Moving students forward

I believe one of our greatest challenges in education is getting the students buy in for active participation. We are all familiar with constructivism, the theory of students learn better in an environment where they actively participate. The challenge for us as educators is convincing the students. How many times have you heard "will this be n the test?". So, I believe the buy in is to convince students of the merit of the exercise. For the last few years, I have been trying to figure out an assessment to replace nursing care plans or concept maps. This semester I am having my clinical group create a scenario for our high fidelity simulation mannequin. The students selected a client and create the scenario. I gave them a template for creation of the scenario. I also have met with them several times to guide them through the process. They have a scheduled practice time to run through their scenario. They will present the scenario to the instructor. They were provided a grading rubric. The students also have experience with the mannequin. Interestingly, even though this has required more work on the students part, they have been truly excited about the process. They will present at the end of the month. I have an evaluation for them to complete. I will post the results. I also need to give credit to the school in Indiana who was the originator of this idea

Tweeting in clinical

Like many schools, the clinical units can not always accommodate all of the students. To address this issue, some students will float to other units. The obstacle has been how to maintain communication with students. I currently give students my cell phone number and they can either call or text me. They also have each other's numbers for emergency situations. Our students are not allowed to use their phones in the clinical setting. They must leave the clinical area. So, how do I communicate with students when there is an interesting experience or teachable moment occurring? I usually try to physically locate students, which is somewhat difficult and many times we miss the opportunity. So my answer was to use Twitter. I could then send an instant message to all students. I developed a policy and student rules/responsibilities. As it sometimes is, the hospital has a strict policy against phone usage by students. So what was a good idea is currently on hold. If anyone has had similar experiences and has gotten it to work, I would appreciate hearing from you. I still think this is a very workable solution and believe in time we will all be tweeting in clinical. Of course, it will be done in a professional and respectful manner.

L

Using Facebook for evolving case study

I found a small snafu with using Facebook for the istan (hfsm) project. Make sure you have you students create a new Facebook account. If they link to their existing account, all of their posts will appear on istan's wall. This created sharing of too much personal information. Once each student created a specific account for this project- problem was solved. As a side note, the students were pretty excited to get started. They are doing a great job educating "istan"

Peer mentoring

My dear friend and fellow educator, Colleen Branchaw and I have decided to implement peer mentoring in our clinical rotation. A 4th semester student will collaborate with a 3rd semester student. The students will be assigned a pre selected group od patients.(2-3). The students will listen to report, review the charts and assess the patients. Then they will collaboratively develop a comprehensive plan of care for each patient. The students will describe how they would prioritize care and what tasks would be delegated and to whom. The students would present the completed project tom their peers during post conference.

iStan's Facebook Page-incorporating FB with hfsm

How to incorporate Facebook into Nursing Education
The report for Childnet International and funded by Becta, the government body for technology in learning, says while teachers and lecturers may be using social networking services they may not recognize the educational potential for their students. (http://www.digizen.org/socialnetworking/). I would like to expand on the educational use of facebook.
I am incorporating facebook into my 4th semester advanced med/surg course. I created a facebook page for our high fidelity mannequin. He instantly got 6 friend requests. I intend to use facebook as an evolving case study. I have created a profile for “iStan”. He lives with his wife, in laws and 1 adult child and 1 toddler grandchild. I have personalized the site with pictures and stories from his life. I plan posting questions to his friends (students). Size will be limited to 8 students. The questions will focus on a variety of topics. The students will be expected to research responses, provide education and appropriate educational materials/websites. All students will participate but I will rotate each student through the lead position. This will ensure each student posts an initial response.
The questions will cover a variety of issues. Questions will focus on all age groups and health care concerns. Eventually professional and conflict resolution items will be included. Some examples could be:
• "My doctor gave me a prescription for a beta blocker. I was taught how to take my pulse but now I am not sure I remember. Please help". The follow up question may be “I am depressed, why?” Goal would be to evaluate critical thinking by students.
• “My doctor told me my BUN is elevated. Should I be concerned?”
• “My doctor does not answer my questions. How do I get him to listen to me?”
• “My mother in law is becoming very forgetful. My wife is concerned she may have Alzheimer’s disease. How would we know?
• “My daughter read an article and has decided not to immunize her son. Is this okay?”

