QSEN Case Western Frances Payne Bolton School of Nursing

Quality and Safety Education for Nurses

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Rapid Cycle Learning in Simulation- Utilizing a postpartum hemorrhage scenario

Posted by on Apr 12, 2017 in News |

Preparation: Students are to complete the assigned textbook reading and a case study article provided prior to the exercise on PPH; etiology, signs and symptoms, nursing assessments, and treatment options. They should also be introduced to Kolb’s Change Theory of Learning, the Plan-Do-Study-Act cycle for change, and rapid cycle learning. Pre-briefing: Students are instructed how the rapid cycle learning will be performed in the simulation lab. Students are told they will conduct an initial assessment of their patient collectively as “one’ nurse in a group format. They will be guided by the faculty facilitator in regards to vital signs with student request. Following a pre-determined time limit (approximately 10-15 minutes) the cycle will end and there will be an immediate debriefing. The students are either audio or video taped during the simulation which is reviewed together immediately following the cycle. The students are then instructed that they will proceed to the next repeat simulation cycle paired together in varied nursing roles, rather than working collectively as “one”. Lastly in the final cycle, students will individually assume an assigned nursing role as the case study continues to evolve. By utilizing rapid cycle learning, students are expected to navigate through a process of reflection and growth within a short time frame, increasing their knowledge, critical reasoning skills, collaboration, confidence, and safety in practice. A predetermined time is established for each action cycle. The cycles can be equal in time or elongated as the scenario evolves with additional complications and necessary interventions. A specified amount of time promotes the urgency of the situation and encourages the students to think and act in a more efficient manner. Lab environment set up: The simulation scenario includes a mannequin with a soft uterus and a large amount of blood on a perineal pad hidden by a coversheet. A family member, played by faculty or another student is present by the bedside. The patient has an intravenous access in upper limb. A medication cart and oxygen delivery source is available in the simulation area. Clinical groups of 4-8 students are recommended. Strategy: The Plan-Do-Study-Act model and Kolb Theory of change demonstrates how learning evolves through phases....

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Using Beers Criteriato Prevent Medication Related Problems in Older Adults

Posted by on Feb 6, 2017 in News |

This strategy can be used for either pre-licensure or RN to BSN students utilizing the clinical setting and either group or individual work in class, in post-clinical conference, or via online discussions or blogs. Prior to clinical, students are assigned the American Geriatric Society 2015 updated Beers Criteria for potentially inappropriate medication use for older adults link for review, the Hartford Geriatric Nursing Beers you-tube for viewing, and the ConsultGeri.org Try This Series site for regarding the Beers Criteria for reading. On the clinical day, a brief discussion can be held in pre-conference about Beers Criteria with a review of definitions for quality and strength of evidence and a brief account of methods used to analyze the evidence and to make recommendations. Students will be instructed to select an older adult patient over age 65 with 8 or more medications. In clinical, students are to record basic patient information like the client’s medical diagnoses, prescribed, routine, prn and over the counter medications as well as vitamin and mineral supplements. They will record these on the first section of the QSEN Beers Learning Strategy Form. After the clinical experience, students are instructed to complete the second section of the form requiring students to utilize the Beers Criteria to analyze the patient’s medications using the 5 tables in the Beers document to review the strength and quality of evidence, rationale, recommendations, safety concerns, risks, etc. The third part of the form includes questions about teamwork and collaboration interventions and appropriate patient centered interventions relevant for the completed evaluation of medications. This third part can be done in writing (individually or as a small group), on-line as part of a blog or discussion board or as part of a clinical post-conference session. The strategy focuses on the application of evidence to practice in the geriatric setting regarding medication safety. Attention is given to quality and safety by focusing on risk reduction and prevention of medication related problems for the older adult vulnerable population. Patient centered care is addressed with individualized interventions based upon the medication evaluation using Beers Criteria. Students are asked to formulate teamwork and collaboration strategies to address medication...

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Nurse as the leader of the team huddle. An unfolding oncology case study.

Posted by on Sep 21, 2016 in News |

Strategy Overview The strategy is an unfolding case study
 involving a man diagnosed with pancreatic cancer The case will teach the student to discover attitudes, beliefs, and values of the professional nurse when caring for cancer patients and managing diagnosis, treatment options including chemotherapy, radiation, and surgery. It begins with his initial diagnosis at 48 years old. He was brought to the emergency room because of severe itching and jaundice. His laboratory and diagnostics are discussed in the case. He had high bilirubin levels and a mas on the head of his pancreas. He also has positive CA-19-9 level, which is discussed in detail. He underwent an ERCP and then was scheduled to have chemo and radiation as well as preparation for a pancreatico-duodenectomy (whipple) procedure. This case discusses pre and post op care and complications this patient...

