Journal of Gerontological Nursing

Sensory Loss Simulation Use In Nursing Education

Molly A Rose, MSN

Abstract

Acknowledging the growing population of people over 65 years of age, nurse educators are developing learning opportunities related to the special needs of the older adult. Among these special needs are the sensory changes that frequently develop as aging occurs. The most common chronic problems of old age are arthritis, hearing impairment, and visual impairment. A decrease in sensory adequacy markedly influences the perception of the world in which the older person lives. It is imperative that nurses understand the affect a certain sensory deficit has on a person's self-image, social interactions, and general ability to function in daily life. One approach to increase sensitivity to these concerns has shown positive results with baccalaureate nursing students. The approach involves providing an experiential workshop on common sensory losses of aging.

During the last semester of their senior year all nursing students are enrolled in a ten-credit course focusing on leadership in nursing and community health nursing. The clinical component includes home visiting at a visiting nurse association, a large proportion of whose clients are older adults, as well as involvement with health education classes at local senior citizen nutrition sites. A unit on gerontology is presented that includes myths of aging, alternatives to institutionalization, elder abuse, sexuality and aging, retirement, and sensory losses. The experiential learning experience on sensory changes in aging takes place during a three-hour class period.

Leon Pastalan1 has been associated with the development of an empathie model to identify how sensory loss affects the older person's function within and adjustment to the environment. The empathic model is composed of devices that simulate the visual, auditory, and tactile sensitivity of the older adult. Based on Pastalan 's simulations, Shore2 presents a training program to improve the understanding of sensory losses that often accompany aging with an emphasis on empathy. Ernst and Shore3 prepare a guide for health educators to sensitize learners to the processes of aging. They include information on how to simulate changes in vision, hearing, taste, smell, touch, and mobility. Hickey4 describes the development and evaluation of a similar simulation program emphasizing hearing and visual deficits. Stilwell5 describes a method to simulate sensory losses to meet the learning needs of nurses and other healthcare professionals.

Purpose

The purpose of the workshop on sensory changes in the older adult is based on both the cognitive and affective components of education. Students are provided with basic information on typical age-related sensory losses so that their nursing interventions are based on facts rather than casual inferences. In addition, the students are given the opportunity to gain an experiential insight, although simulated, into the problems and difficulties of coping with particular sensory losses. It is hoped that this insight leads to a better understanding of how common sensory losses affect older people. The active participation of the students and the subsequent increase in empathy they experience during the simulations are the two major factors that facilitate the objectives of the experiential learning session.

Since the sensory deprivation workshop appears to be an alternative method of teaching students about sensory deficits, it is important to evaluate subsequent student outcomes. This investigation evaluates changes in the students' knowledge base following the class and describes their perceptions of the simulations.

Sample - Thirty-six of the 40 male and female senior nursing students enrolled in the nursing course participated in the three-hour class. Each student completed both the pretest and the posttest, and provided subjective data in a narrative format.

Data Collection - Ernst and Shore6 developed a sampling of true and false statements related to knowledge about sensory changes. Statements were categorized by…

Acknowledging the growing population of people over 65 years of age, nurse educators are developing learning opportunities related to the special needs of the older adult. Among these special needs are the sensory changes that frequently develop as aging occurs. The most common chronic problems of old age are arthritis, hearing impairment, and visual impairment. A decrease in sensory adequacy markedly influences the perception of the world in which the older person lives. It is imperative that nurses understand the affect a certain sensory deficit has on a person's self-image, social interactions, and general ability to function in daily life. One approach to increase sensitivity to these concerns has shown positive results with baccalaureate nursing students. The approach involves providing an experiential workshop on common sensory losses of aging.

During the last semester of their senior year all nursing students are enrolled in a ten-credit course focusing on leadership in nursing and community health nursing. The clinical component includes home visiting at a visiting nurse association, a large proportion of whose clients are older adults, as well as involvement with health education classes at local senior citizen nutrition sites. A unit on gerontology is presented that includes myths of aging, alternatives to institutionalization, elder abuse, sexuality and aging, retirement, and sensory losses. The experiential learning experience on sensory changes in aging takes place during a three-hour class period.

