The challenges of self-monitoring
Clinical placements—the hospitals, clinics, and other health care settings in which students acquire firsthand experience in their fields—are a critical part of nursing education. To safely enter these sites and avoid spreading the coronavirus, Connell students must check themselves for COVID-19 symptoms.
“You have to be able to demonstrate that you’re monitoring for symptoms and are symptom-free before you can go in [to clinical settings],” says DNP candidate Maureen Connolly, a certified adult nurse practitioner. “Nursing is unique in that we’re so physically close to our patients. We’ve got to figure out a way to do this.”
So, when choosing a topic for a practice improvement project to pursue for the rest of the semester, Connolly’s DNP team of four decided to explore whether a group of nursing students could regularly check themselves for COVID-19 symptoms twice a day.
With help from the University’s Research Services staff, they created a symptom self-monitoring tool and then recruited student participants from Connell’s Direct Entry Master’s program. The 16 who volunteered received an email twice a day (at 7 a.m. and 7 p.m.) with a link to an anonymous survey that asked respondents to document whether they were experiencing any COVID-19 symptoms, such as feeling feverish or experiencing a headache, shortness of breath, or new loss of smell. (The team used a secure web platform to record its responses.) Participants could fill out the assessment by smartphone or computer; it took only a few minutes. Anyone who felt unwell was advised to seek medical help.
To the surprise of the DNP candidates, only half of the 16 participant volunteers fully completed the symptom-tracking survey during the 10-day study period. The other eight missed one or more of their symptom checks.
“In this highly motivated group of students, we thought the completion rate would be higher than 50 percent,” says project group member Sherri St. Pierre, a certified pediatric primary care nurse practitioner.
“Our feasibility study showed that 10.8 percent of the symptom survey was not completed, and a total of 38 instances of symptom monitoring was not documented,” notes team member Catherine Conahan, a certified nurse practitioner and oncology certified nurse.
What accounted for the lapses? The team found that technology glitches and changing daily schedules kept some study participants from consistently checking for symptoms twice a day. Another factor, the DNP candidates concluded, is that students need a compelling reason to self-assess—which some may not have felt during the study. In contrast, if they miss a day of symptom screening during the semester, “they may not be able to go to their clinical placements, and then they could not finish the program,” notes team member Donna Cullinan, a certified family nurse practitioner. She says their project shed light on some of the challenges nurses face when encouraging behavior change among their patients: “As nurses, we’re always telling people to change behavior.”
Connell students aren’t using the monitoring instrument this fall; instead, those on campus are expected to check for COVID-19 symptoms once a day using Boston College’s official health-assessment tool for students, faculty, and staff. Some CSON students may also have to follow specific screening guidelines at the clinical sites where they do hands-on training.