nurs 710 project proposal - nursing education...
TRANSCRIPT
Running head: NURS 710 PROJECT PROPOSAL 1
NURS 710 Project Proposal
Joel Vedders
Ferris State University
NURS 710 PROJECT PROPOSAL POSTING 3 2
Abstract
An increased commitment and process changes related to the care of the orthopaedic trauma
population at Spectrum Health in Grand Rapids, Michigan has resulted in acute compartment
syndrome developing into a low frequency, high risk event. Acute compartment syndrome is a
surgical emergency, and nurses play a key role in its recognition. The goal of this scholarly
project is to develop educational activities centered around the recognition and treatment of acute
compartment syndrome. This proposal outlines the development of these activities based on
adult learning theory. Methods for evaluation of this project are also discussed.
Key Words: acute compartment syndrome, evaluation, simulation, adult learning theory
NURS 710 PROJECT PROPOSAL 3
NURS 710 Project Proposal
Within the past decade a greater emphasis was placed on the care of the orthopedic
trauma patient population at Spectrum Health Butterworth in Grand Rapids, Michigan. As a
result of this increased commitment, an operating room (OR) dedicated solely to this population
was instituted. The ability to take a patient immediately from the emergency room to the OR
ensued. Prior to this, patients with complicated orthopedic injuries often waited on an inpatient
unit until an operating room was available. Consequently, nurses were frequently exposed to
complications related to these high energy injuries. One such complication is acute compartment
syndrome (ACS).
“Compartment syndrome occurs when pressure increases within a closed fascia space
that houses muscle, blood vessels, and nerves” (Schoenly, 2013, p. 204). Each group of muscles,
vessels, and nerves forms a compartment which is surrounded by a tough, fibrous, and inelastic
tissue called fascia (Wright, 2009). When pressure increases within this compartment from a
trauma such as a fracture, crush injury, or from external causes such as a bandages or casts that
are too tight, it can have devastating consequences. This can include muscle necrosis, permanent
nerve damage, and even amputation. (Fry, Wade, Smith, & Asensio-Gonzales, 2013).
Compartment syndrome is a surgical emergency, and nurses play a key role in identifying
its early signs and symptoms. The symptoms include pain, paresthesias, pressure, pallor,
paralysis, and pulselessness (Nation Association of Orthopaedic Nurses website, 2013).
Recently, a patient developed compartment syndrome on my unit that went unrecognized for a
number of hours. The patient exhibited signs of ACS, yet the nurse was so focused on
controlling the patient’s pain, the symptoms went unnoticed. Further complicating the case was
NURS 710 PROJECT PROPOSAL 4
the patient’s history of chronic pain and high narcotic tolerance which made it difficult to obtain
an accurate assessment of the patient.
This event prompted a discussion centered around patient safety, it was determined that
although this was a complicated case, the dedicated orthopedic trauma room and the efficiency
with which it functions, has turned compartment syndrome into a low frequency high risk event.
Often, the patient will have had a fasciotomy prior to reaching the orthopaedic unit. Because
compartment syndrome has become less frequently observed on the inpatient unit, and the
devastating consequences it can have, an educational need has been identified. The purpose of
this paper is to outline my scholarly project proposal, which will involve designing a simulation
with the purpose of educating nursing staff on the identification and care of the patient with
compartment syndrome. The proposal will also include its setting, goals and objectives,
identification of a preceptor, timeline of the proposed project, in addition to agency approval.
Goals and Objectives and Activities
The project will be developed in accordance with the recommendations for practice
guidelines of the National Association of Orthopaedic Nurses (NAON). To this end, two goals
have been identified for this scholarly project. The first, as outlined in the proposal planning
guide (see Appendix A), is to create an outline for the development of educational activities for
orthopaedic staff at Spectrum Health. The second goal will be to create educational activities,
with the intent of having them ready to implement in July of 2014.
In order to achieve the above stated goals, several objectives will be formulated as a
guide to successfully complete the scholarly project. First, it will be important to evaluate the
current educational material offered at Spectrum Health related to ACS. Doing this will allow
for identification of strengths in the curriculum, and also find potential gaps where additional
NURS 710 PROJECT PROPOSAL 5
content could be added. In order to accomplish this, I plan to attend the orthopaedic core class
offered at Spectrum Health. The core class is attended by employees newly hired into the
orthopaedic units at both Spectrum Health Butterworth and Blodgett campuses. Doing this will
allow me to hear the content first hand to become more familiar with the material, as well as
make notes related to potential curricular shortcomings. Additionally, it will be important to
meet with the current orthopaedic educators and clinical nurse specialist (CNS) to review current
teaching materials to determine where potential changes could be made. Conducting a needs
assessment with orthopaedic leadership as well as educators will also assist in further uncovering
potential gaps in ACS education.
