NR 536 Design of an Experiential Learning Activity

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Design of an Experiential Learning Activity

Nurse educators must design learning activities that engage students in active learning. Research suggests that students learn best when they are placed in immersive situations that challenge them to analyze information, apply learned knowledge, and use past experiences. The learning activity must also maintain student engagement after completion, encouraging further inquiry and reflection outside the classroom. This enables students to revisit the experience, recall what was learned, and understand how to apply it effectively.

Part 1: The Learning Activity

For this learning activity, I have chosen an evolving case study to be conducted during a post-conference session. The target audience consists of baccalaureate nursing students in their final semester, working in small groups of three to four. Each group will receive the case study information and address specific learning objectives. The five key learning objectives for this activity are as follows:

1. Explain how communication affects the work environment and patient outcomes.
2. Provide rationale for the nurse offering alternative options to the patient.
3. Demonstrate active listening skills to facilitate effective communication.
4. Discuss the benefits of holistic care for the patient.
5. Identify ethical issues presented in the scenario.

Learning objectives offer structure and clarity, guiding both the nurse educator’s assessment and the students’ focus. These objectives are designed to promote active learning, encouraging students to think critically and draw upon their cumulative knowledge. By imagining themselves in the given scenario, students will connect previously learned concepts to a realistic situation, preparing them to handle similar challenges in their future clinical practice. Through group discussions, students will have an opportunity to explore different perspectives and deepen their understanding within a supportive learning environment.

Part 2: The Case Study

The evolving case study is set in a nursing unit, where the nurse educator overheard an interaction the previous evening. The scenario begins at 8:00 AM, with three main characters:

• Healthcare Provider (HCP): Female, 50 years old, MD
• Registered Nurse (RN): Male, 35 years old, charge nurse on the unit
• Nurse Manager (NM): Female, 45 years old, with a master’s degree in leadership

The case study unfolds with the nurse manager receiving an email from the charge nurse regarding an incident that occurred overnight, which he wishes to discuss. The scenario introduces tension as the HCP accuses the RN of overstepping boundaries by suggesting alternative treatment options to a patient without consulting her. This interaction escalates, touching on issues of professional boundaries, communication, and civility.

Each student group will adopt the perspective of one of the three roles: nurse manager, RN, or HCP. They will discuss key themes such as civility, ethics, and conflict resolution, proposing ways the situation could have been managed more effectively. By role-playing these characters, students can practice active listening and critical thinking, encouraging mutual respect and open-mindedness. Effective communication skills are emphasized, as students learn to focus on the speaker’s message rather than formulating their response prematurely (Clark, 2015).

Part 3: Debriefing and Reflection

Debriefing is essential to consolidate learning and allows students to process new knowledge, address misconceptions, and integrate personal experiences. This debriefing session will facilitate group discussions in which students share their insights, reflecting on the case study and proposing alternative approaches. Each group will discuss what went wrong in the interaction, suggest improvements, and exchange perspectives. The Socratic questioning method will be used to encourage deeper reflection, with questions such as:

1. What communication barriers did you identify in the scenario?
2. How would you promote civility in future interactions with the provider?
3. Did the nurse act ethically in this situation? Why or why not?

NR 536 Design of an Experiential Learning Activity

The debriefing will conclude with a discussion on civility and ethics, emphasizing the importance of maintaining a respectful work environment and fostering teamwork in healthcare settings (Clark, 2015). These discussions help students understand the complexities of real-world clinical situations, offering them a knowledge base to draw from in their future practice. By engaging in experiential learning activities that involve role-play, reflection, and Socratic questioning, students gain valuable experience in handling conflict, promoting civility, and maintaining professionalism in healthcare (Foronda, MacWilliams, & McArthur, 2016).

References

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10.

NR 536 Design of an Experiential Learning Activity

Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse Education in Practice, 19, 36-40.

NR 536 Discussions

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Week 1: Social Determinants of Health

The social determinants of health are critical in shaping the health outcomes and well-being of individuals. For health care professionals, it is essential to approach assessments with an open mind, respect for diversity, and awareness of any implicit biases that may influence their evaluation of social, cultural, economic, educational, and environmental factors. During Week One, reflection on these aspects highlighted the importance of incorporating these factors into a holistic health assessment.

