High-Fidelity Simulation for Postpartum Hemorrhage Curriculum Proposal, Exams of Nursing

Download High-Fidelity Simulation for Postpartum Hemorrhage Curriculum Proposal and more Exams Nursing in PDF only on Docsity! Running head: HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 1 High-Fidelity Simulation for Postpartum Hemorrhage Western Governors University College of Health Professions HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 2 Executive Summary This proposal addresses a curriculum gap identified at Western University as the lack of utilization of high-fidelity simulation (HFS) in the prevention and management of postpartum hemorrhage module. A proposed curricular change from LFS to High-fidelity simulations (HFS) to improve the student’s confidence and clinical skills is recommended. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was utilized as a guide for the recommended curricular change proposal. During the analysis phase, a gap analysis was completed to identify the curriculum gap of their current practice. The analysis discovered that underutilization of HFS in preventing and managing postpartum hemorrhage module. A thorough literature review was completed that identified that when nursing students are exposed to simulations, they are more confident and competent in skills at the clinical facility. A force field analysis was completed to identify forces that support and oppose the change and to identify the organization's readiness to change. The force field analysis revealed an absence of the HFS technology utilization that allows educators to provide students with more real-life practice experience, stimulating decision-making skills, and more confidence in the workforce. During the design phase, the course syllabus consisting of the course description, course objectives, teaching, and instructional strategies, learning materials, student learning outcomes, course policies, and a grading policy was created. The masters of science nursing (MSN) student lined up the course syllabus with the module topic from the existing patient-centered care: childbearing family curriculum to promote the module integration. The nursing student's diversity at Western University helped increase the knowledge they gained from this course. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 5 High-Fidelity Simulation for Postpartum Hemorrhage HFS are essential for nursing curriculums. The preventing and managing postpartum hemorrhage module is currently utilizing LFS to help students gather knowledge before entering the clinical setting. The problem identified is that LFS does not adequately prepare students for the clinical setting. The proposed curricular change is to utilize HFS in preventing and managing postpartum hemorrhage modules to improve students' confidence and skills. A literature review is completed to determine evidence-based research that supports the use of HFS in courses. The theoretical framework that will support this improvement proposal is the education theory constructivism. The five phases of the ADDIE model is utilized as the framework for designing the curricular change. The analysis phase consists of a needs assessment, a force field analysis, identifying key stakeholders, and assessing the organization's readiness for the curricular change. The design phase is when the course syllabus, objectives, and learning outcomes are outlined. In the development phase, course materials, learning resources, and assessment activities are designed. The implementation phase is when the proposed curricular content change is put in the curriculum for students. The evaluation phase is when the proposed curricular change is evaluated to see if the set goals for the proposed change were met. A curriculum proposal document is a way to present ideas of improvement or change to a current curriculum to better the program. Literature Review A literature review is a vital step to find credible sources to support the change proposal. Ten excellent sources that support the proposal are seen in the Literature Review Summary Table, Table 1. that is provided at the end of the document. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 6 Curriculum gap The MSN student completed a thorough investigation to identify the curriculum gap of inadequate use of HFS for preventing and managing postpartum hemorrhage module. There are several reasons why this gap emerged. This gap occurred due to veteran faculty not interested in learning how to utilize HFS equipment. This gap has also happened due to faculty feeling uncomfortable setting up simulations because postpartum hemorrhages are episodic events. The constructivist theory is when a student builds on existing knowledge through experiences (Billings & Halstead, 2016). This theory helped to identify the need for utilization of HFS in postpartum hemorrhage because many students do not get to experience this crisis in the clinical setting, allowing them to build their knowledge. Summary of Sources Ten articles were identified as being supportive of the proposal of the change to the preventing and managing postpartum hemorrhage module of LFS technology to HFS technology. Two of the ten articles have a level one strength of evidence. These articles are the ones authored by Labrague, McEnroe, Bowling, Nwafor, and Tsaras (2019) and Kim, Park, and Shin (2016) and are reviews of literature. The meta-analysis by Kim et al. (2016) and a hierarchy of systematic review for Labrague et al. (2019) are the review of the literature. The article by Baptista, Paiva, Gonçalves, Oliveira, Pereira, and Martins (2016) is the only randomized control trial study, which is a level two strength of evidence, of the ten articles that were selected for this proposal. A hierarchy and strength level of three, which is quasi-experimental, was identified for three of the ten articles. The quasi-experiment articles include the one by Basak, Unver, Moss, Watts, and Gaioso (2016), the article by Unver et al. (2018), and the article by Raman, Labrague, Arulappan, Natarajan, Amirtharaj, and Jacob (2019). Sarman and Pardi (2019) article is the only HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 7 single non-experimental study, which is a level four strength of evidence, of the ten articles that were selected for this proposal. The article by Akselbo, Olufsen, Ingebrigtsen, and Aune (2019), the article by Amod and Brysiewicz (2019) and the article by Au, Lo, Cheong, Wang, and Van (2016) are all qualitative studies, which is a level six strength of evidence, of the ten articles that were selected for this proposal. All articles reviewed identified undergraduate nursing students as the primary study group studied. Many different countries were part of the studies identified in the literature review. The results from the literature review were very supportive of the proposal. The results showed that student satisfaction scores of simulations were better for the high fidelity than the low-fidelity simulations. Raman et al. (2019) state that adding HFS to nursing education is beneficial to the students' performance. Amod and Brysiewicz (2019) state that students who have complex, realistic emergencies learn more from their experiences. Akselbo et al. (2019) state that simulations gave students more thought about the nurse's responsibility. Labrague et al. (2019) state that simulations are instrumental in boosting a student's self‐confidence and reducing anxiety when caring for patients. Kim et al. (2016) state that simulation-based nursing education is successful in numerous learning environments. Unver et al. (2018) state that HFS strengthens a student's critical thinking, decision-making skills, and confidence. Baptista et al. (2016) state that satisfaction with the realistic scenarios, students were recognizing critical conditions, and making decisions on interventions were higher with HFS. Basak et al. (2016) state that satisfaction scores from students were higher for HFS. Sarman and Pardi (2019) state that students expressed high satisfaction and self -confidence in learning when using high fidelity clinical simulations. Au et al. (2016) state that nursing students appreciated the HFS more than real clinical time. