Planning Facilitating Supporting and Evaluating Learning - Assignment Example

 Planning, Facilitating, Supporting and Evaluating Learning This summative assessment focuses on invasive haemodynamic monitoring as a pre-registration nursing module being handled by a level 2 instructor (i.e. a mentor). Haemodynamic monitoring is carried out to obtain a more substantial understanding of the pathophysiology of a medical condition being treated that would not have been possible with just clinical assessment. 2.1. Learning outcomes At the end of the module on haemodynamic monitoring, the learner is expected to acquire both theoretical and clinical/practice competency in the three primary principles of invasive haemodynamic monitoring. These are ability to: (1) demonstrate accuracy in handling haemodynamic equipment; (2) analyse and interpret trends from the data output; and (3) apply knowledge of minimum standards for patient safety while on haemodynamic monitoring.. 2.2. Resources required 2.2.1. Charts and diagrams A combination of available paper or cardboard charts and diagrams in the nursing school library was used with mentor-prepared tarpaulin charts including: (1) 8 ft x 8 ft size of the complete haemodynamic monitoring equipment set up; (2) arterial pressure waveform chart; (3) haemodynamic pressures chart; (4) normal haemodynamic values; (5) diagram of pulmonary artery catheter and parts; (6) pulmonary artery pressure and wedge waveforms chart, and (7) swan ganz, cathetarization. Charts are expected to facilitate students comprehension of the subject matter through clear visuals. 2.2.2. Mentor-prepared videos on haemodynamic monitoring processes Videos pertaining to practice-based skills were prepared to facilitate synergy of learning and skills gained through classroom instruction and clinical setting observation and practicum. Videos also reinforce knowledge gained during lecture. 2.2.3. Video recording and playback equipment for the module related video presentations Instead of the conventional DVD player and TV set combination, laptop and LCD projectors may be used since the latter are more handy and easier to set up and keep for future use. 2.2.4. Handouts Since a textbook was assigned, only handouts of lessons from reference books not available in the nursing school library were provided. Aside from this, handouts of prepared reading materials were also provided. Articles from journals regarding recent research on haemodynamic monitoring were also provided as handouts. 2.2.5. Mentor-prepared memory (handy tips) cards Memory cards or handy tips about nursing responsibilities during haemodynamic monitoring were printed in board paper and laminated in the form of bookmarks. At the back of the tip is a personal message from the mentor regarding her desire to be a mentor, friend and confidant of the student. These were distributed to students in the course of the module. Figure 1 shows one of such handy tips given out to students. Figure 1: Mentor-prepared memory cards (Elliott, Aitken and Chaboyer, 2007, p. 119). 2.2.6 Powerpoint presentations Powerpoint presentations pertaining nursing responsibilities in haemodynamic monitoring were prepared. With the use of figures and other visuals, retention of important nursing responsibilities are expected to be achieved. Figure 2: Screenshots of one of the Powerpoint presentations 2.2.7. Assessment questionnaires At the end of the module, written and practical assessment were administered to the students to evaluate whether or not they have acquired the desired learning outcome based on the pre-established minimum competency indicators. 2.2.8. Coaching invites Coaching invites in the form of invitation cards were distributed to students observed to be having difficulties in catching up with the lessons. Invites were computer designed printed out in board paper. When distributed, all the mentor needs to do is write down the name of the student, fill in the date and the time and sign. The original invite is the size of a wallet-size photograph. Figure 8: Sample of coaching invite 2.2.9. Computer unit and Internet connection The computer unit with an internet connection were used for the following purposes: (1) virtual tours of hospital facilities relating to the module on haemodynamic monitoring during the lecture discussions; (2) during web-based counselling for student who are not physically available to report to the venue of the academic counselling or coaching sessions, but have facilities with Internet connection. Eg: Practice Education Portal (PEP) of the university, intranet of the hospital, etc,... 2.2.10. Medical Educational Software The software Haemodynamic Monitoring Part II Clinical Application was prescribed to students either as a single user download purchase or a free trial version. The software was expected to facilitate learning and serve as practice for reviewing during quizzes. Figure 9 next page presents a group of screen shots obtained using the educational software. Figure 3: Screenshots from the Haemodynamic Monitoring Part II Clinical Applicationfrom C&S Solution 2.2.10. Practice Education Portal – Learning community membership The mentor and the students used this resource as a repository of all handouts, PowerPoint presentation, and practice quizzes used in connection with the module. All files may be downloaded from the Practice Education Portal, which was maintained by the mentor during the course of the module. This resource also served as a messaging system between the mentor and the students and among all members of the Learning Community. Each message written by anybody from the group, all members of the group receive which may be a question about the lesson or a reminder about an assigned topic. An online network of learners and the mentor assures each student that they have all the learning materials disseminated to supplement classroom instruction. 2.2.11. Mentor hotline The mentor’s mobile phone number was given to the students at the start of the module so that any difficulties that the students experience or any concerns regarding the module may be reported to the mentor. 2.2.5. Textbook and reference books Prescribed textbooks are coded blue in the reference list, while reference books are coded green. 