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Running head: CLINICAL PRACTICUM 1

Nurse Educator and NPD Specialist Clinical Practicum Paper

Erin Kibbey

Ferris State University

CLINICAL PRACTICUM 2

Abstract

Gaining competency in the role of the nurse educator and nursing professional development

specialist can be obtained through the utilization of a practicum experience. This paper describes

a practicum experience designed to gain experience and practical knowledge related to the

educational process utilized by both of these specialty roles. The three standards of practice this

practicum experience focused on included: a) facilitation of learning, b) participation in

curriculum design and evaluation of program outcomes, and c) use of assessment and evaluation

strategies. Based on these competencies and guided by Kolb’s experiential learning theory,

several key objectives and activities were completed during this experience. This paper

describes challenges related to the application of these roles, strategies applied to address the

challenges, description and analysis of clinical projects completed during the project, and an

evaluation of the practicum.

Keywords: competency, nurse educator, nursing professional development specialist,

standards of practice


Nurse Educator and NPD Specialist Clinical Practicum Paper

According to the American Nurses Association and National Nursing Staff Development

Organization (ANA & NNSDO, 2010) the nursing professional development (NPD) specialist

uses their expertise in nursing education to help other nurses develop their competence in various

settings. They support continuous learning and help create an environment that supports the

adult learning process. Competencies related to the educational process including assessment,

planning, implementation, and evaluation are the same for both NPD specialists and academic

nurse educators (Brunt, 2007). This practicum was designed to gain confidence and skills related

to the educational process within both of these specialty roles. The purpose of this paper is to

describe the clinical practicum experience, including role issues and challenges, strategies

utilized to address role challenges, clinical projects completed, and evaluation of the practicum.

The importance of obtaining hands-on, practical experience prior to taking on a new role

cannot be underestimated. As a future academic nurse educator or NPD specialist, fulfillment of

a 300 hour clinical practicum experience provided the opportunity to gain competency towards

these roles. The following paper describes the clinical practicum intended to provide experience

in the educational process similar to both of these specialty roles.

Practicum Overview

The overall goal of the clinical practicum was to gain competency in the specialty roles

of the NPD specialist and nurse educator as based on my previous background and clinical

experience and future career goals. Since the educational process utilized by these roles is a

competency area I had little experience in, this practicum was designed to specifically focus on

growth in this area. As such, this practicum focused on three particular National League for

Nursing (NLN, 2012) standards of practice. These three standards included: the facilitation of


learning, participation in curriculum design and evaluation of program outcomes, and the use of

assessment and evaluation strategies (2012). Although these standards are specific to the nurse

educator role, the NPD specialist has several responsibilities related to these education based

standards. Some of the key responsibilities for NPD specialists related to educational

competency include: assessing and validating competency, assessing educational needs,

participating in on-the-job activities, orienting, assisting in role transition, and developing

curricula (ANA & NNSDO, 2010). Thus, several of these responsibilities were integrated into

the clinical practicum experience. Finally, the practicum experience provided several additional

opportunities for growth in the ANA and NNSDO (2010) standards of leadership, collegiality,

and collaboration.

In order to gain competency in the educational process as an NPD specialist and nurse

educator, this practicum took place at Munson Medical Center (MMC) in Traverse City,

Michigan. Within this setting, I gained experience in the educational process by working closely

with the program coordinator for the critical care internship program as well as the transition to

practice program. The coordinator for both of these programs, Ms. Hresko, was also my

preceptor for the clinical practicum experience.

Foundational Theory

Progression of competency within the three nurse educator standards of practice were

designed based on Kolb’s experiential learning theory. From this theory comes the notion that

ideas are not fixed, they are shaped and reshaped through experience (Kolb, 1984). Thus,

learning is a process that continually changes through experience. Also central to this theory is

the idea that learning involves the environment and real-world experience. In addition, learning


is a cyclical, adaptive process occurring in all human settings and all life stages. This practicum

amplified these ideas and provided the foundation for the clinical practicum.

Objectives for the practicum were based on Kolb’s (1984) idea that the experiential

learning cycle is a continuous process. The first objective for the practicum was to become

acclimated to the educator role and educational process through observation. The second

objective was to reflect on the observational experiences and the third objective was to apply

knowledge and actively participate in the educational process. This is similar to Kolb’s (1984)

idea that individuals have a concrete experience, they reflect on that experience, they derive

meaning from it, and they try out the meaning they’ve constructed (Jeffries & Clochesy, 2012).

Additional objectives for the practicum were based on the desire to further apply the proposed

concrete experiences, as Kolb’s theory suggests.

Issues, Challenges, and Strategies

In retrospect, five main challenges related to implementation of the NPD specialist and

educator roles were encountered during the practicum experience. These issues related to role

clarity, assessing learning needs, anxiety about teaching, organizing and planning, and

communication. Several strategies and approaches were applied in order to gain further

experience in these roles and to ultimately allow for a successful practicum experience.

Congruence of Role Expectations

Since this practicum was completed at MMC, where I am also a staff nurse employee,

one of the first issues of concern was the congruence of expectations to individuals encountered

while immersed in the practicum. Since I was also working with Ms. Hresko for completion of

another Ferris course, I had similar concerns about the need to clarify and differentiate

expectations and practicum goals compared to the other course. In addition, as I progressed


within the practicum experience, there were various individuals that requested my help with

projects or endeavors that they felt would be mutually beneficial. Some of the time I was able to

help with these requests and still work towards my own practicum goals. However, I did feel

that I had to continually ensure the expectations of others still met the practicum goals for

development in the NPD specialist and educator roles. According to McKinley (2008),

expectations of nursing administration, management, and staff may not be mutually exclusive,

which can result in educators feeling frustrated and spread too thin. There were a few times

throughout the practicum where Ms. Hresko and I were involved in several different projects,

roles, and responsibilities, occasionally resulting in an inability to complete some of the tasks we

had planned on completing for the day. Similarly, it was a challenge to keep in mind that there

are limitations to the role. As McKinley (2008) notes, the clinical educator cannot fix every

problem, nor do they have the answer to every question.

Strategies. One of the main strategies evoked at the beginning of the practicum was to

share with Ms. Hresko the practicum planning guide I had previously created (see Appendix A).

By sharing the goals and objectives for the practicum with Ms. Hresko, she was able to have a

clearer picture of what the practicum experience intended to focus on. From the beginning,

providing clarity about expectations is essential to implementation of the educator role

(McKinley, 2008). In addition, establishment of goals and an outline of specific activities and

responsibilities for a defined time frame can assist the educator in establishing successful

implementation of the educator role (2008).

Another strategy employed to clarify my role outside of my normal job at MMC was to

dress differently than I do as a staff nurse. On the unit I typically work, I wear burgundy colored

scrubs. Once I was visiting units as a student instructor, I wore blue hospital scrubs. This


usually caused those that I typically work with to question why I was wearing something

different, resulting in a conversation that clarified my role as a student instructor for the critical

care interns. Outside of the hospital units, Ms. Hresko also announced my presence at meetings

and clarified my role.

A similar approach was taken with individuals that approached me about helping them

with various projects. I carefully consulted with the individuals and clarified what my role

would be and considered how the activity would be beneficial to my own goals and whether it

was appropriate to take part. For example, I was able to help on several occasions in the

simulation lab, allowing valuable experience in the facilitator and operator roles. However,

before taking part in these opportunities, achieving clarity about expectations, time commitment,

and goals, were key to these being successful experiences for all parties involved.

Assessing Learning Needs

At the onset of the practicum, I was unsure as to how Ms. Hresko had obtained her

insight into what the course learning needs may be for the next class of critical care interns. She

had several ideas about what needed to be included in the next class, but it was not until I saw

the stacks of folders with raw evaluation in her filing cabinet that I began to understand some of

the ways she had assessed learning needs. I was surprised and overwhelmed with the amount of

evaluation data pertaining to the internship that had been collected over the years. Accordingly,

needs assessments for clinical educators can be both formal and informal (McKinley, 2008).

Although Ms. Hresko had clearly looked at feedback, test results, and worked closely

with the past interns, I was concerned about the lack of compilation of the data that could have

been further analyzed to assess learning gaps. For instance, the written tests that had been given

to past interns could have been used to identify areas of education that needed strengthening in


order to achieve program outcomes (McKinley, 2008). However, the raw evaluations, as well as

the pre and post internship knowledge tests were in a filing cabinet but had never been placed

into a usable form. According to Avillion, Brunt, and Ferrell (2007), a needs assessment can

identify specific needs, validate the needs to key stakeholders, and document the identified needs

into a format that can be developed. Because these items were never placed into a format where

the data could be meaningfully interpreted, it was difficult for me to assess the potential learning

needs for the next class of critical care interns.

Strategies. In order to fix the issue of unclear needs assessment data, I compiled the pre

and post test results from the Basic Knowledge Assessment Tool for Critical Care (BKAT). This

tool is an example of a test that can be used to assess the knowledge level of staff and are

available for various nursing care specialties (Toth, 2008). The BKAT-7 or the BKAT-8 were

given to all the previous classes of interns at the start of the critical care internship program and

then again at the end of the internship program. Since the results of how the interns had

improved and what content areas they were still having difficulty with were never placed into

any kind of spreadsheet and analyzed, I spent a great deal of time completing this process. In

scoring the BKAT’s there is an answer sheet and score sheet that tells what content area the

question pertains to (such as emergency situations, electrocardiogram interpretation, monitoring

of lines, ventilators, etc.). Toth (2008), the author of the BKAT, noted that the BKAT can be

useful for identifying needed content and as a measure of learning. Content areas were tabulated

across each of the interns. In total, I tabulated results from 28 interns that completed the BKAT-

8. All 90 questions were examined on both the pre-test and post-test, so this was quite a bit of

data to record.


