Clinical Simulations’ Potential to Improve Geriatric Care

Today, older adults account for more than one-third of hospital stays and 15 percent of emergency room visits.  These numbers will rise as the 65-plus population grows, intensifying the need for more nurses with experience in geriatric care.

How can nursing schools better prepare students to work with older adults?  At the University of Wisconsin–Madison School of Nursing, clinical faculty, research faculty and staff are exploring the potential of clinical simulation scenarios.

“I’m really excited about this,” says clinical assistant professor Kari Hirvela, RN, MS.  “When I’m with the students in their hospital clinical placement, they’re seeing lots of older adults who are really sick. They come to the hospital, get needed care and leave, but often come back again.  We need to do more so that our students really get and can deliver quality home health and preventative care to older adults.”

Over the past year, Hirvela has been working with fellow UW–Madison School of Nursing clinical instructor Paula Woywod, RN, MSN, assistant professor Barb King, PhD, RN, and research program manager Kim Nolet, MS, to develop and pilot four new clinical scenarios, using high, medium and low fidelity simulation equipment.  Clinical simulations have been shown to help nursing students increase their knowledge and confidence in working with older adults, by providing a risk-free environment to practice high-level skills.

Joint Nursing-OT SimulationIn developing new clinical simulation scenarios, “We consulted extensively to determine what would best suit the students throughout their curriculum,” explains Woywod.  “The first scenario focuses on ‘Millie,’ a healthy older adult, introducing students to geriatric care.  In the second scenario, Millie has become hospitalized.  Students learn how the care is different for older adult versus middle-aged or younger hospital patients.”

“The third scenario is more complex,” says Woywod.  “Millie is transitioning from the hospital back to her home.  Students focus on the needs at home, addressing fall risks and safety.”  This simulation involves both nursing and occupational therapy (OT) students.

When instructors ran that scenario with senior-year nursing and OT students in a simulated home environment, “The learning that occurred between those two disciplines was monumental,” says Woywod. “During a simple debriefing, students learned extensively from each other, as well as achieving their own learning objectives.”

The experience also illustrates the importance of practicing how to provide quality team care.

“We were watching the students interact in Millie’s bedroom,” Hirvela recalls.  “In one group, the nursing student was doing the whole interview and the OT student was measuring things.  Afterwards, we discussed with the students how they weren’t really collaborating.  They hadn’t even realized it.  In another group, the OT student was listening to the nursing student, because she was asking questions unfamiliar to but very helpful for the OT student.”

The interprofessional simulation allowed students “to figure out what the other person’s role was, and to adapt their role accordingly,” says Hirvela.  “That was our goal, but it happened to a greater degree than we anticipated.”

Simulation debrief

The fourth simulation scenario, under development for Fall 2016, will involve nursing, social work and OT students in a care conference for Millie, who had a fall resulting in a hip fracture and is now leaving the hospital to enter a skilled nursing facility.  Millie’s daughter, Dina, is also involved.

Simulations and clinicals provide complementary learning experiences, especially for geriatric care.

“At clinical sites, I can’t control what diseases or diagnoses our patients have,” explains Hirvela.  “I can’t control learning objectives. I can’t standardize.  That’s exciting, but maybe one patient’s in tests all day, or the student’s with a nurse who won’t let them work independently.  In the simulations, students are completely independent.  They have to take that risk.  They have to think the situation through for themselves.”

“Developing students’ critical thinking skills is essential to ensuring that our graduates are prepared to address the complexities of older adult needs, including transitions in care, out in the real world,” says Woywod.

The simulations also challenge “students’ assumptions that all older adults are frail and can’t do much,” Hirvela adds.  “Students need to know that older adults are just like them.  They want to live their lives, be happy and healthy, even if they don’t always understand how to be healthy—as younger people sometimes don’t.”

In the new clinical simulation scenarios, “Millie’s our star,” quips Hirvela.  “She has this backstory of having a dog and losing her husband and enjoying gardening.  Students talk quite a bit about her social history in their interviews with her.  That’s really important, so students don’t focus too narrowly on what her problem is right now and where her pressure ulcer is.”

While data on the new simulations’ impacts on student learning is still being analyzed, the initial results are positive.  The simulations, which are being developed with support from the Helen Daniels Bader Fund, will be made freely available by the UW–Madison School of Nursing’s Center for Aging Research and Education upon their completion.

–Diane Farsetta