setting. Whether simulating patient interactions or explaining a clinical procedure, ChatGPT has the potential to be an excellent resource for basic information that nursing students can use as a starting point and then expand their knowledge. 

Talk about the potential for ChatGPT-assisted learning in nursing education. 

ChatGPT could create scenarios or personas for students as they think through the best course of action in providing care for an AI-simulated patient or communicating with a simulated family member. Additionally, ChatGPT can help summarize complex topics in courses nurses often find challenging, such as chemistry or pharmacology. Having a non-textbook take can help break learnings down into digestible pieces.

What are the potential misuses of ChatGPT in nursing education?

Using the current iteration of ChatGPT to diagnose or provide care plans would be dangerous. The information provided by AI can be a valuable time saver; however, the results of queries can contain outright errors. While ChatGPT has numerous advantages, you can run into ethical issues in nursing education, such as plagiarism or cheating. ChatGPT can create unique pieces that include scientific data depending on your prompt. However, it removes the essential components of completing your research, compiling your data, and formulating your thoughts. It can be a slippery slope. On another note, when ChatGPT creates each text, it may be missing critical elements like tone, which makes writing more authentic and personal. ChatGPT lacks empathy – something all nursing students need. 

What are some of the potential limitations and fallacies in the use of ChatGPT? 

As noted, the current iteration of ChatGPT sometimes contains errors in answers to queries. Also, the software cannot currently provide citations for the source of the information in its responses. In nursing education, this has a dangerous potential for students to act on erroneous information. Student nurses will continue to need guidance from educators with years of experience who have well-developed judgment and hands-on knowledge of nursing protocols and pitfalls. ChatGPT cannot also pull recent data. Students seeking information on recent clinical trials or new protocols for patient care might receive responses needing more current data.

As AI continues to develop, will it replace educators in the future?

While AI has advanced rapidly, it’s unlikely it will completely replace human educators in the near future. Educators provide more than just information; they’re mentors, counselors, and more, to their students. Human educators can also empathize with students, bringing creativity and critical thinking to the learning process, which isn’t what AI is known for. Education is a social process, and human interaction, especially in medicine, is essential for effective learning. While AI has its growing list of uses and benefits in the educational realm, it can’t fully replace in-person interaction between educators and their peers, educators and their students, or the human perspective. Right now, AI can serve as a tool to augment the work of educators, providing personalized and adaptive learning experiences and automating routine tasks. This gives educators time to focus on providing their students mentorship, support, and guidance.

Additionally, nursing education is all about hands-on clinical experience. Student nurses stand to absorb more information and build more confidence through hands-on clinical experiences with nurse educators at the helm. While ChatGPT is a helpful piece of technology and can aid in giving students further academic support, it can’t replace the one-on-one guidance they receive from their nurse educators during their most formative years in nursing.

If acquiring knowledge becomes increasingly accessible, what will be the role of higher education in an AI world?

Making knowledge more readily accessible is a good thing. You might ask an AI tool: Give me three options for providing care to this person in this simulated scenario. Compiling knowledge and ideas more quickly can aid life-saving actions. But it can also empower life-threatening actions if misused. Nurses must have supervised early experiences to build their expertise. They need sounding boards and critical feedback as they develop their nursing skills. When a nurse returns to school for an advanced degree, it validates employers and peers that this person has gained access to a certain degree of information that will help them advance in their career. A BSN, MSN, or PhD will still stand as a confirmation that a nurse has not only received the higher education but that they were able to apply it to their practice and demonstrate an understanding of that information. Higher education is vital to developing good nurses we can trust to do the best for their patients.

Does this mean that training critical thinking, rather than delivering the content of the class materials, becomes more important than ever?

Critical thinking and gut instinct have always been vital for nurses, which is necessary for good problem-solving. Student nurses must be aware of anything that rings alarm bells, just as it is for experienced nurses. As general content becomes more available through AI, it will be imperative that nursing educators use their time to help students hone their critical thinking skills and instincts. If something seems off, asking a more knowledgeable nurse, or getting a second opinion, is a good course of action. However, nurses must think quickly and act based on their knowledge and experience. Using AI for information gathering and suggesting solutions can be a time saver, but relying on AI for clinical decision-making could have tragic outcomes.

