There’s No Place Like Virtual Home (for Home Care Simulations)

In the clinic, health care professionals can warn older adults about falls. During a home visit, they can point out the loose rug in the living room or the dim lighting near the stairs. Seeing the home environment first-hand allows professionals to better support older adults’ health and quality of life.

“It’s really reaching people where they live, as opposed to where you’re guessing they live,” explains University of Wisconsin–Madison Senior Scientist Gail Casper, RN, PhD.

A highly cluttered virtual home

As adults live longer and stay in the community, their homes become places for health promotion, medication management, recovery, rehabilitation and palliative care. Yet nursing and other health professional students often don’t have the opportunity to practice delivering care in home settings.

When entering homes that may be very different than their own, “students may have judgmental attitudes that they may not even be aware are coming across,” says Casper. “Or they can be so gentle and so indirect that only the most astute person would pick up that they’re saying there’s a problem.”

“There’s a happy medium that we have to coach,” agrees UW–Madison School of Nursing Clinical Professor Paula Jarzemsky, RN, MS.

Jarzemsky and Casper did just that, developing a simulation to coach students in assessing and communicating about health barriers during home visits. They worked with UW–Madison School of Pharmacy Associate Professor Beth Martin, PhD, MS, RPh and School of Medicine and Public Health Assistant Professor Sue Wenker, PT, PhD, MS to make the exercise inter-professional.

It all started with 20 homes in Southeast and South-central Wisconsin, which had been fully scanned and digitized to develop three-dimensional models for the vizHOME project. Casper directs vizHOME, researching improvements to home-based health practices.

“I kept thinking that this home data is useful for nursing students and health students in general,” says Casper. “So we made videos of someone going through the homes and looking around. We could then have students use the videos to do the kind of things that they would do on a home visit.”

Layout of the virtual home

The video-based virtual home was the first of three homes in the new simulation. Students worked in the same team of three for each home visit, including a first-year nursing undergraduate and physical therapy and pharmacy students early in their graduate training.

During the virtual home visit, students explored their reactions to a highly cluttered home. They also discussed potential challenges to the occupant’s safety and self-care, considering the impact of the space on activities of daily living and medication management.

The second home visit was with a standardized patient (a semi-scripted actor) in the School of Nursing’s home health lab. Students interacted with the standardized patient as they carried out a home safety assessment.

Finally, students conducted actual home safety assessments with independent living residents at Oakwood Village in Madison. During initial and follow-up home visits, they documented and discussed safety and self-care issues with the older adults, making referrals to services as appropriate.

“It’s an eye opener” for nursing students to do home visits, “after a number of clinical hours in settings where we’re pretty much in charge,” says Jarzemsky. “This person is going to need to know how to function without you being there. How do you support them when you’re not in control?”

Fostering interaction and learning across disciplines is important to Jarzemsky.

During the home lab visit with the standardized patient, “We had a bunch of medications out on the counter,” says Jarzemsky. “The pharmacy students were concerned about proper labeling and how the patient managed medications. The physical therapy students were concerned about the clutter and home safety. The nursing students were doing the care coordination, bringing together information and conversing with the patient. It was interesting how the students were already reflecting their disciplines’ areas of expertise.”

These inter-professional interactions were exactly what Jarzemsky and Casper were hoping for when they developed the home care simulation.

The students also valued collaborating with and learning from other disciplines. After the simulation, one student wrote, “My major take away … is the importance of working as part of an interdisciplinary team to get more insight into the patient’s lifestyle and home environment.” Another felt “better equipped to interact with other healthcare professionals.”

Casper and Jarzemsky were surprised that details like video quality and a varying level of home clutter between different steps of the simulation were distracting for some students. Yet overall, the students rated the home care simulation highly.

“The virtual homes provide the platform on which you’re able to coach students on some pretty nuanced stuff,” says Jarzemsky. “With more care happening in the home, that’s important.”

As a nurse, “frequently, the first home visit you make is solo,” adds Casper. “The students really benefit from the opportunity to make a guided home visit and get feedback before they’re out on their own.”

–Diane Farsetta; images courtesy of VizHOME

You can download the simulation guide “VizHOME Virtual Home Visits: A Resource for Nurse Educators” by Gail Casper and colleagues from the CARE website. It includes a sample lesson plan, descriptions of the 20 homes, and personas for residents of each home, including health histories.