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0127000Teaching Template: Peer Evaluation: Patient Communication – Danny RiveraThis Teaching Template is fully modifiable to meet your students’ needs. Please edit for your own use.-2540336550015367000Skills Assessments0183515Teaching Tips & Resources-1270182245Sample completed skill assessments with transcript evidence (Danny Rivera)Patient Case Overviews available by request. Contact our Help Desk.The following rubric can be used after students have completed any patient case to analyze communication for instances of therapeutic, patient-centered care. Peer evaluation facilitates contextualized feedback around the quality of students’ subjective collection processes.018097500RubricMake this available (in print, online, or both) for students to use to they analyze their peers’ skills around patient-centered communication. Students will provide evidence for their skills assessment using their peers’ patient exam transcripts.SkillMetIn ProgressNot MetPatient-Centered CareProvides evidence and demonstrates all skills and knowledge of patient-centered careNeeds to provide additional evidence to demonstrate skills and knowledge of patient-centered careDoes not provide evidence of skills and knowledge of patient-centered carePatient EducationProvides evidence and demonstrates all skills and knowledge of patient educationNeeds to provide additional evidence to demonstrate skills and knowledge of patient educationDoes not provide evidence of skills and knowledge of patient educationEmpathetic CommunicationProvides evidence and demonstrates all skills and knowledge of empathetic communicationNeeds to provide additional evidence to demonstrate skills and knowledge of empathetic communicationDoes not provide evidence of skills and knowledge of empathetic communicationDepth, Flow, and TransitionsProvides evidence and demonstrates all skills and knowledge of proper depth, flow, and transitionsNeeds to provide additional evidence to demonstrate skills and knowledge of proper depth, flow, and transitionsDoes not provide evidence of skills of knowledge of proper depth, flow, and transitions Clinical Reasoning – Implications for PracticeProvides evidence and demonstrates deep reflection of clinical reasoning and implications for practiceNeeds to provide additional evidence to demonstrate deep reflection of clinical reasoning and implications for practiceDoes not provide evidence of reflection upon clinical reasoning or implications for practice0000Skill Assessment #1: Patient-Centered CareHave students fill in the following skill assessment with evidence from their peers’ transcripts. Sample responses for Danny Rivera are included below.Aspect of CommunicationSample Student EvidenceElicit patient values, preferences, and expressed needsAssess presence and extent of pain and sufferingAssess levels of physical and emotional comfortAssess level of patient’s decisional conflict and provide access to resourcesFacilitate informed patient careAct with integrity, consistency, and respect for different viewsDisplay culturally responsive language and behavior0000Skill Assessment #2: Patient EducationHave students fill in the following skill assessment with evidence from their peers’ transcripts. Students should be able to provide at least one piece of evidence for each category of Ensuring Quality Care. Greyed lines represent areas of necessary student improvement.Ensuring Quality CareAspect of CommunicationEvidence from TranscriptEstablish Baseline of Patient KnowledgePatient raises concern about an issue or nurse raises an issue in a sensitive, non-threatening mannerAssess the patient’s knowledge of disease, disorder, or disabilityAssess patient’s resourcesAssess patient’s cultural needsIgnore gaps in patient education or respond in a way that alienates or miseducates patientEducate PatientSupplement pertinent gaps in patient knowledge using age-appropriate concepts and/or metaphorsDelineate possible treatment management plan choices for the patientUse of unclear language, abbreviations, or terms that could be misinterpretedEmpower PatientMake accepting statements of a patient’s views and valuesEncourage patient input and feedback on possible treatment planCriticize or blame patientMake judgements about a client’s motives, conflicts, or defenses0000Skill Assessment #3: Empathetic CommunicationHave students fill in the following skill assessment with evidence from their peers’ transcripts. Students should be able to provide at least one piece of evidence for each category of Ensuring Quality Care. Greyed lines represent areas of necessary student