Life of a Caregiver Simulation: Teaching Students About Frail Older Adults and Their Family Caregivers

Introducing patient stories in health sciences education: the learning experiences of students

BACKGROUND

It has been advocated that the development of medical school curricula must be informed by students, doctors in training, educators, employers, other health and social care professionals and patients, families and carers. Patients are widely employed to teach clinical and interpersonal skills, and while recognised as crucial in health education, they have mostly been offered a passive role. We assessed the impact of patients contributing personal illness narratives in the master curriculum of allied health care professionals on students' learning experiences.

METHODS

We designed a module (Patient and Society) for a master's degree programme in Health Sciences at the University of Southern Denmark in collaboration with six patients. The patients contributed to the teaching by sharing and discussing their personal illness narrative. At the end of the module, as part of the exam, we asked the students to reflect on the patients' contribution to the module and how this affected their learning experiences. The 500-word exam responses of 29 students were analysed, in collaboration with six patients, using thematic analysis.

RESULTS

Including patients' illness narratives lifted students' academic learning, and their personal and professional development. The stories brought theoretical concepts to life; it helped the students to obtain, retain, and apply academic knowledge. Actively and uninterrupted listening to patients' illness experiences promoted empathy and critical reflection on clinical practice. Faced with the impact of a disease on a person's life, seeing the healthcare system through a patient's lens made students reflect critically on the medical positivist model ruling the health care system focused on just fixing the medical problem with very little room for the illness experience.

CONCLUSION

Our analyses support previous findings indicating that patient narratives are a powerful tool to achieve academic and professional development. Working with patients in health education has the potential to work towards a more inclusive epistemological stance in the health care system and health research.

Using simulation to explore medical students' understanding of integrated care within geriatrics

BACKGROUND

Given the increasing evidence and expansion of integrated care (IC) in healthcare, new IC curricula introduced early in undergraduate medical education (UME) are needed. Building on a pilot IC simulation called "Getting to Know Patients' System of Care" (GPS-Care), we aimed to explore students' understanding of patients' complex physical and mental health needs, and to increase our understanding of how students learned in this simulation.

METHODS

177 of 259 first-year medical students participated in GPS-Care at the University of Toronto. Students role-played an elderly patient or caregiver within 5 simulated healthcare professional appointments. Students completed written reflections and 7 students participated in one-on-one interviews. A thematic analysis of the reflections and transcripts was conducted and descriptive data was generated for questionnaires.

RESULTS

Data saturation was reached at 43 reflections and 7 transcripts and the following themes emerged: a) students reflected on patients' complex care experiences, b) students reflected on of the healthcare system needs care, c) students increased understanding of IC, and d) students desire to improve the care of IC patients within the healthcare system.

CONCLUSIONS

In addition to confirming previous pilot study themes, the results from this study identified the role of productive struggle to provide students with a deeper understanding of patients' IC care needs. Moreover, GPS-Care resulted in a transformative learning experience resulting in new insights into the importance of IC early in UME training.

Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors

BACKGROUND

Lifestyle counseling is described as a "major breakthrough" in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students' clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors.

METHODS

In this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item 'readiness to change' health risk behavior tool plus similarity ratings on students' empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students' and actors' evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques.

RESULTS

The main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers' reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students. Students desired immediate and direct feedback after the video-dialogue and -tagging exercise.

CONCLUSIONS

Heart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client's perspective on health risk behaviors.

Development of a novel empathy-related video-feedback intervention to improve empathic accuracy of nursing students: A pilot study

BACKGROUND

Stressed family carers engage in health-risk behaviours that can lead to chronic illness. Innovative strategies are required to bolster empathic dialogue skills that impact nursing student confidence and sensitivity in meeting carers' wellness needs.

PURPOSE

To report on the development and evaluation of a promising empathy-related video-feedback intervention and its impact on student empathic accuracy on carer health risk behaviours.

DESIGN

A pilot quasi-experimental design study with eight pairs of 3rd year undergraduate nursing students and carers.

METHODS

Students participated in perspective-taking instructional and practice sessions, and a 10-minute video-recorded dialogue with carers followed by a video-tagging task. Quantitative and qualitative approaches helped us to evaluate the recruitment protocol, capture participant responses to the intervention and study tools, and develop a tool to assess student empathic accuracy.

MAIN RESULTS

The instructional and practice sessions increased student self-awareness of biases and interest in learning empathy by video-tagging feedback. Carers felt that students were 'non-judgmental', inquisitive, and helped them to 'gain new insights' that fostered ownership to change their health-risk behaviour. There was substantial Fleiss Kappa agreement among four raters across five dyads and 67 tagged instances.

CONCLUSION

In general, students and carers evaluated the intervention favourably. The results suggest areas of improvement to the recruitment protocol, perspective-taking instructions, video-tagging task, and empathic accuracy tool.

Exploring outcomes and evaluation in narrative pedagogy: An integrative review

OBJECTIVES

To identify narrative pedagogy learning outcomes and evaluation methods used for pre-licensure nursing students. Recommend areas for expanding narrative pedagogy research.

DESIGN

An integrative review using a modified version of Cooper's 1998 framework, as described by Whittemore and Knafl (2005).

DATA SOURCES

A computer-assisted search of the literature from 1995 to 2015 was performed using the search terms narrative pedagogy and nursing. Databases included the Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, Educational Resources Information Center, Educational Research Complete, Medline, PsychArticles, PsychINFO, and the Teacher Reference Center. Ancestry searches led to the inclusion of additional articles.

REVIEW METHODS

Twenty-six texts met the criteria for full review and were evaluated for methodological rigor and relevance to the review aims. Nine articles achieved an acceptable quality score and were used for thematic analysis.

RESULTS

Learning outcomes associated with narrative pedagogy were grouped into five themes: thinking, empowerment, interconnectedness, learning as a process of making meaning, and ethical/moral judgment. Multiple methods of evaluation are necessary to evaluate these learning outcomes.

CONCLUSIONS

Narrative pedagogy may be a beneficial philosophical approach to teaching. However, at this time, there is insufficient evidence to recommend its universal adoption. It is too broad in its approach to reliably measure its effectiveness. Future research should examine the effectiveness of specific teaching strategies to promote desired learning outcomes.