Simulation Module for Patients with Hypoglycemia

Simulation Module for Patients with Hypoglycemia Development and Evaluation of Simulation Module for Patients with Hypoglycemia INTRODUCTION Background Human patient simulator (HPS) has been used in medical education (Alinier, Hunt, Gordon, Harwood, 2006) for almost four decades. Since simulation using high-fidelity has begun by applying crisis intervention training on nurse anesthetist   (Fletcher, 1995), over the past 10 years, simulation has been rapidly expanded in nursing education (Dunn, 2004). Simulation education is not just about obtaining simple knowledge and techniques but rather have been considered as a kind of new education method that can train nursing care ability by reproducing real-like clinical situation in a safe environment (Hodge, Martin, Tavernier, Perea-Ryan, Alcala-Van Houten, 2008; Steadman et al, 2006). Moreover, simulation education have been accelerated by shortening of the patient’s admission period and limited chances of nursing student’s participation due to elevated expectations on the medical staff by the patients. Through simulation education, student carry out physical examination directly on simulator and immediately identify physiological changes on the monitor. After implementing the proper intervention, they can get feedbacks from results (Bremner,Aduddell,Bennett, VanGeest, 2006). Therefore education using simulation is becoming the most important subject in current nursing education as a method that can improve problem solving ability and critical thinking of students in clinical situation (Corbridge, McLaughlin, Tiffen, Wade, Templin, Corbridge, 2008; Feingold, Calaluce, Kallen, 2004). Since a simulation practice method has been introduced to the nursing practice educating in South Korea ten years ago, many study results on the effect of simulation education have been reported in the area of pediatric nursing (Yoo, 2013; Shin, Shim, Lee, 2013), maternity nursing practicum (Kim, Ko, Lee, 2012; Kim, Lee, Chae, 2012; Lee Kim, 2011), psychiatric nursing (Choi, 2012), and critical and emergency care unit (Kim, Choi, Kang, 2011; Kim Jang, 2011). Current scenario that can be used in simulation education is not still developed variously in sub-major nursing areas in Korea. Therefore case is not appropriate to situation so there is a difficulty of having simulation practice. Especially, diabetes mellitus is prevalent disease in middle ages. However, it can be controlled by both concrete assessment for differentiation and anticipatory management. And because patients with diabetes mellitus should always manage blood glucose in their life, nursing education to prevent h ypoglycemia is essential education contents. In nursing student education, simulation practice for critical thinking training to identify symptoms and plan nursing care as priority due to hypoglycemia is effective and important nursing problem. In this study, we tried to test the applicability of the simulation by developing simulating education scenario based on the case of hypoglycemia and evaluating student’s performance after using it. The study was done to improve nursing students’ critical thinking on nursing problems and clinical decision-making ability by developing scenario with high-fidelity SimMan simulator based on clinical real situation. The purpose of this study is to develop a scenario and evaluate students’ performance and satisfaction in simulation learning of care for patients with hypoglycemia. METHOD Design This study used a mixed method design which captured both quantitative and qualitative data to evaluate degree of performance and satisfaction as development and applying simulation module with hypoglycemia. In disciplines such as nursing, the phenomena studied are often complex and mixed-method approaches can expand the impact and enhance the flexibility of research designs (Sandelowski, 2000) Participants A convenience sample of 55 nursing students participated from a university located in Seoul, South Korea. We have decided that third year nursing students who have enough basic knowledge on pathophysiology will not have difficulty in applying simulation education on patient with hypoglycemia and developed simulation scenario targeting them. The inclusion criteria to attain hypoglycemia included (a) junior nursing students, (b) completion of fundamental and endocrine system nursing course with the same credits and textbook, and (c) no prior participation in a simulation class focused on diabetes mellitus. The participants ‘ ages ranged from 21 to 25 years. The majority of students 89% were women. Ethical considerations’ Approval to conduct this study was obtained from the Sahmyook university institutional review board (SYUIRB-2013-074). Written informed consent consist of issues of voluntary participation, anonymity, and confidentiality. It explained the purpose of study, the researchers’ credentials, and information regarding confidentiality. Collected data will be managed in the researcher’ office and will be shredded after coding. The IRB proved that there were no factors to this study that would deprive human ethical right, and that all contents and processes confirm to proper research ethics. Process of module development Scenario development Contents of scenario were developed based on real patient’s situation which admitted to emergency unit with shock symptom due to hypoglycemia. In addition, we searched more information on nursing care for hypoglycemia from nursing textbook and protocol. Scenario was focused on developing of student’s ability about assessment and problem identification by critical thinking. For this, the purpose of scenario formulation was to differentiate the origin of shock symptom between hypoglycemia and increasing of intracranial pressure. For testing of validity, five experts consisted of three nursing professors, two nurses who have worked in emergency unit over 10 years reviewed contents of scenario. The scenario was pilot tested using five students (not included in the present study) to determine feasibility and clarity of instructions. No problems were identified. Development