Teaching Nursing Care of Chronic Illness: A Storied Approach to Whole Person Care (Springer Series on the Teaching of Nursing)

257 Pages·2004·0.61 MB·English

by  Pamela Minden RN PhD CS, Colleen Gullickson RN PhD APNP BC

Springer Series on the Teaching of Nursing
Diane O. McGivern, RN, PhD, FAAN, Series Editor
New York University Division of Nursing
Advisory Board: Ellen Baer, PhD, RN, FAAN; Carla Mariano, EdD, RN,
AHN-C, FAAIM; Janet A. Rodgers, PhD, RN, FAAN; Alice Adam Young,
PhD, RN
2004 Research in Nursing and Health, 2nd edition: Understanding and Using
Quantitative and Qualitative Methods, Carol Noll Hoskins, PhD, RN, FAAN,
Carla Mariano, EdD, RN AHN-C, FAAIM, with contribs
2004 Teaching Nursing Care of Chronic Illness: A Storied Approach to Whole
Person Care, P. Minden, RN, PhD, APRN-BC, and C. Gullickson, RN, PhD,
APRN, BC
2004 Developing An Online Course: Best Practices for Nurse Educators, Carol
A. O’Neil, PhD, RN, Cheryl A. Fisher, MSN, RN, and Susan K. Newbold, RNBC,
FAAN, MSN
2004 Academic Nursing Practice: Helping to Shape the Future of Healthcare,
L. Evans, DNSc, FAAN, RN, and Norma M. Lang, PhD, FAAN, FRCN, RN
2003 Teaching Nursing in an Associate Degree Program, Rita G. Mertig, MS,
RNC, CNS
2001 Educating Advanced Practice Nurses and Midwives: From Practice to
Teaching, J. E. Thompson, RN, CNM, DrPH, FAAN, FACNM, R. M. Kersh-
baumer, MMS, RN, CNM, MSN, EdD, and M. A. Krisman-Scott, RN, PhD, FNP
2000 Nursing Informatics: Education for Practice, B. Carty, RN, EdD
2000 Distance Education in Nursing, J. M. Novotny, PhD, RN
2000 Community-Based Nursing Education: The Experiences of Eight Schools
of Nursing, P. S. Matteson, PhD, RNC
2000 A Nuts-and-Bolts Approach to Teaching Nursing, 2nd ed., V. Schoolcraft,
RN, MSN, PhD, and J. N. Novotny, PhD, RN
1999 Clinical Teaching Strategies in Nursing, K. B. Gaberson, PhD, RN, and M.
H. Oermann, PhD, RN, FAAN
1999 Integrating Community Service into Nursing Education: A Guide to Ser-
vice-Learning, P. A. Bailey, EdD, RN, CS, D. R. Carpenter, EdD, RN, CS, and
P. A. Harrington, EdD, RN, CS
1999 Teaching Nursing in the Era of Managed Care, B. S. Barnum, RN, PhD,
FAAN
1998 Developing Research in Nursing and Health: Quantitative and Qualitative
Methods, C. N. Hoskins, PhD, RN, FAAN
1998 Evaluation and Testing in Nursing Education, M. H. Oermann, PhD, RN,
FAAN, and K. B. Gaberson, PhD, RN
1996 Using the Arts and Humanities to Teach Nursing: A Creative Approach,
T. M. Valiga, RN, EdD, and E. R. Bruderle, MSN, RN
1995 Teaching Nursing in the Neighborhoods: The Northeastern University
Model, P. S. Matteson, RNC, PhD
1994 The Nurse As Group Leader: Third Edition, C. C. Clark, EdD, RN, ARNP,
FAAN
1993 A Down-to-Earth Approach to Being a Nurse Educator, V. Schoolcraft, RN,
MS, PhD
1993 An Addictions Curriculum for Nurses and Other Helping Professionals:
Vols. I and II, E. M. Burns, RN, PhD, FAAN, A. Thompson, RN, PhD, and J.
K. Ciccone, MA, APR, Editors
1991 The Nurse Educator in Academia: Strategies for Success, T. M. Valiga,
RN, EdD, and H. J. Streubert, RN, EdD
The authors are nurse educators who each have extensive clinical experi-
ence, Dr. Gullickson in the medical-surgical arena and Dr. Minden in
mental health. Dr. Gullickson is a geriatric nurse practitioner and Dr.
