Teaching good nursing is all in the act
Texas agency has made art form of role-playing
There may be few things in life less exciting than learning about the Medicare 485 form. The very name can make your eyelids droop.
So when a Texas home care agency decided to help nurses refresh their skills on reading and understanding these forms, the clinical director and others made it a fun lesson. They created eight role-playing scenarios.
"We made up fictitious patients, and we completely made up 485s based on the fictitious names and fictitious diagnoses," says Lori Johnson, RN, clinical director for Total Home Health Care of Lubbock, TX. Total Home Health covers the state of Texas with 16 branch offices and three parent offices. The agency is affiliated with Methodist Hospital in Lubbock.
Johnson and other directors portrayed the eight patients. They dressed in bathrobes and other typical clothing and sat in wheelchairs or had catheters taped to them when necessary. Two other employees portrayed physicians, and they were stationed in other parts of the building at specific extension numbers that the nurses knew they could call for a physician consultation.
"We were very elaborate with it," Johnson says. "We are an office full of hams, so we played it up for all it’s worth."
The "patients" followed directions on fact sheets created by the agency’s management staff. Johnson says these were based on typical patient diagnoses and illnesses, including cases the agency had experienced in the past. (See sample role-playing inservice, p. 199.)
Then the nurses, who were divided into eight groups, were required to read the 485 forms and do an assessment based on the 485. They were asked to find any mistakes on the forms, fill out nursing notes, evaluations, communication notes, and write up orders.
The purpose, Johnson says, was four-pronged:
• to demonstrate the importance of good assessment skills;
• to communicate with the patient and family members;
• to communicate with the physician;
• to communicate with other team members.
The scenarios made meeting some of these objectives as difficult as it would be in real life.
"In some scenarios, the patients were senile and could not provide good information," she says.
Johnson, for instance, portrayed a 92-year-old patient who was incontinent. Her 90-year-old sister cared for her, although she couldn’t do everything that was needed.
"I had a diaper on, and that diaper had to be changed, and I had fallen," she says. "So based on that assessment we had to get a social work consult, and we contacted the physician to let him know I had fallen."
The nurses filled out a fall report, notified the physician that the patient had some skin tears and obtained orders for wound care.
The role-playing exercise lasted for about two hours, and the entire staff of licensed workers participated, including the social workers and quality improvement office.
After each group finished the role-playing scenario, they met together in the inservice room and took turns reporting on their findings. The other groups would offer their input on what they would do differently during the different scenarios.
Johnson says the agency continues to use role-playing often, including during team meetings.
"Role-playing brings the employee into the picture," Johnson says. "We could have just stood up there and told the staff to look at the 485 and tell us what’s wrong with it."
But by having the staff engage in role-playing, it made a bigger impression, she asserts. "It allows them to be involved and interact instead of just sitting there."
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