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 10 tubes, and intravenous lines. The knowledge level of the typical learner includes the following concepts: activities of daily living, fluid and electrolyte balance, nutrition, elimination, oxygenation, and perfusion. These students are now just increasing their knowledge and improving their skills. The current learning environment used to teach these students is the standard classroom setting with lecture and scenario-based activities to deliver information to the students. Needs assessment A gap analysis identifies the deficit of current practice with evidence-based practices. This analysis was done to discover an option to improve a student's experience of postpartum hemorrhage. The data received from this analysis will help to guide the improvement to the preventing and managing postpartum hemorrhage module. Need-gap analysis Jannetti (2012) established a three-step process for a gap analysis. First, recognizing the need. The need was identified in the postpartum hemorrhage module in the patient-centered care: childbearing family curriculum through discussions with the stakeholders. They expressed that students currently have low-fidelity simulations which do not promote real-life experiences for students. The second step is to identify what type of deficit is it and what is the best practice. The gaps were reflected by comments that were made by faculty, indicating that the curriculum deficit is in student experience and skills. The faculty stakeholders identified that the best practice is to incorporate learning activities that give students more real-life experiences. The third step is to close the gap. A summary of the key stakeholders' correlating ideas about utilizing HFS in the postpartum hemorrhage module is presented in the affinity analysis diagram, Diagram 1. Diagram 1. The affinity analysis diagram which is located immediately following HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 11 Table 2. Curriculum technology need-gap analysis at the end of this document. The outcome of the discussions about the need in the curriculum held with stakeholders is summarized in the curriculum technology need-gap analysis, Table 2. Table 2. Curriculum technology need-gap analysis is located immediately following Table 1. Literature review summary table at the end of the document. With the attempt to make a change in any area, stakeholders must be identified. With the addition of using more HFS technology into the nursing curriculum, the stakeholders would be the masters of science in nursing (MSN) student who is proposing the change, a faculty member, the program director, and information technology (IT) staff member. Each of these stakeholders has its roles within the gap analysis. The MSN student is going to identify and present the change of utilizing HFS to the module based on evidence-based practices. The faculty member will provide feedback on how students are responding to the use of technology. The IT staff member's role is to provide feedback and opinions about the feasibility of training staff on how to use technology appropriately while also recommending user-friendly software. Curriculum change When a curricular needs assessment was completed in the preventing and managing postpartum hemorrhage module, it was found that incorporating HFS into the module would considerably increase the students learning experience. The module currently is using LFS, which focuses on case studies. These types of simulations are beneficial in that it is helping the student to retain information, but HFS would better prepare a student on how to respond to situations in the workforce. Evidence suggests that the best practice for the student to improve critical thinking skills and confidence is to add HFS into curriculums. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 12 Force field analysis A force field analysis is vital to complete when a change is needed to be made. This analysis identifies forces that support and oppose the change. Having this information helps to strengthen the views of the supporters of the change and then weaken the opinions of individuals who are against the change. The outcome of the force field analysis completed on the readiness of change within the organization is illustrated in the organizational readiness for curriculum proposal, Diagram 2. Diagram 2. Organizational readiness for curriculum proposal diagram is located immediately following Diagram 1. Af finity analysis diagram at the end of the document. Organization factors that facilitate and impede integration. Organizational strengths and weaknesses need to be identified that will support or resist the implementation of the change proposal for preventing and managing postpartum hemorrhage module. An internal strength that would facilitate implementation is the program director’s support of utilizing HFS equipment provided by the facility to improve student learning. An external strength that would facilitate implementation is the state board of nursing, promoting technology to maximize clinical usage. Aebersold (2018) identifies that the National Council of State Boards of Nursing supports simulations to provide an active learning environment for studen ts to practice crucial nursing skills. These organizational strengths can be used as leverage by showing staff that the director and the state board of nursing support the use of HFS. This might help to make some staff more accepting of the change. An internal weakness that would impede implementation is IT personnel being overwhelmed with programming and training of faculty on the HFS equipment. An external factor that would prevent execution is limited state funding for staff training on equipment and software. According to Unver et al. (2018), HFS can have a substantial monetary HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 15 analyze risk factors for postpartum hemorrhage aligns with the QSEN professional standard clinical judgment. The first-course objective is measured by item number three. Which one of the following patients would more likely experience a postpartum hemorrhage? Which is found in the formative assessment. The second-course objective is measured by item number five. What are risk factors for postpartum hemorrhage? Which is found in the summative objective assessment. These assessments are located in Appendix C. Assessments in which are located immediately following Appendix. B Course materials. Teaching strategies, instructional delivery, and learning materials The constructivist theory supports the current syllabus. According to Billings and Halstead (2016), students boost