running head: short title of paper (
Post on 26-Jun-2020
2 Views
Preview:
TRANSCRIPT
Running head: BRADEN RISK ASSESSMENT
Braden Risk Assessment: Education for Staff Nurses
Jessica Toner
Wilmington University
1
BRADEN RISK ASSESSMENT
Braden Risk Assessment: Education for Staff Nurses
Pressure injuries are a known concern in the healthcare field within the United States
(Cooper, 2013). They are harmful to the individual, costly to the organization, and can be
responsible for someone’s death (Bergquist-Beringer, Dong, He, & Dutton, 2013). A pressure
injury is defined as “a localized injury to the skin and/ or underlying tissue, usually over a bony
prominence, as a result of pressure alone or in combination with shear” (Qaseem, Tanveer,
Starkey, Denberg, 2015, p.359).
According to Oaseem et al. (2015), pressure injuries affect an estimated 3 million
people throughout the U.S. in all settings. They go on to say that pressure injuries are responsible
for the causes of death for 115,000 people between the years 1990-2001 and an underlying cause
of death in nearly 21,000. Oaseem et al. (2015) states the estimated cost of treating a pressure
injury is often between $37,000-$70,000, as well as $11 billion spent annually in the U.S. to treat
them. There are countless products, organization, and resources available to assist with pressure
injury prevention, yet the rate of pressure injuries remains high (Bergquist- Beringer et al.,
(2013).
One pressure injury prevention-screening tool is the Braden Risk Assessment.
According to Hyan, Vermillion, Newton, Fall, Li, Kaewprag, Moffatt-Bruce, and Lenz, (2013),
this tool helps to identify those at risk for a pressure injury based on a numeric scoring system.
The tool is made up of six subscales: mobility, friction/ shear, moisture, sensory, activity, and
nutrition (Hyun et al., 2013). See Appendix 1 to view the Braden Risk Assessment Tool Each
subscale is scored on a 1-4 scale or for friction/ shear a 1-3 scale. A total score ranges from 6 to
2
BRADEN RISK ASSESSMENT
23 with a score of less than 18 indicating patient is at risk for obtaining a pressure injury and the
use of this tool is a generally accepted practice across United States health care settings (Hyun et
al., 2013). One barrier to pressure injury prevention is the lack of interventions put into place.
According to Bergquist- Beringer et al., (2013), “only 56.3% to 89.6% of at-risk patients
received interventions to prevent pressure ulcers recommended by clinical practice guidelines
during the 24 hour admission period” (p.411). They go on to say that patients that scored in a
mild to moderate risk for skin breakdown may be more vulnerable than their risk assessment
revealed (Bergquist- Beringer et al. (2013). Evidence shows that if there are interventions
placed, resulting from the Braden Risk Assessment, the patient is at a decreased risk of obtaining
a pressure injury (Oaseem et al., 2015).
Statement of the Problem
Pressure injuries are a known concern in the healthcare field within the United States
(Cooper, 2013). Oaseem et al. (2015) states the cost of treating a pressure injury is between
$37,000-$70,000. Also, $11 billion is spent annually in the U.S. to treat them. One pressure
injury prevention-screening tool is the Braden Risk Assessment. Evidence shows that if there
are interventions placed that were resulted of the Braden Risk Assessment, then the patient is at
a decreased risk of obtaining a pressure injury.
Purpose
The purpose of this capstone project was to reduce the incidence of pressure injuries
by assessing the understanding of staff nurses on the use of the Braden Risk assessment tool and
implementation of interventions. The goal of this capstone project was to develop, implement,
3
BRADEN RISK ASSESSMENT
and educate nurses regarding the use of the Braden Risk Assessment tool to help prevent
pressure injuries and increase awareness of interventions for prevention.
Significance
Implementing an educational session to staff nurses in an acute care setting on the use
of the Braden Risk Assessment Tool will help to improve patient outcomes in pressure injury
reduction (Oaseem et al., 2015). Not only is pressure injury prevention about implementing
interventions, but also about increasing nursing knowledge using evidence-based practice
(Barakat-Johnson et al., 2018). Raising awareness of prevention of pressure injuries and
treatments using a variety of approaches (education, risk assessment tool, grading scores and
clinical guidelines) can help with anticipation of an injury early in admission to a facility
(Kharabshch et al., 2014). According to Berquist-Beringer et al. (2013), a pressure injury tool
should be used to evaluate a patient’s risk upon admission to a facility as well as the initiation of:
daily skin check;
pressure-redistribution surface;
routine repositioning;
nutritional support;
moisture management (Berquist-Beringer et al. (2013).
The Centers for Medicaid and Medicare Services stated in 2008 they will no longer pay for
additional costs related to pressure injuries that are obtained in a facility (Cooper, 2013).
This means education and prevention are more important then ever in order to gain financial
freedom from the cost of paying for treatment.
4
BRADEN RISK ASSESSMENT
Theoretical Framework
According to Theoretical framework in research (Jacob, 2013) a theoretical framework
helps to back the hypothesis of a study with supportive articles and how it relates to the current
research. Theoretical framework helps to guide research and help the researcher determine
what’s measureable and the relationship that will be sought out.
Orem’s Self Care Theory
Orem’s Self Care Theory focuses on goals of the individual or patient maintaining
their optimal level of independence. There are three components that make up the theoretical
framework. The first component is the theory of self care, which includes the ability to care for
ones self to a certain extend depending on age, social interactions and maintain health and well
being. The second component is the theory of self-care deficit. This section is when nursing is
needed and identifies 5 theories of help: action of and doing for others, guiding others,
supporting another, providing an environment to meet future demands and teaching others. These
categories of this theory need to be handled by nurses when the individual requiring the care can
no longer make them possible. The last is the theory of nursing systems. This theory describes
how the nurse, the patient, or both needs will meet the patient’s and stating specific roles for
each individual. See Appendix 2 to view Orem’s Self-Care Theory. The theory states the reason
for the patient needing assistance and closely correlates with this capstone project. When patients
are able to care for themselves, it’s the role of the nurse to continue to encourage their
independence and find the resources to make them successful. However, such as with this
capstone project, when the patient is incapacitated and unable to complete their daily hygiene,
handle their elimination needs appropriately, and maintain a certain level of activity as well as
5
BRADEN RISK ASSESSMENT
getting proper nutrition. When a patient has a low Braden Risk Assessment, it’s the nurse’s role
to step in and manage and implement the necessary interventions for their risk factors (Dorothea,
2012).