How should we evaluate students’ competency in acquiring knowledge in the classroom? For example, should we start implementing traditional paper and pencil formats for exams? 

At every level, we have to trust nurses to make ethical decisions. For student nurses, knowing how to find reliable sources and remember evidence-based practices is crucial to their future careers and the safety of their patients. So, digital exams are still valuable. Requiring students to cite their answers’ sources can ensure they know how to find the information they need to succeed in nursing.  

The best kind of competency evaluation for nurses still resides in clinical practice and access to simulations. Instead of going back to paper and pencil, we should look at ways of harnessing technology so we can place student nurses in virtually realistic situations so they can make real patient care decisions. 

While we are making concerted efforts to address health disparities and promote equity globally, do you see the advancement of technology further widening the digital divide across populations with various socio-demographic characteristics (e.g., age, socioeconomic status, and geographic locations)?

Like every tool and skill, that depends on how we put the technology into practice. Technology can help spread the word about differences in populations and individuals more quickly. For instance, it can help us recognize disease trends in certain populations. It can help more people around the world be aware of cultural resistance or preferences for communicating, being approached by caregivers, and receiving care. In the past, some research findings used male populations and extrapolated those results to females. With technology, we can share broader and specific knowledge more quickly and widely. That, in turn, allows critical and sometimes opposing views to be shared more quickly, adding to critical thinking and sparking further research. While there will always be those that embrace or resist new technology, it also raises the question, is it accessible? Creators of technology, like ChatGPT, place themselves in unique positions to deliver information and services more quickly. However, it’s essential to recognize what must be done to make technological advancements accessible for all. For example, internet access is still not as widely available in certain geographic areas, creating limitations for populations living there. As a result, healthcare resources such as telehealth services become more limited and inaccessible for those populations. I believe steps have been taken to make healthcare resources and services through technology more equitable to these populations, but more work needs to be done to lessen this divide.

How Orbis is Using AI in Cybersight Program 

How Orbis is Using AI in Cybersight Program 

Artificial intelligence (AI) holds significant potential in nursing education to create more sophisticated and complex simulations that help nursing students develop critical thinking skills and prepare them for real-world patient care situations. However, as with any new technology, it also presents concerns and controversies about its use in nursing education.

Dr. Hunter Cherwek is the vice president of clinical services and technologies at Orbis International , with a specific interest in how training and technologies can be used to eliminate avoidable blindness in low-resource communities around the world. In his role, Dr. Cherwek supports Orbis’ clinical training efforts and patient care programs.

Daily Nurse spoke with Dr. Cherwek about Orbis’ use of AI in their Cybersight program and AI’s role in nursing education.

What follows is our interview, edited for length and clarity.

how-orbis-is-using-ai-in-their-cybersight-program

Dr. Hunter Cherwek is the vice president of clinical services and technologies, Orbis International. Photo by Geoff Oliver Bugbee

How can AI be used to improve health on a global scale?

More people in the world have access to the internet than clean water. For example, 98% of adults in Kenya have a cell phone. There are more ways of reaching patients and offering them services than ever. AI has huge potential to diagnose and treat patients in areas where that was previously impossible.

Regarding global eye care and avoidable vision loss, AI can bridge the physical distance required for diagnosing eye diseases. Orbis has shown in places like Rwanda, Vietnam, and Bangladesh, where eye care clinics are few and far between, that AI can detect signs of serious eye conditions like glaucoma, diabetic retinopathy, and macular disease within seconds. This means patients can get treatment immediately or be referred to a specialist at the same appointment without undertaking more costly and sometimes arduous travel or taking time away from home and work obligations.

In eye health, we also see AI acting as an awareness and education tool. AI can better educate patients and health care providers, especially technicians in rural clinics.