improvement.Ensuring Quality CareAspect of CommunicationEvidence from TranscriptStatements that Communicate Empathy, Attention, and RespectValidate a patient’s pain or frustrationCommunicate to a patient you are paying attention, understandingCommunicate that you respect the patientAssess patient’s cultural needsGive misleading or fabricated informationRelate empathy or attention to personal experiencesMake judgements about a patient or discount emotionsCriticize or blame patientMake judgements about a client’s motives, conflicts, or defenses042300Skill Assessment #4: Depth, Flow, and TransitionsHave students fill in the following skill assessment with evidence from their peers’ transcripts. Students should focus on at least two medical topics and examine their logical organization of questions, education, and empathy. Greyed lines represent areas of necessary student ic: Organizational ElementEvidence from TranscriptDepth – is there complete exploration of topic and related, medically relevant follow-up questions?Depth – do you educate or empathize with the patient related to the topic?Flow – what topic was discussed prior?Flow – how is this topic introduced?Transitions – what topic is discussed next, and how is it introduced?Flow/Transitions – do you switch back and forth between topics?Topic: Organizational ElementEvidence from TranscriptDepth – is there complete exploration of topic and related, medically relevant follow-up questions?Depth – do you educate or empathize with the patient related to the topic?Flow – what topic was discussed prior?Flow – how is this topic introduced?Transitions – what topic is discussed next, and how is it introduced?Flow/Transitions – do you switch back and forth between topics?042300Skill Assessment #5: Clinical Reasoning & Implications for PracticeHave students complete this skill assessment on a peer with evidence from their post-exam reflection.ActionEvidence from ReflectionsDescribes experienceSupports clinical reasoning rationale with citations of evidence-based practiceAnalyzes and evaluates actions and missed red flag critical timesRecognizes and addresses own assumptionsCritically explores challenges, failings, or problems, why they occurred, and how they may be addressed19050635Teaching Tips & ResourcesBest PracticesUse peer assessment for formative, in-depth feedback.Use peer assessment to help students take responsibility for their learning, enhance communication, and engage more deeply with course material.Discuss a range of feedback frameworks with your students and develop shared agreement of effective model(s).Feedback exercises should lead to opportunities for students to demonstrate growth.Incorporate positive feedback when responding to students’ communications.Use probing questions that prompt reflection; avoid insults or inflammatory judgments.Use a rubric for evaluation to help quantify subjective feedback.Pedagogical ResearchPeer Teaching among Nursing Students in the Clinical Area: Effects on Student Learning – Journal of Advanced NursingExploring Nursing Students’ Experience of Peer Learning in Clinical Practice – Journal of Education and Health PromotionThe Role of Peer Assessment and Peer Review in Nursing – British Journal of NursingReducing Student Anxiety by using Clinical Peer Mentoring with Beginning Nursing Students – Nurse Educator07620Sample completed skill assessment with transcript evidence (Danny Rivera)Skill #1: Patient-Centered CareAspect of CommunicationSample Student EvidenceElicit patient values, preferences, and expressed needsQ: Are you scared to be in the nurse’s office?A: No, I know they try to help me feel better.Assess presence and extent of pain and sufferingQ: Are you in any pain?A: Nothing really hurts. I’ve just had this cough for about five days…and I feel kind of tired.Q: How often are you coughing?A: I just keep feeling like I have to cough every couple minutes or so. I think it gets worse at night.Assess levels of physical and emotional comfortQ: Do you feel comfortable?A: Not really. I’m just sick, and I hope I feel better.Q: Do you feel stressed or upset?A: I don’t have any stress really…Well, sometimes I feel there is a lot of boring homework and I don’t want to do it all, but I know I always feel better if I get it done!Assess level of patient’s decisional conflict and provide access to resourcesQ: Do you take any vitamins?A: Oh yeah, I take vitamins every day! The gummy dinosaur kind. I don’t think I’m supposed to, but sometimes I sneak extra ones to be super healthy!E: It’s good to take vitamins, but it’s important not to take too many – you need just the right amount.Facilitate