Electronic simulation in nursing education for cultural competency

Technology and Learning

Introduction- From the late 20th century on, technological growth has become so robust that in the last decade there have been vast changes to the educational and business environment based on it automation, cloud computing, new memory chips, and operating systems that take advantage of the new electronic collaboration many enjoy (Vizard 2011). Too, when we think of how technology can transform society, it is also useful to consider new ways of utilizing technology for learning. Of course, there are issues educators face when introducing new technologies in the classroom; namely the failure to fully utilize and/or creatively utilize new technology in the delivery of education. Facilitating learning in a technology-rich environment offers the potential to move participants to higher levels of learning. The effective use of technologies for both the teacher and the learner requires knowledge of what is available to facilitate the learning as well as the skills to utilize the media in a meaningful way (O'Neill, Singh & O'Donoghue 2004). This is particularly true for the sciences, in which technology can vastly improve the understanding and delivery of key concepts, procedures, systems, and even biological processes. Too, faced with the challenge of a faculty shortage in nursing education combined with a technological savvy student body, enhanced learning methods are not only efficient, but necessary (Daley, 2012).

Part a -- Electronic Simulation in Nursing

1. One of the real complexities of 21st century nursing is the manner in which the modern nurse must master clinical knowledge as well as enhanced communication skills, ethical behavior, and difficult choices within the healthcare environment. It seems as if these issues comprise a three-part template for nursing: respect for patient value & individuality, education of patients, and cognition and respect for the realities of contemporary medicine. More often than not, nurses tend to act as the "moral agents" within the system because they are the locus of communication between the physician, the patient, and the family. Too, the diverse nature of modern society means that many nurses will come in contact with individuals who speak a different language and have a different cultural view of healthcare. The use of case studies has been proven to be viable for simulations, and provides an opportunity for a number of different learning outcomes. In this case, our scenario will focus on a nurse who is dealing with a Laotian family from the Hmong region.

2. Learning Outcomes -- After completion of the scenario, the student will be able to: 1) Articulate the importance of communications within the healthcare environment and provide examples of how communication can be used to improve healthcare outcomes; 2) Understand and explain ways to increase nursing advocacy and empathy for individuals from different cultures; 3) Articulate problem-solving solutions for complex issues that involve diverse populations.

Who has the responsibility to lead the issue on patient communications?

4. Besides answering the questions and forming an action plan, the student will complete an ethics matrix using a nursing theorist of their choice, medical ethics definitions and determinations, and their plan for a proactive solution to the problem. (Below is an example using Jean Watson, the columns would be blank for the student):

ANA Code and Watson Theory

Application

Establish a caring relationship with the client.

The first issue was finding a way to communicate. I happened to know that there was a woman who worked in the cafeteria from Laos, and I asked her supervisor if she could act as a translator for an emergency situation. The supervisor agreed, and through some patience, I was able to explain procedures and establish rapport.

Treat patients as holistic beings

Once the translation problem was solved, I was able to understand that in the Hmong culture, epilepsy is treated by the village shaman. I used the idea that the medication we could give the grandmother was made because doctors learned the value of herbal and native medicine, and this would simply help.

Display unconditional acceptance

I placed no value judgments on the family or their belief in non-traditional medicine. The key was to help the grandmother's seizures, that had been getting worse and worse, and to alleviate her symptoms.

The student will then make a presentation to classmates via PowerPoint on the evolution of the situation, application of nursing theory, and a solution-oriented plan.

Part B - Multimedia Presentation

1. Blood pressure is the pressure exerted by blood circulating through the vessels. It is usually measured with a sphygmomanometer which uses the height of a column of mercury to reflect the pressure. Modern devices measure output electronically or digitally. Patients are fitted with a cuff over their upper arm, air pressure is applied, and then listening with a stethoscope to the brachial artery at the elbow, the examiner releases the pressure into the cuff creating a "whooshing" or "pounding" sound. The pressure at which this first occurs is the systolic pressure; the cuff is further released until no sound can be heard, this is the diastolic pressure. The multimedia presentation will use two components -- a PowerPoint presentation that visual shows each step in taking and evaluating Blood Pressure, notes read by instructor; and an interactive portion using students to practice on each other while following the PPT steps.

2. Upon completion of the unit student will: 1) Be able to define the basic vocabulary surrounding blood pressure; 2) Be able to explain in detail the steps of a professional blood pressure examination; 3) Physically demonstrate their ability to take a fellow-student's BP and explain the results to the class.

3. Storyboard-

Step 1 -- Choose the right equipment; stethoscope, appropriate sized blood pressure cuff, and measurements instrument (sphygmomanometer or automated device).

Step 2 -- Prepare the patient; allow them to relax in a darkened room, sitting upright, feet on the floor; remove excess clothing that might hinder the results; do no talk during the exam, but explain to the patient the steps.

Step 3 -- Choose the proper BP cuff size -- most errors occur by not using the right size. Wrap the cuff around the patient's arm, using the Index line to determine the range. Adjust with another cuff if necessary.

Step 4 -- Place the BP cuff on the patient's arm by locating the brachial artery. Position the cuff so that the ARTERY marker points to the biracial artery; wrap the cuff snugly around the arm.

Step 5 -- Position the stethoscope; on the same arm as the cuff, palpate the art at the crease to located the strongest pulse sounds; place the bell of the stethoscope over the brachial artery at this location.

Step 6 -- Inflate the BP cuff by pumping the bulb or turning on the machine. When the BP cuff has inflated enough to stop blood flow there should be no sounds coming from the stethoscope, roughly 160-180 mmHg.

Step 7 -- Slowly deflate the cuff 2-3 mmHg per second.

Step 8 -- Listen for the systolic reading -- the first occurrence of rhythmic sounds heard as blood begins to flow is the systolic pressure. Record the results.

Step 9 -- Continue to listen as the BP cuff pressure drops and the sounds fade. Note the reading when the rhythmic sounds stop. This is the diastolic reading.

Step 10 -- Record results; if possible take with other arm and average.

(Andersen, 2009).

4. An easy and cost effective interactive solution would be done in steps, depending on the number of students in the class.

a. First, have the students break up into teams of two, review the steps with each other, then practice taking BP a few times.

b. Bring the class back together and discuss the steps, review vocabulary, and ask probative questions about potential difficulties encountered.

c. Have the class number off as 1 and 2.

d. Begin with the first group of 1 and 2; coming to the front of the class, have 1 do a blood pressure exam of 2, then 2 of 1. Once done, class should constructively critique. Follow this with all the rest of the class.

e. Once done, have students think/pair/share and write a short 2-3 paragraph outline of what they learned and how this will be beneficial to their practice.