AI is a tool in the doctor’s tool belt. It is not a replacement for the doctor. It is a way, say, for a healthcare worker in a rural clinic, often the only eye health provider for hundreds of miles, to diagnose and treat more efficiently the patients who need their help the most.

Does AI provide students with a convenient and accessible way to access information and practice clinical skills?

Yes, AI-assisted searches, AI-assisted education, and AI-assisted diagnosis are all valuable tools for a student. At Orbis, we have trademarked the term “machine mentoring.” Instead of just learning from a machine, we use machines and AI to mentor doctors, nurses, technicians, and patients. We see huge potential – when AI is properly supervised and studied – to help educate at all levels of eye care, from the patient to the surgeon.

Talk about how Orbis uses AI in its award-winning Cybersight program to expedite teaching, common diagnosis, and in-person training via its Flying Eye Hospital program.

Orbis’s robust telemedicine program, Cybersight, has been important in educating eye care professionals for over 20 years. It started at the dawn of the internet. The platform’s AI tool is only one of its features. Cybersight also connects healthcare workers in their home country with recognized experts from around the world to consult about specific patient cases, participate in live lectures, watch live surgeries, and take virtual courses in eye health. This method has proven to be successful not only in improving patient care but also in mentoring the next generation of eye care professionals.

Now, when a doctor logs on to Cybersight and requests a consult with a world-class expert, they can enable AI to help detect certain diseases by simply submitting a picture of a patient’s retina. The AI can give an immediate result when the patient’s data is submitted, and the image is uploaded. The doctor on the ground at their clinic can take action to treat the patient sitting in front of them before they even speak to the expert. The AI acts as a mentor because it shows the doctor how to recognize the patterns that are attributed to the disease it found. For example, the AI will highlight where the signs of glaucoma are located in the picture and how advanced the case is. Over time, the doctor will learn how to diagnose the condition on their own.

We use Cybersight before and during our Flying Eye Hospital programs. Orbis’s Flying Eye Hospital is the world’s only fully accredited ophthalmic teaching hospital on board an MD-10 aircraft. The Flying Eye Hospital is a state-of-the-art teaching facility with an operating room, classroom, and recovery room. On board, the Flying Eye Hospital, Orbis’s Volunteer Faculty, and clinical staff share their knowledge and expertise with local eye care teams. We use Cybersight to prescreen patients, often using AI, even before the plane has landed in a new country to begin a surgical training program. During the program, we use AI teaching, and we conduct workshops on AI.

What are the potential misuses of AI in nursing education?

AI, as an educational tool, can make a student’s learning faster, but it may not make it deeper unless it is used correctly. Like any tool, it can be used for good or bad. I worry that people will use AI to bypass knowledge that usually becomes hardwired through the learning process. So much of what we are trying to learn in medicine is judgment, critical thinking, and assessment workflows. If AI gives you the answer and you haven’t learned the why behind that answer, you could be doing yourself a disservice. AI can’t teach you how to think like a nurse. AI can’t teach you the human side of nursing. It can’t teach you how to get to a differential diagnosis, create a knowledgeable treatment plan, and build soft skills like communicating with patients and showing compassion.

Also, healthcare professionals would become dependent on AI without developing full competency. On the other hand, AI could be the best thing for a motivated self-starter student. With AI, they have more access to books and more synthesis of information and data. But someone uninterested in self-learning or self-development could quickly become dangerous.

What are some of the potential limitations and fallacies in the use of AI?

Technology is very good at amplifying the behaviors and systems that are already available. Simply throwing technology at a problem cannot solve the problem alone. It is going to enhance what is already there. AI can enhance a good system that is already in place or make a bad one worse.

We don’t know all of AI’s limitations or benefits yet. It’s a field in its infancy, and we are just starting. Orbis is leading the charge in developing AI in global eye health to find the potential benefits of this fascinating new technology.

Anything that can make the human experience better and improve human suffering is a technology I want to explore. I want to validate, test, research, and ensure it gets to the right people for the right purposes.

As AI continues to develop, will it replace educators in the future?

