Running Head: PRACTICUM EVALUATION PAPER1

Running head: PRACTICUM EVALUATION PAPER1

Practicum Evaluation Paper

Joshua C. Lincoln

Ferris State University

PRACTICUM EVALUATION PAPER1

Abstract

This paper reviews the educational and theoretical basis for a practicum using High Fidelity Simulation (HFS) for Ferris State University’s Masters in nursing program. Included are the issues this student faced, the projects he was involved in, and the theoretical frameworks used to create said projects. Also included are the evaluations of this practicum by the student and his preceptor. The projects included are peri-mortem simulation, arterial blood gas (ABG) interpretation, and electrocardiogram (EKG) interpretation. This student relied heavily on Howard Gardner’s theory of multiple intelligences, David Kolb’s experiential theory, Madeleine Leininger’s transcultural theory, and Patricia Benner’s Novice to Expert.

Keywords: High Fidelity Simulation, Multiple intelligences, Kolb’s learning theory, Leininger’s transcultural theory, Benner’s novice to expert.

PRACTICUM EVALUATION PAPER1

Clinical Practicum Paper

The National League of Nursing (NLN) identifies eight core competencies necessary to be a successful and competent nurse educator: (a) facilitate learning, (b) facilitate learner development and socialization, (c) use assessment and evaluation strategies, (d) participate in curriculum design and evaluation of program outcomes, (e) function as a change agent and leader, (f) pursue continuous quality improvement in the nurse educator role, (g) engage in scholarship, and (h) to function with the educational environment (National League of Nursing, 2005). These competencies served as goals and objectives in the clinical practicum in the education track to obtain the Master’s of Nursing through Ferris State University. The purpose of this paper is to describe the practicum, examine any issues, concerns and challenges during the course of the practicum, address strategies and approaches to the issues anchored by evidence-based theory, and reflect upon practicum outcomes through self-evaluation and preceptor evaluation. This student will address the core competencies through creating, implementing, and evaluating high fidelity simulation. He will educate obstetric nurses on arterial blood gases (ABG’s) and electrocardiograms (EKG’s) in an effort to prepare them for their upcoming advanced cardiac life support training. This student also did extensive research on teaching styles and theories to assist him in improving his own teaching methods.

Theoretical Framework

The eight core competencies outlined by the NLN can seem a daunting task to achieve. The first step in achieving these goals is to base instruction and planning on a theoretical framework. Current knowledge of educational theories and research will act as the foundation for educational practice. Once the foundation is established, educators can apply the theories and research into practice by creating multiple learning opportunities for students. The theoretical framework used during the course of this practicum focuses on the work of Gardner, Kolb, Leininger, and Benner. The knowledge of their educational theories provided this student the basis for instructional practice.

Application of Knowledge from Theory and Research

According to the NLN, the future emphasis in nursing education is not only what people learn, but how they learn and how that information translates into practice (NLN, 2005). To facilitate learning, which is the first core competency outlined by the NLN, nurse educators need to be well versed in the theoretical framework of education and learning theories. Part of the theoretical framework revolves around different learning styles. The concept of different learning styles suggestsan educator can tailor instruction to the individual’s learning needs based on their optimal learning modality. These different learning modalities have been explored by researchers such as Howard Gardner and David Kolb. Howard Gardner presented his theory as multiple intelligences. According to Gardner, there are nine different intelligences: visual-spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, linguistic, logical-mathematical, existential, and naturalistic (McFarlane, 2011).

Assessing different learning styles is relatively easy as there are several online inventories educators can use to evaluate students’ learning styles. The inventory contains learning scenarios in which the test-taker would have to agree or disagree or rate based on a Likert scale. For example, the test-taker would check mark or rate a statement if it were true. If the test-taker were to agree with this particular statement and other statements like it,this affinity would most likely indicate that the test-taker would have a particular intelligence (http:/​/​ Students with the interpersonal intelligence have an affinity for problem-solving within groups (McFarlane, 2011). This was a main area in which this student focused as interpersonal intelligence is essential for the multidisciplinary framework in which nursing exists.

David Kolb’s theory revolves around a four stage learning cycle and four different learning styles that transpire as a result of that cycle (McLeod, 2013). His theory is mainly based on learning by experience. The first part of the cycle is called concrete experience. This is any new exposure to a given situation. This new experience leads the learner to the second part of the cycle-reflection. Reflection upon the new experience will help bridge gaps between what was just encountered and any previous knowledge. The third step is called abstract conceptualization. New ideas or changes will occur based on the reflection of the new experiences. The fourth cycle is active experimentation. This is the application of the new ideas or changes to future situations (McLeod, 2013).

