1. National League of Nursing (NLN)
Flight of the Phoenix
Education Summit 2014
September 16 - 20, 2014
Presented by:
Prof. Sandi King, DNPc, RN
Made possible through:
LSSU's Funding Innovations in Teaching Program (FIT) Grant
2. FIT Grant Application
The overall objective for attending the Summit is to have the opportunity to collaborate and dialogue with a diverse nursing education community. The collaboration opportunity and new information I will gain from the educational sessions I plan to attend will ultimately provide me with information and ideas that will help me to excel in my role as a nurse educator at Lake Superior State University (LSSU), as well as prepare me to conduct my independent Capstone Project Study beginning in Spring 2015.
With the new knowledge I will gain at the Summit, in addition to pursing my DNP, I will be able to build my personal leadership, management and educational skills and expand upon my theoretical and evidence-based foundation of nursing. I have a strong desire to further develop my evaluation and research skills and become an instrumental part of advancing our profession
3. The conference, as described in the Summit brochure, was "specifically designed for nurse educators from all types of programs who are Doctoral (DNP) students conducting research in nursing education. The Summit attracted more than 1500 faculty and administrators who gathered to explore nursing education issues, innovations in nursing education, and transformation of teaching practices through pedagogical research. It was a great opportunity for me, as a doctoral student, to become integrated into the network of master teachers and academic scholars."
In particular, there were several workshops and sessions where the main focus was incorporating simulation into nursing programs and conducting independent research, disseminating research findings and research proposal writing for the Doctoral student.
FIT Grant Application
4. Capstone Project Issue
•Lack of quality and consistency of mental health clinical placements
•Lack of evidence-based practice literature on the topic
•Students report anxiety when working with mental health patients
•Students report lack of self-confidence when working with mental health patients
5. Capstone Project Purpose
•Enhance BSN student mental health clinical experience
•Student-reported decrease in anxiety
•Student-reported improvement in self- efficacy (self-confidence)
•Prepare BSN students for career
•Provide quality EBP data
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6. •PICO Question:
In senior BSN nursing students at a rural university and enrolled in a community mental health course, can use of a simulated clinical experience, employing a standardized patient, decrease student-reported anxiety and enhance self-efficacy prior to their clinical interaction with a hospitalized psychiatric patient?
Capstone PICO
•P: Senior BSN nursing students at a rural university enrolled a community mental health course
•I: Use of clinical simulation with standardized patients prior to first face-to-face clinical experience
•C: Usual practice of case study prior to clinical experience
•O: Decreased anxiety and enhanced self-efficacy
7. Personal Mission Statement
“To improve the self-efficacy of nursing students through carefully planned and implemented classroom and clinical learning activities based upon nationally recognized initiatives in evidence-based patient care, safety, utilization of resources, leadership, and collaborative relationships with patients, families, healthcare professionals, and the community.”
Capstone Project Objectives Mission
LSSU Mission Statement
“To help students develop their full potential. We launch students on paths to rewarding careers and productive, satisfying lives. We serve the regional, state, national and global communities by contributing to the growth, dissemination, and application of
knowledge.” (LSSU, 2012, p. 3).
LSSU SON SIM Center Mission Statement
“To provide experiential learning opportunities for students, faculty, and community partners using state- of-the-art technologies and best practices in simulation-based education.” To promote the use of simulation in healthcare education to meet the needs for collaboration, communication and teamwork resulting in improved patient safety and reduction of human error. (R. Hutchins, personal communication, 2014).
8. Personal Vision Statement
“To graduate new nurses who are sought after by local, regional, state and national health care systems based upon their ability to enter the workforce fully prepared to assume a position by demonstrating education and skills superior to new nurses graduating from other institutions.”
Capstone Project Objectives Vision
LSSU Vision Statement
“Our programs grow and evolve in ways that keep our graduates at the cutting edge of technological and societal advances…..”
(LSSU, 2012, p. 3).
LSSU SON SIM Center Vision Statement
“To be recognized as an accredited, state-of-the-art, inter-professional simulation center in health care education for the region, Midwest and Canada.”
(R. Hutchins, personal communication, 2014).
9. Capstone Project Objectives Goals
• Provide Senior-level BSN nursing students with skills that can be
transferred into a Community Mental Health clinical setting leading
to decreased anxiety, increased self-confidence and improved
clinical judgments.
• The overall goal of my project is to provide evidenced-based
practice findings related to the benefit of incorporating simulation,
with standardized patients, into BSN nursing courses, specifically
Community Mental Health and to implement these findings into
nursing education practice for optimal student learning.
