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)