RACHEL KELLER EDD 581 FEBRUARY 17 2014 SUSAN

RACHEL KELLER EDD 581 FEBRUARY 17, 2014 SUSAN GERTEL 1 Action Research Proposal EDD/581 ACTION RESEARCH PROPOSAL

PROBLEM STATEMENT £ The problem is the sequence of education in medical Action Research Proposal simulation. Upon narrowing of the problem, an intervention will be implemented. 2

PROBLEM DESCRIPTION £ £ The problem is inconsistent sequence of education. Setting problems include Acceptability to standardize £ Student’s knowledge Action Research Proposal £ 3

WRITER’S ROLE Education Specialist £ Train multi-discipline medical personal q With high fidelity simulation £ Action Research Proposal 4

PURPOSE OF THE PROJECT £ The purpose of this project is to standardize the sequence of education in medical simulation. Action Research Proposal (Microsoft, 2010) 5

PROBLEM DOCUMENTATION £ Problem is inconsistent sequence of education £ Pre Simulation versus Post Simulation Action Research Proposal £ Influence learners £ Perspective £ Facilitator £ Conformability £ Experience 6

SURVEY Action Research Proposal 7

SURVEY Action Research Proposal 8

LITERATURE REVIEW Simulation in medical education q More effective q Structure is key component q Simulation before education q Better performance q Increase knowledge q Action Research Proposal (Microsoft, 2010) 9

LITERATURE REVIEW q Education before simulation q Action Research Proposal q Improves learning Simulation before education q Negative attitude (Microsoft, 2010) 10

LITERATURE REVIEW Authors of the study Title of the study Sequencing of Web. Based and Manikin Simulators to Teach Shock Physiology in the Medical Curriculum. Ciceroa, M. , Auerbacha, M. , Zigmonta, J. , Rieraa, A. , Chinga, K. , and Baum, C. Simulation training with structured debriefing improves residents' pediatric performance. Pertinent findings that support your project Investigate proper linkage of simulation experiences with medical curricula. The data suggest improved learning when education precedes simulation. Measure the efficacy simulation in learners' skills. Hypothesis simulations and a structured debriefing would improve performance. Structured education is a key component of simulation education to improve learners’ performance. Action Research Proposal Cendan, J. C. and T. Enhancing Learning through Optimal R. Johnson Purpose of the study 11

LITERATURE REVIEW Authors of the study Issenber, B. , & Mc. Gaghie, E. Mc. Gaghie, W. , Issenber, B. , Cohen, E. , Barsuk, J. , Wayne, D. Purpose of the study Pertinent findings that support your project Effectiveness of computerbased instructional simulation: A meta analysis. Analyze effectiveness between two forms of simulation and modes of instruction. Simulation before education may indicate better performance, but negative attitude towards simulation education. Features and uses of highfidelity medical simulations that lead to effective learning. Exploring features and uses of high-fidelity medical simulations that lead to most effective learning High-fidelity medical simulations are effective in medical education. Does Simulation-based Medical Education with Deliberate Practice Yield Better Results than Traditional Clinical Education? A Meta. Analytic Comparative Review of the Evidence This article presents a Simulation is superior to traditional comparison of the clinical medical education in achieving effectiveness of traditional specific clinical skill acquisition goals. clinical education toward skill acquisition goals versus simulation-based medical education. Action Research Proposal Lee, J. Title of the study 12

LITERATURE REVIEW Title of the study Purpose of the study Pertinent findings that support your project Stefaniak, J. , & Turkelson, C. Does the sequence of instruction matter during simulation. Examine sequence of instruction during simulation. Learners who participated in simulation before education demonstrated increased knowledge compared with learners who participated in simulation after a education. Zendejas, B. , Cook, D. , & Farley, D. Teaching first or Examine sequence of teaching last: Does the instruction during timing matter in simulation-based surgical scenarios. Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Action Research Proposal Authors of the study 13

ACTION GOAL q Action Research Proposal The goal of the intervention is to improve knowledge of participants in implementing a standardization in the sequence of education in medical simulation. A three-prong intervention will be implemented to meet the goal, which includes standardizing the sequence of education in medical simulation, instructor training, and weekly collaboration time supported by the administration. (Microsoft, 2010) 14

SELECTED SOLUTIONS Standardizing the sequence of education £ Instructor training £ Weekly collaboration £ Action Research Proposal 15

CALENDAR PLAN £ £ Action Research Proposal £ Study Duration £ March 3, 2014 – May 2, 2014 Instructors £ Educators at the simulation center Participants £ Nurses <1 year 16

WEEK 1: MARCH 3 -7, 2014 Tuesday Wednesday Thursday Friday Instructor training 8: 00 - 10: 00 Instructor training 8: 00 - 10: 00 Weekly Collaboration 1: 00 - 2: 00 Action Research Proposal Monday 17

