Teaching Project Summary Paper: Blood Culture Sample ...



Teaching Project Summary Paper: Blood Culture Sample Collection ProcedureJean WiatrakOld Dominion UniversityTeaching Project Summary Paper: Blood Culture Sample Collection ProcedureThe contamination of blood culture samples is a problem that can lead to unnecessary treatment, hospitalization, and an increase in the patient’s length of stay. Health care providers rely on the accuracy of blood culture results to create a plan of care that sometimes involves the use of antibiotics. “Unwarranted treatment as a result of specimen contamination can compromise patient outcomes and be costly for the health care system” (Bowen, Coleman, & Cunningham, 2016, p. 306). The contamination of blood culture samples can occur during several steps of the collection procedure, such as at the time of skin or bottle prep, during the assembly of the tools needed, at the actual time of venipuncture, or at the time of transfer of the blood specimen. “A wide variety of practices have been found to contribute to specimen contamination, including, but not limited to, inadequate site preparation techniques, improper glove use, and failure to maintain aseptic technique” (Bowen, Coleman, & Cunningham, 2016, p. 306). The current guidelines from the Clinical and Laboratory Standards Institute recommend keeping blood culture contamination rates under 3%. In one study that took place in an emergency department that draws over 700 blood culture samples per month, up to 4.35% were contaminated (Bowen, Coleman, & Cunningham, 2016, p.306). In the emergency department I currently work in, we keep the percentage of blood culture sample contaminations posted in the break room. The goal is to keep the percentage under 3% to receive the full amount of our pay for performance bonus. At the time of this class, I noticed that the percentage was starting to rise and felt that this would be a perfect time for me to teach my co-workers about the proper procedure. The teaching session included three parts that took place over a thirty- minute period. Learners would need to be able to locate the policy for the procedure for our specific hospital system, they would need to demonstrate the procedure after watching my demonstration, and they would have the opportunity to ask any questions or to express any concerns they have about the process.The Emergency Nurses Association (ENA) lists several standards of practice specific to emergency nursing. There are currently sixteen domains, however, I am going to identify the ones that pertain to my teaching project. According to the practice standards, emergency nurses must show clinical expertise in assessment, prioritization, planning, implementation, coordination, and evaluation of the undiagnosed multisystem patient (Jones, Shaban, & Creedy, 2015, p. 195). They must also be an advocate for the patient. For the communication domain, the nurse must effectively communicate all relevant information with family and other healthcare persons (Jones, Shaban, & Creedy, 2015, p. 196). Under the teamwork domain, the emergency nurse must contribute to the work environment to educate peers, collaborate, and engage with the health care team, and partner with others to effect change and generate positive outcomes (Jones, Shaban, & Creedy, 2015, p. 196). These standards mirror the ones laid out by the American Nurses Association. The teamwork domain is directly related to this project in that working together to decrease the incidence of contaminated blood culture samples will result in positive outcomes for our patients. Needs AssessmentI started a needs assessment by interviewing several clinical staff members during my shifts. I found that people seemed to know that the contaminated blood cultures samples can lead to the unnecessary prescribing of antibiotics, but they did not seem to realize that the way they obtain the samples could be a contributing factor in this. They did not know that there is a policy written that they have access to, or if they did know that there is a policy, they did not know how to access it. Some people did not realize that they should be using aseptic technique. Others were unaware that if two sets of blood cultures are ordered, they must be drawn from two different sites on the patient. Once I had established that there was a need for education, I performed an assessment of the nurses and techs using the Staff Educational Needs Survey from the module as a tool to get information on their individual learning styles and any barriers to learning. I found that most of the staff are visual and tactile learners. They seem to favor learning after their shift is over so that they can relax and absorb the information. The target audience is seven registered nurses that are also working toward achieving a bachelor’s degree. They range in age from thirty-four to sixty-two years old. They are all females that were just finishing a busy shift and joined me in the conference room for the session. Their clinical experience levels range from ten to twenty-seven years working as registered nurses. Among the members, there are no cultural or educational differences. There is one older member who did express to me that she tends to be “old school”, but she was very much on board with learning during the session. I chose this audience because they must be able to perform the task correctly on real patients.Teaching PlanAfter the assessing the needs of the learners, I decided that it was important to teach them how to locate the policy, how to demonstrate the skill, and to address any questions or concerns they may have. According to a study, “in order to standardize optimal patient care the following should be addressed 1) criteria for taking blood cultures 2) guidelines for correct aseptic sampling and 3) protocol for following up positive results” (Flanagan, Nabialek, Nicholson, Okafor, & Mcnamara, 2014). I planned a thirty-minute session in the conference room. The purpose