Once I was able to interview and spend more time with the new class of interns I was also

able to begin less formally assessing learning needs. Gaberson and Oermann (2010) note that the

first area of assessment involves understanding the learner’s current level of knowledge, skill,

and attitude. Interactions with interns while on the various critical care units were utilized as an

opportunity to assess the current level of knowledge and skill and other characteristics that could

influence achievement of the internships learning outcomes. In addition, e-journals and post

conferences were helpful for assessing learning gaps and identifying accomplishments in clinical

practice. A second assessment area should consider individual characteristics that could

potentially influence performance (Gaberson & Oermann, 2010). “Understanding the

background, experience, and style of learners, determining the number of learners, and focusing

on the desired outcome must all be a part of the assessment for the educator to select the best

approach to learning” (McKinley, 2008, p. 392). Finally, another strategy for assessing learning

needs is to assess possible barriers to learning (2008). Time, motivation, lack of resources, lack

of support, and resistance to change are potential roadblocks to learning. Thus, all of these

considerations were utilized in the assessment of learning needs and planning of clinical learning

approaches, as well as the development of the first clinical project (see Appendix B).

Anxiety about Teaching

As a novice to the nurse educator role, one of the biggest concerns I had going into this

practicum was worrying about my ability to help new nurses, new critical care nurses, and the

critical care interns learn the essential knowledge and skills to become a competent nurse. As

Penn, Wilson, and Rosseter (2008) point out, “many nurses who have spent years in the practice

setting are only vaguely aware of what is involved in teaching…” (p. 6). This was true in my

case. Although, I have been a preceptor, spent the last six years as a bedside nurse, and was


starting my last semester of graduate school, I had never been immersed in the educator role

outside of the unit I worked. Moving out of my comfort zone and teaching in other areas with

nurses I did not know, was a new experience that definitely evoked some concern at the start of

the practicum. Research has identified effective teachers as knowing how to teach, being

clinically competent, supportive, patient, friendly, and having the ability to maintain collegial

relationships with students and staff (Stokes & Kost, 2012). Educators must also have the ability

to deliver knowledge in an effective manner (2012). Since I was new to the role, I was

concerned about my ability to portray these qualities and actually be an effective teacher.

Strategies. Consequently, the ability to help students’ master essential skills and

knowledge in order to become professional nurses is so paramount that the need for preparation

and development of individuals taking on teaching roles is an important issue (Stokes & Kost,

2012). Therefore, through a variety of experiences, both observational and experimental, my

learning and knowledge about facilitation grew, allowing me to become more comfortable with

teaching. As previously mentioned, the proposed practicum was designed based on Kolb’s

experiential learning theory and cycle of learning. Within Kolb’s cycle of learning the various

learning processes can include concrete experience, reflective observation, abstract

conceptualization, or active experimentation (Ullrich & Haffer, 2009). Thus, in this practicum I

utilized this process in order to gain confidence and ease my fears about teaching. I began by

watching and carefully observing my preceptor and the speaker at the first role transition class,

then reflected on the experiences, and finally I began refining and improving my comfort level

with teaching through active experimentation.

Imperative to Kolb’s cycle of learning framework was the opportunity to interact with

Ms. Hresko, several other educators, and my graduate degree program peers that I got to know


throughout the practicum. Not only did these individuals serve as mentors and guides to the

educator role, but they helped me feel welcome and encouraged throughout the process. In a

study by Schoening (2013) it was found that peer mentors provided beneficial emotional support

during the role transition process from nurse to nurse educator. According to Penn et al. (2008),

faculty mentors and professional development opportunities that promote learning about the

teaching environment and opportunities to enhance teaching skills should be encouraged for

novice educators.

Participating as a facilitator in a role transition class was my first attempt at teaching in

this practicum. The first and main focus during this time was on creating the right tone for

students to feel comfortable sharing, especially with the difficult topics that were presented in the

class. According to the NLN (2012), facilitation of learning can be accomplished by creating an

environment conducive for students to learn the desired outcomes. In addition, I knew it was

also important, as noted by the NLN (2012), to display interest and respect for the learners. I

shared stories that demonstrated patience, caring, and integrity.

Attending the simulation facilitator class was another strategy utilized to become more

comfortable with teaching and facilitating. It was extremely useful to utilize the information

learned from the beginning of the facilitator class and apply it when assigned to act as a

facilitator. I essentially practiced being a facilitator, without having real students. This

opportunity provided individualized attention in both the operator and facilitator roles. In

addition, I was able to obtain feedback from the other learner and the class instructor on my

facilitator techniques. Finally, I had the opportunity to practice debriefing and to discuss

effective ways to debrief. This approach was very helpful in decreasing my anxiety related to

facilitation and debriefing.


According to Shellenbarger and Edwards (2012), simulation activities can benefit

graduate nurse educator students. Accordingly, simulation activities can be a useful way for

novice nurse educators to create scenarios for simulation so they can practice the skills of

planning, implementing, and evaluating teaching and learning skills. Thus, not only was it

beneficial to learn this technology for future use, but the process of learning and practicing using

it throughout this practicum helped me gain experience in feeling more comfortable with

teaching as well as planning, which was another challenge as described in the following section.

Organizing and Planning

Throughout the clinical practicum experience, there were several hours spent planning

and organizing. McDonald (2010), notes that many educators take work home with them and

that an excessive workload for educators is often a factor in faculty retention. From the

beginning, I realized this was a potential issue for the success of my practicum experience. Since

Ms. Hresko’s educator position was only a 24 hour a week position this was a concern from the

start and one that felt like we had to frequently come to terms with. Duties that included

teaching, preparation, administrative meetings, and other committee meetings often times left us

both with the added burden of planning and organizing outside of MMC. Educators must also

prepare students for orienting to the clinical environment, be familiar with the clinical setting,

and know the knowledge and skill level needed in the practice area where teaching will take

place (Gaberson & Oermann, 2010).

During the transition stage from nurse to nurse educator, one of tendencies for novice

educators is to over prepare for student encounters (Schoening, 2013). This was a real challenge

at the onset of this practicum. Before facilitating in skills sessions, I often spent several hours

preparing myself for teaching content that I was already very familiar with. This concern


seemed to coincide with my anxiety of teaching. According to Schoening (2013), novice

educators that over prepare may fear failure due to a lack of experience. In planning my first

clinical project, the physical assessment simulation, I also spent several hours not only in

creating the lesson plan but playing the facilitation over in my head and researching how to

perform a proper head-to-toe assessment. As a critical care nurse of nearly six years, I am very

comfortable performing head-to-toe assessments, but I felt the need to prepare and plan for the

learning activity more than what I believe would be required for an educator that is more

confident in their role.

Strategies. One strategy I utilized to deal with organizational and planning issues was to

frequently consult my calendar and carve out time for necessary tasks. Utilizing the practicum

planning guide (see Appendix A), I placed all of the activities and responsibilities Ms. Hresko

and I had committed to into a calendar. I frequently consulted my calendar and estimated the

length of time it would take to carry out various tasks and plugged those in as necessary. Ms.

Hresko and I frequently communicated via email and telephone in order to ensure we were

prepared for the planned activities. Planning for the lessons also became easier with practice. In

addition, when I came to the realization that I would never be completely prepared for every

single question that could be asked or for every contingency that could occur, I began to lighten

up on my planning. According to Schoening (2013), faculty that successfully transitioned from

nurse to nurse educator identified the strategy of focusing on the learning process, rather than the

product. Thus, teaching became more learner focused than content-focused. This was

something I still need practice with, but was a mindset I tried to utilize as I continued in my

practicum experience.


Communication

One of the biggest issues and concerns encountered during this practicum experience was

related to the topic of communication. According to McKinley (2008), communication is

essential to the success of any role but even more so for that of an educator. Moreover,

McKinley (2008) notes that unclear, indirect, inefficient, and poor communication techniques

can result in frustration and failure. Finally, the NLN (2012) notes that an important competency

for the nurse educator is to practice skilled oral, written, and electronic communication. In

addition, communication should reflect awareness about one’s self and others as well as convey

ideas in a range of situations (2012).

This concern was important in my interactions with the critical care interns. Emphasis on

the lines of communication on clinical units, who to go to for help, and under what

circumstances they should seek help were important issues that needed to be communicated to

students, or in this case the interns, before they entered the critical care units (Gaberson &

Oermann, 2012). Providing feedback that is constructive and respectful was another concern I

had during the practicum experience, due to my lack of experience in this area. Often evaluation

is one of the most intimating skills for new educators (Penn et al., 2008). Another example of a

communication concern that occurred earlier in the practicum was when the last class of interns

were working on their case study presentations. This was the final component to the internship

program and was scheduled for March 14. An issue that came about in relation to

communication was the lack of guidelines about Ms. Hresko’s expectations for the presentations.

In talking with some of the past interns, as well as Ms. Hresko, there was no description of what

the presentation should entail or identification of how the interns would be evaluated based on

the presentation.


Another important consideration when communicating with learners is that too much

information can result in overload and shutting down communication (McKinley, 2008).