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Impaired Perfusion High Risk Obstetrical Simulation

Posted by on Oct 6, 2015 in Teaching Strategies |

Impaired Perfusion High Risk Obstetrical Simulation Because of low patient census and the inability to ensure high risk obstetrical patient experiences, securing student clinical opportunities is difficult. Using the principles of a “flipped classroom”, an eight hour high risk obstetrical simulation clinical was developed for fourth semester, senior level nursing students. The content focused on the concept of impaired perfusion. This learning strategy allowed for student learning in a safe environment (where student could do no harm) while focusing on quality patient-centered care. Pre-briefing Power point presentation (outlined the agenda, outcomes, and expectations). Outcomes included prioritization, critical thinking, becoming more comfortable in the clinical setting, being confident in one’s own nursing skills, and knowing when to ask for help from others in order to ensure patient safety. Discussion on the patient safety initiative TeamSTEPPS. The key principles of team structure, leadership, situation monitoring, mutual support, and communication were highlighted. The reasons for simulation clinical instead of clinical at the hospital were explained (see above). Power point continued with a review of obstetrical content presented in past semesters. The concept of perfusion as it relates to OB high risk situations were presented. Preeclampsia (how it effects the body systems and organs, assessment, management and treatment) and hypertension in pregnancy were explained. Risks for other disorders (HELLP syndrome and Eclampsia) and intrauterine resuscitation methods were discussed. Laboratory/Simulation Experience Group 1 independent paperwork Case studies of high risk OB situations–Drug use and domestic violence, preeclampsia, placental problems (abruption placentae and placenta previa, DIC and HELLP syndrome) Healthy people 2020 objectives (as they relate to the postpartum period) Fetal monitoring tracing Group 2 Skills Laboratory Simulation–students assigned to a “patient” being prepped for a cesarean section. Start an IV, prime tubing, program a pump, secondary (piggyback) and insert a Foley catheter (problem solve with minimal assistance from the instructor). “Trouble shooting” with IV pumps, piggybacks, and tubing and Foley catheter insertion. Unfolding Case Study: 30 week primigravida patient, determine if symptoms were normal or abnormal for gestation. Identify abnormal vital signs, key lab values, important nursing interventions, and plan ahead for emergencies. Role play calling doctor using SBAR. Patient progressed from preeclampsia, HELLP...

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Simulated Medication Adherence Exercise

Simulated Medication Adherence Exercise

Posted by on Oct 1, 2015 in News |

This simulated assignment was developed as part of a junior level pharmacology course and involves students following a mock patient medication regimen for a period of ten days. The purpose of the assignment is to help students gain an understanding of complex medication regimens followed in a home or hospital setting and the importance of the nurse’s role in patient teaching related to pharmacologic therapy, as well as to value actual patient experiences. In order to simulate the types of medications the students would most likely be encountering in the clinical setting, medication lists were obtained from clients at our Nurse Managed Wellness centers assuring HIPPA guidelines were followed. Five different medication regimens were developed using partial client lists that included between five to seven different oral medications. Pill bottles were purchased by the lab coordinator and labels were created for each bottle with the name of the medication and the frequency of administration. Various types of candy were used as the mock pills. The pill bottles for each of the five regimens were placed in storage sized plastic bags. Each student received a bag that contained the medication regimen they were to follow. Students were made aware on the first day of class that they would be receiving an assignment related to medication adherence that would be worth 5% of their grade. No further instructions were provided in advance in order to closely mimic an actual client experience of receiving prescriptions for multiple medications with only having limited information. Students were expected to take all of the mock medications as directed unless they had an intolerance to glucose, lactose, gluten, or allergies to one of the candy products. Students were given three weeks to complete the assignment. For the assignment, students were directed to develop a medication schedule that included: the most likely reason the medication was prescribed; medication interactions; dosing instructions regarding meals or dietary interactions; and the rationale for timing decisions before beginning to take the mock medication regimen. Students were encouraged to modify their diets to reflect their probable health conditions. In addition to the medication schedule, students had to submit a 1.5-2.5 page reflective...

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