Published Back to Strategy Search Strategy Submission Pharmacokinetics; innovative teaching, active learning; safe medication administration Author: Mel Pinter Phd, RN, CNE Title: Faculty Coauthors: None Institution: Hinds Community College Email: melanie.pinter@hindscc.edu Competency Categories: Patient-Centered Care, Safety Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: Patient-centered care (PCC) and safety were the objectives for this learning activity. Strategy Overview: This interactive hands-on learning activity was developed as part of first semester fundamentals of nursing course to provide understanding of pharmacokinetics and safe medication administration. The purpose of the activity was to engage the students and help them grasp the connection between absorption, distribution, metabolism, and excretion. The activity correlated with the didactic content (pharmacokinetics and medication administration) to link the activity to how drugs are effected once they enter the body and how specific patient disorders can affect pharmacokinetics. Afterward, the students were asked to use clinical reasoning to determine how to manage patients with disorders that could impact the absorption, distribution, metabolism, and excretion of drugs. As a ticket to class, students completed a crossword puzzle that included key terms related to pharmacokinetics and safe medication administration. The puzzle was reviewed at the beginning of class to ensure all students had the correct answers and to allow time for questions and clarification of terms. Students were divided into groups of five. Each group had access to a sponge (similar to a car wash sponge which measures 8.75” X 4.75”), a bottle of water, a bowl, a clear cup, a small funnel, and one denture tablet. The denture tablet was dissolved into ¼ cup of water to illustrate how caplets and tablets have to be dissolved before they can be absorbed by the body. Once the tablet was dissolved, this solution was poured into a sponge via the funnel. As the solution began to soak into the funnel, this represented the process of absorption. Absorption is the transformation of the drug from the site of entry in the body into the bloodstream. The process of distribution was discussed as the solution soaked the entire sponge. Distribution is the movement of the drug into body tissues. Metabolism was represented as the sponge being completely soaked. Metabolize means “to change.” Metabolism is the process by which drugs are changed and utilized by the body. The liver is the major site of drug metabolism and the importance of adequate liver function was discussed. Excretion was demonstrated by squeezing the water from the sponge into the bowl. Excretion is the removal of the drug from the body. The kidneys are the major site of drug excretion. The importance of adequate kidney function was discussed and how this could impact the effectiveness of drug therapy. After the sponge activity, the groups were given five index cards. Four of the cards had a condition listed and the fifth card had the rights of medication administration listed. The cards included: a patient decreased hepatic function; a patient with decreased renal function; an elderly patient who is eighty years old; an infant who is four months old; and the rights of medication administration. Based on the card selected, the student had to discuss how their specific condition impacted pharmacokinetics and safe medication administration. The patient with decreased hepatic function does not metabolize drugs as effectively as patients with adequate hepatic function. This patient should be monitored for drug accumulation and drug toxicity. The patient with decreased renal function should be monitored for drug toxicity and accumulation as the renal ability to excrete drugs is altered. Physiologic changes associated with aging alter the body’s response to drug absorption, distribution, metabolism, and excretion. Elderly patients have to monitored closely for drug toxicity. Infants have immature body systems that may affect the ability to absorb, distribute, metabolize, and excrete drugs. Collaboration with the healthcare provider regarding proper medication dosage should be discussed for elderly and infant patients. The student with the rights of medication administration card had to discuss how each right impacted safe medication administration. Submitted Materials: Pharmacokinetics-Sponge-Activity.docx - https://drive.google.com/open?id=10vxsmTzSkHZSEa-UuHfeOBA7TvfNGxUc&usp=drive_copy Additional Materials: Strategy Materials The materials required an initial investment of approximately ten dollars. No funding was received for this activity. The demonstration required no special adaptation of the materials. Additional Materials A sponge (similar to a car wash sponge which measures 8.75” X 4.75”), a bottle of water, a bowl, a clear cup, a small funnel, and one denture tablet. Evaluation Description: As the students were sharing information from their activity and cards, faculty were circulating in the room to listen and confirm correct responses or to provide guidance on incorrect responses. Peer review was also encouraged as students shared information. 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 pharmacokinetics; In the future, I want to use more activities like the sponge activity to demonstrate key concepts; This teaching/learning activity helped me understand pharmacokinetics. Thirty-one of the thirty-eight students who participated, submitted evaluations. Graphic 1 displays the results of the student evaluation. All students either strongly agreed or agreed the learning activity met the learning objectives.

