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From life care to professional care
FROM LIFE CARE TO Senior students had more leadership and cEnical
BETTY J. PAULANKA SANDRA F. D U N N I N G T O N he initial expectations of the eight senior nursing students were not uniformly positive. One predicted the experience would be "monotonous and boring." Another feared she would not "get to practice clinical skills." By the end of the semester, however, students found the advantages outnumbered the disad~gantages. The senior students were all enrolled in a nursing practice course designed to develop leadership and management skills. Students were allowed to select the clinical site they believed Would best help them meet personal and course objectives. Specific course objectives were to apply principles and techniques of leadership and management, analyze how the nursing staff worked together and with other disciplines, evaluate personal goals to improve nursing practice, and begin the transition from student to professional nurse.
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The Retirement Community The facility used as the clinical site is a nonprofit, 450-member community in a rural area. The community has four types of housing: two-bedroom cottages, where residents may continue their pre-entry lifestyle; a 250-unit, highrise apartment complex for elders with varied levels of independence; efficiency-type apartments without kitchen facilities for residents who need minimal to moderate asssistance with activities of daily living; and an 80-bed health care facility for Betty J. Paulanka, MSN, EdD, is chairperson of the Department of Nursing Science, and Sandra F. Dunnington, BSN, MS, is an assistant professor at the College of Nursing, University of Delaware, Newark, DE.
those needing skilled, personal, or respite care. All residents are encouraged to participate in ongoing recreational and social activities appropriate to their health status. Family members visit residents in the health center freely and often participate in providing care. A resident care nurse coordinates 24-hour-a-day health and nursing services to meet the needs of nonhealth center residents. Two physicians are on call 24 hours a day and have daily office hours. Clinical Activities The student's clinical time consisted of two consecutive 8-hour days each week, over a 14-week semester. Orientation began with a three-hour simulation game, Into Aging.* Instructor-led seminars about special needs of the aged, and a one-day orientation to the facility by the inservice educator, completed the orientation. The two faculty members who developed the clinical experience had previously taught in gerontological clinical settings; one had a clinical specialty in medical-surgical nursing and the other a clinical specialty in community-mental health nursing. Most of the students' experiences were coordinated through the inservice educator, a gerontological clinical nurse specialist employed by the retirement facility. She was also the liaison between the retirement com•munity and the college of nursing. Student learning activities were integrated throughout the entire community in both inpatient and outpatient facilities. Students individually carried out many home care activities with the *Hoffman, T. L., arid ReiffS. D. hztoAging:A Simulation Game. Thorofare, N J, Charles B. Slack, Inc., 1978.
288 Gcriatrie Nursing November/December 1989
FIRST REACTIONS Environmental • Negative:"lt's going to be monotonous and boring." • Neutral: "Where are the pianos?"
Learning Opportunities • Negative: "1 won't get to practice clinical skills." • Positive: "It looks like there's going to be a variety of learning experiences in this setting."
Personal/Professional • Negative: "1 believe I will be working more as a nurse's aide." • Positive: "1 feel confident in my ability to work effectively with older people." F I N A L REACTIONS
Environmental • Positive: "The place offers tremendous opportunities and fills many needs." *e Negative: "There seemed to be some conflict between the aides and students."
Leaming Opportunities • Positive: "1 got a chance to utilize my psych skills a lot. And I sharpened other clinical skills too." • Negative: "1 was able to get some skilled experience, but it was limited."
Personal/Professional • Positive: "1 wouldn't have traded this experience for any hospital experience in the world. I have learned more than I thought possible." • Positive: "1 believe I learned a great deal about nursing and myself. It was a perfect setting for a last-semester clinical."
EVALUATION Students named the following factors in the life care community experience as those enhancing the transition to professional nursing: • varied learning opportunities available (5 students) • opportunities to use psychiatric nursing skills (1) • accessibility of entire system (1) • staff support (3) • availability of a variety of clients (2) • personal autonomy within system (1) = instructor guidance (1) • collaboration with other staff (1)
Students named the following factors as inhibitors: • limited opportunity for experience with acute care problems (1) • limited opportunities to practice physical care skills (1) lack of variety of clients (1).
