Nursing Students Make a (Short) First - Extended Edition
By Joseph Gaccione
This year, eight UNLV nursing students made history, even if it was just for a few weeks. UNLV School of Nursing and Dignity Health teamed up for a new initiative called the Community Congestive Heart Failure (CHF) Program. Its mission is two-fold: educate patients in the community and give nursing students more experience with personal interactions and with offering effective health guidelines. Launched in February, COVID-19 disrupted UNLV’s involvement in the CHF program prematurely, but the results were already showing that students improved skillsets.
(NOTE: This story originally appeared in the UNLV News Center. This Extended Edition includes additional interviews from students involved in the program).
The CHF Program is a grant-funded, comprehensive program to assist clients in understanding their health condition and determining the social factors potentially impacting their health status. UNLV undergraduate nursing students go to patients’ homes alongside a community health worker (CHW). The students observe the patients in their natural environments, assess potential barriers blocking their health goals, and educate patients on CHF. Professor Jennifer Pfannes oversees the program on the UNLV side. She and fellow clinical faculty member Minnie Wood helped lay the groundwork for the program in Fall 2019.
UNLV’s involvement with CHF happened by chance. In 2018, Pfannes and a clinical group of nursing students started working with Helping Hands of Henderson in a similar capacity: offering home-based services for people who could not leave their homes. Last fall, Pfannes met Mark Domingo, the disease management program manager for Dignity Health-St. Rose Dominican Community Health, who was interested in the students’ community outreach through Helping Hands. Pfannes: “He said, ‘We’d love to have them be part of our program we’re building.’ Just from there, we started talking and having meetings about what the program would look like, the role of the nursing students, if the program would fit into our clinical model and meet our clinical objectives, and how long we could anticipate the program running.” She added increased enrollment helped the nursing school add on a new clinical group for spring 2020.
How The Program Works
Pfannes is assigned eight students to her clinical group each semester. The students in the CHF program are randomly chosen (because the students are randomly assigned into Pfannes’ clinical group already). Two students are paired up with a Community Health Worker for each client. Appointments with the patients are scheduled, and the students prepare for their visits. “When we come in the morning, [the intake coordinator] gives the students all the pertinent information,” Pfannes said. “She does a pre-screening process with the clients, so the students know what to expect when they go.” When the students arrive at the patient’s home, they have a set process to run through: intake assessments, personal information, patient education, and allotted time for clients to ask questions.
After the students finish their visits, they return to school to debrief. “Each group talks about their client, what the problems are, what the assessment is and what the needs are,” Pfannes said. “Then we formulate a full care plan on what we need to do for the client moving forward.” The CHW will follow up with the patient, and the students move on to a new client for more experience, unless it is determined a patient needs to be seen again.
Normally, patients travel for nursing care to a hospital or clinic. But this program flips the script, giving students a unique experience while getting them out of their comfort zone, according to nursing student Eli Kroytoro. “It’s different having to go into a patient’s home versus having a patient come to you,” Kroytoro says. “It’s different every time – different patient, different home, different setting with a new set of challenges.” Pfannes acknowledges the trepidation students feel making new relationships, especially having to go to their homes rather than a standard, clinical setting. “They’re always anxious in the beginning because a lot of them have never done this before. Being alone with that person and [thinking] ‘What do I say? Do I stand there? Where do I sit?’ It’s all those little things that come with verbal and nonverbal communication. But you have a job to do.”
This does not mean, however, the nursing students are strictly in a clinical mindset. “We’re not giving them a physical assessment or taking their blood pressure,” says student Samantha Migalang. “It’s more of the social aspect of the client’s life rather than directly dealing with their medical issues ourselves.”
That social aspect creates a stronger trust in the patient-nurse relationship, says fellow student Jazmin Lopez. “I had a patient who had pictures of his life everywhere. He was explaining [them] to me. It was cool to experience and see these people are just like us. You just have to find the balance of being in touch with them and keeping connected, but at the same time knowing what you’re there for.”
“They share with you [their] life stories", says Kroytoro. "You can’t really prepare for that, aside from going in and having these conversations with patients and explore these thoughts with them, while also bringing in your nursing background and a scientific knowledge to help ease their pain.”
Aside from the socializing aspect, the students say the biggest lesson this program offers the clients is showing them the signs of congestive heart failure and what could be holding them back from being healthier. “I can look in their pantry and see, with their permission, the types of stuff they're eating and build that on top of what they're saying to see if there's a disconnect between their symptoms, what they're eating, what they say that they're eating, and then how they're doing with their medical condition”, Kroytoro says.
The student nurses often focus on education about how much salt the patients regularly consume or teach them how to look for more physical signs, like constant fatigue and swelling on legs and ankles. But some students say their clients, even with all these signs, didn’t know they had CHF. Some don’t have a primary doctor to discuss these issues, or others assumed they were avoiding harmful diets.
One way the students reinforced their heart health education was designing a small, but informative pamphlet, a key tool they could keep at their house and refer to at any time. The brochure has basic information about CHF (including definition and common symptoms) that serves both as a useful guide but also perpetuates that heart health retention to hopefully keep these patients from being readmitted to the hospital for the same disease process. Student Jordyn Solis says the program’s goal was not about reminding patients to see a doctor, but ways to help them take care of themselves on their own. “We’re there trying to help fix up their environment to make sure they could manage their health, not us manage it.”
Moreover, while not a typical clinical setting, the participating nursing students still benefitted learning from those in-person interactions. Migalang says, “I’m not exactly the most out-going student, but I think working with the CHF program has helped me talk better with patients one-on-one.” Fellow classmate Nicoletta Giangrande added, “When we’re in the hospital, it’s really busy. We are giving medication or checking on other patients and charting. It’s nice just to sit down one-on-one with a patient and have the time to be with them and understand what they’re going through.”
Setting the Stage
The inaugural class of the CHF Program only met for a few weeks before COVID-19 forced social distance restrictions around the world. While the coronavirus outbreak prevents students from going out to clients, Dignity Health is still running the program with their staff. Despite only meeting with patients for a few weeks due to COVID-19, Pfannes came away impressed with what her students accomplished, even from day one. “You don’t always have an enthusiastic group, especially when you tell them they will be the first group of students in a new program; there may be some kinks. But this group was super excited. They wholeheartedly dug in each week and did well beyond what was asked of them.”
Pfannes says the CHF Program is set to run for the next 5 years, per the terms of the grant funding. The students all come away with more nursing experience and knowledge, even if it was just for a short time. Moreover, they all wish they could be out there on the frontlines now during the outbreak.
Kroytoro: “I don't think this is something that should scare people away from the healthcare field. And it's definitely not scaring me away.”
Migalang: “No nursing student ever expected to deal with a pandemic like this, but I'm prepared to keep going with this career.”
Giangrande: “Part of me wishes that we could like fast forward through the program to be able to help.”
Solis: "I think my feelings of just wanting to be there right now, even though I know it's chaotic, confirms to me that I really enjoy nursing."
Lopez: “I didn't stop nursing, and I don't think anything will stop me now.”