Nurse Educator Vol. 39, No. 3, pp. 103-104 Copyright * 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nurse Educator
Teaching Strategies
Debra Webster
Mary C. DiBartolo
Using a Standardized Patient Learning Activity to Teach Baccalaureate Nursing Students About Dementia Care Debra Webster, EdD, RN-BC, CNE Mary C. DiBartolo, PhD, RN-BC, CNE
This department profiles an effort by faculty to integrate geriatric content into the baccalaureate curriculum, as a standardized patient experience. This content was developed for use in the senior-level psychiatric/mental health clinical course to increase the awareness and competencies of students in dealing with this aging patients with dementia.
I
t is estimated that over 5 million Americans are currently diagnosed with dementia-related illnesses.1 The numbers are expected to increase exponentially to at least 16 million by 2050 if a cure or treatment is not found.1 These startling demographic trends have signaled the need for nurses to be better prepared to care for persons with dementia, including consideration of the impact of this illness on the family unit.2 According to the Quality and Safety Education for Nurses (QSEN) competency in patient-centered care, there should be a focus on providing respectful and compassionate care to patients (persons with dementia) while including the family unit in developing the plan of care.3 This includes the recognition of patient preferences, values, and needs while communicating with the patient as an active partner (as appropriate), along with the family unit. However, effective assessment and therapeutic communication skills in the dementia care scenario can be a significant challenge for seasoned nurse and novice practitioners alike. The persistent stigma attached to Alzheimer’s disease2 and its associated aggressive behaviors can be especially intimidating to nursing students. Furthermore, there may be few opportunities for student experiences in the clinical setting to build their skills in evidence-based communication strategies with patients and put into practice the principles of family-focused dementia care. Author Affiliations: Associate Professor (Dr Webster) and Professor (Dr DiBartolo), Department of Nursing, Salisbury University, Maryland. The authors declare no conflicts of interest. Correspondence: Dr Webster, Department of Nursing, Salisbury University, 1101 Camden Ave, Salisbury, MD 21801 ([email protected]). Accepted for publication: February 10, 2014 DOI: 10.1097/NNE.0000000000000027
Nurse Educator
Description of Learning Activity As part of an overall effort by nursing faculty at the authors’ institution to integrate geriatric content into the baccalaureate curriculum, a standardized patient experience (SPE) was developed for use in the senior-level psychiatric/mental health clinical course offered each fall semester. The primary goal of this educational strategy was to provide a more structured exposure to caring for a person with dementia. Such planned SPEs have been successfully implemented in the context of a variety of other mental illnesses, providing students with valuable opportunities to practice interaction skills in a safe and nonthreatening learning environment. While simulations involving SPEs have gained tremendous popularity as an educational strategy in the psychiatric setting, they have not been used as extensively in preparing students to care for persons with dementia. The identification of this instructional gap in the psychiatric/mental health clinical course was the basis for 2 faculty members to collaborate to design this activity. One faculty member is a seasoned psychiatric/mental health nursing course faculty with extensive experience in creating SPEs, and the other is a member of the medical-nursing team specializing in gerontology and, specifically, Alzheimer’s disease and dementia care. Unlike other SPEs developed for this course that focused on other psychiatric disorders and were strictly patient oriented, the dementia-focused SPE included opportunities to interact with family members who are often absent from communications in psychiatric clinical settings. This dementia-specific standardized patient learning activity was part of a pilot project conducted in the university’s medical simulation center on campus. Approval was obtained from the university’s Committee on Human Subjects. The Volume 39 & Number 3 & May/June 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
103
learning activity consisted of several components. First, students participated in a 15- to 20-minute interaction with a family of SPs, which included 1 actor who had been trained to portray a patient with dementia, a second actor who was the concerned spouse, and a third actor who portrayed an adult child. Detailed scripts were written, and the 3 actors were trained by the expert psychiatric faculty member. Each student’s individual interaction was video recorded for subsequent viewing and one-on-one analysis involving the student and faculty member. Two weeks prior to the SPE, students were assigned selected readings in the psychiatric theory course text and 3 articles outlining best practices for dementia care. They also attended two 50-minute class lectures on dementia in the theory course. Just prior to the learning activity, students completed a 15-question pretest to assess their knowledge of Alzheimer’s disease and dementia care. Following the SPE, the students