Leah Spittle BS, RDH EDHP 500: Teaching and Learning Theory Learning Theory Application Project August

5, 2013

Topic: Medical Emergencies in the Dental Office

Audience: 2nd Year Dental Hygiene Students

Learning Objectives: 1- Have a complete understanding of the medical emergencies that are most likely to occur in a dental office. 2- Have a complete understanding of the causes and contributing factors of dental medical emergencies. 3- Recognize the signs and symptoms of the medical emergencies most likely to occur in a dental office. 4- Describe the initial treatments and procedures indicated in the medical emergencies most likely to occur in a dental office. 5- Understand and demonstrate knowledge and the techniques used to prevent the most common medical emergencies in a dental office. 6- Understand stress reduction protocols in a dental office. 7- Learn how to develop a medical emergency protocol that can be used in a dental office.

Learning Theory: Based on my audience, 2nd year dental hygiene students, it is important to note that these students are about to graduate and move into real world clinical hygiene. It is so important that each student knows and understands the medical emergencies that are most likely to occur in a dental office, how to recognize the signs and symptoms, and what protocol to follow if they encounter a medical emergency in their private practice setting. Unlike school, in a private practice, the dental hygienist may find themselves on their own to deal with a medical emergency. To teach the importance of this topic and make sure each student understands all the information to apply it to a real world practice, three learning theories will be applied. These include social learning theory, constructivist learning theory, and cognitive learning theory. First social learning theory will be discussed. The social learning theory fits into teaching this topic of medical emergencies because within this theory it states students learn by two main aspects that are important when deciding upon the methods of instruction (Cherry, 2013). One, by observation and two, by internal motivators, which are essential to this theory (Cherry, 2013). Understanding these two main concepts, that are essential to the social theory, the methods of instruction can be adjusted for this topic. First, it is so important to understand medical emergencies and a student must observe various situations or problems that they may witness in real world situations. This will be done in a didactic format of lecture discussing key topics of medical emergencies, videos of simulated medical emergencies situations in a dental office, and observation of various skills performed by seasoned instructors, such as how to use an epi-pen for allergic reactions. Second is the idea that within the social theory, internal motivators outweigh external. When teaching this topic, the idea of internal motivators is the concept that the students behavior is motivated by wanting to understand the goal (Schmidt and Scholl, 2002). This can also be termed self-regulation. A method of teaching to this internal goal orientation is

showcasing real world videos and experiences of medical emergencies they may encounter. This way the student is internally motivated, and use self-regulation, to completely understand and visualize the importance of how to perform medical emergency protocols correctly in case they encounter them in a real world situation. The next theory to discuss will be the constructivist theory. There are three important aspects to the constructivist theory in relation to this topic. First, that students are active in their learning, second, they are collaborative with peers, and third the notion that this theory is inquire-based (Educational Broadcasting Corporation, 2004). First, this topic allows for students to be active by having class discussions about medical emergency procedures and situations. The goal of the instructor is not to drill understanding into their heads, but to allow for active discussion, questioning, and participation (Bilich and Bray, 2011). Second, is the idea of collaborating with their peers. A method of instruction in this aspect will be group activities like simulations and discussing why the conclusion of a certain medical emergency situation did not work and how they would improve it. Working together is so important in understanding and practicing medical emergency protocols. Finally, the idea of inquire-based understanding means the students are encouraged to question everything they are taught. A method of teaching by encouraging inquires would be to require a research project based on a single medical emergency and present what they learned to the class. For example researching causes of syncope (fainting). The final theory to discuss is the cognitive learning theory. This theory is similar to the constructivist learning theory in students taking an active role in learning. However, only one point will also be added. The notion that prior knowledge or experiences construct understanding and the method of instruction, meaning teaching by active participation in simulation, lecture, and video will allow for the students to change their cognitive understanding of how to deal with a medical emergency, thus changing behavior.

Assessment of Outcomes: First will be the assessment of the understanding of medical emergencies from a social learning theory perspective. Again a key to this theory was observation. It was noted that observation was going to be in didactic lectures, videos, and observation of various skills from professionals. A way to assess understanding would be in written tests and quizzes making sure the fundamentals of understanding facts and figures, related to medical emergencies, were understood. This way a foundation is applied and the instructor is able to make sure the students recognize basic understanding through observation and memorization. Second is the assessments applied to the constructivist learning theory on the topic of medical emergencies. Again, in this theory it is important to have active participation, collaboration with peers, and inquire-based understanding. A form of assessment for this theory is passing some form of simulation of medical emergencies. In researching simulation it was discovered that simulation of medical emergencies should follow initial didactic content then allow for simulation assessments to provide an opportunity to verify competency in these areas (Malamed, 2007). Next, by allowing collaboration with peers, group projects can be put in place to assess research and inquiry of the most common medical emergencies to be found in a dental office, such as asthma attacks. Then the groups can present their findings to the class and the instructor can assess full understanding though the work of a collaborative group project and the research done to understand the topics assigned. Finally, for the cognitive theory, an assessment of understanding would be to have each student use cognitive critical thinking skills and create medical emergency protocol that they could use in a dental office. This way, when they become hired to a dental office and a medical emergency arose, the student would have already practiced their behaviors needed to assess the situation and execute procedures that could save a life.