Appendix 2 Orem’s Self-care Theory
Cognitive Learning Theory
The Cognitive Learning Theory focuses on learning mental and psychological
processes of the mind as opposed to behavior like other theories (Taylor & Hamby, 2013).
Cognitive theory is a type of learning theory, which is a guide for educational system planning
for general classes as well as nurses (Aliakbari, Parvin, Heidari, & Haghani, 2015). See
Appendix 3 to view Cognitive Theory. Cognitive theorists believe learning is an internal process
6
BRADEN RISK ASSESSMENT
that focuses on thinking, understanding, organizing, and consciousness. Students must be able to
take the knowledge they learn and incorporate problem solving, so by exploration they will be
able to actively learn, search for new information and tap into their previous experiences for new
information (Aliakbari et al., 2015). Educating nurses about the Braden Risk Assessment will
give them the ability to think about the scoring system, interpret the results and then explore the
options for intervention by using critical thinking. Being able to apply a specific treatment to
meets the individual patient needs will allow them a chance to be able to build on their already
known understanding of pressure injury prevention.
Appendix 3. Cognitive Theory
Review of Literature
A review of literatures purpose is to “provide a critical written account of the current
state of research on a selected topic” as well as gaps in past research, contribution to the
7
BRADEN RISK ASSESSMENT
understanding of current research, and suggestions for future research (How to write a literature
review, n.d. para 1). The literature review written below reviews article that support Education
of Braden Risk Assessment Risk Assessment using the educational process, teaching theories,
education and nursing theories, continuing education, teaching methods, and evaluation methods.
Pressure Injury Risk Factors
The author of the research article, Predictive Validity of the Braden Scale for Patients
in Intensive Care Units, Hyun et al., (2013) explore in their research if there is a valid pressure
injury risk assessment screen tool that can be used for ICU patients. The problem is, while the
Braden Risk Assessment Tool is valid, it’s uncertain to what extent it should be used for the ICU
patient. Currently the Braden Risk Assessment tool is widely used in acute care hospitals for a
pressure injury risk prevention assessment tool. The problem was identified using safety and
risk-management concerns, quality concerns, and variation in practice. The setting for this study
involved 3 adult ICUs, 39 beds each, 44 in surgical ICU beds. Braden Risks scores were
determined for all patients via electronic health records. Patients who had a pressure injury were
identified by discharge diagnosis and the data collection was approved by the IRB. A total of
7,790 ICU patients were included, with 57% male and 82% female, a mean age of 57.7 and
average length of stay was 10 days. During data collection, the research found the rate of
pressure injuries decreased due to interventions being placed. In prior studies, there seems to be
inconsistencies among the nurses in measuring the pressure ulcer risk by using the Braden Risk
Assessment scale, however, they all received preventive care. The outcomes for this study are
quantitative due to the ability to collect data from the electronic health records. Possible search
terms: Braden risk, pressure injury, ICU, and validity. Evidence used to gather data by the
8
BRADEN RISK ASSESSMENT
researcher from this study includes: publications, standards, and organizational data. The
researcher concludes that after reviewing four years of Electronic Health Records, the Braden
Risk Assessment scale shows little validity for use for an ICU patient with more specific
pressure injury risk factors. This article relates to the capstone project because it validates the
use of the Braden Risk Assessment Tool and the ability to identify risk factors to satisfy learning
objectives.
Pressure Injury Classification
The author of the research article, Risk Assessment and Prevention of Pressure Ulcers,
Qaseem et al., (2015) explore in their research how effective the use of risk assessment tools are
according to setting and patient characteristics and how different risk assessment tools compare
to each other. In addition, they also study what the effectiveness of relative success of
preventive injury reducing interventions and what are harms of interventions. Pressure injuries
are costly, prevalent in all healthcare facilities and are often times preventable. The current
practice is to implement strategies for pressure injury prevention. The researcher identifies the
problem from a safety and risk-management perspective, quality concerns, variations in practice
and financial concerns. The target population for these guidelines is physicians, nurses,
dietitians, and physical therapists. Data was gathered from multiple search engines throughout
the year. Other studies have suggested that prevention of hospital-acquired pressure injuries is
more effective than only providing standard care. This article shows qualitative results and low-
quality evidence that screening tools were better than clinical judgment. Direct comparisons are
limited and tools can help to identify those that are at increased risk, although sensitivities were
low. The research recommends standardizing care, simplify pressure injury interventions,
9
BRADEN RISK ASSESSMENT
documentation, multidisciplinary leadership and ongoing staff education. Evidence that must be
gathered by the researcher includes publications, standards, guidelines and organizational data.
Key Terms to search for include risk assessment, pressure ulcers, American College of
Physicians. This source compliments the capstone project by supporting the learning objectives:
recommending continued staff education, standardizing preventative care, using a pressure injury
prevention tool, interpreting results, and using an array of interventions for prevention and risk
factors, nutrition involvement,
Braden Risk Assessment Score/ Implementation
The article, Risk Assessment tools for the prevention of pressure ulcers, Moore, Z. E.,
and Cowman, S., (2014) explore if the use of a pressure injury risk assessment tool is helpful in
reducing pressure injuries in the healthcare setting. The research identified two research articles
that describe the effects of risk assessments on patient outcomes. After using high quality
Randomized Control Trials, it was confirmed there was no major difference between either tool,
or use of clinical judgement on it’s own. The research describes the use of the Braden Risk
Assessment tool as well as the financial burdeon of pressure injuries. The search methods for the
data for this study include several search engines. Key words to search for include Braden Risk
Assessment, pressure injuries, and prevention. The research concluded there is no advantage of
using a pressure injury prevention tool alone, but adding the nurses clinical judgement can help
to further prevent pressure injuries. This article helps to relate to the capstone project by
supporting the learning objectives for identifying the purpose of the Braden Risk Assessment
Tool, components involved in the scoring systema as well as the validity of the tool paired with
clinical judgement, and completing a Braden Risk Assessment Score using the tool.
