Beyond the Front Door: A Complex Home Visit Simulation

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Excerpt

As nurses and other health care professionals provide more services in clients' homes, nurse educators face challenges in helping students become prepared and confident in transitioning to the home setting.1,2 Meeting clients for the first time in their homes is different from meeting a patient in a hospital room. Although nurses may feel uncertain about their first encounter with a hospitalized patient, the experience takes place in a familiar environment. Nurses who make home visits face different challenges: they often know little about their client and home environment before knocking on the door for the first time. This article describes an innovative home visit simulation designed to better prepare prelicensure nursing students for the uncertainties they may face on home visits. By providing an interactive clinical learning experience with the assistance of a standardized patient (SP), students have the opportunity to apply nursing knowledge and critical thinking as they demonstrate skills related to assessment, communication, safety, and health education when caring for clients in their homes. Concepts from medical-surgical, pediatrics, maternity, psychiatric mental health, and public health nursing courses are integrated into the simulation.
In the past, students had more opportunity to participate in a one-on-one home visit with a client and family; however, this is no longer the case because of the lack of agency availability and extensive compliance requirements from clinical partners.3 Faced with the prospect of new nursing graduates never experiencing a home visit and thus being unprepared to assist clients in the transition from hospital to home and deliver nursing care in the home, a team of nurse educators created a home visit simulation. This experience is especially important now because nurses are increasingly needed to provide care in the home and outside acute care settings4,5 and because care in community settings is viewed favorably for improving population health and decreasing overall health care costs.6
Home visit and community health simulations have been shown to increase student perceived self-efficacy and knowledge of applying the nursing process during a community health visit,7 help students deal with client safety and cultural competence,3 and increase their confidence and decrease anxiety when making a home visit.1 Stanley and Rojas8 developed a home visit simulation with an environmental focus to help students apply individual targeted interventions and consider population-focused interventions.
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