Published Back to Strategy Search Strategy Submission Using QSEN Competencies during a Tornado Disaster Simulation Author: Georgine Berent ED, RN-BC, ACRN Title: Associate Professor Coauthors: Cheryl Smith, MSN, RN & Kenneth Burns, PhD, RN Institution: MacMurray College Email: georgine.berent@mac.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Continuing Education, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Upon completion of this simulation experience, the learner will be able to: 1. Demonstrate the collaboration needed after a natural disaster; 2. Comprehend one’s role/purpose during recovery; 3. Evaluate victims after a natural disaster; 4. Recognize the needs of others not injured during the disaster; 5. Understand the triage levels and color coding of victims; 6. Demonstrate teamwork; 7. Practice delivering safe patient-centered care. Safety : Hands-on learning simulation that identifies safety issues in a school cafeteria after a Level 4 tornado. (Knowledge & Skills) Teamwork and Collaboration : Hands-on learning simulation that requires multi-disciplinary teams (nursing, social work, psychology, criminal justice, and homeland security students) to work together as first responders to a Level 4 tornado. Teams must triage injured children. (Knowledge, Skills, & Attitudes) Patient-Centered Care : Hands-on learning simulation that requires multi-disciplinary teams to respond to injured children meeting their physical, emotional, and psychological needs to lessen the impact and minimize possible PTSD. (Knowledge, Skills, & Attitudes) Strategy Overview: Simulation: Level 4 tornado touched down at a K- 8 school hitting the lunchroom. Debris and victims are scattered about the area. Some victims are crying; some are selectively mute; some are injured. Nursing students along with social work and psychology students must complete triage and minimize the psychological trauma. (Homeland security and criminal justice students can participate in this simulation: Homeland Security: Set up a command post or Emergency Operations Center – EOC; responsible for information sharing, resource allocations, and the smooth delivery of effective service; Criminal Justice: Secure the area; screen all persons entering examining ID badges—remember, this is a disaster area and only qualified responders are allowed in area. Keep parents, concerned citizens, the press, and others outside the triage area.) Submitted Materials: Additional Materials: Evaluation Description: Describe evaluation methods and your assessments (anecdotal or data-based) of learning outcomes and student/faculty satisfaction with this strategy. Please answer the following: 1. The purpose of the Level 4 Tornado Simulation was clear and understandable. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 2. The team communicated effectively with the victims. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 3. The teams communicated effectively between each other. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 4. The actions during the simulation were patient focused. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 5. Interventions made by teams were appropriate. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 6. The content was appropriate supporting the objectives. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 7. The teaching method was effective for the subject matter. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 8. The content added to my knowledge. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 9. The speakers were effective presenters. A. Strongly disagree B. Disagree C. Agree D. Strongly agree 10. This information will affect my professional practice. A. Strongly disagree B. Disagree C. Agree D. Strongly agree

Published Back to Strategy Search Strategy Submission The influence of human factors in medication errors: a root cause analysis Author: Robyn B. Caldwell DNP, FNP-BC, CNE Title: Assistant Professor Coauthors: Institution: Auburn University Montgomery Email: rcaldwe4@aum.edu Competency Categories: Quality Improvement, Safety Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Independent Study Learning Objectives: Knowledge: 1. Examines the human aspect of nursing practice which influences the delivery of safe patient care. 2. Identifies individual components within a health system and its impact on quality patient outcomes. Skills: 1. Demonstrates the use of root cause analysis in identifying human influences in medication errors. 2. Differentiates best practice and local practice in examining nursing medication errors. Attitudes: 1. Values individual responsibility for safety and quality when providing patient care. Strategy Overview: Healthcare organizations strive to provide safe, quality care in every patient setting. The complexities of the healthcare environment however, allows prospective errors. Medication related errors are the most common type of error and also account for a sizable increase in healthcare costs (IOM, 2000). Medication errors account for lost wages, disability, and productivity, and are responsible for over 7000 deaths annually (IOM, 2000). The Joint Commission mandates healthcare systems demonstrate strong leadership which creates a fair and just culture of safety. This approach holds both the organization and individual accountable for safe, quality patient care (Joint Commission, 2017). This accrediting body recognizes that individuals human and capable of mistakes in an often flawed system. This case study examines the human factor in a fatal medication error using a root cause analysis. Submitted Materials: Caldwell_Human-Factors-in-Medication-Errors.docx - https://drive.google.com/open?id=1uXtjzeBSiOdhA68ah3H-OIIHpGqkzFAP&usp=drive_copy Caldwell_Human-Factors-in-Medication-Errors-1.pdf - https://drive.google.com/open?id=1bei61FCgiadWe3_FGAEfY9RmaejUIj0D&usp=drive_copy Additional Materials: https://www.jointcommission.org/framework_for_conducting_a_root_cause_analysis_and_action_plan/ Evaluation Description: This case study was developed in an effort to stimulate discussion about the influence of human errors in healthcare systems. Intended uses include root cause analysis, group discussion, and independent study. The evaluation may be tailored to meet the needs of the audience.