10
BRADEN RISK ASSESSMENT
The research article Bergquist-Beringer, Dong, He, and Dunton (2013), explore how
one is supposed to know which pressure injury prevention program has the best outcomes. The
current practice is to implement an intervention for pressure injury prevention, but some
hospitals implement multifaceted prevention program, which has not been examined. The
problem is identified using variation in practice within the setting, current practice that has not
been validated, financial concerns, quality concerns, safety, and risk-management concerns. The
sample involved 1,419 hospitals across the U.S. and 710,626 patients had been surveyed with
data used was from the first through fourth quarter in 2010. The researcher has shown that best
practices are implemented when a patient is admitted to a facility, which includes implementing
pressure injury prevention strategies: alternative surface for weight distribution, nutrition
referral, Braden Risk assessment tool, routine repositioning, and skin assessments. Besides using
the NDNQI data collection tool, another study that is similar used a CALNOC collection tool
and found that pressure injury rates were 3.6% less equaling 1.8%. This study found that
pressure injuries were already being reduced since the data collection had begun and strategies to
continue reduction should be continued. The results are quantitative. The researcher reveals
there are still 7.9% of patients that acquired a hospital pressure injury, so continued supportive
measures are recommended for improvement. Search terms are pressure ulcer and acute care
hospital. The evidence that is gathered by the researcher includes publications, standards,
organizational data, and guidelines. This article related to the capstone project in a way that the
Braden Risk Assessment Scoring Tool can help determine a pressure injury prevention program
by validating the success of current or change in practice and supporting the learning objectives
for nutrition involvement.
11
BRADEN RISK ASSESSMENT
Continuing Education
The research article Duff, Gardner, and Osborne (2014), explores in their research
what the effectiveness of implementing a Respiratory Skills Update education program as well as
a program on improving nurses’ practice. The problem being addressed by the researcher is the
lack of development of an integrated educational model for continuing education framework that
result in critical thinking in the clinical environment. Currently, the researcher suggests for
changes in education, learning strategies and interactive teaching concepts, but despite there
being so much emphasis on safety and risk management concerns, there are also quality concerns
and variation in practice. The population used is a 400 bed public hospital, all RN’s on 3
surgical floors (25 RN’s total) with all employment types (full time, part time, and causal). They
hypothesized that a supportive clinical learning network, opportunities for practice, reflective
discussion and feedback helps to engage clinicians to think in a self-motivated process. The
researcher discusses previous “studies have examined whether education programs contribute to
nurses’ subsequent use of physical assessment skills” (p. 110). The researcher concludes that
when the nurses are actively engaged in a supportive learning system, it supports a healthier
framework for continuing education. Nurses that were younger, less experienced and better
educated were more likely to take up training opportunities. Important learning connections
were made during the sharing of perspective of the group. Key terms include continuing
education, educational model, and patient safety. The evidence that must be gathered by the
researcher includes standards, guidelines, and organizational data to support this study. The
outcomes will be measured by a pre and post test: comparing skills, seven practice activities, and
participants attitudes to performing respiratory skills and lastly determining short knowledge
12
BRADEN RISK ASSESSMENT
quiz relating to respiratory assessment using multiple choice answered questions. Supporting
nurses with continued education helps this article support the capstone project. Using
technology such as power points with continued education is a necessity to help keep RN’s
engaged and support the technological advances. Using power points with this capstone project
is a way technology can be incorporated into the education.
The author of the research article, Exploring Nurses' Knowledge and Perceived
Barriers to Carry Out Pressure Ulcer Prevention and Treatment, Documentation and Risk
Assessment, Kharabsheh et al. (2014) explores in their research what the nurses level of
knowledge of pressure injury prevention and treatment as well as perceived barriers. The
researcher believes the problem is the attitudes and knowledge of the caregiver (nurse), may be
affecting the care of the patient for pressure injury prevention. Currently, pressure injury
prevention programs consist of risk assessment, pressure injury documentation, training and
education, repositioning, and preventive measures. The researcher states the problem is
identified by unsatisfactory patient and organizational outcomes, safety and risk-management
concerns and quality concerns. The study was conducted in a hospital in Jordan containing more
than 200 beds with medical, surgical and ICU units. Three units were chosen by means of a
random number table from each site, and then all RN’s on the unit were surveyed that had a
Baccalaureate degree and involved in patient care. Pressure injury prevention had to be part of
their daily care and treatment. 45 item questionnaires were provided to each of the nurses to
assess pressure injury knowledge prevention and treatment equaling 216 nurses total. Each were
completed and returned. Other studies comparing to this one is similar except with different
methods, knowledge tests and evaluation criteria. The outcomes for this study are qualitative.
13
BRADEN RISK ASSESSMENT
Pressure injury preventions seem to depend on the knowledge of the nurse caring for that patient.
Possible search terms include pressure ulcers, knowledge, perceived barriers, and Jordan
Nursing. Evidence for this study that must be gathered includes publications, standards, and
organizational data. This study relates to the capstone project by supporting the learning
objectives: to be able to create a care plan based on those at risk, and the need for nurse
education regarding the use of risk assessment tools for optimum patient outcomes.
Educational Process
The author of the research article, Knowledge and Attitudes of Nurses Toward
Pressure Injury Prevention, Barakat-Johnson et al. (2018) explores in their research what the
knowledge and attitudes are for nurses on pressure injury prevention and if there is a relationship
between their attitude, knowledge and years experience. Understanding the knowledge and
understanding of pressure injury prevention is essential in identifying improved processes and
education and if not addressed could explain a large increase in pressure injuries. Current
practice shows there is a discrepancy in nurses being knowledgeable regarding skin integrity and
pressure injury prevention as well as a gap between evidence based practice and the nurses’
knowledge. The problem was identified using safety and risk-management concerns, variation in
practice within setting, and quality concerns. The population surveyed included: nurses in four
hospitals and five community settings in a local health district for a total of over 3,000. With a
total of 749 sufficient returned surveys to use for the data collection. Two valid instruments
were designed to assess attitudes and knowledge toward pressure injury prevention. A survey
was either given out via email or on paper depending on the facility. Their outcomes were
similar to other studies revealing that nurses have good knowledge and display positive attitudes
14
BRADEN RISK ASSESSMENT
towards pressure injury prevention, however the knowledge about pressure injury prevention was
described incorrectly in about 40% of those surveyed. The researcher suggests more research to
evaluate the relationship between attitude, knowledge and pressure injury prevention. They
observe there may be a connection between pressure injury prevention education and the
influence of pressure injury prevention. They also found there to be a significant connection
between knowledge, practice and attitudes. Possible search terms include knowledge, nurse
attitudes, and pressure injuries. The evidence that must be gathered by the researcher includes
publications, standards, and organizational data. The source connects to the capstone project
because it supports the learning objectives to identifying barrier to pressure injury prevention
interventions and how the standards focus on evidence based practice.
