Fellow Name: Dian Colette Davitt PhD, RN
Associate Professor
Department of Nursing
Course ID and Name:
1. NURS 3020 Holistic Health Assessment
2. NURS 4230 Introduction To Nursing Research
Term in which courses will be taught: Fall 2005
Fellowship Dates: September 2004 to August 2005
Project Abstract:
A. Holistic Health Assessment (4 credits) is the second required course in
the nursing program. The content included in this 8 week course is at times
overwhelming to the students. In addition to the body systems covered through
traditional teaching methods, the students must develop skills of physical examination,
practice them on one another and then perform a physical examination on a client
in the community.
B. Introduction to Nursing Research (3credits) is a required 8 week nursing
course. For students, this is one of their most challenging courses. Our goal
with the nurses is that they become consumers of research by acquiring the skills
necessary to critique nursing research studies and to utilize their findings
in practice
Issues:
A. One of the most important and challenging skills for an instructor is to teach physical examination. Conventional methods such as lecture, demonstration and laboratory provide the student with an introduction, but do not allow the student to review a confusing area or fully understand the purpose of each part of the examination Our nurses must utilize these skills daily in their practice. Using a sick hospitalized client (as an example) to develop auscultation skills raises ethical issues, while using healthy fellow students (as is now done) provides only a narrow range of assessments. The problems encountered are lack of time, lack of space and lack of access to a comprehensive multimedia learning package. The importance of accurate health assessment is well recognized as a key strategy in maximizing the value of every health care dollar. This project will offer a practical solution for BSN completion students to access real situations in an authentic, purposeful and low stress learning environment. A multimedia package has the potential to develop both confidence and health assessment skills of a higher degree than now possible in the present setting.
B. The process of incorporating good quality nursing research findings into nursing practice is not straight forward. A review of the literature supports the findings that nurses do not incorporate new research into their practice. The literature states that the explanation for this is that nurses have difficulty in accessing and appraising published research, either because they do not have access to journals and libraries or because they have not been taught how to find and appraise research. The problem for the students is they see no value in the process. The research process is foreign to them. It is my experience that they are well into the 6th week of class before the light goes on. How can I make them see that the connection between education and clinical practice is research? This course needs to become stimulating for them rather than drudgery. I think that by focusing on real clinical situations where research findings enhance students practice, they will see the value and become excited by the process. Research has shown that when clinical nurses have been taught how to identify and appraise research critically they have responded with enthusiasm. Electronic resources will provide for the most current and up to date findings and make research relevant to the student. This can only be accomplished with technology. There is a need to develop and evaluate the use of information and communication technologies to support research training.
Planned Intervention:
A. I hope to develop an interactive clinical simulations/ multimedia learning
package with the help of the new technology available at Emerson Library. This
would allow students to practice and hone their skills in a way that classroom
practice does not now allow. A CD-ROM with step by step instructions on physical
examination would allow the student to practice and review physical examination
skills with feedback. I would like to create a CD ROM that covers the purpose,
techniques, normal findings and abnormal findings of physical examination. A
student would be shown a schematic of the human body with the various systems
highlighted. The student could direct learning by either clicking on part of
the diagram, or clicking on the name of the system from a list on the side of
the screen.
B. My teaching strategy will be to identify a topic for systematic review based
on the student’s area of practice (for instance, treatment intervention).
One topic will be identified for a group of 3-5 students. Students will focus
on the outcomes of the treatment intervention. Since an intervention frequently
has more than one outcome, each student will be assigned a different outcome
to avoid overlap and becoming overwhelmed. This also sets the stage for identifying
the key words for the search. The Emerson library, the librarians and internet
technology will be invaluable. A standardized table will be developed to enable
the students to summarize the studies they have identified. Providing a table
for the students ensures that they identify essential elements of the studies
in a consistent format. After the research is summarized, the studies will be
evaluated using strength of evidence and risk/benefit criteria. The evidence
will be evaluated using rating criteria developed by the Agency for Health Care
Policy and Research of the U.S. Department of health and Human Services. The
evaluation will be conducted in conferences with the librarian, students and
faculty. Feasibility for the use (of the intervention) addresses the risk/benefit
ratio and will be based on the clear understanding of the study. Students will
record the risk/benefits using a plus/minus system and record these in the table
with the research findings. Conducting a systematic review provides a framework
for the analysis of research and as the basis for clinical judgments. This strategy
will allow student to meet the objectives of the course.
Benefits / Evaluation:
A. The effectiveness of this will be evaluated through student testing and
feedback. I teach the course in Kansas City as well as in Webster Groves. By
using the format on only one campus, I will be able to compare the student outcomes.
I am sure that the class utilizing the CD ROM will demonstrate more proficiency
and comfort with physical examination than the class taught only with traditional
teaching methods. Because this is a major undertaking, I will approach this
system by system.
B. I am sure that this approach to Introduction to Nursing Research will have
positive results both from the acquisition of new library search skills and
from the applicability to practice. Evaluation will be accomplished by comparison
of student satisfaction between the St. Louis and Kansas City campus. The St.
Louis campus has the Emerson Library as well as librarians and technological
resources. The Kansas City campus lacks many of these assets. I have the opportunity
to teach for 16 weeks a year on each campus and will be able to evaluate student
outcomes based on the approach used. St. Louis will approach course under the
new pedagogy, while Kansas City will continue with the current format.