Students will be required to read an article “Teaching with Social Networks: Establishing a Social Contract” by Diane Sieber. This article focuses on appropriate social behaviors in a social network environment. The students will sign a contract stating they will comply with the behaviors. The instructor will provide clear guidelines of student responsibilities/expectations. A grading rubric will be provided for this assignment.

Students will respond and offer education/clarification/resources. Students’ responses’ will be read/reviewed and changes made to Istan’s responses based on them. I believe this would create a virtual patient and family for the students in an evolving case study format. In the article by Educause, it states as social networking sites become more mainstream, online groups might begin to resemble existing campus communities and be influenced by the social norms and protocols inherent in such academic communities. The hook for students is using a platform they are comfortable with. Facebook is ranked number one with college students and it is estimated that over 90% of college students communicate via facebook (http://www.insidefacebook.com/2009/07/06/college-students-facebook-use-easing-up-over-the-summer-while-parents-logging-on-in-record-numbers/).

The use of this learning method would only be limited by your creativity and imagination. There is no cost to the students and the learning curve is nonexistent. This teaching method will be evaluated at the end of each semester.

iPads in clinical

I attended a great seminar last week and met many talented nursing educators. And it got me thinking about how infrequently we communicate and share ideas and teaching strategies. I am hoping by posting some of my creative ideas, others will join and and this blog will stir much exchange. So here is my article:

Clinical Preparedness: Stethoscope, Watch and iPad?

The newest technology from Apple is the iPad. The iPad has been described as the new handheld computing device. It is larger than a smart phone but smaller than a laptop. It allows the user to use existing applications (apps), a movie and music player, a photo display device, and an e-book reader, as well as instant access to the web. The graphics are well designed and the touch screen is easy to use. So, can the iPad be more than a new gadget? Is there educational value in the iPad?
Will the iPad revolutionize how the clinical setting? Probably not, but it will definitely augment knowledge and resources for nurses. So, how does the nursing incorporate iPad into clinical? How does this technology improve nursing education?
Listed below are what I believe are the applications of iPad that will be of most use to nurses and nursing students.
1. Healthcare applications. There are currently many healthcare applications available. They range from acute to chronic illness, infectious diseases, A & P, medical calculations to name a few. Some of free and some are costly. An example would be a free A & P application. Besides describing the A & P, it includes case studies, questions and related links. This could be used during down clinical time, when the instructor is busy with one student; another student can be reviewing the application and present a brief synopsis in post conference.
2. Videos for skills. Videos can be accessed and reviewed prior to performing the clinical skill. A great way to review a skill prior to performing on a live patient.
3. Reference materials. Many times instructors post information on the college’s course management site. These are well researched reference materials available to enhance student learning. The students can now access the information in clinical
4. Books. Nurses/nursing students would be able to access textbooks and other reference books. Many of the students textbooks on available online. Also, many have online enhancements. I have used the evolve concept mapping (Iggy text) in clinical. The iPad would allow the students to search through their textbooks for information.
5. Web inquires. The iPad allows instant access to the web and evidence based materials. Students would no longer have to wait until they got home to look up information. Decisions on patient care could be made quicker based on research.
6. Interactive web sites. During down time, nurses/nursing students can search and use interactive web sites for continuing education. Time could be spent practicing heart/lung sounds, assessment skills, blood gas interpretation, etc.
For faculty, the concern is security. How does one keep the iPad safe when in a patient’s room? The most obvious way would be a have access to a locked area where the iPad would be safely stored. Also, for ease of access, purchasing a pouch for the iPad. The iPad can then be carried on your person at all times. When in a patient room, slide the pouch to your backside, underneath your lab coat. It keeps the iPad safe and out of the way.