Published Back to Strategy Search Strategy Submission Teaching SBAR using Story: Online and in Clinical Learning Author: Vicky J.-H. Yeh PhD, RN Title: Coauthors: Gwen Sherwood, PhD, RN, FAAN, ANEF (gwensher@email.unc.edu ); Stephen Powell, MSc (spowell@synensysglobal.com ); Cynthia Foronda, PhD, RN, CNE, CHSE, ANEF (c.foronda@miami.edu ) Institution: University of North Carolina at Chapel Hill & Synensys® Email: yeh.vicky@mayo.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Advanced Practice Providers, Continuing Education, Graduate Students, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: By the end of the course, students will be able to: 1. Describe the components of the Situation-Background-Assessment-Recommendation (SBAR) communication tool to facilitate communication among the healthcare team 2. Recognize and value own role in preventing errors. 3. Analyze a clinical story about a critical event (e.g., medication error, a significant change in vital signs, missed care, etc.) that must be reported to ensure the safety of the patient 4. Engage in deliberate practice to complete multiple story-guided SBAR reporting by applying to one’s own clinical practice 5. Demonstrate effective use of SBAR in reporting a critical incident to other members of the healthcare team by covering critical patient information in an SBAR format, evaluated by a story-specific rubric Strategy Overview: Purpose: In this assignment, learners complete an online asynchronous SBAR reporting practice session using pre-recorded clinical stories followed by application to situations encountered in clinical practice. This strategy can be used with all educational levels, as part of a Transition to Practice orientation or as staff development. Deliberate practice (Ericsson, 1993) (practice -> reflection -> feedback -> repeat cycle) is a theoretical framework that leads learners through a series of practice activities to achieve a particular skill. Pre-licensure learners have few opportunities to practice critical team communication to achieve mastery. The practice sessions are also effective for post-licensure nurses to achieve competency in SBAR. This assignment utilizes deliberate practice to help learners develop confidence in team communication by providing multiple practice sessions. Method: Before completing the online asynchronous SBAR practice session, learners are expected to review the SBAR Quick Review from the SBAR Toolkit (see supplemental materials) or other assigned readings or publicly accessible YouTube videos demonstrating how the SBAR communication tool can be applied in team communications. The learners are to complete an independent online practice session (described below) as assigned. In this first practice session, learners listen to audio-recorded clinical story (an example story and the corresponding script is included in the supplemental materials describing a scenario from various viewpoints (patient, nurse, provider, etc.). The learner must identify a critical incident embedded in the story which necessitates a report to another provider to ensure the safety of the patient. Learners then complete the following steps: 1. Record a verbal report (audio only, simulating making a phone call) in an SBAR format of the critical incident to another member of the healthcare team (e.g., charge nurse, MD, etc.). 2. Complete an SBAR checklist (see supplemental materials) to self-assess the completeness of their SBAR report 3. Respond to 2 reflective questions on what they did well and what they thought could be improved 4. Record a second verbal report of the same scenario addressing areas for improvement 5. Listen to a pre-recorded exemplar SBAR report 6. Learners may repeat the exercise to engage in unlimited practice sessions After successful completion of the first online practice session, learners then are to take what they learned to the real-world of the clinical setting. Each week, learners are asked to identify a situation in practice that requires sharing critical information with another provider. Following the same steps as the online practice sessions, the learners prepare an SBAR report on an assigned patient and present it as part of the clinical debriefing. Learners then work in pairs or small groups to practice giving SBAR reports and offer feedback to each other’s reports according to the SBAR checklist. Learners continue weekly practice sessions together until mastery learning is reached which is defined by achieving all 15 points of the checklist consistently. Submitted Materials: Supplemental-Materials_Final.pdf - https://drive.google.com/open?id=1mMRtx1zyWjJUWbe0MdaWqtNvgGIguzUQ&usp=drive_copy ISBAR-Nurse-to-Physician-Communication-Rubric.docx - https://drive.google.com/open?id=1zKgQy4IVerUtZQQP1NxtK04xjFGUmg8l&usp=drive_copy Additional Materials: 1. Steps of the Scenario-Based SBAR Reporting Practice Cycle 2. SBAR Toolkit 3. Audio Story Sample and Script 4. Learner Self-Assessment SBAR Communication Checklist 5. Self-Reflection Questions 6. Citations and Supporting Work 7. ISBAR Nurse-to-Physician Communication Rubric Evaluation Description: To evaluate learning outcomes, the instructor, preceptor, or teaching assistant will listen to the learner’s 2nd recorded verbal SBAR report using a checklist and provide feedback to the learners via email or the course platform. Alternatively, if the learning group is large, a group class debriefing can be completed to review common SBAR errors. Students can also work in pairs; listen to their peers’ SBAR reports while checking off the items on the checklist. This provides an opportunity for students to provide/receive feedback and would engage them in metacognitive reflection about their own performance. For the clinical setting, each learner submits a feedback report of what they did well and what still needs improvement.

Published Back to Strategy Search Strategy Submission Using evidence in practice Author: Mary Guimond PhD, WHNP-BC Title: Assistant Professor Coauthors: Institution: Duquesne University Email: guimondm@duq.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Write a PICO question Appraise evidence available using electronic resources Select evidence to address PICO question Categorize level of evidence Formulate a response to the assigned nursing problem Strategy Overview: The assignment can be used for large or small classrooms. It works best if student groups are limited to 4 students per group. If more than 10 groups, two facilitators should be available to circulate the room. The purpose of the facilitator is to help focus students on the assignment, clarify questions about the "nursing problem", and to answer questions as they arise. In preparation for this assignment, I use a quick lecture to discuss evidence based practice and I demonstrate how to use the web to find appropriate resources (Google Scholar, Cochrane Database, CINAHL). For evidence based practice theory, I ask students to review an external website for evidence based practice (there are several available via search). Also, because I want to set my students up for success--I have pre-searched Cochran Database for the latest systematic review on the "nursing problem"--students may or may not find the review, but I know that it is an active area of research. Each group is presented with a "nursing problem" for example: A child is being discharged from the clinical after being seen for antibiotic associated diarrhea. The mother is upset because the HCP recommended probiotic rather than a “real medicine” How do you respond? You are working on a surgical unit and the nurses are trying to convince a physician group that early feeding might be a good idea for some patients. What will you say? You are providing discharge instructions for a patient and the doctor has prescribed a porcine-derived insulin product. The patient is concerned because he understood that human insulin is better. How do your respond? Student groups are asked to: A. Develop a PICO question based on their "nursing problem" B. Use computers or smartphones to access evidence in real time (20-30 minutes are given for the research portion) and to evaluate the most recent evidence available C. Determine the level of evidence available D. Use the evidence to formulate a response to their "nursing problem" E. Translate their response to everyday language Each group has 5 minutes to present their work to the class. They are asked to include: "nursing problem", PICO question, evidence, and response. Submitted Materials: Additional Materials: Evaluation Description: Because this is a highly structured assignment, the quality of the student work is generally very good. The facilitators help students to ask the right questions and use their resources efficiently. The nature of the assignment is formative, although I do ask for a written report containing the "nursing problem", PICO question, level of evidence, evidence citation and source, and the response to the person/patient. Students are delighted to find the evidence is readily available.

