1. Mary Jane Cook, MSN, RN, FNP-BC Michigan State University
Integrating Millie into the EHR: An Innovative Use of ACES Cases for Nurse Practitioner Students
Mary Jane Cook, MSN, RN, FNP-BC
Michigan State University
Unfolding Case Across Courses
Millie is an elderly widow who lives in the community. She has multiple chronic medical diagnoses as well as psychosocial problems. Students revisit Millie across the semesters. Targeted assignments are designed to meet the objectives of the course. The initial assignment, in health assessment, asks the students to determine the appropriate history and physical examination components for the patient. Subsequently, in a clinical decision-making course, the assignment involves interpretation of laboratory and imaging results to establish a diagnosis. Millie is again used as the basis of discussion of health promotion interventions for older adults living in the community. Additional assignments include discussion of advanced directives and managing transitions of care.
Objectives
To meet nurse practitioner core competencies for technology and information literacy through the use of the academic electronic health record.
To meet nurse practitioner core competencies for independent practice by providing the full spectrum of health care services to include health promotion, disease, prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care.
To provide a virtual patient simulation that includes active learning strategies and the integration of skills.
ACES Case
Advancing Care Excellence for Seniors (ACES) initiative was designed to promote quality care for the gerontology patient in pre-licensure nursing students (NLN, 2013). However, promoting quality care for the gerontology patient is an essential component of nurse practitioner students’ education in the primary care setting. It is especially important to help older adults maintain their health and safety with the aim of staying in the community and their own homes.
Case Design
Each assignment using the Millie case was designed using the Simulation Design Template (NLN, 2010). Additional audio recordings were created for primary care follow-up visits. The original unfolding case scenarios developed for ACES intended for pre-licensure student were modified to meet the competencies for nurse practitioners. Instead of in-hospital care, Millie was seen for hospital follow up in her primary care office.
In addition to Millie, other patients were created to enhance the NP student’s learning. Frank, a middle aged man, Mia, an infant, and Eli, a school aged child were created using audio narratives to provide the patient’s story.
Students found the cases engaging and similar to clinical experiences. Narrative comments indicated that students wanted more cases on a variety of subjects.
Millie
Microsoft Clipart
Electronic Health Record
The audio recording of the patient’s story was coupled with health data in an academic electronic health record (EHR). The nurse practitioner students access additional health data including lab values, vital signs, and medical diagnoses in the EHR. The goal of the teaching strategy is to simulate a situation the nurse practitioner student would encounter in a primary care setting.
References
National League for Nursing. (2010). Simulation design template. Retrieved from
National League for Nursing. (2013). Aces history and development. Retrieved from
Neehr Perfect Academic Electronic Health Record