ROFESSIONAL CARE rperience in a retirement community than they expected. resident care nurse, assisted with objectives they had set for themphysical examinations and routine selves when the course began and to visits in the physicians' offices, pro- identify factors that facilitated and/ vided nursing care on the health care or inhibited their meeting the objecunits, and participated in staffand re- tives. Finally, students were asked to sident educational programs and rate how the experience prepared them for the role of nurse generalist. support group projects. Some students elected to do teach- (See "Reactions" on the previous ing projects for groups of residents, page.) while others developed staff educaDid Perceptions Change? tion projects. Each student was also Of the eight students who particiassigned a well elderly client or couple in the ap~irtments or cottages. pated in the experience, seven reStudents visited these clients weekly, turned the questionnaire. Students' completed a total nursing history, responses were primarily concerned and implemented an appropriate with one of three themes: environhealth-promotion project. Faculty mental factors, specific learning opoccasionally attended meetings with portunities, and personal/profeswell clients to Observe the students' sional concerns. The initial statements also recommunication skills and techvealed that six of the seven students niques of health assessment. All students participated in an as- had identified negative thoughts and sessment of the milieu of the life care feelings about the experience. Howcommunity. Their assessment led to ever, final statements revealed a the development of two specialized minimal number of negative resupport groups: The music group sponses: The number of positive promoted rea!ity orientation and fo- statements rose from 29.6 percent at cused on the needs of the less mobile the start to 92.6 percent at the end of clients. The other special group was the semester, and the number of negfor spouses of institutionalized resi- ative thoughts and feelings about the facility experience dents. This group concentrated on retirement maximizing efforts to recognize the dropped from 55.6 to 7.4 percent. Students who had initially exneeds of family members. pressed concern about the opportuStudent Perceptions nity to hone skills in the retirement A three-part questionnaire was community ultimately found that used to measure the students' percep- some experiences were more readily tions of the success ofthis clinical ex- available to them than to students in perience. The faculty wanted stu- acute care settings; for example, indents to look at the learning and sertion and care ofnasogastric tubes, changes inherent in a successful tran- drawing blood, and recording sition from senior student to the pro- ECGs. fessional nurse generalist. Personal Learning Objectives Before and after the experience, the students were asked to state their Students identified a variety of facthoughts and feelings about working tors that enhanced or inhibited fulin this geriatric clinical setting. fillment of their personal learning At the end, they were asked to list objectives. The enhancing factors the factors that had changed their outnumbered the inhibiti0g factors thoughts and feelings. They also were almost four to one. asked to review the personal learning Six ofthe seven students rated this
experience as "excellent" in preparing them to become a nurse generalist; one student rated it "satisfactory." The "relaxed atmosphere," the "flexibility" of experiences, and the faculty and staff support that stimulated autonomy in decision making were all listed as positive factors.
What Are the Advantages? Working in the life care retirement community let these students learn in a micro health care system that is relatively stress free. It also provided students with the opportunity to develop ongoing relationships with residents and family members and compare and contrast the needs of elders with iladependent and dependent life-styles. The opportunity for follow-up, the availability of an internal support system, and the respect given to students by both staffand residents fostered successful experiences. Eliminating Stereotypes Many of the students' initial perceptions were stereotypical. For instance, one student wrote, "My mind's eye view of retirement/nursing homes was not a positive one." Positive experiences with elders caused students to change their negative perceptions. Remarks in the weekly clinical logs were overwhelmingly positive. Professional collaboration was also identified as a positive factor. One student wrote, "Every time I got a new patient assignment, I could discuss the patient with a student who had cared for the patient before. This promoted continuity of care and increased quality of care." The fact that students' attitudes changed so dramatically with these experiences supports the basic premise that the retirement community is an appropriate clinical setting for senior nursing students. GN
Geriatric Nursing November/December 1989 289
BETTY J. PAULANKA SANDRA F. D U N N I N G T O N he initial expectations of the eight senior nursing students were not uniformly positive. One predicted the experience would be "monotonous and boring." Another feared she would not "get to practice clinical skills." By the end of the semester, however, students found the advantages outnumbered the disad~gantages. The senior students were all enrolled in a nursing practice course designed to develop leadership and management skills. Students were allowed to select the clinical site they believed Would best help them meet personal and course objectives. Specific course objectives were to apply principles and techniques of leadership and management, analyze how the nursing staff worked together and with other disciplines, evaluate personal goals to improve nursing practice, and begin the transition from student to professional nurse.