According to Penn et al. (2008), the ability to differentiate between critical content and logically

sequencing the information to maximize learning is an important communication consideration.

On the first day of the internship, the interns were given a huge binder of unit specific articles,

the syllabus I developed, the electrocardiogram course book, and the skills lab book. It was very

apparent that this approach resulted in overload and a portrayal of being overwhelmed.

Finally, promoting clear communication with internship preceptors, unit managers, and

others encountered throughout the practicum was another important concern related to

communication. During one of the meetings I attended about the development of the

professional practice model, I was called on to voice my opinion about the idea of back rubs

being part of the model. Knowing that this topic was a source of contention amongst the group,

it was a concern that poor communication about my thoughts on this subject could result in a

poor outcome. Lastly, there was an issue with an intern feeling unwelcomed on one of the

critical care units and proper communication in handling this problem was critical for all parties

involved.

Strategies. One strategy utilized to promote communication to the interns related to the

issue about the case presentations was to provide clear, written expectations for the assignment

as well as a copy of the tool that would be utilized to evaluate the interns on. As such, rubrics

are a type of rating scale and can be used to help provide a clear direction for grading and

assignment criteria (Bonnel, 2012). Since the case presentations by the interns are an important

evaluation component to the internship program, it was deemed necessary by myself and Ms.

Hresko that a rubric could be utilized to help facilitate a clearer understanding of the


expectations for the presentation. Rubrics can be a convenient form for providing feedback and

allows for more discrimination in judging than checklists (Bonnel, 2012). While a rubric worked

well for the case study presentation, a checklist was utilized for the physical assessment

simulation learning activity. The use of a checklist, in this instance, provided me, the observer,

with clear criteria for evaluation resulting in feedback that was viewed as fair, direct,

constructive, and respectful.

Another strategy utilized to combat communication challenges was my promotion of

credibility. McKinley (2008) has said that real-world credibility is an essential component that

needs to be portrayed by the educator. Hence, having appropriate credentials, experience, and

knowledge can communicate a message of credibility (2008). In meeting with the interns it was

conveyed by both Ms. Hresko and myself that we were both still critical care staff nurses, had

obtained critical care certification, and had several years of experience at the bedside. Similarly,

another strategy that is important to communicating credibility is just being available, dressing

the part, and bringing forth a positive attitude (2008). When working with the interns, I met with

them on a daily basis, wore scrubs, lent a hand with patient care, and was available throughout

the day.

Additional communication strategies utilized throughout the practicum focused on the

use of personal attributes. Accordingly, the NLN (2012) facilitation of learning competency

notes the importance of using personal attributes such as caring, confidence, patience, integrity

and flexibility. This strategy is also supported by studies that have found faculty considered the

most successful by students when they possessed attributes such as enthusiasm, flexibility, a

sense of humor, approachability, and respectfulness (Penn et al., 2008). Key to promoting a

positive learning environment is the fostering of collegial working relationships with the


personnel in the clinical learning environment (NLN, 2012; Gaberson & Oermann, 2010). Thus,

Ms. Hresko and I had several discussions with preceptors, unit educators, unit managers, and unit

coordinators in order to keep communication open and foster trusting relationships with staff

members.

Clinical Project

The fourth competency for the nurse educator, or the ability to participate in curriculum

design and evaluate program outcomes, should reflect today’s health care and educate graduates

to be effective nurses in the modern day health care milieu (NLN, 2012). In light of current

health care trends such as the increasing critical nature of patient illness, increasing emphasis on

high quality care, and decreased spending, it is important for curriculum to keep pace (Boland,

2012). In order to help accomplish the goal of developing competency in curriculum design and

evaluation of program outcomes, I originally planned to develop two didactic lessons that could

be incorporated into the critical care internship program. However, after developing the first

lesson, outlined in the following section, the opportunity to develop a program syllabus became a

second clinical project.

Clinical Project 1: Lesson Plan

After careful consideration of learning needs as previously discussed, Ms. Hresko

suggested I plan a simulation activity focused on how to conduct a proper physical assessment

and the differences encountered on the critical care patient. This learning topic was one Ms.

Hresko had identified as an area for potential growth based on feedback from preceptors and

interns in previous classes. In addition, according to Gaberson and Oermann (2010), clinical

instructors are responsible for assessing the level of skill development prior to entrance in to the

clinical setting. Thus, utilization of simulation settings or skills labs can provide this opportunity


before being expected to do so in a fast-paced, demanding environment like critical care

(Gaberson & Oermann, 2010). Once a time and date were established, I coordinated the

reservations for the simulation lab where the learning activity would take place. I also obtained

materials to help in not only designing the simulation activity, but also in evaluation of the

activity and learning outcomes. I utilized a teaching outline the staff development and

simulation coordinator sent to me, in order to begin writing the teaching plan for the simulation.

This project utilized adult learning theory as well as evidence based practice for

developing lesson plans, needs assessments and learning objectives. According to Knowles

(1980) theory of adult learning, adults prefer learning that is practical, promotes self-esteem,

utilizes past experiences, demonstrates respect and allows self-direction, and synthesizes new

ideas with previous knowledge. In looking at the development of a teaching lesson for

simulation, I first focused on the objectives, outcomes, and competencies of what the desired

outcome was for the simulation activity (see Appendix B). Identification of the learners and

their level of expertise, including knowledge gaps, was an essential step in creating the learning

activity with adult learning theory in mind. According to Billings (2012), each lesson should

state the purpose, outcomes, assignments, learning activities, and evaluation being used. Since

the identified learning gap was performing a physical assessment on a critically ill, hospitalized

patient, the learning outcomes focused on improving clinical performance and self-confidence.

The introduction of the critically ill patient in the simulation lab, early in the orientation

period, was felt to be a safe and less threatening way of learning how to perform a complete

physical assessment and become familiar with some of the equipment that would be seen

throughout the orientation period. In addition, the design of this activity considered potential

past knowledge with a plan to integrate new knowledge related to critical care, as adult learning


theory suggests. According to Jeffries and Clochesy (2012), simulation can provide a safe

environment conducive to learning skills that require practicing a number of times. The learning

outcomes and placement of this particular simulation learning activity at the beginning of critical

care orientation was also in line with the idea that learning activities should build from level to

level and be threaded throughout the course as they fit with the program outcomes (Billings,

2012). Moreover, the simulation activity could assist with a more effective method of measuring

the skill and level of comfort the interns possessed before allowing them on the critical care units

(Billings, 2012).

The last stage in developing the lesson plan was determining evaluation methods.

According to Saunders (2003), this should be a twofold evaluation, considering evaluation of

learning or outcomes and evaluation of the instruction or the process. Primary strategies for

evaluating and measuring learning in a clinical setting is through observation, written

communication, oral communication, simulation, and self-evaluation (Bonnel, 2012).

Accordingly, Bonnel (2012) notes the importance of creating a checklist of behaviors and skills

to be observed during the simulation or performance so the potential for direct visualization and

confirmation of student performance is easier to evaluate. In working on the competencies and

evaluation for the simulation activity MMC’s intranet and information from the Lippincott

reference manual were utilized. Thus, organizational and nursing standards were followed and

considered throughout the development of this activity. Since structured observational tools can

contribute to a more objective and fair evaluation, I created an evaluation checklist based on

information from the previously mentioned sources. An analysis of the evaluations for this

project will be discussed further in the evaluation section of this paper.


Clinical Project 2: Program Syllabus

Prior to the start of the critical care internship on March 13, I learned that there was no

program syllabus. A syllabus can be seen as an important component to student understanding

of what is expected of them throughout a course. According to Sauter, Nightingale Gillespie,

and Knepp (2012), the syllabus can also be used during review of instructors and effectiveness in

teaching. Furthermore, the syllabus should be reviewed for expectations that are clear and

evaluation methods that are detailed. I found that Ms. Hresko did have written program goals

but there was really nothing formal, written, and given out to the interns that described all the

things that a normal program syllabus would contain.

Since I was still working toward gaining experience in the competency of curriculum

design and evaluation of program outcomes, I believed working on the components of a program

syllabus and putting them all together would provide me with additional growth in this area.

According to Billings (2012), the syllabus sets the tone for the course and should start off by

being written in a welcoming style. In addition she says a title, purpose, description,

prerequisites, corequisites, outcomes, teaching-learning strategies, learning activities, topical

outline, policies and procedures, assessment and evaluation strategies, as well as the grading plan

should be standard and essential components in a syllabus. Keeping this information in mind

and the difference between creating the program’s syllabus I needed to create for the internship

to one that would be created for an academic course, I set out to the task of creating a program

syllabus (see Appendix C). In doing this, I also had to email the electrocardiogram class

instructor and request course information to add to the syllabus about this program component.

The first step to creating the internship syllabus was to figure out the course outcomes.

Although, my preceptor had already created some broader program objectives, I felt the syllabus


needed to have more specific intern learning outcomes. Objectives and outcomes specify what

students should know, do, value, and determine how they will be graded (Billings, 2012).

Dillard and Siktberg (2012) also note that objectives and outcomes provide the framework for

the curriculum. In addition, learning activities and course objectives should focus on the three

main domains of learning, the cognitive, affective, and psychomotor domain. By matching

objectives with learning activities students are better able to make connections between what the

content is and why it is important, thus, promoting learning. One resource I utilized for this

component was the American Association of Critical-Care Nurse’s website for information about

the learning objectives related to the online modules that the internship utilizes for didactic

learning. According to Dillard and Siktberg (2012), one way to demonstrate that learning

objectives match the assignments is to use an evaluation grid or matrix. Therefore, I did create a

grid to demonstrate how the learning objectives would be assessed. One observation noted after

creating the grid was that in looking at all the various learning activities utilized in the internship

program, there was a great mix of active and passive learning approaches.

