Teaching and Learning Ideas for Wiimali

Wiimali can be used in a multitude of ways depending on your curriculum and learning outcomes. In this document I provide some introductory teaching and learning ideas.

Focusing on Primary Health

When taking the Virtual Tour and exploring the community learners can be prompted to identify the social determinants of health for the residents of Wiimali, specifically the factors that impact positivity and negatively on the health and wellbeing of the community. Learners can identify and discuss the upstream, midstream and downstream approaches to health (including illness prevention and health promotion) evident in Wiimali. Learners can also be encouraged to explore
the roles and responsibilities of the healthcare professionals who work in Wiimali, and particularly those that work in the community.

Cyril’s Smith’s journey
Eileen Poole’s journey
Jamie Lyons – the impact of family centred care
Stories of mental illness
Wiimali Chronicle
Wiimali Community Radio
The pedagogy of Wiimali

Cyril’s Smith’s journey

Cyril’s Smith’s journey from his home to admission and post-operative care following abdominal surgery can be used to illustrate the importance of person-centred and holistic care, clinical reasoning, therapeutic communication, and empathic care.

This series of digital stories includes:

Meet Cyril Smith and Smith family Genogram
Cyril Smith in Wiimali Hospital Ward 2
- Day of Admission
- Day 1 post-op (fluid balance)
- Day 2 post op (fluid balance)
- Day 3 post op (pain management A)
- Day 3 post op (pain management B)

After students view the ‘Meet Cyril Smith’ and ‘Day of admission’ stories they can discuss the following:

Professional issues (positive or negative) that you identified in the interaction with Mr Smith.
Any nursing behaviours that were evidence of empathy and/or a person-centred approach.
Any issues or concerns that you currently have about Mr Smith’s current physical or psychosocial status.
Mr Smith’s feelings, and fears and psychosocial needs.

Students can then answer these questions:

What are the risk factors for surgical patients and the associated nursing implications?
Why are older people undergoing surgery at higher risk of post-operative complications?
What have you learned about Mr Smith so far that may increase his risk of post-operative complications?
What actions would you take to prevent these complications?

A concept map can be used to illustrate:

Risk assessments that should be undertaken pre-op.
Pre-operative patient education aimed at promoting health and preventing complications.
Nursing actions to prevent post-operative complications.
Required referrals to other health professionals.

Post-op fluid and electrolyte balance

After students have viewed the ‘Cyril Smith Day 1 and 2’ stories which focuses on fluid and electrolyte balance, they can discuss the following questions:

What is hypovolemia and what are the causes, signs and symptoms, and expected pathology test results?
How is hypovolaemia different to dehydration?
What is hypervolemia and what are the causes, signs and symptoms, and expected pathology test results?
How can hypervolaemia and hypervolaemia be prevented?
Why are older people are at increased risk of fluid imbalance?
What contributed to Cyril Smith’s fluid status day 1 postop and day 2 post op?
Day 1- IV Fluids are given to Cyril and urine output is minimal– but Cyril’s BP continues to drop. Why? Where has all the fluid gone?
Day 2 – Cyril is hypervolaemic – how did this happen?

Pain management

After students have viewed the ‘Cyril Smith Day 3’ stories, which focus on acute pain management they can:

Compare the videos and identify which one demonstrated a person-centred approach to pain management and why.
Discuss some of the pain myths that were evident in the RNs approach.
Discuss the concepts of multi-modal analgesia and pre-emptive analgesia and how these contemporary approaches were or were not evident in the videos.
Identify and discuss barriers to effective pain management.

Eileen Poole’s journey

Eileen Poole’s journey from her home to the GP and pharmacy, through to admission to hospital because of a medication error, can be used to illustrate the importance of quality use of medicines, interprofessional communication and collaboration, person-centred and holistic care, therapeutic communication, and empathic care.

This series of digital stories includes:

Meet Eileen Poole and Poole Family Genogram
GP Super Clinic
- Eileen Poole’s encounter with Practice Nurse A
- Eileen Poole’s encounter with Practice Nurse B
- Eileen Poole’s encounter with GP
Wiimali Pharmacy
- Eileen Poole’s encounter with Pharmacist A
- Eileen Poole’s encounter with Pharmacist B
Wiimali Hospital Ward 3
- Handover A
- Handover B
- Medication History A
- Medication History B
- IPE, ISBAR and telephone order
- Interprofessional communication and collaboration
- Interruptions and medication safety A
- Interruptions and medication safety B
- Scope of Practice A
- Scope of Practice B
- Safe medication practices – The 5 rights
- Safe medication practices – Checking the patient’s ID
- Discharge team meeting

These stories present a very common scenario in health care – a patient visiting a medical centre where she sees a Practice Nurse and General Practitioner, and then visits a local community pharmacy. Students can explore where therapeutic and interprofessional communication occurs and how it could be improved, and how communication impacts medication safety.