AI can make educators more powerful and more impactful. But there is an element of humanity in medicine and teaching that a machine can never duplicate. AI cannot teach the nuances of interviewing patients and how to show human kindness and compassion. A huge part of the medical field is not about science. Medicine is a very human experience. It is about listening to someone cry when they lose their loved one. It is the art of telling someone about a bad diagnosis while providing hope and a path forward. We can’t outsource humanity to a machine. There is no algorithm for compassion.

Does this mean that training critical thinking, rather than delivering the content of the class materials, becomes more important than ever?

A single lesson can give a student data, information, and knowledge. But the wisdom to use this data, information, and knowledge is where it counts. The hardest thing a surgeon needs to learn is judgment, not how to operate. My favorite professor in ophthalmology said the best surgery he ever did was the one he never started. The ability to evaluate risk and reward cannot be replaced. Technology will help us if we don’t lose sight of our humanity and use it to multiply the information at our disposal.

How should we evaluate students’ competency in acquiring knowledge in the classroom? For example, should we start implementing traditional paper and pencil formats for exams? 

Traditional testing methods to measure knowledge remain critical. But also, it will become more important to evaluate students with oral exams and in role-playing scenarios with actors playing patients. These tests can assess students’ judgment and how much they have internalized the material.

While we are making concerted efforts to address health disparities and promote equity globally, do you see the advancement of technology further widening the digital divide across populations with various socio-demographic characteristics (e.g., age, socioeconomic status, and geographic locations)?

I worry about two divides: the digital divide and the data divide.

We are familiar with the digital divide, where modern technologies are inaccessible in low-resource regions. The data divide is less visible but equally as important. When data from specific populations or regions are not included in a data set that helps determine an algorithm, that algorithm becomes biased and less reliable. At Orbis, we are leading the way to closing both divides. Our goal is to leverage technology and training to connect doctors and eye health professionals with mentors and education, connect patients to the best care, and create a thriving community where eye care is prioritized and eye diseases are understood. It is the job of nonprofits, like Orbis, to globalize access to technology and education, which is exactly what Cybersight does. Cybersight is giving eye health professionals access to world-class training at no cost, no matter where they live.

Anything else to add?

There are thousands of nurses using Cybersight. I encourage your readers to log on and take a look around!

Last-Minute Advice – Preparing Your Students for the NCLEX

Last-Minute Advice – Preparing Your Students for the NCLEX

May signifies everything we look forward to–time for graduations, pinning ceremonies, vacations, and anticipation for warmer weather; however, for the recent nursing graduate, May also signifies a time for preparation for one of the most important exams they may ever take, NCLEX. Graduates can look forward to taking the NCLEX if they remember PUPS. (More on PUPS below).

As nurse educators, we know that prepping for NCLEX differs from preparing for a classroom exam. For one, the NCLEX is a cumulative exam that focuses on one thing, clinical judgment. Can the student make the best decision for their patient at the bedside?

Secondly, the NCLEX tests integrate processes like safety, infection control, and physiological integrity throughout the test. Its not divided into pharmacology, pediatrics, and management like nursing school courses and tests. It is a comprehensive evaluation of the nursing graduates ability to holistically care for a patient, from basic care and comfort to management of other healthcare staff.

Because of this comprehensive and integrated approach, questions may look different and be perceived as more difficult. Medications and disease processes the student did not learn in class may be tested. For most students, the unknown is a scary concept. However, there are things we can do, even last minute, to prepare our students.

Remember PUPS. If youre like most nurses, we care for humans and animals. Hopefully, PUPS is an easy to remember mnemonic and one with a positive connotation.

Practice NCLEX-style questions

Understand the NCLEX

Practice anti-anxiety techniques

Show up prepared

Practice NCLEX- style Questions

There are studies and literature that state a student must answer 5000 to 10,000 questions to be deemed ready for NCLEX. There are hundreds of websites that students frequent that provide many different numbers. I have seen very specific numbers, from 2800 questions to as low as 500. Quantity matters, but quality matters more.

