A young woman glances down at her phone and taps out a series of text messages. Her hands shake. Her voice trembles as she answers questions from attending nurses in short bursts: “I’m fine. I’m not in any pain. I don’t know when I last ate.”
The scene playing out is a simulation exercise in the health promotion course in which nursing students practice assessment, critical thinking and communication skills. Student actors portray a patient and her partner. The nursing students have to think on their feet and assess the situation to provide the best care.
This semester, the exercise was conducted via Zoom video conferencing instead of at the nursing simulation lab because of the campus shutdown in response to COVID-19.
Junior nursing major Shannon Farias says that although remote learning was a big adjustment at first, the online simulation to practice psychiatric nursing was effective. "A majority of care stems from therapeutic communication and building rapport with the patient to provide patient-centered care, which was accomplished using the Zoom format," says Farias, who was one of six Solomont School of Nursing students involved in the three-hour simulation.
Clinical Assoc. Prof. Sandra Mote, who typically uses student actors to play the role of patients in the lab, continued the same strategy for online simulations. It just took a bit more creativity and planning. “I had to imagine how the scenarios would work online. Each week, I brainstormed with the actors and modified guidelines on how to react to students’ questions. The two actors did a great job by not sharing too much information about their relationship and by using body language that was in conflict with their words,” says Mote.
The realistic psychiatric patient scenario included a 27-year-old professional with bulimia who arrived in the emergency room after passing out at home and hitting her head. The students were unaware that the patient, played by student actor and music performance major Olivia Minchello, was abused by her partner, a role played by Tory Riley, an economics major with a minor in theatre. Students in groups of two provided nursing care for the patient, while the others observed.
The nurses assessed the patient by asking questions and screening her for an eating disorder, depression and suicide. Then the patient’s partner arrived. She answered questions intended for the patient and contradicted the patient’s responses. Detecting the patient’s anxiety and discomfort, the students asked the partner to leave the room. She refused.
While this was happening, Mote coached the actors via text, making suggestions to test the students’ skills. After a few more requests, the partner still wouldn’t leave.
The students asked for a “sidebar,” which meant that they wanted to have a side conversation with each other and with Mote. “What are we supposed to do?” they asked.
Mote’s answer: “Whose house is this?”
The students realized that they had the right to remove someone in this situation.
Back in the scenario, they asked the partner to leave or they would call the nurse in charge, who would call security. They also ordered behavioral health and nutrition consultations.
“I often ask whose house is it because students need to be mindful of the setting they are working in and their role in it,” says Mote. “In a hospital, health care professionals have the authority to ask a family member to leave in order to protect patient privacy or safety. However, in the home setting, while they can set limits with a family member, they can’t make a family member leave their own house, even if their presence contributes to the patient’s agitation.”
Despite the challenges of conducting the simulation via video conferencing, the session was successful, says Mote.
"I was very pleased when an observing student commented that they were completely drawn in by the actors and the nursing students. And I have found that I can evaluate students as effectively as if I was in the lab," she says.
Minchello, who has worked as an actor for two semesters with the nursing students, says it’s important that she create a simulation that is authentic and educational.
“I'm so grateful to have this experience with these nursing students because I know I am helping them to be the best they can be when they leave UMass Lowell and delve into the health care world,” says Minchello, who gave the students feedback on what they did well and how they could improve — from the patient’s point of view — during a debrief.
“Nurses work to create a safe, comfortable and private environment for their patients, while also focusing on using destigmatizing language,” Minchello says. “It's amazing to see these student nurses grow throughout the semester.”