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THE LITTLE THINGS: PART 2 OF THE SERIES FROM NURSING STUDENT TO PATIENT AND BACK AGAIN

This story was originally posted by the NLN TEQ blog on October 23rd, 2018

In this three-part Ask the Expert Series, we feature Bhavana Aitha, a senior nursing student at the University of Delaware who explores the reciprocal benefits of working as a simulated patient while helping her university use simulated patients. In this second part of the series, Bhavana talks about the importance of the little things.

By: Bhavana Aitha

Being a nurse can be hectic. We constantly run back and forth from one patient room to the next while providing medical care. As orders and documentation pile up, we prioritize certain tasks and often forget the rest. We are so focused on administering medications and doing our assessments that we fail to realize the importance of the atmosphere in which we communicate with patients. Through health care theater simulations, as both nursing student and patient actor, I have had many experiences that taught me how to be aware of the quality of my nursing care.

The first simulation I ever had as a nursing student, I was petrified. I had little to no experience talking to patients and was overcome with the fear of unmet expectations. It was a diversity simulation, where we were expected to promote healthy behaviors to a patient with hypertension who believed in folk medicine. As I began to speak to my patient, I realized there was an obvious communication barrier. I tried to come up with a plan of care that catered to the patient's needs, which included the use of traditional methods, while also emphasizing the importance of maintaining her blood pressure through drug therapy. My patient believed her traditional approaches worked (e.g., application of garlic cloves to the elbow to rid the body of toxins), and I encouraged her to continue her approach while trying to teach her about the negative effects of a sodium-enriched diet and the importance of a pharmaceutical treatment for blood pressure. I had some trouble explaining to the patient that her diagnosis consisted of hypertension, not high-pertension, but I attempted to educate her on the implications of her new heart medication, which the doctor prescribed, and to see if she was willing to make any lifestyle changes.

At the end of the simulation, I was ready to get some harsh feedback from the simulated patient (SP) and my instructor. I expected to receive feedback on "needing to give simpler explanations" or "improve my medication teaching." I did not expect to hear about something as simple as my proximity to the patient. I was so nervous about what I was going to say that I didn't even begin to think about where I was standing in the room.

This experience made me realize how important little things can be, how quickly they add up. Being worried about speaking to a patient is one thing, but by not thinking about the little things, like where you are standing in relation to the patient or your tone of voice, you're clearly setting yourself up for failure. My proximity to the patient and its impact on connectedness with the conversation was both a surprising yet very valuable lesson that I'm not sure I would have learned without simulation. I have used this feedback moving forward in other simulations and I never forget to stand at a comfortable distance from my patient!

I have also had the chance to play the simulated patient. During one of my experiences, I played the role of a stressed-out college student with many concerns, including an ill mother and an intensive course load. The focus of the simulation was enhancing comfort with anxious patients. The student who played the role of the nurse was friendly and tried to get me to talk openly about my problems. As she spoke, she shook her leg constantly and I was unable to fully concentrate on what she was saying. Her nervous behavior made me even more anxious than the role I was supposed to be portraying. Playing this simulated patient made me realize just how much power a health care provider has, how even little things like body language can have an immense effect on the patient experience. As nurses, we have the control in our jobs to focus on the little things — the little things that enhance the quality of the health care we provide.

Experiences as both a nursing student and SP in the simulation lab have made me realize that the little things matter. Even behaviors we don't usually pay much attention to during our busy schedule can have an enormous impact while communicating with our patients. Sometimes we just have to step aside from all the "skills" (e.g., hanging our IV bags) to try and understand our patient's environment and how we might enhance it. These things may seem little, but they can add up to make a world of difference. I am thankful for the opportunities that I have had in simulations as both a nursing student and patient to help me be a better nurse in real life.

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Bhavana Aitha is currently a fourth-year nursing student at the University of Delaware. She is pursuing an honors degree in hopes to become a future labor and delivery nurse. She has had many simulation experiences as a student and patient actor throughout her education and intends to expose her knowledge to the nursing education community in order to better advance teaching and learning for subsequent student nurses. The standing vice president of the Multicultural Student Nurses Organization, she spends her spare time volunteering for a nonprofit organization called Lori's Hands in efforts to provide assistive care for people with chronic illnesses in her community. 

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