Running head: REFLECTION ARTIFACT 1

Reflection Artifact

Mallory White

Aspen University

N-580 Issues in Nursing Education

March 2018
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Reflection Artifact

Education is a crucial component of nursing both pre- and post-licensure. Issues in

Nursing Education is a course that focuses on different education aspects of education in nursing.

This is the first course in the Aspen University coursework that introduced this student to actual

curriculum development, learning tools, and evaluating the effectiveness of education. The

course also taught this student about differences in teaching in an academic environment versus a

healthcare environment.

Module One

Week one focused on the core competencies of the nurse educator. According to Utley

(2012), there are eight core competencies of nurse educators that reflect the essential skills,

values, knowledge, and beliefs of nursing faculty. The nurse educator competencies were

developed in 2005 by the National League for Nursing Task Group to reflect on the educator’s

important role as a scholar, teacher, and collaborator (Utley, 2012). The eight competencies

delineate how nurse educators design curriculum and develop the profession of nurse educators.

Nurse educators play a vital role in the education of the next generation of nurses. It is

essential that nurse educators maintain the eight competencies developed by the NLN to ensure

positive strides are made for the profession. The competencies ensure nurse educations reflect

the vital skills, values, beliefs, and knowledge necessary to help mold nurses who always strive

to learn and provide quality and safe patient care.

Module Two

Module two focused on teaching and learning in an academic environment. Educational

theories can determine how we, as nurse educators, share our nursing knowledge and skill with
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students. When an educator is considering teaching style, he/she should consider what learning

styles best suits their personal values and beliefs but also the learning environment. Healthcare

today is an environment of organized chaos with an increasingly technological presence.

Thinking about the where the future of healthcare is going, the connectivism learning theory

meets the needs of the next generation of nurses.

Connectivism centers around using technology to create a learning environment.

Connective nurse educators believe that decision-making itself is a learning process, and students

must be in an environment where they choose the meaning of the presented information and

choose what to retain as knowledge. The pace of learning and technology in healthcare is

continually growing to a point where the amount of information presented is beyond what

students can comprehend. Instead of teaching students massive amounts of knowledge,

connectivist educators teach students where to gain knowledge. Seimans (2005) explained that a

teacher’s role is to help students develop the necessary skills to be able to utilize educational

tools and to be able to make sense and apply what they access.

Module Three

Module three focused on teaching and learning in a healthcare environment. Nursing

education does not stop when students leave the classroom. In order to provide education that is

beneficial for the patients, the nurses, and healthcare organizations as a whole, nurse educators

must understand the economic trends in nursing. Nurse educators must also tailor the education

they provide to consider the patients that the staff nurses may provide care. When developing

healthcare education, the nurse educator must also consider the developmental stage of the

learner as well as the literacy of the adult patient populations for whom the nurses are providing

care.
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Education in the healthcare environment can be challenging to achieve because of a large

number of variables. The literacy levels of patients can vary drastically, so nurses must be aware

of the readability of the patient education materials they are providing. The developmental stage

of the nursing staff themselves can also vary and change the education needs. Nurse educators

are also frequently faced with providing education to staff nurses and patients with different

cultural backgrounds. Finally, nurses must also provide education to staff nurses regarding how

their bedside practices can affect the economics of the organization.

Module Four

Module four was aimed at assessment and evaluation strategies in nursing education.

Nurse Educators are being held responsible for the performance of their students, so it is

essential that educators develop methods to evaluate student knowledge and performance to

ensure that objectives are being met and that the individual will become a safe and successful

practitioner. Billings and Halstead (2016) explained that teaching and learning could be

improved only when educators perform assessments of learning. They also explained that the

techniques that are used for classroom assessment are referred to as classroom assessment

techniques [CATs]. When educators use learning assessment techniques, they must do so with

clearly identified outcomes and goals, they must assess a direct action that demonstrates student

learning, and they must have a method of reporting the findings (Barkley & Major, 2016).

Educators must not only teach but evaluate the effectiveness of their teachings. Assessing

students in multiple ways can allow educators to get a better understanding of whether or not the

information they presented was received and understood by students. Using simulation and role-

playing, educators can evaluate if students can apply clinical and skill laboratory knowledge to

patient scenarios in a safe and controlled environment. Video recording of role-playing or

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simulation scenarios not only allows educators to provide a more in-depth evaluation of student

learning, but it also will enable students to self-evaluate their performance and identify areas of

strength and improvement. Classroom lecture learning can be assessed through techniques of

concept mapping or jigsaw exercises. These exercises allow students to take one idea or concept

and evaluate how it is part of a larger whole.