their knowledge through experiences individually and through group work throughout the learning process. In the academic setting, evidence-based practice is also a big part of learning. The teaching strategies for the current syllabus is by lecture and group work. According to Daouk, Bahous, and Bacha (2016), classroom settings need to support collaborative group work with students, and the course instructor is seen as the person who will provide the students with the information to increase their knowledge. The instructional delivery methods utilized are face- to-face and online work. Evensen, Anderson, and Fontaine (2017) discuss prevention and treatment methods for postpartum hemorrhage. This information was used to provide up to date evidence-based information for the learning materials for the course syllabus. Student learning outcome analysis A student learning outcome must be presented in a measurable behavioral statement and be descriptive. The student learning outcome of the student will be able to identify interventions that will prevent postpartum hemorrhage by the end of the module. This student learning HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 16 outcome aligns with Bloom’s taxonomy level of understanding. The expected students’ outcome is that by the end of the module, they will be able to identify interventions that are provided to a patient experiencing a postpartum hemorrhage. The student outcome is measured by the development of formative and summative assessments. This student learning outcome aligns with the course objective of the student will explain the causes of postpartum hemorrhage. Students will learn about what types of interventions are done with patients who have postpartum hemorrhages which will lead to them also learning about the causes. Course and grading policies The course objectives and goals of the curriculum proposal are supported by the attendance policy and grading policy provided by the syllabus. The attendance policy supports the course objectives and goals by requiring students to attend class to be able to gain the appropriate knowledge. For example, the syllabus states that students are required to attend classes regularly and engage in the requirements for each class. The grading policy supports the course objectives and goals in that each student must show through their grades that they fully understand the content presented. For example, the syllabus states that all students must take the final exam and that it is not subject to review. Please refer to Appendix A Syllabus that appears after Diagram 2. at the end of the paper. Development Phase Course material The MSN student followed a systematic procedure independently and collaboratively to create the course materials. Independently the MSN student worked on the course overview, course objectives, and content outline. These critical components assisted the MSN student in selecting the appropriate learning resources of the textbook and two web sites. The MSN student HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 17 independently drafted the formative assessment, summative objective assessment, and summative performance assessment. The MSN student worked collaboratively with the assigned preceptor to develop a well-organized and informative PowerPoint. The MSN student also worked collaboratively with the key stakeholders to update the course syllabus. Learning resources and activities The learning resources of the textbook and web pages will help the students to gain the knowledge to improve their skills. The think-pair-share learning strategy of a scenario-based class discussion activity will help a student to develop clinical reasoning skills that encourage them to think about situations and come up with clinical outcomes that may or may not occur. This learning strategy helps to facilitate a student’s development of self-reflection by having them hear what others came up with in the same situation and promote them to reflect on whether their ideas agreed or disagreed with others. Formative assessment The multiple-choice formative assessment activity assists the educator in being able to assist students who are not understanding the material being presented. The educator will then provide feedback to the student on the returned test paper. This feedback may include specific chapters that the student may need to review. If the student is still unable to understand the material fully then a one on one meeting to discuss material may also be arranged between the educator and student. The formative assessment result will also help guide the student in setting goals which will improve their learning. For example, the student may set a goal that before the next week, they will understand the information identified by the formative assessment activity. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 20 meeting. The PowerPoint will provide a course overview of the module. It is also going to give the faculty with the implementation timeline for the module. The presentation will provide faculty the identified course objective, module content, student learning outcomes, and the types of assessments that will be given to students. This provides the faculty with the knowledge and skills needed to implement the new module. Potential Technical Problems With the implementation of something new, there always needs to be a system in place to monitor for technical issues. A technical issue that could arise could be that the simulation equipment doesn’t work as planned. A solution to this issue could be to make sure that a faculty member or IT staff member is available during times that simulation equipment will be utilized to help if technical problems arise. Another issue that could arise for the technology is the unavailability of the internet for research purposes during the module. A solution for this would be to extend the amount of time for completion of assignments or to provide students with time to access current literature available in print versus using the web. Another potential technical issue is the failure of the PowerPoint projector. The solution for this would be to have printed copies available to handout. Evaluation Planning Phase The final phase of the ADDIE method is evaluation. This phase is to decide if the goals of the modules met and what improvements need to be done to improve the ability and rate of success (Kurt, 2018). A conference was held with the MSN student, lead instructor, and program director to discuss the appropriate course performance metrics to utilize for the module. Current evidence-based performance metrics of course pass rate of seventy-five percent, course completion rate of eighty percent, and overall student satisfaction with the course rate of HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 21 seventy-five percent (National League of Nursing, 2012). The lead instructor and program director didn’t have specific goals at this time. Collaboratively the decision was made to use these metrics due to the utilization of many nursing programs and because they evaluate the module from different aspects and the point of view of the students. End-of-Course Survey Procedure An internet search was conducted by the MSN student to find examples of end of course surveys being used by other nursing programs. The MSN student collaboratively developed with the academic preceptor a ten-item end of course survey for students to fill