10. •To determine baseline student mental health content knowledge
•To determine pre-intervention student-reported anxiety and self-efficacy
scores prior to their mental health clinical experience
•To determine the effect of a simulation experience on post-intervention
student-reported anxiety and self-efficacy scores prior to the mental health
clinical experience
•To determine the student-reported anxiety and self-efficacy scores for
students in the control group completing a case study experience only
•To compare student-reported anxiety and self-efficacy scores for the
simulation and control groups of students
•To evaluate the equivalency of the student groups based on aggregate
analysis of specific demographic variables
Capstone Project Objectives Outcomes
11. • Pre-study information session
• Pre-study Consent form
• Quasi-Experimental with random assignment to groups
• senior-level BSN Nursing students in NURS433
• pre-intervention demographic survey
• pre-intervention mental health knowledge test
• repeated measures of pre- and post-intervention survey to
assess anxiety and self-confidence
• Convenience sample
• Post-study intervention for control group
Capstone Project Methodology & Evaluation: Design
12. Capstone Project Methodology & Evaluation: Population & Sampling
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•Senior BSN Students enrolled in Community Mental Health course
•Anticipated total population of 30 students (n=30)
•Anticipated convenience sample size of 15 students (n=15)
•Inadequate power potential
Participants
Intervention Group
Follow-up
Follow-up
Control Group
Random Assignment
Compare Results
14. • Validated Demographic
Questions Survey
• Mental Health Knowledge Test
• NASC-CDM 26- item scale
• validated quantitative instrument
• forced-choice 6-point Likert-scale
• anxiety and self-efficacy focus
• written permission to use required
Capstone Project Methodology & Evaluation: Instrument Reliability & Validity
White, K. A. (2014). Development and validation of a tool to measure self-confidence and anxiety in
nursing students during clinical decision making. Journal of Nursing Education, (53)1, 14-22.
15. •Study will seek to increase the skills of the nursing students and
allow them to reduce levels of anxiety and gain confidence in their
abilities before working with mentally ill patients
•Study will seek to offer students methods that can be used to handle situations they may encounter with patients who have serious psychiatric or mental health conditions
•Study will seek to educate students on effective ways to work with mentally ill patients to help improve safety & contribute to better outcomes
A confident, skilled new nurse will be readily-employable,
which will help them to achieve their goals in nursing practice,
but will also be an asset to the health care system and the
organization in which they practice.
Capstone Project Summary
16. Summit Agenda
Summit Session Focus: Creative Use of Simulation & Technology
Pre-Summit Workshop: The Basics for New Faculty
Session 1: Outcomes Following a Simulation of Living in Poverty
Session 2: Impact of Simulation on Nursing Students’ Attitudes Towards Schizophrenia
Session 3: Using Simulation Education to Advance Care Excellence for Veterans
Session 4: Ready, Set, Go: Sophomore capstone Scenarios Prepare Students for Clinical Experience
Plenary Session: NCSBN National Simulation Research Study Results
A Validation Protocol for Nursing Simulation Scenario Development
Mission Impossibole: Increasing Confiodence Theough Multi-Patient Simulation
Special Session: Laerdal – Vsims; Virtual Simulaton; Teaching Thinking Differently
Evaluation of Students During Human Patient Simulation: What it’s Worth?
ACES Cases in All Sorts of Places
Post-Summit Workshop: Caring for Vulnerable Populations: Mental Health; Gerontology; Veterans; Alzheimer’s Unfolding Cases. Moderator for Session
Contacted ASU, College of Nursing and Health Innovation
Learning Resource Center/Educational Simulation Program Director for Tour
17. ASU, College of Nursing and Health Innovation
Learning Resource Center/Educational Simulation Program
18. ASU, College of Nursing and Health Innovation
Learning Resource Center/Educational Simulation Program
19. ASU, College of Nursing and Health Innovation
Learning Resource Center/Educational Simulation Program
20. ASU, College of Nursing and Health Innovation
Learning Resource Center/Educational Simulation Program
21. 1. The nurse is told by a client that she is having suicidal thoughts. Which of the following interventions has lowest priority?
A) Administering a mental status exam to assess for psychosis
B) Assessing the client for past history of suicidal attempts
C) Determining the client's concerns and if she has a plan
D) Maintaining a safe, secure environment
2. The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what?
A) Develop rapport based on trust and understanding.
B) Assess the cause of his or her depression.
C) Prevent self-destructive behavior.
D) Assist him or her in the expression of sad and helpless feelings.
3. A mental health nurse is working with a client with antisocial personality disorder. Thenurse has just reviewed the unit rule of one cigarette per break. While telling him about the unit rules, he asks, “Well, if I have not done anything bad all day, can I have two cigarettes instead of one?” The most therapeutic nursing response would be which of the following?
A) “Well, that's a good question. I need to check with the team.”
B) “No, only one cigarette is allowed per break time.”
C) “This is a good example of trying to push your limits.”
D) “It depends on whether or not we can make that exception that day.”