Evaluation

According to Saunders (2003), instructional evaluation can be done formally or

informally. Informal examples could include remarks from learners during the class session.

Thus, the evaluation of the first clinical project, the simulation activity, was completed using

both of these methods. Informal examples included remarks from the group during the

simulation activity. Comments made by the interns during the simulation activity itself were

very positive. In addition, the interns were all very engaged throughout the learning session,

each taking on the role of the nurse performing the physical assessment. An evaluation form for

the simulation learning activity was also created (see Appendix D). The beginning of the


evaluation form was created based on the learning objectives for the simulation. It has been

shown that student ratings are considered highly reliable as well as positively correlated with

student achievement, however, there remains challenges with the validity and reliability of the

instrument used to evaluate teaching effectiveness (Hayes, 2011).

The rest of the evaluation form utilized for the simulation activity was a standard form

created and used by MMC for the simulation lab. The evaluation consisted of a Likert five point

scale, asking the learner to rate how they felt about various evaluation criteria. Likert scales are

the most widely used scaling technique (Polit & Beck, 2012). A Likert scale allows the

evaluator the opportunity to express an opinion on a particular issue through indicating the

degree to which they agree or disagree (Bourke & Ihrke, 2012). Overall, each of the intern’s

evaluations reflected strong, positive feelings towards the learning activity. All responses were

marked “strongly agree” related to their feeling of whether or not they were able to achieve the

learning objectives for the activity. In addition, one of the comments made on the evaluation

noted that hands on learning was a preferred learning method. Lastly, no remarks were made on

the evaluations suggesting recommendations for future simulations.

An evaluation tool was also created as a means of assessing how well the goals for the

entire practicum were met (see Appendix E). The evaluation was completed by myself and Ms.

Hresko. The evaluations were based on the standards of practices for the academic nurse

educator as outlined by the NLN (2012). Both of these evaluations also utilized a Likert five

point scale. Overall, I believe this was a successful practicum experience. Significant

experience was gained in not only the specified areas outlined on the evaluation, but also in

learning more about the nurse educator and NPD specialist roles related to leadership and change

in an organization. Ms. Hresko’s evaluation was also highly rated.


Formal evaluation forms administered to students are often used by institutions at the end

of a course in order to solicit feedback on various criteria and are another way to receive

feedback (Saunders, 2003). Thus, at the end of this practicum I created an evaluation form that

once again utilized a Likert five point scale (see Appendix F). The evaluation form was given to

the interns on April 25, 2014 by Ms. Hresko when I was not present. The evaluations were

collected and given back to me by Ms. Hresko in order to provide the interns with an opportunity

to submit the evaluations anonymously. Evaluations from the interns were overall very positive.

On each of the 21 questions, all interns rated me as “excellent”, which was at the top of the scale

provided. Additional comments provided were also positive in nature. Lastly, in telling the

interns that I would not be working with them anymore, I received several informal comments

that they were going to miss me and that they were really grateful for my help.

Conclusion

Obtaining experience and knowledge in the educational process is an important goal in

the development of the academic nurse educator and NPD specialist roles. Competency in the

educational process can be gained through the utilization of a practicum experience. This paper

described a practicum experience designed to expand competency related to the educational

process utilized by both of these roles. Kolb’s experiential learning theory was described as the

foundation for the practicum experience. Challenges encountered in implementing these roles as

well as the strategies applied to meet these challenges were also detailed. Lastly, this paper

described and analyzed the clinical projects undertaken during the practicum and provided an

evaluation of the practicum experience.


References

American Nurses Association and National Nursing Staff Development Organization [ANA &

NNSDO]. (2010). Nursing professional development: Scope and standards of practice.

Silver Spring, MD: Nursesbooks.org.

Avillion, A., Brunt, B., & Ferrell, M. J. (2007). Nursing professional development: Nursing

review and resource manual (1st ed.). Silver Spring, MD: American Nurses Credentialing

Center.

Boland, D. (2012). Developing curriculum: Frameworks, outcomes, and competencies. In D.

Billings & J. Halstead (Eds.), Teaching in nursing: A guide for faculty (4th ed.). (pp. 138-

159). St. Louis, MO: Elsevier Saunders.

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Teaching in nursing: A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier

Saunders.

Bourke, M. P. & Ihrke, B. A. (2012). The evaluation process: An overview. In D. Billings & J.

Halstead (Eds.), Teaching in nursing: A guide for faculty (4th ed.). (pp. 422-440). St.

Louis, MO: Elsevier Saunders.

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Innovative teaching strategies in nursing and related health professions (5th ed.). (pp.

563-574). Sudbury, MA: Jones & Bartlett Publishers.


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Sudbury, MA: Jones and Bartlett Publishers.


Appendix A

Project Planning Guide

Title of Project: Practicum Proposal for Nurse Educator or NPD Specialist

Goals Objectives Activities TimelineGoal 1:Develop knowledge and experience in the standards of practice for both the education domain of the advanced specialty role of the NPD specialist and competencies I – Facilitate Learning & III – Use Assessment & Evaluation Strategies for the advanced specialty role of the nurse educator (ANA & NNSDO, 2010; NLN, 2012)

1.1Orient to the clinical educator/staff development role at MMC through multiple observation experiences focused on facilitation of learning and the use of assessment and evaluation strategies

1.2Use reflective observation to gain knowledge in facilitation of learning techniques and evaluation strategies

1.1aObserve preceptor facilitation in one role transition class & review class evaluations

1.1bParticipate in interviews and selection process of candidates for internship program

1.1cObserve facilitator and preparation of EKG course for new nurses

1.1dShadow preceptor and her interactions, facilitation of learning, and use of assessment and evaluation techniques with the interns, unit educators, and managers

1.1eMeet with preceptor and interns during any scheduled learning sessions

1.2aEngage in weekly to bi-weekly reflection and journaling of experiences

1.2bMeet regularly with preceptor to discuss, evaluate, and plan experiences for professional growth

1.1aJan. 16

1.1bJanuary

1.1cFeb. 20, 27, Mar. 6, Mar. 13, Mar. 20

1.1dMar. 10 – May 2

1.1eInternship starts Mar. 10

1.2aJan. 13- May 2, 2014

1.2bJan. 13-May 2, 2014


1.3Take on an active role as a facilitator of learning in the clinical setting

1.4Implement assessment and evaluation strategies into active facilitation experiences

1.5Use simulation technology for facilitation of learning in at least one lab session

1.3aHelp preceptor with preparation for start of internship program (preparing program materials, schedules, coordination with unit educators/managers)

1.3bTeach stations at skills labs

1.3cParticipate as facilitator in transition classes

1.3dSelect meetings with interns and preceptor to focus the planning and leading of

1.3eFacilitate agreed upon topics in March EKG course

1.4aUse evaluation strategies and review outcomes from facilitation at skills labs

1.4bUse evaluation strategies and review outcomes from facilitation in role transition classes

1.5aAttend 4 hour simulation operator class

1.5bAttend 4 hour simulation

1.3aJan. 13- Mar. 9

1.3bFeb. 26 & Mar. 20

1.3cFeb., Mar., Apr. (1 day month for 3 hrs.)

1.3dSelect 1-2 Fridays in April

1.3eMar. 27, Apr. 10, Apr. 17, Apr. 24, May 1

1.4aFebruary 26& March 20

1.4bFeb., Mar., Apr. (1 day month for 3 hrs.)

1.5aBy end of February

1.5bBy end of


Goal 2:Gain knowledge and experience in the NLN (2012) nurse educator competency IV – Participation in Curriculum Design and Evaluation of Program Outcomes

2.1Implement at least two didactic lessons into existing educational materials for the critical care interns

facilitator class

1.5cFacilitate simulation scenario(s) at skills lab(s) and with interns, use debriefing and evaluation strategies

2.1aMeet with preceptor to determine gaps in program learning outcomes

2.1bCreate an outline of education needs

2.1cReview the literature on topics that need additional educational facilitation of learning

2.1dRevise curricula and write learning objectives and select appropriate learning activities to fulfill needs

2.1eDetermine and implement evaluation strategies appropriate to the interns and learning goals for new curricula

February

1.5cApril 30 & various date(s) once internship program starts in March

2.1aJan. 13 – Jan 27

2.1bJan.27 – Feb. 10

2.1cFeb. 10 – Feb. 17

2.1dFeb. 17 – Mar. 3

2.1eMar. 3 – Mar. 10


Appendix B

Clinical Project 1

High-fidelity Simulation Case Planning

Munson Medical Center

Scenario name: Critical Care Physical Assessment Simulation

Estimated scenario run time: 20 minutes each intern

Estimated debriefing time: 40 minutes

Target audience: Critical Care Interns

Location of simulation: Simulation Lab

Learning gap: Physical assessment of critically ill hospitalized patient

What outcome/s are you measuring?

Clinical performance

Self-confidence

Brief overview: Fran York is a 75-year-old Caucasian female that lives alone. Her husband Jack passed away a year ago. She has a cat, Pumpkin, who is very important to her. Fran has one daughter, Phoebe Miller, who is 52, lives nearby, and is Fran's major support system.

