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Simulated Learning Experiences

            Simulated clinical experiences enhance learning. A simulated learning environment provides a safe and efficient acquisition of clinical skills (Mendoza-Maldonado & Barria-Pailaquilen, 2018). It also serves as an efficient alternative when there may be limitations to for clinical practice in certain areas (Mendoza-Maldonado & Barria-Pailaquilen, 2018). In this week’s discussion, implementing simulation learning experiences will be explored.

Past Learning Experience

 In nursing school, I can remember being taught the respiratory and cardiac units in class. The objectives were identifying abnormal breath sounds and heart tones respectively.  In the respiratory unit, I can recall the instructors telling us to auscultate each other’s lung sounds. She stated that we had to know what normal breath sounds sounded like before we could identify abnormal breath sounds. That statement is true but we could have benefited more from high-fidelity patient simulators (HFPs). According to Bradshaw and Hultquist (2017), HFPs generate observable responses from a mannequin and allow students to interact with the simulator as they would an actual patient. Additionally, the cardiac unit could have benefitted from a simulation lab. As a nursing student, having HFPs would have enhance the heart tones. I was not able to identify abnormal heart tone until I graduated from nursing school. I found myself “googling” abnormal heart tone to refresh my recollection of what was taught in nursing school and how to identify them.

Utilizing Simulated Clinical Labs

 In retrospect, I believe that HFPs would have prepared me more for the clinical experience. “Simulation may be useful to precede, complement, or replace actual clinical experiences” (Bradshaw & Hultquist, 2017, p. 248). Simulated learning experiences are beneficial to learning. Nurse educators can use simulations to educate future nurses using the latest technology. The future will provide us with advances in technology that will improve realism and a thorough learning experience (Bristol & Zerwekh, 2011).

Bradshaw, M. J., & Hultquist, B. L. (2017). Innovative teaching strategies in nursing and related health professions (7th ed.). Burlington, MA:  Jones and Bartlett

Bristol, T. J., & Zerwekh, J. (2011). Essentials of e-learning for nurse educators. Philadelphia, PA:  F. A. Davis Company

Mendoza-Maldonado, Y., & Barría-Pailaquilén, R. M. (2018). Simulated learning environment experience in nursing students for paediatric practice. Enfermería Clínica (English Edition), 28(3), 205–209. doi: 10.1016/j.enfcle.2018.02.003

 

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JC is an at-risk 86-year-old Asian male with numerous factors that impact his ability to seek adequate care. One major source of concern is his physical and financial dependence on his daughter that is unable to devote ample time and money to him. JC has numerous comorbidities that require consistent medication therapy. JC suffers from hypertension and takes lisinopril daily for management. Failure to treat the hypertension would result in him being at greater risk of suffering from a myocardial infarction or ischemic cerebrovascular accident related to atherosclerosis of various arteries due to continued hypertension. JC also appears to be at risk for developing depression. His feelings of being a burden to his daughter signal that he may already be suffering from the effects of depression related to his overall condition. It is imperative that the clinician further assesses his feelings and his fears to determine his emotional state. Demirtürk and Hacıhasanoğlu Aşılar (2018) stated that patients suffering from depression are at much greater risk for non-adherence to antihypertensive medication therapy, placing them at risk for the complications listed above.

JC also suffers from gastroesophageal reflux disease and takes prilosec daily for management. Failure to treat this condition could cause gastrointestinal ulcers and severe gastrointestinal pain. JC also suffers from vitamin B12 deficiency and gets vitamin B12 injections monthly to correct his deficiency. Failure to seek treatment monthly would result in increased fatigue and place JC at risk for muscle atrophy and activity intolerance related to a sedentary lifestyle. Finally, JC suffers from chronic prostatitis and takes cipro daily. Failure to take the prescribed medication therapy could result in prolonged suffering from the side effects of the disease, including frequency, urgency, and difficulty initiating urination. Each of these side effects places JC at greater risk for falls, as he would likely have to attempt to make it to the restroom frequently if he is able to do so. A lack of physical ability places JC at risk for not being able to routinely get his prescriptions filled, which places him at risk for the adverse complications of non-adherence to medication therapy listed above for each comorbidity. A lack of funding places JC at risk for not being able to pay for his prescriptions that yields the same risks.

JC’s statement concerning not wanting to be a burden to his daughter serves as proof that the clinician needs to further explore that situation and determine if his daughter is able to be of assistance with JC’s care. If JC is unable to provide self-care and lacks resources that allow him to seek care outside of his daughter that is unable to assist, then the clinician needs to seek resources for JC so that he does not avoid healthcare out of ignorance or embarrassment. Lee, Rhee, Kim, and Ahluwalia (2015) conducted a study of Asian American immigrants to determine their health literacy compared to participants of other descents, and determined that the Asian American participants had significantly lower health literacies than the other ethnicities in the study. The study concluded that for this reason, Asian American patients are much less likely to seek indicated healthcare for necessary reasons.