Four different learning styles emerge from the learning cycle. The first is diverging. These individuals like to look at things from different perspectives and prefer to watch rather than do. Students could elect to act as the problem solver in a group scenario. The second learning style is assimilating. These individuals are focused on ideas and concepts rather than people and they prefer information in the form of lecture and reading. This particular learner would probably not like group work where many individuals are putting in their ideas. This student would likely prefer reading about simulation in articles or in textbooks (McLeod, 2013). The third learning style is converging. These individuals like to solve problems and answer questions. They are interested in technical tasks and less interested in social and interpersonal issues. The fourth learning style is accommodating. This individual likes hands-on activities and relies on intuition over logic. These individuals rely on others for information, but will then carry out their own analysis (McLeod, 2013). All of these modalities are covered by the use of simulation in training. Training participants will have an opportunity to use any of these four roles to better their understanding thus increase their level of expertise. Learning about how students or nurses gain expertise is an important aspect of this practicum so it can be utilized in the simulations and lecture portions. It also is important for nurse educators to present material in a culturally competent manner (NLN, 2005).

Two theorists whose work in educational theory specifically addresses nursing education are Leininger and Benner. Their work gives nurse educators a more succinct framework from which to base instructional practice. In the 1970s, Madeleine Leininger’s pioneering work was at the forefront of cultural sensitivity in nursing. Her theory of transcultural nursing translates to increased cultural sensitivity and better care in the nursing profession. Leininger’s focus was to increase patient care by facilitating change in curricula in nursing programs (Hughes & Hood, 2007). Leininger’s work encourages nurse educators to integrate cultural awareness into their instruction. Cultural awareness which, if broken down, refers to the recognition to an existence of a fact or a set of facts(Schim, Doorenboos, Benkert, & Miller, 2007). Facts and statistics are often presented at cultural awareness training sessions, but without active discussion and true learning about different cultures (Schim, Doorenboos, Benkert, & Miller, 2007).

Leininger’s theory involves so much more than the presentation of facts and numbers. Although facts have their place, it is a dangerous practice for nurses to assume that all patients from a specific race, for example, will have the same needs. Leininger stresses the need for students to acquire a knowledge base for different cultures, but be sensitive while trying to apply the knowledge in practice (Schim, Doorenboos, Benkert, & Miller, 2007). This student used these principles in developing both the simulation and classroom lecture portions of this practicum. More valuably, since this student has never taught in the clinical setting, he utilized the landmark work by Patricia Benner on the theory of skill acquisition to mold the educational sessions.

Patricia Benner published her work on nursing skill acquisition detailing how novice nurses transition to advanced beginner, competent, proficient, and expert. Benner theorized how nurses go through these various stages as work towards gaining expertise (Benner, 1984). As delineated in Benner (1982) nurses traverse through five levels of skill attainment to achieve the expert level. Novice is the first level which is described as a nurse who is analyzing signs and symptoms without a true situational awareness and is constrained by strict guidelines without regard for individual circumstance. The advanced beginner “is one who can demonstrate marginally acceptable performance” (Benner, 1982). According to English, (1993) this level should be attained after a foundational program in nursing school.

The third level is competent. A competent nurse is starting be become more

self-actualized and less constrained by institutional guidelines (Benner, 1982). This nurse is starting to become aware of the intricacies of processes and begins to become more attuned to outcome based nursing. The proficient nurse is able to be more situationally aware and focuses on the patient as a whole using a more holistic view of medicine (Benner, 1982; Benner, 1985; Benner, 2010). This allows the nurse to modify care based on experience and make decisions based on his or her analytical processes and abstract abilities. The final level is the expert nurse. An expert nurse can base decisions on an intuitive grasp of situations without having to go through the minutia of the novice(Benner, 1982; Benner, 1985;Benner, 2010). They are thinking on a theoretical plane, using both mid-range and grand theory to practice. The issue faced during this practicum was dealing with nurses at different levels of expertise and how to mold the education setting to the betterment of all involved. In creating the simulation this student decided to focus on peri-mortem cesarean section(c-section) deliveries as this was an issue of which none of the nurses were comfortable. This will be addressed in greater detail later in this paper.