The research article Aliakbari et al. (2015), explore if a variety of theories should be
applied to educational activities. The researcher explains that not just one teaching model should
be used for educational purposes. Learning theories are divided into three categories:
behaviorism, cognitive and constructivism, with each being thoroughly explained. The theory of
cognitive focuses on the internal aspect of the learner and is useful for nursing education because
it involves observation, examples or patterns. Using this theory for this capstone project will
help the learner be able to focus their already known knowledge of the Braden Risk Assessment
tool and use their critical thinking skills to implement the necessary interventions.
The research article Cook (2013), explore which pressure ulcer screening assessment
tools works best for pressure injury prevention. Since pressure injuries are such a problem in
healthcare, preventable, and costly, determining risk factors early on can help with prevention,
although it’s more challenging in an ICU setting. Currently, there are several risk factor
15
BRADEN RISK ASSESSMENT
screening tools, but in the ICU setting they appear to be less helpful for pressure injury
prevention. The problem is identified using: safety and risk management concerns, quality
concerns, and unsatisfactory organizational and patient outcomes. The study identified ICU
patients, although they don’t give the population or patient demographics. Previous studies have
take a picture of the current pressure injury on a hospital unit, if the patient shows signs of a
pressure injury then it’s staged. Multiple studies show the incidence of pressure injuries in ICU
range from 10%- 41%. Other studies show implementing pressure injury prevention strategies
help to avoid a pressure injury, but in an ICU setting the risk factors vary more than the average
stable unit level patient. The outcomes are quantitative and the pressure ulcer data can be
collected to determine prevention outcomes as well as the number of interventions needing to be
placed for prevention. More qualitative data will need to be used to determine the patient’s
individual risk factors and what special interventions will be needed for pressure injury
prevention. Possible search terms include moisture, pressure injury prevention, and ICU
patients. Evidence that must be gathered by the researcher for this study includes publications,
standards, and organizational data. The researcher suggests future research to determine device
related pressure injuries and prevention, the effects of different medication and appropriate
pressure injury prevention risk screening tool. The article supports this capstone project because
it supports the use of the Braden Risk Screening Assessment Tool, applying interventions and
the ongoing need to identify those at risk as well as the learning objective for pressure injury
staging and areas at risk for skin breakdown.
Design
16
BRADEN RISK ASSESSMENT
The research article Poon (2013), explore the benefits of providing a blended
educational experience to students by an institutional method. The researcher shows how
educating students via face-to-face and online can be beneficial to enhance their learning. They
predict there is a significant relationship between the students’ experience, blended learning
strategy, and ultimate achievement. This article discussed how blended learning could help
promote student engagement, provide prompt feedback, provide a sense of community, effective
use of resources and increase student satisfaction. The research discusses how there have been
several courses that have used a blended method to deliver the educational information, and
twenty out of thirty reported having improved student outcomes. Blended learning also increases
autonomy and reflection, while embracing technology. They mention the challenges of using a
blended method for educational delivery are limited time for the universities involved, student
frustration from unrealistic expectations, and inability to support advanced technology. The data
was collected by interviews from undergrad aware recipient and a questionnaire for students all
with diverse disciplines. 200 questionnaires were returned and revealed the benefits of a blended
course are the flexibility to meet the needs of those whose learning styles vary. The face-to-face
time included seminars, field trips, laboratory time, and lectures. A flipped classroom is used to
prepare students by viewing the required technology based education before attending class. The
research discusses another benefit to a blended educational approach is beneficial for teachers,
hands-on education, and technology driven learning. The key terms to search for are blended
learning, institutional approach, and student learning experiences. This article supports this
capstone project due to the benefits of face-to-face learning combined with some technology-
based education, which is used for the educational strategies.
17
BRADEN RISK ASSESSMENT
Instructional Strategies / Blooms Taxonomy
The research article Taylor and Hamdy (2015), explore in what ways an adult learner
learns. Adults learn different than children, so the education being taught needs to be relevant
and incorporate their needs. This article explores the main types of learning theories and the way
each theory has developed into one another. The learning theories explored include
instrumental, humanistic, transformative, social, motivational, and reflective. Historically the
researcher discusses that learning derives from experiences, but as behaviorists become involved
in learning theories, they have determined an adult learner can learn by positive reinforcement.
Adult learners need to know why, self-concepts, readiness to learn, orientation to learning and
motivation for a successful learning session. Blooms Taxonomy can further promote learning
outcomes. Many adult learners use a variety of learning modalities to understand their intended
information. Evidenced gathered by the researcher includes publications and guidelines.
Possible search terms include learning theories, andragogy, and Bloom’s Taxonomy. The article
supports this capstone due to using the learning theory cognitive learning theories for the adult
learner to educate about the Braden Risk Assessment tool.
The author of the research article, Effective Lecturing (n.d), discusses how lecturing is
often slide presentations with monologue and can be done in an area with a large seating option.
Some instructors are more active, while others are less and focus more on the contents of the
material only. The concept of backward design should be used to ensure objectives are being met
while clarify any misunderstood information at the end of the session. They suggest using
repetition, make handouts relevant, assess prior knowledge, and break down the concepts. This
correlates to the capstone project because power point and lecture will be used to educate the
18
BRADEN RISK ASSESSMENT
nurses about the use of the Braden Risk Assessment tool, and although it will be a short
presentation, nurse engagement is still a necessity. This was also completed using a backwards
design, which includes the topic of education, meeting desired objectives, and determining how
the education then be relayed to the learner.
The research article Adams (2015), discusses how using the Blooms taxonomy
method for learning objectives promotes a higher cognitive skill level and therefore a deeper
learning and transfer of skills. The key terms for research include Bloom’s Taxonomy for
Learning Objectives, teaching, and cognition. This article discusses how Blooms Taxonomy
contains six categories of cognitive skills, which range from lower order skills to higher skills.
The stages of Blooms Taxonomy include: knowledge, comprehensive, application, analysis,
synthesis, and evaluation. The knowledge refers to the concrete information and process. The
comprehension includes being able to teach back the information being taught in their own
words and applying it to a situation for relevance. The next step is analysis, which refers to the
critical thinking skills. Next comes synthesis, which refers to applying the information to
specific situation and lastly is evaluation, which includes judging the value of the session. This
article supports the capstone project because Blooms Taxonomy is used to support the learning
objectives.