One exercise involved identifying three specific social determinants: access to mass media (e.g., cell phone/internet), social/family support, and health literacy. Each plays a vital role in patient care and health outcomes. For example, during the COVID-19 vaccine rollout, it became clear that access to internet and cell phone services was essential for scheduling appointments and managing health information through online systems like MyChart. Without this access, many patients struggle to manage their care. Similarly, social support systems are a cornerstone of holistic care, particularly in stressful health situations. Identifying if a patient lacks support can prompt healthcare providers to connect them with available resources. Health literacy is another key component; understanding a patient’s capacity to comprehend their diagnosis, treatment, or care instructions enables nurses to tailor educational approaches for improved outcomes.

Using a holistic approach, certain questions can help gauge the influence of social determinants on individual health. For example:

1. “Do you have access to medical records and care information electronically?”
2. “What kind of support system do you have at home?”
3. “What is the best way to educate you about new information related to your health?”

The Synergy Model provides a valuable framework for understanding the dynamic relationship between nurses and patients. This model underscores the importance of the nurse’s competencies in improving patient outcomes by recognizing social and health literacy needs. Addressing biases and respecting differences in age and cultural backgrounds further enriches person-centered care and enhances inclusivity.

Week 2: Health Promotion and Preventive Education

Health promotion models offer effective frameworks for advanced nursing practice, particularly in promoting preventive care and addressing health variables holistically. For example, in managing glaucoma—a chronic eye condition that can lead to blindness if untreated—education on preventive measures and risk factors is essential, especially for elderly patients who may be more susceptible. Regular eye exams, understanding family history, and maintaining protective measures are crucial preventive actions.

Two variables, including accessibility to eye care and health literacy, influence health promotion efforts. Patients without adequate insurance coverage may face financial barriers to regular eye exams, affecting early detection and treatment. Moreover, low health literacy can hinder patient understanding of care instructions. Employing the “teach-back” method allows nurses to confirm that patients comprehend their condition and care, thus enhancing the effectiveness of education. Advanced knowledge in physical assessment, pathophysiology, and pharmacology supports this process, allowing nurses to communicate medical information accurately and promote long-term health effectively.

Week 3: Nurse as Educator for Respiratory Conditions

In Week Three, the role of the MSN-prepared nurse as an educator was emphasized, with a focus on respiratory health. Chronic or acute respiratory conditions, such as chronic obstructive pulmonary disease (COPD), necessitate patient education and supportive health promotion models. By using the Health Belief Model, nurses can better understand patient perceptions of risk and encourage proactive management of their respiratory health.

For example, asking patients, “What concerns do you have about managing your respiratory symptoms?” and “What strategies have been helpful in coping with breathlessness?” helps assess readiness and adaptability. Encouraging cultural sensitivity and openness fosters respect and builds trust, making education more effective.

Case Scenarios and Continuum of Care Transitions: Osteomyelitis

In Week Five, a scenario involving osteomyelitis, an infection in the bone, underscored the importance of a continuum of care. Osteomyelitis often requires surgery and prolonged IV antibiotics, with potential transitions across multiple care settings. Such a journey, from emergency department admission to surgical units, rehabilitation, and possible long-term outpatient care, introduces numerous physical, psychosocial, and economic challenges.

Patients with osteomyelitis face potential physical limitations, psychosocial stressors, and financial burdens, particularly if they require home adaptations. Holistic, advanced assessments in pathophysiology and pharmacology are essential for person-centered, safe care during these transitions, especially in anticipating complications and supporting recovery goals.