Published Back to Strategy Search Strategy Submission Using the Process of Evidence-Based Practice to Assess Clinical Practice Protocols-A Group Project Author: Donna Beuk Title: Assistant Professor Coauthors: Institution: Auburn University @ Montgomery Email: dbeuk@aum.edu Competency Categories: Evidence-Based Practice, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Independent Study Learning Objectives: Value the concept of EBP as integral to determining best clinical practice Read original research and evidence reports related to area of practice Locate evidence reports related to clinical practice topics and guidelines Explain the role of evidence in determining best clinical practice Question rationale for routine approaches to care that result in less-than-desired outcomes or adverse events Value the need for continuous improvement in clinical practice based on new knowledge Strategy Overview: Undergraduate nursing students enrolled in an Evidence-Based Practice nursing course learn the process of EBP along with evidence discovery and appraisal in order to apply and integrate clinical practice guidelines into nursing practice. "Using the Process of EBP to Assess Clinical Practice Protocols" is a group capstone project assignment. Students self-select groups of 3 - 4. The project includes: (1) Identify a clinical question. (2) Obtain an agency practice protocol related to the clinical question. (3) Historically research the clinical practice protocol and evaluate across the nursing continuum to solidify rationale(s) for the EBP. (4) Prepare a written and oral presentation of findings. (5) Provide suggestions to increase compliance of protocol in the practice setting. Submitted Materials: Additional Materials: Evaluation Description: Grading Rubric for Assessing Practice Protocols Project Written Component: (75%) 1. Write an evidence-based practice (PICO) question related to your Patient Care Protocol. Discuss the significance of this question to nursing practice (10 pts) 2. Review the evidence (research, systematic reviews, and clinical practice guidelines) on your question (a minimum of 6 (maximum of 8) articles must be included). These articles must include at least 3 research studies, and 3 non-research studies. Discuss your search strategies for finding your evidence on CINAHL, Medline and other databases. It is expected that you also search review databases such as Cochrane, Johanna Briggs, and for Practice Guidelines from AHRQ. (Search strategy description - 5 points) 3. Use the attached form/grid sheet to present relevant points and initial evaluation of your literature. You must turn in a copy of all articles with your project. (Grid – 20 points) 4. Write a brief synthesis summary of the findings of the articles with APA citations. This paper should be 3-4 pages long and must be a synthesis and not just a linking of abstracts. (Synthesis -20 points) 5. Answer the following Consistency of Evidence Questions: a) Are there replications of studies with consistent results? b) Are the studies well designed? c) Are recommendations consistent among systematic reviews, evidence-based practice guidelines, and individual studies? d) Are there identified benefits to the patient for applying evidence-based practice recommendations? e) Are there identified risks? f) Have cost studies been done on the recommended action, intervention, or treatment? (10 points) 6. List your recommendations for evidence-based practice. Evaluate the Evidence Rating and Quality Rating of each article. (10 points) Presentation: (25%) 1. Content representative of paper, well organized, and clear to audience (5 points) 2. Oral Summary of work with Interprofessional Team (5 points) 3. Audiovisuals for presentation are of good quality – follow good poster guidelines (10 points) 4. Professional manner, language, and dress during presentation (5 points)

Published Back to Strategy Search Strategy Submission Rapid Improvement Strategies: Slide Presentation Author: Shirley M. Moore RN, PhD, FAAN Title: Associate Dean for Research and Professor of Nursing Coauthors: Institution: School of Nursing, Case Western Reserve University Email: Shirley.moore@case.edu Competency Categories: Quality Improvement Learner Level(s): Continuing Education, Graduate Students, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Describe the key focuses of rapid improvement strategies Compare traditional and rapid improvement strategies Apply rapid improvement strategies to an improvement initiative Strategy Overview: One of the criticisms of CQI is that it can take a long time to plan, test, and evaluate an improvement. Making fast changes lasting and pervasive, rapid improvement strategies speed things up without changing the nature of necessary improvement activities. These slides have been used to teach rapid improvement strategies in both small and large groups and in an electronic course on CQI. They have been used with professional audiences (health professionals engage in quality improvement, and with students learning quality improvement. The students have ranged from undergraduates to physicians and other professionals learning about process improvement. I usually have the group do an in-class on online exercise following these slides in which they redesign a current improvement project they are doing by applying the rapid improvement strategies, thus allowing them to experience the usefulness of these techniques to speed up the improvement process and learn the strategies. Submitted Materials: Additional Materials: I would be happy to provide more information on the use of rapid improvement strategies and how to teach them. I am best reached at Shirley.moore@case.edu Evaluation Description: This class on rapid improvement strategies has been rated highly by students over the past 6 years. Most important is that they describe in their improvement projects how they applied the rapid improvement strategies. Our students are required not just to do an improvement project, they must show that they integrated rapid improvement strategies.

Published Back to Strategy Search Strategy Submission OB Unfolding Case Author: Carol F. Durham Ed.D(c.), RN Title: Director Clinical Education & Resource Center and Clinical Associate Professor Coauthors: Kathy Alden, RN, MSN, EdD(c), IBCLC Clinical Associate Professor, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Camille Lambe, RN, PhD Institution: UNC-Chapel Hill School of Nursing Email: noreply@noreply.org Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Core-Competency: Patient Centered Care The teaching strategy is designed to evaluate the following KSAs: Knowledge: Integrates understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity Attitude: Respects and encourages individual expression of patient values, preferences and expressed needs Skill: Provides patient-centered care with sensitivity and respect for the diversity of human experience Knowledge: Understands relationships among physical and emotional discomfort and human suffering Attitude: Seeks to relieve pain and suffering, whether mental, physical or spiritual Skill: Assesses presence and extent of pain and suffering & Assesses levels of physical and emotional comfort Knowledge: Understands nursing roles in coordination and integration of care, transition and continuity Attitude: Values shared responsibility and decision making, even when conflict occurs Skill: Clearly communicates care provided and needed at each transition in care Core-Competency: Teamwork and Collaboration The teaching strategy is designed to evaluate the following KSAs: Knowledge: Understands the impact of effective team functioning on safety and quality of care Attitude: Appreciates the risks associated with handoffs between providers and across transitions in care Skill: Follows communication practices that minimize risks associated with handoffs among providers and across transitions in care Core-Competency: Safety The teaching strategy is designed to evaluate the following KSAs: Knowledge: Able to list general categories of errors and hazards in care Attitude: Open to communication of potential or real errors from any member of the health care team, patient or family Skill: Participates in data collection and aggregation of improvement data Strategy Overview: Just as the construction industry emphasizes the importance of using the “right tool for the job,” so it is with the choice of an instructional strategy in nursing education. There must be careful thought in selecting the instructional method best designed to meet specific learning objectives. Unfolding case scenarios provide a bridge between