out anonymously at the end of the course. This survey was designed to evaluate the instructor’s performance, learning materials, technology usability and usefulness, assessment and assignments, peer collaboration, and overall course satisfaction. Please ref er to Appendix D End of course survey in which appears after Appendix C Assessments at the end of the paper. Survey Question Analysis An analysis of the student’s feedback from the end of course survey is essential. The elements of the instructor’s performance, learning materials, technology usability and usefulness, assessment and assignments, peer collaboration, and overall course satisfaction are covered in the end of the course survey. The element of instructor performance is assessed in items one and two. The instructor presented the concepts, and the instructor effectively organized and facilitated the learning activities. The element of learning materials is assessed in item three. The learning materials (books, readings, and handouts) increased your knowledge and skills. The element of technology usability and usefulness is assessed with question eight. The technology utilized was user friendly and useful for the course. The element of assessments and assignments is assessed in question four. The exams and assignments were reflective of the course objective. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 22 The element of peer collaboration is measured with question five. This course helped to improve collaboration skills with your peers. The element of overall satisfaction with the module is assessed with question nine. Overall, I am satisfied with this course. For survey entirety, please refer to Appendix D End of course survey, which is located following Appendix C Assessments at the end of the paper. Formative Evaluation Plan Formative evaluation is to expand and improve the module on an ongoing basis during implementation (Giannotti, Peikes, Wang, and Smith, 2013). The feedback from this plan helps the lead instructor and program director to identify if the module is effective and if the students can meet the course objectives and student learning outcomes. If the feedback indicates that the module is off track, the lead instructor and program director can make appropriate changes to the module. The lead instructor will monitor the module performance. A twice-monthly meeting with lead instructor, faculty, and program director will be held. During this time, a discussion of how students are accepting student involvement and learning materials. This is also the time that collaboration will occur between lead instructor, faculty, and program director to make adjustments to module lecture or student learning activities. The lead instructor is also going to have a conference with the IT faculty. This conference is going to be held after HFS is operational to discuss the readiness for student access. Another conference will be held after students have accessed HFS to gather input on how effective and possible changes can be made to simulations to improve module for next time. The module performance can be measured by distributing a survey to students in the middle of the module. This action will allow students to give their feedback on what areas of the HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 25 References Aebersold, M. (2018). Simulation-based learning: No longer a novelty in undergraduate education. Online Journal of Issues in Nursing, 23(2), 1. https://doi.org/10.3912/OJIN.Vol23No02PPT39 Akselbo, I., Olufsen, V., Ingebrigtsen, O., & Aune, I. (2019). Simulation as a learning method in public health nurse education. Public Health Nursing, 36(2), 226–232. https://doi.org/10.1111/phn.12560 Amod, H. B., & Brysiewicz, P. (2019). Promoting experiential learning through the use of high- fidelity human patient simulators in midwifery: A qualitative study. Curationis, 42(1), 1– https://doi.org/10.4102/curationis.v42i1.1882 Au, M. L., Lo, M. S., Cheong, W., Wang, S. C., & Van, I. K. (2016). Nursing students’ perception of high-fidelity simulation activity instead of clinical placement: A qualitative study. Nurse Education Today, 39, 16–21. https://doi.org/10.1016/j.nedt.2016.01.015 Baptista, R. C. N., Paiva, L. A. R., Gonçalves, R. F. L., Oliveira, L. M. N., Pereira, M. de F. C. R., & Martins, J. C. A. (2016). Satisfaction and gains perceived by nursing students with medium and high-fidelity simulation: A randomized controlled trial. Nurse Education Today, 46, 127–132. https://doi.org/10.1016/j.nedt.2016.08.027 Basak, T., Unver, V., Moss, J., Watts, P., & Gaioso, V. (2016). Beginning and advanced students’ perceptions of the use of low- and high-fidelity mannequins in nursing simulation. Nurse Education Today, 36, 37–43. https://doi.org/10.1016/j.nedt.2015.07.020 Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). Available from https://bookshelf.vitalsource.com/#/books/9780323290548/recent HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 26 Daouk, Z., Bahous, R., and Bacha, N. (2016). Perceptions on the effectiveness of active learning strategies. Journal of applied research in higher education, 8(3), 360-375. https://doi.org/10.1108/jarhe-05-2015-0037 D’Sa, J. L., & Visbal-Dionaldo, M. L. (2017). Analysis of multiple-choice questions: Item difficulty, discrimination index and distractor efficiency. International Journal of Nursing Education, 9(3), 109–114. https://doi.org/10.5958/0974-9357.2017.00079.4 Giannotti, K., Peikes, D., Wang, W., & Smith, J. (2013). Formative evaluation: Fostering real- time adaptions and refinements to improve the effectiveness of patient-centered medical home interventions. Retrieved from https://pcmh.ahrq.gov/page/formative-evaluation- fostering-real-time-adaptions-and-refinements-improve-effectiveness Jannetti, A. (2012). A representation: Incorporating a needs assessment and gap analysis into the educational design. Retrieved from https://www.suna.org/events/needsAssessment.pdf Kim, J., Park, J.-H., & Shin, S. (2016). Effectiveness of simulation-based nursing education depending on fidelity: a meta-analysis. BMC Medical Education, 16, 152. https://doi.org/10.1186/s12909-016-0672-7 Kurt, S. (2018). ADDIE Model: Instructional Design. Retrieved from https://educationaltechnology.net/the-addie-model-instructional-design/ Labrague, L. J., McEnroe, P. D. M., Bowling, A. M., Nwafor, C. E., & Tsaras, K. (2019). High‐ fidelity simulation and nursing students’ anxiety and self‐confidence: A systematic review. Nursing forum, 54(3), 358–368. https://doi.org/10.1111/nuf.12337 HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 27 National League for Nursing. (2012). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, masters, practice doctorate, and research doctorate programs in nursing. New York, NY: National League for Nursing. Nichols Hess, A., & Greer, K. (2016). Designing for engagement: Using the ADDIE Model to integrate high-impact practices into an online information literacy course. Communications in Information Literacy, 10(2), 264–282. Raman, S., Labrague, L. J., Arulappan, J., Natarajan, J., Amirtharaj, A., & Jacob, D. (2019). Traditional clinical training combined with high‐fidelity simulation‐based activities improves clinical competency and knowledge among nursing students on a maternity nursing course. Nursing Forum, 54(3), 434–440. https://doi.org/10.1111/nuf.12351 Sarman, S., & Pardi, K. W. (2019). Satisfaction and confidence in using clinical simulation models among undergraduate nursing students in a public university in Malaysia: A cross-sectional study. International Journal of Nursing Education, 11(4), 130–134. https://doi.org/10.5958/0974-9357.2019.00104.1 Unver, V., Basak, T., Ayhan, H., Cinar, F. I., Iyigun, E., Tosun, N.,... Köse, G. (2018). Integrating simulation-based learning into nursing education programs: Hybrid simulation. Technology and health care: Official journal of the European society for engineering and medicine, 26(2), 263–270. https://doi.org/10.3233/thc-170853 HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 30 depending on fidelity: a meta- analysis." simulations in nursing education affected nursing students. It showed that high fidelity technology significantly improved a student's learning capabilities. nursing students from Norway, the USA, China, Korea, Iran, the United Kingdom, and Australia. based nursing education was prosperous in many learning environments. based education in nursing curriculums has notable effects on a student's education. -A large number of articles available. Weakness: -Articles were omitted if they were not published in Korean or English. Unver, (2018) “Integrating simulation- based learning into nursing education programs: Hybrid simulation.” This study was done to look at how a hybrid simulation technique during an emergency setting affects a nursing student. This quasi- experimental study was completed on 79 undergraduate nursing students in Ankara, Turkey. The students proclaimed that simulations strengthen their critical thinking skills, decision- making skills, and self- confidence. This quasi- experimental study encourages the integration of hybrid simulations experiences into nursing curriculums. Level III Quasi- experimental study Strength: -A large number of student participants. Weakness: -The study was completed outside of the United States. Baptista, (2016) “Satisfaction and gains perceived by nursing students with medium and high-fidelity simulation: A randomized controlled trial.” This trial was done to analyze nursing student’s satisfaction with medium- and high- fidelity simulations. This controlled trial had 85 fourth-year nursing students who were enrolled in the bachelor's degree program at Coimbra from Portugal. The trial results revealed that satisfaction with the realistic scenarios and students recognizing critical conditions and making decisions on interventions were higher with HFS. This randomized trial discusses investing in HFS activities if educators want their students to be motivated and interested in learning. It also shows that students are better equipped in the clinical setting after the knowledge they gained Level II Randomized Control Trials Strength: -The trial size was useful. Weakness: - The trial was not completed in the United States. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 31 from HFS environments. Basak, (2016) “Beginning and advanced students’ perceptions of the use of low- and high- fidelity mannequins in nursing simulation.” This quasi- experimental study shows how using low and high-fidelity mannequins differ in helping students to learn skills. The quasi- experiment was completed by students who were first- and fourth-year undergraduate nursing students from a Bachelor of Science in Nursing program and an accelerated nursing program. The conclusion was that students had higher satisfaction scores for the high fidelity versus the low fidelity simulations. The study identified that students had a decrease in stress levels and an increase in self- confidence and competence when high- fidelity simulations were utilized. Level III, Quasi- experimental Strength: -The approximate fifty percent split of beginners versus advanced nursing students participating in the study. Weakness: -The size of the study group Sarman, (2019) “Satisfaction and Confidence in Using Clinical Simulation Models among Undergraduate Nursing Students in a Public University in Malaysia: A Cross- sectional Study.” This study was done to examine the happiness and self- confidence of a student when using clinical simulation. This non- experimental study was completed on undergraduate nursing students enrolled in a public university in Malaysia. The results were that students expressed high satisfaction and self- confidence in learning when using high fidelity clinical simulations. The study showed support for the use of simulations in nursing education courses. Level IV Non- experimental study Strength: A large number of samples Weakness: -The study was not completed in the United States Au, (2016) “Nursing students' perception of high-fidelity simulation activity instead of clinical placement: A This study was done to examine how nursing students felt about using HFS in their clinical courses. This qualitative study was done on 80 undergraduate nursing students at a school in Macau. The results of this study showed that nursing students appreciated HFS more than real clinical time. This study revealed that students believed that HFS was very useful and should be set as a requirement. Level VI Qualitative study Strength: - A large number of student participants HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 32 qualitative study.” Weakness: - The study was not completed in the United States. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 35 The MSN student will then record a 30-minute lecture online and upload the link to the e-Portfolio. 06/15/2020 Summative performance assessment On 06/15/2020 students will present their summative performance assessment presentations. 06/16/2020 10 item end-of-course survey The MSN student will work with the preceptor/lead instructor to review end-of- course student surveys used by Western University. The MSN student will then create a 10-item survey. The survey will be reviewed with the preceptor/lead instructor and program director. Changes will be made if needed. On 06/16/2020 the 10-item end- of- course survey will be delivered to the students. The MSN student will then upload this finished activity to the e-portfolio 06/16/2020 Summative Objective Assessment On 06/16/2020 the class will be given the summative objective assessment. 06/17/2020 Reflection-Experience Teaching a Live Course The MSN student will write a reflective journal about her experiences teaching a live course. This will be uploaded to the e-portfolio. 06/19/2020 Reflection-CPE Learning Experience Synthesis The MSN student will write a 2-3-page paper in APA format. This paper will reflect on the experience the MSN student had during the MSN courses. This will be uploaded to the e-portfolio. 06/19/2020 DocuSign The MSN student will verify that the DocuSign log is signed by the preceptor and MSN student. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 36 Diagram 1. Affinity Diagram HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 37 Diagram 2. Organizational Readiness for Curriculum Proposal Forces FOR Curriculum Proposal Curriculum Proposal Forces AGAINST Curriculum Proposal Opportunity to improve faculty morale Utilizing high- fidelity simulations in the preventing and managing postpartum hemorrhage module to improve student's confidence and skills. Fear of change Underutilized HFS Faculty resistance Outdated process Cost of staff training on equipment and software HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 40 in health promotion activities. 