Minden is certified as a psychiatric nurse clinical specialist. They share
an interest in end-of-life care and both have completed the ELNEC
faculty preparation course. In addition to their love of teaching, both
have a passion for using humor as a therapeutic tool and have completed
research relevant to this. They each have several publications on the
topic and have presented at national and international conferences.
Pamela Minden, PhD, RN, APRN, BC
Associate Professor of Nursing
Edgewood College–Nursing Department
A Registered Nurse for twenty-seven years, Dr. Minden earned a bache-
lor’s degree fromArizona State University, a master’s degree in psychiat-
ric/mental health nursing from Boston University, and a doctorate in
curriculum and instruction from the University of Wisconsin–Madison.
Prior to joining the Nursing Department at Edgewood College in 1993
she worked in a variety of clinical, consultative, and administrative
capacities. A special interest in the spiritual dimension of health and
alternative care approaches has led her to pursue advanced training in
hypnosis, strategic family therapy, and parish nursing.
Colleen Gullickson, PhD, RN, APRN, BC
Professor of Nursing
Edgewood College–Nursing Department
A nurse educator for the last twenty-five years, Dr. Gullickson earned
a bachelor’s degree from the University of Wisconsin–Milwaukee, a
master’s degree in nursing from University of Wisconsin–Madison, and
a doctorate in nursing from the University of Illinois–Chicago Medical
Center. She completed post-masters work at Marquette University and
is certified as a geriatric nurse practitioner. She taught at the University
of Colorado–Denver and the University of Wisconsin–Madison before
accepting a faculty position at Edgewood College in 1993.
TEACHING NURSING
CARE
OF CHRONIC ILLNESS
Pamela Minden, RN, PhD, CS
Colleen Gullickson, RN, PhD, APNP, BC
Copyright © 2005 by Springer Publishing Company, Inc.
All rights reserved
No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the
prior permission of Springer Publishing Company, Inc.
Springer Publishing Company, Inc.
536 Broadway
New York, NY 10012-3955
Acquisitions Editor:
Production Editor: Janice Stangel
Cover design by Joanne Honigman
04 05 06 07 08 / 5 4 3 2 1
CIP to come
Printed in the United States of America by Integrated Book
Technology.
We dedicate this text to the numerous students, clients, colleagues, and
friends who shared their stories so others might learn what it means
to live a life in the face of chronic illness. Their wisdom continues to
humble and inspire us.
Contents
Preface vii
1. Living a Life With Chronic Illness 1
2. Understanding Our Educational Environment 9
3. Using Stories to Teach Whole-Person Care 21
in Chronic Illness
4. Teaching the Theory Component 43
5. Teaching the Clinical Component 87
6. Using the Experiences of Students 133
Appendix A. Case Examples 147
Appendix B. Sample Wellness Interviews 159
Appendix C. Sample Wellness Group Documentation 169
Appendix D. Clinical Evaluation Tools 185
Appendix E. Sample Completed Clinical Evaluation Tools 195
Appendix F. Adrian’s Story 209
Appendix G. John’s Story 223
Index 241
v
This page intentionally left blank
Preface
o doubt there are a variety of reasons for choosing to read this
book. Perhaps you are new to nursing education and are looking
Nfor specific how-to information. Maybe the title piqued your
interest because you wonder, “What is different about teaching chronic
illness?” Whatever your motivation, we hope our storied approach to
teaching whole-person care for individuals and families faced with
chronic illness will encourage and inform both those in nursing practice
and in nursing education.
We are nurse educators, and each of us has over 25 years of clinical
experience, Colleen’s experience is in the medical-surgical arena and
Pamela’s is in mental health. In addition to being doctoral-prepared
teachers, Colleen is a geriatric nurse practitioner, and Pamela is certified
as a psychiatric nurse clinical specialist. Our intent is to provide a
comprehensive portrait of a theory course and a clinical course in
chronic illness. Paired these courses serve as a conduit for teaching
about the provision of nursing care with people experiencing enduring
health concerns that impinge on the lives they want to lead. Both
courses emphasize long-term management of complex physical and
mental problems occurring at a variety of age levels, and the importance
of multidisciplinary collaborative planning and continuity of care. Each
takes into consideration not only the effects of disease and disability
on the individual, but also on the individual’s support system and on
the larger community.
