Winona Health ICU Orientation
Abstract
This paper presents a continuation of the previous discussion to allow for an analysis of the curriculum determined at that time. The curriculum that this project explores is to be implemented at Winona Health (2018) which is a small 70 bed community hospital is seated 45 miles between two large multispecialty clinics and hospitals, one clinic/hospital being well known throughout the world as the number one medical center. An overview of the facility and the curriculum presented in the previous section of the project are provided as well as a discussion of the theoretical foundation and organizing design that best describes the curriculum. The competency-based learning design and the experiential learning theory were discussed relating to the history, major concepts, and application of each to the curriculum. Based on the research available for the competency-based learning design and the experiential learning theory, it is determined that the curriculum can help to orient the newly graduated nurses to the facility and foster an ongoing learning environment.
Overview
The curriculum that this project explores is to be implemented at Winona Health (2018) which is a small 70 bed community hospital is seated 45 miles between two large multispecialty clinics and hospitals, one clinic/hospital being well known throughout the world as the number one medical center. It has been difficult to retain quality nurses; many leave following a year of service to experience a larger medical facility, pursue education or for financial reasons. The facility has recently undergone a significant loss of nurses which resulted in the necessity to spend the exaggerated labor cost of hiring travel nurses to meet the needs of the patients. To avoid the continuum of this costly practice, the facility turned to recruiting new Associate Degree Nurses from the local non-accredited nursing program at the local technical college. With a sign on bonuses and positive recruitment, we were able to obtain seven new graduates for the Intensive Care Unit. However, it was quickly realized that these inexperienced nurses would not only need to be properly trained on the demands of the Intensive Care Unit but also adapted to the policies and procedures of the facility. Therefore, an effort was initiated to design an official orientation competency-based curriculum.
Orientation for the Intensive care unit will be based on the American Association of Critical Nurses, Essentials of Critical Care Nurses Orientation or ECCO (AACN.org, 2018). The flexibility of the ECCO allows the curriculum to meet the needs of different learners as Tseng, H., and Walsh (2016) point out that blended delivery methods of knowledge yield higher scores and greater satisfaction among the students. Given the recognition of different learning styles and the extensive list of competencies that the ICU nurse must be able to apply to uphold the mission and values of the facility, the curriculum will include information provided by face to face instruction from the hospitals nurse educator, computer-based training using information and techniques recognized by the American Association of Critical Nurses, and group meeting/discussions which will be scheduled on a weekly basis; these all will be completed in conjunction with the education provided by the orientee’s preceptor when they are providing care to patients. As the competency-based curriculum necessitates an assessment of the competencies, this nursing orientation curriculum will provide advanced computerized and face to face presentations including a learning system for computerized examinations, also known as computer-based training. By maintaining the ongoing meetings with the nurse educator, it will ensure that scenarios that arise on the floor will be quickly addressed. Maintaining an ongoing relationship with the preceptor will allow the nurses to apply the competencies under the guidance of a tenured ICU nurse and foster long term healthy relationships in the workplace.
Organizational Design and Theoretical Framework
When considering the organization and design of the curriculum, I feel that it meets the criteria of a competency-based curriculum and can be discussed through the lenses of the Experiential Learning Theory as presented by Kolb (2014). While multiple theories have been explored to come to this assertion, the combination of face-to-face, computer generated, and hands on experiences lend to the decision to focus on this theoretical framework.
History
According to Parson, Childs, and Elzie (2018), competency-based learning began at the turn of the 19th century and was reignited during the 1970s to streamline education and reduce the associated costs while still ensuring that the students were able to complete the program with the necessary skills to enter the void positions. The competency-based learning curriculum is found to be relevant in all disciplines, but Parson, Childs, and Elzie (2018) note that the healthcare industry has leaned heavily on this design due to the wide range of knowledge and skills that must be acquired during the educational or training process.
The experiential learning theory was first presented by Kolb in 1984 in order to redirect the typical behavioral analysis of the learning process. The theorist explains that the more traditional ways of discussing the process of learning support the idea that all individuals learn the same and that each individual, regardless of their personal and work experiences, can acquire the knowledge through traditional educational delivery so long as their behavioral and cognitive functions are aligned. Kolb (2014) however, recognizes that each individual is different and that, in order to determine how or what they will learn, one must take into account these experiences. The theory has evolved through the continued emphasis of the theorist, but the primary concepts remain intact.
Major Concepts
According to Parson, Childs, and Elzie (2018), the major concepts of the competency-based learning are based in the idea that the outcomes of learning are more important than the emphasis on the method of teaching or the time constraints of traditional learning. The researchers explain that the goal of this form of learning is to prepare the learners to apply the skills and knowledge in a practical manner so that the ongoing process of learning extends beyond the initial information delivery. The design is learner-centered, evidence-based, and encourages ongoing discussions to determine new areas of opportunities for improvement (Parson, Childs, & Elzie, 2018).
According to Kolb (2014), the major concepts of the experiential learning theory are founded on the notion that all students learn through their experiences, perceptions, behaviors, and cognitive abilities. The knowledge is received through any number of delivery systems but often decoded differently based on these varying characteristics. Kolb (2014) explains that, in order to be able to apply the knowledge or skills in an appropriate manner, the knowledge must be flexible and adaptable to these experiences. In other words, Kolb (2014) states that the application of knowledge and the experience of this application can serve as a tool for additional knowledge that may never have been taught in the traditional setting.