When interacting with JC, it would be important to be sensitive regarding the self-care activities that he is unable to do for himself. It is apparent the JC is embarrassed concerning his inability to care for himself, as he is stating concern about being a burden to his daughter. For this reason, it is extremely important that the clinician be sensitive regarding his inability to provide self-care so that JC does not shut down emotionally. Also, the clinician would need to be very careful not to break JC’s spirit by focusing on the unfavorable circumstances regarding his inability to provide self-care and the lack of support resources that JC possesses. JC is making an active effort to seek healthcare despite his shortcomings. It is important that the clinician avoid overwhelming JC with the facts of the situation to avoid breaking JC’s spirit and causing him to lose the aspiration to seek necessary medical care. Applauding JC’s effort and perseverance throughout the circumstances could be effective in inspiring JC to continue putting forth his best effort.

To further assess the patient’s health history, I would ask the following questions:

Is there anyone else besides your daughter that can assist you with your healthcare needs?

Can you further explain the aspects of your care that you need assistance with so that I can be in a better position to get you the care that you need?

Do you consistently take your prescribed medications? If not, what keeps you from consistently taking them?

What are your feelings regarding assisted living?

Would you be interested in speaking with a social worker to further explore your specific situation so that we can provide you with the assistance that you need?

            The above listed questions would aid the clinician in establishing a rapport with JC while also providing needed information concerning JC’s needs. Ball, Dains, Flynn, Solomon, and Stewart (2015) stated that it is important to build rapport prior to progressing the patient’s health history for better comfort and results. The questions above introduce the idea of additional support resources without coming across as aggressive or forceful. In JC’s case, it is important that the clinician present these things in a helpful manner to ensure that JC doesn’t begin to feel as if he is a burden to the clinician or any of the support resources.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Demirtürk, E., & Hacıhasanoğlu Aşılar, R. (2018). The effect of depression on adherence to antihypertensive medications in elderly individuals with hypertension. Journal of Vascular Nursing, 36(3), 129-139. doi:10.1016/j.jvn.2018.06.001

Lee, H. Y., Rhee, T. G., Kim, N. K., & Ahluwalia, J. S. (2015). Health literacy as a social determinant of health in Asian American immigrants: Findings from a population-based survey in California. Journal of General Internal Medicine, 30(8), 1118-1124. doi:10.1007/s11606-015-3217-6

 

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ncorporating Technology in Community-Based Learning

We live in a world in which we need to share responsibility. It’s easy to say “It’s not my child, not my community, not my world, not my problem.” Then there are those who see the need and respond. I consider those people my heroes.
—Mr. Rogers, American educator and television host

Nurses hold great power both inside and outside of clinical settings. Patients and communities rely on nurses for information, care, and strategic leadership. As such, nurse educators must equip their students with the knowledge, skills and attitudes necessary for successful interactions with local and global communities. Since bridging the gap between academia and authentic experience can be difficult to accomplish inside the classroom, many universities have incorporated service learning into their curriculum. Service learning, a type of experiential learning, allows nursing students to collaborate with geographic (location-based) and functional (health-based) communities. Many times, this collaboration allows nursing students to examine the external factors that are impacting patient education and health. Technology, a generally positive external factor, has had an increased emphasis in these service learning experiences.

In this Discussion, you use the scenario provided below to imagine that you are involved with a service learning project that uses technology to address community-based learning needs.

Scenario:

This semester, you are taking a course that has a service learning component. During the first week of the class, you selected your community-based population and eagerly set out to make a difference. Over the next few weeks, you interacted with patients and documented their medical questions and health concerns. You also met with nursing professionals to hear their accounts of working with this specific community of patients. Upon personal reflection, you have noticed that not only has your empathy for this community increased but so has your awareness and self-confidence. As you come closer to the end of your semester and thus your final project, you meet with your instructor to discuss expectations. Your instructor acknowledges your hard work and commends you for the reputation that you have built in such a short amount of time. She feels that you have really become close to this community and as such, would like your final project to be a PowerPoint presentation that highlights the learning needs of the community. In your presentation, she would like you to incorporate a technology that could be adopted into a new community-based program. As you thank your instructor for the opportunity, she hands you a document that outlines your PowerPoint expectations.

To prepare

• Reflect on the health-centered learning needs of patients in your community, communities with which you are familiar, or communities abroad. Consider not only patients grouped by geographic location, but also those that represent a functional community, such as expectant mothers or patients with breast cancer or muscular dystrophy.
• Reflect on the mobile applications and social networking sites you have used for both personal and professional reasons. How might these technologies help to address patient learning needs?
• Select either a geographic community or functional community to further investigate.
• Using the websites in this week’s Learning Resources and your own scholarly research, identify specific learning needs of your selected community of patients. The learning need that you select might be associated with a health concern, preventative care practices, health management, or basic patient education.
• Browse the Internet to select a mobile application, social networking site, or other technology that might be appropriate for your patient community. Once selected, save pictures, videos, and/or capture screenshots that highlight the benefits of this technology.
• Review the section Guidelines for PowerPoint in Chapter 8 of the Herrman course text.
• Describue how you would construct a PowerPoint that explains the following:
  • Learning needs of the community, as well as their relevance (i.e. why does this matter? Why should patients and nurses care to address this learning need?)
  • A mobile application (i.e. handheld tablet or smart phone) or social media website that could help to address this need and why
  • Suggestions for using this technology
  • Any concerns or potential problems that might be associated with this technology
  • Follow-up activities to increase the success of patient/nurse integration into daily activities

 

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