1. Jessica McClusky CRITICAL THINKING IN PATIENT CARE

2.  The purpose of this Critical Thinking in Patient Care course is to assist the new graduate nurse to increase critical thinking proficiency. Through discussions and case studies, the nurse will identify patient health problems and appropriate interventions. Focus will be on choosing the most important primary interventions. Using simulation, nurses will collaborate to effectively treat a deteriorating patient. COURSE DESCRIPTION

3. 1.Build a holistic picture of patient care, organize ideas, and identify interventions. 2.Select most appropriate interventions in patient care situations where multiple interventions are applicable.  (Holland Hospital, 2013) LEARNING OBJECTIVES

4.  Every Friday  Three consecutive weeks  Begins August 1, 2014  Teaching strategies:  Large group discussion  Case studies  Small group collaboration  Simulation INSTRUCTIONAL DELIVERY AND SCHEDULE

5. AssignmentObjectiveGradeDue Pre-course worksheet Determine baseline knowledge Admission to course based on completion Completed and brought to day 1 of class Small group case studies 1Pass/FailCompleted in class Session 1 Critical Thinking Pathways 1, 2Pass/FailCompleted in class Session 2 Patient Simulation1, 2Pass/FailCompleted in class Session 3 COURSE LEARNING & ASSESSMENT METHODS

6.  Student must be at Proficient or Expert level to receive a Pass for the course.  If student is at Needs Improvement level, student will follow up with the Nurse Educator on their home unit for remediation.  If student is at Below Expectations level, student will repeat the course and develop a plan for success with the Nurse Educator on their home unit. NURSE ACADEMY POLICIES

7. SessionDateContentTeaching Methods Session 1 Objectives: 1 August 1 1.Discuss pre-course worksheet a)Determine gaps in knowledge b)Share examples 2.Provide overview of critical thinking and tips for organizing patient information 3.Discussion of patient situations and decision- making Group discussion of pre-course assignment Lecture Assignment: Small group case- study COURSE SCHEDULE

8. SessionDateContentTeaching Methods Session 2 Objectives: 1 & 2 August 8 1.Review information organization and holistic patient view 2.Introduce critical thinking pathway concept and practice 3.Practice and discussion of critical thinking pathways Lecture Large group discussion Assignment: Critical thinking pathway development

9. COURSE SCHEDULE SessionDateContentTeaching Methods Session Objectives: 1 & 2 August 15 1.Review information organization and holistic patient view 2.Review critical thinking concepts and tips 3.High-fidelity simulation of patient situation Lecture and discussion Simulation and debriefing Assignment: High-fidelity simulation

10. Pre-Course Worksheet  Complete with preceptor on unit during clinical time  Be prepared to discuss your scenario and interventions during class  Scenarios will be discussed as a large group for further understanding of critical decisions made and to identify areas of improvement  Evaluation: Admission to course based on completion of worksheet COURSE LEARNING RESOURCES

11. Small Group Case Studies  Students will divide into groups of 3 to 4  Each group is presented with a patient situation  The group will collaborate to identify concerning vital signs/symptoms/complaints within the case study  The group will discuss potential options for interventions, focusing on care of the patient as a whole  The group will present their assessment and interventions to the class for group discussion and feedback COURSE LEARNING RESOURCES

12. RUBRIC: SMALL GROUP CASE STUDIES ComponentBelow ExpectationsNeeds ImprovementProficientExpert A. Small group case study patient scenario The student does not participate in small group discussion. The student only notes minimal patient warning signs OR interventions identified are inappropriate or incorrect. The student contributes minimally in small group discussions. Some warning signs are recognized but suggestions for interventions are not included. The student is an active participant in small group discussion. Most warning signs are recognized and suggestions for improvement are included. The student is a leader in the small group discussion. Recognizes patient warning signs and offers multiple thorough ideas and interventions. B. Group presentation and class discussion of case study The student does not participate in group presentation or class discussion The student minimally participates in group presentation or class discussion. Provides no or inappropriate feedback to other groups. The student is an active participant in group presentation and class discussion. Provides feedback to other groups after presentations. The student acts as a leader in group presentation and class discussions. Provides constructive and thoughtful feedback to other groups after presentations.

13. Critical Thinking Pathways  Students will divide into groups of 3 to 4  Groups are presented with a patient scenario  The group will collaborate to develop a critical thinking pathway based on the patient scenario  These pathways will be utilized in during the patient simulation experience in session 3 COURSE LEARNING RESOURCES

14. EXAMPLE: CRITICAL THINKING PATHWAY

15. Critical Thinking Pathways  Students will divide into groups of 3 to 4  Groups are presented with a patient scenario  The group will collaborate to develop a critical thinking pathway based on the patient scenario  These pathways will be utilized in during the patient simulation experience in session 3 COURSE LEARNING RESOURCES

16. RUBRIC: CRITICAL THINKING PATHWAYS ComponentBelow ExpectationsNeeds ImprovementProficientExpert A. Collaboration in small group The student does not participate in small group discussion. The student only notes minimal potential complications OR interventions identified are inappropriate or incorrect. The student contributes minimally in small group discussions. Some complications are recognized but suggestions for interventions are not included. The student is an active participant in small group discussion. Most complications are recognized and suggestions for interventions are included The student is a leader in the small group discussion. Evaluates and identifies potential complications with provided diagnosis. Provides strong, thorough interventions to add to the pathway B. Logical development of critical thinking pathway The student does not list potential complications OR the complications listed are inappropriate. Interventions are missing or inappropriate. The student provides a short list of potential complications related to the provided diagnosis. The interventions provided are partially appropriate. The student provides a list of potential complications related to the provided diagnosis. The interventions provided are appropriate. The student provides a thorough list of potential complications related to the provided diagnosis. The interventions provided are complete, appropriate, and holistic.

