Author: Stacy Lutter, D.Ed., RN-BC
Title: Assistant Professor
Institution: York College of Pennsylvania
Patient-centered care learning objectives for completion of this assignment:
• Knowledge: Integrate understanding of multiple dimensions of patient centered care
• Attitude: Value seeing health care situations “through patients’ eyes”
• Knowledge: Examine common barriers to active involvement of patients in their own health care process.
Safety learning objective for completion of this assignment:
Skill: Demonstrate effective use of strategies to reduce risk of harm to self or others.
This simulated assignment was developed as part of a junior level pharmacology course and involves students following a mock patient medication regimen for a period of ten days. The purpose of the assignment is to help students gain an understanding of complex medication regimens followed in a home or hospital setting and the importance of the nurse’s role in patient teaching related to pharmacologic therapy, as well as to value actual patient experiences. In order to simulate the types of medications the students would most likely be encountering in the clinical setting, medication lists were obtained from clients at our Nurse Managed Wellness centers assuring HIPPA guidelines were followed. Five different medication regimens were developed using partial client lists that included between five to seven different oral medications.
Pill bottles were purchased by the lab coordinator and labels were created for each bottle with the name of the medication and the frequency of administration. Various types of candy were used as the mock pills. The pill bottles for each of the five regimens were placed in storage sized plastic bags. Each student received a bag that contained the medication regimen they were to follow.
Students were made aware on the first day of class that they would be receiving an assignment related to medication adherence that would be worth 5% of their grade. No further instructions were provided in advance in order to closely mimic an actual client experience of receiving prescriptions for multiple medications with only having limited information. Students were expected to take all of the mock medications as directed unless they had an intolerance to glucose, lactose, gluten, or allergies to one of the candy products. Students were given three weeks to complete the assignment.
For the assignment, students were directed to develop a medication schedule that included: the most likely reason the medication was prescribed; medication interactions; dosing instructions regarding meals or dietary interactions; and the rationale for timing decisions before beginning to take the mock medication regimen. Students were encouraged to modify their diets to reflect their probable health conditions.
In addition to the medication schedule, students had to submit a 1.5-2.5 page reflective paper about their experience. They were asked to specifically address: any barriers encountered in being adherent to the medication regimen and any barriers encountered in following dietary recommendations; any tools utilized to facilitate adherence which could improve patient safety; and the importance of patient preferences, values, and background in providing patient-centered care.
This assignment was found to be a valuable learning experience and took minimal class time to explain and distribute. This assignment can be easily replicated or created into a research study. The students who completed this assignment now have a personal experience with a complex medication regimen and may be able to share strategies with patients that they found to be helpful. This assignment promoted a patient-centered approach and highlighted the importance of the nurse in facilitating patient education regarding medication adherence, which can improve patient outcomes.
Survey Responses: The survey responses for the 43 students who completed the assignment in Spring 2015 revealed that only 9% of students did not miss a dose. Many students (37%) missed 3 doses of medication and 9.3% missed 5 or more doses. Ninety-three percent of students stated the assignment increased their empathy. The majority of students agreed or strongly agreed that the regimen was difficult to follow (86%). The majority of students agreed or strongly agreed that this was a valuable learning experience (88.4%). Students differed in their perceptions of being successful in following the medication regimen: 60% agreed or strongly disagreed , 30% disagreed, and 10% were neutral. The student responses indicate students experience difficulty in following a medication regimen, which does affect their level of empathy towards patients.
Anecdotal : Overall, the assignment has been well received. In the reflective papers, students shared examples of strategies they found to be supportive in adhering to their medication regimen. Some students received positive encouragement from friends and family members. The majority of the students report using some form of technology, such as cell phone alarms or apps to facilitate adherence. In addition to sharing strategies that helped them to be successful, students also reported the challenges they faced in following their medication regimen. They did not always remember to carry their medications with them or did not eat meals at regular times. Some students acknowledged the difficulties they experienced despite not really having to deal with actual side effects. However, some students did not like the taste of some of the mock medications, particularly at certain times of the day. In general, their reflective papers were thoughtful and indicated appreciation for the experience. As one student stated, “Now I understand what my grandmother has to go through.” The faculty perceive this to be a meaningful assignment and have been using it for over two years in undergraduate pharmacology.