Module Five

Curriculum design and program evaluation were the main focuses of module five. The

Quality and Safety Education for Nurses [QSEN] project was designed to address the challenged

educators faced when trying to prepare future nurses with the knowledge, skills, and attitudes

that are necessary to improve the quality and safety of the healthcare systems in which they will

one day work (QSEN Institute, 2018). The QSEN Institute (2018) outlined six competencies that

educators can use as a part of their curriculum. Incorporating the QSEN (2018) competencies

into nursing school curriculum allows educators to produce practitioners who possess the

knowledge, attitudes, and skills necessary to be productive members of the healthcare team.

The ultimate goal of nursing practice is to provide quality and safe patient-centered care.

Nurses can achieve this through evidence-based practices, striving for quality improvement,

ensuring teamwork and collaboration with all members of the healthcare team, and utilizing

informatics. Incorporating the QSEN (2018) competencies into nursing school curriculum

allows educators to instill the knowledge, skills, and attitudes that are necessary to produce

providers that can provide the highest quality and safest care to patients. The best way to address

the QSEN (2018) competencies is to weave them into all aspects of the curriculum. Teamwork

and collaboration is one QSEN (2018) competency that can easily be incorporated into all

aspects of the nursing school curriculum.

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Module Six

During module six, this educator learned about change and leadership in nursing

education. A leader can be a nurse in any position at a variety of healthcare organizations who

possess an interest in developing the ability to lead an interprofessional team for creating

innovative solutions. Leaders influence change by securing the right people, establishing a

common purpose, and being open to new possibilities to discover solutions to complex problems

(O'Neal, Bianchi, & Adams, 2018). To be effective leaders and change agents, nurse educators

must not only be aware of the strengths and areas of improvements for his/her students, but the

educator must also be mindful of his/her abilities. Educators must also gain an understanding of

the leadership style that they feel best relates to their educational goals and outcomes. Finally,

educators must be leaders regarding creating a learning environment that is conducive to learning

and without incivility.

Across all settings, nurse educators are leaders and change agents who participate in

efforts to improve nursing education, develop educational innovations, and gain leadership skills.

Increasing awareness for leadership styles has allowed this educator to become a more effective

leader and change agent. This educator was also able to identify areas of strengths, like

technology, and areas that need improvement, like communication and teamwork. Educators

must have self-awareness as well as awareness of their students to create a learning environment

to foster knowledge and development in civil manners.

Module Seven

Module seven centered around continuous quality improvement and technology in

nursing education. Advances in technology drive education in healthcare. Educators are being

faced with technology advancements in classroom designs and teaching techniques. Nurse
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educators can use simulation exercises to support learning in nursing education and to enhance

learning outcomes and promote safe patient care environments. Nurse educators also use

electronically-mediated technologies to improve teaching and learning. Nurse educators must

identify and overcome the challenges of technology-rich learning environments in nursing

education to promote student learning, which in turn increases patient safety and outcomes.

Nurse educators face many challenges when incorporating technology into a nursing

curriculum. High-fidelity simulation is becoming a popular method of allowing students to

provide hands-on care to a mannequin to improve their assessment skills as well as their clinical

judgment skills. Simulation scenarios can also be used for interprofessional groups that allow

nurses to learn more about the roles of other members of the healthcare team. Educators also

face challenges when designing, developing, and implementing a web-based curriculum.

Educators must consider how to use technology to keep students engaged while providing

opportunities for learning and professional development. Finally, learning and adapting to

changes in technology is not just the responsibility of nursing students. Nurse educators must

continuously serve as examples for learning and seek ways to adjust their curriculum to meet the

needs of the students and patients better.

Module Eight

The final module in the course focused on the educational environment and scholarship.

Nurse educators have an essential role in the scholarship of teaching, facilitating learning,

politics within the nursing profession, and engaging in lifelong learning and scholarship.

Educators must ensure they are using new technologies with current evidence-based practices to

facilitate learning and develop students who can function safely as a registered nurse. Nurse

educators can also promote the growth of nursing as a science and profession by engaging in
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politics. Finally, nurses can participate in an educational environment by being lifelong learners

themselves. When educators strive for continual learning and professional development, they

not only improve their knowledge and practice, but they encourage their students to do the same.

Through the scholarship of teaching, facilitating learning, political involvement, and

lifelong learning nurse educators can enhance nursing as a science and profession. Facilitating

learning is one fundamental concept for nurse educators defined by the National League for

Nursing. Educators can promote learning by striving to incorporate technologies and current

evidence-based practice into the curriculum. Political initiatives, like expanding the role of

Advanced Practice Registered Nurses can not only help promote nursing as a science and

profession, but it can provide significant benefits to populations like veterans. Finally, when

nurse educators engage in lifelong learning and scholarship, they can encourage students to be

involved in learning while growing their knowledge and skills.

