1

Simulation case: Older person

ObjectiveTo provide a set-up where the students can practise assessing customers' smoking habits and their impacts, and to learn how to motivate customers to reduce and quit smoking. In addition, the aim is to learn different types of guidance methods and observe their effects on the discussion and the customer's engagement.

In the case exercise, the aim is to practise using the Fagerström questionnaire/mini-intervention and learn about motivational interviewing

Target group and the group sizeStudents should have some prior knowledge of the Fagerström questionnaire (Appendix 1) and how it is used, motivational interviewing, the health benefits of quitting smoking (how soon they can be expected), and mini-interventions in smoking cessation. See the information leaflet: https://www.thl.fi/documents/10531/105429/THL_mini-interventio.pdf

One of the students acts as the customer and one or two others can act as nurses. 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 customer 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 equipment A 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 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.

Simulation case – Older person: the material has been 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

2

Simulation case: Older person

Assignment and work instructionsIt 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.

Case: A customer (an older person) visits a practical nurse/registered nurse's office. The purpose of the visit is to discuss the customer's smoking habits and dependence. The customer is somewhat dismissive of his/her smoking and its effects, although he/she does want to quit. He/she also wonders if there is any point in quitting at this age, believing that the health benefits probably won't be felt until much later.

Ask students observing/assessing the scenario 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.

NotesThe debriefing is an important part of simulation case exercises.

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 customer should assess

the way he/she was 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 – Older person: the material has been 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

3

Simulation case: Older person

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 – Older person: the material has been 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

4

Simulation case: Older person

Appendix 2

Simulation assessment

Interaction observations/non-verbal communication

Content of advice (information/instructions)

Choice and use of methods

Simulation case – Older person: the material has been 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

5

Simulation case: Older person

Appendix 3

Tips for the supervisor/debriefer:

Give constructive feedback! Provide concrete examples of how to deal with the situation.

Did the nurse ask the customer how long he/she has been smoking, how much he/she smokes per day, in what situations, any previous attempts to quit

The nurse should ask open-ended questions to allow the customer to respond in his/her own words (e.g. what does smoking mean to him/her, how did he/she start smoking)

Is the nurse able to get the customer 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)? Would the customer benefit from group guidance? Are follow-up measures

suggested?

Bibliography:

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

Tupakasta vieroituksen mini-interventio. Accessed 20 January 2016. https://www.thl.fi/documents/10531/105429/THL_mini-interventio.pdf

Simulation case – Older person: the material has been 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