Her current medical problems include: hypertension, atrial fibrillation, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia.

Fran is taking several anti-hypertensive medications, diuretics, Coumadin, and analgesics.

She was admitted to the hospital last night with a diagnosis of urinary tract infection, dehydration, and change in mental status.

The scenario takes place at 7:00 AM shift change. Fran has been in her room on A2 for about six hours. Due to her confusion, Fran did not take her medications properly in the


days prior to admission and as a result, her blood pressure is very elevated. Fran's daughter, Phoebe is at the bedside and is quite concerned about the confusion and elevated blood pressure.

The learner receives handoff report from the previous nurse and is expected to perform and document a general assessment.

Learning objectives:

At the end of the simulation, the participant will be able to:

Perform a complete systematic head to toe assessment of a simulated patient.

Identify major alterations in assessment findings: elevated blood pressure, confusion, rhonchi, murmur

- Evaluate the data

Respect and maintain patient privacy within the context of the examination.

Implement patient safety standards throughout the assessment.

Communicate clearly to patient, family member and all members of the healthcare team.

Simulation outcome checklist

(Lippincott skills checklist, ACLS, NRP or other

See attached

Monitor Layout List parameters that you want to show:

Initially just the ECG, once student assesses then add as they assess the BP, temp, SpO2

Patient Description

Name

Age

Weight and Height

Gender

Fran York

75 years old

48 kg, 61 inches

Female

History of present complaint Fran’s daughter became concerned yesterday when she stopped over to check on her and found her still in her


bathrobe at 3:00 PM. The house was very unkempt, and Fran couldn’t remember her daughter’s name. Fran was brought to the emergency department by her daughter and she was admitted to A2 around midnight. U/A, CBC, and basic metabolic panel labs have been completed and sent to the lab. Results are available.

Setting A2 - Acute care hospital unit

Patient Info:

History, Meds, Allergies and

Physician/s

Religion: Lutheran

Emergency Contact: Phoebe (daughter). Phone: 555-1210

Allergies: No known allergies

Immunizations: Influenza & pneumonia

(2 years ago)

Attending Physician/Team:

Dr. Yost

Past Medical History: Glaucoma, hypertension, atrial fibrillation, osteoarthritis, stress incontinence, hypercholesterolemia

Social History: Widow for one year; involved in church activities and gardening. Daughter and grandchildren live nearby.

Primary Medical Diagnosis: Dehydration; UTI

Surgeries/Procedures & Dates: Cholecystectomy at age 30


Show this information on the monitor before starting the simulation.

Initially just the ECG, once student assesses then add as they assess the BP, temp, SpO2

Make this information available throughout the simulation.

Significant Lab Values:

Urine Analysis:

Color: dark amber, cloudy

Specific gravity: 1.050 (normal 1.005-1.035)

ph 6.0 (normal 4.5-8.0)

RBC - 9 (normal 0-2)

WBC - 150,000 (normal 0-5)

Basic Metabolic Panel

Na - 149

K - 3.5

Glucose - 105

CBC

H/H - 9.9/32 WBC 12,000

Physician Orders:

Bedrest

Bathroom privileges with assistance

Regular, low fat diet

I & 0

Home Medications:

captopril, metoprolol, furosemide, Coumadin, Lipitor,


pilocarpine eye drops, Fosamax, Celebrex, Tramodol for arthritis pain prn

Continue home medications and add:

ciprofloxacin 200 mg IV q 12 hours

acetaminophen prn

IV fluids D5 .45 NaCl 20 mEq KCL at 60ml/hr

List equipment needed:

A. SimMan and equipment & SimMan 3G and equipmentB. Ventilator (not used in the simulation but will be used after)C. Central lineD. TelemetryE. WoundF. Chest tube G. Stage I pressure ulcerH. FoleyI. IV pole, pump, with IV solutions, bags with expiration datesJ. Computer with Powerchart training modeK. Checklist for evaluationL. Facilitator cards

Prep of the simulator:

I. Content outline

A. Introduce students to expectations of simulationa. Treat SimMan as you would a real patient.

i. Manikin talks (unless vented), blinks, has pulses, heart sounds, breath sounds, etc.

b. Student learning objectives include:i. Conduct a head-to-toe assessment of the patient

ii. Identify critical assessment findings (will be outlined on outcome checklist)

iii. Evaluate patient dataiv. Use SBAR techniques when communicating with other members of

the health care teamv. Document patient assessment

c. Facilitator will be a family member and observe, will be given a role cardd. Facilitator can answer questions about what manikin can do.e. After the simulation you will be charting your assessment in Powerchartf. At the end, the team will debrief.


B. Intro. To SimMana. Capabilities: pulse oxygen can be applied, take BPb. Gather all of your assessment data is if it was a real live patientc. Check IV and medications

C. Simulationa. Physical Assessment on non-vented pt with SimMan software

i. Receive report1. FY is a 75-year-old female admitted from home with

confusion. Her daughter noticed she wasn’t making sense or acting right when she stopped in to visit her yesterday evening. Her daughter brought her in to the ED yesterday afternoon; she was in the ED until about midnight. FY has a history of hypertension, atrial fibrillation, glaucoma, osteoporosis, arthritis, elevated cholesterol, and stress incontinence. It is unclear whether she has taken her medications properly the past few days, her daughter couldn't tell from looking at her medication box. Labs just came back, I haven’t had a chance to look at them. She has medications ordered, but they just came up from pharmacy and they all need to be given. She has not had any pain.

Number of roles and participants per scenario: 2

Primary nurse - Intern Family member - Facilitator

Timing Patient Patient/Manikin Student Cue/Prompt What


(approximate) and

Frame Name

Monitor Settings

(Actions)

(Actions) Expected Interventions

(Events)

advances frame to next frame?

Initial:

0-5 minutes

Initial State:

Vital Signs

Only initial display is heart rhythm/rate (pt is on a tele monitored floor)

Once interns takes vitals then display BP, spO2, temp

BP 180/110, P – 100, A-fib

R – 25 (do not display, want to check accuracy of intern’s assessment); T - 98.4

Vocal Sounds:

“My daughter dropped me off and left me here. I’m not quite sure where I am or why I’m here. I feel ok. I can’t believe how my life has changed in the past couple of weeks now. Howard died a couple of weeks, no months ago. I can’t remember. Why can’t I remember? Things have changed. I don’t like that; I’ve always been a strong woman. I feel ok and I take a lot of pills – not sure what they all are you can look on the kitchen counter or ask my daughter what they are. Where is Phoebe? I haven’t seen her in 6 years; no one ever comes to see me.”

Heart, lung

Wash hands

Introduce self

Identify patient

Take vital signs

Begins head-to-toe assessment

Role member providing cue:

Daughter

Cue: “I don't think she's been taking her medicine.”


sounds etc.

Murmur

Rhonchi

5-10 minutes

Complains of headache

“Has anyone checked on Pumpkin lately?"

Continues assessment

Notice elevated BP


Daughter – 7-8 minutes into scenario

Cue: “Isn’t her blood pressure too high?”

10-20 minutes

(If student asks about medications)

“I don't remember when I took my Lopressor last.” Continues to complains of headache

Calls Dr. Yost to notify of BP using SBAR communication tool

Completes physical assessment


Dr. Yost

Cue:

“Has she taken her antihypertensive? I’ll be there shortly”

Debriefing outline/questions:

A. What do you think went well?B. How did you feel throughout the simulation experience?C. Did you have the knowledge and skills to meet objectives?D. What were the key assessment findings and interventions?E. What would you do differently if we repeated the simulation?F. How can you apply this to your clinical practice?G. Differences in assessment techniques with a vented pt.

a. Demonstrate on other manikin H. Discuss areas for improvement.

Physical Assessment Evaluation Criteria


GeneralGather appropriate equipmentPerforms hand hygienePuts on gloves, if necessaryIntroduce selfIdentify the ptProvide privacy and maintain pt dignityExplain your purposeChecks patient concerns (chief complaint) prior to start of assessmentPhysical environment (temp, cleanliness, equipment in use or in room)

Inspection - using senses of vision, smell, and hearing to observe condition of various body parts, including any deviations from normal

Visually surveys the patient (details of appearance, overall condition, body habitus)Makes sure body area being inspected is sufficiently exposed and adequately lit, noting overall condition, color, shape, texture, odor, sound, and sizeLOCDisposition (facial expressions, mood, behavior)Note tubes, drains, IV's, etc. (include amount, color, odor, etc.)Always looks before touchingPerforms Vital Signs

Palpation - touching and feeling body parts with hands to determine the following characteristics

Texture (roughness, smoothness)Temperature (warm/hot/cold)Moisture (dry/wet/moist)Motion (stillness/vibration)Consistency of structures (solid/fluid filled)Tender areas are palpated last

Auscultation - Listening for various breath, heart, vasculature, and bowel sounds using a stethoscope

LungsHeartBowelsVasculature

Additional ConsiderationsProvide opportunity for patient to ask questions, express concerns, etc.Pt bed in lowest position once completeLock bed wheels if necessaryCall light within reach and pt is aware of how to useBedside table and personal items are within reachPerforms appropriate documentation of nursing assessment

References:


Lippincott Procedures – Assessment techniques, Ventilator management; Lippincott Skills Checklist – Assessment techniques, Cardiac Assessment

Weber, J. (2010). Nurses’ handbook of health assessment (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins

Appendix C


Clinical Project 2

Critical Care Internship Program

Program Description

The purpose of the Critical care Internship program is to provide the novice nurse with the essential foundation to safely care for patients and their families with in the critical care environment. The program consists of five months of clinical and didactic training.