References: (1) Bilich Lisa, Bray Brenda. Human Patient Simulation for Teaching Medical Emergencies in a Dental Office. MedEdM Portal: Associations of American Medical Colleges. Version 1. February 17, 2011. Accessed: August 9, 2013. https://www.mededportal.org/publication/8259

(2) Cherry Kendra. Social Learning Theory: An Overview of Banduras Social Learning Theory. About.com.education: Psychology. 2013. Accessed: August 9, 2013. http://psychology.about.com/od/developmentalpsychology/a/sociallearning.htm

(3) Educational Broadcasting Corporation. Workshop: Constructivism as a Paradigm for Teaching and Learning. Thirteen ED Online: Concept to Classroom. 2004. Accessed: August 9, 2013. http://www.thirteen.org/edonline/concept2class/constructivism/index.html

(4) Malamed Stanley F. Chapter 2: Prevention. Medical Emergencies in the Dental Office 6th Edition. Mosby Elsevier. 2007.

(5) Schmidt Charles T, Scholl Richard W. What is Motivation: Sources of Motivation Theory. University of Rhode Island: Labor Research Center. 2002. Accessed: August 9, 2013. http://www.uri.edu/research/lrc/scholl/webnotes/Motivation.htm

Medical Emergencies Handout

The 911 Call 1-State YOUR name. 2-State the name of the practice. 3-State the practice location. 4- Say the crossroads. 5-State the PATIENTS symptoms, status, whether unconscious or conscious, stable or unstable or alert etc. 6-State where the entrance to the practice is. 7-State whether the entrance is blocked, or obstructed 8-State that someone will greet them. Blood Pressure Guidelines Normal= <120/80 Prehypertention=120-139/80-89 Mild HBP=140-159/90-98 Moderate HBP=160-179/100-119 Severe HBP=180-209/110-119 Very Severe HBP=>210/>120 ASA Guidelines I-Normal healthy person with no systemic disease II-Patient with mild systemic disease III-Patient with severe systemic disease (uncontrolled mild) IV-Patient with severe systemic disease that is a constant threat to life V-A moribund patient that is not expected to live without and operation VI-A patient on life support waiting to provide organ donation AHA Antibiotic Prophylaxis Guide Use only on pts with: -artificial heart valves -Previous infective endocarditis -Valve repair with prosthetic material -Many congenital (from birth) heart abnormalities, such as single ventricle states, transposition of the great arteries, and tetralogy of Fallot, even if the abnormality has been repaired -ALL pts during the first two years following any joint replacement. Regimen Patients not allergic to penicillin: -2 grams amoxicillin orally 1 hr prior to dental TX. Patients not allergic to penicillin but cant take oral meds -ampicillin 2 g intramuscularly or intravenously 1 hour prior to the dental procedure Patients allergic to penicillin -Clindamycin 600 mg orally 1 hour prior to the dental procedure Patients allergic to penicillin and unable to take oral medications: -Clindamycin 600 mg IV 1 hour prior to the dental procedure Important Phone Numbers Poison control Fire Department Police Department EMS Pharmacy Ambulance Service Hospital Physician Oral Surgeon Electric Company Water Company Gas Company Drs Cell Phone

Common ME in a Dental Office

Syncope -Ammonium inhalant, broken and waved two inches from nose -Ambu bag ready or resuscitation if pt is not conscious -Albuterol, 2 puffs initially, wait 2 min then repeat up to 10 rounds -Prepare epi-pen if symptoms worsen -Benadryl Tabs (25-50mg) -Two stat the one BID until symptoms alleviated *if symptoms occur slow then mild reaction generally *Happens fast -Call 911 -Epi-pen(.3) or twinjet -open and insert through pant legs (upper thigh) or shirt (upper arm) -PPO2 or assisted breathing if pt is not conscious. *never use glucose substitutes on an unconscious patient -Glucose substrate tube squirt in pts mouth -Give orange juice, pure sugar (2 TBS) pure sugar candy, soda -Provide Nitro tabs or spray -spray 2 squirts under tongue -Tab put under tongue (can repeat up to 3 times) -call 911 after 3rd tab and no response -Take vitals every 10 min -PPO2 if pt is unconscious -NO latex gloves -if headache occurs reassure pt its normal -Treat as angina then assume MI if tx does not help -CALL 911 IMMEDIATELY -Provide CPR if unconscious

Asthma Mild allergic reaction

Severe allergic reaction

Hypoglycemia

Chest pain/angina

Heart Attack/Myocardial Infarction

Handout Connections: This handout was created for the dental hygiene students to use once they graduate and are working in a private practice. It is intended that the students save this handout and post it somewhere in their office once they begin working. This way they will have a common place to look if a medical emergency arises, or if they forget necessary and important medical information needed for daily clinical practice. First, there is a box with the proper protocol for making a 911 call if there is a medical emergency. Second, there is a box with the current blood pressure guidelines that they can refer to if a patient presents with higher or lower blood pressure (Malamed, 2007). Third, there is a box with the current American Society of Anesthesiologists (ASA) guidelines for the physical classification system for patients (Malamed, 2007). Fourth, there are the current American Heart Associations guidelines for antibiotic prophylaxis, as well as the current antibiotic prophylaxis regimen if needed (Malamed, 2007). Fifth, there is a place to document important phone numbers so there is easy access to the most important numbers during a medical or other emergency. Finally sixth, there is a quick list of the most common medical emergencies to occur in a dental office, and a brief overview of the procedures to perform if one may occur (Malamed, 2007). It is important to note that this handout is not all encompassing to every medical emergency that may occur. It is simply a quick guide that is intended to be hung up by the dental hygienist in their dental office once they find a permanent job. This handout applies to the seven main objectives that were set up, as well as to the theories discussed. After graduation, this will keep the student active with medical emergency information (constructivist), connecting with internal motivators, that being the goal of keeping the dental office efficient and safe (social), and, by seeing this handout posted everyday in their office, it will remind them to check their behavior and be readily cognizant of what is going on around them (cognitive).