Issues/questions that can be addressed after viewing the ‘Meet Eileen Poole’ and GP Super clinic stories:

What are the key elements of the communication approach used by Practice Nurse A and how does this differ from the communication approach used by Practice Nurse B?
How did Mrs Poole respond in each interaction?
Why do you think the patient didn’t ask any questions of Practice Nurse A?
Did Practice Nurse A elicit all of the relevant health assessment information from Mrs Poole?
Did Practice Nurse A demonstrate person-centred care?
How could Practice Nurse A have created a more comfortable environment for Mrs Poole that would enable her to share her concerns?
Why are effective communication skills essential for accurate and informed health assessment?
What are the implications of effective communication for safe and effective practice?

In the digital stories situated in the pharmacy and hospital students can be asked similar questions with a particular focus on communication and medication safety. A number of the stories also provide positive and negative examples of communication interactions that can be compared and contrasted.

Medication Safety interactive learning experiences Wiimali Hospital – Ward 1 provides a series of interactive learning experiences that focus on safe medication administration for three patients in Wiimali hospital:

Bill Peters
Margaret McDonald
George Franks

Jamie Lyons – The impact of family centred care

Wiimali hospital paediatric Ward includes two brief interactions about Jamie Lyons. Jamie is an eighteen (18) month old boy who presented to the Emergency Department (ED) with his mother Caroline. Jamie is the older sibling of Sam his eight (8) week old brother. Jamie has a three (3) day history of vomiting and diarrhoea and has been admitted to the ward for rehydration via a nasogastric (NG) tube and observation. The main focus of the two videos is family centred care.

Begin this activity by asking students to share their impressions of Caroline, Jamie and the family unit. Students are sometimes critical of Caroline and her unemotive and seemingly distant emotional response to Jamie. When the students’ assumptions and perspectives have been uncovered, read and discuss Caroline’s ‘back-story’ with the class. Help them to appreciate the meaning of family-centered care as they are afforded this glimpse into the Lyons’ family unit. Help then consider how ‘knowing’ the families they care for will help them to provide more holistic care.

Back story

Caroline was born and grew up in Wiimali a regional community about four hours north of Sydney. She was an only child and very close to her mother. Her father was an alcoholic and intimate partner violence was common when he had been drinking. When Caroline was 15 her mother died from a cerebral haemorrhage. Caroline moved to Walgett when she was 16 to find work and to get away from her father who had become increasingly abusive. She struggled with loneliness until she met Nelson at a local pub. He became her rock and provided the security she had longed for. They married when she was 20. Seven years later they were excited to find out they were having a baby. Their greatest sadness was watching Nelson’s mother fight a long battle with breast cancer. She died two years ago. Six weeks later Nelson was killed in a car accident. Caroline was 5 months pregnant.

Since Nelson’s death Caroline’s life has been turbulent and her emotions labile. Jamie’s birth brought some sense of purpose but no real joy. She began a relationship with a man who had been a workmate of Nelson’s but it was fraught with problems from the start. She had one miscarriage then fell pregnant again. She escaped the relationship when his violence was directed, not only towards her, but also to Jamie. Caroline has lived in Wiimali Riverside Caravan Park for the last six months.

Conclude this part of the activity by watching the Wiimali Riverside Caravan Park video and discussing the implications for Jamie’s discharge planning and follow-up care.

The second part of this activity focuses on the management of Jamie’s dehydration.

Caroline states that Jamie has had multiple episodes of vomiting, at least once every two hours for the last twenty-four (24) hours. Jamie has had watery faeces that is greenish brown in colour. Caroline indicates that Jamie has had two (2) or three (3) episodes of diarrhoea every hour for the past twenty-four (24) hours.

Jamie has been refusing food and most fluids for the last two (2) days, However Caroline states that she has been able to get him to drink small amounts of lemonade.

On examination Jamie is pale and his skin is warm and dry to the touch. Jamie has dry mucous membranes and is notably lethargic.

Caroline tells you that Jamie has become more lethargic today, “he just can’t seem to keep his eyes opened” Caroline adds. You notice that Jamie has sunken eyes and sallow cheeks.

Caroline tells you that Jamie has developed a red “bumpy” rash. On examination you see a red raised rash on Jamie’s legs and torso.

Jamie’s last vital sign observations reveal the following results:

Pulse rate: 165 beats/minute
Respiration rate: 39 breaths/minute
Blood pressure: 110/70 mmHg
Temperature: 39.1°C
Weight: 11.5 kgs

The medical officer sates that Jamie s 5% dehydrated.

This information can be used as a stimulus for discussing the:

Physiology and pathophysiology of gastroenteritis and dehydration in children
Signs and symptoms of gastroenteritis and dehydration
Stages of dehydration
Management of gastroenteritis and dehydration
Discharge planning for a child with gastroenteritis and dehydration

Stories of mental illness

Three linked stories of people experiencing mental illness occur in the Wiimali Hospital Emergency Department and Mental Health Unit. These include:

Mary’s experience of psychosis
Richard’s attempted suicide
Grace’s experience of anxiety

Students can be asked to focus on the therapeutic use of self and therapeutic optimism displayed by the mental health nurses and the effectiveness of these approaches.

Blog posts

A number of community members provide personal insights about living in Wiimali through a series of Blog posts. The posts, which are sometimes provocative and challenging, can be linked to tutorial activities to help students to understand the social determinants of health more deeply.