theory and clinical practice. Critical thinking and clinical decision making skills are developed and refined as students apply previous knowledge in simulated patient situations. Knowledge and skills attained from classroom and clinical experiences can be applied in patient care situations. The use of unfolding cases allows a condensing of vital learning experiences that assists the learner in developing clinical reasoning and decision-making skills. Additionally, a simulation can be repeated to allow students to correct misconceptions, fill in knowledge gaps and hone clinical skills. This can be beneficial in boosting self-confidence and self-esteem as students are learning to think and act like nurses. Unfolding cases can assist faculty in addressing problems related to lack of consistency in students’ clinical experiences. Students are placed throughout hospitals and community agencies, working on a variety of units. There is often a lack of consistency in student learning experiences. Even students assigned to the same unit will encounter individual patients with unique problems and needs. It is impossible to assure that every student who graduates from a nursing education program will have had the same opportunity to provide care for any specific type of patient. Many variables influence student learning experiences in the clinical setting. These include such things as patient acuity and diagnosis, facility access, time of day, as well as clinical and teaching expertise of clinical instructors and nursing staff. Use of well-developed case studies allows for greater consistency in learning experiences. Learning occurs in a controlled environment where groups of students are exposed to the same scenarios, under the same conditions. Submitted Materials: Additional Materials: If additional information is desired please contact Carol Durham, Director, Clinical Education & Resource Center at Carol_Durham@unc.edu and be CERTAIN to list in the subject line "QSEN teaching" otherwise the request may not be received. Evaluation Description: This synthesis/learning activity is designed to replace one day of clinical for students in OB. The course coordinator assigns students to the rotational pattern by dividing clinical groups into two groups of five students (five seems to be the maximum number to allow an effective experience with the patient simulator). Each clinical faculty assists with the simulation experience for his/her group. Students spend six hours in simulated obstetric clinical experiences, one hour with the human simulator (2 cases) and four hours rotating to 4-5 course specific unfolding cases (link to unfolding cases submission). This case actually builds on one of the unfolding cases and continues the patient care scenario into critical care. The patient for the unfolding case is Annie Foster and she is taken from a routine prenatal clinic visit through the course of events that end with her being critically ill in a surgical intensive care unit. The learner encounters Annie in one of the unfolding cases and then again as one of the patient simulator cases (see OB Sim script). Supporting materials are used throughout the case to make the experience as realistic as possible (see the additional unfolding Annie Foster files). Depending on the objective of the simulated experience, there may or may not be pre-exercise assignments for the students. If the educator intends for the experience to be a synthesis of what the students have learned to date, then there are no pre-exercise assignments. However if the intent of the simulated exercises is to deliver content, then there would be pre-exercise assignments for the learners. Unfolding cases can be developed from many clinical examples. A template for developing unfolding cases can be found in the unfolding case template file.

Published Back to Strategy Search Strategy Submission Developing Empathy for Older Adults with Sensory Deficits (For Face-to-Face Learners and Distance Learners) Author: Megan Lieb DNP, RN Title: Assistant Proefessor Coauthors: Institution: Ohio Northern University Email: m-lieb.2@onu.edu Competency Categories: Patient-Centered Care Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom Strategy Type: General Strategy Learning Objectives: 1) Assess own level of bias related to care of varying populations (gender, age ethnic, cultural, and social backgrounds) (skill). 2) Verbalize the impact of providing patient-centered care with sensitivity and respect for the diversity of human experience (skill). 3) Value seeing health care situations “through patients’ eyes” (attitude). Strategy Overview: Developing Empathy is a teaching strategy developed to illustrate the concepts of common sensory deficits related to tactile, visual, or auditory changes in all populations, including older adults. The strategy utilized an Implicit Association Test to assess attitudes and beliefs related to age (Project Implicit- Harvard University). The test may determine that age bias is present that the student was not aware of. Preparation: For this activity, students were introduced to common sensory deficits, including macular degeneration, cataracts, glaucoma, hearing loss, and decreased tactile sensation. Lecture format or online modules were used to complete the introduction which covered the types of conditions, assessment, diagnostic procedures, treatment, and patient education. Activity: Students were assigned a variety of “deficits”. Visual deficits were simulated through the use of simulation glasses (can be ordered through Chronic Care Challenges or made using standard lab goggles). Goggles were assigned to simulate the central loss of vision (black dot taped to the middle of goggles), opacity of the lens (layers of plastic wrap around the goggles), or decreased peripheral vision (tape sides of goggles). Hearing impairment was simulated by gently inserting cotton balls into the outer ear. The decreased tactile sensation was simulated using gloves. Students were then asked to complete a range of activities on campus. Examples included having coffee with a friend, returning library books, doing homework, completing errands. If students are distance learning, supplies could be picked up or household items utilized (old sunglasses and plastic wrap from the kitchen). Activities could include folding laundry, changing batteries in a smoke detector, or dinner with family. Debriefing: Debriefing can be completed in-person or virtually. Students should reflect on their initial age bias assessment. The use of reflective journaling may also be used if synchronous time is not possible. Students should reflect on: 1) Their own level of age bias 2) The lived experience as a person with sensory deficits common to older populations 3) What strategies they, as health care providers, could use to promote patient-centered care for the patient with sensory deficits Making Connections: Students should be encouraged to contemplate how these experiences may be similar or dissimilar to healthcare experiences. The facilitator should expand on how bias may be related to a variety of differences including gender, skin color, social background, or sexuality. Project Implicit (Harvard University) offers many different Implicit Association Tests to assess attitudes and beliefs related to those differences. Submitted Materials: Developing-Empathy-1.docx - https://drive.google.com/open?id=1xNbsxt839mLNR_UooopvnsN7zR9xvzyg&usp=drive_copy Additional Materials: Project Implicit: https://implicit.harvard.edu/implicit/takeatest.html Chronic Care Challenges Simulation Glasses: https://www.graylinemedical.com/products/nasco-chronic-care-challenges-simulation-glasses-set-chronic-care-challenges-simulation-glasses-set-of-6-sb24999u?variant=31856087892025 Evaluation Description: Evaluation: Students can be encouraged to complete the Implicit Association Test again to see if implicit bias has changed. Students should be asked to reflect on the experience or what it is was like to see day to day activities “through the patient’s eye”. Students anecdotally reported feeling left out because they did not want to burden others with moving more slowly and carefully or having to ask others to repeat what they were saying to follow along with and engage in the conversation. Others self-reported they withdrew from others because they felt unwanted (due to their deficits) or that things would be “easier if they did not participate”. In general, students reported an improved ability to share the feelings of others and that they would be more cognizant of the sensory deficits of patients and consider ways to improve patient care.