met as a group for a facultyled, structured debriefing session where emphasis was placed on the knowledge, skills, and attitudes of patient-centered care and the importance of involving both family members in the development of a plan of care. Selected video clips from the 2007 movie, The Savages, were also used as a springboard for discussion of emotionally charged family issues that can arise. During the debriefing, students also completed a self-evaluation of communication techniques that were utilized (identifying strengths and areas for improvement), as well as a written self-reflection focusing on what they learned, how they would apply this information as a practicing nurse, and any challenges they encountered. For comparative purposes, the same 15-question posttest was given 1 week after the SPE to assess effectiveness of learning. This SPE-based learning activity was effective in achieving desired learning outcomes, which included accurate assessment of dementia, demonstration of therapeutic communication skills, empathy and caring, and understanding patient values, preferences, and beliefs as identified in the QSEN competencies. Furthermore, it gave the students experience in providing appropriate dementia education and resources to the patient and family. The learning activity was not graded, rather it served as a vehicle for offering essential feedback to assist students in practicing critical communication strategies specific to dementia care, as well as improving therapeutic communication skills with family members. Upon review of pretest and posttest scores on the knowledge test, there was noticeable improvement in the scores on the dementia knowledge posttest. Anecdotal feedback was also extremely positive. Students noted that the foundational knowledge of Alzheimer’s disease and pertinent resources, along with the opportunity to practice dementia-specific communication strategies, was critical in enhancing their confidence in dealing with complex patient and family interactions, which, in turn, reduced their anxiety. Several students commented specifically on how the SPE emphasized the need to maintain respect and dignity of the person with dementia, yet acknowledging the importance of family involvement and support. As a group, they believed it was a valuable experience in learning how to maintain
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boundaries and set limits when dealing with emotionally charged family issues, while bracketing one’s own opinions and feelings in such situations to remain objective. On the other hand, faculty identified 1 area of improvement for the majority of students. In the future, faculty will emphasize the importance of physical safety considerations along with more guided instruction on how to proactively address these considerations when interacting with dementia patients and their families.
Conclusion Given the aging of the US population, the anticipated surge in persons with Alzheimer’s disease, and the projected need for professional caregivers that are suitably equipped to care for this population and their caregivers, nurse educators must continue to think outside the box to develop innovative dementia-specific learning experiences in a nonthreatening environment that are both realistic and engaging. The use of SPEs provides opportunities for faculty to create controlled situations in which students can practice evidence-based care and communication techniques with both patients and the family unit in the challenging dementia care scenario. This more structured hands-on training is not only helpful in finetuning one’s interaction skills, but can also give students a safe environment to build their skills of engaging family members in dementia-based care and decision making. Furthermore, it reinforces the student’s knowledge about Alzheimer’s disease, its impact on families, and the multitude of resources available to family members to assist in coping with this diagnosis. While SPEs have gained tremendous popularity as an educational strategy in nursing curricula today, this specific application of the SPE in persons diagnosed with Alzheimer’s disease or a related dementia is an important step in expanding its utility to dementia care. It is also hoped that a modified version of this learning activity can be implemented at the university’s medical simulation center to include professional dementia caregivers who are working in area hospitals and long-term-care facilities, as another strategy to improve the overall quality of care for persons with dementia and their caregivers. In light of the increasingly common clinical site constraints, research is needed to document the effectiveness of the SPE as an educational strategy in providing diagnosis-specific scenarios for learning, as well as the feasibility and benefits of expanding this essential training beyond the campus-based student learners.
References 1. Alzheimer’s Association. Latest Facts & Figures Report. Available at http://www.alz.org/alzheimers_disease_facts_and_figures.asp. Accessed December 10, 2013. 2. Keeley AC, Chase L. Effects of mental illness on the family: experiential family assessment to promote students’ affective learning. J Nurs Educ. 2011;51(2):111-114. 3. Preheim GJ, Armstrong GE, Barton AJ. The new fundamentals in nursing: introducing beginning Quality and Safety Education for Nurses’ competencies. J Nurs Educ. 2009;48(12):694-697.
Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nurse Educator
Teaching Strategies
Debra Webster
Mary C. DiBartolo
Using a Standardized Patient Learning Activity to Teach Baccalaureate Nursing Students About Dementia Care Debra Webster, EdD, RN-BC, CNE Mary C. DiBartolo, PhD, RN-BC, CNE
This department profiles an effort by faculty to integrate geriatric content into the baccalaureate curriculum, as a standardized patient experience. This content was developed for use in the senior-level psychiatric/mental health clinical course to increase the awareness and competencies of students in dealing with this aging patients with dementia.
I
t is estimated that over 5 million Americans are currently diagnosed with dementia-related illnesses.1 The numbers are expected to increase exponentially to at least 16 million by 2050 if a cure or treatment is not found.1 These startling demographic trends have signaled the need for nurses to be better prepared to care for persons with dementia, including consideration of the impact of this illness on the family unit.2 According to the Quality and Safety Education for Nurses (QSEN) competency in patient-centered care, there should be a focus on providing respectful and compassionate care to patients (persons with dementia) while including the family unit in developing the plan of care.3 This includes the recognition of patient preferences, values, and needs while communicating with the patient as an active partner (as appropriate), along with the family unit. However, effective assessment and therapeutic communication skills in the dementia care scenario can be a significant challenge for seasoned nurse and novice practitioners alike. The persistent stigma attached to Alzheimer’s disease2 and its associated aggressive behaviors can be especially intimidating to nursing students. Furthermore, there may be few opportunities for student experiences in the clinical setting to build their skills in evidence-based communication strategies with patients and put into practice the principles of family-focused dementia care. Author Affiliations: Associate Professor (Dr Webster) and Professor (Dr DiBartolo), Department of Nursing, Salisbury University, Maryland. The authors declare no conflicts of interest. Correspondence: Dr Webster, Department of Nursing, Salisbury University, 1101 Camden Ave, Salisbury, MD 21801 ([email protected]). Accepted for publication: February 10, 2014 DOI: 10.1097/NNE.0000000000000027
Nurse Educator
Description of Learning Activity As part of an overall effort by nursing faculty at the authors’ institution to integrate geriatric content into the baccalaureate curriculum, a standardized patient experience (SPE) was developed for use in the senior-level psychiatric/mental health clinical course offered each fall semester. The primary goal of this educational strategy was to provide a more structured exposure to caring for a person with dementia. Such planned SPEs have been successfully implemented in the context of a variety of other mental illnesses, providing students with valuable opportunities to practice interaction skills in a safe and nonthreatening learning environment. While simulations involving SPEs have gained tremendous popularity as an educational strategy in the psychiatric setting, they have not been used as extensively in preparing students to care for persons with dementia. The identification of this instructional gap in the psychiatric/mental health clinical course was the basis for 2 faculty members to collaborate to design this activity. One faculty member is a seasoned psychiatric/mental health nursing course faculty with extensive experience in creating SPEs, and the other is a member of the medical-nursing team specializing in gerontology and, specifically, Alzheimer’s disease and dementia care. Unlike other SPEs developed for this course that focused on other psychiatric disorders and were strictly patient oriented, the dementia-focused SPE included opportunities to interact with family members who are often absent from communications in psychiatric clinical settings. This dementia-specific standardized patient learning activity was part of a pilot project conducted in the university’s medical simulation center on campus. Approval was obtained from the university’s Committee on Human Subjects. The Volume 39 & Number 3 & May/June 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
103
learning activity consisted of several components. First, students participated in a 15- to 20-minute interaction with a family of SPs, which included 1 actor who had been trained to portray a patient with dementia, a second actor who was the concerned spouse, and a third actor who portrayed an adult child. Detailed scripts were written, and the 3 actors were trained by the expert psychiatric faculty member. Each student’s individual interaction was video recorded for subsequent viewing and one-on-one analysis involving the student and faculty member. Two weeks prior to the SPE, students were assigned selected readings in the psychiatric theory course text and 3 articles outlining best practices for dementia care. They also attended two 50-minute class lectures on dementia in the theory course. Just prior to the learning activity, students completed a 15-question pretest to assess their knowledge of Alzheimer’s disease and dementia care. Following the SPE, the students met as a group for a facultyled, structured