Post on 05-Jul-2020
PROJECT ON
CARE OF PATIENT ON MECHANICAL VENTILATOR
(NURSING RESEARCH PROPOSAL)
HNH 514 Advanced Theory and Practice in Nursing Education II
FALL 2018
PART 1 Introduction
General overview
Purpose
This project is an individual type learning project where the main purpose is learning
to teach the nursing students (based on the nursing syllabus) how to take care of the
patients on mechanical ventilator.
General description:
On receipt of permission from the required stakeholders (Nursing College principal,
Nursing tutors, incharge nurse, etc.) in the clinical setting, pretest (using multiple
choice questionnaires) will be assigned to the nursing students for assessing the
prior knowledge regarding care of mechanically ventilated patients. Post that, a
teaching session will be arranged for the nursing students. Different methods of
teaching will be demonstrated using various aids for teaching and assessing the
learning requirements of the nursing students. Demonstration of the procedures like
suctioning and weaning from ventilator will be given in the clinical area. A post
session-test will be arranged for the nursing students using same set of
questionnaires.
Evaluation of the teaching methods and learning outcomes will be based on the
difference of scores in post-test and pre-test results.
A checklist will be prepared to evaluate the demonstration of different procedures
like suctioning and weaning from ventilator by nursing students.
Background and necessity of the project
Respiratory failure develops when any of the systems like pulmonary system, central
nervous system, cardiovascular system fail to maintain their optimum functioning.
Acute respiratory failure occurs from several reasons, including pulmonary disease,
neuromuscular disease, shock and the need for airway protection or temporary
respiratory support after major surgery. If cared inappropriately, prolonged
mechanical ventilation risks for complications like ineffective airway clearance,
airway obstruction, pulmonary barotrauma, unexpected or accidental extubation,
respiratory infections, imbalanced nutrition and anxiety in patients. Error free,
effective, efficient and comprehensive nursing care is required for caring patients on
mechanical ventilator.
The student nurses are in learning phase. They lack appropriate knowledge and
eventually are unable to rationalize, think critically and creatively or use a problem-
solving approach based upon the scenarios in the clinical setting. Besides, they also
lack practice and skills to care for the patients on mechanical ventilator (Jamshidi et
al, 2016). Thus, provision of ineffective care will aggravate patient’s condition, will
increase their hospital stay and its complications. This could eventually affect their
physical, psychological, social and economic status.
Enhancing the knowledge of student nurses will build up confidence in themselves
and gradually aid them to provide effective, structured and well planned nursing care
to the patients on mechanical ventilator. This will help in minimizing the
complications in the mechanically ventilated patients and pave the way for their
speed recovery.
Bastable’s (2019) Assessment of Learning Needs
The nursing students who are in last year of their nursing course are in emerging/
early adulthood phase. Their learning needs include active participation during
teaching. They need to be encouraged in selecting the type of training material to be
used during teaching and methods of teaching. They desire practical and relevant
information. Therefore, teaching in a clinical setting will be more preferable. They
need to be explained that the session will help them when they practice nursing
independently. This will aid them to understand ‘What’s in it for me’. (Bastable S. and
Dart M., 2007)
1. Target Population:
All the nursing students in their last year of nursing course from the XYZ nursing
college who are aware of the basic nursing care of patients will be the target
population.
2. Learner environment:
a. Following methods of teaching will be performed in lecture hall:
Lecture
Group discussion
Simulation scenarios
Role play
b. Following methods of teaching will be performed in clinical area:
Demonstration of procedures
Nursing care plan
Nursing case study
3. Learners’ readiness to learn:
Physical readiness: Physically, the nursing student can learn with their
optimal functional capacity. Therefore, any nursing procedures can be
taught to them easily. (Bastable S. and Dart M., 2007)
Emotional readiness: Nursing students will be happy to learn during the
lecture hall environment. However, some experiences may be
psychologically draining for the nursing students in the clinical area like
intensive care unit. (Bastable S. and Dart M., 2007)
Experience: As the nursing students are the last year nursing course
students, they will be aware of the clinical ward setting and the basic
nursing procedures. However, they will have very little exposure to
advanced nursing care in the intensive unit care set up.
Knowledge readiness: Nursing students will be aware of the anatomy
and physiology of the respiratory system. However, lack of knowledge
and skills expected with respect to advanced nursing.
4. Perceived and actual needs of the learners (Bigdeli, et al (2015):
The expected needs of the nursing students differ significantly than the actual
needs in the clinical environment. They do not have positive perception of the
clinical environment as their expectations are not met in the clinical
environment. Therefore, theoretical teaching environment is preferred for than
the teaching in clinical area.