informed patient careQ: May I listen to your lungs?A: Sure.Q: Can you tell me about your family medical history?A: My mom sometimes talks about her diabetes, cholesterol…Oh, and blood pressure. Papi talks about cholesterol too. He smokes too. I know that’s bad.Act with integrity, consistency, and respect for different viewsQ: Do you like to play outside?A: I don’t really play sports on a team or anything. I like to shoot hoops and ride my skateboard with Tony sometimes. But most of the time we play video games.Display culturally responsive language and behaviorQ: What is your primary language?A: It’s English, but I know some words in Spanish!Skill #2: Patient EducationEnsuring Quality CareAspect of CommunicationEvidence from TranscriptEstablish Baseline of Patient KnowledgePatient raises concern about an issue or nurse raises an issue in a sensitive, non-threatening mannerQ: How much sleep do you get at night?A: Most times I sleep for about 8 hours…Mom says that’s how much I need…but I haven’t been able to fall asleep much because of my cough.E: Your mom is right – 8 hours is best! Let’s take care of this cough so you can get back to a full night’s rest.Assess the patient’s knowledge of disease, disorder, or disabilityQ: How often do you wash your hands?A: I was my hands before I eat or after I go to the bathroom.E: That’s great – you need to always keep your hands clean to avoid getting sick.Assess patient’s resourcesQ: Who takes care of you?A: When my parents go out or go to work my Abuelo and Abuela always watch me.Assess patient’s cultural needsQ: What do you like to do for fun?A: Usually I play video games or read or try to write stories. If Tony is here, we do that stuff together.Ignore gaps in patient education or respond in a way that alienates or miseducates patientQ: Do you take any vitamins?A: Oh yeah, I take vitamins every day! The gummy dinosaur kind. I don’t think I’m supposed to, but sometimes I sneak extra ones to be super healthy!E: You are a very healthy boy!Educate PatientSupplement pertinent gaps in patient knowledge using age-appropriate concepts and/or metaphorsQ: Does anyone smoke at home?A: Well…sometimes Papi smokes cigars in the house and my mom has to tell him to go outside. I breathe it a little bit then, but it’s not all the time or anything. I don’t like how it smells.E: Smoke can hurt your lungs, even if you aren’t the one smoking. This is called secondhand smoke. It’s important to avoid the area where Papi is smoking.Delineate possible treatment management plan choices for the patientQ: Does your throat hurt?A: It feels a little bit sore, yeah.E: To help the soreness, you can try a cough drop or some hot tea.Use of unclear language, abbreviations, or terms that could be misinterpretedQ: Have you been immunized?A: Like getting shots? It seems like I get shots whenever I go to the doctor. Mom says I need them for school, but I hate it.Q: Are you up-to-date for your pneumococcal vaccine?Empower PatientMake accepting statements of a patient’s views and valuesQ: Do you have any religious preferences?A: My family’s Catholic. We go to mass every Sunday.E: That’s wonderful; it’s healthy to spend time with people you love.Encourage patient input and feedback on possible treatment planQ: What relieves your pain?A: The only thing that really hurts is my right ear, but it just hurts a little bit. It just started…I’m not sure what will make it feel better.E: Thanks for telling me. An earache can be a sign of infection. I’ll take a look.Criticize or blame patientQ: How do you feel?A: I don’t feel so good. I keep coughing and I feel a little bit tired.E: That’s probably because you don’t play outside enough.Make judgements about a client’s motives, conflicts, or defensesQ: Does anyone in your life smoke?A: Well…sometimes Papi smokes cigars…E: That means you’ll probably smoke when you grow up.Skill #3: Empathetic CommunicationEnsuring Quality CareAspect of CommunicationEvidence from TranscriptStatements that Communicate Empathy, Attention, and RespectValidate a patient’s pain or frustrationQ: What is bothering you?A: My abuela brought me here because I’ve been feeling sick. I have been coughing a lot…and I feel kinda tired.E: I know how frustrating it is to have a cough. I will try my best to municate to a patient you are paying attention, understandingQ: Do you cough up anything?A: Sometimes this slimy, clear stuff comes out.E: I hear that your cough doesn’t produce yellow mucous. Thanks for telling municate that you respect the patientQ: What’s your favorite subject?A: My favorite subjects in school are Computers and English.E: Those were my favorites, too. You’re