is to provide emergency room clinical staff with the information necessary to perform the proper technique for collecting blood culture samples with the goal being a reduction in the number of contaminated samples. The first teaching method is a two minute 1:1 instruction on how to access and identify the policy that outlines the steps for collecting blood cultures. “This requires interpersonal skill and sensitivity on the part of the educator” (Bastable, 2014 p. 480). I used PowerPoint to display the steps in order on the computer and watched that each learner was able to access the site successfully. The second teaching method used is a demonstration return demonstration technique to show the proper procedure and then allow the learners to show me that they can demonstrate the skill. I created a kit that includes all the necessary items for drawing blood cultures. “Learners must be able to clearly see and hear the steps being taught” (Bastable, 2014, p. 483). I allotted twenty minutes for this, but this was not enough time for all learners to play both roles in the demonstration. The third teaching method to be used was an 8-minute discussion to allow the learners to express any questions or concerns they have about the proper procedure for collecting blood cultures. Because we ran out of time during the demonstration portion of the session, I believe the learners were ready to leave and therefore, no one asked any questions or voiced any concerns. ImplementationThe actual day of the learning session did not go exactly as planned. Fewer participants attended than I was planning on, which ended up being a good thing because we ran out of time. They had just finished a shift and I had a difficult time getting them to focus and stop chatting amongst themselves. Using my PowerPoint presentation to access the policy went as planned. My demonstration went well, but then the return demonstration took too much time. When it came time for the discussion portion of the session, I believe the learners were ready to go home and no one asked any questions or voiced any concerns. One learning theory that was used is the Cognitive Learning Theory. According to Bastable (2014) “the cognitive domain is known as the ‘thinking’ domain. This domain involves the acquisition of information and addresses the development of the learner’s intellectual abilities, mental capacities, understanding, and thinking process” (Bastable, 2014, p. 436). Using this theory, each learner can develop memory, understand, and process the new information. I did not identify any cultural barriers during this teaching session. All attendees had the same education and were female. They were all eager to learn and seemed to be interested. All members were able to participate with the 1:1 instruction, demonstration return demonstration, and discussion teaching methods. The only barrier I was able to identify is time. Each portion of the session took longer than I had anticipated. EvaluationThe first objective, based on the cognitive knowledge domain was evaluated by viewing the policy on the learner’s computer screen. Using a PowerPoint to guide them, all seven members were able to access the site. For this domain, the goal was met and no changes to the teaching plan were made. The second objective, based on the skills domain was evaluated by myself observing the participants for proper technique. Only four of the members were able to be evaluated because we ran out of time. It was very difficult to assess sterile technique because the room became chaotic with the learners talking and being at different stages of the procedure. I was not a very effective educator during this portion since only half of the members were able to demonstrate the skill. The instruction did not meet the objective and the goal was not met. I had to move on to get to the last objective during the period.The third objective, based on the attitude domain was evaluated by an open forum discussion where the goal was for the learners to express any questions or concerns they have about the procedure. This was very unsuccessful because no members spoke at all. After the demonstration portion, they began packing up their things and started to leave the room. The goal was not met.SummaryThis assignment taught me many new skills on conducting a teaching project to my peers. I learned that there are several stages that need to occur during the planning phase. Before this project, I had not considered the importance of assessing the needs and learning styles of the participants. I liked how the project mirrored the steps in the nursing process showing that it does not only apply to working with patients in the clinical setting. I learned to be more organized and to pay more attention to time constraints. I feel this was an overall positive experience. I do think the learners did take away some knowledge. I found that I need to be more assertive to control a chaotic room better. In retrospect, I would have practiced the session with a close friend before executing the real thing.ReferencesBastable, S. B. (2014). Nurse as educator: Principles of teaching and learning for nursing practice (4th ed.). Sudbury, MA: Jones and Bartlett.Bowen, C. M., Coleman, T., & Cunningham, D. (2016, July). Reducing blood culture contaminations in the emergency department: It takes a team. Journal of Emergency Nursing, 42, 306-311. , M., Nabialek, T., Nicholson, A., Okafor, I., & Mcnamara, R. (2014, April). G43(P) A retrospective study on the impact of contaminated blood cultures. Archives of Disease in Childhood, 99. Retrieved from , T., Shaban, R. Z., & Creedy, D. K. (2015, November). Practice standards for emergency nursing: An international review. Australasian Emergency Nursing Journal, 18, 190-203. AHonor Code:I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violations of the Honor Code. I will report to a hearing if summoned.Name: Jean Wiatrak ................
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