Author: Erin Lemler, BSN, MSN student RN
Title: University of Wisconsin-Eau Claire
Institution: UWEC College of Nursing and Health Sciences
Pre-Licensure ADN/Diploma, Pre-Licensure BSN
Classroom, Clinical Setting
KSA Learning Objectives:
- Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of patients and families
- Examine common barriers to active involvement of patients in their own health care processes
- Describe strategies to empower patients or families in all aspects of the health care process
- Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management
- Assess own level of communication skill in encounters with patients and families
- Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care
- Discuss principles of effective communication
- Continue development of pharmacologic knowledge base
- Establish student nurse/client relationship with a faculty-selected well elder residing in a community-based setting
- Integrate current and newly acquired pharmacology knowledge about client’s medications
- Develop a client-specific medication report utilizing Situation-Background-Assessment-Recommendation (SBAR) format
- Prepare a presentation of client-specific SBAR medication report, utilizing adult learning strategies appropriate to client’s situation
- Present SBAR medication report to client, and request feedback from client
Overview of Strategy:
This activity is designed to give nursing students an opportunity to apply theoretical pharmacology knowledge learned in the classroom to a “real-world” clinical setting, and reinforce therapeutic communication skills. Wissman and Wilmoth (1996) note a lack of available experiences for students to apply theoretical pharmacology content until later courses in future semesters. They also cite students frequently have difficulties with retention and application of this theoretical knowledge to specific clients and their pharmacologic needs (1996). The proposed strategy, based in part on the work of Wissman and Wilmoth (1996), may help decrease the delay between acquisition and application of pharmacology knowledge.
This strategy can also be used to emphasize the importance of client education for medication regimen safety and compliance. It also encourages nursing students to begin seeing the “whole picture” of their clients, beyond a name and diagnosis.
This activity would utilize a population of well elders living in the community, preferably in an independent senior-living apartment complex, as the clinical setting. The clients would be independent in their medication administration/management. Faculty would hold an informational meeting and sign-up for interested apartment complex residents. Faculty would then individually contact potential clients to assign them a student. This could take place prior to the beginning of the semester, if faculty so chooses.
Alternatively, faculty may streamline the process by utilizing a senior complex the school has an established relationship with, and/or pair students with an elder they have had previous contact with from an earlier and/or concurrent therapeutic communication course.
Within the first two weeks of the semester, students would be given the contact information for their client in order to set-up an introductory meeting. At the introductory meeting , student will introduce themself to the client and conduct a short learning styles inventory. The meeting should last about 30 minutes.
A second meeting between the student and client will be used to review the client’s past medical history(pmh), medications (prescribed, OTC, and herbal), the prescribed medication instructions, and how the client actually takes the medications. Students and clients should plan for this meeting to last a minimum of 30 minutes, but likely longer depending on the complexity of the client’s pmh and medication regimen.
The student will then have a faculty-determined time frame to complete the written SBAR report on the client’s medications.
The Situation section should include basic demographic information about the client: age, gender, preferred learning style, and any difficulties the client may have managing medications (i.e. disorganized pill bottles, forgetting to take a daily evening medication, etc).
The Background section would list the client’s pmh, medications, and prescribed and actual administration practices.
The Assessment section would contain basic medication information: name, dosing considerations, indications, action, side effects, interactions, monitoring considerations, nursing considerations, and/or why the client has the medication prescribed, etc.
In the Recommendation section, the student would identify potential interactions between the client’s medications, and individualized suggestions for the client to help better manage the medications. Some examples of suggestions for clients may include: using a mediplanner, placing bedtime medications by their toothbrush as a cue, using a refrigerator magnet as a reminder to take certain medications with food, and other hints too numerous to list here.
After faculty feedback on their written SBAR report, the student would then present the SBAR medication report to the client, utilizing the client’s preferred learning styles, adult learning strategies, and appropriate modifications for client’s situation. Creativity is encouraged for the SBAR presentation to the client. A short (< 1 page) description of their client presentation will be handed in to faculty at the time the written SBAR is due. Students will also provide clients with a form (and SASE) for feedback to be returned to faculty.
As a proposed strategy, the evaluation is still being developed. Faculty may wish to add/delete elements of this strategy as fits best for their course. Faculty may wish to evaluate students on their SBAR medication report using a rubric of their own development, so as to assess the areas they find most pertinent. Another idea for evaluation would be to have students complete a personal reflection on what they learned from the process; what was easy, what was difficult, “aha” moments, etc. Client feedback would also be useful to faculty in planning future sections of the course.
An important item to stress to elder clients: working with the student nurse is not a substitute for visits to the regular healthcare provider, nor should they deviate away from the medical recommendations of their provider, without notifying the provider.
Wissman, J.L. & Wilmoth, M.C. (1996). Meeting the learning needs of senior citizens and nursing students through a community-based pharmacology experience. Journal of Community Health Nursing, 13(3), 159-65.