Published Back to Strategy Search Strategy Submission Using Unfolding Case Studies to Develop Clinical Forethought in Novice Nursing Students Author: Brenda Moench RN, MS, CNE Title: Nursing Instructor Coauthors: Institution: University of Wisconsin Milwaukee Email: moench@uwm.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: The student will describe patient-centered care as applied to the home and long-term care settings. (Knowledge) The student will identify safety interventions to protect patients from falls in the long-term care setting. (Knowledge) The student will describe the value of seeing health care situations through the patient’s eyes. (Attitudes). The student will explain how clinical forethought is used to predict potential complications. (Skills and Attitudes) Strategy Overview: Unfolding case studies as a teaching strategy are ideal for novice learners in a pre-licensure nursing program. The author has used unfolding case studies to illustrate principles of patient-centered care and safety in a Health and Illness course in a concept-based curriculum. First semester students develop knowledge, skills, and attitudes about patient-centered care as they identify salient features in the case study that are opportunities to intervene with patient-centered care. Clinical judgment is required to interpret the complex clinical situations found in current nursing practice (Tanner, 2006). Lack of clinical judgment poses a risk to patients and can lead to negative patient outcomes. Clinical judgment requires forethought, which is the process of looking ahead to the needs of the patient to prevent problems before they occur. It is described by Patricia Benner (2008) as a “habit of thought and action” that involves “future think.” The predictions and actions involved in clinical forethought are obvious to the experienced nurse and unfamiliar to novice students as they lack professional experience. Clinical forethought can be introduced using unfolding case studies that encourage students to make a patient’s values, preferences and beliefs an important factor in their care. Nurse Educators are challenged with writing case studies that require students to see how clinical judgment could facilitate safety and patient-centered care. While every case study that is focused on patient-centered care includes patient preferences, values, and beliefs; individual case studies can be tailored to focus on psychosocial, financial, emotional and/or developmental aspects that might also influence the patient’s health. Including aspects of health aids students in understanding the context of the story. To begin this learning process, students receive the first narrative of the unfolding case study and are asked to underline words that stand out as important. Novice student nurses, limited by lack of experience, tend to focus more on the physical aspects of the patient and less on patient preferences and values. As students encounter additional case studies throughout the semester, they begin to recognize patient-centered care as an integral part of patient care. Successful case studies provide sequential snapshots of the patient’s illness trajectory in the context of their lived experience. The advantage of unfolding case studies is that they reveal information incrementally, which mirrors nursing practice. Experienced nurses faced with limited context for a patient’s situation use clinical forethought (based on past experiences) to predict possible complications. In unfolding case studies, students are asked to use clinical forethought to predict what could happen next. By asking questions after each incremental stage, the instructor provides prompts students to consider how nursing actions contribute to the patient’s trajectory. After students' complete parts of the unfolding case study, they have an opportunity to reflect on the impact nurses have on their patients. Reflecting backward on the patient trajectory highlights what clinical forethought might have predicted. Students are asked to reflect on steps they might have taken to accommodate patient preferences (patient-centered care) in the case study. Students get a glimpse of the power of informed prediction to prevent adverse outcomes. Safety Unfolding Case Study Purpose: The purpose of this assignment is for students to describe patient-centered care, to identify safety interventions, to explain clinical forethought and to value seeing health care through the patient’s eyes. Instructions: This strategy can be used with individual students or with groups of students. For both clinical and classroom settings, each stage is presented on one slide or on an individual piece of paper at incremental intervals beginning with Stage I and ending with Stage III. Answers are written in the Learning Management System used by your college, on paper, or on a notecard and turned in after each stage. The instructor may choose to add course content during the time between each stage. Students cannot change their answers to previous stages. Answers to all the questions are discussed at the end and there’s an opportunity to reflect on clinical forethought. Student knowledge, attitudes, and skills are assessed using the rubric at the end of the assignment and during class discussion. Stage I Unfolding Case Study: Jean is an 88-year-old widow with four grown sons and numerous grandchildren. She was living alone, caring for her own home for the past 35 years since her husband died. At home, Jean could make meals, take care of her hygiene, pay her bills, and use the bathroom on her own. She had enjoyed being at home and continued to take care of herself and her home. One day she developed mild abdominal pain. She thought it was related to something she ate, but it persisted, so she decided to go to her family doctor. She was not concerned about the cost of seeing a doctor as she had excellent health care coverage under her deceased husband’s insurance. Jean was taken to the clinic and underwent lab tests and a CT scan, for which her doctor concluded she had ovarian cancer. Since the treatment would not provide a cure, she opted to let cancer take its course. The clinic nurse told Jean to call if she needed anything. Jean was a strong independent woman, as she had to be after becoming a widow at such a young age. But now, she was facing an unexpected diagnosis of cancer. Stage I Questions: 1. Underline the words in the case study that stands out for you as important. What is your rationale? 2. What aspects of health are included in part I? How are these aspects related to patient-centered care? 3. What activities of daily living are a part of Jean’s functional ability in the home setting? Stage II Jean had been living alone at home for two months after her diagnosis. One day when waking up she developed lightheadedness. She called her son to help her. Her son insisted on driving her to the emergency room, where the doctors decided she would be admitted for tests. A CT scan revealed cancer had metastasized (spread) to her brain. The doctor and nurse discussed the situation with her four sons. The four sons were unable to stay with their mother. Although Jean was a very independent woman who wanted to go home, she would not be allowed to return home, but instead, the social worker arranged for her to be admitted to a long-term care facility. Stage II Questions: 1. What interventions protect patients from falling in the long-term care setting? 2. How is the ability to perform activities of daily living (ADL’s) related to safety? Stage III Jean wanted nothing more than to live her final days at home. It was disappointing to her that she went to the hospital for lightheadedness and now would never return home. In long term care, she secretly hoped she would be able to return home, she thought, if she worked hard enough. Her mood was uplifted when visited by her grandchildren. One evening, after her visitors had left, Jean placed her call light on for assistance to use the restroom. She waited for 20 minutes and nobody came to help. She was worried she would be incontinent and soil her underclothing, so she got up on her own. Unfortunately, she was too weak and dizzy and fell on the carpeted floor. Now she was really scared. She thought she certainly wouldn’t be allowed to return home after falling. Fortunately, she was not injured, but would not be allowed to leave her bed without the help of others. She became depressed and sadly, died one week later in the long-term care, surrounded by her family. Stage III Questions 1. Reflect on your answers to part I of the case study. Did Jean’s desire for independence stand out to you as important? If the staff knew Jean valued her independence, how could they have used this information to promote safety? 2. Explain how clinical forethought is used to predict potential complications and what it means to you as a future nurse. 3. Describe the value of seeing healthcare through the patient’s eyes. How can nurses have an impact on the lives of patients like Jean? 4. In your opinion, did Jean receive patient-centered-care? Why or why not? Submitted Materials: Teaching-Strategy-QSEN-TS-241-1.docx - https://drive.google.com/open?id=1AECA5dGZdE6YPXxF0DmMMC8M9maipFe5&usp=drive_copy Additional Materials: Benner, P., Hughes, R.G., & Sutphen, M., (2008). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Tanner, C.A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204-211. Evaluation Description: Evaluation- Rubric

