Article / Research Article

Beppu University, Japan.

Tomoko Matsunaga ,
Beppu University, Japan.
Submitted : 25 Mar 2025 ; Published : 28 April 2025

The nature of on-the-job training in nursing colleges has changed significantly since 2021. Although COVID-19 has been identified as a concentrated contact since May 2023, the practice facilities have responded differently since it became a Category 5 infectious disease. Gerontological nursing practice was conducted in consultation with the practice facilities. Of the total six hospital training courses, one group from each of the three courses was on-campus training for a total of 15 students. Considering the issues raised in the previous literature, a group (5 students) was assigned one simulated patient, and the students were asked to develop the nursing process (collection of information, planning, implementation, and evaluation). The effect of this practice was that it was more effective than the hospital practice in terms of time spent in the hospital. The effect of this practice was that the students could analyze and plan nursing care more carefully than in hospital practice, with more time to spare. The students were able to share in the implementation of the plan and felt satisfied that the training was similar to that of hospital training. Students had an opportunity to practice how to collect information and how to listen, and they were able to deepen their learning among themselves. The simulated elderly patient living in the community has a disease but visits the hospital every few months. The nursing assistance consisted mainly of dietary, medication, and lifestyle guidance, which showed a bias in nursing assistance compared to the hospital training.

Keywords: Gerontological nursing practicum, Corona disaster, Community elderly, Simulated patients in the practice

Since 2021, the nature of on-the-job training at nursing colleges in the face of the corona pandemic has changed dramatically.
This is due to the impact of the spread of new coronavirus infection (COVID-19), which has required a variety of measures for on-site training at nursing colleges since January 2021. The university used the “Guidelines for Clinical Practice in Response to the Outbreak of Novel Coronavirus Infections” for its practical training but was forced to conduct on-campus training. Subsequently, as of May 2023, COVID-19 became a Category 5 infectious disease transition, so the students were no longer identified as concentrated contacts, but the practical training facilities responded differently. The college discontinued the aforementioned practice guidelines and consulted with the practice facilities. Of the total of six hospital training courses, one group in each of the three courses became on-campus training.

In the on-campus training at corona disaster, Omori commented, “In the online training, even in the case of training with videos and faculty members acting out simulated patients, there were issues such as the inability to build trusting relationships and lack of experience in nursing skills and communication, etc.” and Suzuki commented, “Even if the content of the training was structured for reality through simulations, it was difficult for individual nursing subjects to understand the content of the training [1, 2]. Suzuki states, “It was difficult to express the lives and feelings of individual nursing subjects even though the content of the training was structured to be realistic through simulation [2]. Considering these issues, we set up an elderly person living in the community as a simulated patient in this on-campus training, and a group of five students took on one simulated patient to develop the nursing process (information gathering, planning, implementation, and evaluation), attempting a format similar to hospital training.

Gerontological Nursing Practicum II (hospital) (90 hours) in the third year of a four-year university, a practicum in which one elderly patient is accepted and the nursing process is developed. During the period when the hospital had difficulty accepting patients due to the corona disaster (September 2023 – January 2024), five students in one group were assigned one elderly simulated patient, and a nursing plan was drawn up and implemented. Groups (1), (2), and (3) were on-campus training.

One local elderly patient visited the school on Tuesday of the first week (1:00 p.m. to 3:00 p.m.) and Tuesday of the second week (1:00 p.m. to 3:00 p.m.) On Tuesday of the first week, vital signs were measured, and information was collected (if the patient had received medications and tests, test data and medication book were brought). Wednesday (evaluation of implementation and revision of plan) Week 2, Thursday, summary presentation. After the summary presentation, the trainees reflected on the training and presented their learning and impressions from the training.

The objectives and goals of the training were the same as before the COVID-19 disaster.

The evaluation was based on a score evaluation (out of 100 points) using a practical training evaluation form. Details of the schedule are shown in Table 1.

Ethical considerations: Student evaluation scores were taken into consideration so that individuals could not be identified, and students’ final impressions were taken from notes written down by faculty members so that names could not be identified and approved by the Ethics Committee.