Application
To apply the competency-based learning to the presented curriculum, the focus is on the learning outcomes and the ability of the individual to apply the skills learned to their work in the ICU. Although there is a timeline of delivery of the initial knowledge, the nurses are not restricted to this timeline for learning because of the ongoing relationship with the preceptor and continued meetings with the nurse educator. Competencies will continue to be developed through hands on experience while the patient outcomes will be ensured by the design of the program.
To apply the experiential learning theory, it is important to note that medical knowledge is not static and that practice changes often come as the result of an analysis of these experiences. The program focuses on the different ways that an individual learns by providing multiple delivery methods and encouraging a learning environment. Additionally, the weekly meetings will allow the nurses to discuss any practice issues and, as a result, allow them to initiate new knowledge through their personal experiences and perceptions. This critical element of the orientation process will foster an evidence-based environment, continued learning, and strong working relationships between the different levels within the facility. According to Kolb (2014), the experiential learning theory focuses on the goal of seeking knowledge which, in healthcare, is a desirable characteristic.
Agenda
Monday
8:00AM – 10:00 AM
Welcome to Winona Health Intensive Care Unit, meet and greet the nurse educator and nurse manager of the unit
Staffing in the Intensive care Unit
HUC role and job description
CNA role and review of job description
10:30AM – 11:00 AM
Review of orientation procedure
Review the ECCO model for orientation
11:00 AM – 12:00 AM
Sign into Cerner and CBT’s (clinical based training)
Medication administration, patient safety reviewing using the scanner
12:00PM – 1:00 PM Lunch
1:00 PM – 3:00 PM
Review restraints, application, and charting
Review CIWA scoring
Review Braden Scoring
Review of catheter insertion, charting and daily required care
3:00 PM – 3:15 PM break
3:15 PM – 3:30 PM
Review CPR
4:00 PM – 5:00 PM
Question answer
Start ECCO
Tuesday
7:30 AM – 10:00 AM
Review of heart rhythms and sounds
10:00 AM – 10:15 AM Break
10:15 AM – 12:00 AM
Review of heart rhythms
12:00 PM – 12:30 PM Lunch
12:30 PM – 2:00 PM
Lung sounds and ABG analysis
2:15 PM – 2:30 Break
2:30 PM – 4:00 PM
Lab values
Wednesday
7:30 AM – 9:00 AM
Quality and Safety
9:00 AM – 9:15 AM
Hand Hygiene
9:15 AM – 10:00 AM
Infection Control
10:00 AM – 10:15 AM Break
10:15 AM – 11:00 AM
SBAR Communication
11:00 AM – 12:00 PM
Interprofessional Communication
Time Management
12:00 PM – 12:30 PM Lunch
12:30 PM – 2:00 PM
ECCO training
2:00PM – 2:15 PM Break
2:15PM – 4:00 PM
Inpatient Code Blue
Skills Stations to include:
- Bed Alarm
- Care Planning Overview and how to resolve Care Plan Activity at Discharge
- Pressure Ulcer Prevention
- Baxter Sigma Infusion Pump
- Guldman Repositioning Sling – repositioning patient in bed
- Over the Head Isolation Gowns
- BD Insyte Auto guard
- Accucheck blood glucose meter
- BD Safety Glide Syringes for TB, Insulin and Allergy In-service
Thursday
7:30 AM – 10:00 AM
ECCO training
10:00 AM – 10:15 AM Break
10:15 AM – 12:00 PM
Putting it all together
12:00 PM – 12:30 PM Lunch
12:30 PM – 4:30 PM
Meet preceptors
Spend time getting to know preceptor and their regimen for orientation
Friday
7:30 AM – 9:00 AM
Breakfast and learn with nurse educator
9:00 AM – 4:30 PM
Floor with preceptor
Weekly the orientee will be working with their preceptor and gaining further knowledge and improving nursing skills.
Every Monday AM there will be a breakfast lunch and learn with the nurse educator from 7:30 AM – 9:00 AM, this will be followed with time on the floor.
Closing
In closing, this paper has provided an overview of the facility and curriculum that was presented in the previous section of the project. This led to an analysis of the curriculum to include a discussion of the design and theoretical framework. The competency-based learning design and the experiential learning theory were discussed relating to the history, major concepts, and application of each to the curriculum. The curriculum has been found to meet the criteria of each, and the application strengthens the initial intention of orienting the new nurses while also improving the overall environment in the facility by promoting ongoing learning and an evidence-based emphasis to the practice.
References
Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and development. FT press.
Parson, L., Childs, B., & Elzie, P. (2018). Using Competency-Based Curriculum Design to Create a Health Professions Education Certificate Program the Meets the Needs of Students, Administrators, Faculty, and Patients. Health Professions Education.
Tseng, H., & Walsh Jr, E. J. (2016). Blended vs. Traditional Course Delivery: Comparing Students’ Motivation, Learning Outcomes, and Preferences.
Winona Health. (2018). [Data file].
