Don't know how to teach Pharm? Fake it!!!

[ADPIE10]

I'm currently taking Pharm as part of an ADN program at my local community college. I also took Pharm from another community college with a highly respected veteran instructor. It's fun to compare and contrast the two because one is highly respected by thousands, and the other is often perceived as a kook.

The kookie one admits that she hasn't taught Pharm before. She's been doing a really bad job of teaching the material. She creates PowerPoint talking points from the textbook, and reads from the book.

We recently studied pharmaceutics, pharmakokinetics and pharmacodynamics. Instead of administering a well written 10 question NCLEX objectively gradeable quiz, she chose to have the students answer the following:

Scenario: You are making a home visit to a client. The discharge prescriptions are the following:

Medication- A: Take 20 mg twice daily for two more days and then once a day for four days on an empty stomach.

Medication-B: Take 500 mg three times a day with meals.

The client says to you, "This is too complicated for me! Can I take 20 mg of Medication-A once a day for eight days? After all, I'll be taking the same amount of drug. And, can I take A and B at the same times? I'll never remember to take them if I have to take one before I eat and the other after."

explain to the client why the medications should be taken as prescribed.

With the number of pharm questions on the NCLEX, I can't imagine how the other students are going to be able to pass the NCLEX if our knowledge continues to tested by these types of questions. :chuckle Sure, who cares about understanding about excipients or disintegration or dissolution. Let's have a long-winded essay about following directions... If you don't know the subject and you can't test it, then FAKE IT!

[ADPIE10]

Patient education is a large part of what nurses do in real life. If you don't understand the basic concepts, you won't be able to teach to someone with no understanding. It looks to me as if she is trying to see if you understand the basic concepts. I see nothing wrong with this question.

Curious - if you have taken this course before, why are you taking it again now?

Excellent question! The course is part of a suite of classes per semester that is approved by the BRN of my state. Nursing classes from other colleges don't qualify. At least this was the way it was explained to me.

No biggie, it's always good to review important topics.

[ADPIE10]

I think that everyone has made good points.

By the way, the question wants the student to explain to the patient why compliance is necessary, not how to achieve compliance. Many people frequently misinterpret the question. :loveya:

[loricatus]

I would like to say that most nurses who come out of school know practically nothing on how to deal with patients because of the book learning needed to pass NCLEX. That is why the question posed to you surpasses what most instructors give.

Now, on how to answer these type of questions---WHY..., questions:

What qualities of the drug and the elderly person make the proposed plan inadequate?

You must learn, from the book, the pharmacokinetics of the drug and apply it to the physiology of the elderly. I am sure the answers are all there, you just have to put it all together. Then, you have to translate it into lay terminology for the elderly person to be able to relate to your explanation and understand why it is important to take it a certain way & what the ramifications will be if done incorrectly-here communication and advocacy play an important part.

In reality, if you answer this question, you are preparing for a multitude of NCLEX type of questions because you have to put two and two together. Although NCLEX may pose single focus questions, nursing requires a compilation of various subject matter. This is why I find the method your instructor is using to be excellent.

I'll give you a little real world example of what happened to me Friday. A patient was complaining that surgery had to be delayed a few hours because he decided to take a glass of coke, rather than stay NPO. The doctor and a few pre op nurses did explain why the surgery was delayed; yet, when I got him in PACU, he was still upset that he had to wait. I did not know exactly what was told to him; so, I went on about how when under anesthesia he got a tube down his throat so the doctor can't see if he burps up anything in his stomach. Also, that if he does burp up something from his stomach, he could choke to death or come down with a bad case of pneumonia and possibly wind up on a ventilator. I realized that this man was a little mentally slow, so I adjusted my explanation in a way I felt he would take it seriously. Well, as soon as I finished explaining, he thanked me and said that nobody before explained it like that and now he understood why it was important that he didn't have the surgery at the time planned. Since this was a day surgery and he was to go home after recovery, he would have been quite upset over his treatment if he didn't get the type of explanation HE could understand.

The type of question you were given teaches you to be able to deal with situations like this. POINT BLANK-Book learning, then regurgitation, makes you into the type of nurses that dealt with the patient in pre op.

[ADPIE10]

Now, on how to answer these type of questions---WHY..., questions:

What qualities of the drug and the elderly person make the proposed plan inadequate?

You must learn, from the book, the pharmacokinetics of the drug and apply it to the physiology of the elderly...

I'll give you a little real world example of what happened to me Friday...

The type of question you were given teaches you to be able to deal with situations like this...

Hi Loricatus,

Thanks for your response. I really appreciate that you tried to answer the question. Unfortunately, like many students in my class, you would have been criticized for not reading the scenario and assessing the facts. Once you identify the person as an elderly person within the scenario, you've added detail that didn't exist in the scenario. The subsequent nursing implications that you derive from that assumption may be biased. We've only had an 1 and 1/2 hours of classroom instruction. I'm sorry that I didn't state this previously.:imbar What do you think your answer would be now?

