A low fidelity simulation of the concept of frailty : Time compression as a tool to identify manifestation of frailty, to plan interventions, and to conduct family conferences

Title: A low fidelity simulation of the concept of frailty with nurse practitioner students: Time compression as a tool to identify manifestations of frailty, to plan interventions, and to conduct family conferences Frailty is common clinical syndrome in older adults. It is associated with an increased risk of poor health outcomes including falls, delirium, malnutrition, hospitalization, and mortality. These sequelae impact intimate relationships and the fabric of nuclear and extended families. Elucidating the concept’s essential components and its effect on family dynamics are critical elements in the education of a geriatric nurse practitioner. A clinical simulation was designed by two nursing professors to reflect three separate time periods in the life story of Anna, a prototypical Minnesotan older adult. Her story is capsulated at the age of 65, 80, and 85 years of age. At each age, weight, energy level, physical activity level, muscular strength, stage of chronic disease, and immune system function are outlined. Also, the dynamics of her family are woven into the simulation. Students are asked to evaluate Anna at 80 and 85. By comparing and contrasting Anna’s health at these two time periods, the nurse practitioner student consolidates the theoretical framework of frailty. Also, integration of family dynamics into the simulation, affords many learning opportunities for nurse practitioner students. They have the option,to negotiate ethical dilemmas, to assist a client in the life transitions associated with frailty, and to provide practical interventions for slowing the process. The effectiveness of the simulation was assessed on a pilot group of second semester nurse practitioner students. A pre and post assessment on the concepts of frailty was administered. An Objective Structured Clinical Examination on conducting difficult conversations was completed. Qualitative feedback was elicited from the nurse practitioner students. Results are summarized by theme. A two year nurse practitioner program is too short a time period for students to see changes in a client. This simulation compresses the passage of time and in so doing, teaches the student to anticipate the changes associated with frailty and to assist both client and family in management of the transitions.