Once potential strengths and weaknesses within the current orthopaedic education have
been recognized, it will be important to identify topics to included in the educational activities.
NAON’s core curriculum for orthopaedic nursing will be used as a guide to ensure proper
nursing considerations are addressed. Databases such as Clinical Key, Cinahl, and PubMed will
be utilized to obtain current literature, in addition to resources found in the bibliography, to
further clarify pertinent topics to cover in the educational offering. An additional activity will be
to meet with the orthopaedic trauma surgeons to receive input regarding key points to address
related to ACS.
As new material is added to the current orthopaedic curriculum it will be important to
incorporate adult learning theory into the development of the educational activities. “Learning
theories and frameworks provide the structure that guides the selection of learning activities”
(Billings & Halstead, 2009, p. 192). Reviewing literature related to adult theory will be an
important activity as this project takes shape, specifically as it relates to Malcolm Knowles
principles of adult learning, as this was chosen as one of the foundational theories for this
NURS 710 PROJECT PROPOSAL 6
proposal. An additional activity will be to review literature related to different teaching
strategies that can be used while implementing the scholarly project. This can be done under the
guidance of my preceptor.
The second goal's objectives will allow for implementation of the scholarly project in
July, 2014. First, a simulation will be developed. Using a simulation template will be the main
activity associated in creating a quality simulation. Templates often include the scenario's title,
focus area, scenario description, objectives, equipment needed, essential resources, simulator
level, participant description, required student actions, instructor interventions, and evaluation
(Campbell and Daley, 2009). Second, PowerPoint slides will be developed based on the
literature research and input from physicians, educators, leadership, and my preceptor. These
two activities will be incorporated into Spectrum Health’s current orthopaedic core class. Using
these two teaching strategies allows for the content to be addressed in two different styles.
Simulation allows the learner to be actively involved in the activity, and has many
advantages. It provides immediate feedback, and allows the learner to apply their knowledge in
a mistake free environment, increases interdisciplinary teamwork skills, and improves critical
thinking (Nehring & Lashley, 2010). The PowerPoint will be used to clarify any content within
the simulation that may have been confusing, and to ensure all key concepts of ACS were
covered. According to Billings and Halstead (2009), students learn in a variety of ways so it is
very important to incorporate activities that stimulate all learners. Using simulation, in addition
to a PowerPoint presentation will be an effective way to present the material.
Evaluation
The final objective will be to evaluate the effectiveness of the simulation and PowerPoint
presentation, in addition to assessing whether the goals for the scholarly project have been met.
NURS 710 PROJECT PROPOSAL 7
An evaluation tool will be created to distribute to the participants in the educational activity. The
tool will utilize a series of questions with the incorporation of the Likert Scale (Appendix B).
The questions will seek information from the learners related to perceived knowledge before and
after the activity, in addition to the effectiveness of the instructor and the value of the material
taught. The evaluation tool will also provide an opportunity for the learner to offer feedback
related to areas which need improvements. This evaluation tool will provide valuable
information which will allow for program improvement.
A second activity will be to create an evaluation tool for my preceptor to complete
(Appendix C). This tool will allow the preceptor to judge the overall effectiveness of the
scholarly project. There will be an opportunity for my preceptor to provide a brief narrative,
where constructive feedback can be given. This feedback will aid in my professional
development as an educator and provide information for areas of potential growth.
Dates and Timelines
This project will take place during the summer semester of 2014. The tentative dates can
be found within the project proposal planning guide (refer to appendix A). Resources for the
scholarly project will be gathered throughout the spring semester 2014 as the proposal is being
formed. The intent is to begin creating the educational activity in mid-May 2014, with the goal
of having the learning activities ready to present by mid-July, 2014.
Foundational Theory
"Effective education of adults through simulation requires a sound understanding of adult
learning theory" (Zigmont, Kappus, & Sudikoff, 2011, p. 47). Since the goal of the scholarly
project is to develop and implement learning activities in the form of a simulation and
PowerPoint presentation it seemed appropriate to use a combination of two theories. Malcolm
NURS 710 PROJECT PROPOSAL 8
Knowles’ Principles of Adult Learning, in addition to Kolb's Experiential Learning Theory
(ELT). Knowles used guiding principles related to the design and implementation of adult
learning. First he believed that a person’s experiences form a platform for potential learning
activities (Vandeveer, 2009). Second, adults want to learn information that is relevant to them
whether that be in their personal life or their job. Third, the learning activities must be problem-
centered. It is important to design the training in such a way that it is as close to what the learner
would experience in the work environment. (Vandeveer, 2009).