INSTRUCTOR TRAINING Participant Time Where Jerome March 3, 2014 8: 00 -10: 00 Oak Classroom Jamie March 4, 2014 8: 00 -10: 00 Oak Classroom Suzanne March 5, 2014 8: 00 -10: 00 Oak Classroom Rami March 6, 2014 8: 00 -10: 00 Oak Classroom Cheryl March 7, 2014 8: 00 -10: 00 Oak Classroom Action Research Proposal Date 18

INSTRUCTOR TRAINING AGENDA Welcome and explain purpose of study 8: 30 - 9: 00 Explain the education process with groups A and B 9: 00 - 9: 10 Break 9: 10 - 9: 50 Equipment, technology, and scenarios 9: 50 - 10: 00 Questions and wrap-up Action Research Proposal 8: 00 - 8: 30 19

STUDENT AGENDA Group A Welcome and explanation of study 8: 05 - 8: 25 Education 8: 25 - 8: 45 Simulation 8: 45 - 8: 50 Questions 8: 50 - 9: 00 Student complete survey and test Action Research Proposal 8: 00 - 8: 05 20

STUDENT AGENDA Action Research Proposal 21

WEEK 2: MARCH 10 -14, 2014 Tuesday Group A 8: 00 - 9: 00 Wednesday Thursday Friday Weekly Collaboration 1: 00 - 2: 00 Action Research Proposal Monday 22

WEEK 3: MARCH 17 -21, 2014 Tuesday Group B 8: 00 - 9: 00 Wednesday Thursday Friday Evaluate Results Weekly Collaboration 1: 00 - 2: 00 Action Research Proposal Monday 23

WEEK 4: MARCH 24 -28, 2014 q Study Group A q Friday, March 28 Monday Tuesday Group A 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Weekly Collaboration 1: 00 - 2: 00 24

WEEK 5: MARCH 31 -APRIL 4, 2014 q Study Group B q Friday, April 4 q Evaluate Results Monday Tuesday Group B 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Evaluate Results Weekly Collaboration 1: 00 - 2: 00 25

WEEK 6: APRIL 7 -11, 2014 q Study Group A q Friday, April 11 Monday Tuesday Group A 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Weekly Collaboration 1: 00 - 2: 00 26

WEEK 7: APRIL 14 -18, 2014 q Study Group B q Friday, April 18 q Evaluate Results Monday Tuesday Group B 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Evaluate Results Weekly Collaboration 1: 00 - 2: 00 27

WEEK 8: APRIL 21 -25, 2014 q Study Group A q Friday, April 25 Monday Tuesday Group A 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Weekly Collaboration 1: 00 - 2: 00 28

WEEK 9: APRIL 28 -MAY 2, 2014 q Study Group B q Friday, May 2 q Evaluate Results Monday Tuesday Group B 8: 00 - 9: 00 Wednesday Thursday Friday Action Research Proposal q Weekly collaboration Evaluate Results Weekly Collaboration 1: 00 - 2: 00 29

EXPECTED OUTCOMES Standardization of course sequence is complete 1. 2. 3. 100% of courses are sequenced 90% of instructor’s trained in course sequence 100% of staff have time established for weekly collaboration Action Research Proposal £ The outcomes: 30

MEASUREMENT OF OUTCOMES The outcomes: Knowledge Acquisition 1. q Learners tests Action Research Proposal Acceptability of Sequence 2. q q Learners surveys Educators journal entries 31 (Microsoft, 2010)

ANALYSIS OF RESULTS £ Implemented plan has impacted the problem £ Quantitative £ Learner’s Test Qualitative Learner’s Survey £ Educator’s Journal Entries £ Action Research Proposal £ 32

ANALYSIS OF RESULTS £ Present findings to leadership Action Research Proposal Written report £ Presentation £ 33

QUESTIONS Action Research Proposal (Microsoft, 2010) 34

REFERENCES Cendan, J. and Johnson, T. (2011). Enhancing Learning through Optimal Sequencing of Web-Based and Manikin Simulators to Teach Shock Physiology in the Medical Curriculum. Advances in Physiology Education, 35(4), 402 -407. £ Ciceroa, M. , Auerbacha, M. , Zigmonta, J. , Rieraa, A. , Chinga, K. , and Baum, C. (2012). Simulation training with structured debriefing improves residents' pediatric disaster triage performance. Prehospital Disaster Medicine, 27(3), 239 -244. £ Lawrence D. (2007). The ethics of educational research. Journal Of Manipulative & Physiological Therapeutics, 30(4), 326 -330. £ Lee, J. (1999). Effectiveness of computer-based instructional simulation: A meta analysis. International Journal of Instructional Media, 26(1), 71 -85. £ Hendricks, C. (2009). Improving schools through action research: A comprehensive guide for educators (2 nd ed. ). Upper Saddle River, NJ: Pearson Action Research Proposal £ 35

