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Simulation case: Young couple

ObjectiveThe objective is to practise authentic guidance situations, learn to provide information about the dangers of smoking and describe its impact on fertility/pregnancy/unborn children.

Target group and the group sizeStudents should have prior knowledge of

Dangers of smoking and its effects on fertility, pregnancy and the unborn child Electronic cigarettes Motivational interviewing

Two students act as customers and one student acts as the nurse. Other students watch the simulation in the classroom and assess it afterwards. Alternatively, the case simulation can be recorded and played back.

The simulation can be supervised by one or two people to monitor the time, present the cases, debrief and provide feedback. The supervisor can be a lecturer or an advanced student.

Time use Description of the simulation process: approx. 15 min. If there are several simulations

in one day, the presentation should be given only once, before the first simulation. Role assignment and briefing of the role players: 5 min. A brief description of the case customers to the observing students: 2 min. The customer case simulation: approx. 20 min. (Timed by the lecturer or the camera

operator if the simulation is recorded on video) Debriefing and assessment: approx. 20 min.

Preparation, supplies, facilities and equipmentA simulation classroom or video equipment for making a recording for later viewing.

The simulation requires an environment (a simulation space or a classroom set up for video recording) set up as a nurse's office. The Fagerström questionnaire form (Appendix 1) and other guidance materials are placed on a table.

Choose the participants for the simulation: one or two students to act as nurses and one student to act as the customer.

Assignment and work instructionIt is recommended to have two supervisors guiding the simulation case. One can brief the student acting as a nurse and the other can brief the student who takes the customer role. Alternatively, the case assignment can be a paper handout.

Simulation case – Young couple, an exercise authored by HAMK nursing students. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016

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Simulation case: Young couple

Case: The nurse is seeing a couple (in their early 30s) who both smoke. The couple are thinking of starting a family and they would like to quit smoking. The woman is especially ready to quit and sees smoking as a bad habit and addiction. The man still needs motivation and discussion. He is thinking of not quitting until the baby is born and doesn't feel the matter is urgent. However, his wife thinks that it would be easier to quit together and support each other. They have already attempted to quit smoking without success. The woman is also interested in the impact of smoking on conception.

The couple are interested in using electronic cigarettes as replacement therapy.

Ask students observing/assessing the scenario (Appendix 2) to pay particular attention to what went well, what could have been done differently, and what they learned from the scenario. They should also assess interaction and the use of different methods.

Notes

Give a round of applause to the role players after the simulation.

Ask the customer/nurse what the scenario was like as an experience. The nurse should self-assess his/her guidance skills, and the customers should assess the

way they were treated, heard and helped. What went well, what could have been done better, what did they learn?

The observing students should assess the participants' performance in a constructive way. Students can be divided into 2-4 groups, with a specific assessment topic given to each group. Assessment topics can include (Appendix 2. Simulation assessment form):

Interaction/non-verbal communication Methods used The nurse's knowledge/guidance skills

The supervisor(s) should assess the topics with the students (Appendix 3. Assessment and discussion tips for the supervisor/debriefer)

Simulation case – Young couple, an exercise authored by HAMK nursing students. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016

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Simulation case: Young couple

Appendix 1

Fagerström's questionnaire on dependence

Question Quantity Points

How soon (in minutes) after waking up do you have your first cigarette?

less than 6 3

6-30 2

31-60 1

over 60 0

How many cigarettes do you smoke per day?

less than 10 0

11–20 1

21–30 2

over 30 3

Scoring:

Total points 0–1 = low nicotine dependence, 2 = moderate dependence, 3 = high dependence, 4–6 = very high dependence

Simulation case – Young couple, an exercise authored by HAMK nursing students. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016

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Simulation case: Young couple

Appendix 2

Simulation assessment

Interaction observations/non-verbal communication

Content of advice (information/instructions)

Choice and use of methods

Simulation case – Young couple, an exercise authored by HAMK nursing students. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016

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Simulation case: Young couple

Appendix 3.

Tips for the supervisor/debriefer:

Give constructive feedback! Provide concrete examples of how to deal with the situation. What did the student learn from the situation? What went well in his/her view? Which

areas needed more attention? Did the nurse ask the customers how long they had been smoking, how much they smoke

per day, in what situations, any previous attempts to quit (what quitting aids did they use and why didn't these work in their opinion)

The nurse should ask open-ended questions to allow the customers to respond in their own words (e.g. what does smoking mean to them, how did they start smoking)

Is the nurse able to get the customers to reflect on the benefits and risks of smoking? Does the nurse give information about the health benefits of quitting? Is the nurse interested in the customer's answers, does he/she listen? Does the nurse ask about support networks (family, friends) The nurse should not recommend electronic cigarettes as a replacement due to insufficient

research data; other smoking cessation methods should be suggested instead.

Sources:

Fagerströmin riippuvuustesti. Terveysportti /Käypä hoito. Accessed 1 December 2006. http://www.kaypahoito.fi/web/kh/suositukset/suositus?id=hoi40020

Simulation case – Young couple, an exercise authored by HAMK nursing students. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016