Published Back to Strategy Search Strategy Submission Simulating an Evidence-based Practice Committee to Teach Pre-licensure Students the Evidence-based Practice Process Author: Elizabeth Murray PhD, RN, CNE Title: Associate Professor Coauthors: Institution: Florida Gulf Coast University School of Nursing Email: emurray@fgcu.edu Competency Categories: Evidence-Based Practice, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: This teaching strategy addresses the following KSAs related to Evidence-based Practice and Teamwork and Collaboration QSEN Core Competencies: Evidence-based Practice The learner will: • Differentiate clinical opinion from research and evidence summaries. • Describe reliable sources for locating evidence reports and clinical practice guidelines. • Explain the role of evidence in determining best clinical practice. • Describe how the strength and relevance of available evidence influence the choice of interventions in the provision of patient-centered care. • Read original research and evidence reports related to area of practice. • Locate evidence reports related to clinical practice topics and guidelines. • Value the concept of EBP as integral to determining best clinical practice. Teamwork and Collaboration The learner will: • Describe your own strengths, limitations, and values in functioning as a member of a team. • Acknowledge your own potential to contribute to effective team functioning. • Describe impact of own communication style on others • Value teamwork and the relationships upon which it is based Strategy Overview: Purpose The purpose of this group activity is to build on previous learning related to evidence-based practice that occurred during the term. Learners function as members of an Evidence-based Practice Committee at Eagles Community Hospital (named for the University mascot) and engage in the evidence-based practice process. Overview This activity uses the Johns Hopkins Nursing Evidence-based Practice (JHNEB) Model and learners are required to use the book, The Johns Hopkins Nursing Evidence-based Practice: Model and Guidelines (3rd ed.) by Dang and Dearholt. Prior to participating in this group activity, learners engaged in the following individual activities: 1. Learners explored and defined a clinical problem, described significance to nursing, and developed a PICOT question. 2. Next, learners identified keywords and established a search strategy to explore the evidence related to their PICOT question. 3. Learners conducted a literature search related to their PICOT question and selected three (3) pieces of evidence to appraise using the JHNEB Appraisal Tool for Research (Appendix E) and JHNEB Appraisal Tool for Non-Research (Appendix F). Leaners were required to select at least one (1) evidence summary and one (1) piece of primary evidence. 4. Finally, leaners created a summary matrix of the above evidence appraisals using the JHNEB Evidence Summary Tool (Appendix G). Learners will function as an Evidence-based Practice Committee (EBP) for Eagles Community Hospital. Learners are divided into groups based on the condition/topic selected at the beginning of the semester. Committee members identify a clinical practice (nursing intervention) that is well-supported by evidence and related to the symptom selected by the team. Members will conduct the synthesis process to identify a recommendation to address a PICOT question. The EBP committee will develop a PowerPoint presentation to promote adoption of the clinical practice by nursing staff (classmates). This activity is divided into three (3) parts. Part 1: Learners form an EBP Committee of 3-4 members who are interested in the same clinical problem. 1. The committee members will select a Committee Facilitator who will be responsible for keeping the team on task, assigning deadlines for members to submit additional materials, facilitate discussions, and report committee activities in class using report sheet by uploading to team files in the learning management system (LMS) or Google Docs. 2. Members will share their Individual Evidence-based Summaries with each other and discuss the following related to each member’s Evidence-based Summaries (discussion can take place face-to-face or in an online forum): a. What symptoms were addressed? b. What nursing interventions were identified? c. Was there significant evidence? d. What were the levels of evidence identified using JHNEB Evidence Level and Quality Guide (Appendix D)? Were all levels of evidence identified? If not, what was missing? e. Were there Clinical Practice Guidelines (CPGs) related to the interventions identified? 3. Members identify the levels of evidence missing and conduct a review for each. Then each member will bring evidence (1 piece) from each missing level back to the committee for review. 4. The Committee will summarize work using the EBP Committee Report sheet and the facilitator will present to the class the following week. Part 2: 1. The EBP Committee will review all members’ Evidence-based Summaries and select one (1) symptom and one (1) nursing intervention to address that symptom. The nursing intervention MUST be an autonomous intervention nurses can perform without requiring collaboration with a primary care provider (MD, OD, ANP, PA). 2. The Committee will write a PICOT question using the symptom and nursing intervention selected. 3. Next, the Committee will review all members’ Evidence-based Summaries and choose evidence specifically related to the symptom and nursing intervention selected and summarize the evidence using the Evidence Summary Matrix (combine previous evidence). a. Evidence Summary Matrix MUST include: i. Eight (8) pieces of evidence ii. A minimum of one (1) piece of evidence for each level b. Learners may need to conduct searches for additional evidence. 4. The Committee will engage in the Synthesis Process using the JHNEB Synthesis Process and Recommendations Form for the eight (8) pieces of evidence. The members will refer to Appendix H in textbook for Key Points for this discussion. 5. Once completed, the Committee Facilitator will present to class. Part 3: The Committee will review Synthesis of Findings and: 1. Finalize recommendation for clinical practice change 2. Determine which Translation Pathway represents the overall strength of the evidence (the overall strength should qualify for the Strong Pathway or the Good Pathway). 3. Discuss the fit and feasibility of the clinical practice change. 4. Finally, the EBP Committee will outline the results of the EBP Process and their Action Plan for Success using the Action Plan Planning Tool (Appendix I) in a PowerPoint presentation and present it to the class. Submitted Materials: 316.-Simulating-EBP-Committee-Strategy-Overview.docx - https://drive.google.com/open?id=1spiGKFzfGo_tCgSPgxcReLkGbj4O3nON&usp=drive_copy 316.-Self-Assessment-Peer-Assessment.docx - https://drive.google.com/open?id=1suDlYdX2tHDMeQfULz82i2vcLSPmf28d&usp=drive_copy 316.-Rubric-for-EBP-Committee-Presentation.docx - https://drive.google.com/open?id=1sv-pVMyeaH7ZDnqyX1SqOe3gr0xsEGEb&usp=drive_copy 316.-EBP-Committee-Report-Sheet.docx - https://drive.google.com/open?id=1sDpF5FB033xQpypeZh9frYZQbq-PSKl4&usp=drive_copy Additional Materials: For detailed student guidelines for each part of the teaching strategy and the presentation, please contact emurray@fgcu.edu The Johns Hopkins Nursing Evidence-based Practice Model and tools are available here: https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html Evaluation Description: 1. Upon completion of the presentations, learners conduct a self-assessment of their contributions and collaboration as a team member and peer-assessment using a rating scale of 0-5 (0=minimum effort and 5= outstanding effort) of several KSAs related to the Teamwork and Collaboration Core Competency. 2. Learners are graded individually for their work on Parts 1, 2, & 3 (see rubrics attached). 3. Learners are graded on their PowerPoint and on their individual presentations (see rubric attached). Learners Although response rates on the Perception of Instruction Surveys at the end of the term were low (8 out of 30 responding), they were positive. On the item “Overall this course was effective in improving my knowledge of course content” 87.5% indicated strongly agree and 12.5% indicated agree. Learner Comments "The PowerPoint and doing each step of the process each week helped me fully grasp what all goes into EBP committees". "The course group project was very helpful in supporting learning…provided a more in-depth look at the material and the group project allowed me to work on my communication and teamwork skills". "I think this class really helped me better understand the process behind EBP and when to apply it in patient settings". "The class gave a lot of insight into evidence-based care, the importance and how we can research and implement it in the future". Faculty Rubrics are used to evaluate Parts 1, 2, & 3 of the strategy as well as the group presentations Faculty believe that student feedback and evaluations demonstrated learners gained knowledge of evidence-based practice and teamwork and collaboration. In addition, learners valued the group experience. This strategy can be used in a face-to-face course or online course.

