Friday, July 13, 2012


Personal Class Design Part II
by Alberta E.  Gudes, BSN, RN

Grand Canyon: NUR-649E: Nurse Education Seminar II
Professor Cherryl Llanos, MSN, RN
July 11, 2012

Note from the Author: This academic project was written with inspirations taken from the Michael E. DeBakey Veterans Affairs Medical Center's Employee Education System.

Overview of Project 1
The project is a 4-hour training designed for clinicians with extensive exposure to different medical disciplines. They are physicians, physician assistants, nurse practitioners, registered staff nurses, program support clerks, and licensed vocational nurses. They are pooled together into a team to a training program called TEACH in order to assist and improve Patient Aligned Care Team (PACT) in hospitals or patient-centered public health centers. TEACH is an acronym for Tune, Explore, Assist, Communicate, and Honor, hence the training is called TEACH for PACT.
Members of the TEACH for PACT will provide information and insights to the training based on their present engagements within their own operating environment. This is based on the inspirations of Billings & Halstead (2009) quoting that the National League for Nursing (NLN) stated that in a rapidly-changing environment, where complex care is being provided in a variety of settings, clinicians must be offered new educations that are most effective in helping them in their practice.

LEARNER OBJECTIVES (Cognitive Domain)

General Objectives 

By the end of the training, members of the Patient Aligned Care Team (PACT) will comprehend each module of the TEACH program as a result of attending and actively participating in the activity sessions, be able to demonstrate learning to the other members of PACT for comments, and on the basis of these comments, will explain the same principles in their own words in a real or simulated situation for the training instructor to assess.

Specific Objectives

Based on the discussions during the training sessions, members are able to demonstrate in their own understanding the learning in each TEACH module.
·         T Module – Tune to the patient.
The PACT members are able to express in their own words on the processes of effective listening and questioning skills that would achieve the goal of being able to be attuned to the learner/patient engagement.
·         E Module – Explore the patient’s concerns and preferences.
The PACT members are able to explain to the learner/patient the principles by using examples from other context or situation so that their needs and preferences can be assessed.
·         A Module – Assist the patient in behavior changes.
The PACT members are able to apply health coaching strategies in order to assist learner/patient in coping with behavior changes using simulated patient scenarios.
·         C Module –Communicate effectively
The PACT members are able to translate their learning so that it fits to the level of understanding of the learner/patient, thus enabling the PAC Team handle the patient’s uncertainty and conflict.
·         H Module – Honor the patient as a partner.
The PACT members are able to show and explain in their own words the characteristics of teacher/clinician-learner/patient to succeed in partnering with patients.

LEARNER OBJECTIVES (Psychomotor Domain)

General Objectives 

By the end of the training, members of the Patient Aligned Care Team (PACT) will differentiate each module of the TEACH program as a result of attending and actively participating in the activity sessions, by showing their learning through performance indicators to the other members of PACT for comments, and on the basis of these comments, will identify the same principles in their own words in a real or simulated situation for the training instructor to assess.

Specific Objectives 

Based on the activities during the training sessions, members are able to duplicate in their own understanding the learning in each TEACH module.
·         T Module – Tune to the patient.
The PACT members are able to execute in their own style on the processes of effective listening and questioning skills that would achieve the goal of being able to be attuned to the learner/patient engagement.
·         E Module – Explore the patient’s concerns and preferences.
The PACT members are able to draw to the learner/patient the principles by using examples from other context or situation so that their needs and preferences can be assessed.
·         A Module – Assist the patient in behavior changes.
The PACT members are able to design health coaching strategies in order to assist learner/patient in coping with behavior changes using simulated patient scenarios.
·         C Module –Communicate effectively.
The PACT members are able to revise their learning so that it fits to the level of understanding of the learner/patient, thus enabling the PAC Team handle the patient’s uncertainty and conflict.
·         H Module – Honor the patient as a partner.
The PACT members are able to distinguish and explain in their own words the characteristics of teacher/clinician-learner/patient to succeed in partnering with patients.

OUTLINE

The following outline is taken entirely from Exclusive Class Design – Part 1:
Registration/Welcome/Introduction-registration will be sent by outlook e-mail; staff must register online and must sign in upon arrival to classroom.
1.      Introduction
2.      Explain TEACH objectives and expectations
3.      Provide students with a schedule/timeframe
4.      Patient education: TEACH for Success workbooks
a.          Distribute workbooks
b.      Explain workbooks and instructions
I.                   Teach T-Tune to the patient explanation.
This teaches centers on beginning effective rapport between clinicians and patients.  It helps partakers identify behaviors that help and hinder effective relationship, and it provides opportunities for partakers to practice effective listening and questioning skills.
II.                Teach E- Explore the patient’s concerns, preferences, and needs explanation.
This teaches partakers recognize all basics of a learning assessment.  It displays partakers how to use a range of needs assessment methods, and how to distinguish limits to learning as well as favorites for learning.
III.             Teach A- Assist the patient with behavior changes explanations.
This teaches partakers appreciate and use a health coaching tactic to assisting patients with behavior change with simulated patient scenarios.
IV.             Teach C- Communicate effectively explanation.
This teaches partakers how to fit their message to patients and how to deal with patient uncertainty and conflict.
V.                Teach H- Honor the patient as a partner explanation.
This teaches partakers identify features of real clinician-patient trusts and skills needed to successfully partner with patients.

CLASS TIME FRAME

Learner Objective
Timeframe
Teaching Strategy
Evaluation Method
T Module – Tune to the patient.