Program Objectives

1. Provide a consistent approach for critical care orientation.2. Reduce nurse turnover and attrition in the critical care units.3. Establish a supportive environment to promote nurse maturation, acceptance and

successful transition from academia to the RN role.4. Provide a sustained approach for addressing the critical care shortage and current

vacancy rates.5. Attract new critical care recruits through an internship-marketing program.6. Promote overall job satisfaction for program participants and existing staff.7. Foster an educational environment that supports critical thinking and evidenced

based practice.8. Maintain AACN practice standards and healthy work environment

initiatives.9. Endorse Relationship Based Care principles.10. Establish preceptoring and mentoring role components to support skill acquisition

and position integration.11. Facilitate competency through AACN’s ECCO module test scores, Skills lab

competencies, Simulation competencies, EKG class exercises, blended learning activities, self-evaluation, and unit Educator, preceptor and program coordinator evaluations.

12. Provide safe, quality, critical care to fulfill the community need.

Program Teaching Strategies

Clinical Practicum with Preceptor(s) Computer based modules via Essentials of Critical Care Orientation (ECCO) by the

American Association of Critical-Care Nurses (AACN) Hands-on Skills Labs High Fidelity Simulation Articles


Basic ECG Interpretation Classroom Course Case Studies/Clinical Reasoning Activities Guided Self-Reflection Conferences/Face-to-Face Meetings

Program Schedule

Please see the program calendar for information on specific dates of required labs, classes, meeting times, etc. Interns will be notified of changes to the schedule via email. It is the intern’s responsibility to check his/her outlook email to be aware of schedule changes.

Program Coordinator Information

Patti Hresko, MSN, RN, CCRN Critical Care Internship Coordinator Office: South One (Offices past payroll)Phone: O: (231) 392-0193 H: (231) 264-9193 C: (231) [email protected] method of contact: Email

Participating Clinical Units

Emergency Department (ED)o Offers state-of-the-art design and technology with 43 private rooms,

including three full service trauma bays. Accredited through The American College of Surgeons as a Level II Trauma Center, the only one in northern Michigan.

o Manager: Kristi Johnsono Resource Clinician/Unit Educator: Rachel Blanchard

Intensive Care Unit (ICU)o 20-bed unit that serves a combined medical/surgical, trauma, and

neurological population. The Progressive Care Unit is housed in the ICU and is responsible for caring for a variety of patients with multisystem complexity.

o Manager: Jerry Hurono Resource Clinician/Unit Educator: Cathy Mowbry

Cardiothoracic Unit (A2)o 30-bed unit which encourages open visitation. The innovative acuity

adaptable rooms are designed to provide efficient care to cardiac surgical patients, immediately post-op until patient discharge.

o Manager: Eva Voisino Resource Clinician/Unit Educator: Jeanette Reynolds

Cardiac Care Unit (A3)o 30-bed unit in the Webber Heart Center is also acuity-adaptable. A3 serves a

patient population that includes adult cardiac critically ill and cardiac interventional patients.


o Manager: Lori Kirkeyo Resource Clinician/Unit Educator: Julie Bergsma

Program Materials

The following materials will be provided for you: Critical Care Internship binder with research articles and relevant critical care

nursing information ECCO skills lab book

Policies

You are accountable for your own learning which includes keeping track of changes to the program syllabus and calendar made by the coordinator and unit schedulers throughout the program.

It is the intern’s responsibility to contact the program coordinator with any issues, concerns, or questions related to the internship program.

The Internship covers a large amount of material. It is imperative to keep up with assigned ECCO modules. Professional conduct is expected at all times including dress code and social media policies. Please review Munson’s employee handbook.

Program Learning Outcomes

By the end of the internship program, the critical care intern will be able to:

1. Identify and implement evidence-based care strategies to prevent hospital-associated infections and complications.

2. Evaluate assessment data and develop a plan of care for patients with critical illness.

3. Understand basic hemodynamic monitoring concepts.4. Identify the clinical consequences of basic cardiac arrhythmias and choose

interventions that are appropriate for basic cardiac arrhythmias.5. Demonstrate knowledge of common conditions experienced by acutely ill patients

requiring critical care nursing. 6. Develop a treatment plan for patients experiencing critical illness.7. Evaluate the effectiveness of the treatment plan for patients experiencing critical

illness.8. Analyze and evaluate the role of the critical care nurse and seek to improve the

quality and effectiveness of nursing practice.Program Learning Activities & Assessment Methods

Assessment Activity Outcome(s) Due Date


Assessed

Clinical Competency Orientation Tool & Weekly Goal Sheets

1, 2, 3, 4, 5, 6, 7, 8 Weekly

Basic Knowledge Assessment Test (BKAT) 3, 5Start of internship & end of

internship

ECCO Module Exams 1, 2, 3, 5, 6, 76 modules must be completed

prior to skills labs, rest must be completed by end of internship

Skills Lab & Simulation Competency Tools 2, 3, 4, 5, 6, 7, 8 See course calendar

ECG Exam 4 May 1, 2014

Case Study Presentation 1, 2, 5, 6, 7, 8 End of internship

Case Studies/Clinical Reasoning Activities 1, 2, 3, 4, 5, 6, 7, 8 Throughout orientation program

Reflection Journals 8 Weekly

Description of Required Learning Activities

Clinical Practicum with Preceptor(s)A. Goal: To provide opportunities for the student to gain knowledge and participate in

patient care. B. Description: Upon completion of hospital orientation, the intern will rotate on each

of the four participating critical care units for approximately one week per unit. This is considered the familiarization period. After familiarization, the intern will be assigned to one of the critical care units. The intern will spend the next 4 months of their clinical practicum on their assigned unit to complete critical care orientation.

C. Objectivesa. During familiarization the critical care intern will:

i. Have an understanding of the various patient diagnoses treated on the participating critical care units

ii. Meet interdisciplinary team members on participating units.iii.

b. At the end of the clinical practicum the critical care intern will:i. Become aware of the various aspects of nursing care as an

interdisciplinary component of patient care. ii. Identify the operation of the department, i.e.

1. Duties and functions of the various personnel2. Equipment 3. Role-play with the interdisciplinary team using SBAR

Communication 4. Use information and patient care technology to communicate

effectively with members of the healthcare team


iii. Observe and/or assist with the use of treatments and therapeutic measures related to the department.

1. Administer and document administration of medications in the critical care environment

2. For assigned patients, compare observed practices with published standards.

iv. Identify the need for skills in assessment based on all body systems. 1. Perform patient assessment and evaluation of patient’s

response to pharmacological agents v. Identify the skills needed in patient and family teaching.

1. Address end-of-life decision making vi. Provide emotional support for the client, family members as needed.

1. Provide evidence-based, patient-centered end-of-life care to a dying patient and their significant others.

vii. Infection control 1. Reporting communicable diseases required 2. Universal Precautions

D. Evaluation: Clinical Competency Orientation Tool & Weekly Goal Sheets

Basic Knowledge Assessment Test (BKAT)A. The BKAT is a 90-item paper and pencil test that measures basic knowledge in

critical care nursing. These items measure content related to the following areas of critical care nursing practice: cardiovascular, pulmonary, monitoring lines, neurology, endocrine, renal, gastrointestinal/parenteral, infection control, hypothermia, burns, and spiritual care.

B. The BKAT will be taken once at the beginning of the internship program and once at the completion of the program to assess knowledge attainment.

ECCO Module ExamsA. ECCO is comprised of 10 critical care training modules; each containing multiple

lessons that provide in-depth, interactive content. Each module addresses the anatomy and physiology of a distinct body system, relevant diagnostic information and the clinical presentation and management of common disorders for each of the body systems.

B. A variety of media formats are used in the modules including: text, audio, video, animation, and tests.

C. Interns will be paid 62 hours of educational time for completion of the ECCO modules. Modules that correlate with the skills lab topics should be completed PRIOR to attending skills lab. All other modules are required to be completed by the end of the orientation program.

D. Module content includes:a. Introduction to Care of the Critically Illb. Care of the Patient with Cardiovascular Disordersc. Care of the Patient with Pulmonary Disordersd. Basic Hemodynamic Monitoringe. Care of the Patient with Neurological Disorders


f. Care of the Patient with Gastrointestinal Disordersg. Care of the Patient with Renal Disordersh. Care of the Patient with Endocrine Disordersi. Care of the Patient with Hematological Disordersj. Care of the Patient with Multisystem Disorders

ECCO Skills Labs, Simulation, & Case StudiesA. There will be four skills labs tailored for “hands-on” learning to take place over five

major content areas that correlate with ECCO learning modules including: cardiovascular, pulmonary, hemodynamics, and neuro/multisystem (neuro and multisystem are combined into one skills lab).

B. See ECCO skills lab description sheet on the next page for information about meeting locations, times, and topics covered for each of the four skills labs.

C. Simulation and unfolding case studies, as well as written case studies will be also be utilized throughout the orientation program. The purpose of these learning opportunities is to promote critical thinking, clinical reasoning, and adherence to internal and external standards of care. During simulation, the interns will often work together to care for a patient (simulated by a manikin) as a specified scenario unfolds. The intern is expected to fully engage and participate in the simulation session.