5. Identified learning needs: The identified six domains of learning needs as per
Clinical Learning Environment Inventory (CLEI) scale (according to the
priority) are as follows (Bigdeli Sh, et al (2015):
a. Innovation: Innovative methods of teaching increases effectiveness of
learning. Therefore, group discussions, role play, demonstration methods
of teaching introduced.
b. Student satisfaction: It is important in clinical education and is the outcome
of clinical education. This will be taken care during the study by
ccordinating with the incharge nurse.
c. Individualization: Taking independent decisions for planning of nursing
care for the patients is the expectation of nursing students. Hence, it is
necessary that the nursing students become fully competent in their
knowledge and skills through effective clinical education.
d. Task orientation: The students to be made aware of the objective of the
teaching and learning.
e. Personalization: Individual personality will be considered. They should be
given respect, support and recognition in the clinical area. There will be
proper student and instructor interaction.
f. Involvement: Clear instruction will be given to the nursing students as what
are they supposed to do in clinical area. Students expect to be involved in
clinical activities. The instructors will facilitate involvement of students in
clinical activities.
6. Availability of resources:
Few methods of teaching will be performed in lecture hall of the nursing
college. This will be planned and scheduled based on nursing student’s
availability and Lecture hall availability. Teaching in clinical area will be
performed during the student’s posting in the intensive care unit and will be
coordinated with their current mentors/instructor.
7. Assessing organization demands:
Both the demands and expectations of the clinical area and nursing college
will asked for and will be taken into consideration while teaching the nursing
students.
8. Time management issues (Qtait M., Sayej S., 2016):
Interruptions in the scheduled plan are expected which lead to time
management concerns. Students tend to procrastinate due to lack of
motivation, task overload, fear and anxiety. Administrative and organizational
obstacles expected during this study conduct due to their policies, customs
and traditions. This will be overcome by effective communication with the
stake holders and appropriate planning.
Learning Theory/Theoretical Framework:
Learning theories for the educational program design are:
a. Classical Philosophical
b. Field Theory
c. Association Theory
d. Structure theory
The philosophical approach to the implementation of this project: There
are 2 causes in learning in philosophical approach of learning. Here, a man
thinks, feels, wills, lives moves, perceives and understands through the
ultimate internal principle, which is termed as soul. A person can acquire
knowledge only through nature by means of discovery and instructions.
Teacher imitates the nature during instructions and gives the same
instructions which he goes through discovery.
In this project, the researcher will be conducting education programs with the
nursing students and provide them the instructions and background when
they are in the clinical setting and will take care of the patients on mechanical
ventilator.
Project Description: A narrative discussion
Rationale:
In this project, we are trying to study the effect of various teaching methodologies on
the knowledge and skills of student nurses in caring for mechanically ventilated
patients. The hypothesis is that upgrading the knowledge and skills of student nurses
will build up confidence in themselves and will aid them to provide effective,
structured and well planned nursing care to the patients on mechanical ventilator.
This will help in minimizing the complications in the mechanically ventilated patients
and pave the way for their speed recovery.
1. Learn and understand the anatomy and physiology of the respiratory system
and respiratory failure.
2. Assess the respiratory system through various ways of assessment (e.g.
Auscultation).
3. Enlist various risk factors and causes of respiratory failure.
4. Assist for the process of endotracheal intubation.
5. Identify the various modes of mechanical ventilation.
6. Identify various trouble shooting alarms of the mechanical ventilator and
causes and their remedies.
7. Able to frame a nursing care plan with nursing diagnosis, outcomes,
interventions along with their rationale for the patient on mechanical ventilator.
8. Demonstrate various specific vital procedures like suctioning, weaning from
ventilator.
9. Demonstrate various nursing interventions for the care of patient on
mechanical ventilation.
10. Enlist the risk associated and complications for the mechanically ventilated
patient.
Learning outcomes
The knowledge and skills of the student nurses will be enhanced and will be able to
assess and care for the patients on mechanical ventilator efficiently.
Project Design
On receipt of permission from the required stakeholders (Nursing college principal,
Nursing tutors, in charge nurse, etc.) in the clinical setting, pretest (using multiple
choice questionnaires) will be assigned to the nursing students for assessing the
prior knowledge regarding care of mechanically ventilated patients. Post that, a
teaching session will be arranged for the nursing students. Different methods of
teaching will be demonstrated using various aids for teaching and assessing the
learning requirements of the nursing students. Demonstration of the procedures like
suctioning and weaning from ventilator will be given in the clinical area. A post
session-test will be arranged for the nursing students using same set of
questionnaires.