NR 536 Discussions

Social Determinants of Health: Impact on Patient-Centered Care

NR 536 Discussions

References

Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health. Retrieved from https://www.cdc.gov/socialdeterminants/index.htm

World Health Organization. (2019). Social determinants of health. Retrieved from https://www.who.int/social_determinants/en/

NR 536 Week 7 Designing an Experiential Learning Activity

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Experiential Learning Activity

Part 1: Foundation for the Learning Activity

Experiential learning is an essential approach that integrates multiple facets of nursing practice, including theoretical knowledge, practical skills, challenges, communication, collaboration, ethical considerations, and professional codes of conduct, into a unified learning experience (Jones & Guthrie, 2012). It emphasizes “hands-on” skills, psychomotor abilities, concept mapping, and interactive methods (Nunes et al., 2015). The purpose of this paper is to design an experiential learning activity tailored for young nurses with less than two years of clinical experience. This activity aims to enhance their skills, knowledge, and quality of practice. The activity will cover essential learning objectives and be tailored to specific learners within designated settings and scenarios.

Description of the Experiential Learning Activity

This learning activity will be conducted in a skills lab replicating an ICU environment, equipped with a full-sized human patient simulator (HPS) mannequin simulating a chronic condition. The activity is structured as part of a mentoring program for new graduates. Groups of five nurses, including recent graduates and those with under two years of experience, will be assigned varied roles with specific responsibilities. A mentor will observe and record each group’s interactions, decisions, patient outcomes, ethical choices, and civility within the simulated workplace setting.

Each group will receive a scenario that outlines the characters’ attributes, including their attitudes, skill levels, and roles. The mentor may intervene only if the group strays from the set objectives or storyline. Following the scenario, group members will evaluate each other’s behaviors and discuss challenges faced in patient care and interprofessional communication, aiming to propose solutions (Victor et al., 2015). Observers not actively participating will conduct guided observations to contribute to the reflection process. In this reflective phase, the mentor will facilitate by asking questions and suggesting alternatives, following Kolb’s experiential learning model to incorporate abstract conceptualization, active experimentation, concrete experiences, and reflection.

Learning Objectives

This activity encompasses three primary objectives: enhancing interprofessional communication and collaboration, promoting ethics-based decision-making, and instilling an understanding of workplace civility. These objectives will be woven into scenarios and characterizations to create an authentic learning environment. The simulated ICU setting, with the HPS mannequin, aligns with the competencies expected of new graduate nurses and supports the development of their clinical and interpersonal skills.

Part 2: Presentation of the Learning Activity

Description of the Setting

The skill development lab, set up to resemble an ICU in an acute care environment, will include two adjacent rooms and a central hallway. The lab will be equipped with a ventilator, patient monitoring system, and a full-sized HPS mannequin representing a patient with congestive heart failure at risk of developing ventilator-acquired pneumonia. This lab setup divides into four areas: the ICU with a ventilator and HPS mannequin, two adjacent rooms separated by a compartment, and a hallway. Observing students will be seated in a circular arrangement around the activity area, while participants will engage in various roles—one nurse handling the mannequin, an assistant, nurses in two adjacent rooms, a mentor, and a student acting as a nurse leader.

Identification of the Characters and Roles

The nurse educator assumes the roles of instructor and observer, as well as the non-participating student and nurse leader. This individual will facilitate the activity, manage resources, mediate conflicts, and promote civility. The nurse leader exhibits strong decision-making, communication, and problem-solving skills but struggles with patience under pressure. The nurse (Nurse 1) stationed bedside as the anesthesiologist and monitor has a calm, cooperative demeanor, yet displays low self-confidence. Another nurse (Nurse 2), responsible for hygiene and rapid triage, is outgoing, confident, and empathetic. In the adjacent rooms, Nurse 3 is assertive, experienced, and prone to dominate discussions, while Nurse 4 is skilled but introverted and non-confrontational. These varied characteristics influence interactions and outcomes within the scenario.

Outline of the Scenario

The setting involves three patients: a 65-year-old male with congestive heart failure in the ICU and two others in adjacent rooms. Hospital policy mandates bundle treatments to prevent infections in bedridden patients, including a 30-degree ventilator angle and scheduled physiotherapy. When a family member raises concerns over a missed physiotherapy session, the ICU nurse notices a discrepancy in ventilator angle in one room. This discovery leads to a conflict between Nurse 1 and Nurse 3, with incivility and ethical issues surfacing as the conversation escalates. Nurse 2 intervenes by alerting the nurse leader, while Nurse 4 remains passive. The nurse leader ultimately steps in to mediate, involving all parties to resolve the dispute.