T Agenda 15 minutes -Review of key concept of teach T Module
10 minutes – Listening exercises
5 minutes -Applying learning to practice
Required time 30 minutes


Participants are grouped by three’s. One acts as the Listener, the second as the Talker and the third is Observer. Then, after the activity, the observer will report to the group what he/she observes.




The evaluation method to be applied in the activity is Plan-Do-Study-Act (PDSA) model for the entire process.
Also, another tool to be used is the PACT Compass. It is a data resources for primary care, which can be accessed at http://vssc.med.va.gov
Primary Care Almanac can also be utilized as an evaluation method for this activity.
E Module – Explore the patient’s concerns and preferences.


E Agenda 15 minutes-Review of key concept of teach E
10 minutes- Needs assessment practice
5 minutes – Applying learning to practice
Required time 30 minutes

Integrating elements of assessment by providing participants 2 different colored sticky notes. Participants would write factors that would lead them achieve their goals using the pink sticky note and the blue sticky note would be used for factors that hinder them from achieving their goals. After accomplishing the 2 colored sticky notes, participants are asked to read the notes before the class and let them place the notes corresponding to the parts of the human body like the head, heart and gut, arm and leg for the skills. Below the human body sketch is the environment, wherein participants could also put the sticky notes if it corresponds to the situation.

A Module - Assist the patient with behavior changes explanations.

A Agenda 15 minutes-Review of key concepts of teach A
10 minutes- Health coaching practice
5 minutes - Applying learning to practice
Required time 30 minutes


Participants are asked to create an action plan that would support them in coaching the patient’s life goals and values. They will distribute the action plan to other participants for feedback and discussion in front of the class.

C Module –Communicate effectively.

C Agenda 15 minutes- Tailoring messages
10 minutes – Dealing with patient uncertainty
5 minutes- Applying to practice
Required time 30 minutes

Participants are asked to list down and enumerate words and languages that would be used to communicate with the patients. They will role play the words to their fellow participants and determine how these words and languages affect them.

H Module – Honor the patient as a partner.

H Agenda 15 minutes-Review of key concepts of teach H
10 minutes-Partnering skills practice
5 minutes- Applying learning to practice
Required time 30 minutes
Participants are asked to group themselves in two’s. One will act as the Patient and the other is the Clinician. They will do an open dialogue on things that matter to the patient and the clinician that will build their trust with each other.


RATIONALE:

The writer chooses to use three evaluation methods namely the Plan-Do-Study-Act (PDSA), PACT Compass and Primary Care Almanac with the hope that by using these methodologies, the objectives of the training can be met. According to Billings & Halstead (2009), “a variety of teaching strategies can be used to appeal to different learning styles and thus maximize student learning”.   From this concept, the best tool to be able to evaluate the outcomes of the different learning styles is to employ a combination of evaluation strategies as reflected in the class timeframe.  As Stavropoulou & Kelesi (2012) said that “Evaluation is becoming a necessary part of education, particularly in present times, when educational systems are subjected to continuous criticism and debate”. Henceforth, a combination of evaluation approaches becomes a necessary evil to ensure that outcomes are deeply rooted from evidence-based studies to make the training design and its processes reliable and solid.
The PDSA model is deemed to be an essential evaluation approach if taking into account the statement from the Institute of Innovation and Improvement of the National Health Services (NHS) in the United Kingdom saying that, “Using PDSA cycles enables one to test out changes before wholesale implementation and gives stakeholders the opportunity to see if the proposed change will work”. The NHS further said that “One may not get the results he expects when making changes to the processes, so it is safer and more effective to test out improvements on a small scale before implementing them across the board”. Thus, in this kind of training design, the writer believes that the PDSA model is just apt and appropriate.
The PACT Compass is also utilized as an evaluation tool in this training design because PACT Compass contains provider panel management, wherein all data relevant to patient care such as better access, better patient, satisfaction, better staff, the right care by the right person at the right time, can be found. This can be used to guide and check whether data achieved in the training can be improved by benchmarking the data from PACT Compass.
Likewise, the Primary Care Almanac is another helpful evaluation tool in the training since this resource contains data of patients for identification and management including one’s specific PACT-teamlets. Also, it is database of disease management like High risk, volume, and cost, Hypertension, Diabetes, Ischemic heart disease, Asthma, Depression, Obesity, Chronic Renal Failure and many more.
With all of the above approaches combined, there is a high percentage that the training design will achieve its intended goals successfully.

References

Billings, D. M., & Halstead, J. A. (2009).Teaching in nursing: A guide for faculty. St. Louis,
            Mo: Elsevier/Saunders.
Johnson, P., & Raterink, G. (2009). Implementation of a diabetes clinic-in-a-clinic project in a family practice setting: using the plan, do, study, act model. Journal Of Clinical Nursing, 18(14), 2096-2103. doi:10.1111/j.1365-2702.2008.02774.x
MacKeracher, D. & Gross, P. (n.d.) Writing Learning Objectives. Retrieved on July 11, 2012 at http://www.unb.ca/fredericton/cetl/_resources/pdf/writinglearningobjectives.pdf
National Health Services (NHS).(n.d).  Institute of Innovation and Improvement. Retrieved July 11, 2012 at http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/plan_do_study_act.html
Stavropoulou, A., & Kelesi, M. (2012). Concepts and methods of evaluation in nursing education--a methodological challenge. Health Science Journal, 6(1), 11-23.

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