Published Back to Strategy Search Strategy Submission Tic Tac Toe ABGs: Interpretation and Patient Safety Author: Nancy Jaskowak Cresse DNP, MS, ANP-BC Title: Clinical Assistant Professor, Nurse Practitioner Coauthors: Marian Nowak, DNP, MPH, RN, DNP, MPH, RN, Assistant Professor, Rowan University School of Nursing Institution: Rutgers University School of Nursing-Camden Email: njay@camden.rutgers.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting, Skills or Simulation Laboratories Strategy Type: Online or Web-based Modules Learning Objectives: Through participation in this class student will: •Review how respiratory physiology impacts ABG measurement (K) •Identify three variables that may affect readings (K) •Enable rapid ABG interpretation to minimize risk of harm to patients (K,S). Strategy Overview: Introduction to Arterial Blood Gases An arterial blood gas (ABG) test measures the acidity (pH), levels of oxygen, and carbon dioxide in arterial blood. ABG’s are often used in conjunction with other tests to check how well the lungs are able to move oxygen into the blood and remove carbon dioxide from the blood. Lets look at ABG values, and what the ABG measures: • pH. This value measures the hydrogen ions (H+) in the blood. The normal pH of blood is between 7.35 and 7.45. A pH of less than 7.35 is called acidotic, and a pH of greater than 7.45 is considered alkalotic. • Partial pressure of carbon dioxide (PaCO2). A measure of the pressure of carbon dioxide in the blood and how well carbon dioxide is able to move out of the body. Remember, CO2 is an acid, so the higher the pCO2, the more acidic the value is. • Bicarbonate (HCO3). Bicarbonate serves as a buffer that keeps the pH of blood from becoming too acidic. The higher the bicarbonate (HCO3) the more alkaline the value. • Oxygen saturation (O2Sat). O2 saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen. • Partial pressure of oxygen (PaO2). The pressure of oxygen in the blood and how well oxygen is able to move from the airspace of the lungs into the blood. Although it is included in arterial blood gas values, oxygen values have no role in diagnosing an ABG. If oxygenation is not normal, consider supplementing with oxygen, per clinical evaluation. So, when looking at the bullets above, only three (3) items influence the blood gas diagnosis: the pH, pCO2, and HCO3. Implications of ABG An arterial blood gas (ABG) test is done to: • Assess presence of respiratory diseases. • Assess how treatment for lung disease is working • Determine if oxygen or mechanical ventilation is needed. • Determine if the right amount of oxygen is being adminisered. • Measure the acid-base level in patients with heart failure, kidney failure, uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose. Results To calculate ABG’s we use the normal parameters in yellow… Parameter Range Partial pressure of carbon dioxide (PaCO2): 35-45 mm Hg (4.6-5.9 kPa) pH: 7.35-7.45 Bicarbonate (HCO3): 22-26 mEq/L (22-26 mmol/L) Oxygen content (O2CT): 15-22 mL per 100 mL of blood (6.6-9.7 mmol/L) Oxygen saturation (O2Sat): 95%-100% (0.95-1.00) The normal values listed here are called a reference range. The normal values for children may differ from the adult values listed here. See Attachment Uncompensated or Compensated ABGs Many times, a condition that leads to an ABG diagnosis is battled by the body’s effort to help correct, or compensate. It is the body’s way to assist, to try to return the pH toward normal. Compensation rarely returns the pH to exactly normal, but it does sometimes get it closer. Compensation is either Respiratory or Metabolic, or not present (Uncompensated). Look back to the Tic Tac Toe grid. If a value is off by itself in another column, it is the compensation! You document compensation by putting the first name of the system represented. If pCO2 is in the column by itself, then it is Respiratory Compensation. If the HCO3 is in a column off by itself, then it is Metabolic Compensation. Remember, compensation takes time. Metabolic compensation is not usually seen for 6-12 hours, with maximum effect in 2-4 days. Respiratory compensation can start increased ventilation within minutes to reduce a bodily (metabolic) acidotic problem, and maximum effect can take 12-24 hours. If compensation is present but the pH is abnormal, it is considered partially compensated. If the compensation has driven the ph back to almost normal, it is considered compensated. But it is not necessary to label which type compensation when you interpret the ABG. So, for a respiratory acidosis that has evidence of compensation, your interpretation would be documented as Compensated Respiratory Acidosis. If both respiratory and metabolic systems are contributing to the same acidosis or alkalosis, it is referred to as Combined . Variables Affecting Results Variables that may affect readings include: fever or hypothermia, anemia or polycythemia, smoking prior to the test, secondhand smoke inhalation, carbon monoxide, or certain paint or varnish removers in closed or poorly ventilated areas. So now you can identify the source of the problem, the presence of compensation, and the type. Bravo! Submitted Materials: Tic-Tac-Toe-Attachment.docx - https://drive.google.com/open?id=1R82B4HyvFtf6PhavP3-gjJmvFzAxtVEy&usp=drive_copy Tic-Tac-Toe-Part-2.docx - https://drive.google.com/open?id=1R7p6ajoByPKG5-AXP7x1zPZSn17kHOd2&usp=drive_copy Tic-Tac-Toe-References.docx - https://drive.google.com/open?id=1R2525D9Y7e8HIIimjmZb7uiVLaL77GYw&usp=drive_copy Additional Materials: Attached below are 1)instructions to set up Tic Tac Toe grid; 2)evaluation components; 3)references. Included here is link to Tic Tac Toe ABG video (video site included due to written permission by originators). Please copy and paste the following address in your browser to view. https://www.youtube.com/watch?v=URCS4t9aM5o References Lung Disease & Respiratory Health Center. (ND) (2016) ABG. Retrieved from: http://www.webmd.com/lung/arterial-blood-gases?page=5 Ischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health. Davis MD, et al. (2013). AARC clinical practice guideline: Blood gas analysis and hemoximetry: 2013. Respiratory Care, 58(10): 1694-1703. DOI: 10.4187/respcare.02786. Accessed March 12, 2014. Video.You Tube Video (2016). Tick Toe ABG Retrieved from: Acid Base Case Study. (2016). Retrieved from: ww.fammed.usouthal.edu/Pulmonology/Self-StudyAids/ABGs/ABGCaseQuestions&Answers.pdf Video.You Tube Video (2016). Tick Toe ABG Retrieved with permission from: https://www.youtube.com/watch?v=URCS4t9aM5o https://www.chegg.com/homework-help/definitions/uncompensated-partially-compensated-or-combined-abg-problems-14 Wayne, G. (2015). 8 step guide to ABG analysis: Tick Tack Toe Method. Retrieved from: http://nurseslabs.com/8-step-guide-abg-analysis-tic-tac-toe-method/ Evaluation Description: Evaluation 1)ABG Pre test 2)ABG Post Test 3)Informal Feedback 4)Demonstration on clinical area

Published Back to Strategy Search Strategy Submission Nursing Students Using Interpreter Tools to Foster Therapeutic Communication with NON-English Speaking Patients in Varied Care Settings Author: Maria del Carmen Molle MSN, RN-BC Title: Assistant Professor-Nursing Coauthors: Professor Heather Heithoff, MN, RN Institution: Raritan Valley Community College Email: maria.molle@raritanval.edu Competency Categories: Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: The student will: -Describe various interpreter tools and their function. -Recognize non-English or limited English speaking patient populations and assess their communication needs. -Identify potential or actual safety barriers when a translator tool is not used. -Identify potential or actual quality problems when a translator tool is not used. -Provide examples of therapeutic and non-therapeutic communications with supportive rationales. -Evaluate the communication encounter for communication effectiveness. -Provide potential solutions to safety barriers and quality problems. Strategy Overview: The nursing student’s understanding of language diversity in our patient care settings and being able to effectively communicate with the diverse patient populations we care for. Effective communication between the patient and their healthcare team enables the patient to receive safe, patient-centered care (NPSG, 2020). The nursing student using available interpreter tools encourages professional behaviors such as communication, patient advocacy, teamwork and collaboration, and management of patient care (Belleza, 2020). The clinical educator has the responsibility to model professional behavior in the clinical setting for nursing students as outlined in the NLN’s The Scope of Practice for Academic Nurse Educators and Academic Clinical Nurse Educators (2020) as well as exposing nursing students to various interpreter tools to provide language congruent nursing care while being a manager of that patient’s care (NCSBN, 2020). Strategy Implementation: This learning activity incorporates the use of an interpreter tool to facilitate therapeutic communication between the nursing student and a non-English or limited English speaking patient in varied care settings such as a clinic, hospital, doctor’s office, or other outpatient settings. This activity can also be adapted to use in lecture, skills lab, or incorporated into a pre-existing simulation exercise for the junior or senior nursing student as an interactive learning activity. Submitted Materials: QSEN-278.1-NRS122-IPR-1.docx - https://drive.google.com/open?id=12impoa73GDtPVsWBn4NYwb8zbHSesV4t&usp=drive_copy QSEN-278.2-IPR-Rubric-1.docx - https://drive.google.com/open?id=12euiWdVX3BG0fRRpUXW7p5IhQzyp1crI&usp=drive_copy Additional Materials: QSEN- Intrapersonal Process Recording (IPR) 2020 and IPR Grading Rubric 2020 templates. References Belleza, M. (2020). Therapeutic Communication Nursing Care Management. Nursinglabs. Christensen, L.S, and Simmons, L.E., (2020). The Scope of Practice for Academic Nurse Educators and Academic Clinical Nurse Educators. Wolters Kluwer. National Council of State Boards of Nursing (2020). 2019 NCLEX RN test plan. https://www.ncsbn.org/testplans.htm. National Patient Safety Goals (2020). https://www.jointcommission.org. Squires, A. (2018). Strategies for Overcoming Language Barriers in Healthcare. Nursing Management, April 2018, 49:4. Evaluation Description: The nursing student is provided feedback on the learning outcomes by completing an Intrapersonal Process Recording based on the criteria outlined in the IPR Grading Rubric (Pass or Fail vs actual numerical grade). The feedback is provided by the clinical professor and the student has an opportunity to also respond.