Interactions between the Characters

Sample Dialogue:

Nurse 3: “What are you doing here?”

Nurse 1: “The family reported missed physiotherapy. I also noticed the ventilator angle is incorrect. I’m just checking for potential issues. I suggest adjusting sedation timing for patient comfort and recovery.” (Exemplifies interprofessional communication)

Nurse 3 (angrily): “I don’t need a rookie telling me what to do. Here, the assigned nurse handles the patient. It’s my responsibility!” (Displays incivility and cultural prejudice)

Nurse 1: “I was born here. I’m just trying to help the patient, but I apologize if it’s seen as interference.” (Reflects on ethical dilemmas)

Debriefing

The debriefing process is integral to this experiential learning activity, facilitating participant reflection and understanding (Victor et al., 2015). Initial debriefing introduces participants to the purpose and objectives of the simulation, clarifying roles and responsibilities and allowing for questions about each role’s impact and the experiment’s objectives (Romaniuk et al., 2020). The second debriefing, conducted in the lab setting, further prepares participants with a scenario walkthrough, while a rehearsal finalizes role positioning and readiness (Young & Dufrene, 2020).

Socratic Questions

1. How does open-ended communication compare to scripted dialogues in experiential learning?
2. Is it effective to conduct only one simulation with a single group?
3. What barriers might hinder successful implementation of this learning activity?

Conclusion

Experiential learning activities significantly enhance nursing competencies, incorporating key objectives like collaboration, ethical decision-making, and workplace civility. This design integrates Kolb’s model within a simulated ICU using HPS mannequins, effectively addressing new graduates’ learning needs.

NR 536 Week 7 Designing an Experiential Learning Activity

References

Jones, B., & Guthrie, K. (2012). Teaching and learning: Using experiential learning and reflection for leadership education. New Directions For Student Services. https://doi.org/10.1002/ss.20031

Nunes, S., Prado, M., Kempfer, S., & Martini, J. (2015). Experiential learning in nursing consultation education via clinical simulation with actors: Action research. Nurse Education Today, 35(2). https://doi.org/10.1016/j.nedt.2014.12.016

Romaniuk, D., Paula, M., & Liu, L. (2020). Comparison of debriefing methods after a virtual simulation: An experiment. Clinical Simulation In Nursing, 19. https://doi.org/10.1016/j.ecns.2018.03.002

NR 536 Week 7 Designing an Experiential Learning Activity

Victor, C., Turk, M., & Adamson, K. (2015). Effects of an experiential learning simulation design on clinical nursing judgment development. Nurse Educator, 40(5). https://doi.org/10.1097/NNE.0000000000000159

Young, A., & Dufrene, C. (2020). Successful debriefing—Best methods to achieve positive learning outcomes: A literature review. Nurse Education Today, 34(3). https://doi.org/10.1016/j.nedt.2013.06.026

NR 536 Week 5 Develop an Evolving Case Study

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

NR 536 Week 5: Development of an Evolving Case Study

Overview of Evolving Case Study

The objective of this case study is to create a comprehensive treatment plan aimed at preventing and alleviating symptoms associated with ventilator-associated pneumonia (VAP) in the intensive care units (ICU) of acute healthcare settings. This case study is particularly targeted at nursing staff who have accrued at least three years of ICU experience. Key concepts covered include patient safety, infection control, and evidence-based practices in preventing VAP, such as the use of oral hygiene protocols (Hua et al., 2016), awareness of antibiotic resistance (Khan et al., 2017), sedation management, and physical assessment practices (Álvarez-Lerma et al., 2018). Additional topics include physiotherapy (Zampieri et al., 2015), and appropriate medical device use to enhance patient care and reduce VAP risk.

Case Study Setting

This scenario unfolds within the ICU of an acute healthcare facility, where a patient with respiratory failure receives oxygen supplementation, intubation, and mechanical ventilation. The patient is under sedation and is also receiving IV anticoagulants, IV fluid infusions, and is connected to monitoring equipment, including cardiac and pulmonary monitors and a vital sign machine. Wall suction is also in place.