Pre-Summit Exam
22. 1. A 27-year-old female has been brought to the emergency department by EMS following a violent sexual assault that took place in the parking garage of her building. Which of the following tasks would fall most clearly within the scope of practice of a forensic nurse? What is the role of the forensic nurse? 2 points
a) Providing reassurance to the woman that the care team and the police will prioritize her care
b) Collecting specimens from the woman for use as evidence
c) Asking the woman to describe the perpetrator in detail and documenting her statement
d) Assisting with diagnostic tests to determine the extent of the woman's injuries
Rationale:
2 A young client with a new diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which of the following instructions should the nurse provide to this client? 2 points
Explain the rationale for your answer choice?
a. “Try to limit your fluid intake to no more than four to six glasses per day”
b. “If you don’t feel substantially different in a few days, increase your dose by 50%”
c. “When you exercise, try to avoid doing so at the hottest times of the day”
d. “Try to adapt a low-salt diet as soon as possible”
3. A 39-year-old woman was the victim of a violent assault 1 year ago and, in the ensuing period, has developed the symptoms of posttraumatic stress disorder (PTSD). Additionally, she has become heavily dependent on alcohol and required multiple visits to the emergency department for alcohol poisoning. What category of dual diagnosis does this client exhibit? 2 points Explain the rationale for your answer choice?
a. Primary diagnosis of major mental illness with a subsequent secondary diagnosis of a substance- related disorder
b. Substance-related disorder that results in a secondary mental illness
c. Mental illness and substance-related disorder occurring simultaneously with no apparent etiologic relationship
d. Substance-related disorder and mood disorder occurring due to an underlying traumatic experience
Post-Summit Exam
23. Post-Summit Exam
1. Scenario: A 35-year-old female client is newly admitted to an acute care mental health facility for her third episode of major depressive disorder. She lives at home with her husband and two school-age children. She has stopped taking all of her medications – except her Paxil and an herbal remedy, cooking, doing housework, and grooming herself or the children during the past 3 weeks. She has not let the house for the past 4 weeks. She says she has a complete lack of energy to do anything, a lack of appetite with a 10-pound weight loss, constipation, abdominal pain, and an inability to sleep more than 5 hours each night (wakes up early and cannot get back to sleep) and has been “seeing things” in the shadows. She states that she developed a rash on her arms and legs and has been having spells where she feels like her heart is “beating out of her chest” about 6 weeks ago. About 4 weeks prior to this admission, the client charged over $5,000 onto the family credit card in EBay and TV Shopping Channel purchases, which has put the family into debt. During the admission interview with you, the client states, “It would be better for my family if I just wasn’t around ever again. I’m no good for them anymore, and I have no control over any part of my life.” 16 points
24. Post-Summit Exam
a. Complete OMAHA Care Plan – brief, with provided information. Choose top 2 domains for focus. 6 Points
b. Complete DSM-IV information for this client – with provided information. 4 points
Axis 1:
Axis 2:
Axis 3:
Axis 4:
GAF Score:
c. Which should be included in this client's plan of care? 2 points Explain the rationale for your answer choice?
i. A simple, structured daily schedule with limited choices of activities
ii. A daily schedule filled with activities to promote socialization
iii. A flexible schedule that allows the client opportunities for decision making
iv. A schedule that includes mandatory activities to decrease social isolation
d. The client’s husband tells the nurse, “I hope my wife will be able to take her St. John’s Wort here in the hospital because it has always helped anxiety.”
Which of the client’s symptoms could be related to taking St. John’s Wort? 2 points Explain the rationale for your answer choice?
e. The client started taking Paxil (paroxetine), an SSRI, about 7 weeks ago. What should the client and her husband know about taking this medication (contraindications)? 2 points Explain the rationale for your answer choice?
e. The client started taking Paxil (paroxetine), an SSRI, about 7 weeks ago. What should the client and her husband know about taking this medication (contraindications)? 1 point Explain the rationale for your answer choice?
27. “I liked the exam this week. It was challenging, but easy to work through. I am starting to like this style”.
“Reviewing for the exam was important and proves to be effective”.
“The main points of this week’s topics were going over the exam and what the test questions will look like. We learned why it is important to know why you choose an answer and the rationales for choosing the right one. This skill of taking the test in this way can be applied to taking the NCLEX”.
“Wednesday’s main topic was test review. This review put a lot of my stress and anxiety at bay and I feel much better about Monday’s test.”
“Monday’s main topic was our first test! I didn’t know what to expect for the test and I became stressed when it was handed out and I had to fill out a care plan and DSM axes, however, I think that the test made me think outside of the box and critically think instead of just picking between four answers”.
“After the first test, I now know what to expect for future tests and have less stress. I think that it’s nice to know that I actually knew what I was talking about, because I could explain my reasoning for choosing answers, rather than simply taking a wild guess between four choices”.
28. Thank You!
Feedback?
Suggestions?
It is only through
proper preparation of practitioners that there can be an improvement in service delivery.