17. High-Fidelity Simulation  Students will be placed into the same groups as they were in for Session 2  Students will participate in two simulations:  1- Structured to match the diagnosis presented in Session 2  Students will utilize their critical thinking maps to work through a patient scenario  2- A random patient condition or diagnosis determined by the instructor  Debrief will follow each simulation COURSE LEARNING RESOURCES

18. RUBRIC: SIMULATION ComponentBelow ExpectationsNeeds ImprovementProficientExpert A. Simulation #1 and debrief The student does not contribute to the simulation and group decisions. The student shows no knowledge of critical thinking skills. Does not consider the holistic care of the patient. The student contributes minimally to the simulation and group decisions. The student shows minimal knowledge of critical thinking skills. Rarely considers the holistic care of the patient. The student is an active participant in the simulation and participates in group discussion and decisions. Shows knowledge of critical thinking skills and demonstrates most verbally. Somewhat considers the holistic care of the patient. The student is a leader through the simulation and guides the group to come to collaborative and appropriate intervention decisions. Critical thinking is demonstrated through verbally discussing potential issues and multiple interventions before choosing the most appropriate. The holistic care of the patient is upheld B. Simulation #2 and debrief The student does not contribute to the simulation and group decisions. The student shows no knowledge of critical thinking skills. Does not consider the holistic care of the patient. The student contributes minimally to the simulation and group decisions. The student shows minimal knowledge of critical thinking skills. Rarely considers the holistic care of the patient. The student is an active participant in the simulation and participates in group discussion and decisions. Shows knowledge of critical thinking skills and demonstrates most verbally. Somewhat considers the holistic care of the patient. The student is a leader through the simulation and guides the group to come to collaborative and appropriate intervention decisions. Critical thinking is demonstrated through verbally discussing potential issues and multiple interventions before choosing the most appropriate. The holistic care of the patient is upheld

19.  Billings, D.M. & Halstead, J.A. (2012). Teaching in nursing: A guide for faculty (4 th ed.). St. Louis, MO: Elsevier Saunders.  Breese, U. & French, R. (2012). Adult learning theory and patient education for low back pain. Journal of Allied Health, 41(4), 198-203.  Clapper, T. (2010). Beyond Knowles: What those conducting simulation need to know about adult learning theory. Clinical Simulation In Nursing, 6(1), e7-14. doi:10.1016/j.ecns.2009.07.003  Fero, L., Witsberger, C., Wesmiller, S., Zullo, T., & Hoffman, L. (2009). Critical thinking ability of new graduate and experienced nurses. Journal Of Advanced Nursing, 65(1), 139-148. doi:10.1111/j.1365- 2648.2008.04834.x  Fero, L., O’Donnell, J., Zullo, T., Dabbs, A., Kitutu, J., Samosky, J., & Hoffman, L. (2010). Critical thinking skills in nursing students: comparison of simulation-based performance with metrics. Journal Of Advanced Nursing, 66(10), 2182-2193. doi:10.1111/j.1365-2648.2010.05385.x  Goodstone, L., Goodstone, M. S., Cino, K., Glaser, C. A., Kupferman, K., & Dember-Neal, T. (2013). Effect of Simulation on the Development of Critical Thinking in Associate Degree Nursing Students. Nursing Education Perspectives, 34(3), 159-162. REFERENCES

20.  Greer, A., Pokorny, M., Clay, M., Brown, S., & Steele, L. (2010). Learner- centered characteristics of nurse educators. International Journal Of Nursing Education Scholarship, 7(1). doi:10.2202/1548-923X.1710  Hegarty, J., Walsh, E., Condon, C., & Sweeney, J. (2009). The undergraduate education of nurses: looking to the future. International Journal Of Nursing Education Scholarship, 6(1), 1-11. doi:10.2202/1548-923X.1684  Holland Hospital. (n.d.). Critical thinking/clinical reasoning [PowerPoint slides}.  Sharpnack, P. A., Goliat, L., Baker, J. R., Rogers, K., & Shockey, P. (2013). Thinking like a nurse: Using video simulation to rehearse for professional practice. Clinical Simulation In Nursing, 9(12), e571-7. doi:10.1016/j.ecns.2013.05.004  Sherwood, G. & Barnsteiner, J. (2012). Quality and safety in nursing: A competency approach to improving outcomes. West Sussex: Wiley- Blackwell.  Theisen, J. L., & Sandau, K. E. (2013). Competency of new graduate nurses: A review of their weaknesses and strategies for success. Journal Of Continuing Education In Nursing, 44(9), 406-414. doi:10.3928/00220124- 20130617-38  QSEN (n.d.). http://qsen.org/competencies/graduate-ksas/ REFERENCES