Patient Profile

Name: Mr. XYZ
Gender/Age/Weight/Height: Male, 65, 252 lbs, 5’10”
Allergies: Codeine
Past Medical History: Patient has a history of diabetes, asthma, an ischemic stroke in December 2019, paroxysmal atrial fibrillation, coronary artery bypass surgery in 2016, as well as a history of smoking (40 pack years) and alcohol use.
Present Illness History: Mr. XYZ was admitted on February 8, 2020, with complaints of tachypnea, shortness of breath, and chest pain. The patient experienced a rapid desaturation and developed respiratory distress, necessitating intubation in the emergency room.
Social History: He is a retired software engineer living with his wife, with two adult children residing out of state.
Primary Medical Diagnosis: The patient’s main diagnosis is pulmonary embolism, complicated by pleural effusion, respiratory failure, and hypoxemia.
Surgeries and Procedures: These include a CT scan, blood and urine cultures, arterial blood gas testing, a COVID-19 test, daily EKGs, blood tests, and chest X-rays.

Table: Evolving Case Study Information and Learning Objectives

Debriefing

Stage 1 Focus: What preventive measures are effective in reducing VAP in chronically ill patients?
Stage 2 Focus: Should components of the VAP bundle, such as head inclination and oral hygiene, be implemented more than once daily?
Stage 3 Focus: How can we swiftly control bacterial growth in the lungs and trachea?
Overall Case Study Focus: What comprehensive methods ensure prevention and treatment of VAP in bed-bound patients?

References

Álvarez-Lerma, F., Palomar-Martínez, M., Sánchez-García, M., Martínez-Alonso, M., Álvarez-Rodríguez, J., & Lorente, L. et al. (2018). Prevention of ventilator-associated pneumonia. Critical Care Medicine, 46(2), 181-188. https://doi.org/10.1097/ccm.0000000000002736

Bardia, A., Blitz, D., Dai, F., Hersey, D., Jinadasa, S., Tickoo, M., & Schonberger, R. (2019). Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. The Journal Of Thoracic And Cardiovascular Surgery, 158(4), 1094-1100. https://doi.org/10.1016/j.jtcvs.2019.01.014

Fortaleza, C., Filho, S., Silva, M., Queiroz, S., & Cavalcante, R. (2020). Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units. The Brazilian Journal Of Infectious Diseases, 24(5), 373-379. https://doi.org/10.1016/j.bjid.2020.08.004

NR 536 Week 5 Develop an Evolving Case Study Hellyer, T., Ewan, V., Wilson, P., & Simpson, A. (2016). the intensive care society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal Of The Intensive Care Society, 17(3), 238-243. https://doi.org/10.1177/1751143716644461

Hua, F., Xie, H., Worthington, H., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd008367.pub3

NR 536 Week 5 Develop an Evolving Case Study

Khan, Z., Ceriana, P., & Donner, C. (2017). Ventilator-associated pneumonia or ventilator-induced pneumonia. Multidisciplinary Respiratory Medicine, 12. https://doi.org/10.4081/mrm.2017.224

Olanipekun, T., & Snyder, R. (2019). Mortality risk in ventilator-acquired bacterial pneumonia and nonventilator icu-acquired bacterial pneumonia. Critical Care Medicine, 47(10), e851-e852. https://doi.org/10.1097/ccm.0000000000003662

Pinho, R., Tanure, L., Pessoa, J., Santos, L., Couto, B., & Starling, C. (2020). Impact of each component of a ventilator bundle on preventing ventilator-associated pneumonia and lower respiratory infection. Infection Control & Hospital Epidemiology, 41(S1), s259-s260. https://doi.org/10.1017/ice.2020.824

Prasad, R., Daly, B., & Manley, G. (2019). The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. Special Care In Dentistry, 39(5), 524-532. https://doi.org/10.1111/scd.12414

NR 536 Week 5 Develop an Evolving Case Study

NR 536 Week 5 Develop an Evolving Case Study Vieira, P., de Oliveira, R., & da Silva Mendonça, T. (2020). Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles?. Medicina Intensiva. https://doi.org/10.1016/j.medin.2020.09.009

Xie, X., Lyu, J., Hussain, F., & Li, M. (2019). Drug prevention and control of ventilator-associated pneumonia. Front Pharmacol, 10(298). https://doi.org/10.3389/fphar.2019.00298

