Hands-on learning boosts students’ feel for patient care

14 December 2018

A partnership with Alexandra Hospital has made it possible for a foundation course on nursing care knowledge and skills to be extended from the classroom to the hospital, starting this academic year.

At Alexandra Hospital, nursing students assist with taking vital signs and other aspects of patient care.

Year One nursing students are relishing the opportunity to practise their nursing care knowledge and skills outside the classroom after weeks of tutorials and lab work, thanks to a collaboration with Alexandra Hospital.

A new curriculum with an added emphasis on bridging the theory-practice gap has been piloted in the first-year Fundamentals of Nursing (NUR1114) module this academic year, as a result of the collaboration.

NUR1114, which provides students with foundational knowledge and nursing skills to care for patients in different healthcare settings, is taken by undergraduates in the first semester of nursing school. The old curriculum requires students to complete 39 hours of weekly tutorials and lab practice in a simulated hospital ward in the school.

Under the new curriculum, students spend six hours learning nursing procedures and patient care in the simulation ward, apply what they have learnt for four hours during a field visit at Alexandra Hospital, return to the lab for another four hours of skills training, followed by a second clinical session where they practise their skills for four hours.

At Alexandra Hospital, two to five students shadow a registered or enrolled nurse and perform basic nursing practice under his or her close supervision. Nursing students assist with many aspects of patient care, such as bathing, feeding and taking care of patients’ hygiene needs. They also assist with taking vital signs, assessing the patients’ skin condition and wound care.

Tutor Tan Khoon Kiat briefs students on their learning objectives before the afternoon session begins.

Working in shifts from 8 am to 1230 pm or 1 pm to 530 pm, the students start their field visit with a briefing by their tutor on their learning objectives and what they can expect during the clinical session. They spend the rest of the time observing nurses and assisting with patient care.

In addition, students need to get the clinical staff and their clinical tutor to sign off on a log of skills to indicate they have observed the key principles when carrying out the procedures. They are also required to write a reflection journal on what they have learnt from the patient care experience and how they can do better in future.

270 students took part in the 2018 sessions, which ran on Sept 8-9, Sept 15-16, Oct 27-28 and Nov 3-4.

Closing the gap

The objective of the new curriculum is to integrate lab and tutorial learning into actual patient experience, says Dr Lydia Lau, who worked on the new curriculum.

For Dr Lau, creating an authentic setting for students to experience patient care is the most powerful way to get them to view a patient’s needs holistically and adopt a patient-centric model of care from day one.

“When we place students in the hospital, they can immediately consider an individual patient’s needs and how to meet those needs. It gives them the opportunity to problem solve, adapt and adjust – and hopefully, develop their critical thinking as they have more opportunities for practice and reflection,” she adds.

Students who experience patient care in an authentic setting learn to view a patient’s needs holistically, says Dr Lydia Lau.

Many students, like Paula Nazarene Evangelista Say, have never interacted with or cared for elderly patients in their lives. The Alexandra field visit opened her eyes – and her senses – to the sights, smells and drama in a real hospital ward. “I was shocked when an elderly patient pulled out his IV in front of me and blood started dripping from it. Nothing in the lab could have prepared me for this scene," she says. "When I bathed a patient for the first time in my life, the smell that activated my senses after I removed the uncle’s soiled diaper was also nothing I have experienced before,” she recalls.

The permanent resident from the Philippines, who speaks only English and Tagalog, found that language barrier hampered her ability to communicate with the predominantly dialect-speaking elderly patients in the ward. “I felt helpless when a Hokkien-speaking patient asked me to call for his son, even though he has no next-of-kin. I wanted to reassure him but ended up asking my classmate to translate for me,” she says. She’s now exploring taking up Mandarin and dialect electives in school.

Year one student Lim Ye Sheng says he felt uneasy when he was reminded by the nurse to communicate with a patient who was unable to speak or open his eyes, before taking his blood pressure reading. "We have been so used to practising this on our classmates that when I had to do it on a stroke patient, I had to relearn and readjust my practice to respect the patient’s rights,” he says.

First-year nursing students will eventually be exposed to clinical rotations in December and next June, but fast-forwarding this experience has been pivotal in lessening the culture shock and preparing them better for their upcoming clinical rotations, they say.

“The field visits helped me to bridge the theory-practice gap and contextualise learning immediately after picking up the skill so that I can modify and adjust it before it’s forgotten,” says Teo Wei Zhou, who assisted a nurse in feeding a patient through a nasogastric tube. He found the experience more challenging than doing it on a manikin, but says he’s more confident now and can fully appreciate the need to place the tubing correctly to avoid complications.

His experience is echoed by schoolmate Wong Kai Lin. “Even though we learnt the basic skills for patient care in the lab, in a real hospital setting, we realised how important it was to individualise the care and how much more learning there is to do along the way as we adjust to the real-life conditions of patients,” she says.

More confident, competent

After the postings, students can contribute more confidently to class discussions.

Dr Lau says that after the postings, students return to classes with a better grasp of clinical skills and a newfound confidence in contributing to class discussions, as they no longer need to imagine the scenarios described by their tutors.

Paula agrees. "After this posting, we can better relate what we are learning to real patients. We are no longer just memorising the conditions or anatomy such as how the muscles work without knowing the importance of it,” she says.

In addition to their nursing experience, the students also appreciate the way the nurses contributed to their learning. “The nurses were very kind and helpful. They taught us skills that we have not learnt, like how to turn patients every two hours to reduce risk of developing pressure injury, and what to look out for when taking vital signs. They really helped us every step of our learning process,” says Paula.

“We are very appreciative to the Hospital for partnering us through field visits to support undergraduate nursing students with hands-on training, and to the welcoming nurses for coaching and supervising our students,” Dr Lau adds.