Kolb's ELT will assist in the development of the simulation. Experiential learning has
the student directly involved in the learning activity. There are four different aspects of ELT
which include active experimentation, concrete experience, reflective observation, and abstract
conceptualization (Jeffries, Clochesy, & Hovancsek, 2009). Kolb's theory is "linked directly
with simulation and can guarantee a clinical event (concrete experience), reflection (debriefing),
conceptualization (reviewing and understanding), and experimentation (learning on the
simulator)", (Waxman & Telles, 2009, p. 232). A low frequency high risk event such as ACS is
not always seen while a nurse is in orientation or as a student in nursing school. In the absence
of " real" clinical experiences, simulation assists the learner to move from knowledge, to
application of this knowledge in the clinical setting (Zigmont et al., 2011). Developing a
simulation with these guiding principles as the foundation will assist in the development of the
learning activities, especially as it relates to simulation.
Practicum Setting
My practicum will take place at the Cook Institute simulation lab at Spectrum Health
Butterworth Hospital in Grand Rapids, Michigan. A copy of the student/agency agreement can
be found in Appendix D. Spectrum Health Butterworth is the only Level 1 Trauma center in the
NURS 710 PROJECT PROPOSAL 9
Grand Rapids area. It is part of a much larger health system comprised of multiple hospitals,
outpatient and urgent care centers, extended care facilities, and a dedicated children's hospital
and cancer pavilion. Spectrum Health has used simulation in a variety of settings including
medical surgical, pediatrics, surgical services, and the emergency departments for several years.
Wang (2011) reported that the medical community has embraced simulation because of its
importance in improving patient safety and clinical training. According to Berndt (2010),
simulated clinical experiences positively affect critical thinking, competency levels, and skill
acquisition. Spectrum Health is committed to simulation as a way of providing training in a safe
non-threatening environment.
The simulation lab is 2200 square feet and consists of three large simulation rooms which
are all designed to mimic a real hospital room, creating a very realistic clinical environment. The
largest room is equipped with audio and video capabilities allowing the instructor to speak to the
staff during the simulation and also enabling the simulation scenarios to be recorded. The
simulation lab is also equipped with a staging area where supplies are kept in order to set up a
variety of simulations. There is also a media booth with one-way glass where the high-fidelity
simulators are controlled allowing the simulation to be observed while not being a distraction.
The simulation rooms are not used only for high-fidelity simulation, but for task training with
low simulation mannequins as well. The final room is the debriefing room where the class can
meet once the scenario is completed. This room is equipped with a large monitor where the
simulation can be reviewed. "Participating in simulation provides the hands-on learning, but the
facilitated debriefing is where the cognitive processes that lead to long-term learning and
application occur" (Nehring & Lashley, 2010, p. 370). This new simulation lab has included all
NURS 710 PROJECT PROPOSAL 10
of the necessary elements in providing an excellent learning experience for staff and is the
perfect venue to carry out the learning activities.
Preceptor
An experienced preceptor is able to identify learning opportunities and serve as a guide
in helping the student with goal achievement. Selection of a preceptor is therefore very
important, and is key to the success of my scholarly project. There are certain characteristics
preceptors must possess. "A preceptor is an individual with demonstrated competence in a
specific area who serves as a teacher/coach, leader/influencer, facilitator, evaluator, socialization
agent, protector, and role model to develop and validate the competencies of another individual"
(Ulrich, 2012, p. 1). In addition to these characteristics it is also important for the preceptor to be
an expert in the selected content you wish to learn. Since the focus of my scholarly project will
involve development of a simulation, choosing a preceptor with expertise in this arena is
important.
My preceptor for the scholarly project will be Vickie Slot MSN, RN. A copy of the
student/preceptor contract can be found in Appendix E. Mrs. Slot attended Calvin College prior
to attending Grand Valley State University (GVSU), where she graduated with honors with her
BSN degree. She then returned to GVSU from 2003-2006 where she received her Master of
Science in nursing (MSN) with an education focus. Her experience in simulation is extensive.
While in graduate school her projects were directed toward simulated learning. Mrs. Slot was
also instrumental in the design, development, and implementation of the first high fidelity
simulation at Hope College, where she was director of nursing laboratories for five years. In
addition, Mrs. Slot was also certified in simulation instructional methods in 2001, and has
attended several simulation related conferences, classes, and workshops which keeps her current
NURS 710 PROJECT PROPOSAL 11
in the ever changing world of simulation. Her most recent conference attendance was in San
Francisco in late January, 2014 where she earned her certification as a healthcare simulation
educator.
