By Danya Lusk
Meet Butch Sampson, 62, a homeless vet exposed to Agent Orange in Vietnam, and Randy Adams, 28, who saw combat in Iraq. Sampson and Adams were created by Janet Willhaus, assistant professor in the School of Nursing, to be used as part of a teaching paradigm for treating veterans and their family members.
Wilhaus created the characters for the National League for Nursing’s newly launched Advancing Care Excellence for Veterans (ACE/V), which was developed in partnership with Laerdal Medical.
Willhaus’ characters and others like them are used in unfolding cases during simulations. The cases better prepare nursing students to effectively treat veterans suffering from post-traumatic stress disorder, traumatic brain injury and a host of related physical, mental health and social ills associated with combat.
An unfolding case is one that evolves over time in a manner that is unpredictable to the learner. They combine the power of storytelling with the experiential nature of simulation scenarios, and are intended to create a robust, meaningful experience for students, one that provides a simulated experience of continuity of care.
The unfolding case model includes the following:
- A first-person monologue, recorded by a professional actor, that introduces the individual or couple and the complex problems to be addressed
- Simulation scenarios designed to help students practice assessment and intervention of veterans, with suggestions for debriefing and links to appropriate evidence-based assessment tools, including those from the Veteran’s Administration and Centers for Disease Control
- An innovative final assignment that asks students to finish the story
- An instructor toolkit with suggestions on how to use the various components of the unfolding cases and incorporate them into the curriculum
For example, in Adams’ scenarios, the students meet Adams while he is being discharged from the emergency room after surviving a car accident in his home town. The students listen to his monologue as he tries to describe his experience of the accident, occasionally experiencing disorientation about whether he is home or in Iraq, where he served. The students also listen to a recording of his wife, simulating a phone conversation with her when she is asked to come get him from the hospital. After listening to the recordings, students simulate working through the discharge process using a manikin or a standardized patient actor to fill in as Adams. They schedule future appointments, assess his potential concussion and work through his reluctance to be treated.
The next time the students interact with Adams is when he appears at a clinic without an appointment, having skipped prior follow-up appointments. In the final interaction, the students conduct assessments during a scheduled follow-up, to which Adams brings his wife. Adams’ traumatic brain injury and post-traumatic stress disorder allow students to explore how combat experience may complicate medical assessments once they return home.
In April 2012, Michelle Obama and Jill Biden called on American health care providers to better address the acute health care needs of veterans. The National League for Nursing (NLN) participated in the Obama-Biden initiative, Joining Forces, by marshaling the best teaching resources and tools then available on a website for nurse educators. Educators can access the tools to prepare the next generation of nurses to care for this unique population of military personnel and their families. Thanks to a partnership with Laerdal Medical, the NLN was able to expand this area of nursing education with comprehensive case studies for healthcare educators to use for free.
Willhaus became involved in the project in 2012 near the end of her fellowship at the NLN. As a veteran herself, Willhaus brought first-hand knowledge from her experience as a deployed nurse case manager in the United States Army Reserves. Additionally, she and fellow authors Ann Ganzer and Cindy Fitzgerald shared their materials with a number of veterans for review. They piloted the cases with a variety of nursing schools across the country in order to fine tune the materials and ensure that the materials remained adaptable to details particular to regional practices.
“These cases allow students to see that veterans are everywhere,” said Willhaus. “Vets have specific needs based on the era that they served in. The Korean War vet has trouble 50 years after the war with his trench foot injury, a common injury for Korean War vets. The Vietnam vet was exposed to Agent Orange, which led to him developing diabetes. Additionally, he is homeless, which complicates his medical care. How do you manage diabetes when you’re homeless and do not know when or what your next meal might be?”
The case materials can be used for healthcare students, practicing nurses and interprofessional medical teams, including dietitians, physical therapists and nurses, to further develop their skills and critical thinking surrounding veterans and veterans’ needs.