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Preventing Catheter-Associated UTIs: Implementing a “Clinical Activity Template” to Incorporate EBP

Posted by on Sep 12, 2011 in Teaching Strategies |

Research shows that by implementing a specific set of nursing interventions (a bundle) with patients who have indwelling catheters, catheter-associated urinary tract infections (CAUTIs) can be prevented. Nursing students must be prepared to integrate this knowledge into the clinical setting by seeking out necessary resources to find the evidence, comparing those findings to current practice on the nursing unit, and implementing the interventions according to eidence-based practice and patient-centered care. As Medicare/Medicaid reimbursement decreases, healthcare reform takes shape, and patient acuity worsens, healthcare organizations across the nation are focusing on prevention now more than ever. Preventable complications such as CAUTIs have now made the Center for Medicare & Medicaid Services’ (CMS) list of “Never Events”. This makes CAUTIs part of every RN and Hospital Administrator’s vocabulary, so it is expected that the students are aware of this, as well. This Clinical Activity Template (CAT) for evidence-based practice has been completed based on the Universal Template tool, which was previously submitted. This design and KSA format allows faculty to assess student competency in the stated KSAs, as well as providing students with the opportunity to assess themselves. The “Knowledge” must be completed prior to entering the clinical setting, since this is the foundational concept of situated learning. The “Skills” are the activities that occur throughout the clinical experience. The “Attitude” component is assessed during post-conference verbally through discussion. This is one of the most important aspects of implementation, as it allows the students to apply the knowledge acquired during the pre-planning and clinical experience. Additionally, it allows the faculty to pose questions for discussion which incorporate systems thinking, as opposed to focusing on the task that was performed on their assigned patient(s). It is during post-conference debrief and the written self reflection that follows where the instructor can observe/assess the students’ “attitude”. I recommend a structured self-reflective model to organize the students’ thinking process. In our program we utilized Dr. Christine Tanner’s Model for Clinical Judgment (2006) to assess clinical judgment and competency in the affective domain. The students can use this worksheet in any clinical setting to guide their experience. Instructors can likewise define this worksheet as a performance...

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Health Literacy: Incorporating QSEN (Quality and Safety Education in Nursing) Competencies into a Senior Capstone Project and Paper

Posted by on Apr 13, 2011 in Teaching Strategies |

This is an integrative project that requires the student to connect and relate what they have learned throughout the nursing program. The product to be turned in is a paper that is scholarly, evidence based, and experiential. Two parts of the paper are turned in. The first part is scholarly and evidence based and can be turned in by the fourth week of the semester. The second part is experiential and should be turned in by the twelfth week of the semester. Directions Part 1 You will be doing a two part paper/project on Health Literacy integrating the QSEN competencies into your performance and then writing a paper reporting on that project. After reading a minimum of four original research articles, identify and discuss in your paper the best current evidence on health literacy. In the introduction to your paper, define health literacy, explain why health literacy is important in today’s healthcare environment, provide the rationale for ensuring that patients should become more health literate. Identify particular barriers to health literacy that you expect you will encounter in the particular population of patients that you are dealing with i.e. oncology patients,  ICU patients, elder patients, children, etc. This is determined by your clinical assignment and the unit that you are on. When you write, use your own words as much as possible so that you demonstrate that you understand health literacy and how it relates to your patient population. You are encouraged to use cause-effect diagrams and flow charts to help make your discussion more clear. Directions Part 2 Among the patients who you are assigned to this semester, identify a patient with limited health literacy. Using the language of the QSEN (Knowledge, Skills & Attitudes) KSA’s, discuss your interventions  to improve the patient’s  (and perhaps family’s) health literacy . The goal is to show that you improved at least one aspect of this patient’s understanding of their disease management. Do not make it a litany of the entire patient teaching that you did for a patient. (Read Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., and Warren, J. (2007). Quality and safety education for...