Published Back to Strategy Search Strategy Submission Care for the COVID In-patient: Common Practices in End-of Life Care Author: Kathy Jo Meyers Ph.D., RN., ACNS-BC Title: Post-doctoral Fellow Coauthors: Davico Smith-Washington, RN Institution: Veteran Administration Quality Scholars Email: kathy.meyers@va.gov Competency Categories: Evidence-Based Practice, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Advanced Practice Providers, Faculty Development Strategies, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: The interdisciplinary team will be able to verbalize common end-of-life practices. The interdisciplinary team will have increased knowledge of common medications used to improve symptomatic care at end-of-life in the in-patient. The interdisciplinary team will state the improvement in one outcome in end-of-life care through the use of the evidence-based end-of-life resource sheet. Strategy Overview: Due to the COVID pandemic, staff of all disciplines was reassigned to the acute COVID units. Many staff had no prior exposure to potential traumatic incidences and end-of-life care. Through focused questionnaires, knowledge deficits were identified. A subsequent multi-week educational series based on the End-of-Life Nursing Education Consortium (ELNEC) curriculum as well as a Resource Sheet was created to guide clinical practice at end-of-life for the COVID in-patient. Submitted Materials: Meyers_EOL-Meds-Practice_03.24.2021-1.pdf - https://drive.google.com/open?id=1k20H8ZfuCu2lPI6lzmxkdX_r3X6p2GMz&usp=drive_copy Meyers_EOL-Practice_03.24.2021-1.pdf - https://drive.google.com/open?id=1jvQT-f6L8LLXrHz0NP7oRps6bmOuaewt&usp=drive_copy Additional Materials: Evaluation Description: In the pre-implementation phase, open-ended questions were used to identify areas of need for the staff. After an educational series, an End-of-Life Resource Sheet was designed based on the needs assessment and the ELNEC curriculum. The accuracy of the resource sheet was confirmed with experts in the field. Resources used included the End-of-Life Nursing Education Consortium (ELNEC) curriculum, the American Association for Hospice and Palliative Medicine, the Hospice and Palliative Nurses Association, National Hospice and Palliative Care Organization, and the Veterans Administration Evidence-Based Practice Committee. This validity of the practice strategy was assessed via interviews with various interdisciplinary stakeholders including physicians, managers, nurses, and patient caregivers. Continual staff evaluation of the resource during development included statements that the resource would be a helpful refresher of end-of-life content. The final evaluation of the End-of-Life Resource Sheet included interviews with staff nurses and nursing assistants. There was confirmation that staff was able to verbalize end-of-life common practices and common medications used for various symptoms such as dyspnea, pain, and nausea. After the occurrence of five patient deaths, comfort with using the tool will be measured via focused inquiries with the staff regarding the use of the resource sheet and any further recommendations for education. The End-of-Life Resource Sheet was laminated and placed in the Unit Procedure Binder as a quick reference for the staff when caring for an in-patient at end-of-life. The interdisciplinary team plan is to revisit the effectiveness of the resource yearly to determine if updates are needed in protocols or medications. This End-of-Life Resource Sheet is specific to the campus of origin; however, it can be replicated for use to suit the needs of outside sources.