7. Demonstrate a comprehensive understanding of the concepts of pain, pain relief measures, and theories of pain. Safety: Minimizes the risk of harm to patients and providers through both system effectiveness and individual performance. 8. Compare effective safety strategies when caring for the hospitalized antepartum, intrapartum, and postpartum patient to reduce the risk of harm to self or others. 9. Apply newborn security measures in the hospital setting. Patient-Centered Care: Recognize the patient or designee as the course of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. 10. Employ effective communication strategies used with the childbearing woman and her family. 11. Demonstrate an understanding of multiple dimensions of patient-centered care in an individualized plan of care to include the childbearing patient, family preferences, and values. 12. Incorporates didactic content in the care of the childbearing woman and her family. Methods of Evaluation: Examinations: Exams 1-5 12% each ATI 12% Final Examination 13% Assignments: 1% each Interactive Clinical Scenarios: HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 41 Psychosocial Adaptions Nutrition Placenta Previa Pregestational Diabetes Mellitus Preterm Labor Pharmacological Pain Relief Measures Normal Postpartum Assessment Postpartum Hemorrhage DVT Perinatal Loss Breastfeeding Postpartum Teaching/Knowledge Other: 1% each Labor Induction Concept Map ATI Learning System 3.0: Maternal-Newborn Practice Exam 1 ATI Learning System 3.0: Maternal-Newborn Practice Exam 2 HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 42 Grading Scale: Course Grade A 93-100 B 86-92.9 C 78-85.9 D 70-77.9 F 0-69.9 III. Course Requirements: 1. Class Attendance: You are required to attend your classes regularly and engage in the requirements for each class ; otherwise, your financial aid may be revoked either partially or in full. This would result in an amount due by you to the University immediately. Please refer to the University website for more details. 2.Course Readings: a. Textbooks: Desavo, M.F. (2017). Maternal and Newborn Success: A Q&A review applying critical thinking to test taking (3rd ed.). Philadelphia, PA: FA Davis. ISBN# 978-0-8036-5941-4 Durham, R.F., & Chapman, L. (2014). Maternal-newborn nursing: The critical components of nursing care (3rd ed.). Philadelphia, PA: FA Davis. ISBN# 978-0-8036-6654-2 OB/GYN Peds Notes (3rd ed.). (2017). Philadelphia, PA: FA Davis. RN Maternal Newborn Nursing Edition 10.0. (2016). ATI Nursing Education. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 45 5. Clinical: You are expected to attend your clinical days. In the case of an extreme emergency, please contact your clinical instructor. A clinical make-up day will not be scheduled. Competencies: You are required to perform the competencies/skills you have learned in Performance Outcomes I and Performance Outcomes II. Those skills will not be reviewed in the clinical setting. If you are unable to perform a skill in the clinical setting, you will be asked to leave clinical. In addition to the information in your student handbook, there are a few additional items you will need to know for your clinical day: a. No watches, rings (except a plain wedding band), necklaces, hoop earrings, or other jewelry. Wear your watch to clinical, remove, and keep it in your pocket. If you wear a ring with a stone, such as an engagement ring, you will be asked to remove the ring. b. You may wear a long-sleeve t-shirt under your scrub top. You must be able to push the sleeves up to your elbows to scrub in prior to providing care to the postpartum patient and newborn. c. Cover all visible piercings other than 1 set of earrings in the lower ear lobe. You may wear one set of stud earrings. d. Tattoos on arms do not have to be covered unless offensive. Tattoos on the neck and face need to be covered. e. No fingernail polish. Not kidding. Your fingernails need to be short and clean. If you are wearing fingernail polish, you will be asked to remove the polish prior to providing patient care. f. Don’t forget your name badge! HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 46 6. Clinical Evaluation: You are required to complete your clinical evaluation prior to meeting with your clinical instructor. It is your responsibility to articulate how you met the clinical objectives. Your clinical instructor will provide you with additional feedback. Failure to complete the clinical evaluation will result in an incomplete for the course. You will be required to schedule an appointment with the faculty member the following semester. Failure to present the faculty member with a complete clinical evaluation will result in an incomplete for the course. It is your responsibility to schedule a day and time to complete your clinical evaluation with your clinical instructor. 7. ATI Skills Modules You are required to complete the ATI Skills Modules as outlined in the “Methods of Evaluation” section of the syllabus. Once you complete your assignment, download as a PDF document and upload it into the Electronic Learning Management System in the Assignments tab. I will not accept hard copies, pictures of the assignment, scenario grades If your assignment does not contain your name, you will receive a zero for the assignment emailed to me, or assignments with handwritten grades or assignment names. 8. FA Davis Interactive Clinical Scenarios: You are required to purchase an FA Davis Edge code to access the interactive clinical scenarios and post your proof of purchase in the Assignments link in the Electronic Learning Management System. The proof of purchase must include your name and your name only. Failure to post your proof of purchase will result in a grade of zero for the interactive clinical scenario assignments. You are provided three (3) opportunities to complete the assignment for a high score. Once you complete the scenario, you are required to download your results in a PDF and post in the HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 47 Electronic Learning Management System. Your score will be your grade for that assignment. Late assignments are not accepted. 9. Class Preparation You are required to prepare for class prior to attending class. Class preparation is listed in the course calendar. You will not be allowed to attend class if you have not posted your class preparation assignment in Electronic Learning Management System on the scheduled date and time. All class preparation assignments are due Thursdays by 11:55 PM unless otherwise stated in the course calendar. I will not accept hard copies or pictures of the assignment. If your assignment does not contain your name, you will receive a zero for the assignment. IV. Grading Procedures: Test/Exam Study Guides/Blueprints: Nursing faculty do not provide either test blueprints or study guides for course exams or quizzes. In general, all material covered in class, assigned as readings or included in slide presentations, whether or not the material is mentioned explicitly in class, maybe included on exams and or quizzes. Information about exams and quizzes are provided in this syllabus. Testing: Testing will occur via Exam Soft. Please review the Academic Integrity Policy in your student handbook. Test Review: After an exam has been reviewed and grades posted, the faculty member will release the exam categories for your review. A test review will occur the following week before class. You will be required to sign in and sign