We must inform our students that practicing NCLEX-like questions is critical to success and where they can find those questions. Please provide them with the names of credible resources and encourage them to practice as many questions as possible.

Practice means answering the questions and remediating them to understand what they do and dont know. Practice does not mean answering question after question but never reviewing the answers and rationales. The question banks students use for preparation should include an opportunity for testing in an NCLEX-like environment and provide a review of answers with rationales. The practice question banks should also have alternate-type questions on NCLEX and be written at the cognitive levels of application and analysis.

Practice means simulating the real testing environment by sitting in a quiet room and answering the questions on the computer while you time yourself. The NCLEX today is 75-145 questions with a five-hour allotment. Encourage your students to take a 75-question minimum test and to take several 145-question tests as well. Practicing a few questions at a time is okay but should be only some of the practice. 

Endurance is important. Most students graduate from nursing school and have never taken more than 100 questions at one time. However, they must practice a 145-question test and note when they get tired or lose concentration to take a break in the real” test. Therefore, a student should never sit for NCLEX without having the benefit of practicing 145-question tests. 

Understand the NCLEX

All students taking the NCLEX should have visited the website ncsbn.org many times. They should know the NCLEX blueprint–the definitions of the client need categories tested and at what percentage they are tested. Students want to know what is on the test to feel more comfortable and confident. The NCSBN gives them that information. Maybe not to the specificity the student wants, but it provides much beneficial information, and knowledge is power.

For example, a student must know that physiological adaptation, management of care, and pharmacological and parenteral therapies make up almost 50% of the NCLEX-RN. Therefore, these three areas command more attention than the other five areas of the test plan.  

Students should also watch the videos on the ncsbn.org website that explain the testing procedures for check-in and while taking the test. These videos include what you can and cannot bring with you, allowable breaks, accommodation requests, and much more. Knowing what to expect lessens anxiety.

Practice Anti-anxiety Techniques

As mentioned above, one of the reasons students practice questions is to understand their mental and physical endurance. Students should note when they get tired or lose focus while taking a long exam. For some students, thats around 50 questions. For others, its about ten questions. Students need to know this before sitting for NCLEX. When they reach their limit, instruct them to take a mental break. That could mean taking fingers off the keyboard and eyes off the screen, completing a few stretches of the shoulders and neck, or taking a few deep breaths.

A quick note about deep breathing: its not just something to do. Deep breathing better oxygenates your brain, stimulating the parasympathetic nervous system, which aids in calmness. Deep breathing is an important anti-anxiety strategy for us all. 

Other techniques to combat anxiety include getting adequate sleep (which is especially important the night before the test); eating a good meal before the test so that you are not hungry (do not overdo it on carbs or sugar, which can cause sleepiness); proper hydration preferably with water and a bathroom break before the exam; positive talk before and during the exam (You got this!); eating peppermint candy or chewing peppermint gum which can decrease anxiety and possibly increase mental alertness (Ive had several students who swear by peppermint); and the most crucial technique to combat anxiety, is tip #4–show up prepared.

Show Up Prepared

There is no better technique for success than attending an exam and feeling well-prepared. Know where the testing center is and leave early to give yourself plenty of time for unexpected traffic. Students should double-check with ncsbn.org that they have the correct documents to get into the test.

At this point in their preparation, they know the content, the process, and what to expect. There are no surprises because they have used PUPS – practiced thousands of questions, understand how the test works and what is being tested, know how to calm anxiety because they have practiced calming techniques, and are showing up prepared and confident.

_______________

References

https://nursejournal.org/resources/nclex/tips-on-passing-the-nclex-from-nurses/

https://www.ncsbn.org/2019_RN_TestPlan-English.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814313/

Hanson-Zalot, M. , Gerolamo, A. and Ward, J. (2019) The Voices of Graduates: Informing Faculty Practices to Establish Best Practices for Readying NCLEX-RN Applicants. Open Journal of Nursing9, 125-136. doi: 10.4236/ojn.2019.92012.