MERGING THE NEEDS OF A TRAUMMA UNIT AND A GRADUATE EDUCATION PROGRAM

1. MERGING THE NEEDS OF A TRAUMMA UNIT AND A GRADUATE EDUCATION PROGRAM Joan E. King, RN, ACNP, PhD Jerry Murley, MS Judy Sweeney, RN, MS Jeanne Novotny, RN, PhD Sarah Hutchison, RN, BSN Vanderbilt University School of Nursing

2. Vanderbilt University Medical Center • Level One Trauma Facility • Trauma Unit was opened in 1998 • 31 bed unit (14 ICU beds) • 93 staff members (5 NP’s, 63 RN’s, 25 tech’s)

3. Vanderbilt University Medical Center • School of Nursing • Graduate Program • Acute Care Nurse Practitioner track was started in 1995 • Graduate students can subspecialize in: • Trauma • Cardiovascular-Cardiology • Nephrology • Oncology • HIV-AIDS

4. Merging Needs • Educate the 93 nurses and tech’s to the new Trauma Unit • Variety of backgrounds • Variety of expertise • Educate graduate nursing students who desire to focus in trauma care • Variety of backgrounds • Variety of expertise

5. COMMON FOCUS • All were interested or involved in Trauma Care • All needed to learn the most recent advancements in caring for Trauma patients

6. TEAM BUILDING • Expertise was needed in: • Trauma Nursing • Graduate Education • Asynchronous Learning Techniques • Graphic Designing • Database Management • Computer Programming

7. TEAM BUILDING • A new committee was established that consisted of: • Acting director of Continuing Education within the School of Nursing • Director of the Instructional Technology at the School of Nursing • The Clinical Manager of the Trauma Unit • Two faculty members who are actively involved in teaching in the ACNP program

8. IDENTIFYING THE GOALS AND DESIGNING THE FORMAT • The first module to be developed had been pre-selected by the Medical Director of the Trauma Unit … HYPOTHERMIA • Goal was to develop a Web-based module that would meet the learning needs of: • the Trauma Unit • the ACNP Program • Similar Institutions beyond Vanderbilt’s walls

9. THE CHALLENGE • Develop a Web-based module • That could be accessed any time, any where • Meet the educational needs of a wide variety of adult learners: • Nurse Practitioners (NP’s) • Graduate Students focusing on becoming NP’s • Staff RN’s • Tech’s: Patient Care Partners

10. ADDITIONAL GOALS • Divide the content into manageable subunits • To provide objectives that would guide the learning activities • To provide quizzes and a final exam that would provide feedback to both the learner and the institution • To make if possible to earn continuing education credits (CEU’s)

11. ADDITIONAL GOALS • To track detailed student performance data • To centrally organize the data for easy retrieval by faculty and managers • To create an evaluation tool that would allow students/participants to provide feedback for future upgrades of the module

12. THE WORK!!! • To achieve these goals the committee divided into two subcommittees. • One group worked on the development of the content of the module, and the development of the objectives, quizzes and final exam • One group worked on the development of the computer programs what would be needed to assist in the launching of the module as well as in the collection of the data

13. THE WORK!!! • The committee met as a whole every two weeks to: • Share their progress • Exchange ideas and thoughts about how they envisioned the participants would navigate through the program • Exchange ideas and thoughts about the supra-structure that was needed to support these ideas

14. SUBMODULES • Submodules were developed in the following areas: • Introduction and definitions • Physiology • Pathophysiology • Coagulopathies • Cardiovascular Changes • Alterations in oxygenation with hypothermia • Summary of pathophysiological changes

15. SUBMODULES • Objectives and quizzes were developed for each submodules • A program was developed to allow the learner to have instant feedback on each quiz • Learners are allowed to revisit any submodule as often as they deem necessary • The quizzes can all be taken multiple times

16. SUBMODULES • The database records each quiz grade and archives previous grades • The final exam may be taken only once • A program was developed for the final exam that allows the learner to: • compare their answers with the correct answers with rational for the correct answers • obtain their final grade for the module

17. VARIETY OF LEARNING NEEDS • Initially it was decided that the NP’s and the graduate students would have the same content, quizzes and final exam • The RN’s would take the same content as the NP’s and graduate students excluding the last submodule which focused on protocols and “orders”

