Taking an active role in your nursing education is one of the best ways to ensure you stay ahead of your training. Many nursing students and teachers swear to the effectiveness of using SNAPPS (Summarize, Narrow, Analyze, Probe, Plan, and Select) in their nursing training. SNAPPS is a learner-centered approach or model to presenting a patient case in a clinical setting that allows you to organize patient information meaningfully.
In this guide, our nursing writers will provide a learning activity for SNAPPS, define what the tool is and the steps involved, and provide effective tools on how to use it successfully.
As a nursing student, you must understand what SNAPPS is and how you can incorporate it into your clinical encounters. This way, you can develop your ability to organize information in a way that is helpful and guides your oral presentation. Therefore, during your studies, you will encounter an assignment like the following:
A. Using a patient encountered in the clinical setting, provide an oral presentation of the experience through Voice Thread or Kaltura through the SNAPPS model to the preceptor to mimic a real-life presentation:
B. In addition to the oral presentation, the student should submit their written findings for their research on the case and the identified self-directed learning topic.
C. The written assignment must be submitted on the “SNAPPS Template for Written Assignment.” This must be followed by the appropriate evidence-based references and use appropriate citation styles (APA format).
SNAPPS is an acronym that stands for the six steps of learning in a clinical setting (summarize, narrow, analyze, probe, plan, and select) and is used in clinical outpatient settings. As a teaching method for clinical training, SNAPPS allows the learning experience to be student-centered, where students begin by providing a concise summary of the facts to the preceptor, followed by the five steps of verbalization and reasoning.
In other words, you take an active role in your nursing education by doing the following:
Both students and preceptors are trained separately for about an hour on how to use the tool.
As a guide for patient presentations, SNAPPS can help you as a nursing student make the right diagnosis, identify clinical uncertainties, establish the need for learning, and differential diagnosis. For instance, research on the effectiveness of SNAPPS in clinical gynecology skills for midwifery students in Iran, showed that it significantly helped them in the diagnosis and treatment of common diseases.
When this is achieved, it creates a student-centered learning environment where you have more control over your nursing training process. For example,
If, during a clinical rotation, the patient being seen has asthma and the student in question is more knowledgeable about asthma, then it would help if they focused on asking the patients about themselves on matters that don't have to do with asthma. Asking questions about asthma could be seen as a time waste because the student already knows about it. Therefore, the student could ask a question that is not about asthma, for instance, about hypertension, since they don't have much knowledge about it. This way, they can control what they learn instead of relying on their teacher to do it.
SNAPPS targets learners as equals, if not as important as a successful contributor to their educational success. The model emphasizes that you and your teachers should have a collaborative interaction where you are taught how to lead. The role of the teacher in these cases is just to watch and guide through the clinical presentation to master the steps until you gain expertise in the training.
The six steps of SNAPPS are as follows:
Take the patient's history, perform physical assessments, and present your concise findings to the preceptor. Begin by asking the patient what brought them to the hospital, the symptoms they are facing, and the history of their health. Besides asking, you can also get this information by reviewing the patient's chart. If this is their second visit, note the significant changes to the patient's condition since they last visited the hospital.
Please note that the length of the summary varies depending on the complexity of a patient’s case. However, it should not be more than 50% of your learning encounters and only last between 3-5 minutes. Thus, during assessments, you should only present relevant facts because if the preceptor needs further information, they can get it from you.
For example,
Lindsay is a 56-year-old woman who works as an accountant and has been experiencing pain in her right arm for the past six months. No other body part has been affected, and he denies any other illnesses or conditions. She complains of having difficulty performing even the simplest tasks, such as lifting a cup of tea.
The preceptor should encourage you to use a higher level of abstraction to present the patient's case. In other words, you should use terms such as, semantic qualifiers where “yesterday” is acute and “the third time” is recurrent, to make a successful diagnosis.
At this point, you can explain two or three possible health issues the patient could have, particularly if this is the patient's first visit. For a patient's second (follow-up) visit, you could focus on why the patient’s sickness is active, present alternative therapeutic interventions, or suggest health strategies to prevent the worsening of the disease.
