Pigs' Feet and Dishpan Hands: Interactive Nurse Practitioner Education

Monday, 30 October 2017

Lisa R. Roberts, DrPH, MSN
School of Nursing, Loma Linda University, Loma Linda, CA, USA

Purpose: To provide Nurse Practitioner (NP) students the opportunity to gain confidence approaching office procedures.

Background: NPs report the perception of being ill prepared by their NP program, and lack confidence, to perform procedures including casting, electrocardiogram (ECG) interpretation, splinting, suturing, and simple office procedures [1, 2]. Yet a large percentage of NPs certified in adult or family practice are working in nontraditional settings such as high-acuity emergency departments and intensive care units [3], where such skills are often required. Therefore, a series of workshops and labs have been embedded in the course curriculum.

Methods: A Breast and Pelvic lab is embedded in the Women’s Health module, allowing students the opportunity to experience doing a breast and pelvic exam with immediate feedback and coaching from an experienced, knowledgeable, standardized patient and instructor. A 12 Lead ECG Interpretation workshop is part of the cardiac curriculum and consists of students’ completion of three interactive computerized modules, followed by an interactive classroom exercise interpreting ten case-based 12-lead ECGs with the guidance of a clinical expert. Pigs feet with pre-made abscesses are utilized in an Office Procedures workshop, for a tactile sense of realism. The students are given the opportunity to practice incision and drainage, followed by a number of other simple procedures including suturing, stapling, excisional biopsy, punch biopsy and wound packing. Additionally, stuffed dishwashing gloves with simulated subungual hematomas are supplied in the Office Procedures workshop to allow students to practice evacuation using a cautery stick. During the orthopedics module, basic x-ray interpretation is taught followed by the Splinting and Casting lab, where students apply gutter, spica, sugar-tong, and stirrup splints, as well as short arm and leg casts, and removal using a cast saw.

Results: Students consistently engage in these learning experiences enthusiastically and report a sense of relief afterwards. While the fear of the unknown is relieved, students also acknowledge their novice skill level. They are appreciative of the opportunity to try these procedures before encountering the need in the patient setting. Some students develop a clear appreciation for the type of practice setting they will seek or avoid upon graduation.