ECCO Skills Lab: January 2014 – April 2014All Skills Labs Are Located In Meeting Room 11 & 12

Time: 0800-1230 Pulmonary: Cardiovascular: Hemodynamics: Neuro & Multi-System:


May 28, 2014 June 25, 2014 July 30, 2014 April 30, 2014

Estimated pre-assignment completion time:

12.75 hours

ECCO modules which must be completed prior to attending skills lab:

Introduction to Critical Care Nursing (4.5)

Pulmonary (8.25)

o Respiratory distress & Intubation

o Ventilators/CPAP/ BiPAP

o Trach care & suctioning

o ABG’s


15.5 hours


Cardiovascular (15.5)

o Cardiac assessmento Groin managemento Heart soundso Temporary

pacemakerso Permanent

pacemakerso Arterial lines


12.75 hours


Hemodynamics (8.75)

PA Catheter Modules (4)

o PA Caths: Insertion & SVO2

o PA Caths: Waveforms and Trouble-Shooting

o PA Caths: Blood draws & Removal

o PA Caths: Cardiac Output

o Mega Codeo CVP


13.25 hours


Neurologic (8.75) Multi-System (4.5)

o Neurological Assessment

o Multi-system/Sepsis Simulation

o Neuro Simulation/ICP

o Neuro Case Studieso Organ Donation

Clinical Experience:

Patient care with preceptor relevant to ECCO topics covered

Adjunct Learning Activities:

Policy/procedure review/case review (on unit)

Don’t forget to complete all other ECCO modules by the end of the internship program

Renal, GI, Endocrine, and HematologyBasic ECG Interpretation Course

A. Focus of Course Content: The content of the course will focus on basic ECG interpretation skills for cardiac monitoring that a nurse needs to utilize in the care of critically ill patients.


B. Hours and Length of Course: Basic ECG Interpretation classroom time occurs once a week for five weeks. The classroom time total is 9 hours. Class time per day varies according to the week. The education may have nursing contact hours. Participants will spend at least 6 hours outside of class reading, studying and completing homework.

C. Rationale of the Course: Most critically ill patients will be on a cardiac monitor. Cardiac monitoring takes place in areas like telemetry units, acute critical care, the emergency room, recovery room, outpatient and procedural areas, obstetric units, pediatric units and interventional radiology. Basic ECG interpretation is a valuable skill to have. This course provides the opportunity to practice and learn the skills of interpreting cardiac rhythms that will help the critically ill patient. Nurses need to take the interpretation in context with the patient, and make a decision for interventions and education.

D. Course Description: The Basic ECG Interpretation education is a blended learning experience. Students are expected to complete the assigned reading and review prior to each class. During the class time, an instructor will review the key points. Learning activities will include interpreting strips and case studies to strengthen concepts and skills.

E. Course Outcomes: At the completion of the Basic ECG Interpretation course, the participant will be able to:

a. Interpret basic cardiac rhythms using a standard process.b. Identify the clinical consequences of basic cardiac rhythms.c. Choose interventions that are appropriate for basic cardiac rhythms.d. Identify key points for patient education regarding basic cardiac rhythms and

their interventions. F. Course Delivery Method: This education will be presented weekly in a classroom

setting. The course provides an opportunity for the learner to practice and develop the basic ECG Interpretation skills needed in the critical care environment. This delivery format follows adult learning principles and experiential learning. The learning activities will engage visual, auditory, verbal, social and physical learners. The use of technology will engage the millennial generation.

G. Attendance Policy: Interns are expected to attend all sessions as this learning activity is required for their position in the critical care department. If an interns is ill or unable to attend, they must call the Basic ECG Interpretation course instructor and also the internship program coordinator. The session content will need to be completed either on the nursing unit with their preceptor or educator, or during the next cycle of Basic ECG Interpretation.

H. Course Instructors:a. Nancy Irish, MSN, RN-BC has taught Basic ECG Interpretation since 1997.

She has over 20 years of critical care experience in cardiac, surgical and emergency critical care. She also performed 12 lead ECGs and interpretation for home care cardiac patients. She graduated with an ADN from Northwestern Michigan College in 1979, a BSN from Ferris State University in 1993, and an MSN from Walden University in 2012. Email is the best method of contact: [email protected] or phone: 935-7275.

mailto:[email protected]


b. Debra Hart, MSN, BS, RN has been one of the primary and/or substitute teachers of Basic ECG Interpretation since 1988. She has over 15 years of cardiovascular patient care experience in acute and critical care settings. Deb graduated with an ADN from Northwestern Michigan College in 1974, a BS in Allied Health Education from Ferris State University in 1987, and an MSN from Walden University in 1012. Email is the best method of contact: [email protected] or phone: 935-6498.

I. Course Resources: a. Aehlert, B. (2013). ECG’s made easy (5th ed.). St. Louis: Mosby Year Book, Inc.b. Atwood, S., Stanton, C., & Storey-Davenport, J. (2009). Introduction to basic

cardiac dysrhythmias (4th ed.). China: Mosby Jems Elsevierc. Dubin, D. (2011) Rapid interpretation of ECG’s (6th ed.). Hong Kong:COVER

Inc.d. Wolters Kluwer, & Lippincott, Williams & Wilkins. (2011). ECG interpretation

made incredibly easy (5th ed.). Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.

e. Wolters Kluwer, & Lippincott, Williams & Wilkins. (2013, July 12) Cardiac Monitoring. Retrieved from http://procedures.lww.com/lnp/view.do?pId=656349&s=p&fromSearch=true&searchQuery=cardiac+monitoring

f. www.skillstat.com J. Special Requirements: Interns will need to borrow the “Basic ECG Interpretation

made Incredibly Easy,” 5th ed. book. This book can be signed out in Staff Development, Monday through Friday 0700-1630.

K. Please see the following Basic ECG Interpretation Schedule for details regarding class dates and times, expected learning to complete prior to class, class topics, and class locations.

L. Evaluationa. Participants must pass the written ECG exam with 84% and all mandatory

rhythms identified correctly.b. If participants score between 80-84% on the written ECG exam and have all

mandatory rhythms correctly identified, they must meet and review their exam with their unit educator. The unit educator will verify that they have passed the exam after the meeting.

c. If participants incorrectly identify a mandatory rhythm (VFib, VTach, AFib, Asystole and 3 degree AV block) and/or score less than 80%, they will need to do a retake exam, after they have practiced more.

d. An education activity evaluation will be administered at each class date and at the end of the course.

e. Learning outcomes will be measured via a brief online rhythm quiz at 3 months and 6 months after passing the written ECG exam.

Basic ECG Interpretation Schedule

Start Date: March 27th Schedule

http://www.skillstat.com/

mailto:[email protected]


Date Time Complete Prior to Class Class Topics Location

Day 1

ThursdayMarch 27

4:00-7:00 p.m.

Read chapters 1-4 prior to the 1st class, filling in the Sinus Node Arrhythmia note sheets as you read chapter 4. Complete all of the chapter quizzes.

A & P, Basic Interpretation, Sinus

Rhythms

14

Day 2

ThursdayApril 10

4:00–5:30 p.m. Read chapters 5 – 6,chapter quizzes,

and complete homework

Atrial and Junctional Rhythms

D6 meeting room 1

Day 3

ThursdayApril 17

4:00 – 5:30 p.m. Read chapters 7-8,chapter quizzes,


Ventricular Rhythms, and AV Blocks

14

Day 4

ThursdayApril 24

4:00-6:00 p.m. Read chapters 9 and 10,chapter quizzes,


Pacemakers, Interventions and Review

14

Day 5

ThursdayMay 1

4:00-5:00 p.m.Rhythm Review

1. Read “Brushing up on Interpretation Skills”

2. Read “Look Alike Challenge”

3. www.skillstat.com

Written Test 14

Case Study PresentationA. Objective: Presentation of an evolving case study appropriate for your peers.

Choose a Critical Care topic. Follow the format of the educational planning table worksheet on the following page to create your outline. Choose and/or develop


audiovisual aides for presentation of the case study. Review project with program coordinator prior to presentation. Deliver the presentation. Evaluate the effectiveness of the presentation.

B. Instructionsa. Each individual will select a topic of interest.b. Selected topic must be approved by program coordinator before you begin

working on the project. c. Develop evolving case study that shows progression of patient’s disease

process, with complications.d. Case study must be higher level learning geared toward nursing peers

utilizing Evidence Based Practice. Case study may include experiences on your particular clinical unit.

e. Presentation should be developed using the attached worksheet.f. Presentation should be scholarly, well researched utilizing current scholarly

journal articles, appropriate websites, and AV/media/PowerPoint.g. Time frame for each presentation is approximately 1 hour.h. A copy of the presentation worksheet should be emailed to

[email protected] by date on program calendar and must include references in APA format.

C. The presentation must include the following information:a. Introduction: Section consists of introducing/presenting the patient.