Published Back to Strategy Search Strategy Submission Quality Improvement Project: Using Problem and Solution fishbone diagrams Author: Jeanette Koshar RN, NP, PhD Title: Professor Coauthors: Institution: Sonoma State University Email: koshar@sonoma.edu Competency Categories: Evidence-Based Practice, Quality Improvement Learner Level(s): Graduate Students, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Pre-licensure: QI: Seek information about outcomes of care for populations served in care setting QI: Appreciate the value of what individuals and teams can to do to improve care EBP: Participate in structuring the work environment to facilitate integration of new evidence into standards of practice Teamwork and Collaboration: Clarify roles and accountabilities under conditions of potential overlap in team member functioning Graduate: EBP: Initiate changes in approaches to care when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events QI: Use a variety of sources of information to review outcomes of care and identify potential areas for improvement QI: Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals Strategy Overview: I start out with this quote: Albert Einstein: "We can't solve problems by using the same kind of thinking we used when we created them." I have used these fishbone diagrams for classroom discussions, didactic assignments and clinical assignments. They are effective in each setting. I have used these as the basis of discussion/assignments related to these Adverse Events: The Lewis Blackman Story Video ( http://www.qsen.org/video/ ) and First Do No Harm ( http://www.p4ps.net/guides/p4psbrochure.pdf ). The post-licensure BSN students rated this as one of the most helpful assignments they had in an EBP/Research course. Use both the problem and solution diagrams. The problem one is common and I developed the solution one to assist students in making evidence-based practice recommendations. They need to use both to make the connection between problems and solutions. I tried using just one as a stand-alone activity and it didn’t work. Sources of evidence: Use of the diagrams emphasizes that EBP draws from nurse expertise, patient preference and the literature. Have them find and incorporate an EBP article pertinent to the solution. Have students bold the items they assess as key to the problem and the solution. This helps students prioritize causes and identify a key solution. Submitted Materials: 125.Fishbone-diagrams-submission.docx - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: File format: Here is a website for the QSEN Quality Improvement Project Fishbone problem and solution assignment: http://www.sonoma.edu/users/k/koshar/n303/qsen.htm. They are set up similarly in each course. You will also find a link to well-done QI problem and solution fishbone diagram examples. Feel free to use all or any part of this information and just cite us as the source. Evaluation Description: Here is the evaluation rubric I developed Quality Improvement Grading Criteria Points Completes the Fishbone Problem and Solution Diagrams. Clearly states the problem and solution. Bold the item(s) (i.e. under people, equipment) that you assess as being key to the problem and solution. 1 Includes at least one item in each of the six categories (i.e. People, Processes, etc). 3 Uses the 6 areas of competencies: Patient Centered Care, Teamwork and Collaboration, Evidence-Based Practice, Quality Improvement, Safety and Informatics. 3 Evidence: uses each of the 3 sources of evidence (patient preference, nurse expertise, the literature) 1 Cites at least one EBP article in the solution diagram. Briefly explain how it informs your solution. 1 Is succinct 1 Clinical Presentation 2 Total 12

Published Back to Strategy Search Strategy Submission Unfolding Case Study with Live Role Play Author: Allison Younger MSN, RN Title: Clinical Instructor Coauthors: Institution: Stephen F. Austin State University Email: youngeram@sfasu.edu Competency Categories: Patient-Centered Care, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom Strategy Type: Case Studies Learning Objectives: Patient-Centered Care: Recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. - Assess patient values, preferences, and needs as part of the clinical interview -Interpret relevant assessment data of the patient with cardiac disease. - Create an individualized teaching plan for a patient with cardiac disease. -Manage care of the patient with cardiac disease, taking into consideration specific patient values and preferences. Teamwork and Collaboration: Function effectively within nursing teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. -Discuss assessment findings and how they relate to specific patient care. -Integrate the contributions of team members to provide complete patient education and assessments. Strategy Overview: The Unfolding Case Study with Live Role Play is a teaching strategy designed to help students practice individualized, patient-centered care and strengthen teamwork and collaboration skills by utilizing the nursing process within a flipped classroom setting. Students achieve meaningful learning by connecting new concepts to previous knowledge and by practicing these new concepts in an acted scenario. By doing so, students become more confident in the clinical setting and are prepared to deliver a higher level of quality nursing care. This strategy addresses all learning types by providing written material for visual learners, in-depth discussion for auditory learnings, and acting out physical client care for tactile and kinesthetic learners, and thus increases the quality of the education environment. The students prepare for class by reading the assigned text and reviewing the posted lecture content. Note that the PowerPoint presentation included here is not the lecture content that the students have access to prior to this activity. The lecture they are provided is a voice-over presentation that provides content they are required to know and understand for this unit. They are encouraged to bring their text and lecture content to class with them to use as a reference during the active learning scenarios. The PowerPoint presentation that is included in this activity is an instructor-only presentation that is used to guide the activity as the case study unfolds in the classroom. Students do not have access to it and only see it during class to help summarize information during discussions. The instructor introduces the patient (a fellow instructor playing the role) to the class and guides them through the nursing process of caring for the patient throughout the progression of the disease process, through assessment, planning, interventions, and evaluation. This activity was designed for a BSN medical-surgical course specific to cardiac disease. However, this strategy can be adapted to fit a wide variety of disease processes and patients along a spectrum of health-care needs. The original activity followed the care of a patient with newly diagnosed hypertension to the progression of coronary vascular disease with stable angina, to outpatient angioplasty, and finally to an introductory level of managing the care of acute coronary syndrome. Students assessed and interviewed the patient, performed necessary interventions (including appropriate patient-centered teaching), and evaluated the outcomes along the spectrum of care as the patient progressed in the disease process. This activity involved whole-class discussions as well as smaller group work with the instructor frequently summarizing and clarifying concepts along the way. The posted documents describe when whole class discussions were used and when students were divided into groups. After each phase (assessments as a large group, education as small groups, interventions as small groups, and evaluation as large groups) the instructor uses the PowerPoint to summarize and clarify the information. Submitted Materials: 240-Final-Version-Unfolding-Cardiac-Case-Study-with-Live-Role-Play-PPT5.22.19-1.pptx - https://drive.google.com/open?id=1nDdwf15eJlfQhphfvsTQiQXr2eXTh2DF&usp=drive_copy l.240-Final-Version-Unfolding-Cardiac-Case-study-with-Live-Role-Play-write-up5.22.19.docx - https://drive.google.com/open?id=1zZeO8aW9xRonXH1mTVFF-gKWX-0KLhOa&usp=drive_copy Additional Materials: Materials Used Pillow (placed under patient’s clothes to show obesity) Wig to show advanced age Pack of cigarettes Spray bottle with water to mimic diaphoresis Stretcher bed Oxygen mask Empty medication bottles (Nitroglycerin, aspirin, morphine) ECG leads IV kit Evaluation Description: Evaluation of this innovative teaching strategy is performed with a post-survey tool and direct observation. 100% of post-surveys showed that this teaching strategy improved confidence in application of the nursing process and ability to individualize care plans based on specific patient needs. Instructors present during this activity observed respectful teamwork/collaboration and delegation of tasks among all participants. Students also provided voluntary feedback in support of this type of flipped classroom and voiced appreciation of how it helped connect concepts to actual patient care.

