NURSING AT McLEAN

Learning Through Groups: Engaging Patients in the Clinical Experience

by Michelle Buechner, Brittney Howell, Danielle Korta, Leigh Pescatore, Lauren Stouffer, Gerri Weiss, MGH - IHP
Student Nurses at McLean

Student nurses from the MGH Institute of Health Professions have created new ways to engage patients on ABII, the acute inpatient psychiatric unit. We developed a targeted series of group activities to involve this patient population more actively in the clinical experience. Groups include Nutrition Jeopardy, Line Dancing, and Yoga/Relaxation. Nutrition and exercise are vital to those with mental illness, who are at increased risk of developing co-morbid conditions, such as cardiovascular disease, diabetes, and obesity.

Our goal was to engage patients in these groups to facilitate a comprehensive assessment of patient function. ABII services an acute population, which is often considered difficult to engage. We designed a collection of interactive experiences that allow patients to participate in enjoyable, educational, and therapeutic activities. Nutrition Jeopardy presented information in the form of a computerized game show, along with healthy snack choices. Topics included portion sizes, healthy choices, and the food pyramid. The questions were designed to challenge the players, but not to stump them. Patients formed teams and created team names. Working together to earn points fostered positive group dynamics and led to a spirited atmosphere. The energy in the room increased with each correct answer.

Upbeat music drew the patients over to the West wing, where the students and patients joined together in a variety of line dances, which offered opportunities for each person to participate to the extent that he or she felt comfortable. The dances were upbeat, easy to learn, fun, and simple to teach. The greatest benefit was that they provided an effective form of exercise for thirty minutes, a difficult feat to achieve in an inpatient hospital setting. One patient commented that it felt good to get up and move. This opportunity to exercise benefits those restricted to the unit.

Yoga and relaxation, including stretching and breathing, provided the final strategy for our overall goal of increasing health and wellness. This group worked as effectively as the others. The stretches required no previous yoga experience, so the group accommodated the many different skill levels represented. The diverse patients all responded to the yoga's calming atmosphere. Patients who were experiencing manic episodes were able to focus quietly during the experience. Many of the participants showed enthusiasm during and after the group, saying that they felt "centered."

These group activities offered us an alternative way to assess patients. Providing a focused activity that was fun and active changed the manner in which the participants behaved. For example, patients who were unable to concentrate on a conversation could focus on the quiz questions and learn steps to a new dance. The participants in these groups demonstrated teamwork and patience with each other.

As students, we highly valued the experience. The active groups offered a comfortable way to approach and interact with patients. Creating the programs required that we think more deeply about the needs of our patients and the therapeutic impact of our choices. We targeted our nutrition questions to reflect the challenges presented by psychopharmacological medications. We considered the importance of physical activity and the difficulty of incorporating it into life on an inpatient unit, and we recognized the need to help relieve stress and anxiety. Working with the groups showed us the importance of offering patients ways to feel connected to the world outside the campus. These interactive sessions dramatically demonstrated that these patients are individuals in need of compassionate care.

Editors note: Catherine Coakley, Nurse Director ABII, is the clinical instructor for the MCH-IHP nursing students.

09.2011