out. No items will be allowed in the classroom. Once the exam review begins, late students will not be allowed in the classroom. Students wishing to appeal a test question must do so via email within 24 hours of the test review. Individual exam reviews will not be held. Once the test review is complete, the exam is closed HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 50 based on instructor and clinical site availability. An alternative clinical day may also be scheduled. You are expected to attend the rescheduled clinical day. Childcare, upcoming exams, work, scheduled appointments, etc. are unexcused absences from the rescheduled clinical and will result in a clinical failure of the course. Academic Integrity Each student in this course is expected to abide by the University Academic Integrity Procedures found in the University Student Handbook V. Academic Dishonesty Cheating in all its forms, including plagiarism and cheating on visual work, is considered an academic matter to be controlled and acted upon by the individual faculty member. Students guilty of academic dishonesty on examinations in any course shall receive, as a minimum penalty, a grade of F in that course. Such action shall be taken by the instructor, with written notification to the appropriate University administrators. Repeated offenses shall subject the student to suspension or dismissal from the University. Students involved in facilitating academic dishonesty, among others, such as by the unauthorized dissemination of examination materials, will be subject to disciplinary action beyond that called for by their own cheating in a course. Cheating includes, but is not limited to the following actions: During exams: 1. Copying from another student. 2. Providing answers to another student. 3. Memorizing exam questions for later recall. 4. Distributing test questions to students in other classes. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 51 5. Producing, concealing, sharing, or using; notes, signals, “crib sheets”, or other materials whether paper, visual, digital, or electronic in nature to remind the student or others of test material or answers. 6. Taking photos of tests or answer sheets whether or not the intent is to distribute these materials. 7. Communicating test content to students who have not yet taken the exam. For other assignments: 1. Collaborating on assignments unless specifically informed by the instructor that the assignment is a group assignment. 2. Misrepresenting the contribution of students on a group assignment. Plagiarism is “the act of stealing and using, as one’s own, the ideas, or the expression of the ideas of another.” Whether that other is another student or a published author, plagiarism is cheating. Plagiarism also includes "self -plagiarism" which is the act of copying one's own work from one assignment to another without proper citation of the work or instructor knowledge and consent (for unpublished works). Detailed instructions on avoiding plagiarism will be provided in required English courses, and comments also may be made by instructors in other courses for which papers are written. Guidelines and policies affecting dishonesty and most other aspects of student life may be found in the Shepherd University Student Handbook. Effective August 28, 2017, it is the policy of the Nursing Education Department that the following materials [“prohibited items”] may not be used by a student as a part of study- preparation for a test in any Nursing Education course, unless expressly first approved in writing by the Course Instructor: HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 52 • Copies of tests previously administered by the Course Instructor or any other instructor of University Nursing Education, unless distributed to all students in the class by the Course Instructor • Copies of a “course-instructor” version of an assigned textbook • Copies of test-banks or other sample tests published for faculty by textbook publishers For purposes of this policy: 1) possession of prohibited materials shall constitute presumptive evidence of use by the possessing student; 2) receipt and possession of any document compiled by a student who was in possession of prohibited items shall constitute presumptive evidence of use by the receiving student if the receiving student knew or should have known that the content derived from prohibited items; 3) possession of prohibited items shall constitute “receiving assistance in coursework in a manner not authorized” under the Academic Integrity Policy of the University and will be addressed by the professor consistent with that policy . Any student who currently has possession of prohibited items in August 2017, contemporaneous with the promulgation of this new policy, maybe absolved from a penalty by promptly [before any tests are administered] completing the following: · The student will schedule an appointment with the Department Chair and the Course Instructor(s) affected. The student will remit all prohibited items to the faculty at this time. The Course Instructors will take such action as is necessary, changing the planned tests for the entire class or arranging for one or more alternative tests for the student(s) who have possessed prohibited items. Examinations: The only items you are permitted to have at your desk during an examination is your personal laptop computer or tablet. If the exam requires the use of a calculator, one is available in HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 55 preterm PROM Intrapartum Module: 1. Labor and Delivery Processes: premonitory s/s and true vs. false labor 2. Pain Management: non-pharmacological management and pharmacological management of labor pain. 3. Fetal Assessment During Labor: Leopold’s Maneuvers, intermittent auscultation , and palpation, continuous electronic fetal monitoring, fetal heart rate patterns, Category I, II, & III tracings 4. Nursing Care During Stages of Labor: stages & phases of labor 5. Therapeutic Procedures to Assist with Labor & Delivery: external cephalic version, bishop score, cervical ripening, induction of labor, augmentation of labor, amniotomy, vacuum-assisted birth, forceps-assisted birth, cesarean birth, vaginal birth after cesarean (VBAC) 6. Complications Related to the Labor Process: prolapsed umbilical cord, meconium-stained fluid, fetal distress, dystocia of labor, precipitous labor, uterine rupture, anaphylactoid syndrome of pregnancy Postpartum Module: 1. Physiological Adaptations: BUBBLEE assessment, body system changes, pharmacological and nonpharmacological comfort measures 2. Adaptations: psychosocial & maternal adaptation, paternal adaptation, sibling adaptation 3. Client Education & Discharge Teaching: self -care: perineum, breasts, rest/sleep, activity, nutrition, exercise, contraception, sexual activity, postpartum danger signs 4. Postpartum Disorders: deep-vein thrombosis, thrombophlebitis, pulmonary embolus, coagulopathies, uterine atony, subinvolution of the uterus, inversion of the uterus, retained HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 56 placenta, lacerations, hematomas, 5. Complication: Preventing and management postpartum hemorrhage 6. Postpartum Infections: endometritis, mastitis, wound infections, urinary tract infections 7. Maternal Mood Disorders and Anxiety 8. Contraception: oral contraceptives, emergency contraception, diaphragm, sterilization 9. Postpartum medications and medications