Learning Needs Assessment
A Learning needs assessment can be defined as closing the gap between what is
known and what is unknown. One will be able to more effectively provide education to their
audience when it’s known what the learner knows and what the learner doesn’t know. A
learning needs assessment helps to develop an educational strategy for learning to make them
19
BRADEN RISK ASSESSMENT
effective and for the objective of the course to be met (Grant, 2002). A learning needs
assessment will be given out before the education is initiated to determine the needs of the
nurses.
The author of the research article, The Lecturers Toolkit, Race (2014) discusses the
importance of knowing the needs of your learner so you can best provide their education
successfully. When giving education via lecture, it must be engaging for the learner and
incorporating the use of technology during a lecture can help with student learning. Being able
to provide something visually as well as verbally can help to cover a few ways an individual may
learn. Some students are more hands on, so the more senses that are introduced when
performing the education, the better the learner is likely to retain and use what they’ve been
taught. This can be incorporated into the capstone project by changing the approach to the power
point plan if the learner needs something other than a lecture form of education.
Evaluation According to the business dictionary, and evaluation is defined as a ”rigorous analysis
of completed or ongoing activities that determine or support management accountability,
effectiveness, and efficiency” (Business dictionary, 2018, para 1).
The research article, Designing Quality Multiple Choice Questions (n.d), discusses
how administering a test using multiple-choice questions can effectively assess student learning,
because of their flexibility, relatively easy implementation, and grade that allow the instructor to
use a variety of teaching strategies. The researcher discusses how using multiple-choice
questions can test recall, problem solving, and conceptual awareness. The breakdown of
preparing a multiple choice question and how it ties learning activities and objectives of the
20
BRADEN RISK ASSESSMENT
course is also explained. This data from this type of evaluation can be captured using
quantitative data. This relates to the capstone project because the test questions used before and
after will be multiple choice, so it will test the knowledge of the learners understanding after the
education is given.
The article Case-Based Learning (n.d), discusses how students use their world
knowledge to apply to case scenarios which promotes higher levels of cognition. This has a
strong history of successful implementation in the medical field. The researcher states how
using case- scenarios can help students collaborate learning, integrate learning and help develop
basic and extrinsic motivation to learn as well as encouraging self-reflection and development of
a variety of skills. The researcher discuss a study in which groups ranging consistently from 2 to
15 students, educators varied in the time they used case-based learning ranging from 2 hours to a
year. The instructor plays a passive role and help to keep the students engaged and enhance
thinking. This article supports this capstone project by incorporating the Blooms Taxonomy
scale for objectives and also incorporating case scenarios for learning strategies.
The author of the research article, How to assess students' prior knowledge, Carnegie
Mellon University (2016) discusses how it’s not enough to assess learners’ skills at the end of an
educational session, so administering a pre and post test can help to assess how much knowledge
they have gained throughout the course. There are a variety of options to use when assessing
their prior knowledge, which include portfolios, self-reports, classroom assessment techniques
(CAT’s), concept maps, and concept tests. A concept test can be used to assess current
knowledge or understanding of a course. Typically these tests consist of one to five multiple-
choice questions and are beneficial in large classroom settings where is may be difficult to assess
21
BRADEN RISK ASSESSMENT
the current knowledge of each individual student. The research states the questions must be
direct and distractors provided to reveal common errors. Search terms for this source include
concept tests, educational innovation, and Eberly Center. This article supports the capstone
project due to a pre and posttest being performed to assess to assess growth of the learner.
The research article Pritchard, M. (n.d.), discusses summative evaluation, which is
completed at the end of an educational session. The source discusses how the aim is to
determine if the project achieved the intended objectives, and uses both qualitative and
quantitative data collection. This provides awareness into the unintended consequences and
lessons for improvement. It also allows the educator to make future recommendations for
research and budgeting. Lastly, a summative evaluation allows a deeper understanding of the
process of change to gather knowledge for improvements. This evaluation will be used for this
capstone project to determine if the education the nurses received achieved the objectives that
were set as well as feedback to improve the education as well as the educator.
22
BRADEN RISK ASSESSMENT
Appendix 1- Braden Risk Assessment Tool
Goal
The goal of this capstone project was to develop, implement and educate nurses
regarding the use of the Braden Risk Assessment tool to help prevent pressure injuries and
increase awareness of interventions that can be implemented for prevention.