debriefing session where emphasis was placed on the knowledge, skills, and attitudes of patient-centered care and the importance of involving both family members in the development of a plan of care. Selected video clips from the 2007 movie, The Savages, were also used as a springboard for discussion of emotionally charged family issues that can arise. During the debriefing, students also completed a self-evaluation of communication techniques that were utilized (identifying strengths and areas for improvement), as well as a written self-reflection focusing on what they learned, how they would apply this information as a practicing nurse, and any challenges they encountered. For comparative purposes, the same 15-question posttest was given 1 week after the SPE to assess effectiveness of learning. This SPE-based learning activity was effective in achieving desired learning outcomes, which included accurate assessment of dementia, demonstration of therapeutic communication skills, empathy and caring, and understanding patient values, preferences, and beliefs as identified in the QSEN competencies. Furthermore, it gave the students experience in providing appropriate dementia education and resources to the patient and family. The learning activity was not graded, rather it served as a vehicle for offering essential feedback to assist students in practicing critical communication strategies specific to dementia care, as well as improving therapeutic communication skills with family members. Upon review of pretest and posttest scores on the knowledge test, there was noticeable improvement in the scores on the dementia knowledge posttest. Anecdotal feedback was also extremely positive. Students noted that the foundational knowledge of Alzheimer’s disease and pertinent resources, along with the opportunity to practice dementia-specific communication strategies, was critical in enhancing their confidence in dealing with complex patient and family interactions, which, in turn, reduced their anxiety. Several students commented specifically on how the SPE emphasized the need to maintain respect and dignity of the person with dementia, yet acknowledging the importance of family involvement and support. As a group, they believed it was a valuable experience in learning how to maintain
104
Volume 39 & Number 3 & May/June 2014
boundaries and set limits when dealing with emotionally charged family issues, while bracketing one’s own opinions and feelings in such situations to remain objective. On the other hand, faculty identified 1 area of improvement for the majority of students. In the future, faculty will emphasize the importance of physical safety considerations along with more guided instruction on how to proactively address these considerations when interacting with dementia patients and their families.
Conclusion Given the aging of the US population, the anticipated surge in persons with Alzheimer’s disease, and the projected need for professional caregivers that are suitably equipped to care for this population and their caregivers, nurse educators must continue to think outside the box to develop innovative dementia-specific learning experiences in a nonthreatening environment that are both realistic and engaging. The use of SPEs provides opportunities for faculty to create controlled situations in which students can practice evidence-based care and communication techniques with both patients and the family unit in the challenging dementia care scenario. This more structured hands-on training is not only helpful in finetuning one’s interaction skills, but can also give students a safe environment to build their skills of engaging family members in dementia-based care and decision making. Furthermore, it reinforces the student’s knowledge about Alzheimer’s disease, its impact on families, and the multitude of resources available to family members to assist in coping with this diagnosis. While SPEs have gained tremendous popularity as an educational strategy in nursing curricula today, this specific application of the SPE in persons diagnosed with Alzheimer’s disease or a related dementia is an important step in expanding its utility to dementia care. It is also hoped that a modified version of this learning activity can be implemented at the university’s medical simulation center to include professional dementia caregivers who are working in area hospitals and long-term-care facilities, as another strategy to improve the overall quality of care for persons with dementia and their caregivers. In light of the increasingly common clinical site constraints, research is needed to document the effectiveness of the SPE as an educational strategy in providing diagnosis-specific scenarios for learning, as well as the feasibility and benefits of expanding this essential training beyond the campus-based student learners.
References 1. Alzheimer’s Association. Latest Facts & Figures Report. Available at http://www.alz.org/alzheimers_disease_facts_and_figures.asp. Accessed December 10, 2013. 2. Keeley AC, Chase L. Effects of mental illness on the family: experiential family assessment to promote students’ affective learning. J Nurs Educ. 2011;51(2):111-114. 3. Preheim GJ, Armstrong GE, Barton AJ. The new fundamentals in nursing: introducing beginning Quality and Safety Education for Nurses’ competencies. J Nurs Educ. 2009;48(12):694-697.
Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