In addition to her experience in simulation, Mrs. Slot also has experience teaching.
These experiences include teaching introductory and advanced nursing skills classes at Hope
College, adjunct faculty at GVSU from 2001-2005, and was also an instructor in the LPN
program for Olympia Career Training Institute. Currently, Mrs. Slot is a simulation nurse
educator at Spectrum Health. She has worked in this capacity since 2011. Her expertise in
simulation allows her to participate in strategic planning and development in simulation
programming and curriculum. Vickie's teaching experience, in addition to her extensive
knowledge in simulation, are a great combination which makes her an excellent choice as my
preceptor for my scholarly project.
Conclusion
Beginning in May of 2014, the development of this scholarly project will start. The goal
of this project is to create educational activities for the orthopaedic staff at Spectrum Health
related to the care of the patient with ACS. Activities such as a PowerPoint and simulation will
be created using evidence based information in accordance with NAON standards and Spectrum
Health's policies. The activities will be formed using concepts of adult learning theory. The
completed scholarly project will be ready for delivery by mid-July, 2014.
NURS 710 PROJECT PROPOSAL 12
References
Berndt, J. (2010). The ethics of simulated nursing clinical experiences. Teaching and Learning in
Nursing, 5, 160-163. http://dx.doi.org/10.1016/j.teln.2010.03.004
Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St
Louis, MO: Saunders Elsevier.
Fry, W. R., Wade, M. D., Smith, R. S., & Asensio-Gonzales, J. A. (2013). Extremity
compartment syndrome and fasciotomy: a literature review. European Journal of Trauma
Emergency Surgery, 39, 561-567. http://dx.doi.org/10.1007/s00068-013-0329-8
Jeffries, P., Clochesy, J. M., & Hovancsek, M. T. (2009). Designing, implementing, and
evaluating simulations in nursing education. In D. M. Billings, & J. A. Halstead (Eds.),
Teaching in nursing: A guide for faculty (3rd ed., pp. 322-334). St. Louis, MO: Saunders
Elsevier.
National Association of Orthopaedic Nurses website. (2013). http://www.orthonurse.org/
Nehring, W. M., & Lashley, F. R. (Eds.). (2010). High-fidelity patient simulation in nursing
education. Sudbury, MA: Jones and Bartlett Publishers.
Schoenly, L. (Ed.). (2013). Core curriculum for orthopaedic nursing (7th ed.). Chicago, IL:
National Association of Orthopaedic Nurses.
Ulrich, B. (Ed.). (2012). Mastering precepting: A nurse’s handbook for success ( ed.)
Indianapolis, IN: Sigma Theta Tau International
Vandeveer, M. (2009). From teaching to learning: Theoretical foundations. In D. M. Billings, &
J. A. Halstead (Eds.), Teaching in nursing a guide for faculty (3rd ed., pp. 189-226). St.
Louis, MO: Saunders Elsevier.
NURS 710 PROJECT PROPOSAL 13
Wang, E. E. (2011, November). Simulation and adult learning. Disease a Month, 57, 664-678.
http://dx.doi.org/10.1016/j.disamonth.2011.08.017
Waxman, K. T., & Telles, C. L. (2009). The use of Benner’s framework in high fidelity
simulation faculty development: the bay area simulation collaborative model. Clinical
Simulation in Nursing, 5(6), e231-e235. http://dx.doi.org/10.1016/j.ecns.2009.06.001
Wright, E. (2009). Neurovascular impairment and compartment syndrome. Paediatric Nursing,
21(3), 26-29.
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). Theoretical foundations of learning
through simulation. Seminars in Perinatology, 35, 47-51.
http://dx.doi.org/10.1053/j.semperi.2011.01.002
NURS 710 PROJECT PROPOSAL 14
Appendix A
NURS 710 Project Proposal Planning Guide
Project purpose: The purpose of this paper is to outline my scholarly project proposal, which
will involve designing a simulation with the purpose of educating nursing staff on the
identification and care of the patient with compartment syndrome.
Goals Objectives Activities Timeline
Goal 1:
Create a framework for
the development of
educational activities
for orthopaedic staff at
Spectrum Health
related to the care of
the patient with acute
compartment syndrome
(ACS).
1.1
Identify current
strengths and
weaknesses in current
ACS education at
Spectrum Health
1.1
a.) Attend orthopaedic
core class currently
offered at Spectrum
Health to assess
information being
taught related to ACS
and pain management
b.) Meet with current
orthopaedic educators
and clinical nurse
specialist (CNS) to
review current
teaching materials.