REFERENCES CONTINUED Issenber, B. , & Mc. Gaghie, E. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning. Medical Teacher, 27(1), 10 -28. q Mc. Gaghie, W. , Issenber, B. , Cohen, E. , Barsuk, J. , Wayne, D. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A Meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706– 711. q Microsoft, (2010). Image “All graphics”. q Stefaniak, J. , & Turkelson, C. (2013). Does the sequence of instruction matter during simulation. Society for Simulation in Healthcare, 00(00), 1 -6. q Zendejas, B. , Cook, D. , & Farley, D. (2010). Teaching first or teaching last: Does the timing matter in simulation-based surgical scenarios. Journal of Surgical Education, 67(6), 432 -438. Action Research Proposal q 36

APPENDIX A: EDUCATION SCENARIOS STATUS ASTHMATICUS Level II (In-Hospital) Action Research Proposal Your patient is a 6 -year old male, who was playing outside and developed difficulty breathing and shortness of breath. The patient came into the Emergency Department by his parents, who are currently out registering him into the ED. The patient is unable to answer the ED staff in complete sentences. Patient has audible wheezing upon presentation. The parents are unable for additional until midway through the scenario. 37

STATUS ASTHMATICUS ALGORITHM Action Research Proposal 38

FBAO ARREST Level II (In-Hospital) Action Research Proposal Your patient is a 7 -year old male, who was playing in the lobby and collapsed suddenly. Witness assesses the child and called for help. He is unresponsive, blue, and apneic. 39

FBAO ALGORITHM Action Research Proposal 40

SUPRAVENTRICULAR TACHYCARDIA Level II (In-Hospital) Action Research Proposal Your patient is an 8 -month-old male, Mother reports several days of increased fussiness, breathing hard and sweating when eating. Today seems short of breath and pale, refusing to eat or drink. Seen at PCP and referred to the ED. HR 220, CR- 3 seconds. Liver down. Patient irritable with decreased responsiveness. 41

SUPRAVENTRICULAR TACHYCARDIA ALGORITHM Action Research Proposal 42

HEAT ILLNESS Level II (In-Hospital) Action Research Proposal Your patient is a 6 -month old male, who was not “acting like himself”, is poorly responsive and “sweaty”, and seems to becoming progressively worse over past few minutes. Help was called. He still has poor responses, labored breathing, pale, and clammy upon assessment. 43

HEAT ILLNESS ALGORITHM Action Research Proposal 44

APPENDIX B: PARTICIPANT TESTS AND ANSWERS Action Research Proposal Test Weeks 2 and 3 Action Research Proposal 45

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 2 & 3 Action Research Proposal 46

ACTION RESEARCH PROPOSAL ANSWERS WEEKS 2 & 3 4. D 5. B 6. A 7. C 8. C 9. B 10. C Action Research Proposal ANSWERS 1. B 2. D 3. B 47

ACTION RESEARCH PROPOSAL TEST WEEKS 4 AND 5 Action Research Proposal 48

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 4 &5 Action Research Proposal 49

ACTION RESEARCH PROPOSAL ANSWERS WEEKS 4 & 5 Action Research Proposal ANSWERS 1. C 2. A 3. C 4. B 5. C 6. D 7. C 8. B 9. B 10. C 50

ACTION RESEARCH PROPOSAL TEST WEEKS 6 & 7 1. Simple measures to restore upper airway patency in a child may include any of the following EXCEPT: a. b. c. d. Using head tilt - chin lift to open the airway Cricothyrotomy Perform foreign body airway obstruction relief techniques Use airway adjuncts (e. g. , nasopharyngeal or oropharyngeal airway) 2. Stridor is a sign of what? a. c. d. Pneumonia Aspiration Upper airway obstruction Bronchoconstriction 3. The Glasgow Coma Scale (GCS) is scored based on response to all of the following EXCEPT: a. b. c. d. 4. Eye opening Verbal response Motor response Cardiac Output Medications used in the treatment of Croup may include: a. b. c. d. Action Research Proposal b. Dexamethasone Nebulized epinephrine Heliox All of the above 5. Common causes of upper airway obstruction include all of the following EXCEPT: a. b. c. d. Aspirated foreign body Asthma Swelling of the airway Retropharyngeal abscess 51