Evaluation of the teaching methods and learning outcomes will be based on the
difference of scores in post-test and pre-test results.
A checklist will be prepared to evaluate the demonstration of different procedures
like suctioning and weaning from ventilator by nursing students. Data of the pretest
scores and post test scores of the answered questionnaires will be collected and
compared. Also, reverse demonstration of the procedures by the nursing students
will be evaluated using the checklist. Assistance will be taken from the in charge
nurse for the allocation of the mechanically ventilated patients in the intensive care
unit for the nursing students to perform the procedures in supervision of the
researcher and their nursing tutor.
The data collection tool will be a set of questionnaires with multiple choice answers,
including 10 questions used for the pre and post-test. Questionnaires are the most
often tools used in nursing research. This helps to assess the knowledge and to
know the effects of the interventions taken to upgrade the knowledge base in order
develop the nursing knowledge base (Chiarini M., (2015).
Evaluation: A pretest for determining the knowledge of the nursing students will be
taken using a set of questionnaires with multiple choice answers. Those answers will
be graded and database will be generated. Post the implementation of various
methods of teaching, the students will be given again the same set of
questionnaires. Data will be generated by grading the answers given by the same
set of nursing students for the second set of questionnaires. Both the data sets will
be compared using statistical considerations for measuring the outcomes
(Science.gov 2017).
The demonstration by the students will be evaluated using checklist in order to check
the skill development of the nursing students.
Anticipated Outcomes
There will be multiple impacts of this project.
Firstly, there will be enhancement of knowledge in nursing students. Skills for various
procedures will be more polished and error free. Secondly, this will have a direct
impact on the nursing care of the patients on mechanical ventilator. It will reduce the
chances of Hospital acquired infections, as sterile techniques will be used to perform
the nursing procedures. Thirdly, the project will help the in charge of the intensive
care unit to delegate the care of the mechanical ventilated patients and thus reduce
the workload on the nursing staff, until the ongoing research. Fourthly, it will benefit
the care takers of the patients as appropriate nursing care will minimize further
complications in the patients and thus reduce their economic burden of
hospitalization. Lastly, this project will help the researcher to learn to conduct the
research, draw analysis of the data collected and publish the results.
Resources used in preparation of the proposal
1. Jamshidi N. et al, (2016), The Challenges of Nursing Students in the Clinical
Learning Environment: A Qualitative Study, The scientific world journal,
Volume 2016, Article ID 1846178, 7 pages
http://dx.doi.org/10.1155/2016/1846178
2. Parsh B, (2010), Eight traits make great nursing instructors, Nursing2018,
volume: 40 Number 1-Supplement: 2010 Nursing Career Directory, page 16 – 16,
retrieved from
https://www.nursingcenter.com/journalarticle?Article_ID=959745&Journal_ID=54
016&iIssue_ID=959737
3. Science.gov (2017), Sample records for one-group pretest-posttest design,
retrieved from https://www.science.gov/topicpages/o/one-group+pretest-
posttest+design
4. Young D., Seibenhener S, (2018), Preferred Teaching Strategies for Students in
an Associate of Science Nursing Program, Teaching and Learning in Nursing,
retrieved from https://www.jtln.org/article/S1557-3087(17)30081-1/pdf
Resources intended to be used for the project:
1. Medical-Surgical nursing books for the preparation of the questionnaires
2. Statistical books/sites to draw the statistical considerations.
PART II Literature Review:
Literature review regarding the need for educational program:
Nursing research helps nurses to improve the patient care by knowing the best
possible practice in nursing care. As the trend of health care changes at higher pace,
nurses need to be change their practice based on latest discoveries. (Northeastern
state university, 2017)
Mechanical ventilation is required when the respiratory system fails to exchange the
gases in the lungs. Long term mechanical ventilation of the patients leads to
ventilator associated pneumonia, ventilator associated lung injury and other
complications like muscle wasting, oral ulcers, etc. (Deranged Physiology, 2015)
The knowledge of the nursing students expands in caring the mechanically ventilated
patients by providing them the knowledge with the help of education programme.
(Aluosh S., 2017)
The role of a teacher is to organize the process of teaching and learning properly.
The content of the curriculum should be well organized and should be prepared
based on the levels. Thus, the advanced nursing (i.e. care of patients on ventilator)
is included in the last year of nursing course. In humanistic theory of learning, the
learning focus should be on the need of the learner. The training materials should be
planned well advanced prior to the teaching. (Filipatali T., 2013)