18. VARIETY OF LEARNING NEEDS • Initially the Care Partners were given similar content as the other nursing staff, but certain slides were deleted from “their program” • Pilot testing proved the content was too advanced • A second module on hypothermia was written specifically for the Care Partners

20. Oxygen Dissociation The oxygen dissociation curve shifts to the left with hypothermia, meaning that less oxygen is dissociated or removed from hemoglobin and consumed until tissue and capillary oxygen levels are very low. This leaves tissues with decrease oxygen extraction and rising serum lactate levels . There is difficulty determining the oxygen debt in shock states, because cellular function is impaired, leading to possible cellular hypoxia, acidosis, and cell death. SHIFT TO LEFT pH PCO2 Temp. 2,3-DPG SHIFT TO RIGHT pH PCO2 Temp. 2,3-DPG (Alspach,1991 & Fritsch, 1995)

21. Sample Quiz Question • Mr. Trauma sustained bilateral fractures and his core temp is 34.6. Because of his hypothermia, the oxygen will 1. dissociate more readily at the cellular level 2. dissociate less readily at the cellular level * 3. there will be no change

22. Sample Rationale Oxygen Dissociation Curve • 1 B. Hypothermia shifts the oxygen dissociation curve to the left. This means that hemoglobin has an increase affinity for oxygen. At the alveolar level this implies that oxygen will bind quickly, but at the cellular level oxygen will not freely dissociate.

23. Protocols • For Fluid Replacement • Consider • Age of patient • Comorbidities such as CHF, CAD, Renal Failure and Diabetes • Type of injuries in addition to hypothermia • The extent of the injuries

24. CHALLENGE: KEEPING THE FOCUS ON HYPOTHERMIA • Wide variety of terminology and abbreviations • Fertile field for future programs with “Hyperlinks” • Current approach: Development of a • Glossary of terms • Bibliography

25. DATA COLLECTION • Demographic Data to determine • Who our customers are • How well each individual performs • Differences that may emerge based on • Educational levels • Years of Experience • How long it takes an individual to complete the program • How many times they take the program

26. PILOTING • Ten members of the VUMC Trauma Unit piloted the module to determine appropriateness of the content • Two graduate students piloted the course • Two faculty members piloted the module to help refine movement through the program to help make it “user friendly”

27. PILOTING • Committee members were asked twice to “take the course” also help pilot the course and verify that what had been developed is truly what they had envisioned.

28. CURRENT STATUS • The Trauma Unit has made the program accessible to each staff member • Access to the program is through the Vanderbilt University School of Nursing Homepage and a code is provided to enter the program • The module will be incorporated into the graduate program this Spring

29. CURRENT STATUS • Preparing to launch this program on the Web for outside users • Upon receipt of a fee, individuals will receive an access code • They will be eligible for CEU’s • Institutions can pay for an entire unit or staff to take the course and an institutional code will be provided • Managers will be given the data as to who took the course and their individual final scores

30. LESSONS LEARNED • IT IS NOT A LINEAR PROCESS • Dialogue between the subgroups is vital • Changes in the content or the development of different levels, made changes in the supra-structure mandatory • Database needs and issues impacted how the learner could or would navigate through the program

31. ISSUES THAT EMERGED • Can a “student” skip sections • Can a “student” go back and review sections • Must a “student” take each quiz • Can a “student” repeat a quiz • Do the quizzes count in the final grade

32. ISSUES THAT EMERGED • Can a “student” jump to the final exam • Can a “student” take the final exam more than once • If a “student” is not satisfied with their grade can they retake the course • Is the course free • Who pays and how

33. LESSONS LEARNED • Piloting is essential in terms of determining: • Content validity • If the content is “free standing” • How easy it is to navigate through the course

34. LESSONS LEARNED • INTERDISCIPLINARY PROCESS: • Combined expertise in: • Computing • Web- base activities • Graphic and database design • Clinical Expertise • Educational Expertise

35. ACHIEVABLE GOAL • DEVELOP AN INTERACTIVE COMPUTER LEARNING MODULE • ACCESSIBLE ANY TIME, ANY WHERE • THAT TAKES THE “TRAUMA” OUT OF LEARNING • CAN MEET THE NEEDS OF A WIDE VARIETY OF NURSING PERSONNEL AS WELL AS GRADUATE STUDENTS