Group 1 : 5 students, simulated patient A, male, 70s, UTI, hypertension. In gathering information, five students were assigned to interview, measure vital signs, and communicate with the patient. Information was collected from the medication book, and recent laboratory data brought documents.

Nursing Problem: The patient often awakens at night with urination and does not sleep soundly. She did not have a good understanding of the effects of her medications.

In nursing planning and implementation, we discussed, prepared a pamphlet, and provided guidance on medication (drug action and side effects), dietary guidance (salt intake and high-sodium foods), and lifestyle guidance to reduce nocturnal awakenings.

Practice Evaluation: The group averaged 80 points.
Comments on the Practical Training: “I was nervous because it had been a long time since I communicated with patients. I had practiced measuring vital signs, so I was able to do it smoothly. When I forgot to ask questions during the interview, other members of the group asked me, which was helpful. All group members were able to collect information together to ensure that there were no omissions. Analysis was done individually, but we were able to discuss it at the conference and share information. The nursing plan was developed individually, opinions were exchanged at the conference, and priorities were set for the plan. Implementation was divided up, so instruction was divided up, and I was able to see what the other students had done, so I was able to describe the content of the implementation. We were able to achieve our goals because we were able to take more time than in the clinical sessions to fully consider the content of the instruction.”

Group 2 : 5 students, simulated patient B, male, 70s, angina pectoris, hypertension, history of cataract surgery. In gathering information, the five students were assigned to interview, measure vital signs, and communicate with the patient. Information was gathered from the medication book, and recent laboratory data brought documents.

Nursing Problem: She sometimes has extra oral medications but does not care. She has had cataract surgery on her right eye, and her right eye has recently become difficult to see, but she has left it alone. He has been drinking an increasing amount of alcohol.

In nursing planning and implementation, guidance on medication (drug action, side effects, time to take medication), cataract symptoms and treatment, guidance on the need to see a doctor, and lifestyle guidance on alcohol consumption were discussed, pamphlets were prepared, and guidance was provided.

Practice Evaluation: Group average 80.4 points.
Comments on the Practical Training: “I was able to do it smoothly because I had practiced interviewing and measuring vital signs. The other members of the group were also listening to me when I was interviewing the patient, so I was able to gather all the information I needed. We were able to discuss the information at the conference, and after analyzing the information, we were able to confirm it. We developed our nursing plans individually and exchanged opinions at the conference, but it was difficult to organize our opinions. The planning was done by setting priorities. It was good that we were able to share the implementation of the plan and carry it out together. I don’t usually communicate with the elderly, so the elderly talked a lot to me, even though it was only for a short time. It became easier to talk with the elderly. Since we shared the responsibility of conducting the program, there was not much content, but we were able to provide good guidance and confirm the response. However, I wondered if the conversation could have been deepened if the patients had been there for a few more days. I would have liked to confirm that they understood the content of the instruction. Although it was different from the hospital, it was good to be able to provide guidance. It was fulfilling to be able to think things through.”

Group 3 : 5 students, simulated patient C, female, 70s, osteoporosis, hypertension, history of lumbar vertebral compression fracture. In gathering information, five students were assigned to interview, measure vital signs, and communicate with the patient. Information was gathered from the medication book, and recent laboratory data brought documents.

Nursing Problem: They were not familiar with osteoporosis and did not know what medications they were taking. She is concerned that her back pain and posture have worsened since her compression fracture. Physical activity has decreased.

In nursing planning and implementation, osteoporosis was explained in an easy-to-understand manner. Medication guidance (about oral medications, including pictures of medications, explanation of actions, side effects, and time to take medications) and dietary guidance (diet high in Ca, cooking methods, etc.) Pamphlets were prepared and guidance was provided. Instruction was given on how to wear a corset when in pain, when to see a doctor, and simple leg exercises.
Practice evaluation: Group average 78.2 points.

