Abstract:

Introduction:
Myasthenia Gravis (MG) is an autoimmune condition that causes muscle weakness and excessive fatigue. It is classified as a rare disease, affecting about 15 in every 100,000 people in the UK. People with MG endure progressive deterioration of their respiratory, cardiovascular and musculoskeletal functioning. Their challenges with nutrition and speech are also overbearing. The humanistic burden of MG extends to psychological comorbidities leading to reduced quality of life. Simulated placement is a safe environment to train health care providers on the assessment and care of patients with rare diseases. Case studies based on lived experience infused into simulated placements enhances the critical thinking, clinical reasoning and professional competencies of nursing students. This study explored the impact of simulated placement based on the lived experience of a person with MG on the learning experiences of year 2 nursing students.

Methods:
This study presented the case of a virtual patient, Parker Smith, whose story is derived from the lived experiences of a service user with MG. The students were exposed to 16 hours of placement experience for this topic, which was within the context of ‘disability’ of the assessment and care of deteriorating patients. The activities within the placement were aligned with the Nursing and Midwifery Council’s proficiencies and professional values. Ethical consent of the service user to share and publish their lived experience was obtained in accordance with the University’s regulations. The simulated placement was created on CANVAS pages, and software like Yuja, h5p, and editable pdf documents were utilized to create interactive activities for the nursing students. The patient’s journey is introduced from the virtual patient’s visit to general practitioner services. Thereafter, the case study is threaded through the need for a referral to the Speech and Language Assessment Team, and health education on food choices to prevent aspiration and enhance nutrition. The case study proceeds with the worsening of Parker’s dysphagia requiring him to be admitted within a neurology unit, where he sustains a fall, necessitating the evaluation for intracranial insult and neurological observation. End of placement survey appraised the effectiveness of the simulated learning experiences of student nurses. Thematic analysis was utilized to unveil the constructs submerged within the descriptive statements of the students.

Results:
The average rating on the reality vibe experienced by the 102 students within the simulated placement was 4.2 out of five. Students’ descriptive statements revealed three major themes. The primary theme of ‘patient experiences is beyond research and textbook wealth’ reiterated the wholesome learning assimilated from patient’s health journey. The theme ‘significance of humanistic approach in caring’ echoed the students need to look beyond the boundaries of therapeutic management to empathetic communications, individualized support and advocacy. The revelation of the ‘raw truth on the impact of ruthless caring’ influenced the students need to revisit their approach to patient care.

Conclusion:
The simulated learning experiences aligned with the journey of the service user, magnified the holistic care requirements of patients with MG. The claim of a higher realistic experience contributes to the success of the simulated pedagogy to divulge deeper understanding towards rare diseases.

Keywords:

Simulated placement, Myasthenia Gravis, case study, virtual patient, lived experience.