Zampieri, F., Nassar Jr, A., Gusmao-Flores, D., Taniguchi, L., Torres, A., & Ranzani, O. (2015). Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-0868-y

NR 536 Week 5 Develop an Evolving Case Study

Zhao, J., Li, L., Chen, C., Zhang, G., Cui, W., & Tian, B. (2020). Do probiotics help prevent ventilator-associated pneumonia in the critically ill patients? A systematic review with meta-analysis. ERJ Open Research, 00302-2020. https://doi.org/10.1183/23120541.00302-2020

NR 536 Week 4 Discussion

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Health Risks for Vulnerable Cardiovascular Patients

In an out-patient cardiovascular clinic serving low-income and homeless individuals, MSN-prepared nurse leaders encounter unique health challenges within this vulnerable population. Cardiovascular disease in this demographic often presents increased health risks, including cholesterol issues, uncontrolled hypertension, and diabetes. Patients may also struggle with unmanaged stress, anxiety, or depression, which can exacerbate heart health complications. Additional risks include a lack of regular physical activity, poor diet, substance abuse, and smoking. These combined factors contribute to significant obstacles in managing cardiovascular health within this community.

Physical and Social Determinants of Health Influencing Cardiovascular Health

Various physical and social determinants play critical roles in affecting the cardiovascular health of this population. Accessibility to healthcare resources, such as primary care clinics, mental health services, and support groups, remains a significant social determinant. Proximity to care can be a challenge, as patients may live far from healthcare facilities and lack reliable transportation options, especially given the economic instability faced by low-income and homeless individuals. A prominent physical determinant affecting this population is their living environment. Many patients live in unsanitary conditions and lack consistent access to nutritious foods, further compromising their ability to adhere to heart-healthy diets or specific medical recommendations. Recognizing these determinants allows healthcare providers to address underlying issues that hinder cardiovascular health in this population.

Person-Centered Strategies to Promote Cardiovascular Health

To effectively support cardiovascular health in this population, MSN-prepared nurse leaders can employ three person-centered strategies. First, assess each patient’s unique goals of care to tailor treatment and resources to their needs. Second, assist patients in identifying and connecting with local resources that support their healthcare goals, including social services and support networks. Third, provide education that aligns with patients’ objectives, helping them understand the path toward goal attainment and fostering future health maintenance. These person-centered approaches help patients feel more empowered and supported in managing their cardiovascular health.

Competency in Advanced Health Sciences

Advanced skills in health assessment, pathophysiology, and pharmacology are essential for MSN-prepared nurses serving this population. Competency in these areas enables nurse leaders to accurately assess health risks and identify early signs of complications. With a deeper understanding of disease processes and pharmacological interventions, nurse leaders are better equipped to provide effective, individualized care, facilitate preventive strategies, and act as a reliable support system for patients navigating complex health challenges.

NR 536 Week 4 Discussion

Table of Key Considerations for Cardiovascular Health in Vulnerable Populations

NR 536 Week 4 Discussion

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education.

NR 536 Week 3 Developing Critical Thinking Questions

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Week 3 Assignment: Developing Critical Thinking Questions

Concept to be Presented: Protection and Movement – Infections

This assignment focuses on creating critical thinking questions related to protection and movement, specifically addressing infections like ventilator-associated pneumonia (VAP). The learner targeted in this case is a staff nurse working in an acute healthcare hospital with three years of experience in patient protection and infection management. Developing critical thinking skills in such healthcare professionals is crucial to improve patient outcomes, particularly in infection prevention and control.

Problem Recognition

A 65-year-old male patient has been admitted with chest pain, later diagnosed as localized pleuritis. In this healthcare setting, the hospital-acquired pneumonia (HAP) rate is reported at 3.8%, with a high possibility of VAP among patients. Reducing these infection rates and preventing VAP are the primary goals in managing this patient’s care.

Table 1: Critical Thinking Questions for Problem Recognition

Clinical Decision Making

To address the VAP risk, the healthcare team implemented a VAP prevention bundle, aimed at reducing VAP incidence, hospital stay duration, and treatment costs. This approach aligns with evidence-based practices in infection control.