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 6 & 7 6. The initial impression consists of assessing all of the following EXCEPT: a. b. c. d. Consciousness Deformity Breathing Color 7. Types of shock include all of the following EXCEPT: Hypovolemic shock b. c. d. Hypoglycemic shock Distributive shock Cardiogenic shock 8. Common causes of acute community-acquired pneumonia include which of the following? a. b. c. d. Streptococcus pneumonia Mycoplasma pneumonia Chlamydia pneumonia All of the above Action Research Proposal a. 9. A room air Sp. O 2 reading less than _____ in a child indicates hypoxemia. a. b. c. d. 99% 97% 95% 94% 10. Signs of increased respiratory effort include all of the following EXCEPT: a. b. c. d. Abdominal bloating Nasal flaring Chest retractions Head bobbing or seesaw respirations 52

ACTION RESEARCH PROPOSAL ANSWERS WEEKS 6 & 7 4. D 5. B 6. B 7. B 8. D 9. D 10. A Action Research Proposal ANSWERS 1. B 2. C 3. D 53

ACTION RESEARCH PROPOSAL TEST WEEKS 8 & 9 1. You are caring for a 5 -year-old patient with supraventricular tachycardia (hear rate = 220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable. Which of the following would be the best treatment to provide without delay? a) b) c) d) Place cold packs on the distal upper and lower extremities Ask the child to blow through a small straw Exert light pressure on the eyes bilaterally Provide synchronized cardioversion at 0. 5 to 1 joules/ kilogram a) b) c) d) Administer repeated fluid boluses of isotonic colloid Administer repeated fluid boluses of isotonic crystalloid Begin immediate dopamine infusion Begin immediate dobutamine infusion Action Research Proposal 2. You are initiating treatment for a child with septic shock and hypotension. While administering high-flow oxygen you determine that the child’s respirations are adequate and Sp. O 2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion? 3. You arrive on the scene of a 12 -year-old who suddenly collapsed on the playground. The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer just brought the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next? a) b) c) d) Obtain intravenous access Attempt defibrillation Change compressions: ventilations from 30: 2 to 15: 2 Attempt endotracheal intubation 54

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 8 & 9 4. You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following should you attempt now? Synchronized cardioversion at a dose of 2 J/kg Synchronized cardioversion at a dose of 4 J/kg Unsynchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 4 J/kg 5. You are treating a 5 -month old with a 2 -day history of vomiting and diarrhea. The patient is listless. The respiratory rate is 52 breaths/ minute and unlabored. The heart rate is 170/ minute and pulses are present but weak. Capillary refill is delayed. You are administering high-flow oxygen, and intravenous access is in place. At this point, the most important therapy is to: a) b) c) d) Administer an epinephrine bolus Begin bag-mask ventilation Provide a rapid 20 ml/kg isotonic crystalloid fluid bolus Administer a bolus of 0. 5 g/kg of dextrose Action Research Proposal a) b) c) d) 6. Which of the following groups of clinical findings would be most consistent with categorizing a patient with compensated shock? a) b) c) d) Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulses Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea Normal blood pressure, normal level of consciousness, bounding distal pulses, hypercarbia, hypoxemia, and normal urine output Unresponsiveness, normal breathing, and good distal pulses. 55

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 8 & 9 7. You are caring for an 8 -month-old with bradycardia and very poor perfusion that has persisted despite effective ventilations with high-flow oxygen. You should begin chest compressions if the heart rate is: a) b) c) 8. You are called to treat a 5 -year-old with a 3 -day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/ min and regular with poor capillary refill. You provide bag-mask ventilations (BVM) with high-flow oxygen that produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first? a) b) c) d) Perform transcutaneous pacing Administer epinephrine IV Administer atropine IV Resume bag-mask ventilations Action Research Proposal d) More than 200/min More than 150/min Less than 100/min Less than 60/min 56

CONTINUED ACTION RESEARCH PROPOSAL TEST WEEKS 8 & 9 a) b) c) d) Epinephrine IV Transcutaneous pacing Atropine IV Dobutamine IV infusions 10. When monitoring the quality of chest compressions during resuscitation, you should ensure that providers are a) b) c) d) Action Research Proposal 9. You are caring for a child who was resuscitated after a drowning event. The child is intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO 2 detected. The heart rate is slow and the monitor shows a sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and central pulses are weak. Intravenous access has been established. The core temperature is 37. 3 Celsius. Based on the PALS bradycardia algorithm, which of the following should be provided first? Pushing hard – ensure that the chest is compressed ¾ of the anterior-posterior diameter Pushing fast – compress at a rate of 150/ min Allowing complete recoil – let the chest return to its original position between compressions Minimizing interruptions – do not permit interruptions for more than 1 minute 57

ACTION RESEARCH PROPOSAL ANSWERS WEEKS 8 & 9 Action Research Proposal ANSWERS 1. D 2. B 3. B 4. A 5. C 6. B 7. D 8. D 9. A 10. C 58