The courses are part of a 4-year baccalaureate nursing program at
Edgewood College in Madison, Wisconsin. They are positioned in the
middle of five semesters of nursing coursework that are each designed to
reflect six curricular strands: caring, health, client/person, professional
nursing, environment, and critical thinking. These strands, which are
integral to each nursing course and the overall program, become in-
creasingly complex at each level of the curriculum.
In their first nursing semester, students learn about community-based
primary prevention across the lifespan, and in their next semester, they
learn about secondary prevention with adults in acute-care settings. The
vii
viii Preface
chronic illness courses then expand the focus to tertiary prevention,
move the definition of client from that of an individual or a family to
groups, and place students in both inpatient and community settings
to promote understanding of the need for a continuum of care.
Situating the chronic illness courses in the third semester of the
nursing programallows students to develop confidence and competency
inmore familiar skills (e.g., communication, interviewing) and concrete
skills (e.g., physical cares, IVs, medications) before exposing them to
the complex and controversial issues surrounding chronic illness man-
agement. In these two courses, they observe firsthand the dynamic
interdependence between individuals with chronic illnesses, their imme-
diate supports, and the more global health care system. The two courses
are crucial in preparing students to care for families with complex
health concerns in the fourth semester and with communities at risk
in their final semester. In essence, the chronic illness courses move the
students from a myopic perspective to a more panoramic one.
Chapter 1 identifies the impetus for developing and teaching courses
in chronic illness at Edgewood College. It then briefly explores how
the hegemony of the biomedical model and the character of chronic
illness conspire to create negative mindsets in our students when they
first venture into tertiary care.
A context for understanding how we teach about chronic illness is
provided in Chapter 2, where you will find a brief overview of the history
and mission of the academic institution where we have taught for the
last 11 years. We reflect there as well on how the values of justice, truth,
compassion, community, and partnership inform and guide the liberal
arts curriculum that forms the foundation for nursing education at
our college. The chapter delineates key aspects of Edgewood’s nursing
curriculum, where the two chronic-illness courses are pivotally posi-
tioned in the latter part of the junior year.
The theoretical frame in which the two courses are embedded is
presented in Chapter 3. Our storied approach to whole-person care, a
pedagogical integration of two cognitive modes—the logico-scientific
and the narrative—is also discussed. Three organizing themes—self-
regulation, stigma, and caregiver issues that serve as lenses for learning
the clinical knowledge and skills necessary for providing holistic care
to individuals and families encountering challenges associated with
chronic illness—are then elaborated on and illustrated.
At the inception of the chronic illness courses in 1996, Edgewood
nursing faulty as a whole collaborated to create specific learning objec-
Preface ix
tives for each, which continue to direct curriculum development and
assessment of student learning. These are delineated in chapters 4 and
5 respectively, as are our methods for achieving them. Chapter 4 centers
on what and how we teach in the theory course. Classroom strategies
to promote understanding of the lived experience of chronic illness,
and the knowledge and skills to manage it are elucidated. Chapter 5
explains our instructionmethods in both the psychosocial/spiritual and
medical/surgical components of the clinical course, where students
learn to shift their focus of care from “doing to” to “being with.”
Chapter 6 brings us metaphorically full circle as three students who
return to our classroom as guest speakers recount parts of their learning
journeys. Though unsolicited, their affirmation of our teaching reas-
sures that our methods can transform skepticism about chronic care
into a powerful appreciation for the courage and creativity of persons
living a life under the perpetual influence of illness. Their comments
illuminate the student side of the teaching-learning process and exem-
plify the fact that, as educators, we will never know how our students
are internalizing our course content unless we ask.
Regardless of how or why you have acquired this text, we trust you
will find it amply supplied with scholarly and practical information for
enhancing clinical and classroom instruction, especially as relates to
the care and management of long-term health concerns. We hope as
well that it inspires nursing practitioners, educators, and students to
reach outside their comfort zones, as have we and our students, to
promote the clients we have been privileged to serve, quality whole-
person care. We are grateful for all they have taught us and for their
opportunity to pass it along to you.