of evaluation checklist The evaluation checklist focused on the attainment of critical thinking ability rather than implementation skill and was divided into three categories: assessment, problem identification, and interventions. Finally, 4 items were deleted and 16 items reached by consensus (Table 1). The items were selected, reviewed, and analyzed by a seven expert panel including two nursing professors, five advanced practice nurses. Process of debriefing Debriefing questions were also developed focused on critical thinking as three phase process. Description phase : ‘What decision did you make when patient complains dyspnea? Why did you do?’; Analysis phase : ‘Did you have an enough understanding about nursing care for patient with hypoglycemia after this simulation practice?’; and Application phase: ‘How can you cope real nursing situation in future through what you learned?. These three phases for debriefing are based on clinical judgment model by Tanner (2006). After taking simulation practice, students had debriefing time for about 20~30 minutes per group of four students. The nursing students were encouraged to reflect on their critical thinking. Data collection procedure Data were collected from May6, 2013 to June 28, 2013. The study’s purpose and its procedures were explained to the participants prior to obtaining informed consent. All participants enrolled in this study voluntarily and anonymously, were made aware that there was no disadvantage to nonparticipation as well as information regarding confidentiality. In addition, the data would be reported as a whole and not individually. The ratio of participation was 98%. Before the simulation, students received an orientation that included how to operate the simulator, simulation learning objective, the scenario information, and patient’s health status. Four nursing students have teamed up to have a discussion of the simulation scenario. Students were asked to wear uniforms and to treat these as actual professional situations. The simulations were scheduled in simulation rooms in which the high-fidelity patient simulators were used. One operator and one instructor observed the simulations from the control room. Each simulation lasted 20 minutes, with the simulation module including debriefing taking about two hours per group. The evaluation checklist was evaluated as a group and was handed to two instructors in a sealed envelope. After simulation module, student satisfaction was measured using the Satisfaction of Simulations Experience (SSE). Instruments The evaluation checklist tool using 3-point Likert scale (1: not fulfill, 2: partially fulfill, 3: fulfill) was a researcher-developed tool designed to assess simulation-based performance. The higher the evaluation checklist score, the better the performance. Content validity was conducted from nurse educators, simulation experts, and clinicians (n=10). The results of the content validity index were above 80% (Waltz and Bausell, 1981). Inter-rater reliability between two independent raters was established using Cohen’s kappa. Satisfaction which students felt about simulation practice was measured just after finishing the debriefing session using the Satisfaction of Simulations Experience (SSE) scale developed by Levett-Jones and colleagues (2011). This scale consists of 18 items in the area of debrief and reflection (9 items), clinical reasoning (5 items), and clinical learning (4 items). Each item was scored on a 5-point Likert scale. Higher scores indicated higher satisfaction. Cronbach’s alpha coefficient in this study was .94. Data analysis The evaluation checklist and the SSE were analyzed using SPSS 18.0 for Windows to calculate descriptive statistics including means and standard deviations. Debriefing data were analyzed using the Matrix Method (Garrad, 2007). Four researchers was analyzed all papers related to debriefing. It were photocopied and organized as a review matrix that, once labeled appropriately, would serve as a structured abstract of all of the documents. The 3C’s (i.e., codes, categories, and concepts) of analysis was used to capture key characteristics of interest, thereby summarizing a large amount of textual information into meaningful themes (Lichtman, 2006). RESULT Scenario of simulation-based hypoglycemia The patient’s case was developed based on scenario objectives and performance measures. The simulated patient was a 55-year-old man admitted via the emergency unit complaining of dizziness and sweating. The algorithm proceeded as follows: assessment, problem identification, intervention (Fig. 1). Evaluation Checklist The evaluation checklist consisted of three categories and 16 items. To identify a statistical measure of inter-rater agreement for items, Cohen’s kappa was measured. Cohen’s kappa for the evaluation checklist was 0.61, good strength of agreement, and each category ranged from 0.33 to 0.97. The mean score of each category and item is shown in Table 1. The mean score is average of numbers of two measurers. The total mean score was 2.68 ( ±.129). The mean score of assessment was 2.56 ( ±.199), problem identification was 2.91 ( ±.193), and intervention was 2.71 ( ±.192). Debriefing Student comments about the simulation experience were grouped 2 categories, 9 subcategories, and 303 significant statements using content analysis (Table 2). The categories were as followed: Self-reflection and Improvement of competency. The most frequent subcategories, in order, were nursing intervention, coping ability deficiency, perception of real situation, clinical thinking deficiency, knowledge deficiency and communication. Satisfaction with simulation experience The SSE scale was used to assess participation in the simulation experience. The total mean score of SSE was 4.15 ( ±.68). The mean score for debrief and reflection was 4.21 ( ±.58), clinical reasoning was 4.09 ( ±.50), and clinical learning was 4.08 ( ±.46). The highest score item in SSE was â€Å"I received feedback during the debriefing that helped me to learn†, and the lowest was â€Å"The facilitator made me feel comfortable and at ease during the debriefing† (Table 3).

