BACKGROUND-Patient-centered care is an essential value in nursing, (Grilo, Santos, Rita & Gomes, 2014) but patient safety must always take precedence when nurses are making decisions (Edwards, 2013). When selecting student centered learning activities, it is important to consider learner characteristics which may impact learning. Generational influences and learning style preferences are two characteristics which may be an important consideration for educators (Nick, 2015). With this strategy, the author created a case study while also taking into consideration the learning needs of the nursing students by using technology and media. This case study was designed for courses which contained student learning outcomes related to legal and ethical aspects of nursing. One of the courses was an RN-BSN course, and all students enrolled in this course held active nursing licenses. The other course is a mental health course in which pre-licensure BS students were enrolled. The Quality and Safety Education for Nurses (QSEN) competencies of Safety and Patient-centered Care were used to define and measure student learning outcomes based on the learner targets of Knowledge, Skills, and Attitudes.
QSEN defines Patient-centered care as to: “Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs” (p. 1-2, QSEN.org, 2014). The demonstration of the application of knowledge can be assessed by the student responses when reflecting on patient/family/community preferences, values, coordination and integration of care. The student can also reflect on how to provide comfort and emotional support in a safe and ethical manner. The achievement of the skills required for a registered nurse also can be measured with the student reflections which consider patient values, preferences and expressed needs to other members of healthcare team. The assessment of the affective domain of learning (attitudes) is accomplished by providing case study examples which portray health care situations “through patients’ eyes” and evaluating the student responses to the case study questions. Also, QSEN defines safety as such that it “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance”. The practical use of knowledge can be applied by students in this case study by reflecting on processes used in understanding causes of error and allocation of responsibility and accountability (cause and failure mode effects analysis). The evaluation of outcomes related to skills can be measured by identifying the efficient use of strategies to reduce the risk of harm to self or others. In this case study, the outcomes of QSEN attitudes can be quantified by the student’s reflection on the value of vigilance and monitoring by patients, families, and other members of the health care team.
METHOD-A longitudinal, qualitative approach was used to evaluate student reflection using a pre and post-survey. The implementation of this teaching and learning strategy occurred in several courses, over several consecutive semesters. This case study provides a brief insight into a case scenario by having students observe scenes 18-20 in the film titled “The Notebook.” The Notebook is a story about a married couple, who are very close to one another, and the wife has Alzheimer’s Disease. The husband reads to his wife from a notebook as an effort to help her reorient her to reality. An ethical dilemma emerges within these scenes, and without further discussion, students are asked to reflect on their thoughts and attitudes relating to the how the nurse in the film chose to solve this ethical dilemma and complete a pre-survey. Students are then given a post-survey to complete by collaborating with their group members which guide them through concrete steps when facing an ethical dilemma.
RESULTS-The majority of students in the pre-survey stated they would solve the dilemma just as the nurse in the film. After reflection and group discussion, many of the students reported that the actions of the nurse could have legal and safety implications which were not considered and would choose alternative methods to solve the dilemma. In mid-semester (formative evaluation) and end-of-semester surveys, all students reported a high level of satisfaction with the learning activities and technology used for teaching and learning.
CONCLUSION-Millennial students who considered digital natives, appreciate the use of technology media and a collaborative approach to learning (Garwood, 2015) and this case study was useful in promoting the QSEN competencies of knowledge, skills, and attitudes which are related to safety and patient-centered care.