Impression of the Practical Training: “I was able to do it smoothly because I had practiced interviewing and measuring vital signs. In the hospital training, I could get some information just by copying from records, but this time I was able to gather information by asking directly, which was a good experience for me. I felt that it is difficult to obtain information by actually listening. I was able to learn how to listen by watching other members of the group listening. I was able to analyze information carefully. I was able to learn a lot by discussing and carefully reviewing the planning process. The conference was very useful for exchanging ideas and opinions. It was good that the implementation of the program was divided up and everyone was able to participate. The elderly people were easy to talk to, they spoke to me on their own, and I was able to communicate with them. I was not good at speaking, but I had a chance to talk with the elderly, which gave me confidence. I thought it would be useful for my future practice. It became easier to talk with the elderly. Although we were divided into groups, there were many things to teach, so each of us was able to teach them well. I would be happy if they could make use of this training in the future. I have not had much experience in teaching patients in practical training, so it was very useful. I was told that they would cherish and use the pamphlets I gave them, so I was really glad that I did the training. It would have been nice to see what happened after the training.”

The average overall practice evaluation at the end of the practicum was 78.0 points.

In the gerontological nursing practice, one group in each of the three hospital training courses out of the total of six courses were conducted on-campus, with a total of 15 students participating in the on-campus training. Considering the issues raised by the previous literature, a group (five students) was assigned to take care of one simulated patient, and the students were asked to develop the nursing process (information gathering, planning, implementation, and evaluation). The students were given the opportunity to work on the development of the nursing process. The following is a discussion in light of the issues from the previous literature that were considered and addressed.

• “In the online training, even when the video or the faculty member played the role of a simulated patient, it was not possible to build a relationship of trust”, we were able to communicate within a limited time by taking elderly people living in the community as simulated patients, and although the implementation was shared, everyone was able to implement it and confirm their reactions [1]. Although the implementation of the program was divided up, it was possible to obtain realistic reactions from the elderly by using the elderly living in the community as the simulated patients. Although it is difficult to establish a relationship of trust, the elderly in the community showed sincere acceptance of what the students taught them.
• Regarding “Issues such as lack of experience in nursing skills and communication, etc [1].”In nursing skills, educational guidance was the main focus. However, considering the content of the guidance appropriate to the subject, we should consider guidance on medication (action and side effects of medication, time to take medication, etc.), dietary guidance (how to take salt and foods high in salt, diet high in Ca, cooking methods, amount of alcohol consumption, etc.), explanation of diseases, treatment methods and necessity of medical examination, how to wear a corset when in pain. The company had prepared pamphlets and provided instructions on how to wear a corset when in pain, when to visit the doctor, simple leg exercises, etc. The size of the pictures and letters was taken into consideration, and the volume of the voice was carefully considered.

However, the simulated elderly patient who lived in the community had a disease but visited the hospital once every few months, and the nursing assistance consisted mainly of dietary, medication, and lifestyle guidance. Compared to the nursing assistance in the hospital practice, there was a bias in nursing assistance.

Communication was well done, taking into consideration the hearing loss of the elderly and the way they spoke. Students were paying attention to each other and communicating with each other. In addition, more conversation was made by the elderly, making it easier to talk with them. Some students who were not good at talking to the elderly, but the elderly were willingly talked to the students, which helped them to relax, and some students gained confidence as they had a chance to talk with the elderly. Since they have little experience interacting and conversing with the elderly, this on-campus training was a good experience for them to communicate with the elderly.

• Regarding “It was difficult to express the individual lives and feelings of the nursing subjects even though the content of the training was structured to be realistic in the simulation [2]”. By using elderly people living in the community as simulated patients, we were able to directly understand the reactions of the elderly and obtain information. The students were able to hear directly from the elderly living in the community by interviewing and listening to the elderly, and they were able to obtain first-hand experience. In the hospital practice, some information can be obtained by simply copying from records, but in this case, students were able to gather information by directly listening to the person, and felt that actually listening to the person and obtaining information is difficult. I was able to learn how to listen by watching other members of the group listening. Seeing the expressions on the faces of the elderly people being asked, I was keenly aware of the need to explain what was difficult to understand and to get information by breaking it down.

It can be said that the group was able to directly learn about the individual lives and sentiments of the subjects.

Regarding the above three perspectives, we believe that by setting up elderly people living in the community as simulated patients and conducting on-campus training, the issues in the previous literature were cleared and a positive effect was obtained for the on-campus training.