Article-eMars-Challenge for Nursing Education

eMars-Challenge for Nursing Education

One of the newest technological advancements in healthcare is the use of an electronic or computerized medication administration reporting system (eMars). Research has shown that implementation of this type of system decreases medication errors in the hospital setting (http://www.dh.org/body.cfm?id=434).
One of the JCAHO initiatives is to improve patient safety and decrease adverse drug reactions (ADRs) related to medication errors (JCAHO, 2009). Hospitals are using electronic or computerize medication administration systems with bar coding to address this initiative (Hughes and Blegen, 2008).
Implementation of these systems presents a new challenge to nursing educators. No longer do students have access to a patient’s MAR. For security reasons, many clinical facilities are opposed to granting students access to patients’ medical records. Faculty is now being taught how to navigate the computerized systems. The faculty then accesses the MAR for the student prior to administering the medication. This results in multiple barriers to the way that medication has been administered in the past.
The systems require a learning curve for faculty to become comfortable with the technology. Several agencies surveyed reported they require 4-8 hours of education prior to being allowed to access the computer system. Most faculty require a yearly update, usually at the beginning of the fall semester. Other barriers include: limited access to the computers (many times faculty needs to wait until the nurses have completed their medication pass), relying on the nursing staff to keep the faculty member abreast of any patient changes, time spent listening to report and reviewing the chart for each medication order. Because of the amount of time spent preparing for medication administration for the patient(s) and the fact that there are 8 clinical students in each rotation who are assigned 2 to 3 patients, some hospitals recommend only two to three students administer medication on a single clinical day.
Each student is given an electronic patient worksheet which is a synopsis of the patient’s assessment information, tests, medications, etc., for the period since admission.
So the dilemma becomes how to maximize the experience for all students. Several strategies were developed. Strategies include:
Clinical Simulation
All students are required to practice and pass a skills competency. Included in this is medication preparation and administration for all routes. Medication administration is a component of high fidelity simulation critical thinking labs. Students review an electronic medication administration tool and administer medication as indicated for their patient. During the simulation creative strategies are used which include: potential allergic reaction, a violation of the 5 rights, indiscernible signature, no armband, etc.
Medication Administration Tool
A medication administration tool was created that would mimic a medication pass (Appendix A). All elements of safe medication administration were included. The topics included information about each medication (dose, route, frequency and classifications), indications, labs/supporting data, side effects and evaluation of effectiveness. Students who are not assigned to pass medication on that clinical day would still be responsible for completing the tool on each of their assigned patients.
Checking Patient’s Chart
Students must check patient’s chart prior to administering medication. The original order must be checked against the eMar for accuracy. Faculty will also review the original orders.
Saline Flushes
Faculty requests nursing students perform all IV saline flushes. The students then perform the procedure under the supervision of the faculty. Faculty can evaluate technique. Students practice hand movements as well as safety when administering an IV medication.
Changing IV Tubing
Faculty requests nursing students perform all IV tubing changes. The students then perform the procedure under the supervision of the faculty. Faculty can evaluate technique and monitor competency.

Evaluation- A qualitative survey was completed by each student at the end of the semester. The survey focused on the number of times students were administering medications in each semester. Also graduating students were asked if they felt competent to administer medication. The results demonstrated
(1) Frequency of administration of medication increased as the students progressed through the semesters (Appendix B).
(2) Frequency of practice in the nursing lab for medication administration decreased as the students progressed through the semesters
(3) 85.1% of all graduating students felt prepared to administer medication (Appendix C). 14.9% of all graduating students did not feel prepared to administer medication. Upon further investigation, these students expressed a desire for more supervised practice.

Analysis
By augmenting traditional medication administration practices with creative and innovative solutions, the faculty was able to meet the educational goals of the students. Also, remediation opportunities were created to assist the students who did not feel prepared to administer medication. At completion of the program, all graduating nursing students felt prepared and competent to safely administer medications

I will be more than happy to provide all forms as requested. Thanks, Kathy