Leon Pastalan1 has been associated with the development of an empathie model to identify how sensory loss affects the older person's function within and adjustment to the environment. The empathic model is composed of devices that simulate the visual, auditory, and tactile sensitivity of the older adult. Based on Pastalan 's simulations, Shore2 presents a training program to improve the understanding of sensory losses that often accompany aging with an emphasis on empathy. Ernst and Shore3 prepare a guide for health educators to sensitize learners to the processes of aging. They include information on how to simulate changes in vision, hearing, taste, smell, touch, and mobility. Hickey4 describes the development and evaluation of a similar simulation program emphasizing hearing and visual deficits. Stilwell5 describes a method to simulate sensory losses to meet the learning needs of nurses and other healthcare professionals.

Purpose

The purpose of the workshop on sensory changes in the older adult is based on both the cognitive and affective components of education. Students are provided with basic information on typical age-related sensory losses so that their nursing interventions are based on facts rather than casual inferences. In addition, the students are given the opportunity to gain an experiential insight, although simulated, into the problems and difficulties of coping with particular sensory losses. It is hoped that this insight leads to a better understanding of how common sensory losses affect older people. The active participation of the students and the subsequent increase in empathy they experience during the simulations are the two major factors that facilitate the objectives of the experiential learning session.

Since the sensory deprivation workshop appears to be an alternative method of teaching students about sensory deficits, it is important to evaluate subsequent student outcomes. This investigation evaluates changes in the students' knowledge base following the class and describes their perceptions of the simulations.

Sample - Thirty-six of the 40 male and female senior nursing students enrolled in the nursing course participated in the three-hour class. Each student completed both the pretest and the posttest, and provided subjective data in a narrative format.

Data Collection - Ernst and Shore6 developed a sampling of true and false statements related to knowledge about sensory changes. Statements were categorized by the various sensory deficits. They suggested that a set of statements from each category be used to compile a pretest and a set of the remaining statements be used to compile a posttest. The intention being that the use of different statements would help minimize the effect of pretest sensitization.

The instruments prepared, in this case for the pretest and the posttest to measure knowledge changes, were based on the above recommendations. Each questionnaire contained 14 statemens in a truefalse format (see Table 1). In addition, students were asked to provide subjective data in answer to the following questions: "What did you learn from this class?" and "What feelings did you experience during the simulation?"

The students graded their own pretests and posttests at the end of the session. They anonymously recorded and handed in the number of incorrect answers for the pretests and for the posttests. Each student also wrote a narrative to answer the questions stated above. After the information was recorded, the students were advised that the data would be used to evaluate the effectiveness of this teaching modality.

Workshop Procedure

The class began with the students completing the pretest questionnaire. The students were then divided into small groups of four or five and instructed to take a piece of paper with them to record reactions during the simulation experience. Each student in each small group was given a device to simulate one of the common sensory changes of aging. To simulate the experience of visual problems, students were either blindfolded or given glasses or goggles coated with vaseline. To simulate loss of hearing, ear plugs commonly used in industry were worn. High- and low-frequencies were blocked and ordinary conversational tones were difficult to hear. Sugarless bubble gum was chewed and pushed against the upper front teeth to simulate the effect of ill-fitting dentures on speech delivery. Some students wore gloves with tape wrapped around the joint area of the fingers to effect a decrease in tactile sensation and simulate stiffened joints.

Table

TABLE 1EXAMPLES OF STATEMENTS ON PRETEST AND POSTTEST

TABLE 1

EXAMPLES OF STATEMENTS ON PRETEST AND POSTTEST

Table

TABLE 2RESULTS OF PRETEST AND POSTTEST

TABLE 2

RESULTS OF PRETEST AND POSTTEST

Engs, et al,7 described a number of tasks to attempt while experiencing the various sensory losses. Four of these tasks were chosen to provide an immediate impact experience for the students involved. One such task required the group to work together toward the goal of cutting a piece of fabric into a circle, threading a needle, and sewing a button on it. Instructions were read by either the person with the vaseline-coated glasses or the person with the simulated dentures. The hearing impaired person was not permitted to read the instructions. The person with decreased tactile sensation and stiffened joints had to help thread the needle and sew the button. After the four tasks were completed the students were given questions for discussion within their small groups. As a large group they shared some of their general reactions and the feelings they encountered during the experiential session.