In addition, the evaluation score for the practical training was higher than the overall average score of 78.0 points for all three groups.
Other comments from the students on the effects of the on-campus training were: “Compared to the hospital training, we had more time and were able to carefully analyze and plan nursing care. The students were satisfied that they were able to practice in a manner similar to that of hospital practice, with the implementation of the plan being shared. Students had an opportunity to practice how to collect information and how to listen, and they were able to deepen their learning with each other. The students were also able to experience synergistic effects among themselves, such as “We were able to practice how to gather information and how to listen.

As for future issues, regarding the content of nursing skills, the simulated elderly patient living in the community has a disease but visits the hospital every few months, and the nursing assistance consisted mainly of dietary, medication, and lifestyle guidance. Compared to the nursing assistance in the hospital practice, there was a bias in the nursing assistance. It is necessary to incorporate nursing assistance that is difficult to experience with simulated patients living in the community.

One of the students commented after the training, “I wanted to confirm whether I understood the content of the instruction. It would have been nice to see what happened after the instruction. Although the simulated patients were visited on two days, we believe that even a half-day visit after the instruction would have helped to determine the effectiveness of the program.

This time, a group of five students took on a simulated elderly patient living in the community and developed a nursing process (information gathering, planning, implementation, and evaluation), which was similar to the practice of taking on a patient in hospital practice. The effect of this practice was that the students were able to analyze more carefully than in hospital practice, with more time to spare, and to develop and implement nursing plans, making the practice more similar to hospital practice. Students had the opportunity to practice how to gather information and how to listen, and they were able to deepen their learning among themselves. Since they have little experience interacting and conversing with the elderly, this on-campus training was a good experience for them to communicate with the elderly.

As a future issue, the simulated elderly patient who lives in the community has a disease but visits the hospital every few months, and the nursing assistance was mainly dietary, medication, and lifestyle guidance. In addition, additional days for visiting simulated patients should be considered [3-10].

1. Omori, Miho (2022) Literature review on the alternative practice of on-site training for nursing students in the corona disaster. Bulletin of Teikyo University of Science 18: 157-164.
2. Ikuko Suzuki (2023) Literature review on issues of on-the-job training in nursing colleges conducted in the corona disaster. Bulletin of the Faculty of Nursing, Shumei University 5: 63-71.
3. Nakamura, Motoe, Yamamoto, et al. (2022) On-campus training in gerontological nursing in response to the spread of COVID-19 infection: Focusing on gerontological nursing practice II (hospital practice), Bulletin of Japanese Red Cross Hiroshima College of Nursing 22: 11-20.
4. Kinoshita K, Ando R, Namba K (2022) Students’ learning in alternative in-school training for gerontological nursing practice under the influence of new coronavirus infection, Bulletin of Niimi Public University 42: 55-62.
5. Mitani M (2024) Gerontological nursing practice in the COVID-19 disaster: Educational effects and issues of half-day practice utilizing an in-hospital study waiting room, Bulletin of the Faculty of Health and Welfare 1: 85-89.
6. Ayaka Sugimoto, Yuko Yamamoto, Midori Takahashi (2022) Approaches to gerontological nursing practice in the COVID-19 disaster, Bulletin of Takarazuka University 35: 177-188.
7. Toshiko Taniji, Junko Yamamoto, Kazue Toki, et al (2022) Thoughts of students graduating after experiencing alternative practice in the corona disaster, Bulletin of SenriKinran University 19: 33-40.
8. Keiko Tsuboi, Mayu Akisada, Nobue Ishibashi, et al (2020) Gerontological nursing practice utilizing online characteristics, Nursing Education 61: 940-947.
9. Hasegawa K, Sasaki Y, Sato Y (2020) Alternative measures for maternal and adult nursing field practice, Nursing Perspectives 45: 40-45.
10. Ministry of Education, Culture, Sports, Science and Technology: Report of the Expert Group on the Quality of Clinical Practice in Nursing Colleges under the New Coronavirus Infection (2021.6.8): On Maintenance and Improvement of the Quality of Education of Clinical Practice in Nursing Colleges. (https://www.mext.go.jp/content/20210608-mxt_igaku-000015851_0.pdf)