PhD Thesis Defense: Björn Bouwmeester Stjernetun

Björn Bouwmeester Stjernetun defends his thesis "Knowing Me, Knowing You: Bridging Perspectives through Age-Suit Simulation Intervention in Nursing Education".

The PhD thesis defense will be held in Room G110 at the University of Skövde and will also be streamed online. 

Join the livestream: https://his-se.zoom.us/j/69911135837?pwd=CbBDQIlAwfGTT0NnTPi3Syz9c5Agq9.1

Abstract

Background: The ongoing shift in healthcare from hospital settings to care in the home reflected in the Good and Close Care reform indicates that newly graduated nurses will increasingly provide care for older persons in their own homes. Person-centred care, which underpins this integrated reform, depends on understanding the patient as a person by adopting their perspective. However, sustaining such care within a highly specialised health system remains challenging. Nursing students may feel unprepared for, and lack motivation to engage in, the care of older persons. In addition, age-related stereotypes within society and among care providers present further barriers.

These challenges highlight the need for didactic strategies that strengthen students’ knowledge of person-centred care for older persons. Age-suit simulation, which promotes perspective-taking by allowing participants to ‘walk in an older person’s shoes’, has been shown to enhance empathy and improve attitudes. However, previous research has made limited use of age suits and has rarely simulated the oldest age group (85+). Moreover, earlier studies have often overlooked realistic home environments and have lacked both longitudinal evaluation and a clear theoretical foundation.

Aim: The overall aim of this thesis was to study nursing students’ experiences of an age-suit simulation intervention grounded in experiential learning within a home environment.

Method: The four studies employed different research designs. Studies I and IV were quantitative. Study I used a quasi-experimental pre-test–post-test design with a control group, while Study IV adopted a longitudinal design. Differences between groups were analysed using the Mann–Whitney U-test, and multiple regression analysis was applied to examine effects over time. Studies II and III adopted qualitative, inductive designs. Study II was based on group interviews conducted during reflection seminars and employed reflexive thematic analysis. Study III was an observational study in which the data were also analysed using reflexive thematic analysis.

Results: Participation in the age-suit simulation had a significant effect on increasing scores on the Perspectives on Caring for Older Patients-Short Form (PCOP-SF) both immediately after the simulation and throughout the remainder of the nursing programme. This indicates that the intervention enhanced students’ favourable perspectives towards caring for older persons. Female sex and a greater number of years of prior work experience were also associated with reporting more favourable perspectives, as measured using the PCOP-SF. Students reported that the age-suit simulation increased their awareness of the vulnerability and loneliness that older persons may experience when living with various impairments. The embodied experience of the physical, psychological, and social impacts of ageing served as an important reference point in students’ post-simulation reflections. As highlighted in the findings, students’ new insights and understandings were often related to key concepts of person-centred care, such as preserving dignity and autonomy by being patient, allowing sufficient time in care situations, and getting to know and focusing on what matters to the person. The home environment, including the use of welfare technology, was described by students as presenting both potential risks—such as fall hazards or technology that is not suited to the individual—and opportunities, as an accessible home could alleviate some of the challenges associated with living with impairments. A prominent finding concerned the impact of impaired vision, which was explored further when students simulated the roles of a blind person and an attendant. During these simulations, two distinct approaches to collaboration were observed: students either adapted to one another’s limitations or became distant from each other. In both approaches, a key influencing factor was students’ ability and motivation to establish and maintain effective verbal and non-verbal communication.

Conclusions: This thesis revealed that students who participated in the age-suit simulation held more favourable attitudes towards caring for older persons compared to those who did not participate. The findings support the timing of the intervention in the second year of a three-year programme. In this study, the age suit was employed as a geriatric suit, which may account for the immersive and challenging nature of the experience. The results also provide support for using experiential learning theory as a framework for age-suit simulation, as the outcomes align with the concepts of the learning cycle. In particular, students perceived the simulation as an extraordinary experience that prompted reflection and critical thinking, leading to new insights and understanding. As demonstrated in the findings and discussed in this thesis, the age-suit simulation particularly drew students’ attention to a heightened sense of vulnerability, including experiences of isolation and loneliness. Another perspective on vulnerability emerged from dependence on a healthcare system in which personhood is often overlooked. Students further reported that the simulation influenced their anticipated clinical practice. In particular, the importance of being patient, allowing sufficient time, and being fully present was highlighted as a key takeaway from the simulation, essential for preserving dignity and autonomy when caring for older persons.

Supervisors

• Catharina Gillsjö, Professor, University of Skövde
• Jenny Hallgren, Associate Professor, University of Skövde
• Elzana Odzakovic, Assistant Professor, Jönköping University

Opponent

• Mirjam Ekstedt, Senior Professor, Linnaeus University

Committee

• Christine Gustafsson, Professor, Sophiahemmet University
• Staffan Karlsson, professor, Kristianstad University
• Hanna Falk Erhag, Senior Lecturer, Sahlgrenska Academy, University of Gothenburg