associated with postpartum disorders, infections, and maternal mood disorders. Newborn: 1. Assessment: APGAR scoring, New Ballard Scale, vital signs, assessment by each body system, cord blood collection, airway obstruction, hypothermia 2. Nursing Care of Newborns: periods of reactivity, laboratory tests, diagnostic screening, respiratory complications, identification, thermoregulation, bathing, feeding, sleep, elimination, infection control, family education, umbilical cord care, newborn medications, cold stress, hypoglycemia 3. Newborn Nutrition: nutritional needs, breastfeeding, formula feeding, risk factors for impaired nutrition, monitoring adequate growth, interventions, complications 4. Nursing Care & Discharge Teaching: crying, quieting techniques, sleep/wake cycles, oral & nasal suctions, positioning, bathing, feeding, elimination, diapering, cord care, circumcision care (pre & post-procedure), clothing safety, car seat safety, wellness checkup, danger signs to report 5. Assessment & Management of Newborn Complications: neonatal substance withdrawal, hypoglycemia, respiratory distress syndrome, preterm newborn, small for gestational age, large for gestational age, postmature infant, newborn sepsis, birth trauma/injury, hyperbilirubinemia HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 57 Week Senior Year – First Semester Course Calendar Fall 2019 Dates & Topics subject to change Bring textbook to class! TOPIC 1 Course introduction Fundamentals of maternal child nursing 2 Prenatal care & complications of pregnancy Bleeding & infections in pregnancy 3 Antepartum Antepartum testing & procedures, fetal monitoring 4 Labor & Delivery Non-pharmacological and pharmacological pain relief measures 5 Labor & Delivery Complications & Emergencies 6 Postpartum - Normal postpartum assessment - Preventing and managing postpartum hemorrhage 7 Newborn -Normal newborn assessment -Newborn complications 8 Discharge planning and education HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE Pathophysiology > Maternal obesity > Multifetal gestation > Preeclampsia Etiology > Uterine atony > Trauma : Laceratian > Retained tiswue or Placenta accreta, increta, percreta, previa > Coagulation Etiology > Uterine Atony > Treatment > Uterine message > Administration of uterotonic agents: > Drain bladder with a foley catheter HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE Etiology > Trauma > Laceration » Treatment > Hemostasis > Timely repair Etiology > Retained tase > Weatmene > Nacuak vores > Placenta accreta, increta, percreta, previa > Moterectomny > Comereation manager Etiology HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE Signs and Symptoms Heavy bleeding Tachycardia TNE Prevention > Third stage labor management > Avoiding episiotomies > interdisciplinary team training with realistic simulation should be used to improve perinatal ssfety. Prevention > administering oxytocin (Pitocin} with or s00n after the detivery » Controlled cord traction (firandt-Andrews maneuver) to detiver the placenta > Uterine massage after deltvery of the placenta. 62 HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 65 - Learning resources Davidson, M. R., London, M. L., & Ladewig, P. W. (2020). Old’s maternal-newborn nursing & HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 66 women’s health across the lifespan (9th ed). Hoboken, NJ: Pearson. Evensen, A., Anderson, J. M., & Fontaine, P. (2017). Postpartum Hemorrhage: Prevention and Treatment. Retrieved from https://www.aafp.org/afp/2017/0401/p442.html March of dimes (n.d.). Postpartum hemorrhage. Retrieved from https://www.marchofdimes.org/pregnancy/postpartum-hemorrhage.aspx Bejar, C. (2013, November 7). Case study: Postpartum hemorrhage. Retrieved from https://prezi.com/stneemhv2mbh/case-study-postpartum-hemorrhage/ - Learning activities 1) A PowerPoint slide presentation 2) A research activity involving a student to identify two credible websites identifying risks and management of postpartum hemorrhage 3) A scenario-based class discussion activity. - Scenario: 37-year-old black female P7007 at term admitted in early labor. The patient’s past obstetrical history was significant for a progressive increase in the size of her children at birth, with her last child weighing 9lbs 3 oz. The patient’s cervical exam showed dilation of 4 and -1, the patient AROM with clear fluid prior to the exam. She delivered a 10lb 2oz baby with a moderate shoulder dystocia that was treated effectively. The placen ta delivered spontaneously without difficulty. The discussion will be held to discuss the patient’s risks for hemorrhage. - The patient had persistent bleeding during the episiotomy repair that responded to fundal massage and intravenous Pitocin. The placenta was examined by the physician and was noted to be complete; no cervical and vaginal lacerations were noted. On initial postpartum evaluation by the nurse, the patient had heavy bleeding with clots and a boggy, flaccid uterus. Discuss with the class about possible treatment options. - The patient was given 250mcg of hemabate IM but continued with a persistently atonic uterus. The patient was given 0.2mg methergine IM. Her uterus began to firm, and the bleeding decreased significantly. No further bleeding ensued, and the patient was transferred to the postpartum unit without incident. Another discussion will be held about how the patient responded to treatment. HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 67 Appendix C Assessments Formative assessment Questions 1. Which of the following volume is considered as a postpartum hemorrhage for a c -section delivery? a. 500ml b. 2000ml HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 70 3. What is the most common cause of postpartum hemorrhage? a. Vaginal laceration b. Retained placental fragments c. Uterine atony d. Factor V clotting disorder 4. True/False Pitocin is the first-line medication used to treat PPH? 5. What are risk factors for postpartum hemorrhage? a. History of postpartum hemorrhage b. Macrosomia c. Obesity d. All of the above 6. True/False breastfeeding can help reduce the risk of PPH. 7. What is an early symptom of PPH? a. Increase heart rate b. Uncontrolled bleeding c. Pale skin tone d. Decrease blood pressure 8. What is a complication of PPH? a. Anemia b. Myocardial ischemia HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 71 c. Death d. All of the above 9. How many stages are involved with PPH? a. 2 b. 5 c. 3 d. 4 10. What percentage of women will experience a PPH? a. 3%-5% b. 10%- 15% c. 30%- 40% d. 50%-60% Answers 1. A- Within 4 hours 2. False 3. C- Uterine atony 4. True 5. D- All of the above 6. True 7. B- Uncontrolled bleeding HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 72 8. D-All of the above 9. C- 4 10. A- 3%-5% Performance assessment The instructor will provide the students with a list of the different methods used to prevent and treat postpartum hemorrhage. They will collaborate with a classmate and pick a risk factor to research and build a PowerPoint or poster board to help with the guidance of the discussion forum. The students are going to pair up with each other. The group of students will then research and gather information about the risk factor they chose. This presentation will then be presented to their peers at the end of the module. The presentation will need to be a minimum of fifteen-minutes and must include a PowerPoint or poster. The presentation must include an