2.3. Learning experiences The charts and diagrams are indispensable tools of the nursing mentor, since mastery of a skill involves a lot of visuals. From experience, these teacher tools are a favourite across all fields because, especially in nursing and medical profession, these are readily available from the bookstores. The main disadvantage commercially available charts is their small size. This was why I opted to invest in bigger tarpaulins, which are more durable, easier to keep because they do not get creased or crumpled like the conventional charts and diagrams. The students, who admitted that the charts and diagrams in tarpaulin form helped keep their focus on the lessons, enthusiastically received the bigger tarpaulins. I started out with the first tarpaulin, the 8 ft. x 8 ft haemodynamic monitoring system, with a lesson, which I discussed in the formative assessment. The action plan went well. With the bigger visuals, the students said they were more ready to go about with the activity in the practice setting. As far as these learning resources are concerned, charts and diagrams are still very much acceptable in nursing mentorship as long as these are “accurate and up-to-date, completely relevant to the individualized teaching and learning situation for which it is intended, and appropriate to make the points that the teacher practitioners wish it to make in the specific situation” (Jarvis and Gibson, 2001). In the practice setting, when the mentor demonstrates how processes like zeroing the tranducing system in haemodynamic monitoring is done, the learning experience goes by in a tick and in most cases, repeating for clarity is not an option. This is the reason why students feel that the lessons are being taught too fast. This was the rationale for the use of videotaped practice modules - so that the demonstration may be repeated all over again or shown in a slower tempo. Personally, a videotaped demonstration of a real-life clinical process like those in haemodynamic monitoring is the next best thing for student nurses to learn the necessary skills. Handouts are an integral part of teaching and learning. I make sure, though, that handouts are not just photocopies of pages of a textbook or reference book. For good reference books that are not readily available in the library, using the optical character recognition function of scanners is a much better alternative if the mentor proof reads the output and incorporates an annotation into the handout. From experience, doing this preparation saves me time in explaining, since my handouts are uploaded in the Practice Education Portal (PEP) at least 3 or 4 days before the topic in the handout is discussed. I usually assign my students to download the handouts and make sure they are read before class. I use a different strategy for handouts of research articles in journals. Research-based practice is a must for the teaching nurse and I believe that this early, the importance of research as a necessary adjunct to teaching, learning and practice should also be inculcated to the next generation of nurses. Most handouts of research articles are photocopied or scanned and uploaded to the portal. I want my students to be familiar with how research articles are written in the same way as I need them to understand the implications of the research article to the main lesson. This has not been a totally easy job because asking my students to summarize one or two relevant research articles and share them in class or in the PEP did not produce very promising results. At the very least, 10 summarized research articles were turned in by each student at the end of the module. From the student comments in the portal, the memory cards or handy tips made a good impact on them, but only after I included two of these handy tips as a true or false item in a short after-lecture assessment. Since then, all the memory cards have really been committed to memory. The PowerPoint presentations were also made available at the PEP. From a message sent through the portal, one student found out that it is easier to memorize lists using the PowerPoint presentations and most of the other students who tried the study technique confirmed that the strategy worked. If only for the fact that the students are using the PowerPoint presentations as a review material, I will continue preparing and/or adopting ready-made ones from the Internet. 2.4. Coaching and facilitation Coaching is an import facet of mentoring. Most students, however, do not voluntarily seek coaching sessions. From experience, mentors should really work around the dimension of approachability. If mentors are perceived to be approachable, students will not hesitate to request for an academic counselling. I also made sure that students know of my availability for coaching. So as not to embarrass anyone who receives a coaching invite, I make it a point to give invites to all my students. I also explained that coaching is not only for the slow learners. I made sure that the students understand that we are a team and the coaching is supposed to be a team practice. This strategy has been very effective because even top performers are actually showing up in the venue after being given an invite. Web-based coaching through PEP member’s chat was also offered to students who are not physically available to report for coaching. The only requirement is that usernames of all members had been provided to the mentor so that they may be added to the list of contacts. This is also a well-received coaching strategy. It was noted that students who are rather shy and uncomfortable with a face-to-face coaching resort to web-based coaching, and are, thus given the opportunity to be mentored during difficult stages of the module. Virtual tours from the Internet as a way of facilitating mastery of the lesson has been well received. This does not need to be done in the lecture room every time. Students may be given a list of web sites to visit and they can work their way from there. Instead of using dummies as patients, real life models in the form of student volunteers are requested to participate in role playing scenarios with the use of borrowed equipment from the hospital which are not anymore being used. This was especially useful during the haemodynamic accuracy practice exercises. Students take turns as patient and nurse while the rest of the class observe and comment about what went right or what went wrong in the practice demonstrations. 