Wiimali Chronicle

The Wiimali Chronicle provides regular updates about the dynamic and unfolding nature of the community. These articles have been specifically designed to provoke discussion and debate about issues that impact on the community and the health and wellbeing of the residents of Wiimali. Educators can select specific news articles that align with tutorial content and weekly learning outcomes.

The key topic areas include:

Edition 1
- Hospital alternatives on the way – improved primary healthcare initiatives
- Long wait for pregnant mum to see doctor – poor services for pregnant women with long waiting times at GP and ED
Edition 2
- Diabetes emergencies in children rise – increasing prevalence not matched with increasing community health services
- Big fine over workplace death – the impact of breaches to the Occupational Health and Safety Act
Edition 3
- 100th baby born at new birth centre and push for midwifery care – promoting mother and baby friendly birth facilities
Edition 4
- Impact of coal mining in the Wiimali area: Concerns escalate – impact on communities and the environment
- Calls to fix deadly stretch of road – Community campaign to force the state government to fix a notorious ‘black spot’
Edition 5
- Singing for health – a project to improve the health of African refugees living in Wiimali
- Sunshade for seniors project – Wiimali Carers’ receive funding from the Cancer Council NSW to purchase a marquee so that disabled clients can enjoy outdoor activities
Edition 6
- OAM awarded to Mrs Deborah Louise Brennan of Wiimali – for services to nursing and the community
- Aged care provider enters receivership – Voluntary administrators appointed to oversee administration off Wiimali Gardens
Edition 7
- Mothers promote breastfeeding – Australian Breastfeeding Association hold a picnic to promote breastfeeding and celebrate World Breastfeeding Week
  Warning: kids left in hot cars – Baby dies after being left in hot car
Edition 8
- Cultural festival celebrates diversity – recognition of the benefits of cultural diversity
Edition 9
- Camps that prevent chronic illness are a winner – AMS initiative to prevent chronic illness for younger members of the Aboriginal and Torres Strait Islander community
- Healthier babies for Wiimali – funding awarded by the State Government to improve the health of babies born to young Aboriginal and Torres Strait Islander women from Wiimali
- Wiimali Aboriginal Community Information and Assistance Day – advertisement
Edition 10
- New health promotion institute most appropriate – The Yurakauwe Institute, operated and staffed by Aboriginal and Torres Strait Islander people, to support health promotion
- Students get health promotion strategy right – Two Aboriginal nursing students develop a health promotion strategy focused on smoking and sports
  performance
Edition 11
- Black spot crash: more lives lost – two men die at a known ‘black spot’
- Tributes – obituary section of Chronicle

Wiimali Community Radio

The Wiimali Community radio also provides regular updates about the dynamic and unfolding nature of the community. These announcements can be used to provoke discussion and debate about issues that impact on the community and the health and wellbeing of the residents of Wiimali. Educators can select announcements that align with tutorial content and weekly learning outcomes.

The key topic areas include:

Program 1
- Car accident in Wiimali – community action to address a black spot
Program 2
- ‘Talking books’ for dementia sufferers – a person-centred care strategy
Program 3
- Environmental conservation by property developers
- Community action for a new high school
Program 4
- Cost of living impact as electricity costs soar
- Rising unemployment in Wiimali
- Safety of coal mines
Program 5
- Homelessness study to guide Local and State council
- Wiimali resident Anita van der Mortel receives OA for her work with refugees
Program 6
- Difficulty attracting doctors to rural areas with Practice Nurses and Nurse Practitioners often filling the void
- Wiimali hospitals nurses hold a stop working meeting to discuss nurse:patient ratios
- Funding needed to prevent Wiimali Mental Health Unit from closing
Program 7
- Flexible hours for fathers proposed by the Minister for the Status of Women
- A new intervention called ‘Healthy Schools: Healthy Futures introduced to stem teenagers’ risky behaviours such as substance abuse and violence
Program 8
- Fire at Wiimali Riverside Caravan Park – a woman and her child died from smoke inhalation
Program 9
- Delays in services for Aboriginal communities due to government inertia and failure to work in partnership with communities
- Super police station at Wiimali long overdue
Program 10
- Wiimali AMS now has a visiting audiologist to help address extremely high levels of otitis media and hearing loss in Aboriginal children
- Recognition that may Aboriginal people who are incarcerated suffer with significant heating loss
Program 11
- A mother and child hit and killed by a four wheel drive accident – being investigated by crash investigation unit
- Wiimali Council bans the use of battery caged eggs
- Two brothers, 15 and 17 years, drown in strong currents of the Gubiy river

The pedagogy of Wiimali

Levett-Jones, T., Bowen, L. & Morris, A. (2015). Enhancing nursing students’ understanding of threshold concepts through the use of digital stories and a virtual community called ‘Wiimali’. Nurse Education in Practice(15), 91-96. https://www.ncbi.nlm.nih.gov/pubmed/25487056
Day, J., Levett-Jones, T. & Taylor, A. (2014). Using a virtual community to enhance nursing students’ understanding of primary health care. Collegian.21(2), 143-150. http://www.collegianjournal.com/article/S1322-7696(13)00094-2/pdf

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