High-Level Realism in Simulation: A Catalyst for Providing Intimate Care

Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study

BACKGROUND

a lack of adequate training in palliative care leads to a greater emotional burden on nurses.

PURPOSE

to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students.

METHODS

a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted.

RESULTS

there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control.

CONCLUSIONS

the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.

Journey less travelled: Female nursing students’ experiences in providing intimate care in two nursing education institutions in Gauteng province, South Africa

Background

Intimate care is not facilitated in South African nursing education and training. Nursing students encounter it for the first time in clinical practice, where they see and touch the naked bodies of patients. The societal segregation of gender roles has led to the feminisation of the nursing profession, suggesting that women are more caring and maternal and that intimate care implementation comes more easily to them than to their male counterparts.

Aim

This study explored female nursing students’ experiences of intimate care for diverse patients.

Setting

The study was conducted in two nursing education institutions in Gauteng province, South Africa.

Methods

Descriptive phenomenology was used to describe the lived experiences of participants. Seventeen female nursing students were purposively sampled. Data were collected using semi-structured interviews and analysed using Moustakas’ (1994) eight steps.

Results

Four themes emerged: intimate care comprehension, preparedness for providing intimate care, reactions in providing intimate care and coping mechanisms when providing intimate care to diverse patients.

Conclusion

Intimate care forms a basis on which nursing students prioritise the physical needs of patients by providing care that exposes their bodies and requires touch. The students were taught to provide care with respect, maintaining patient autonomy and nursing professionalism. Unfortunately, age and gender barriers create feelings of discomfort and embarrassment. More needs to be done to support and empower nursing students in providing intimate care to diverse patients competently, confidently and comfortably.

Contribution

Understanding the experiences of participants in providing intimate care to diverse patients will assist nurse educators in intimate care facilitation and support. The female nursing students will be empowered and trained to execute intimate care in a manner that is culturally, religiously and ethically acceptable.

Mask-Ed (KRS Simulation) an approach to deliver intimate care for neophyte nursing students: the creator's experience

Nurses deliver intimate care to patients in a variety of ways, especially when attending to showering, bathing, toileting and managing chronic or surgical wounds located in body regions such as the genitalia or breasts. Neophyte undergraduate nursing students can experience fear and anxiety at the thought of carrying out this level of care; hence, there is a need for preparation prior to undertaking clinical placements when students encounter real patients. The preparation should begin in the laboratory context of their tertiary educational settings. Traditionally, task trainers and manikins have been used to demonstrate and practise this care in such environments. However, the realism of experiencing true human responses, by both the patient and student, can be lost through these modalities. In recent years, a simulation approach, Mask-Ed, has enabled intimate care to be taught to students in a university setting in Australia where the laboratory context provides a safety net. Mask-Ed involves the informed educator wearing highly realistic silicone props that include torsos, faces and hands. Having donned the props, the educator then transforms into another person. The newly created person has a backstory designed to enable the educator to become a platform for teaching and to coach students through the clinical experience. The following discussion explains the background to Mask-Ed and the underlying framework that is used to implement the technique to teach intimate care. Mask-Ed is considered one of the most realistic approaches to simulation and is used in healthcare facilities and tertiary educational institutions globally.

Evaluation of the 'Empathic Care of a Vulnerable Older Person' e-simulation

BACKGROUND

Healthcare reports have identified that the nursing care provided to frail older people is sometimes indifferent, unkind, and lacking in empathy. Compelling research indicates that these types of healthcare interactions can result in both emotional and physiological harm. Thus, there is a need for authentic learning experiences that enhance nursing students' empathy towards older people and that they can reflect upon, learn from and transfer to their real-world practice. e-Simulations provide a pragmatic way of addressing this need.

AIM

The aim of this study was to evaluate the impact of an 'Empathic Care of a Vulnerable Older Person' e-simulation on nursing students' empathy levels.

SETTING AND PARTICIPANTS

A convenience sample of first year nursing students from one university in the United Kingdom and two Australian universities was recruited for the study.

DESIGN AND ANALYSIS

A three-group pre-post study was conducted using the Comprehensive State Empathy Scale to evaluate the impact of the effectiveness of the e-simulation. Sample characteristics were summarised using descriptive statistics. Dependent t-tests and analysis of variance (ANOVA) were used to compare the changes in empathy scores pre post and differences between groups.

RESULTS

A total of 684 nursing students participated in the study; their average age was 23 years. Overall, there was a significant increase in empathy scores from pre-test to post-test. Post-hoc comparison of the three groups indicated that the e-simulation had a greater impact on the empathy levels of participants from Universities 2 and 3, compared to those from University 1.

CONCLUSION

e-Simulations using narrative methodologies that cater for learners' emotional memory appear to be an effective approach for enhancing empathy towards older people. However, further studies are needed to explore how this learning activity might inform and influence learners' future clinical practice.