This year, eight UNLV nursing students made history — even if it was just for a few weeks.
Its mission is twofold: educate patients in the community; and give nursing students more experience with personal interactions and offering health guidelines. Launched in February, the novel coronavirus pandemic disrupted UNLV’s involvement in the program prematurely, but the results were already showing in students’ improved skills.
Finding a partnership
The Community Congestive Heart Failure 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. The students observe the patients, assess potential barriers blocking their health goals, and educate them about heart failure.
Professor Jennifer Pfannes oversees the program for UNLV. She and fellow clinical faculty member Minnie Wood helped lay the groundwork for it in the fall.
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. Mark Domingo, the disease management program manager for Dignity Health-St. Rose Dominican Community Health, was interested in the community outreach students did with Helping Hands.
“He said, ‘We’d love to have them be part of our program we’re building,’” Pfannes said. “From there, we started talking and having meetings about what the program would look like and the role of the nursing students.”
Knowledge that doesn’t come from the classroom
Eight students are assigned to Pfannes’ clinical group each semester. Two of those students are assigned to the program and paired up with a community health worker for each client.
When the students arrive at the patient’s home, they gather intake assessments and personal information, conduct patient education, and let clients ask questions.
“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 community health worker will follow up with the patient, and the students move on to a new client.
The program gets students 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 said. “It’s different every time – different patient, different home, different setting with a new set of challenges.”
Those challenges can leave students uncertain and nervous, but by adapting to new and uncomfortable circumstances now, students are gaining skills now that will be critical by the time they enter the workforce.
“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,” Pfannes said. “But you have a job to do.”
It’s a chance for students to learn about clients as people, not just as patients.
“They share with you [their] life stories,” Kroytoro said. “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 to help ease their pain.”
Finding context for patients
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 said.
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 congestive heart failure. 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, including common symptoms, that serves both as a useful guide that will hopefully keep these patients from being readmitted to the hospital.
Setting the stage
The program’s inaugural class only met for a few weeks before coronavirus-related restrictions forced students to suspend visits, though Dignity Health staff is continuing to going to clients’ houses.
Even if it was only for a few weeks, the program has grant funding for the next five years, and the early returns saw Pfannes impressed with what her students accomplished.
“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,” she said. “But this group was super excited. They wholeheartedly dug in each week and did well beyond what was asked of them.”