Application of Knowledge from Practice

Educators have specific curricula they must deliver, but it is the educator’s choice in the method of deliver or how they put it into practice. Applying educational theory into practice may seem challenging for educators due to a plethora of teaching strategies and methods available. It is imperative teachers explore these various teaching strategies as the student population becomes more diverse. Based on the work of Gardner and Kolb, students are different and have unique learning needs. One method educators may employ to address the theory of multiple intelligences and different learning styles is differentiated instruction.

Differentiating instruction means recognizing students’ different learning styles and needs, tailoring lessons to those needs, and designing fair assessments for those lessons as to gage student learning (Heacox, 2002). Educators grounded in only one delivery method are truly cheating their students. Interpersonal intelligence is based on the idea that students learn through interaction with others in a group (MacFarlane, 2011). For this practicum, being aware of these different styles allowed me the flexibility to modify my educational approach depending on the reactions from the various groups of students. In the classroom setting, the educator could set up small-group discussions around a particular theme or topic. For example, students could participate in group discussions about post-simulation lab training. Students would work together to figure out what went wrong and what went right or any other topic the instructor would like to focus upon. Another example of employing the work of Gardner is using the simulator itself. This is hands-on learning or what Gardner would refer to as the

bodily-kinesthetic intelligence (McFarlane, 2011). Modeling nursing procedures via the simulator would particularly appeal to those who would learn best by hands-on tasks that are interactive. Simulation would also fit Kolb’s work on the learning cycle and the resulting learning styles. If, in general, students learn through the experiences they encounter, then working through scenarios via high fidelity simulation (HFS) would act as an appropriate application of theory being put into practice. During the simulation experience, students will move through the learning cycle as outlined by Kolb. For most nurses, working with HFS is a new experience. As the nurses continue through the simulation training, they will naturally progress through the cycle as facilitated by the nurse educator. As a result of the new experiences with the simulator, connections will be made from what they previously knew and what they just experienced. This will allow them to generate ideas they will apply in the future. A debriefing in the form of group discussion would work nicely in this situation as the students work through the last three phases of Kolb’s learning cycle. This group dynamic also allows for students to demonstrate their particular learning style as described by Kolb. For example, some students will demonstrate the converging learning style by asking questions and using problem-solving skills (McLeod, 2013).

Jigsaws are a type of cooperative learning strategy used to promote discussion and student-led learning (Hotler, 2013). This type of strategy is ideal for promoting student interaction and an excellent method to allow students to foster self-learning. It is also a great benefit as this method can be adapted to almost any type of theme or topic. The basic premise of this method is as follows. The teacher will address the main topic to be discussed. The teacher will then divide students into groups giving each of the groups a subtheme. For example, consider there are three subthemes to the topic. Each group will have time to read an article and discuss the main points about their theme. This is considered round one. In round two, one (or possible multiple) of the members from each group will move to another group acting as the resident expert on the topic. The expert will relay the information about their theme, while the others will offer information on their topic. This rotation will take place once more in round three so that there is one expert from each of the subthemes in each group. At this point, everyone in the class should be well-versed on the subthemes of the original topic (Hotler, 2013). The use of cooperative learning can be used to discuss cultural sensitivity in support of Leininger’s work in transcultural nursing. Transcultural nursing is a method used in nursing programs to increase cultural awareness. This method is designed to increase cultural competencies and to break-down any misconceptions or negative feelings about people who are of different from the student (Hughes & Hood, 2007).

Role of the Nurse Educator

The role of the nurse educator throughout the course of the practicum diverged from the nursing faculty point of view. The learning group did not consist of nursing students. The learning group was made up of trained nurses. However, the eight core competencies identified by the NLN were appropriately applied, as the trained nurses were introduced to new concepts which would increase and diversify their knowledge base. Along the duration of the practicum, this student used educational theory and practice to create appropriate instruction mirroring how faculty educators would prepare for instruction utilized in nursing programs.

Practicum Overview

The clinical practicum took place at Mercy Hospital of Cadillac (MHC). Currently MHC is partnered with Munson Healthcare and Trinity Health. MHC has 97 licensed beds with over 700 employees including 85 medical staff. Lori Barnes, RNC and Director of Nursing Education and Obstetrics, acted as the preceptor, mentor and guide throughout the practicum experience. The primary emphasis of the practicum was the education of the obstetrics staff. The content involved HFS, ABG, and EKG interpretation. The content delivery was a mix teaching methods. The practicum also included case reviews, peer-reviews, and high-risk medication education. These experiences offered opportunities to collaborate with other hospital staff and work with the obstetrics team outside of the role of educator.

Description and Analysis of Clinical Project