T
The Retirement Community The facility used as the clinical site is a nonprofit, 450-member community in a rural area. The community has four types of housing: two-bedroom cottages, where residents may continue their pre-entry lifestyle; a 250-unit, highrise apartment complex for elders with varied levels of independence; efficiency-type apartments without kitchen facilities for residents who need minimal to moderate asssistance with activities of daily living; and an 80-bed health care facility for Betty J. Paulanka, MSN, EdD, is chairperson of the Department of Nursing Science, and Sandra F. Dunnington, BSN, MS, is an assistant professor at the College of Nursing, University of Delaware, Newark, DE.
those needing skilled, personal, or respite care. All residents are encouraged to participate in ongoing recreational and social activities appropriate to their health status. Family members visit residents in the health center freely and often participate in providing care. A resident care nurse coordinates 24-hour-a-day health and nursing services to meet the needs of nonhealth center residents. Two physicians are on call 24 hours a day and have daily office hours. Clinical Activities The student's clinical time consisted of two consecutive 8-hour days each week, over a 14-week semester. Orientation began with a three-hour simulation game, Into Aging.* Instructor-led seminars about special needs of the aged, and a one-day orientation to the facility by the inservice educator, completed the orientation. The two faculty members who developed the clinical experience had previously taught in gerontological clinical settings; one had a clinical specialty in medical-surgical nursing and the other a clinical specialty in community-mental health nursing. Most of the students' experiences were coordinated through the inservice educator, a gerontological clinical nurse specialist employed by the retirement facility. She was also the liaison between the retirement com•munity and the college of nursing. Student learning activities were integrated throughout the entire community in both inpatient and outpatient facilities. Students individually carried out many home care activities with the *Hoffman, T. L., arid ReiffS. D. hztoAging:A Simulation Game. Thorofare, N J, Charles B. Slack, Inc., 1978.
288 Gcriatrie Nursing November/December 1989
FIRST REACTIONS Environmental • Negative:"lt's going to be monotonous and boring." • Neutral: "Where are the pianos?"
Learning Opportunities • Negative: "1 won't get to practice clinical skills." • Positive: "It looks like there's going to be a variety of learning experiences in this setting."
Personal/Professional • Negative: "1 believe I will be working more as a nurse's aide." • Positive: "1 feel confident in my ability to work effectively with older people." F I N A L REACTIONS
Environmental • Positive: "The place offers tremendous opportunities and fills many needs." *e Negative: "There seemed to be some conflict between the aides and students."
Leaming Opportunities • Positive: "1 got a chance to utilize my psych skills a lot. And I sharpened other clinical skills too." • Negative: "1 was able to get some skilled experience, but it was limited."
Personal/Professional • Positive: "1 wouldn't have traded this experience for any hospital experience in the world. I have learned more than I thought possible." • Positive: "1 believe I learned a great deal about nursing and myself. It was a perfect setting for a last-semester clinical."
EVALUATION Students named the following factors in the life care community experience as those enhancing the transition to professional nursing: • varied learning opportunities available (5 students) • opportunities to use psychiatric nursing skills (1) • accessibility of entire system (1) • staff support (3) • availability of a variety of clients (2) • personal autonomy within system (1) = instructor guidance (1) • collaboration with other staff (1)
Students named the following factors as inhibitors: • limited opportunity for experience with acute care problems (1) • limited opportunities to practice physical care skills (1) lack of variety of clients (1).