Table 2: Critical Thinking Questions for Clinical Decision Making

Prioritization and Clinical Intervention

The healthcare team prioritized 24-hour patient monitoring to lower VAP risk, aiming to minimize potential stress and workload implications for nurses. The use of multimodal interventions, including sedation management protocols, was also considered for optimizing care.

Table 3: Critical Thinking Questions for Prioritization and Clinical Intervention

References

Álvarez-Lerma, F., et al. (2018). Prevention of ventilator-associated pneumonia. Critical Care Medicine, 46(2), 181-188. https://doi.org/10.1097/ccm.0000000000002736

Bardia, A., et al. (2019). Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. The Journal of Thoracic and Cardiovascular Surgery, 158(4), 1094-1100. https://doi.org/10.1016/j.jtcvs.2019.01.014

Fortaleza, C., et al. (2020). Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units. The Brazilian Journal of Infectious Diseases, 24(5), 373-379. https://doi.org/10.1016/j.bjid.2020.08.004

Hellyer, T., et al. (2016). The intensive care society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 17(3), 238-243. https://doi.org/10.1177/1751143716644461

Hua, F., et al. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008367.pub3

NR 536 Week 3 Developing Critical Thinking Questions

Khan, Z., et al. (2017). Ventilator-associated pneumonia or ventilator-induced pneumonia. Multidisciplinary Respiratory Medicine, 12. https://doi.org/10.4081/mrm.2017.224

Olanipekun, T., & Snyder, R. (2019). Mortality risk in ventilator-acquired bacterial pneumonia and nonventilator ICU-acquired bacterial pneumonia. Critical Care Medicine, 47(10), e851-e852. https://doi.org/10.1097/ccm.0000000000003662

Pinho, R., et al. (2020). Impact of each component of a ventilator bundle on preventing ventilator-associated pneumonia and lower respiratory infection. Infection Control & Hospital Epidemiology, 41(S1), s259-s260. https://doi.org/10.1017/ice.2020.824

Prasad, R., et al. (2019). The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. Special Care in Dentistry, 39(5), 524-532. https://doi.org/10.1111/scd.12414

NR 536 Week 3 Developing Critical Thinking Questions

Vieira, P., et al. (2020). Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles? Medicina Intensiva. https://doi.org/10.1016/j.medin.2020.09.009

Xie, X., et al. (2019). Drug prevention and control of ventilator-associated pneumonia. Front Pharmacol, 10(298). https://doi.org/10.3389/fphar.2019.00298

Zampieri, F., et al. (2015). Nebulized antibiotics for ventilator-associated pneumonia: A systematic review and meta-analysis. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-0868-y

Zhao, J., et al. (2020). Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis. ERJ Open Research, 00302-2020. https://doi.org/10.1183/23120541.00302-2020

NR 536 Week 2 Collaboration Café Reply 2

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Week 2 Collaboration Café Reply 2

Hi Lorraine Ledgerwood,

I agree with your statement that certain strategies can facilitate faster adoption of clinical decision-making skills among learners. According to Nibbelink and Brewer (2018) and Price et al. (2017), the intuitive approach proves to be more accurate and dependable than narrative thinking in the development of clinical judgment skills. This suggests that when evaluating similar clinical cases, the role of intuition becomes evident, particularly in the cue acquisition process, supporting better decision-making outcomes.

Price et al. (2017) further emphasizes that nurse educators should actively encourage learners to engage in structured reflections on their decision-making processes. By doing so, students are presented with opportunities that drive them toward utilizing contextually informed and holistic intuitive processes. This structured reflection can help learners cultivate the intuition necessary for high-quality clinical decision-making.

Thank you for sharing such an insightful post!