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Using a Fishbone (RCA) Diagram to Problem Solve Falls

Posted by on Feb 18, 2011 in Teaching Strategies |

This strategy is a participative exercise that gets students to analyze a safety problem, work with a fishbone diagram, search out root causes, identify limits of doing an RCA with limited input, identify the importance and use of statistical data for making a case, and identify one strategy that would impact the incidence of falls in this unit. The story with directions There has been a sharp increase in the number of falls on your unit. Last year there were 2 in a 1 year period. This year there have been 3 over the last 3 months. During this same time period there were several staff transfers out of your unit and the positions have not been filled due to a hiring freeze. You are dealing with what could be called chronic understaffing, staff working double shifts, and low morale. The float personnel who are sent to your unit have not been implementing the existing fall risk assessment protocol when they admit a patient. A spot check of your charts show that 50% of the patients on your unit have not had a standard fall risk assessment done on admission. When you go to find the tool or form that is used for the assessment you can find no forms. Next, you look at the facts involving an individual patient who fell on your unit. Mrs. Nguyen is an 85 year old non English speaking patient who was admitted because of a transient ischemic attack and to rule out a stroke. She was in for observation and diagnostic testing. She got up to go to the bathroom. Since it was 2 a.m. apparently all the lights were out in the room. She tripped over a wheelchair that had been used earlier in the day to take her to interventional radiology. Using the attached fishbone diagram, fill in the problem statement and the causes that you identify. Be prepared to discuss one impactful intervention that you would like to make to address the problem. Discussion Questions: What contributory causes did you identify? Where did you place on the fishbone diagram such things as lack of staff, overworked staff, lighting conditions,...

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Integrating QSEN Competencies into a Capstone Simulation

Posted by on Aug 31, 2010 in Teaching Strategies |

This teaching strategy is a capstone simulation conducted in the nursing skills laboratory with a small group of senior nursing students in the last course before they enter their preceptor experience.  Students complete this simulation when they are studying about urinary tract infections, sepsis and multiple organ dysfunction syndrome.   Using a high fidelity mannequin, students progress through the various complexities and unpredictable events that occur when caring for a geriatric patient whose condition changes dramatically.  Students are selected randomly to fill the five primary roles in the scenario:  Nurse A, Nurse B, an unlicensed assistant, the patient’s daughter, and a medical resident.  Later in the simulation, students from the radiologic technology and respiratory therapy programs join the scenario to collaborate with nursing students in managing their unstable patient.   Three student observers answer key questions designed to encourage clinical reasoning, and they contribute their impressions during the debriefing. The simulated patient is an 85 year old Italian female who is transferred from a long term care facility to an acute care hospital with a urinary tract infection that rapidly progresses to sepsis followed by multiple organ dysfunction.  Within two hours of admission, the patient becomes hypotensive, oliguric, tachycardic, and tachypneic. The student identifies signs of Systemic Inflammatory Response Syndrome and calls a Rapid Response.  The Sepsis Bundle Protocol is implemented, but the patient continues to progress to septic shock and is transferred to ICU.   During the course of the simulation and the debriefing that follows, students apply the knowledge, skills and attitudes for five of the QSEN competencies. Patient Centered Care is emphasized when students consider the patient’s individualized cultural and developmental needs. During the scenario, the student demonstrates therapeutic communication with the patient’s family, considering caregiver role strain and psychosocial concerns.    When the patient’s condition worsens, the student informs the ICU nurse about the patient’s wishes related to end of life care. Throughout the simulation, the nurse answers the family member’s questions and elicits input about patient’s care.    Teamwork and Collaboration comes alive in this simulation when students from the Respiratory Therapy and Radiologic Technology programs collaborate with nursing students and participate in the plan of care as the patient’s condition...

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Developing A QSEN Competency Checklist for Simulation Experiences

Posted by on Jun 7, 2010 in Teaching Strategies |

This strategy utilizes the QSEN Competency Checklist for Simulation Experiences developed by LRC Faculty at The Frances Payne Bolton School of Nursing. The checklist incorporates the six QSEN competencies and their related KSAs. This tool guides faculty in the design, implementation, and evaluation of simulation experiences for undergraduate nursing students. The checklist ensures the inclusion of QSEN competencies and related KSAs for every simulation experience. Faculty have used this checklist in conjunction with The NLN’s Simulation Design Template to guide their simulation...

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