Required elements: Patient initials, date of birth, age, race and gender, current ht & wt, and date of admission.

i. Chief complaint: (why the pt came into the hospital) and primary admitting diagnosis.

ii. HPI: history of present illness (length of illness and signs and symptoms on admission). Provide a detailed course of illness and his or her present health state (are they better, worse or the same).

b. Overview of patient: History, bio-psycho-social assessments, diagnostic tests (and why they were ordered), pharmacological interventions (including reason it was prescribed, therapeutic effects expected, and adverse effects to monitor), EKG interpretation, hemodynamics, nutritional measures, and genomic considerations.

c. Pathophysiology: Review pathophysiology of the condition including etiologies, clinical manifestations, expected outcomes, current research, demographics, and relating this information to the assigned patient.

d. Plan of Carei. Part 1: Generate and discuss nursing diagnosis in planning care for

the patient. ii. Part 2: Priorities of care, plan, and evaluation of outcomes.

e. Research-based Interventions: Evaluate the care this patient received related to your research of the condition.

f. References: Cite all references used in the paper. The references must include at least one peer-reviewed journal article. The article must be less than 5 years old, and must be longer than 2 printed pages to count. Your


other references can be textbooks and internet sites. The reference section must follow APA 6th edition format

D. Evaluation of Presentationa. Please see rubric on the following page for evaluation criteria.


EDUCATIONAL PLANNING TABLELIVE EVENT

Educational Activity:

Purpose of Activity: To improve the knowledge of nurses caring for patients with cardiac tamponadeInstructions: Type directly into blank cells of the tables.

OBJECTIVESList learner’s objectives in behavioral terms. (After completing this activity, the learner will be able to…)

CONTENTProvide an outline of the content for each objective. It must be more than a restatement of the objective.

TIME FRAMEState the time frame for each objective.

PRESENTERList the faculty for each objective.

TEACHING METHODSList the teaching methods, strategies, materials & resources for each objective.


(Add more rows as needed by placing cursor outside of last row and clicking ‘Enter’ key.)

Total minutes for this activity/session (including time spent evaluating the activity) =List the evidence-based reference(s) used for developing the content of this educational activity/session next to the appropriate category.

Information from organization/website:(may be published or unpublished content. Examples – Centers for Disease Control, National Institutes of Health)

Peer –reviewed journal/resource:(reference should be within past 5-7 years)

Clinical guidelines:(published or online. Example -www.guidelines.gov)

Expert resource:(individual, organization, or educational institution - book, article, website)

Textbook reference:Other:

Running head: PRACTICUM PAPER 54

Case Study Presentation RubricBelow Expectations Needs Improvement Meets Expectations Exceptional Comments

Organization

Below Expectations Needs Improvement Meets Expectations Exceptional Comments

The presentation was not clearly organized and was difficult to follow.

There was no introduction or

conclusion.

The presentation was somewhat organized, but it

may be a little difficult to follow. The presentation

was missing an introduction or summary.

The presentation was organized, but clear

learning objectives and summary may be

missing. An introduction provided sufficient

background on topic and preview of major points.

The presentation was well organized with clear objectives, introduction

of topic and major points, and summary.

Content


Presentation content lacks depth and breadth. Major points are unclear.

Objectives are incomplete and not clearly supported by appropriate sources.

Presentation content is somewhat developed.

Major points are somewhat clear. Objectives may not be complete and

may not be clearly supported by appropriate

sources.

Presentation content is developed. Major points

are stated clearly. Objectives are mostly

complete and supported by appropriate sources.

Presentation content is thoughtfully developed

and supported by appropriate and current sources (< 5 years unless

a classical resource). Major points are stated

clearly and supported by specific examples.

Subject Knowledge


Presenter does not have grasp of information;

presenter cannot answer questions about subject.

Presenter is uncomfortable with information and is

able to answer only rudimentary questions.

Presenter is at ease with expected answers to all questions, but fails to

elaborate.

Presenter demonstrates knowledge by answering

questions with explanation.

Audio/Visual


Presenter uses no audio/visual aids.

Presenter use audiovisual aids to read out the

material.

Presenter's A/V relates to text and presentation.

Presenter's A/V explains and reinforces topic and

presentation.

Eye Contact


Presenter reads all of report with no eye

contact.

Presenter occasionally uses eye contact, but still reads

most of report.

Presenter maintains eye contact most of the time but frequently returns to

notes.

Presenter maintains eye contact with audience,

seldom returning to notes.

Elocution


Presenter mumbles, incorrectly pronounces terms, and speaks too quietly for audience to

hear.

Presenter's voice is low. Presenter incorrectly pronounces terms.

Audience members have difficulty hearing

presentation.

Presenter's voice is clear. Presenter pronounces most words correctly.

Most audience members can hear presentation.

Presenter uses a clear voice and correct,

precise pronunciation of terms so that all

audience members can hear presentation.

Enthusiasm


Shows absolutely no interest in topic

presented.

Showed some negativity toward topic presented.

Occasionally showed positive feelings about

the topic.

Demonstrated a strong positive feeling about

topic during entire presentation.

CreativityBelow Expectations Needs Improvement Meets Expectations Exceptional CommentsNo creativity/information

appears to be taken be directly from a book.

Lacks creativity. Shows some creativity. Creative.

PRACTICUM PAPER 55

Reflection JournalsA. Reflecting on one’s practice is considered an important part of the

learning process. Thus, each week interns will make a journal entry of observations, insights, and discoveries encountered that week. Personal reflections should be related to clinical tasks, activities, and/or experiences.

B. Examination of progress, identification of strengths and weaknesses, and goals for improvement should also be included in your journal entries.

C. Journals should be approximately one page in length. Please date each entry by the week and place all entries into one ongoing document.

D. Journals should be emailed to the program coordinator at the end of the intern’s clinical week.

Intern Evaluation of Program

Interns are provided the opportunity, and are strongly encouraged to participate in a program evaluation at the end of the internship.

PRACTICUM PAPER 56

Appendix D

Simulation Evaluation

Munson Medical Center - Simulation Evaluation FormTitle of Presentation: Critical Care Physical Assessment Simulation

Date: 3/21/14 Location: Sim Lab

Please complete the evaluation form below by placing an “X” in the box that best fits your evaluation of the educational activity. Completion of this form is required to successfully complete this conference and be awarded contact hours for the program.

Purpose/Goal of this Simulation:

At the end of this program, I was able to:

Strongly Agree

Agree Neutral Disagree Strongly Disagree

1. Perform a full systematic head-to-toe physical assessment on a simulated patient

4

2. Identify major alterations in the assessment

4

3. Evaluate patient data 44. Communicate clearly to patient,

family and healthcare team4

I clearly understood the purpose and objectives for the simulation.

4

The scenario resembled a real-life situation.

3

Did the scenario allow you to use your critical thinking and decision making skills?

4

Did the scenario allow you to use your communication skills?

4

The simulation provided a variety of ways in which to learn the material.

4

The prep material provided to review before the simulation was valuable.

4

The debriefing session was well-organized.

4

The facilitator, _Erin , demonstrated expertise in the content area.

4

Feedback provided during the 4

PRACTICUM PAPER 57

debriefing was constructive.The simulation activity reinforced my knowledge base.

4

After participating in the simulation activity, do you feel more confident in a similar situation in the clinical environment?

4

What did you find most valuable participating in the simulation?Hands on training is always the best for me

What would you like to see done differently in the next simulation?None

How will you apply the information from the simulation activity into clinical practice?All of it I will apply

PRACTICUM PAPER 58

Appendix E

Practicum Evaluations

Student name: Erin Kibbey________________________________________________________

Evaluated by: Erin Kibbey________________________________________________________

Goal/Objective Strongly Disagree

Disagree Neutral Agree Strongly Agree

Comments

Standard of Practice: Facilitation of Learning

Shows enthusiasm for teaching,

learning, and nursing

X

Demonstrates interest and respect for

learners

X

Uses personal attributes such as caring, patience,

integrity, flexibility, etc. to facilitate

learning

X

Serves as a role model of

professional nursing

X

Models critical and reflective thinking

X

Creates opportunities for learners to

develop critical thinking skills

X

Uses information technologies

skillfully to support the teaching-learning

X

PRACTICUM PAPER 59

process

Practices communication that reflects awareness of

self and others

X

Ability to convey ideas in a variety of

contexts

X

Demonstrates recognition of

multicultural, gender, and experiential

influences on teaching and learning

X

Implements a variety of teaching strategies

X

Teaching strategies are appropriate to learner, outcomes,

context, content, etc.

X

Engages in self-reflection and

continued learning to improve teaching

X

Standard of Practice: Use Assessment & Evaluation Strategies

Uses literature to develop evidence-

based assessment and evaluation practices

X

Uses a variety of strategies to assess

and evaluate learning

X

Provides timely feedback to learners

X

Provides constructive feedback to learners

X

PRACTICUM PAPER 60

Uses evaluation data to enhance the

teaching-learning process

X

Standard of Practice: Participate in Curriculum Design and Evaluation of Program Outcomes

Ensures curriculum reflects current

nursing and health care trends

X

Identifies program outcomes

X

Identifies learner needs

X

Writes appropriate learning objectives

X

Selects appropriate learning activities

X

Implements appropriate

evaluation strategies for new curricula

X

Bases curriculum design on

educational principles, theory,

and research

X

Demonstrates overall knowledge of

curriculum development

X

Comments:

PRACTICUM PAPER 61

PRACTICUM PAPER 62

PRACTICUM PAPER 63

PRACTICUM PAPER 64

Appendix F

Evaluations from Interns

Evaluation 1

PRACTICUM PAPER 65

PRACTICUM PAPER 66

Evaluation 2

PRACTICUM PAPER 67

PRACTICUM PAPER 68

Evaluation 3

PRACTICUM PAPER 69

PRACTICUM PAPER 70

Evaluation 4

PRACTICUM PAPER 71

PRACTICUM PAPER 72

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