NURS 710 Project Proposal
NURS 710 Project ProposalJoel VeddersFerris State UniversityAbstractAn 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 theoryNURS 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 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 ActivitiesThe 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 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 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. EvaluationThe 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. 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 TimelinesThis 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 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 SettingMy 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 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 of the necessary elements in providing an excellent learning experience for staff and is the perfect venue to carry out the learning activities.PreceptorAn 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 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. ConclusionBeginning 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. ReferencesBerndt, J. (2010). The ethics of simulated nursing clinical experiences. Teaching and Learning in Nursing, 5, 160-163. , 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. , 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). , 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 InternationalVandeveer, 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.Wang, E. E. (2011, November). Simulation and adult learning. Disease a Month, 57, 664-678. , 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. , 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. ANURS 710 Project Proposal Planning GuideProject 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.GoalsObjectivesActivitiesTimelineGoal 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).Goal 2: Complete the creation of the educational activities and have them ready for implementation in July of 2014.1.1 Identify current strengths and weaknesses in current ACS education at Spectrum Health1.2Identify material to be included within the educational activities1.3Incorporate adult learning theory and principles into the development of the educational activities2.1Develop a simulation and PowerPoint to be incorporated into Spectrum Health’s current orthopaedic core class using a variety of teaching strategies 2.2Evaluate the effectiveness of the simulation, and self-evaluation of the attainment of the goals of the scholarly project.1.1a.) Attend orthopaedic core class currently offered at Spectrum Health to assess information being taught related to ACS and pain managementb.) Meet with current orthopaedic educators and clinical nurse specialist (CNS) to review current teaching materials.c.) Conduct a needs assessment with managers, leadership, and orthopaedic educators.1.2a.) 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 activities1.3a.) 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.2.1a.) 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 class2.2 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.1.1a.) To be completed by June 1, 2014b.) To be completed by June 1, 2014c.) To be completed by June 1, 20141.2a.) To be completed by June 10, 2014b.) To be completed by June 10, 20141.3a.) To be completed by June 15, 2014b.) To be completed by June 15, 2014c.) To be completed by June 15, 20142.1a.) To be completed by July 10, 2014b.) To be completed by July 10, 20142.2 To be completed by July 17, 20142.2a.) To be completed by July 17, 2014b.) To be completed by July 17, 2014Appendix BEducational Activity Evaluation ToolKey: 1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agreePlease 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:Appendix CPreceptor Evaluation ToolListed 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).ObjectiveObjective MetObjective UnmetComments 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 activitiesAdditional Preceptor Feedback Goal 2: Complete the creation of the educational activities and have them ready for implementation in July of 2014.ObjectiveMetUnmetComments2.1: 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:Appendix DAppendix EBibliographyBerndt, J. (2010). The ethics of simulated nursing clinical experiences. Teaching and Learning in Nursing, 5, 160-163. , D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St Louis, MO: Saunders Elsevier.Bradshaw, M. J., & Lowenstein, A. J. (Eds.). (2011). Innovative teaching strategies in nursing and related health professions (5th ed.). Sudbury, MA: Jones and Bartlett Publishers.Brewer, E. P. (2011). Successful techniques for using human patient simulation in nursing education. Journal of Nursing Scholarship, 43(3), 311-317. , S. H., & Daley, K. M. (Eds.). (2009). Simulation scenarios for nurse educators. New York, NY: Springer Publishing Company.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. , E. I., & Oleksak, M. (2013). Compartment syndrome after tibial plateau fracture missed due to peripheral neuropathy. Injury Extra, 44, 13-14. , S., Ponnuru, S., Nishisaki, A., Szyld, D., Davenport, M., Deutsch, E. S., & NadKarni, V. (2012, December). The emerging role of simulation education to achieve patient safety. Pediatric Clinics of North America, 59(6), 1329-1340. , 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.Khan, F. N., Bidwai, A. C., & Atkinson, D. (2011). Compartment syndrome of lower leg associated with undisplaced fibula fracture. Injury Extra, 42, 15-16. , A. C. (2010). Acute compartment syndrome of the leg: pressure measurement and fasciotomy. Orthopaedics and Traumatology: Surgery and Research, 96, 913-917. Association of Orthopaedic Nurses website. (2013). , W. M., & Lashley, F. R. (Eds.). (2010). High-fidelity patient simulation in nursing education. Sudbury, MA: Jones and Bartlett Publishers.Neill, M. A., & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: a literature review. Clinical Simulation in Nursing, 7, e161-e168. , S. M. (2012, April). Acute lower extremity compartment syndrome. Advance for NPs and PAs, 22-27.Qasim, S. N., Rachha, R., & Sood, M. (2010). Unusual presentation of acute atraumatic compartment syndrome- a case report and review of literature. Injury Extra, 41, 115-117. , M. G., & Scheffer, B. K. (2010). Critical thinking tactics for nurses: achieving the IOM competencies (2nd ed.). Sudbury, MA: Jones and Bartlett.Schoenly, L. (Ed.). (2013). Core curriculum for orthopaedic nursing (7th ed.). Chicago, IL: National Association of Orthopaedic Nurses.Tzioupis, C., Cox, G., & Giannoudis, P. V. (2009). Acute compartment syndrome of the lower extremity: an update. Orthopaedics and Trauma, 23(6), 433-440.Ulrich, B. (Ed.). (2012). Mastering precepting: A nurse’s handbook for success ( ed.) Indianapolis, IN: Sigma Theta Tau InternationalVandeveer, 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.Wang, E. E. (2011, November). Simulation and adult learning. Disease a Month, 57, 664-678. , 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. , 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. , C. R. (2010). Becoming a nurse educator dialogue for an engaging career. Sudbury, MA: Jones and Bartlett.Zulkosky, K. D. (2012). Simulation use in the classroom: impact on knowledge acquisition, satisfaction, and self-confidence. Clinical Simulation in Nursing, 8, e25-e33. ................
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