Published Back to Strategy Search Strategy Submission Using Gamification to Validate the Need for Evidence Based Practice: The Marshmallow Challenge Author: Shannon S. Layton DNP, MSW, RN, LICSW, CNL, NEA-BC, CWCN Title: Instructor Coauthors: Tedra S. Smith, DNP, CRNP, CPNP-PC, CNE Institution: University of Alabama at Birmingham Email: sslayton@uab.edu Competency Categories: Evidence-Based Practice, Quality Improvement, Teamwork and Collaboration Learner Level(s): Continuing Education, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Knowledge: After exposure to the evidence-based practice (EBP) teaching strategy the learner will be able to verbalize the relevance of evidence-based practice in driving and sustaining quality improvement in the healthcare environment (EBP, QI). Skills: using low fidelity simulation the learner will conduct PDSA cycle(s) without the benefits of evidence-based knowledge (QI). During the debriefing portion learners will verbalize awareness of the need to incorporate EBP into routine approaches to care (EBP). Attitudes: Value the role of EBP in directing continuous quality improvement in the patient care environment (EBP,QI) Strategy Overview: Purpose: To provide faculty and students with access to a low fidelity simulation that simultaneously engages auditory, visual and kinesthetic learners in order to promote use of evidence based practice. This strategy is adapted from Design Thinking Expert Dennis Boyle’s exercise The Marshmallow Challenge originally used to foster team communication and critical thinking during a difficult challenge. Our faculty adapted it to drive home the advantages of using evidence based practice, teamwork and effective communication to solve difficult healthcare related challenges. Submitted Materials: Blinded-_instructional_video_link.pdf - https://drive.google.com/open?id=1av-PHmDapm_OlhkGHshPv1du9FQEsMWs&usp=drive_copy QSEN_Debrief_Instructor_Expanded_Version.pdf - https://drive.google.com/open?id=1lxMegtN4c23ow6d3MCzYcjMc5pqSWW3R&usp=drive_copy QSEN_Debrief_Instructor_Short_Version.pdf - https://drive.google.com/open?id=1lww8M570ZdbJwWXq74C_TCx5ZbiYdbnd&usp=drive_copy QSEN_Teaching_Strategy_Video_Outline_Marshmallow_Challenge..pdf - https://drive.google.com/open?id=1lwPcPCZAL4YsO2Fhgjwn8qt9ErFydMw7&usp=drive_copy QSEN-Student-Self-Reflection_Individual_Team_Debrief.pdf - https://drive.google.com/open?id=1lG9q4W9zDrmz4WC8yG-2mOEc26vy3Q-d&usp=drive_copy Additional Materials: Marshmallow Challenge Game (Dennis Boyle): 20 spaghetti noodles per team, one yard length of masking tape, one yard length of sting, one giant/large size marshmallow, one pair of scissors per group. Background Music (optional) Debriefing Tool (attached) Debriefing Video (attached) Instructional Video (attached) Evaluation Description: Debriefing of students using the materials provided allows for instructor evaluation and remediation of objectives.