1.1
a.) To be completed
by June 1, 2014
b.) To be completed
by June 1, 2014
NURS 710 PROJECT PROPOSAL 15
1.2
Identify material to be
included within the
educational activities
c.) Conduct a needs
assessment with
managers, leadership,
and orthopaedic
educators.
1.2
a.) Search Clinical
Key, Cinahl, and
Pubmed for literature
related to ACS.
b.) Meet with
orthopaedic trauma
physicians to
determine key
teaching points
related to ACS to be
included in the
learning activities
c.) To be completed
by June 1, 2014
1.2
a.) To be completed
by June 10, 2014
b.) To be completed
by June 10, 2014
NURS 710 PROJECT PROPOSAL 16
1.3
Incorporate adult
learning theory and
principles into the
development of the
educational activities
1.3
a.) Review literature
related to Malcolm
Knowles principles of
adult learning theory.
b.) Review the
literature related to
different teaching
strategies that can be
utilized.
c.) Determine
teaching strategies
and content to be used
within the learning
activities using the
guidance and
expertise of my
preceptor.
1.3
a.) To be completed
by June 15, 2014
b.) To be completed
by June 15, 2014
c.) To be completed
by June 15, 2014
NURS 710 PROJECT PROPOSAL 17
Goal 2:
Complete the creation
of the educational
activities and have
them ready for
implementation in July
of 2014.
2.1
Develop a simulation
and PowerPoint to be
incorporated into
Spectrum Health’s
current orthopaedic
core class using a
variety of teaching
strategies
2.1
a.) Write simulation,
including outline and
objectives, using
simulation template
provided by my
preceptor.
b.) Develop
PowerPoint slides for
presentation of
learning material.
c.) Incorporate
simulation and
PowerPoint into
orthopaedic core class
2.1
a.) To be completed
by July 10, 2014
b.) To be completed
by July 10, 2014
2.2 To be completed
by July 17, 2014
NURS 710 PROJECT PROPOSAL 18
2.2
Evaluate the
effectiveness of the
simulation, and self-
evaluation of the
attainment of the
goals of the scholarly
project.
2.2
a.) Create and
evaluation form for
use by my preceptor
to determine if
scholarly project
goals and objectives
were met.
b.) Create an
evaluation tool for
staff to complete
following learning
activities.
2.2
a.) To be completed
by July 17, 2014
b.) To be completed
by July 17, 2014
NURS 710 PROJECT PROPOSAL 19
Appendix B
Educational Activity Evaluation Tool
Key: 1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agree
Please follow the above key and respond to each statement by circling a number.
1. The instructor was knowledgeable about the material presented. 1 2 3 4
2. The instructor demonstrated effective communication skills. 1 2 3 4
3. The instructor implemented teaching strategies appropriate to meet
the needs of the staff. 1 2 3 4
4. The educational offering increased my understanding of acute
compartment syndrome. 1 2 3 4
5. The content can be easily applied to practice. 1 2 3 4
6. The physical environment was conducive to learning. 1 2 3 4
Please provide comments below which you think would make this learning activity more
effective:
NURS 710 PROJECT PROPOSAL 20
Appendix C
Preceptor Evaluation Tool
Listed below are our agreed upon goals and objectives for the clinical project. Please review each of the objectives listed in the far left hand column. Once these objectives have been reviewed, place an “X” in the appropriate box next to the corresponding objective, verifying whether the objective was “met” or “unmet” by the student. Next, provide comments in each box in the far right column explaining how each objective was met, or offer suggestions for improvement. Finally, provide any additional comments/feedback for student improvement that you may have in the bottom feedback section provided.
Goal 1: Create a framework for the development of educational activities for orthopaedic staff at Spectrum Health related to the care of the patient with acute compartment syndrome (ACS).
Objective Objective Met Objective Unmet Comments 1.1: : Identify current strengths and weaknesses in current ACS education at Spectrum Health1.2: Identify material to be included within the educational activities1.3: Incorporate adult learning theory and principles into the development of the educational activities
Additional Preceptor Feedback
NURS 710 PROJECT PROPOSAL 21
Goal 2: Complete the creation of the educational activities and have them ready for implementation in July of 2014.
Objective Met Unmet Comments
2.1: Develop a simulation and PowerPoint to be incorporated into Spectrum Health’s current orthopaedic core class using a variety of teaching strategies
2.2: Evaluate the effectiveness of the simulation, and self-evaluation of the attainment of the goals of the scholarly project.
Additional Preceptor Feedback:
NURS 710 PROJECT PROPOSAL 24
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NURS 710 PROJECT PROPOSAL 25
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NURS 710 PROJECT PROPOSAL 26
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NURS 710 PROJECT PROPOSAL 27
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