There’s no place like home for community health clinicals

Many hospitals and healthcare agencies that host nursing students from Binghamton University’s Decker College of Nursing and Health Sciences have significantly reduced the number of students they allow due to the COVID-19 pandemic. Some have even suspended their programs.

A lack of available clinical sites for students is the dilemma Clinical Instructor Deborah Palmer and Clinical Associate Professor Jodi Sutherland, MS ’07, PhD ’15, found themselves facing this fall.

Palmer and Sutherland are course coordinators for the Practice of Nursing IV (NURS 363), the fourth in a series of five nursing-practice courses all undergraduate nursing students must complete. NURS 363, which students take in their senior year, focuses on chronic disease management and community health. The course includes a community health clinical rotation, and in a typical year, the coordinators work with more than 30 community agencies to provide students with a clinical experience.

2020 has been everything but normal.

When Palmer and Sutherland reached out to these agencies, they learned most had restricted or paused in-person clinical experiences due to rates of COVID infection. That’s when they decided to bring the problem home — literally.

“Jodi and I were brainstorming ideas to provide the nursing students with a meaningful clinical experience in community health, and she came up with the idea of simulating a home care visit in an actual home,” Palmer said.

“We wanted to create a significant community health learning activity in which students could practice skills, critically think and apply clinical reasoning in the home care setting,” Sutherland added.

Palmer and Sutherland developed a home care scenario based on a real example of skilled nursing orders for a home care patient. Now, they needed a patient — and a house.

That’s where their colleagues stepped in.

Patti Reuther, director of Decker’s Innovative Simulation and Practice Center, provided supplies and a human-patient simulator (manikin) for the practice. Patrick Leiby, Decker’s director of technology and innovation, provided a webcam and other equipment so Palmer and Sutherland could observe and communicate with the students via Zoom technology. And, Melissa Sutherland, professor of nursing and director of the Kresge Center for Nursing Research (she’s also Jodi Sutherland’s sister), lent them a home in Binghamton.

Once everything was set, students were given an assigned date and time for their visit. The night before the practice, the students received information about their “patient,” including demographic data, diagnosis, medications, durable medical equipment and supplies, safety measures, nutritional requirements, allergies, functional limitations and discharge plan. They also got their skilled nursing orders and were asked to complete a medication prep sheet prior to the visit.

Each student had only 50 minutes to complete the visit. During that time, students were required to perform a head-to-toe assessment, administer a flu vaccine, perform wound care and reconcile the patient’s medication. Additionally, the students were assessing the patient’s environment for any safety issues. They were also asked to document and chart the patient findings and assessment on a paper chart created to simulate the required documentation of an actual, real-time home care visit.

Palmer and Jodi Sutherland observed all the students during their visits and took turns lending their voice to the manikin — Artemis “Arty” Sufficient.

“We were evaluating the students’ ability to complete the skilled nursing orders and their application of the nursing process (assessment, planning, intervention and evaluation), as well as the demonstration of therapeutic communication, compassion/care, patient education and clinical reasoning,” Jodi Sutherland said.

“The majority of the students have not had the opportunity to give an [intramuscular] injection or perform wound care,” Palmer added. “This simulation gave them the opportunity to practice those skills.”

Providing care in a home was also a new experience for most of the students, so they were apprehensive about their performance.

“I was definitely challenged during the simulation,” said Jade Greenfield of Washington Heights in Manhattan. “I had to practice a large variety of nursing skills including wound care, a comprehensive head-to-toe [assessment], vital signs, medication reconciliation and medication administration. These are all crucial skills that we would not have been able to practice without the simulation due to the unique circumstances of attending nursing school during the pandemic.”

Despite the challenges, students enjoyed the clinical experience and felt more assured of their ability to practice as nurses.

“This experience helped me to feel more confident in both my assessment and patient-communication skills,” said Anne Welte of Windsor, N.Y. “It was a great opportunity to be given the autonomy to provide care to a patient on my own and decide how to react and communicate with the patient. It also gave me experience in providing patient education, an important component of home care.”

The students were also particularly pleased with the realism of the simulation.

“This home care simulation was so carefully planned, and it was obvious that hard work was put into it,” said Kate Annesi of Washingtonville, N.Y. “The professors thought of everything — from cords on the floor that could cause the patient to fall, to hidden snacks around the house that he shouldn’t be eating. This was creative, effective and such a nice change. I can always expect nothing short of amazing from Decker faculty; they truly want us to be our best.”

Based on the positive feedback, Palmer and Jodi Sutherland intend to continue the experience for accelerated students in the spring semester if clinical placements are still limited or unavailable. They may even create additional scenarios.

Jodi Sutherland added that it’s possible a future iteration of the experience might be conducted in the expanded simulation center within Decker College’s new home on the University’s Health Sciences Campus in Johnson City. Decker is moving to the new building in December.

“For now, though, the family connection has allowed nursing students to have a home care visit despite the challenges of COVID,” she said.

“There are so many opportunities in community health,” Palmer added. “Our goal is to expose the students to an area of nursing that is beyond the four walls of the hospital. Most of the students don’t realize all of the areas in the community that have nursing opportunities.”