321CHAPTER 27
Discharge Teaching for an Immigrant Woman With Congestive Heart Failure and Atrial Fibrillation
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
Leonie Rose Bovino
In my role as a laboratory instructor, I have developed and implemented simulation experiences using human patient simulators (HPSs) to meet course outcomes.
Mary Ann Cordeau
I have been involved in development and research related to simulation-based experiences (SBEs) since 2006. Drawing on Leonie’s knowledge of Jamaican culture and the need to provide students with realistic culturally relevant patient teaching experiences, we paired to develop this scenario.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALTY
The clinical simulation laboratory at Quinnipiac University resembles a hospital unit with five rooms, each with a patient and control area separated by one-way glass. With the appropriate props, rooms can be arranged to mimic an emergency room, community setting, and a home health setting. All five simulation rooms can be used simultaneously and are equipped with an audiovisual system (AVS) for recording, debriefing, and streaming real-time scenarios to any other classroom in the building. There are three adult HPSs, one pediatric and one newborn HPS, and a maternity HPS. The rooms are large enough to hold group clinical simulation experiences—the glass doors to each simulation room can be closed for private SBEs.
C. SPECIFIC OBJECTIVES FOR SIMULATION USAGE WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
SBEs begin in the fall semester of the third year. Students have SBEs in most content areas; they are increasingly being used to meet clinical course outcomes when clinical experiences are limited. This 322scenario is designed for third- and fourth-year baccalaureate (RN) students who have completed or are concurrently in a medical–surgical nursing course and have had cultural competence and patient teaching content. This scenario is delivered in a course that focuses on preparing students to meet the provider-of-care role, the designer/manager/coordinator-of-care role, and member-of-a-profession role (American Association of Colleges of Nursing [AACN], 2008). AACN’s (2008) Essentials of Baccalaureate Education in Professional Nursing were used to develop course outcomes. Key elements from the National Council of State Boards of Nursing (NCSBN, 2015)—National Council Licensure Examination for a Registered Nurse (NCLEX-RN®) detailed test plan were used in developing this scenario. International Nursing Association for Clinical Simulation and Learning (INACSL, 2013/2016) INACSL Standards of Best Practice were used for scenario design and implementation. On completion of the course, the student should be able to:
1. Demonstrate expected proficiency in the application of knowledge and performance of clinical skills related to community and public health nursing.
2. Demonstrate expected proficiency in the application of pharmacotherapeutic knowledge and the performance of related clinical skills.
3. Demonstrate expected proficiency in the application of knowledge and performance of clinical skills related to health teaching and health counseling.
4. Demonstrate expected proficiency in the application of knowledge and performance of clinical skills related to health promotion and wellness.
D. INTRODUCTION OF SCENARIO
Setting the Scene and Technology Used
The scene takes place on a cardiac telemetry unit of a hospital. A simulated patient is used. If available, a system for recording and viewing the SBE can be used for debriefing. If not, no special technology is used in this scenario.
Scenario Objectives
INASCL Standards of Best Practice for Participant Objectives (Lioce et al., 2013) were used when developing scenario outcomes. After participating in this SBE, the learner is able to:
1. Assess patient and family understanding of self-care management for congestive heart failure (CHF) and atrial fibrillation (AF).
2. Assess patient and family ability to follow discharge instructions and comply with the prescribed treatment regimen.
3. Provide clear, culturally sensitive, holistic, evidence-based, and patient-preference instructions to patient and family about self-care and management of CHF and AF.
4. Identify and communicate available resources for self-care management of CHF and AF.
The NCLEX-RN test plan categories and subcategories (NCSBN, 2015) addressed in this scenario include the following:
Safe and effective care environment: Utilize information resources to enhance the care provided to a client (evidenced-based research, information technology, policies, and procedures), Recognize the need for referrals and obtain necessary orders, Identify community resources for the client, Health Promotion and Maintenance: Provide care and education for the adult client ages 65 through 85 years and over, Identify risk factors for disease/illness (age, gender, ethnicity, lifestyle), Educate the client on actions to 323promote/maintain health and prevent disease (diet), Evaluate client understanding of health promotion behaviors/activities (weight control, exercise actions), Psychosocial Integrity: Cultural awareness/cultural influences, Assess the importance of client culture/ethnicity when planning/providing/evaluating care, Recognize cultural issues that may impact the client’s understanding/acceptance of psychiatric diagnosis, Incorporate client cultural practice and beliefs when planning and providing care, Respect cultural background/practices of the client (does not include dietary preferences), Therapeutic Communication: Assess verbal and nonverbal client communication needs, Respect the client’s personal values and beliefs, Allow time to communicate with the client, Use therapeutic communication techniques to provide client support, Encourage the client to verbalize feelings (fear, discomfort), Evaluate the effectiveness of communications with the client, Pharmacological and Parenteral Therapies: Adverse effects/contraindications/side effects/interactions, Assess the client for actual or potential side effects and adverse effects of medications (prescribed, over-the-counter, herbal supplements, preexisting condition), Provide information to the client on common side effects/adverse effects/potential interactions of medications and inform the client when to notify the primary health care provider, Pharmacological and Parenteral Therapies: Medication administration, Educate client about medications, Educate client on medication self-administration procedures, Participate in medication reconciliation process, Reduction of Risk Potential: Changes/abnormalities in vital signs, Apply knowledge needed to perform related nursing procedures and psychomotor skills when assessing vital signs, Apply knowledge of client pathophysiology when measuring vital signs, Laboratory values, Educate client about the purpose and procedure of prescribed laboratory tests, Physiological Adaptation: Illness management, Apply knowledge of client pathophysiology to illness management, Educate client regarding an acute or chronic condition, Educate client about managing illness (chronic illnesses).
The AACN Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) addressed in this scenario include:
Essential VII: Clinical Prevention and Population Health, Objectives 3, 4, 5
Essential IX: Baccalaureate Generalist Nursing Practice, Objectives 3, 4, 5, 7, 10, 16, 17
Description of Participants
The simulated patient is a 78-year-old Jamaican woman of mixed race (Black, White, and Asian) who presently resides in the United States, but has lived in Jamaica for most of her life. One RN student who has been briefed on his or her role serves as a daughter/son scenario role player. The patient’s child was also born in Jamaica but started living in the United States after marrying a U.S. citizen at the age of 22 years. Another student serves as the RN caregiver and is expected to prepare for the scenario in advance by reading about the pathophysiology of CHF and AF, the medical and nursing management of patients with these common and often comorbid conditions, and Jamaican cultural practices.
Although English is the official language of Jamaica, Patois, which is a combination of English and some African languages, is commonly spoken. Most Jamaicans are of partial African descent. Families are close-knit and usually provide both emotional and economic support to each other. Jamaicans typically distrust those in authority and place faith in those they know well. Religion is important to Jamaican life and the majority are Christians as evidenced by the fact that Jamaica has the highest number of churches per capita in the world. Jamaicans typically address people by their official title (Mr., Mrs., or Ms.) until a personal relationship is established. They are also typically reserved until they get to know someone. They can be direct communicators and tend to say what they think. They expect others to be equally direct. Herbal medicines are popular; when traditional herbs fail, modern medicine is tried. A large number of herbs are used to cure a variety of illness and maintain good health. Jamaican cuisine consists of many unprocessed foods, smaller portions of meats and a high content of starches, beans, and vegetables. It includes a mixture of dishes from the indigenous people (Arawaks), the Spanish, British, Africans, Indian, and Chinese who lived on the island.
324E. RUNNING OF THE SCENARIO
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