An awareness exercise preceded the lecture-discussion component of the class. In this exercise each student listed five things that they planned to accomplish in their lifetime. They were to eliminate those that they would be unable to do if they lost their vision, lost their hearing, or had crippling arthritis.8 A brief discussion of feelings about these losses and the effect on their lives followed to encourage empathy.

The lecture-discussion segment covered several ideas. Sensory changes in the older adult vary in degree and tend to develop gradually. There are numerous physiological explanations for the common losses. Older people often develop compensatory mechanisms and are able to cope with and adapt to these changes. Early detection of sensory changes through assessment of sensory abilities is vital. Nursing interventions to help older adults evaluate sensory assets and compensate for any deficits were discussed. The posttest was administered following the lecture-discussion segment. The workshop session ended with correction of the tests and recording of subjective reactions by the students.

Table

TABLE 3FREQUENCY OF STUDENTS' FEELINGS DURING SIMULATION

TABLE 3

FREQUENCY OF STUDENTS' FEELINGS DURING SIMULATION

Results

The pretest showed a mean number of incorrect responses of 4.0. The mean number of incorrect responses on the posttest was 0.8. The paired t-test revealed that there was a significant improvement in the knowledge base of the students after the class on sensory changes (t=10.19, df=35, p<0.001) (see Table 2).

When answering the question about the feelings experienced during the experiential session, students reported a number of common reactions including frustration, isolation, depression, dependency, anger, and anxiety (see Table 3). Students' statements related to what they learned from the simulation included:

"To be more aware of people with sensory changes."

"The ability to be patient."

"To be more aware of the everyday problems faced by people with sensory deficits."

"To be better able to help people who are sensory impaired without making them feel helpless."

Conclusions

The outcomes showed that in this particular student population there was a significant improvement of the knowledge base on sensory changes in the elderly. The students' comments imply that an affective change also occurred as they became more aware of the impact of the sensory losses that may occur with aging. One of the goals of the simulation was to encourage empathy. Based on the feelings expressed by the students during the simulation, it appears that they experienced many feelings common to those with sensory losses. Observations of the personal involvement and the attenti veness of the students were interpreted as reflecting a high degree of interest in this method of teaching. While the results presented do not suggest unqualified success of this technique without comparative data, the descriptive data presented do support the use of this experimental process.

In summary, aging and the aged are salient issues in American society and are especially important among healthcare providers. Nurses who have factual information about aging and an understanding of the changes older people may experience can help to enhance the independence, functioning, and satisfaction of the older adult. Provision for experiential learning sessions by educators in nursing is one approach to enhance the nursing care of the older person whether in hospitals, nursing homes, home health, or ambulatory health centers.

References

  • 1. Pastalan LA: The empathie model: Methodological bridge between research and design. Journal of Architectural Education 1977; 31(1):14.
  • 2. Shore H: Designing a training program for understanding sensory losses in aging. The Gerontologist 1976; 16(2):157-165.
  • 3. Ernst M, Shore H: Sensitizing People to the Processes of Aging: The Inservice Educator's Guide, 6th printing. Denton, Texas, Center for Studies in Aging, 1978.
  • 4. Hickey T: The Development and Assessment of In-Service Practitioner Education Based on the Simulation of Age Related Sensory Impairments University Psuk, The ftennsyivania State University Gerontology Center, 1975, ppl-17.
  • 5. Stilwell E: Creating an understanding of the behavior of disabled older adults, in Stil well E: Readings in Gerontological Nursing. Thorofare, NJ, Charles B Slack, Ine, 1980, pp 247-250.
  • 6. Ernst M, Shore H: Sensitizing People to the Processes of Aging: The Inservice Educator's Guide, 6th printing, Denton, Texas, Center for Studies in Aging, 1978.
  • 7. Engs RC, Barnes SE, Wantz M: Health Games Students Play: Creative Strategies for Health Education. Dubuque, Iowa, Kendall/ Hunt Publishing Co. 1975; pp 65-71.
  • 8. Krieger D: Foundations for Holistic Health Nursing Practice. Philadelphia, JB Lippincott Co, 1981, p 247.

TABLE 1

EXAMPLES OF STATEMENTS ON PRETEST AND POSTTEST

TABLE 2

RESULTS OF PRETEST AND POSTTEST

TABLE 3

FREQUENCY OF STUDENTS' FEELINGS DURING SIMULATION

10.3928/0098-9134-19860701-08

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