Learning Representation

Nurse educators are faced with the challenge of developing effective and innovative

programs that align with the current trends in healthcare and to educate nurses with a high level

of professional autonomy, evidence-based knowledge, and a high level of clinical judgment

skills (Johnsen, et al., 2018). At Firelands Regional Medical Center [FRMC], the nursing director

of the inpatient psychiatric unit was noticing that the patients on her unit were increasing in their

medical needs in addition to their psychiatric illnesses. The psychiatric unit was experiencing

more medical emergencies than ever, so the nurse director sought out the help of the clinical

education department to teach her psychiatric nursing staff how to recognize early signs of

patient deterioration and what interventions to perform to improve patient outcomes.

Developing a Teaching Plan

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Patients with psychiatric diagnoses and co-existing medical conditions can be challenging

to assess, evaluate, and treat (Puskar, Smith, Herisko, & Urda, 2017). Medical emergency

training for psychiatric nurses is essential to improve patient outcomes. Puskar, Smith, Herisko,

and Urda (2017) shared that little research exists concerning what education needs are for

psychiatric nurses in regards to medical emergency situations or the use of medical emergency

treatments in psychiatric facilities. Early recognition of patient deterioration by psychiatric

nurses can decrease adverse patient outcomes, even death.

Dickerson and Graebe (2018) identified that the first step to developing a teaching plan is

to determine the problem or opportunity for improvement that has created the request for

education. Assessment of the practice group of the psychiatric nurses found that many of them

were unfamiliar and uncomfortable with identifying and treating patient’s medical illnesses. The

second step according to Dickerson and Graebe (2018) is to analyze the situation to determine

what gaps exist that are causing these problems to occur. It was determined that the inpatient

psychiatric unit was admitting patients with more medical diagnoses than in previous years. In

the past, if patients required medical care, their medical and psychiatric illnesses were managed

on a medical unit. Dickerson and Graebe (2018) shared that step three involves identifying the

hap for learners. It was identified that many of the nurses had worked in the psychiatric unit for

five years or more, and many have never been involved in a medical emergency situation.

Because many of the nurses have no hands-on experience with handling medical emergencies, it

was decided that high-fidelity simulation was the best method to teach the psychiatric nurses

about detecting early signs of patient deterioration and the importance of timely interventions.

Bloom’s Taxonomy hierarchy was used as a framework for leveling and developing

objectives to help students achieve their expected outcomes. The INACSL Standards Committee
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(2016) shared that Bloom’s Taxonomy hierarchy progresses from lower level objectives like

remember and understand to higher level objectives like apply, analyze, evaluate, and create. The

simulation scenarios were designed to promote student development of patient assessment skills,

identifications of abnormal values or early signs of deterioration, management of care, and the

implementation of appropriate interventions.

Clinical Judgement Simulation Class

Below is a teaching plan that will be used in a simulation class to help psychiatric nurses

gain clinical judgment in recognizing patient deterioration.

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Table 1

Purpose: To improve patient safety, the quality of care, and patient outcomes of psychiatric
patients through the use of high-fidelity simulation.

Goal: After simulation class, the nurse will utilize clinical judgment to recognize patient
deterioration and make the decision to intervene for the patient by calling a physician, calling
for the medical emergency team [MET], calling a stroke alert, or calling a code blue.

Scenario Objectives Additional methods of

instruction

#1: While participating in the simulation Discussion:

A 52-year-old male scenario, the nurse will be able to: Differentiating
comes to nurses station Identify signs of angina angina vs.
yelling and suddenly anxiety
begins to hold his chest Demonstrate proper technique
and complains of chest for monitoring patient vital
pain, stating he feels like signs and analyze to identify Handout:
he could die. He what patient vital signs are out FRMC Chest
appears anxious and of normal range Pain Standard
diaphoretic. of Care
Demonstrate proper technique
for applying cardiac monitor

Properly recognize ST-

segment elevation on a
cardiac monitor

Initiate Medical Emergency

Team [MET]

Follow FRMC Chest Pain

Standard of Care

Actively participate in a
debriefing with the group to
determine strengths and areas
for improvement
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#2 While participating in the simulation Discussion:

60-year-old male ate scenario, the nurse will be able to: How to
lunch then went to his Identify signs of a stroke determine last
room for a nap. One known well
hour later, you walk into Demonstrate proper technique
his room to perform an and rationale for monitoring Importance of
assessment, and he blood glucose levels in patients monitoring
presents with garbled that present with signs or blood sugar
speech. symptoms of a stroke
Early
Initiate Stroke Alert recognition and
treatment to
Properly perform Cincinnati improve patient
Stroke Assessment, assessing for outcomes and
facial droop, arm drift, speech maintain stroke
changes, and identifying the last accreditation
known well time for the patient

Actively participate in a
debriefing with the group to
determine strengths and areas for
improvement

#3 While participating in the simulation Discussion:

A 24-year-old male had scenario, the nurse will be able to: Do not assume
an afternoon visit with Identify the presence of drug overdose -
some friends and family respiratory distress -investigate
in the common other potential
room. Mid-afternoon initiate a code blue causes
while doing rounds, you
find him laying in bed Properly perform bag-mask Importance of
unconscious, gray in ventilation knowing your
color, with no effort to patient’s
breathe Identify potential causes of the medical history,
patient’s respiratory distress even on a
If nurse suggests psychiatric unit
possible drug overdose Identify dextrose and treatment
and administers Narcan - choice for hypoglycemia and Handout:
-no response demonstrate proper Narcan vs.
administration Romazicon
If nurse monitors blood
sugar --reading comes Actively participate in a
back at 29 debriefing with the group to
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determine strengths and areas for

improvement

#4 While participating in the simulation Discussion:

A 28-year-old male scenario, the nurse will be able to: If patient
walked out to nurse’s Demonstrate proper technique for changes after
station, while drinking a monitoring vital signs and interventions,
cup of coffee, and identify values that are out of the nurse must
complains of feeling as normal range re-assess and
if his heart is determine what
fluttering. He appears Intervene by notifying the future
anxious and physician of the patient’s interventions
diaphoretic. The patient increased heart rate are necessary
had just arrived to your
unit but admits that he
failed to tell the
emergency room staff Handout:
that earlier in the day he FRMC Medical
took some dietary Emergency
supplements and energy Team Policy
pills and Record

Vital signs: HR 145, BP

136/70, SpO2 95% on
room air
Initiate MET

Demonstrate proper placement of

You have left the pulse-
ox reader on the
patient’s finger, and
while waiting for the
physician to call you
back, you notice that the
patient’s heart rate has
increased to 180 bpm
cardiac monitor leads and stat-
pads
Actively participate in a
debriefing with the group to
determine strengths and areas for
improvement

Conclusion

Effective teaching plans can help guide nurse educators to effectively educate the nursing

students or those who are already professional nurses. Bastable (2019) explained that the

educator must determine what the students are expected to accomplish before a decision can be
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made about the content to be taught or the teaching methods and instructional methods are to be.

This educator identified a deficit in clinical judgment and the recognition of early signs of patient

deterioration in psychiatric nurses. It was determined simulation was the best method to teach

the nurses to identify early signs of patient deterioration and intervene appropriately to improve

patient outcomes.

Conclusion

Throughout this course, this educator has gained knowledge and skills to help improve

personal performance as a clinical nurse educator in a hospital setting. This course has not only

assisted with knowledge attainment but also professional development. Through the course, this

educator was able to create artifacts that can be added to an e-portfolio that will be used for job

attainment after graduation. The e-portfolio serves as an indicator of educational and

professional growth throughout the modules. Each module served to help this educator develop

as an educator according to the NLN (2018) core competencies of nurse educators while

preparing for certification as a Certified Nurse Educator.

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References

Barkley, E. F., & Major, C. H. (2016). Learning assessment techniques: A handbook for college

faculty. San Francisco, CA: Jossey-Bass.

Bastable, S. B. (2019). Nurse as educator: principles of teaching and learning for nursing

practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.

Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (4th ed.). St.

Louis, MO: Elsevier Saunders.

Dickerson, P. S., & Graebe, J. (2018). Analyzing gaps to design educational interventions. The

Journal of Continuing Education in Nursing, 49(1), 4-6. doi:10.3928/00220124-

20180102-02

INACSL Standards Committee. (2016). INACSL standards of best practice: Simulation

outcomes and objectives. Clinical Simulation in Nursing, S13-S15.

doi:10.1016/j.ecns.2016.09.006

Johnsen, H. M., Fossum, M., Vivekanan-Schmidt, P., Phil, D., Fruhling, A., & Slettebø, Å.

(2018). Developing a serious game for nurse education. Journal of Gerontological

Nursing, 44(1), 15-19. doi:10.3928/00989134-20171213-05

O'Neal, P. V., Bianchi, A., & Adams, E. (2018). The PRO leader model. Nursing Management,

49(2), 48-59. doi:10.1097/01.NUMA.0000529930.04494.fc

Puskar, K., Smith, M. D., Herisko, C., & Urda, B. (2017). Medical emergencies in psychiatric

hospitals. Issues of Mental Health Nursing, 32(10), 649-653.

doi:10.3109/01612840.2017.58763
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QSEN Institute. (2018). Quality and Safety Education for Nurses. Retrieved from http://qsen.org/

Seimans, G. (2005). Connectivism: A learning theory for the digital age. International Journal of

Instructional Technology and Distance Learning. Retrieved from

http://www.itdl.org/journal/jan_05/article01.htm

Utley, R. A. (2012). Theory and research for academic nurse educators: Application to practice.

Sudbury, MA: Jones and Bartlett.