Core competencies established by national nursing advisory groups emphasize preparing students to act responsibly and engage with multidisciplinary teams during disaster-type situations (Trautman, 2015). Limited curricula are available to guide schools of nursing in providing the necessary education (Downes, 2015). Escalating uncertainty regarding the international impact of Ebola virus disease (EVD) and other infectious diseases with the potential to lead to public health emergencies prompted educators to develop interactive, multidisciplinary training for baccalaureate nursing students. The aim of this clinical learning session was to prepare nursing students for safe and effective response to EVD and other emerging infectious diseases.
Under faculty guidance, students participated in a clinical learning session that included didactic, tabletop, and hands-on learning activities. Students were provided information on the importance of interprofessional collaboration with community partners at local, state, and federal levels. Emphasis on interdisciplinary teaming in preparation for potential public health crises underscores the need for professional collaboration and enhances students' understanding that care delivered by a high-functioning team leads to improved outcomes (Trautman, 2015).
The use of tabletop exercises helped students understand the importance of working within their communities in developing proactive, rather than reactive, preparedness and response plans (Rega & Fink, 2014). Increasing students' understanding that health care is not dispensed in isolation fostered exploration of effective teaming (Trautman, 2015). Didactic presentations on legal and ethical issues, as well as unforeseen effects on children and families, helped students understand their professional role with regard to decision-making and public messaging.
According to the American Academy of Pediatrics (2014), threat assessment is the individual's emotional response to perceived vulnerability rather than personal experience of an event. The stigma of caring for individuals with infectious diseases, such as EVD, and public paranoia because of misinformation were explored and addressed (Menzel, 2015). Meaningful learning utilizing discussion, video clips, and images highlighted the importance of communication and the coordination of efforts in order to mitigate the potential for hysteria in relation to the public's perceived threat assessment. Students were challenged to utilize critical thinking, clinical decision-making, and effective communication throughout the clinical learning session.
CLINICAL LEARNING SESSION OVERVIEW
Faculty created an innovative, interactive, learner-centered model utilizing National League for Nursing (NLN) (2014) Ebola Crisis Response resources to prepare senior-level BSN students to bridge the gap between theory and practice. In response to international concern about the EVD public health emergency and the existence of the virus within the United States, it was determined that specific education was needed to prepare students to respond effectively. Nurse faculty used 11 activities to create a clinical learning session to increase students' awareness and understanding of the potential and actual impact of EVD and other infectious diseases. A three-hour session was scheduled within the curriculum for senior-level students.
The 11 activities in the clinical learning session began with a session overview and a Three Words exercise (Simpson, Fenzel, Rehm, & Marcdante, 2010) in which students recorded three words or images to describe their understanding of EVD and other infectious diseases. This activity was followed by a short debriefing where students and faculty shared their three words and common themes were highlighted.
State and local responses to EVD were presented by content experts from the county public health department. An Ebola overview from the Centers for Disease Control and Prevention (CDC) (2015) was used to review the pathophysiology, etiology, signs and symptoms, and transmission of EVD. Faculty demonstrated the process for donning and doffing personal protective equipment, with subsequent student return demonstration using the buddy system. Specific respirator components were not covered because of the need for fit testing in alignment with CDC guidelines (CDC, 2015).
Following a short break, students were provided examples of the impact of social media on public fear and misperceptions using video clips, webcasts, and news clips. A didactic presentation on caring for patients with EVD focused on the legal rights and responsibilities of nurses, as well as ethical dilemmas students may encounter in professional practice in the event of a local EVD or other infectious disease occurrence or disaster. Medical triaging and care provision utilizing the ethical value of social justice were presented. Didactic presentations concluded with a short review on the impact of pandemics on children and families. Information related to threat assessments and secondary trauma of children was highlighted to underscore the importance of consistent and age-appropriate messaging.
Students were shown a news segment reflecting the experience of nurses caring for patients with EVD in the United States, and the weblink was provided. Students were encouraged to begin work on elevator speeches on how they would communicate to others about EVD in the United States. A summary of key talking points, opportunities for collaboration with community partners, and clinical resources for health care providers was provided. The clinical learning session ended with repeating the Three Words exercise (Simpson et al., 2010).
SESSION EVALUATION
At the conclusion of the clinical learning session, 93 of 107 students (87 percent) completed a 16-item evaluation focused on their satisfaction with current learning, self-confidence related to EVD and other infectious diseases, and three open-ended questions on the experience. Feedback from the learning session reflected a positive student experience.
The evaluation consisted of a 5-point Likert scale, with scores ranging from 1 (strongly disagree) to 5 (strongly agree). In five questions contained in the Satisfaction With Current Learning area, with a range of 3 to 5, responses indicated the following: simulation provided a variety of materials and activities to promote learning (4.43); students enjoyed how the session was taught (4.40); and students felt the teaching materials used in the session were motivating and helped them learn (4.35).
For eight questions in the Student Self-Confidence in Learning area, with a range of 4.0 to 4.5, the students indicated the following: material covered critical content necessary for mastery of the curriculum related to infectious disease (4.35); instructors used helpful resources to teach the session (4.5); and students felt they mastered the content of the session activity presented (4.10).
Feedback from the three open-ended questions reflected a positive student experience. Student input focused on several key areas of learning related to increased knowledge, confidence, and the importance of accurate, fact-based communication and collaboration. The response to the Three Word exercise (Simpson et al., 2010) was enlightening and helped set the stage for the learning session. Initially, student responses included "deadly outbreak contagion," "small village decimation," and "massive public fear." A notable perception change was observed at the end of the session when the exercise was repeated; responses included "not so scary," "nurses can educate," and "work together helps."
Open-ended session comments indicated a better understanding by students of their role in the community: "I learned a more objective perspective and just how easily the wrong information can get portrayed" and "We need to be cool, calm, and collected when there is a communicable disease scare." The students also recognized that in the midst of public fear they must remember "To make sure to take care of the WHOLE patient!" Student comments for future clinical learning sessions concentrated on the need for additional time. Feedback from students indicated that they felt empowered to educate and provide effective care for patients with communicable diseases in the future.
FUTURE STEPS
Revisions for future sessions will include additional interactive, scenario-based tabletop exercises and a time allotment of four hours. Consideration is being given to the involvement of other health science students to strengthen interdisciplinary teaming and provide additional reality checks to facilitate student learning.
It is recommended that schools of nursing consider replicating this topic and method in future curriculum development to prepare for public health threats. With the addition of this learning session to meet a current public health threat, faculty need to be cognizant of curriculum overload. This session highlighted the importance of faculty adjusting focus and priorities with student curricula to meet core baccalaureate essentials and address current public health needs.
REFERENCES