2.5. Support The educational software that may be downloaded free from the developers for a limited time for those who do not want to actually buy the software received excellent feedback from the students. According to the students, the software helps reinforce learning especially about computations and provide comprehensive review questions. The PEP provided students with the opportunity to interact with the mentor and the other members of the group, especially when a session is missed. Hence, other than being a repository of module-related documents and messaging system, the PEP also provided substantial support for students in many different ways. The mentor hotline is also an excellent support for students who will be late or absent for a scheduled lecture or hospital observation. From student feedback, there were actually students who faked a concern just to test if the call will be entertained. Later on, however, every call received from the hotline is a real need which requires support from the mentor. 2.6. Monitoring learner progress Short quizzes right after discussions are on-the-spot assessment of student recall of theories and concepts. Outcomes of this assessment serve two purposes: (1) day-to-day record of the results shows learner progress; and (2) results give the cue whether or not reinforcement or re-teaching is required. There were also practical assessments about processes that are usually unannounced. In some cases, I just observed a student in the practice setting and recorded the observations. This helped me monitor the learner progress on acquisition of necessary skills. This way, I would have a clear basis when I finally give the final mark to the student. 2.7. Minimum competency indicators The following minimum competency indicators were discussed with the learners at the start of the module. Competency Minimum Competence Required Assessment Instrument Accuracy in levelling the transducer to the appropriate level and adjusting this level to the changes in the patient’s position No erroneous low reading and false high reading; No placement above or below the phlebostatic axis; Does not take measurement when patient is in lateral position Practical assessment (through mentor observation) Accuracy in zeroing the transducer in the pressure monitoring system to atmospheric pressure Exact zero mm Hg reading and minimal baseline drift Practical Assessment and Bedside Monitor Reading Accuracy in evaluating the response of the haemodynamic monitoring system Fast-flush wave testing skill Practical Assessment Skill in trending data from the reading 95% accuracy Written assessment Mastery of minimum standards of haemodynamic pressures at resting values for central venous pressure, right ventricular pressure, pulmonary artery wedge pressure, left atrial pressure, left ventricular pressure and aortic pressure 100% accuracy Written assessment Mastery of minimum standards of normal haemodynamic values for stroke volume, stroke volume index, cardiac output, cardiac index, flow time (corrected), systemic vascular resistance, systemic vascular resistance index, pulmonary vascular resistance, Pulmonary vascular resistance index, mixed venous saturation, left ventricular stroke work index, right ventricular stroke work index, right ventricular end-systolic volume, right ventricular end-systolic volume index, right ventricular end-diastolic volume, and right ventricular end-diastolic volume index 100% accuracy Written assessment 2.9. Conclusion From the hindsight, there are a handful of revelations from my experience with this module, which emerged only while I was preparing this essay. First, there is always a better way of presenting an idea in class, which determines whether or not students will be sold to the idea. This was made apparent in the coaching invites. Secondly, no matter how noble a teaching strategy is, students tend to brush them aside, unless it becomes rather obvious that such will really help them pass quizzes or assessments. The memory cards were never actually memorized until I included them in the quizzes as true or false items. Thirdly, teaching is not just a science, but a synergy of science and art. Transmitting knowledge becomes difficult unless the senses, particularly students’ audiovisual faculties, are satisfied. Additionally, mentoring a group of students regarding this module also changed some of my own views about mentoring. For quite sometime, I always believed that Powerpoint slides are teacher resources for presenting lessons. It never occurred to me that they are also great aids for students in reviewing and memorizing. Another eye-opening experience was the actual utility of so-called educational softwares. I have always discouraged students from using encyclopaedias in CD form before because of their general tendency to copy and paste items from the CD straight to their reports or assignments, without understanding and paraphrasing. I thought twice in prescribing the software as a review material. But students’ overwhelming acceptance of the software as review aide and practice resource for quizzes changed my attitude about educational softwares. Writing this essay brought the best in me as a mentor because I came into realization that teaching is a dynamic process. It matters not whether a mentor has taught a particular module for so many times. Each experience is unique and the teaching style and techniques should be tailor-fitted to the needs of the students. As a mentor, I believe that my students were able to meet their learning outcomes, but I also learned much from the experience. This is where the beauty of the teaching profession lies – knowing that in my own little way, I was able to contribute to the practice and ultimately, because of the inherent dynamism of the teaching process, mentoring students also mean continuous learning is required of the mentor. Good mentors should, therefore, never stagnate, but grow professionally by enhancing their teaching arsenal with more knowledge and new ideas. References Antonelli, M., Levy, M., Andrews, P. J. D., Chastre, J., Hudson, L. D., Manthous, C., et al. 2007. Haemodynamic monitoring in shock and implications for management. Intensive Care Medicine, 33(4), pp. 575-590. Elliott, d., Aitken, L., and Chaboyer, W. 2007. ACCCN’s rritical care nursing. Marrickville: Elsevier Australia. Hadian, M. and Pinsky, M. R. 2007. Functional haemodynamic monitoring. Current Opinion in Critical Care, 13(3), pp. 318-323. Jarvis, P. & Gibson, S. 2001. The teacher practitioner and mentor in nursing, midwifery, health visiting and the social services. 2nd ed. Cheltenham, UK: Nelson Thomas Ltd. Woodrow, P. 2000. Intensive care nursing: A framework for practice. London: Routledge. Read More