It's a challenging question and other Nursing Instructors in the faculty are finding it difficult to answer the question themselves. There's a lot of room to make mistakes... The student only has 15 minutes to answer the question. Thanks and please try to answer the question again. Seriously, it would be highly appreciated. :loveya:

[Melinurse]

Originally Posted by Melinurse

She's just trying to see how you'll apply what you already should know based on readings and lectures. My instructor did the same thing and I am truly glad now that I am a nurse. It's not just patient teaching it is also patient safety. Listen a little closer, she may be preparing you to be a great nurse instead of a good nurse.

I've also learned that you can even learn alot from the so-called bad instructors so keep your ears open. Good luck with your studies.

Melinurse, not sure what you are getting at. My post was supportive of this technique being used by the instructor. I believe I stated, albeing using different words, many of the sentiments that you have voiced in your post. I fail to see where I implied that the instructor was bad for giving the students this assignment. Am I missing something?

Yes, I was merely saying you can learn something from everybody. From my own personal experience with a bad teacher ( NOT saying this one was/is bad ) I have found out that there is always something to be learned. That is all that the statement meant. No offense intended.:loveya:

[ADPIE10]

I think that it's awesome that we have a community of nurses that are willing to talk and brainstorm. I know what I know, but I don't know what YOU know. It's important for everyone to know that all of your opinions are valued. Please try to answer the original post.

Originally, I thought that this was a frivolous post, but I've come to recognize that there is a really great answer out there!

Based upon the definition of standard of care, if we can arrive arrive at a common explanation for the client, I would be very grateful. I've been on this forum for many months.. I know that I can count on you.

Thanks.

[Acosmo27]

that question seems much more applicable and valuable than any pharm nclex question can provide you.

[ADPIE10]

that question seems much more applicable and valuable than any pharm nclex question can provide you.

Great!, so how would you answer it?

[Tharem]

Scenario: You are making a home visit to a client. The discharge prescriptions are the following:

Medication- A: Take 20 mg twice daily for two more days and then once a day for four days on an empty stomach.

Medication-B: Take 500 mg three times a day with meals.

The client says to you, “This is too complicated for me! Can I take 20 mg of Medication-A once a day for eight days? After all, I’ll be taking the same amount of drug. And, can I take A and B at the same times? I’ll never remember to take them if I have to take one before I eat and the other after.”

explain to the client why the medications should be taken as prescribed.

Ok, here's my answer (I tried to keep it in lay terms):

"Medication A must be taken on an empty stomach because mixing it with food can stop it from working. You have to take it twice a day for the first two days because a certain amount has to be in your system those first two days for it to start working properly.

You have to take medication B with meals because it could damage your system without the extra protection of food. Mixing it with food does not prevent it from working - unlike medication A."

[ADPIE10]

Ok, here's my answer (I tried to keep it in lay terms):

"Medication A must be taken on an empty stomach because mixing it with food can stop it from working. You have to take it twice a day for the first two days because a certain amount has to be in your system those first two days for it to start working properly.

You have to take medication B with meals because it could damage your system without the extra protection of food. Mixing it with food does not prevent it from working - unlike medication A."

You've come closest to the answer so far! You've addresed the aspects of pharmaceutics that include disintegration and dissolution. I think that we could better address parts of Pharmacokinetics: absorption, distribution, metabolism (biotransformation), and excretion. The problem is answering the question for the professor, but addressing the patient.

In the area of Pharmacodynamics, how can we address dose response and maximal efficacy? Onset, Peak, and Duration of Action? Receptor Theory? Therapeutic Index and Therapeutic Range (Therapeutic Window)? Peak and Trough? Loading Dose? Side Effects?

The more that we communicate using layman's words, the more points we could get.

[loricatus]

Hi Loricatus,

Thanks for your response. I really appreciate that you tried to answer the question. Unfortunately, like many students in my class, you would have been criticized for not reading the scenario and assessing the facts. Once you identify the person as an elderly person within the scenario, you've added detail that didn't exist in the scenario. The subsequent nursing implications that you derive from that assumption may be biased. We've only had an 1 and 1/2 hours of classroom instruction. I'm sorry that I didn't state this previously.:imbar What do you think your answer would be now?

It's a challenging question and other Nursing Instructors in the faculty are finding it difficult to answer the question themselves. There's a lot of room to make mistakes... The student only has 15 minutes to answer the question. Thanks and please try to answer the question again. Seriously, it would be highly appreciated. :loveya:

The purpose of my response was to get you thinking in the right direction rather than thinking that your instructor cannot teach. My intent was not to specifically answer your question for you; but, to put you in the right mindset. You will have to answer the question yourself. It would not be fair to you to give you the answer.

What is your answer to the question you posed?

Some hints: What do you know about peak, trough and maintenance? How could you put that into lay terminology. What do you know about absorption? How can you explain that to someone who gets confused easily? What do you know about drug interactions? And, how can you explain the consequences of such? Now, what can you do as a nurse to assist someone with their proper medications and timing---that's the easy part and allows you the most creativity.

[ADPIE10]

The purpose of my response was to get you thinking in the right direction rather than thinking that your instructor cannot teach.

Thanks anyway. You've made your point? I can tell from your response that you have a lot of experience with home visits.