Published Back to Strategy Search Strategy Submission Academia - Practice Partnership: Integration of QI Capstone Projects in a Clinical Setting Author: Lynette Savage RN, PhD, COI Title: Assistant Professor, University of Providence Joint Appointment Coauthors: Lisa Harmon Institution: Providence St. Joseph Health Email: Lynette.Savage@uprovidence.edu Competency Categories: Quality Improvement, Teamwork and Collaboration Learner Level(s): RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Course Syllabus Learning Objectives: LO1. Synthesize curriculum content through reflective practice, use of FOCUS PDCA model, and a comprehensive integrative project. LO2. Construct safer and improved patient-centered care processes through inter-professional teams. LO3. Select a clinically based nursing quality initiative from approved list provided. LO4. Obtain manager support and instructor permission. LO5. Complete a review of literature and prepare a written proposal including a project summary, needs assessment, and review of literature. LO6. The proposal will be presented to the appropriate staff involved in the work, e.g. nurse manager, interdisciplinary team members, region or system office "lead" for this topic, and/or senior leadership to solicit feedback prior to project implementation. LO 7. Implement, then evaluate and analyze the data collected for the Capstone project. LO8. Disseminate knowledge gained and lessons learned in a final Capstone Project scholarly paper. Knowledge: Describe strategies for improving outcomes of care in the setting in which one is engaged in clinical practice. Analyze the impact of context (such as, access, cost or team functioning) on improvement efforts. Skills #1: Use a variety of sources of information to review outcomes of care and identify potential areas for improvement. Skills #2: Propose appropriate aims for quality improvement efforts. Skills #3: Assist leadership in shaping the dialogue about and providing leadership for the introduction of best practices. Attitudes: Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals. Strategy Overview: The Capstone project is the culminating academic experience for the RN to BSN completion program students provide the opportunity to explore an issue in conjunction with their nurse manager, department, division, or regional senior leader that is important to the healthcare organization or specific nursing unit. Based on the Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2010), these issues may include, but are not limited to: nurse leadership, quality care and patient safety, evidence based practice, healthcare policy development, interprofessional communication and collaboration, population health promotion and disease prevention, and professional values. Part of the focus of these classes is based on the Quality and Safety Education for Nurses (QSEN) work. Explaining the importance of variation and measurement in assessing quality of care will be a concentration of the Capstone project. Appreciating how unwanted variation affects care and valuing measurement is fundamental in providing good patient care. The Capstone project demonstrates the student learner's ability to synthesize as well as apply the cumulative knowledge, skills, and attitudes acquired in the academic program to current workplace specific, prioritized issues. The Capstone project affirms the student's ability to identify key issues, think critically and innovatively to solve these issues in an ethical and feasible manner, and to effectively communicate findings in an intra- and inter-professional context. Because of this, the work associated with the Capstone learnings will take place in a structured, sequential way during the last three semesters of the program. The first Capstone course, consists of a project selected by the student, in concert with the nurse manager and faculty, that includes a needs assessment, appropriate literature review, a project plan, and implementation of the selected project. The second Capstone course, concludes with data analysis and dissemination of project learnings through an academic paper. The purpose is to provide the student learner with "tools" that can be utilized in the clinical setting to improve patient care and safety. A preceptor will be used for the Capstone experience in the RN-BSN Completion Program to assist in guiding nursing students during their educational process. Utilizing preceptors provides an additional learning forum for nursing students' continued improvement of patient care delivery, understanding of the integrated healthcare organization, and fostering their development as nurse leaders. Examples of qualified preceptors may include but are not limited to: nurse manager, assistant nurse manager, educator, clinical nurse specialist, nursing director, or clinical nurse leader. Both student and preceptor will utilize evidence-based practices to ensure quality outcomes. Considering the student learner's facility and organizational needs, students will select a QI project from this menu of options for their capstone project: · Hospital acquired pressure ulcers (HAPU) · Patient falls - with injury · Catheter associated urinary tract infection (CAUTI) · Central line associated bloodstream infections (CLABSI) · Patient handovers · Surgical site infections including colorectal and/or hysterectomy · Sepsis · Delirium · Venous thromboembolism (VTE) · Other topic: _____________ (must receive approval from the student's Manager and/or Chief Nursing Officer (CNO) to deviate from the menu of options). The student learner will: (a) contact the nursing personnel lead to learn more about this topic and the specific needs for the organization and (b) understand the metric for the topic as well as the current status for the student learner's individual nursing unit, department, or division prior to project selection. Submitted Materials: 1.-Partnership-between-Academia-and-Practice-2017-05-03-2.pptx - https://drive.google.com/open?id=1n9TwECaNgSvIOO6t-trwF4rcJA-qxb31&usp=drive_copy 2.-Guide-to-Capstone-Curriculum-Delivery-2017-03-30-2.docx - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy 3.-Team-Contribution-Evaluation-Tool-2017-10-21-2.docx - https://drive.google.com/open?id=1YcPoyKTxrxzEApLgVJWVrmdv0_nD1V34&usp=drive_copy 4.-GAP-Analysis-Tool-Action-Plan-2017-10-21-1.docx - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: 1. Partnership between Academia and Practice (Overview of the Process) 2. Guide to Capstone Curriculum Delivery 3. Team Contribution Evaluation Tool 4. GAP Analysis Tool and Action Plan 5. Course syllabi (Capstone 1 and Capstone 2) * *Please contact Lynette Savage, RN, PhD, COI, University of Providence, if you would like to receive copies of the syllabi. Lynette.Savage@uprovidence.edu 503 349-0215. Evaluation Description: The Capstone project affirms the student's ability to identify key issues, think critically and innovatively to solve these issues in an ethical and feasible manner, and to effectively communicate findings in an intra- and inter-professional context. There are three evaluation pieces to this work: (1) Team Contribution Evaluation Tool, (2) Reflection on the Capstone Process, and (3) final scholarly paper based on the year-long process defined in a rubric, as well as SBAR Presentation to classmates. 1.Team Contribution Evaluation Tool: Purpose: The intent of the Tool is to teach learners how to analyze team members' performance and construct feedback. This tool is confidential between the individual student and faculty. Working on teams is an everyday experience in the work place. However, when you begin to implement different processes sometime teams struggle and may not be as functional during change. As part of the self-reflection portion of this program, each student learner will complete a Team Contribution Evaluation Tool. There are two parts of the tool: (a) evaluating other team members and (b) self-evaluation. Part of this work is to look retrospectively to understand what you could have done differently to improve the team process. Select one of the options for completing the form: Option 1: For this assignment, students may work either individually or in small groups of 2-3 students. If you are working in a small group of students for the Capstone project, please complete the form based on those members of your Capstone group. Option 2: If you are working on the Capstone project individually, please complete the form based on members of the team at your unit, department, facility, program, or clinic. 2.Reflection on the Capstone Process: What did the student learn during this experience that they can use in their clinical environment? 3.Written Paper and Presentation: Each student learner will receive a final grade for: (a) the scholarly paper based on an established rubric and (b) class presentation utilizing a Situation, Background, Assessment, and Recommendations (SBAR). Identified Successes: The success of the project is not determined based on meeting a proposed target or goal (e.g. 0% Fall Rate; 95% Hand Hygiene compliance). Success is based on the student learner understanding and experiencing the FOCUS PDSA process, working through implementing a change process, and learning what worked versus what were opportunities for improvement in the process.