Published Back to Strategy Search Strategy Submission Staff work-arounds assignment Author: Lisa Day RN, PhD Title: Assistant Clinical Professor Coauthors: Elaine L. Smith RN, MSN, MBA, CNAA, Clinical Assistant Professor, University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, North Carolina Institution: UCSF, School of Nursing, Dept. of Physiological Nursing Email: lisa.day@nursing.ucsf.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Students will: demonstrate skills in identifying gaps between practice on the unit and what has been identified as best practice demonstrate skills at finding professional practice standards and research literature related to a specific nursing intervention demonstrate skills in accounting for patient preferences within the boundaries of safe and therapeutic practice demonstrate attitudes and behaviors that show that they value teamwork and want to contribute to maintaining standards of safe and effective care Strategy Overview: This assignment is meant to familiarize the student with standardized nursing policies, procedures, standards of care, and other evidence based nursing practice guidelines, and to encourage students to observe actual nursing practice on the units to note compliance with, deviations from, or “work arounds” by RN’s when implementing nursing procedures. The following aspects of the assignment can guide students in preparation for clinical conference discussion, in writing a paper or in putting together a poster presentation. Choose a nursing policy or procedure that is commonly used on your nursing unit. Examples : Central line dressing change, Hand washing, Insertion of a peripheral IV catheter, Obtaining lab specimens, Pain management Find the current written nursing policy or procedure in place for your institution/unit and answer these questions: *How easy/difficult was it to find the policy/procedure? *Did the RN’s know where to find the written policy/procedure? *How was the policy/procedure originally disseminated to the staff? *Is the policy/procedure evidence-based? Review the current practice standards from professional organizations and/or oversight and accreditation groups (eg: JCAHO, CDC) and/or the research literature Observe RN’s on the unit performing the identified procedure and describe: *what steps the RN took *in what ways the RN deviated from the written policy/procedure *what prompted the RN to make the deviations she/he did *as many details as you can recollect Discuss why RN’s may or may not follow the institution’s written policies and procedures. Reflect on the opportunities and challenges of evidence based practice and the implementation into actual bedside nursing practice. Discuss what the proper response should be when you as an RN discover unsafe practice that deviates from standards, policies or procedures. Submitted Materials: Additional Materials: Evaluation Description: Students are evaluated on how thoroughly they address each of the five categories listed in the strategy overview. A grading rubric based on these categories can be used to score each student’s presentation, paper or poster. In my experience students do a good job with this assignment. They take their work as investigators seriously and are able to find literature and national standards on the internet with faculty guidance. The most difficult step is knowing what to do with the information when students uncover unsafe practices. A discussion of the best action is always fruitful and some students are willing to bring their findings to the attention of the manager or educator on the unit. Others prefer to have the faculty talk with the managers without identifying students by name.

Published Back to Strategy Search Strategy Submission Building Student Confidence in Clinical Communication with SBAR and Conversation Scripts Author: Cari Granier MSN, RN Title: Instructor of Nursing Coauthors: Institution: Nicholls State University Email: cari.granier@nicholls.edu Competency Categories: Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Patient-Centered Care: 1. The student will assess their own level of communication skills in encounters with patients, families, and healthcare staff. 2. The student will utilize the conversation script to apply principles of effective communication in the clinical setting. 3. The student will communicate care provided and needed at each transition in care using the SBAR method. 4. The student will identify ways to improve their own communication skills. Teamwork and Collaboration: 1. Students will verbalize risks associated with handoffs among providers and across transitions in care. 2. The student will use communication strategies to function competently within their own scope of practice as a member of the intra- and inter-professional team. 3. Students will adapt their own style of communication to meet the needs of the team and situation. 4. Students will utilize SBAR to minimize risks associated with handoffs among providers and across transitions in care. Safety: 1. Students will verbalize communication strategies that create a culture of safety. 2. Students will use SBAR to communicate observations or concerns related to hazards and errors to patients, families, and the health care team. Strategy Overview: During clinical rotations, nursing students communicate with patients, visitors, faculty, and members of the interdisciplinary health care team. While effective communication leads to better outcomes and quality of care, ineffective communication among care providers is a major factor in medication errors, delayed treatments, injury, and mortality. Because of this correlation, it is crucial that nursing students are trained to communicate effectively and feel confident in their communication abilities. Nursing faculty can help students strengthen communication skills by encouraging the use of the situation-background-assessment-recommendation (SBAR) technique and providing students with a communication script resource. Students were given a template to help guide their SBAR conversations for the beginning of shift and end of shift reports (see attached template). This template was designed to help students communicate the most important details of their assigned patient’s diagnosis along with any concerns to their peers, instructor, and assigned nurse. The conversation script includes questions geared towards initiating and maintaining conversations with patients and their families (see attached script). Students were then instructed to provide follow-up questions and/or comments that express an interest in the patient’s life, hobbies, or preferences with a goal of moving the conversation beyond patient care and medical needs to create meaningful bonds and build trust with patients and visitors. It is important for students to reflect on their current communication abilities and identify strengths and areas for improvement. The following four questions can be used to guide students through self-reflection about their own communication abilities prior to and after interventions. How often do you feel confident communicating with patients one-on-one? How often do you feel confident communicating with a patient when family is present? How often do you feel confident communicating with your assigned patient’s nurse? And, how often do you feel confident communicating with your clinical faculty? Students should answer using a Likert scale with the following response options: never confident, rarely confident, often confident, and always confident. Submitted Materials: Reflection-Resource-1.pdf - https://drive.google.com/open?id=1mEO9QGj6GxEPq_F_-VPeRSelg1xNssU3&usp=drive_copy Conversation-Script-Resource-1.pdf - https://drive.google.com/open?id=1cmwPLQ3zmYpBZpTvNBdsWJbdkKNoEI_x&usp=drive_copy QSEN-305.1SBAR-Template..docx - https://drive.google.com/open?id=13PrTl-bLgTAwSccAI6FhYSWMf0srngL8&usp=drive_copy Additional Materials: Evaluation Description: Prior to beginning their second clinical rotation, 17 baccalaureate clinical nursing students utilized the self-reflection resource questions (see attached reflection resource) to report their perceived confidence levels in their own clinical communication abilities. Afterwards, students reviewed the SBAR technique and conversation script with their clinical faculty and practiced in simulation labs. Students were encouraged to use these skills during their clinical rotation. At the end of the rotation, students once again reported their perceived confidence levels using the same self-reflection questions. Overall, students reported an increased confidence with clinical communication. When communicating with patients, there was a 29.4% increase in students reporting always feeling confident, a 29.4% increase with patient communication when family was present, a 41.2% increase when communicating with nurses, and a 17.7% increase with assigned course faculty. Faculty utilizing this resource reported easy implementation with observed improvement in student clinical communication.