A Transformation to Family-Focused Nursing Practice is Evident in Undergraduate Students
Young, Patricia K.
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Session presented on Saturday, April 9, 2016: Introduction and Purpose: Teaching and learning are interactive and dynamic processes that require nurse educators to focus on the learner and learning (Cahill, Turner, & Barefoot, 2010). In the learner-centered paradigm educators create a collaborative environment where teaching engages students in experiences that promote intellectual processes of thinking in new ways. Nursing faculty have the responsibility to create learning experiences that will advance nursing practice (Bell, 2010; Holtslander, Solar, & Smith, 2013; Sowan & Jenkins, 2013). The responsibility for creating engaging learning approaches is particularly important for transforming practice with families. The purpose of this paper is to share and analyze exemplars of teaching/learning strategies in one academic community that integrate research, apply evidence, and engage undergraduate students in innovative projects that translate evidence to family-focused nursing practice. Method: Faculty have developed innovative teaching learning projects that tackle the complexities of current family nursing practice and family health. Faculty aimed to develop learning experiential learning experiences to emphasize the human dimension of family and application of family nursing knowledge. There was a deliberate intent to include action-oriented pedagogical approaches such as simulation and service learning experiences that have been shown to engage students in learning and help them develop a sense of competence in their practice (McKinnon & Fealy, 2011). Ongoing dialogue among faculty teams aimed to be meaningful learning experiences and create a long, lasting impact on the student's ability to acquire confidence in meeting family needs through mastery of competencies and course outcomes (Fink, 2013). Results: Student course evaluation data suggests that students view the family as a recipient of their care and undergraduate students are capable of applying family nursing theory as they engage in interviews, conversation, and nursing actions with families. Faculty evaluation data indicate that family nursing science research is evident in all courses, not merely a research course. Rather faculty and students keep research and family central to all learning experiences. Recent completion of student assignments in the first of the family courses yielded data that are encouraging. For example, one of the learning experiences involved students video-recording themselves while conducting interviews using different family theoretical models over four weeks and critiquing each other as they view them with their instructors. After analyzing these theoretical models for their usefulness in nursing practice, students select a model or blend models, construct an interview guide, and conduct a fifth interview. Students see the progress they make over four weeks and are more confident when they independently conduct their last family interview. The early course evaluation data from these beginning students suggest nursing students are finding the interview experience valuable and inspiring faculty to continue on this path with students' comments on evaluation data such as: I really have begun to understand how the interview process is a therapeutic nursing practice. In these interviews, the family gets a chance to express how they feel and what they are going through. Sometimes just having a listening ear that really cares and is present can heal a family emotionally. The family can work through the problems that they are having by verbally talking through it in the interview. Providing a safe space for a family to share their experiences makes them happy and is therapeutic. In another learning experience student groups select an area of concern for families during illness, such as caregiving or family protection, and then review related literature, provide exemplars, and recommend family focused nursing actions based on evidence to create a scholarly poster for a poster session. Ten posters based on these reviews were displayed in the halls of the School of Nursing and students explained and defended their work to poster session attendees. It was evident that students held a new appreciation for implications of family health, meanings of family during a disease process, and the power of a nurse's action to accentuate or soften the suffering of a family during an illness experience. Evaluation data included student comments: I really understand how difficult it can be for a family with an adult family member with a chronic illness, such as diabetes to cope. I never thought about how it [an illness or disease] affects and the family before and how much distress it can cause a family." The Family Constructs Framework is consistently being used to guide students' examination of family nursing research. As part of experiential experiences, students arrange a partnership with family that is experiencing health needs, disabilities, or ongoing chronic illness. During student-family interactions the student explores family's health and illness experience by obtaining the family's illness story and reviewing related literature. Based on current evidence and family data students identify family constructs that are relevant to this family. Next, the student investigates research to identify appropriate family level nursing actions. During subsequent student-family interactions students apply nursing actions as negotiated with the family. Students integrate research throughout this family follow-through experience to guide their assessment, thinking, and actions. A faculty comment about this work with students supports the value of the assignment: It has been a lot of work, but students have learned a great deal. They seem to have been able to grasp the need to care for the hospitalized patient with an illness and their family. These written assignments certainly provide evidence that the students are thinking family in all that they read, do, and learn. Scenarios used in simulation learning experiences that address family illness experiences seem to be assisting students to recognize family suffering with illness, the impact of family nursing practices and reciprocal nature of individual and family health. Students who completed a family simulation that aimed to help students manage family anxiety with a family member's acute illness highlight understandings of family experiences and confidence in family nursing practices in following comments: I totally understand a family not wanting to leave the side of their family member in the hospital and now I know how to invite them into the room. Students participate in academic-community partnerships where they participate in service learning projects that focus on families in communities. Partnering with a community action group, students in a research course gained hands-on experience with data analysis. The data collected was from local communities about awareness of Alzheimer's disease and development of dementia friendly communities. Students are able to evaluate outcomes regarding awareness of Alzheimer's disease, the impact on the community and on caregivers and family. Students work together to identify areas where they could partner with community members to serve the needs of families who are caregivers for persons with Alzheimer's disease. In this way, students gain invaluable experience working in partnership with community members, taking an active role in developing relationships and identifying interventions to aid the community, and by becoming more informed consumers of scientific research. A senior symposium allows public discussion of students' examination of family dynamics during crisis and the role of the nurse in caring for families in crisis who are experiencing complex alterations. This project provides students the opportunity to apply evidence in Big Idea to solve an identified crisis. As baccalaureate prepared nurses, students are expected to assume the role of family and societal advocacy. This experience allows faculty and students to participate in a culminating experience that translates evidence to a practice project. Conclusions: These nurse educators create learning experiences that strengthen students' beliefs that illness was a family affair and that nursing care influenced health of the individual and family. Faculty course design intended to guide students in developing confidence and comfort in family nursing practice, in spite of the barriers they would encounter as they entered the current practice world. Evaluation data to this point suggests learner centered experiences that promote active learning with families are valued by students and faculty. Faculty remain committed to developing courses with intentional teaching learning practices that would guide students to develop a focus on the family that would thrive in their future nursing practice.