Author: Brenda Johnson, PhD, RN, GNP-BC
Title: Associate Professor
Institution: Illinois State University Mennonite College of Nursing
Coauthors: Linda Heitman, PhD, RN, APRN-BC
Patient Centered Care: Knowledge
Integrate understanding of multiple dimensions of patient centered care:
coordination and integration of care, information, communication, transition and continuity
Teamwork and Collaboration: Skills
Function competently within own scope of practice as a member of the health care team
Value vigilance and monitoring (even of own performance of care activities) by patients, families and other members of the health care team.
It is common for students in an acute care clinical to be assigned to a different patient each week. Often this is for one 8-hour shift or at most, two consecutive days with each patient. While this approach is an effective way to teach skills and certain clinical judgments, it is not as effective in showing students how patient needs vary across time and settings or their responsibility for ensuring successful transitions across care settings.
This assignment consisted of the initial assessment and plan of care for one adult and one elderly patient in the critical care unit and the student following this same patient throughout the patient’s hospitalization and into a post-acute setting (e.g. rehabilitation, long-term care, and home health). One specific tool was developed by the Gerontological Nursing course instructor to guide students in the steps of the assignment as well as in the specific physiological, functional, and post-discharge needs for equipment and support service for the elderly patient. A similar instructional tool specific to the needs of the young or middle-aged adult patient was developed by the Critical Care course instructor.
Students were put into teams of four for completing all components of the assignment. Requirements of this assignment included a written plan of care and a videotape simulating a report to a case manager or to an interdisciplinary patient conference as the patient’s specific situation would warrant. The first plan of care and conference was done as soon as possible after admission to the ICU. The second plan and conference was in consideration of transfer out of the ICU. The third was in anticipation of discharge from the hospital. When possible, a videotaped addendum was added to the third case study discussion for the purpose of analyzing the patient’s progress and status over a one to two-month period of time.
Implementation of project
Instructors developed three videotaped interdisciplinary patient care conferences which depicted one simulated case study at three different points in time. These videotapes were shown to the students as examples of the videotaped conferences they were to do for the adult and the elderly patient from their critical care clinical.
Four students were assigned to care for one adult and one elder in their critical-care clinical. The students met one day per week for three weeks and then one-half day for three weeks for follow-up on their assigned patient. Their Adult Health Critical Care instructor was with them for the first three weeks of their clinical and then both this instructor and the Gerontological Nursing course instructor met with the students for the three weeks of follow-up with each group’s assigned patient. The students met in a conference room at the University’s Center for Scholarship in Teaching and Learning for the taping of the patient care conference. These tapes were not placed on an online server and were provided only to the instructors in order not to risk violation of patient confidentiality. These videotapes were shown to students only in a private classroom setting in which confidentiality of patient information could be ensured.
Worksheet for Geriatric Client
Pre and Post-Test
Student Evaluation of Assignment
The instructors developed an exam based on the simulated case that assessed the student’s knowledge of the nursing care issues as well as the student’s ability to anticipate potential complications and prioritize care. This exam was given to the students immediately after they watched the simulated videotapes at the beginning of the course and then, again as a post-test at the end of the course. The exam contained both objective and subjective questions. Rubrics for evaluating the student responses to the exam were created.
Analysis of the pre and post-tests revealed that students were able to identify a greater number of patient problems as well as to propose solutions to these problems with greater specificity and accuracy. They were, also, able to explain in greater depth and detail the threats that these problems posed to the safety and quality of care for these patients.
A subjective student evaluation was, also, created. Students gave an overall rating of 4.5 out of 5 that this assignment assisted them in identifying, prioritizing, and communicating adequately patient care needs across time and settings.
The instructional tools developed for this assignment could be utilized in a variety of settings for teaching and evaluating the concepts of transitional care. Videotaped patient care conferences provide an excellent springboard for discussions of students about the prioritization of care needs and communicating these needs in a team meeting at different points in a person’s trajectory of illness and recovery. The rubrics can be individualized to many different scenarios. The videotapes may be done in a Simulation Lab with synchronous or asynchronous peer review and instructor debriefing