23
BRADEN RISK ASSESSMENT
Learning Objectives: Table 4
Table 4Capstone Objectives1. Design an educational module
a. Format: face-to faceb. Time-frame: 2 weeksc. Setting: Conference room on an acute hospital unitd. Sample and size: 20 Registered Nurses and/or Licensed Practical Nursese. Learning objectives: At the end of the learning session, the nurse will be able to:
Describe the purpose of the Braden Risk Assessment Tool Interpret the Braden Risk Assessment Scores Discuss what classifies as a stage 1 pressure injury Identify three pressure injury risk factors Justify two interventions for pressure injury prevention Complete the Braden Risk Assessment Describe two areas of skin breakdown concern from each case scenario Create a plan of care for the case scenarios that have a qualifying risk score from the Braden
Risk Assessment Verbalize how a nutrition referral is placed for their organization Identify 2 barriers of successful implementation of interventions
Design: Power point & Lecture and Case Scenario discussion1. Develop a nursing staff model for the delivery of the educational module
a. Obtain necessary approvals:i. Review plan with unit educator/ nurse manager
1. Determine logistics of planning, implantation and evaluation of educational projecta. Identify access to sample subjects: random, simple sampleb. Identify any limitations and restrictions: time frame to reach all staff, room
availability, staff timing during shiftc. Obtain all necessary approvals- verbal consent from participants
ii. Develop and implement a nursing needs assessment (NNA) with participants to:1. Determine sample participant demographics- RN and LPN2. Determine sample participant preferences via LNA3. Determine sample participants learning needs: Provide LNA before pre-test4. Format: Face-to-face5. Conduct pretest at same time as LNA6. Provide information for voluntary verbal consent to participate7. Determine hypotheses (usually 1-3) for associations to test with data received
from evaluation tools: a. Staff will be aware of use of Braden Risk Assessment. b. staff will be able to identify pressure injury risk areas. C. staff will be affected by their barriers as well as lack of understanding of implementing interventions based on Braden Risk Assessment scores.a. Identify plan for post module data analysis
24
BRADEN RISK ASSESSMENT
2. Develop the educational modulea. Complete current ROL and EBP (five years to date)b. Develop format, content and instructional strategies
4. Develop evaluation toolsa. Pretest/Posttest (questions are the same for each test)
i. Question Formatting: multiple choice, fill in the blank and case scenario ii. Purpose of tool: To determine baseline knowledge. The learner has met the objectives
when they receive 80% on post-test (8 out of10 questions)- 1 point per question iii. Plan for data analysis: list quantitative (statistical tests) and qualitative tests planned.b. Course evaluation including instructor evaluation i. Format: 5-point Likert-scale i. Purpose of tool: determine the effectiveness of educational content by meeting
learning objectives, educational strategies, and instructor effectiveness iii. Plan for data analysis: list quantitative (statistical tests) and qualitative tests planned5. Implement educational module.6. Evaluate results of data from evaluation tools: pre/ post test, course evaluation (minimum
tools are NNA, a. Collate and analyze data b. Present data and analysis in tables and figures to include in paper7. Write the review, evaluation, and summary and conclusions of the capstone project paper8. Devise a working plan to accomplish the capstone project and paper (Capstone Plan)
Capstone Plan – Table 5
Table 5Capstone PlanStep Action Item Start Date Completion
DatePlan for Completion of MSN 8400 5/14/2018 7/1/2018
1 Complete approved components of capstone paper ‘to date’ Problem Statement Theoretical Framework ROL Goal and Objectives Capstone Plan
6/14/186/2/20186/14/20186/14/20186/10/20186/17/2018
completeComplete
CompleteCompleteCompleteOngoing
2 Obtain clearance to proceed to Capstone 8500 from faculty member Completion and approval of development of educational
module “to date” Completion and approval of capstone paper to date Completion and approval of outcome measures (nursing
needs assessment, pre and post-test and course evaluation tools)
6/14/2018
5/21/2018
7/1/20185/28/2018
6/14/2018
6/17/2018
7/1/20186/3/2018
25
BRADEN RISK ASSESSMENT
Logistics of the implementation of the project Timeline for implementation, evaluation and final write-up
through MSN 85007/9/20187/9/2018
7/16/20188/19/2018
Plan for implementation of Project 7/16/2018 7/27/2018
3 Request permission from Education Department Send email to 7E SDS to gain approval for educational
module Approval obtained
7/9/2018
7/9/2018
7/9/2018
7/9/20184 Request approval from 7E Nursing Manager with face to face meeting
Email tentative dates to 7E manager Email 7E manager tentative dates in July for staff able to
attend and reservation of conference room Meeting date scheduled Approval received
6/27/2018
OngoingOngoing
OngoingOngoing
6/27/2018
OngoingOngoing
OngoingOngoing
5 Write a Needs Assessment Determine sample size: goal = 20 Voluntary Basis, Random Sample Contact participants/tentative date of module Write pretest/posttest and course evaluation Obtain faculty approval
Pretestposttestcourse evaluation
Send pretest to staff via face to face Receive completed pretests from all subjects
6/10/21086/10/20186/15/20187/16/20186/18/2018 7/9/20186/18/20186/18/20187/16/20187/16/20187/16/2018
6/17/20186/17/20186/17/20187/27/2018complete7/9/2018completecomplete7/27/20187/27/20187/27/2018
6 Receive and collate responses from Needs Assessment and pretest 7/27/10 8/6/2018
7 Date and Setting for Education Module Confirm date for reservation of setting Confirm exact number of staff (20 over 2 weeks)
7/16/20186/16/20187/16/2018
7/16/20186/16/20187/27/2018
8 Obtain current content for educational module Ongoing Ongoing9 Begin developing education module
Complete PPT on module ‘to date’Receive and utilize peer feedbackReceive and utilize faculty feedback
6/18/2018 6/24/2018
10 Finalize design of education module components Obtain faculty approval
7/8/2018 7/12/2018
Plan for Completion of MSN 8500
11 Collate data from pilot educational module Pretest and Posttest Course evaluation (including instructor evaluation) Display result and data in tables and figures
7/16/20187/16/20187/16/2018Ongoing
7/27/20187/27/20187/27/2018Ongoing
26
BRADEN RISK ASSESSMENT
12 Complete Capstone Paper Complete review of capstone section Complete evaluation of capstone section Complete summary and conclusion section Complete abstract section
Identify keywords
Ongoing Ongoing
13 Final Review of Capstone Project Obtain Faculty Approval Final Submission Signed Library Release
Ongoing Ongoing
14 Prepare Poster Presentation Ongoing Ongoing15 Complete Graduate Reflections Paper Ongoing Ongoing17 Poster Presentation Ongoing Ongoing
Appendix A
Learning Needs Assessment Tool- Table 6 Table 6Learning Needs Assessment Tool
1. My highest degree of education5 - Phd 4- MSN 3-BSN 2-ADN 1-
Diploma/ LPN2. Years practicing nursing5=30-40 4=29-20 3=19-10 2=9-1 1= <13. My interest in pressure injury prevention5-very interested 4-moderatelyinterested 3-somewhat interested - 2- less than
somewhat interested 1- no interest4. I learn best by5- Hands-on 4- reading material 3-discussion 2- lecture 1- all of the above5. I feel as if I have the necessary resources to adequately complete pressure injury preventions
5 - always 4- usually 3-sometimes 2- rarely 1- never6. Please include any other comments
27
BRADEN RISK ASSESSMENT
Appendix BLearning Needs Assessment: Data Set and Analysis – Table 7
Table-7Learning Needs Assessment Questions: Scores Pre and Post Education (n=#) Participant
Ratings: Pre Education
High (5)
Moderately high
(4)
moderate(3)
Moderately low
(2)
Low(1)
x̅
(# (%)
(#) (%) (# (%)
(#) (%) (#) (%)
R) (%)
1. My highest degree of education
2. My years practicing nursing
3. My interest in pressure injury prevention
4. I learn best by:5. I feel as if I have
the necessary resources to adequately complete pressure injury preventions
Σ x̅6. CommentsParticipant
Ratings: Post Ed.