For examples,
Given the case, I determined that Lindsay could be suffering from either osteoarthritis, rheumatoid arthritis, or bursitis.
You must show commitment and enthusiasm at this stage, just like in the micro-skills model of clinical teaching. You should also present an initial differential early on to your preceptor before finally expounding or revising it.
Be advised that, at this point, the patient's needs should be prioritized. For instance, if the patient come to the hospital because of arm pain but they are presenting with severe chest pains, that should be addressed first.
You must engage in a case-focused discussion where you compare and contrast the different diagnostic
possibilities. An effective analysis is one in which you consider the patient's medical history, signs and symptoms, and current condition. It could also involve performing a physical examination, lab tests, vital signs, and the emotional state of the patient. Consider also asking about the patient’s environmental factors. The aim here is to get a comprehensive understanding of what could be going wrong in the patient’s life.
Ensure to verbalize this discussion in front of your preceptor. The analysis could be as follows:
Osteoarthritis is higher on my list given the age of the patient and because the conditions occur slowly over time; Lindsay has been experiencing pain for the past six months. Rheumatoid arthritis is lower on my list because the patient doesn’t have deformities and hasn’t reported any other illnesses. Bursitis is much lower on the list because she hasn't reported any injuries, and due to the nature of her job, there is no overuse either.
Sometimes, you could combine the analysis with the narrow differential diagnosis and compare and contrast each in turn. This process is effective in testing your critical thinking process and showing how you reached your conclusion.
Please note that all learners are different, and how you reach your conclusion will vary. However, the general expectation is that you should all follow the strategy for discussing the differential diagnosis through comparing and contrasting.
At this stage, seek clarifications or ask your preceptor relevant questions about what you don't understand. The preceptor, in turn, can answer these questions and clarify any areas of confusion, allowing you to understand what is being taught fully. Probing is the most unique step in the SNAPPS learning approach because it allows you to highlight what you don’t understand instead of the teacher controlling what you should learn.
Probing allows you to access the preceptor’s knowledge by asking relevant questions. In turn, the preceptor can gain an understanding of your knowledge base and thought process. Thus, you need to probe information on areas of importance in the clinical setting.
For example,
Is there anything else that you would include in the differential diagnosis?
The preceptor may provide any other diagnosis for the condition that you did not consider and offer an explanation for it.
Discusses a management plan for the patient with the preceptor and suggests possible intervention plans for the medical issue. You must show that you are committed to the process but are also open to learning from the preceptor by acknowledging their vast experience in the medical field.
The management plan is, essentially, the answer to the “what next?” question. Now that you have identified the diagnosis of the patient’s condition. Once this is identified, the healthcare professional must commit to the plan.
So, using the above example, the plan for Lindsay's health condition could be suggested as follows:
I would recommend a prescription-strength Nonsteroidal anti-inflammatory drug (NSAID), Duloxetine (Cymbalta). If these don’t work, I suggest Cortisone injections for the patient.
Finally, it would help if you chose focused, patient-based questions. After the case presentation or seeing the patient with your preceptor, you should identify a learning issue that is directly related to the patient's case. Take time to read on the matter and do more research to understand everything pertaining to the case. This reading should happen immediately after your encounter with the patient.
For example,
I would like to understand how NSAIDs can help with the pain and what cortisone injections can do.
In addition, you are encouraged to read on the specific matter to answer the question instead of reading a whole chapter touching on the matter.
The learner-centered tool can be used in other disciples as well.
Nursing and medical students who have managed to use SNAPPS during their clinical rotations have reported the following feedback:
Here are some tips on how to use the SNAPPS approach successfully in your nursing education.
Note that you can use the SNAPPS model to present and analyze a patient case study assignment.
SNAPPS is a learner-focused approach that helps students understand, organize, and retain critical information about the patient during clinical rotations. By implementing the model and effectively summarizing, narrowing, analyzing, probing, planning, and selecting, you can develop a holistic care plan that addresses patient's needs.
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