Tanglewood Case 3

Tanglewood Case #3 Nelson Ivan Castro PID# 3774408 1. Recruitment Guide Position: Sales Associate Reports to: Store Manager Qualifications: High School Diploma. Good communication and writing skills. Leadership and analytical skills. Ability to learn and apply a variety of policies and procedures. Work effectively as a part of a team. Relevant Labor Market: Regional Northeast Timeline: There are continuous hiring activities to interview future candidates for the positions. Activities to undertake to source well-qualified candidates: * Employee referrals Posting job on company site * Radio and newspaper advertising * KIOSKS * Job services * Staffing Agency Staff Members involved: * Store Manager * Store Assistant Manager * Department Manager Budget: $2000- $3500 2. We understand that recruitment is one of the most difficult aspects for an organization, who is looking for potential employees. There are different types of recruitment, but I believe that Tanglewood should use an Open Rec ruitment process. This step will allow them to have a variety of applicants from different races, cultures and ages.Also, it will allow them to recruit employees with different strengths and weaknesses, helping them to create a team work that is supported by all of its members. On the other hand, Tanglewood can use targeted recruitment for high management positions that might require specific KSAOs, so the job can be developed. * Media: Tanglewood is media advertising, such as print, radio, and television advertising sources, coupled with respondents filling out a standardized job application. This is an open method of recruitment since it gives the opportunity to a large body of people to apply for the job. Referrals: it is a targeted method since allow employees from Tanglewood to promote and show the positions available to people who might meet the job requirements. * Kiosk: Is an open method since a large variety of people to apply for any position at the store, instead of writi ng on a piece of paper their personal information, they type it into the system. * State Job Services: It can be an open method since all unemployed people can look for any positions available. However, it can be targeted since some positions will require some specific qualifications for certain positions available. Staffing Agency: It can be both targeted an open since they can look for special people with specific qualifications, and people with basic skills for any regular job. 3. Western Washington branches find that referrals possess a higher qualification and retention rate than kiosks, media and job service; it also provides the highest percent of applicants hired. Furthermore, Job service is very practical for this side of the company, even though the percentages and the number of applicants hired are less; it provides the same satisfaction as referrals.On the Eastern Washington branches, referrals also play an important role in the recruitment process, even though Kiosks an d media both provide a high number of applicants, the hiring and retention rate for referrals is way much higher allowing this to be an important tool for this branch to find future employees. On the other hand, for Northern Oregon branches find that by using staffing agencies a better way to find their employees since it provides them with a higher qualification, short and longer retention.The Kiosks and media provide certain type of percentage and even though they are cheaper, they are not as effective as hiring an agency. Finally, In Southern Oregon Kiosks provide the bigger pool of applicants, but it holds a low retention and qualification rate. In this branches they also prefer to use staffing agencies since it provides a better short and long time retention and qualification for the job; however, staffing agencies represent a higher costs, since it is more expensive than referrals and kiosks. . The Northern Oregon suggests an idea of using Kiosks and staffing agencies for hiri ng employees for all the stores, they believe this is the most accurate way that Tanglewood should use and implement to recruit new workforce; these methods have not only been successful Northern Oregon, but for South Oregon region too. However, The Eastern and Western regions have used a different approach, they have used the employee referral tool to recruit new employees, and it has been successful until the moment.I believe this region does not have a valid point, because if they decide to generalize the hiring and recruitment process into general ways as Kiosks and staffing companies, these other branches might start using and hiring people who does not have clearly understand what the needs, tasks, basic requirements and knowledge for the job are. Also, by implementing these new policies these branches might not receive the same quantity of people trying to enter the organization, and quality from the employees, affecting the working environment and results of these stores. . Tanglewood wants to keep improving their customer service quality