ROFESSIONAL CARE rperience in a retirement community than they expected. resident care nurse, assisted with objectives they had set for themphysical examinations and routine selves when the course began and to visits in the physicians' offices, pro- identify factors that facilitated and/ vided nursing care on the health care or inhibited their meeting the objecunits, and participated in staffand re- tives. Finally, students were asked to sident educational programs and rate how the experience prepared them for the role of nurse generalist. support group projects. Some students elected to do teach- (See "Reactions" on the previous ing projects for groups of residents, page.) while others developed staff educaDid Perceptions Change? tion projects. Each student was also Of the eight students who particiassigned a well elderly client or couple in the ap~irtments or cottages. pated in the experience, seven reStudents visited these clients weekly, turned the questionnaire. Students' completed a total nursing history, responses were primarily concerned and implemented an appropriate with one of three themes: environhealth-promotion project. Faculty mental factors, specific learning opoccasionally attended meetings with portunities, and personal/profeswell clients to Observe the students' sional concerns. The initial statements also recommunication skills and techvealed that six of the seven students niques of health assessment. All students participated in an as- had identified negative thoughts and sessment of the milieu of the life care feelings about the experience. Howcommunity. Their assessment led to ever, final statements revealed a the development of two specialized minimal number of negative resupport groups: The music group sponses: The number of positive promoted rea!ity orientation and fo- statements rose from 29.6 percent at cused on the needs of the less mobile the start to 92.6 percent at the end of clients. The other special group was the semester, and the number of negfor spouses of institutionalized resi- ative thoughts and feelings about the facility experience dents. This group concentrated on retirement maximizing efforts to recognize the dropped from 55.6 to 7.4 percent. Students who had initially exneeds of family members. pressed concern about the opportuStudent Perceptions nity to hone skills in the retirement A three-part questionnaire was community ultimately found that used to measure the students' percep- some experiences were more readily tions of the success ofthis clinical ex- available to them than to students in perience. The faculty wanted stu- acute care settings; for example, indents to look at the learning and sertion and care ofnasogastric tubes, changes inherent in a successful tran- drawing blood, and recording sition from senior student to the pro- ECGs. fessional nurse generalist. Personal Learning Objectives Before and after the experience, the students were asked to state their Students identified a variety of facthoughts and feelings about working tors that enhanced or inhibited fulin this geriatric clinical setting. fillment of their personal learning At the end, they were asked to list objectives. The enhancing factors the factors that had changed their outnumbered the inhibiti0g factors thoughts and feelings. They also were almost four to one. asked to review the personal learning Six ofthe seven students rated this
experience as "excellent" in preparing them to become a nurse generalist; one student rated it "satisfactory." The "relaxed atmosphere," the "flexibility" of experiences, and the faculty and staff support that stimulated autonomy in decision making were all listed as positive factors.
What Are the Advantages? Working in the life care retirement community let these students learn in a micro health care system that is relatively stress free. It also provided students with the opportunity to develop ongoing relationships with residents and family members and compare and contrast the needs of elders with iladependent and dependent life-styles. The opportunity for follow-up, the availability of an internal support system, and the respect given to students by both staffand residents fostered successful experiences. Eliminating Stereotypes Many of the students' initial perceptions were stereotypical. For instance, one student wrote, "My mind's eye view of retirement/nursing homes was not a positive one." Positive experiences with elders caused students to change their negative perceptions. Remarks in the weekly clinical logs were overwhelmingly positive. Professional collaboration was also identified as a positive factor. One student wrote, "Every time I got a new patient assignment, I could discuss the patient with a student who had cared for the patient before. This promoted continuity of care and increased quality of care." The fact that students' attitudes changed so dramatically with these experiences supports the basic premise that the retirement community is an appropriate clinical setting for senior nursing students. GN
Geriatric Nursing November/December 1989 289