NR 536 Week 2 Collaboration Café Reply 2

Discussion of Techniques for Clinical Decision-Making

References

Nibbelink, W., & Brewer, B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917–928. https://doi.org/10.1111/jocn.14151

NR 536 Week 2 Collaboration Café Reply 2

Price, A., Zulkosky, K., White, K., & Pretz, J. (2017). Accuracy of intuition in clinical decision-making among novice clinicians. Journal of Advanced Nursing, 73(5), 1147–1157. https://doi.org/10.1111/jan.13202

NR 536 Week 1 Collab Cafe Hollistic Assessment and Social Determinants of Health

Name

Chamberlain University

NR-536: Advanced Health Assessment, Pathophysiology & Pharmacology for Advanced Nursing Practice

Prof. Name

Date

Social Determinants of Health and Their Impact on Health and Person-Centered Care

Social determinants of health are various factors influencing an individual’s health and well-being, often tied to political, social, and economic conditions (Islam, 2019). For this assignment, the selected social determinants are income, transportation, and time. Individuals with low income face higher risks for adverse health outcomes as they are less likely to have health insurance, a regular source of care, or access to new drugs, technologies, and primary or specialty care (Khullar & Chokshi, 2018). Additionally, many may refuse care due to its cost. For healthcare providers, delivering person-centered care to these individuals can be challenging, especially when patients decline necessary care due to financial constraints. Similarly, limited access to transportation restricts an individual’s ability to attend healthcare appointments or access nutritious food, impacting their health. Without reliable transportation, patients might miss crucial appointments, affecting their health outcomes. Time also plays a significant role; maintaining a healthy lifestyle requires time for healthcare access, proper nutrition, exercise, and rest. Individuals who cannot devote time to health-related activities may experience deteriorating health. Providers can advise on healthy habits, but these suggestions may not be practical for individuals without adequate time resources (Islam, 2019).

Strategies for Assessing Social Determinants of Health Using a Holistic Approach

Using a holistic approach to assess social determinants of health can provide healthcare providers with valuable insights into factors impacting an individual’s health. One effective method is the use of screening tools, which are brief questionnaires that cover areas such as housing, food, transportation, utilities, and personal safety (O’Gurek & Henke, 2018). Another approach is to engage in open-ended conversations with individuals to better understand their personal circumstances. Combining these methods allows providers to examine an individual’s specific concerns through questionnaires and subsequent discussions, addressing topics that emerge as potential barriers to health. Some example questions to explore social determinants might include: (1) “What is your current living situation?” (2) “In the past six months, have you ever worried about running out of food?” and (3) “Within the last six months, have you struggled to pay for essentials like food, housing, or medical care?”

The Synergy Model Framework for Addressing Health Literacy and Social Determinants

The Synergy Model emphasizes the importance of a positive, responsive relationship between nurses and patients, wherein patient needs guide nursing actions (Cordon et al., 2021). According to this model, effective nursing care involves assessing the patient’s needs and developing tailored strategies to address them. In building connections with patients, nurses first evaluate their ability to address each individual’s unique circumstances. Effective communication is essential to assess social determinants and health literacy, allowing nurses to determine the patient’s knowledge level and understanding of healthcare. By asking questions about the individual’s medical history and their prior experiences with healthcare, nurses can gauge health literacy. Following this, social determinant assessments are conducted in a clear, straightforward manner to facilitate understanding, enabling a patient-centered approach to address specific health challenges.

References

Cordon, C., Lounsbury, J., Palmer, D., & Shoemaker, C. (2021). Applying the Synergy Model to inform the nursing model of care in an inpatient and ambulatory care setting: The experience of two urban cancer institutions, Hamilton Health Sciences and Grand River Regional Cancer Centre. Canadian Oncology Nursing Journal, 31(2), 186-194. https://doi.org/10.5737/23688076312186194

Islam, M. M. (2019). Social Determinants of Health and Related Inequalities: Confusion and Implications. Frontiers in Public Health, 7, 11. https://doi.org/10.3389/fpubh.2019.00011

Khullar, D., & Chokshi, D. A. (2018). Health, income, & poverty: Where we are & what could help. Health Affairs Health Policy Brief, 1-5. https://doi.org/10.1377/hpb20180817.901935

NR 536 Week 1 Collab Cafe Hollistic Assessment and Social Determinants of Health

O’Gurek, D. T., & Henke, C. (2018). A practical approach to screening for social determinants of health. Family Practice Management, 25(3), 7-12. https://www.aafp.org/fpm/2018/0500/p7.html?