to better assist the costumers; they should focus on obtaining sufficient quality from the variety of people who would like to work at Tanglewood, allowing employees to see this company and this position as a long term commitment. If we pay attention what Tanglewood is scared the most is the retention rates of positions from their employees, since employees do not believe and feel any kind of closure between them and the job.Furthermore, Tanglewood has noticed before that many employees hired without any kind of retail experience do not recognize the importance of having good customer service skills, and training is not enough to solve this issue. Tanglewood should look for people with certain skills for specific positions, they should look for quality employees who have at least a minimum of knowledge, and with the help of training reinforce their knowledge and teach them how to apply this on their job. 6. A realisti c recruitment message is a basic way of communication that states the name of the company and the job as it is.The purpose of this type of communication is that companies try to sell the job to applicants with only the positive things about the job, like good salary and benefits. Job attributes in an RJP for an associate: POSITIVE JOB ATTRIBUTES * Dental, Vision and Medical care. * Belong to a strong and respected workforce. * Training in different learning areas. * Different opportunities to obtain promotion. NEGATIVE JOB ATTRIBUTES * Salary has not risen for the past four years. * Promotions are very selective. * Annual reduction of benefits for family members.A branded message is when an organization wants to show a good image, so future applicants might develop a connection feeling towards the organization, in this way the company will try to sell the idea to the applicant by saying that this company is a great place to work surrounded by nice, helpful and committed people. * Wo uld you like to work in a nice competitive environment in which you can exceed your abilities as a professional? Well, come and apply at Tanglewood stores, and learn and master your abilities while getting paid; receive medical, dental and vision care and 401K. Don’t waste your time!!

Essay on Romanticism - 4035 Words

Romanticism In spite of its representation of potentially diabolical and satanic powers, its historical and geographic location and its satire on extreme Calvinism, James Hoggs Private Memoirs and Confessions of a Justified Sinner proves to be a novel that a dramatises a crisis of identity, a theme which is very much a Romantic concern. Discuss. Examination of Romantic texts provides us with only a limited and much debated degree of commonality. However despite the disparity of Romanticism (or Romanticisms) as a movement it would be true to say that a prevalent aspect of Romantic literature that unites many different forms of the movement, is a concern with the divided self. As the empirical Rationalism of the eighteenth century was†¦show more content†¦Griffiths agrees that the central distinctive feature of Romanticism is the search for a reconciliation between the inner vision and the outer experience. 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Strengths and Weaknesses - Free Essay Example

Sample details Pages: 1 Words: 269 Downloads: 1 Date added: 2017/09/13 Category Advertising Essay Did you like this example? A. Strengths Weaknesses Regarding my education, my strengths are determination, good communication skills and having an open mind. These strengths will help me achieve my goal of becoming a dental hygienist by keeping me focused, staying in touch with my fellow classmates finding new ways to learn. My weaknesses are Tunnel Vision, procrastination and lack of patience. I know I will have to try to overcome these weaknesses or at least find ways to work around them. With my tunnel vision I will need to learn to allow myself to be focused but not forget my other responsibilities. I’ll need to learn to manage my time properly to avoid work building up and causing stress and finally I’ll need to develop my patience so that I can successfully complete my program. B. Employability Skills To make myself an asset to employ, I will have to dominate fundamental, personal management, and teamwork skills. I’ll need to communicate to the best of my ability with my peers and my environment. Manage information in my field when problems arise, be able to think creatively to come to appropriate conclusions. Don’t waste time! Our writers will create an original "Strengths and Weaknesses" essay for you Create order My attitude will have to be positive and responsible. My confidence and capability will have to project outwardly. Managing my priorities time will be crucial to my success. I’ll take full responsibility for my actions, the actions of my group projects that I undertake. I will have to take the initiative while working with others to ensure that our purpose and motives are met. Also I will respect the opinions perspectives of my team members as we work together.