Published Back to Strategy Search Strategy Submission Coding Practice Using ICD-10 for Nurse Practitioner Students Author: Beth Vottero PhD, RN, CNE Title: Associate Professor Coauthors: Institution: Purdue University Northwest Email: bstarnes@pnw.edu Competency Categories: Informatics Learner Level(s): Graduate Students Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Value the importance of standardized terminologies in conducting searches for patient information Describe and critique taxonomic and terminology systems used in national efforts to enhance interoperability of information systems and knowledge management systems Strategy Overview: Family Nurse Practitioner students have little opportunity to work with ICD-10 coding prior to clinical experiences. Feedback from FNP students identified a need to incorporate more background information and introduction to ICD-10 coding of patient presentations. A discussion question was created for an online graduate Nursing Informatics course to introduce these students to ICD-10 coding in a non-threatening manner to help students gain insights into how to correctly code, then interpret, a patient's presentation. The discussion question is attached as a file. The instructor helps students to make the link between the ICD-10 codes and standardized nursing language (NIC/NOC, NANDA, etc.) by having student access the provided websites. The instructor can encourage students to continue the discussion using ICD-10 codes to follow-up with the patient over time and can guide students to continue coding a patient based on what they would expect to see during follow-up clinic visits. Submitted Materials: 239-RevisedCoding-Discussion-and-Rubric-Revision.docx - https://drive.google.com/open?id=1qPGlv7Ho-t7dSwosI-atfCNRunxpGFXn&usp=drive_copy Additional Materials: Evaluation Description: Students are evaluated using a standard discussion evaluation tool based on the initial response, level of engagement with classmates, number of posts and quality of posts. A rubric used for this discussion is provided with the discussion question.

Published Back to Strategy Search Strategy Submission Evidence-Based Practice Course Application Strategy Author: Elizabeth Kudzma DNSc, MPH, RNC Title: Professor, Division of Nursing Coauthors: Maureen L. Murphy Phd EdM CNM, Cathleen C. Santos MSN RN Institution: Curry College Email: ekudzma@curry.edu Competency Categories: Evidence-Based Practice Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: Online or Web-based Modules Learning Objectives: Learning Objectives modified from QSEN Identify reliable sources for locating evidence reports and clinical practice guidelines. Apply pertinent evidence-based reports related to clinical coursework. Level original research and evidence reports related to coursework. Distinguish clinical opinion and consensus from research and evidence summaries. Describe how the strength of available evidence influences the choice of interventions in provision of nursing care. Strategy Overview: Students are exposed to a wide variety of evidence in their nursing classes. In many cases relevant current studies are cited and summarized in classes frequently in PowerPoint format. This simple strategy asks faculty to level the type of evidence used in the research study when discussing it in class. If PowerPoint format is used, the level of evidence can be cited at the bottom of the slide. Viewing the level of evidence with the research study summary should provide application of the information about levels of evidence to the current topic under study. Students should be exposed to exemplars in evidence-based practice, PICO format and levels of evidence early in the nursing curriculum. For later classes, only a few slides (see PowerPoint presentation attachment) at the beginning of a course may be necessary to reacquaint the student with major principles of evidence-based practice and levels of evidence. Since there are several rating guides for levels of evidence, several sources might be used. We used the following sources for evidence-based nursing conceptual content and for grading level of evidence: Melnyk, B. & Fine-Overholt, E. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Williams & Wilkins. Siwek, J., Gourlay, M., Slawson, D. & Shaughnessy, A. (2002). How to write an evidence-based clinical review article. Am Fam Physician 65, 251-258. Submitted Materials: Additional Materials: Evaluation Description: This strategy increases student engagement in nursing classes where study examples are cited. Instead of viewing use of evidence-based investigation as dry and involved primarily with the nursing research course, students found that they could actually level evidence and discuss why a study would fit into a particular level or category. Through use of this strategy, students became more thoughtful about levels of evidence and were able to discriminate levels of evidence. In an introduction to vital signs and blood pressure, students were able to recognize that the Siwek et al. (2002), Level C consensus/ expert opinion, applied to the Seventh Report of the Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) statement about categories of hypertension and pre hypertension. Also, as a result of this strategy, students became more discriminating and practical about use and issues surrounding randomization in various studies. The strategy assists students to see that evidence-based practice applies in a diversity of nursing curricular areas. Evaluation of the strategy can also be accomplished through exam questions on the various studies or focused papers in which the student is asked to discuss levels of evidence and rationales.

Published Back to Strategy Search Strategy Submission QSEN Teaching Strategy: Sponge Relay and Cardiac Output Author: Katie Morales PhD, RN, CNE Title: Assistant Professor of Nursing Coauthors: Cindy Johnson, PhD, RN; Carrie Barr, MSN, RN Institution: Berry College Email: Kmorales@Berry.Edu Competency Categories: Evidence-Based Practice, Patient-Centered Care Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Learning Objectives: Evidence-based practice (EBP) and patient-centered care (PCC), and safety were the objectives for this learning activity: Knowledge: (EBP) Demonstrate knowledge of basic scientific methods and processes, explain the role of evidence in determining best available clinical practice, explain the role of best practice in clinical practice. (PCC) Integrate understanding of the dimensions of care in the patient with cardiac dysfunction while providing information, physical comfort, and emotional support. Provide safe and effective care to the client experiencing cardiac dysfunction. Skills: (EBP) Base individualized plan on patient values, clinical expertise and evidence. (PCC) Provide patient-centered care for a patient with cardiac dysfunction while considering patient values, preferences and expressed needs. Attitudes: (EBP) Value the need for continuous improvement in clinical practice. (PCC) Value the patient's expertise with own health and symptoms. Strategy Overview: This interactive hands-on learning activity was developed as part of a senior level adult-health course to provide understanding on advanced cardiac concepts such pre-load and afterload. The purpose of the activity was to engage the students and help them grasp the connection between cardiac output, heart rate, and stroke volume. The activity correlated with the didactic content (the role of heart rate and stroke volume on cardiac output) to link the activity to specific cardiac disease conditions, with a discussion of related clinical symptoms and anticipated treatment. Afterwards, the students were asked to discuss how the activity demonstrated cardiac output, stroke volume, and heart rate. In addition, students were asked to troubleshoot cardiac output issues identified in the sponge relay. Students were divided into two teams of five, with the remaining students