(5) (4) (3) (2) (1) x̅
(# (%)
(#) (%) (# (%)
(#) (%) (#) (%) (R)
(%)
1. Current education level
2. Years practicing3. Current interest4. Learn best by5. Feel as if
resources are available
Σ x̅
Learning Needs Assessment Questions: Change in Scores Pre and Post EducationParticipant Questions Pre Education Post Education ∆
x̅ (%) x̅ (%) x̅ (%)
30
BRADEN RISK ASSESSMENT
Current education levelYears practicingCurrent interestLearn bestResources are availableOverall Σ x̅ (%)Legendx̅ = meanR= rating scale mean # = number frequency%= percent of total∆ = change
Appendix C Course 8500Pre and Post Test with Answer Key
Table 8Pre and Post Test Tool# Question LO1. What is the purpose of the Braden Risk Assessment Tool? 1a To help prevent skin breakdown (correct)b To help with assessment of skinc To help with mobility assessmentd To help with prediction of hydration status
2. A score of less than _?_means the patient is at risk for a pressure injury 2a <20b <18 (correct)c <15d <12
3. What characteristic classifies a sage 1 pressure injury? 3a. Broken skin over a bony prominenceb. Red, blanchable skin over a bony prominencec.. Purple area over sacral regiond. Non-blanchable redness, over intact skin over a bony prominence (correct).4. What are 3 pressure injury risk factors? 4a. Bowel and bladder incontinence (correct)b. Immobility (correct)c. finishing most meals that consist of French fries, soda and candyd. Neuropathy (correct)
5. What are 2 options for pressure injury interventions? 5a. Turning q2 hours (correct)b Incontinence care with turns and as needed (correct)c Assessing social issues for help
2
BRADEN RISK ASSESSMENT
d. Providing Nail Caree. Constipation relief
6. Based on the Case Scenario: what is the score of the Braden Risk Assessment? (use braden risk tool attached)
54 y.o. female admitted for back surgery. Since surgery, she’s had decreased sensation and movement to her LLE. She’s unable to walk and insists on keeping her foley catheter in due to fear of loss of bladder function and is continent of bowel. She eats 50% of her meals most of the time.
6
a. 8-9b. 11-12c. 13-15 (correct)d. 18-20
7. Based on the above case scenario, choose 2 areas at risk for a pressure injury?30 y.o male diagnosed with new paraplegia from a car accident. He’s unable to move his legs, has no sensation from nipple line down and is therefore incontinent of bladder and bowel. He’s been eating 50% of his meals due to some depression from his new diagnosis.
7
a. Sacrum (correct)b. Back of headc. Elbowsd. Between knees (correct)e. Left heel onlyf. Both heels (correct)
8. Choose 3 components to create a skin care plan based on the above patient scenario. 8a. Consult nutrition (correct)b. OOB in chair all day for activitiesc. Turn q2 hours (correct)d. Elevate only one heel at a timef. Allow patient to shift weight as he desires
9. What is the wording used to place a nutrition referral ? 9a. Consult nutritionb. Nurse referralc. Nutrition consult
10 What are 2 barriers that may prevent you from successfully implementing necessary interventions to prevent pressure injuries?
10
a. Lack of timeb. Patient acuityc. Lack of equipmentd. Don’t care much about pressure injury preventione. Patient refusal
3
BRADEN RISK ASSESSMENT
f. Unsure of how to perform adequate turns
Appendix D Course 8500Pre and Post Test Data Set and Analysis
4
BRADEN RISK ASSESSMENT
5
Table 9Pre Test Data Set and Analysis (n= ?)Q LO 1 2 3 4 5 6 7 8 9 10 x̅
n # % # % # % # % # % # % # % # % # % # %1234567891011121314151617181920
% % % % % % % % % % %Σ x
Post Test Data Set and Analysis (n= ?)12345678 9
101314151617181920
% % % % % % % % % % %Σ x̅
Legendn= sample sizex̅ = sample meanΣ x̅ = total mean∆ = changeQ= question #LO= learning objective #
BRADEN RISK ASSESSMENT
Appendix E Course 8500Pre and Post Test Data Set: Analysis of Change from Pre to Post Test Scores
Table 10Change in Pre to Post Test Scores (n=?)
Q LO Pre Test x̅ (%) Post Test x̅ (%) ∆ x̅ (%)1 12 23 34 45 56 67 78 89 9
10 10Σ x̅
Legendn=sample sizex̅ = sample meanΣ x̅ = total mean∆ = changeQ= question #LO= learning objective #
Appendix FCourse and Instructor Evaluation Tool: Data Set and Analysis
Table 11Instructor and Course Evaluation Tool: Data Set and Analysis (n=?)Rating Scale 5 4 3 2 1
Course Content andLearning Objectives Questions
StronglyAgree
Agree
Neutral Disagree StronglyDisagree
x̅
Q # % # % # % # % # % R %1. Overall, the educational module was excellent2. The educational module was well organized3. The Learning objectives were identified at the beginning of the moduleCourse Evaluation Σ x̅4. Overall, the education met the stated Learning Objectives4.1. I can describe the purpose of the Braden Risk Assessment Tool4.2. I can interpret the Braden Risk
6
BRADEN RISK ASSESSMENT
Assessment Scores4.3. I can discuss what classifies as a stage 1 pressure injury4.4. I can identify three pressure injury risk factors4.5. I can justify two interventions for pressure injury prevention4.6 I can complete the Braden Risk Assessment4.7 I can describe two areas of concern from the case scenario4.8. I can create a plan of care for the case scenarios that have a qualifying risk score from the Braden Risk Assessment4.9. I can verbalize how a nutrition referral is placed for my organization4.10. I can identify 2 barriers to successful implantation of interventionsLO Evaluation Σ x̅
LNA Questions1) My highest degree of education2) Years practicing nursing3) My interest in pressure injury
prevention4) I learn best5) I feel as if I have the necessary
resources to adequately complete pressure injury preventions
6. My knowledge in pressure injury prevention area has increased.7. My interest in pressure injury prevention has increased.8. My application of knowledge in pressure injury prevention will increase.9. My increased knowledge in pressure injury prevention will improve my current practice.LNA Evaluation Σ x̅
Instructor Evaluation10. Overall, the instructor was excellent11. The instructor used instructional methods effectively to promote learning12. The instructor was knowledgeable in the pressure Injury prevention via use of the Braden Risk Assessment Tool
7
BRADEN RISK ASSESSMENT
12. The instructor provided an opportunity for questions and answersInstructor Evaluation Σ x̅
Participant Comments13. What recommendations or modifications do you have to improve the educational module?14. Please share any other comments.Legend n= sample size x̅ = mean R= rating scale mean # = absolute frequency %= relative frequency
References
Adams, N. E. (2015). Bloom’s taxonomy of cognitive learning objectives. Journal of the
Medical Library Association : JMLA, 103(3), 152-153. doi:10.3163/1536-
5050.103.3.010.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511057/
Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in
nursing education. Journal of Education and Health Promotion, 4(2). doi:10.4103/2277-
9531.151867 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355834/
Barakat-Johnson, M., Barnett, C., Wand, T., & White, K. (2018). Knowledge and Attitudes of
Nurses Toward Pressure Injury Prevention. Journal of Wound, Ostomy and Continence
Nursing, 45(3), 233-237. doi:10.1097/won.0000000000000430
https://vnet.christianacare.org/sp-3.30.0b/,DanaInfo=ovidsp.tx.ovid.com+ovidweb.cgi?