a smart kid.Assess patient’s cultural needsQ: What does your family do for fun?A: My family always eats dinner together, and that’s really fun. And on the weekends sometimes we go to a movie all together or something.Give misleading or fabricated informationQ: Do you drink water?A: I drink water…Abuela is always trying to get me to drink more though.E: Don’t worry about what Abuela says. You probably get enough water as it is.Relate empathy or attention to personal experiencesQ: Does anything hurt right now?A: Nothing really hurts. I’ve just had this cough for about five days…and I feel kind of tired.E: I feel tired every day. Being a nurse is hard work.Make judgements about a patient or discount emotionsQ: Does your ear hurt?A: My right ear is starting to hurt a little bit…my left one is OK though.E: It’s probably nothing then. Criticize or blame patientQ: Do you feel sick?A: My cough mostly stays the same no matter what I do.E: You’re not treating it right. If you did the right things, you wouldn’t have a cough.Make judgements about a client’s motives, conflicts, or defensesQ: Why did you come to the nurse today?A: My Abuela brought me here because I’ve been feeling sick. I’ve been coughing a lot…and I feel kinda tired.E: I’ll bet you wanted to get out of class.Skill #4: Depth, Flow, and TransitionsTopic: Danny’s coughOrganizational ElementEvidence from TranscriptDepth – is there complete exploration of topic and related, medically relevant follow-up questions?Onset – When did your cough start?Frequency/duration – How often are you coughing?Character – What does your cough feel like?Aggravating factors – Does anything make your cough worse?Relieving factors – Does anything help the cough?Related symptoms – Is your nose runny?/Do your ears hurt?/Does your throat hurt?Depth – do you educate or empathize with the patient related to the topic?I’m sorry to hear your throat is sore.Drinking plenty of water can help with soreness.It’s important to avoid secondhand smoke.Flow – what topic was discussed prior?Established chief complaintFlow – how is this topic introduced?Empathetic statement followed by clarifying questionsTransitions – what topic is discussed next, and how is it introduced?Medical history; introduced by asking if any other family members have asthmaFlow/Transitions – do you switch back and forth between topics?Q: What does your cough feel like?A: My cough seems kind of gurgly and watery.Q: What do you like to do for fun?Skill #5: Clinical Reasoning & Implications for PracticeActionEvidence from ReflectionsDescribes experienceConducted a thorough HPI and medical hx interview with Danny. Discussed what is done at home for his current illness and discussed his activity and meal intake. Conducted a physical exam. Discussed differential diagnosis and prescribed medications, educated on how to take the medications, and encouraged to return if not getting better.Supports clinical reasoning rationale with citations of evidence-based practiceThe clinical reasoning was related to HPI, including a persistent cough, otitis media, and bronchitis. Antibiotics and cough suppressants are necessary to help treat the patient's symptoms and cure any bacterial infections present. A thorough exam was performed in order to make a determination for differential diagnoses. Education for the patient and family is necessary based on patients age.Analyzes and evaluates actions and missed red flag critical timesPerhaps I should have kept asthma/ allergies on the list of differentials, however, since the patient was not wheezing, had a “blow test” that was within normal limits (greater than 80%) and did not have redness/ itchy watery eyes, I ruled these out. Perhaps should the child not get better, or report wheezing, or increased coughing/ worsening symptoms, then it may definitely be worth sending to pulmonology to check lung function, as well as allergy to check for allergens. Educating the family on avoiding smoke and other triggers would also be included.Recognizes and addresses own assumptionsI need to have more than one differential diagnosis in my assessment. I was too focused on one aspect of Danny's history and it too narrowly focused my attention on his other symptoms.Critically explores challenges, failings, or problems, why they occurred, and how they may be addressedI have no real past experience in pediatric assessment. I do need to sharpen my assessment skills with the pediatric population. I feel that I did perform fair in the assessment, I do, however, need to remember to incorporate empathetic notations. ................
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