observing. Two 2.5-gallon buckets were filled with water and two empty buckets were placed approximately 63 feet apart. Fill lines were indicated on the empty buckets. Two large sponges (9x4.5x3inches) were placed in the buckets containing water. Each team member grabbed the sponge from the full bucket, ran to the empty bucket, wrung out the sponge, and ran back to tag the next team member. The first team who filled the empty bucket to the fill line won. Winners were given a box of Swedish Fish candy. The learning activity represented how cardiac output is affected by heart rate, stroke volume, contractility, and preload. The relay participants demonstrated heart rate, as teams had to be faster running between buckets in order to fill the bucket (cardiac output) more quickly. Stroke volume was demonstrated as the volume wrung out of the sponge needed to be optimal to fill the bucket. The force used to wring the sponge represented contractility. Preload was demonstrated by the amount of fluid in the first bucket available for the sponge to absorb. The fluid, which was transferred to the second bucket (initially empty) via the sponge, represented cardiac output. Follow-up discussion addressed related concepts identified a priori as difficult for the students. For example, the leakage around the first bucket (initially full) represented incompetent valves. Inadequate sponge fill time represented inadequate cardiac fill time, which can occur in diastolic heart failure. Leakage of water from the sponge along the relay route represented decreased oncotic pressure. The effect of afterload (resistance) and the role of vasodilator and vasoconstrictor medications were discussed. Future use may include a wide mouth bucket and a narrow mouth bucket to demonstrate the effect of afterload (resistance) on cardiac output. Submitted Materials: QSEN-Relay-Revised.docx - https://drive.google.com/open?id=1pa8O6_moxC9e-Vp_ON0mNszwcIW565Df&usp=drive_copy Additional Materials: The materials required an initial investment of approximately six dollars. No funding was received for this activity. The demonstration required no special adaptation of the materials. Evaluation Description: Student feedback was obtained using a survey which included the following items: This learning activity was beneficial; I enjoyed this interactive learning activity; I learned new information related to nursing care of adults with cardiovascular disorders; In the future, I want to use more activities like the sponge relay to demonstrate key concepts; This teaching/learning activity helped me understand the cardiac process. Twenty of the 26 students submitted evaluations. Graphic 1 displays the results of student evaluation. All students either strongly agreed or agreed the learning activity met the learning objectives. Space for individual feedback was provided on the surveys for how to improve the activity in future learning activities. The three main themes identified in the summary of student feedback included: active involvement of entire class rather than passive observation, more time for collaboration, and the creation of a handout or PowerPoint slide illustrating key concepts. Student comments included the activity "brought everything together in a fun way" and the "visualization brought a better understanding of key cardiac concepts." Raw student feedback is included in Appendix 1. While the evaluation for this activity was a survey, future use may include a pre-test/post-test evaluation of concepts (Appendix 2).

Published Back to Strategy Search Strategy Submission End-of-life Simulation Author: Carla Hunt RN, MSN Title: Clinical Instructor Coauthors: Institution: Mercy College of Nursing Health Sciences Southwest Baptist University Email: carla.hunt@mercy.net Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: At the completion of this end-of-life simulation, the learner will be able to: 1. Perform a physical assessment and analyze the findings to manage end-of-life symptoms; 2. Practice therapeutic support and compassionate end-of-life communication; 3. Assess spiritual needs and provide culturally sensitive nursing care; 4. Demonstrate a patient and family-centered approach to care; 5. Analyze the completed advanced directive and advocate to uphold the patient’s wishes; 6. Utilize nursing process to develop an individualized plan of care; 7. Evaluate personal beliefs and values that influence a nurse’s ability to provide care to the dying; 8. Perform the nurse-to-nurse death verification and death documentation utilizing a standardized expiration checklist. 9. Demonstrate post mortem care and safe handling precautions; 10. Practice interdisciplinary collaboration as death approaches and at the time of death. Strategy Overview: The End-of-Life (EOL) simulation occurs in a simulation lab and is intended to facilitate clinical correlation to oncology, palliative, and end-of-life content presented in the third semester classroom. Required pre-assignments are EOL lecture attendance or power point review, completion of Caring Conversations of Young Adults (2012), and review of the journal article, Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies by Sherman, Matzo, Ferrell, and Malloy (2005). In the EOL simulation, student groups of two rotate in and out of the simulation to perform a physical assessment, compassionate comfort care, effective communication, interdisciplinary collaboration, and post-mortem care. Students demonstrate physical assessment for a non-responsive patient and perform post mortem care on the female Sim Man manikin. Students demonstrate compassionate comfort care and effective communication through interaction with the Sim Man manikin and a live patient’s mother that is role played by a faculty member. Communication with the live patient’s mother is scripted to facilitate confidence and competence in EOL skills. Students demonstrate interdisciplinary collaboration through telephonic communication with a second faculty member acting out the role of interdisciplinary team members. An observer faculty member remains with the students to takes notes and be present for the debriefing session. The simulation is intended to run 45 minutes and then a 15 minute emotional break is provided before students proceed to the 60 minute debriefing session. Submitted Materials: 134.LIVING-WILL-DECLARATION-OF-Doris-Says.docx - https://drive.google.com/open?id=1DW-ATih3eQFchaIqI-_rWk6bw6q6uAj2&usp=drive_copy 134.Sim-Doris-Say.docx - https://drive.google.com/open?id=1DW-ATih3eQFchaIqI-_rWk6bw6q6uAj2&usp=drive_copy 134.Sim-Doris-Say-CAT-scan.docx - https://drive.google.com/open?id=1EJYxaxw_-OaMizWD_FnpAxGW-e8xMedG&usp=drive_copy 134.Sim-Doris-Say-H-and-P.docx - https://drive.google.com/open?id=1EIr0EmocjRw2h7BMlnfwr-wa7KvsDOyp&usp=drive_copy Additional Materials: Read the journal article: Sherman, D. W., Matzo, M. L., Pitorak, E., Ferrell, B. R., & Malloy, P. (2005). Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies. Journal for Nurses in Staff Development, 21(3), 93-100. Complete the Caring Conversations for Young Adults available via web link http://www.practicalbioethics.org Read the Missouri Advance Directive available via web link http://www.caringinfo.org/files/public/ad/missouri.pdf Evaluation Description: This simulation was utilized during the Spring 2013 semester with third semester students after presentation of the oncology course content. Nine clinical groups participated in the EOL simulation. Student feedback indicated the simulation fostered a positive learning experience through an interactive approach to EOL communication. A live faculty member used to role play a grieving mother was positively received by students. Faculty observers and the debriefing faculty member reported the simulation was well organized, had good flow, and facilitated the necessary end-of-life competencies. The final page of the simulation includes an evaluation tool for students to complete following the simulation.