&S=LPFFFPECPADDONHHNCEKLEGCNLOOAA00&is_ajax_call=1&Open+Link=S
.sh.22.43%7c0%7c
8
BRADEN RISK ASSESSMENT
Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013). Pressure Ulcers and Prevention
Among Acute Care Hospitals in the United States. The Joint Commission Journal on
Quality and Patient Safety, 39(9), 404-414. doi:10.1016/s1553-7250(13)39054-0
https://www.jointcommissionjournal.com/article/S1553-7250(13)39054-0/abstract
Carnegie Mellon University. (n.d.). How to assess students' prior knowledge - Eberly Center -
Carnegie Mellon University. Retrieved from
https://www.cmu.edu/teaching/assessment/priorknowledge/
Case-Based Learning | Center for Teaching and Learning. (n.d.). Retrieved from
https://ctl.yale.edu/faculty-resources/strategies-teaching/case-based-learning
Cooper, K.L. (2013). Evidence- Based Prevention Ulcers in the Intensive Care Unit. Critical
Care Nurse, 33(6), 57-66. doi:10.4037/ccn2013985
https://vnet.christianacare.org/sp-3.30.0b/,DanaInfo=ovidsp.tx.ovid.com+ovidweb.cgi?
&S=JHPJFPJEEKDDONKHNCEKMEOBFGHCAA00&Link+Set=S.sh.49%7c2%7csl_
10
Designing Quality Multiple Choice Questions | Center for Teaching and Learning. (n.d.).
Retrieved from https://ctl.yale.edu/MultipleChoiceQuestions
Dorothea Orem's Self-Care Theory. (2012). Retrieved from
http://www.currentnursing.com/nursing_theory/self_care_deficit_theory.html
Duff, B., Gardner, G., & Osborne, S. (2014). An integrated educational model for continuing
nurse education. Nurse Education Today, 34(1), 104-111. doi:10.1016/j.nedt.2012.11.022
https://www.researchgate.net/profile/Beverley_Duff/publication/233983537_An_integrat
9
BRADEN RISK ASSESSMENT
ed_educational_model_for_continuing_nurse_education/links/
59e1a5f0a6fdcc7154d7d1de/An-integrated-educational-model-for-continuing-nurse-
education.pdf
Effective Lecturing | Center for Teaching and Learning. (n.d.). Retrieved from
https://ctl.yale.edu/EffectiveLearning
Grant, J. (2002). Learning needs assessment: Assessing the need. Bmj, 324(7330), 156-159.
doi:10.1136/bmj.324.7330.156 https://www.bmj.com/content/324/7330/156
How to write a literature Review. (n.d.). Retrieved from
https://library.concordia.ca/help/writing/literature-review.php?guid=purpose
How has this term impacted your life? (2018). Retrieved from
http://www.businessdictionary.com/definition/evaluation.html
Hyun, S., Vermillion, B., Newton, C., Fall, M., Li, X., Kaewprag, P., . . . Lenz, E. R. (2013).
Predictive Validity of the Braden Scale for Patients in Intensive Care Units. American
Journal of Critical Care, 22(6), 514-520. doi:10.4037/ajcc2013991
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042540/
Jacobs, G., Witteloostuijn, A. V., & Christe‐Zeyse, J. (2013). A theoretical framework of
organizational change. Journal of Organizational Change Management, 26(5), 772-792.
doi:10.1108/jocm-09-2012-0137
https://www.emeraldinsight.com/doi/abs/10.1108/JOCM-09-2012-0137
Kharabsheh, M., Alrimawi, R., Assaf, R., & Saleh, M. (2014). Exploring Nurses' Knowledge and
Perceived Barriers to Carry Out Pessure Ulcer Prevention and Treatment, Documentation
10
BRADEN RISK ASSESSMENT
and Risk Assessment. American International Journal of Contemporary Research, 4(4),
112-119. http://www.aijcrnet.com/journals/Vol_4_No_4_April_2014/15.pdf
Moore, Z. E., & Cowman, S. (2014). Risk assessment tools for the prevention of pressure ulcers.
Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd006471.pub3
http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006471.pub3/full
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk Assessment and Prevention
of Pressure Ulcers: A Clinical Practice Guideline From the American College of
Physicians. Annals of Internal Medicine, 162(5), 359. doi:10.7326/m14-1567
http://annals.org/aim/fullarticle/2173505
Poon, J. (2013). Blended learning: An instit utional approach for enhancing students' learning
experiences ,. Journal of Online Learning and Teaching, 9(2), 217-288.
http://dro.deakin.edu.au/eserv/DU:30057995/poon-blendedlearning-2013.pdf
Pritchard, M. (n.d.). Summative Evaluation. Retrieved from
http://www.evaluationtoolbox.net.au/index.php?option=com_content&id=40
Race, P. (2014). The Lecturers Toolkit. doi:10.4324/9781315767277
https://books.google.com/books?
hl=en&lr=&id=d1CcBQAAQBAJ&oi=fnd&pg=PP1&dq=learning+needs+assessment&o
ts=eCdxctzulQ&sig=_ojgZ1dFuSVy2u_gvVahmRsWXbk#v=onepage&q=learning
%20needs%20assessment&f=false
Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and
teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11).
11
BRADEN RISK ASSESSMENT
doi:10.3109/0142159x.2013.828153
https://www.tandfonline.com/doi/full/10.3109/0142159X.2013.828153
12
top related